Acute Health Problems Research Articles

Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention

BackgroundEmergency Departments (EDs) are a first point-of-contact for many youth with mental health and suicidality concerns and can serve as an effective recruitment source for randomized controlled trials (RCTs) of mental health interventions. However, recruitment in acute care settings is impeded by several challenges. This pilot RCT of a youth suicide prevention intervention recruited adolescents aged 12 to 17 years presenting to a pediatric hospital ED with suicide related behaviors.MethodsRecruitment barriers were identified during the initial study recruitment period and included: the time of day of ED presentations, challenges inherent to study presentation, engagement and participation during an acute presentation, challenges approaching and enrolling acutely suicidal patients and families, ED environmental factors, and youth and parental concerns regarding the study. We calculated the average recruitment productivity for published trials of adolescent suicide prevention strategies which included the ED as a recruitment site in order to compare our recruitment productivity.ResultsIn response to identified barriers, an enhanced ED-centered recruitment strategy was developed to address low recruitment rate, specifically (i) engaging a wider network of ED and outpatient psychiatry staff (ii) dissemination of study pamphlets across multiple areas of the ED and relevant outpatient clinics. Following implementation of the enhanced recruitment strategy, the pre-post recruitment productivity, a ratio of patients screened to patients randomized, was computed. A total of 120 patients were approached for participation, 89 (74.2%) were screened and 45 (37.5%) were consented for the study from March 2018 to April 2019. The screening to randomization ratio for the study period prior to the introduction of the enhanced recruitment strategies was 3:1, which decreased to 1.8:1 following the implementation of enhanced recruitment strategies. The ratio for the total recruitment period was 2.1:1. This was lower than the average ratio of 3.2:1 for published trials.ConclusionsEDs are feasible sites for participant recruitment in RCTs examining new interventions for acute mental health problems, including suicidality. Engaging multi-disciplinary ED staff to support recruitment for such studies, proactively addressing anticipated concerns, and creating a robust recruitment pathway that includes approach at outpatient appointments can optimize recruitment.Trial registrationClinicalTrials.gov: NCT03488602, retrospectively registered April 4, 2018.

Objective Assessment of Acute Pain in Foals Using a Facial Expression-Based Pain Scale.

Simple SummaryResearch has shown that objective assessment of pain in horses can be performed by subjectively scoring facial expressions. So far, no studies have been conducted to develop a pain measuring tool for the assessment of pain in foals. In other species like pigs and sheep, facial expressions have been shown to be good indicators of pain in neonatal animals. In this study, a pain scale that is already available for mature horses (EQUUS-FAP: Equine Utrecht University Scale for Facial Assessment of Pain) was adapted to measure different types of acute pain in neonatal and older foals with acute pain based on facial expressions. The scale was based on a pain scale that has been shown to be useful in mature horses with various types of acute pain (colic, orthopaedic, and head-related pain). This pain scale was tested in 20 patients with different types of acute pain (colic, laminitis, postoperative pain) and 39 healthy control animals. The authors found that the EQUUS-FAP FOAL (Equine Utrecht University Scale for Facial Assessment of Pain in Foals) is a reproducible pain scale that can be used to assess pain in neonatal and older foals.Pain assessment is very important for monitoring welfare and quality of life in horses. To date, no studies have described pain scales for objective assessment of pain in foals. Studies in other species have shown that facial expression can be used in neonatal animals for objective assessment of acute pain. The aim of the current study was to adapt a facial expression-based pain scale for assessment of acute pain in mature horses for valid pain assessment in foals. The scale was applied to fifty-nine foals (20 patients and 39 healthy controls); animals were assessed from video recordings (30–60 s) by 3 observers, who were blinded for the condition of the animals. Patients were diagnosed with acute health problems by means of clinical examination and additional diagnostic procedures. EQUUS-FAP FOAL (Equine Utrecht University Scale for Facial Assessment of Pain in Foals) showed good inter- and intra-observer reliability (Cronbach’s alpha = 0.95 and 0.98, p < 0.001). Patients had significantly higher pain scores compared to controls (p < 0.001) and the pain scores decreased after treatment with NSAIDs (meloxicam or flunixin meglumine IV) (p < 0.05). Our results indicate that a facial expression-based pain scale could be useful for the assessment of acute pain in foals. Further studies are needed to validate this pain scale.

Developing the health examination protocol for asylum seekers in Finland: project results

Abstract Issue Initial health assessment is crucial for identification of healthcare needs and screening of acute health problems among new asylum seekers. As in other countries, practices across reception centres in Finland varied and health data was inconsistently recorded, making systematic monitoring through the electronic health record system (EHR) challenging. Description of the issue The main objectives of the national Developing the health examination protocol for asylum seekers in Finland project (TERTTU, 2017-2019) were to unify practices across reception centres through development of health assessment content and the quality of EHR recordings. The project consisted of three phases: 1) baseline evaluation; 2) conduct of a population-based health examination survey among asylum seeking adults and children; 3) development work guided by findings of stages 1 and 2, supplemented with thematic qualitative interviews with end-users (reception centre nurses, asylum seekers and authorities supervising services). Results The project exceeded expectations. Altogether 1087 adults and children participated in the survey (participation rate 76 %). Survey findings were published in a national report, providing the main evidence-base for development work. This was complemented by thematic interviews with 15 reception centre nurses, 19 asylum seekers and 3 authority representatives. Health assessment protocol was piloted and further developed based on feedback from end-users and transferred into the reception centres EHR. A handbook for the health assessment was published, supported with educational short videos. Lessons Successful implementation required close collaboration with authorities responsible for providing services for asylum seekers and involvement of end users at all stages. Results of this project benefit all other countries receiving asylum seekers. The study protocol is available in English, Somali, Kurdish (Sorani), Dari, Arabic, Russian, French and Finnish. Key messages The initial health assessment protocol for asylum seekers and supporting materials developed in the TERTTU project benefits all receiving countries. Systematic recording of health data was also developed, which will be used for planning health system response according to the health care needs of new asylum seekers.

Delimitation of Anxiety Disorder with Panic Attacks and Therapeutic Considerations for Approach

One of the most acute mental health problems in recent years is anxiety disorders, where panic disorder is the most invalidating and suffering expression on the part of the sufferer. The research in this regard is extensive, from its causes and neurobiological expressions, through the pharmacology of its treatment and the usefulness of psychotherapy in the treatment and accompaniment of the patient. However, the divergences in the choice of psychotherapeutic current to use in these cases, makes it difficult to approach the theoretical causes of the problem, as well as the solution. This article aims to clarify the diagnostic and theoretical differences between panic disorders and other expressive disorders of pathological anxiety, in addition to conducting a longitudinal study of the treatment of patients diagnosed with severe anxiety, known as panic, with a humanist cutting therapy with cognitive-behavioral elements, finding their level of elevated efficacy, 80% of cases evaluated are resolved are resolved , in terms of remission of symptoms, in a time less than or equal to 10 months, assessing the patient's perception of the most useful intervention parts and the periodicity affordable for them.

Pre-implementation adaptation of primary care cancer prevention clinical decision support in a predominantly rural healthcare system

BackgroundCancer is a leading cause of death in the United States. Primary care providers (PCPs) juggle patient cancer prevention and screening along with managing acute and chronic health problems. However, clinical decision support (CDS) may assist PCPs in addressing patients’ cancer prevention and screening needs during short clinic visits. In this paper, we describe pre-implementation study design and cancer screening and prevention CDS changes made to maximize utilization and better fit a healthcare system’s goals and culture. We employed the Consolidated Framework for Implementation Research (CFIR), useful for evaluating the implementation of CDS interventions in primary care settings, in understanding barriers and facilitators that led to those changes.MethodsIn a three-arm, pragmatic, 36 clinic cluster-randomized control trial, we integrated cancer screening and prevention CDS and shared decision-making tools (SDMT) into an existing electronic medical record-linked cardiovascular risk management CDS system. The integrated CDS is currently being tested within a predominately rural upper Midwestern healthcare system. Prior to CDS implementation, we catalogued pre-implementation changes made from 2016 to 2018 based on: pre-implementation site engagement; key informant interviews with healthcare system rooming staff, providers, and leadership; and pilot testing. We identified influential barriers, facilitators, and changes made in response through qualitative content analysis of meeting minutes and supportive documents. We then coded pre-implementation changes made and associated barriers and facilitators using the CFIR.ResultsBased on our findings from system-wide pre-implementation engagement, pilot testing, and key informant interviews, we made changes to accommodate the needs of the healthcare system based on barriers and facilitators that fell within the Intervention Characteristics, Inner Setting, and Outer Setting CFIR domains. Changes included replacing the expansion of medical assistant roles in one intervention arm with targeted SDMT, as well as altering cancer prevention CDS and study design elements.ConclusionsPre-implementation changes to CDS may help meet healthcare systems’ evolving needs and optimize the intervention by being responsive to real-world implementation barriers and facilitators. Frameworks like the CFIR are useful tools for identifying areas where pre-implementation barriers and facilitators may result in design changes, both to research studies and CDS systems.Trial registrationNCT02986230.

A Hybrid {Silk@Zirconium MOF} Material as Highly Efficient AsIII-sponge

Exposure of humans to Arsenic from groundwater drinking sources is an acute global public health problem, entailing the urgent need for highly efficient/low-cost Arsenite (AsIII) up-taking materials. Herein we present an innovative hybrid-material, ZrMOF@SFd operating like an “AsIII-sponge” with unprecedented efficiency of 1800 mg AsIII gr−1. ZrMOF@SFd consists of a neutral Zirconium Metal-Organic Framework [ZrMOF] covalently grafted on a natural silk-fiber (SFd). ZrMOF itself exhibits AsIII adsorption of 2200 mg gr−1, which supersedes any -so far- known AsΙΙΙ-sorbent. Using XPS, FTIR, BET-porosimetry data, together with theoretical Surface-Complexation-Modeling (SCM), we show that the high-AsΙΙΙ-uptake is due to a sequence of two phenomena:[i] at low AsIII-concentrations, surface-complexation of H3AsO3 results in AsIII-coated voids of ZrMOF, [ii] at increased AsIII-concentrations, the AsIII-coated voids of ZrMOF are filled-up by H3AsO3via a partitioning-like mechanism. In a more general context, the present research exemplifies a mind-changing concept, i.e. that a “partitioning-like” mechanism can be operating for adsorption of metalloids, such as H3AsO3, by metal oxide materials. So far, such a mechanism has been conceptualized only for the uptake of non-polar organics by natural organic matter or synthetic polymers.

Return-To-Play Decision Making in Team Sports Athletes. A Quasi-Naturalistic Scenario Study.

Competitive athletes act within cultures of risk in sports and often decide to return to sport despite having acute health problems. The outcomes of such risky return-to-play decisions can not only negatively affect their future health, but may also limit their sports performance or even upset their career paths. Following risk-management-decision theory with its focus on active risk defusing, we developed a model for understanding the process of return-to-play decision making from an athlete’s perspective. Based on the method of active information search, a quasi-naturalistic return-to-play decision scenario was created in order to assess amateur team sport athletes’ decision-making strategies. The main goals were to identify different information acquisition patterns and to analyze the influence of varying sporting consequences on decision making. A total of 72 competitive team sport athletes (36 females, 36 males, m = 25.7 years of age, 3rd to 6th league level) from three disciplines (volleyball, basketball, and handball) participated in the experimental study. Facing the same medical scenario (a partial tear of the supraspinatus tendon), athletes show different approaches to return-to-play decision making. The main focus is on the potential sporting consequences of withdrawal from competition due to injury, with only a few players favoring well-informed decisions based on thorough risk analysis. The athletes who chose the medically risky alternative to play hurt mostly employed strategies of active risk defusing, which got activated when severe sporting consequences were perceived. Those who chose to withdraw from competition primarily referred to maximin heuristic, particularly when social pressure to play was reduced. The findings can be used to improve rehabilitation-related communication and shared return-to-play decision making in sports.

747-P: (Social) Profiling Youth with T1D: Examining the Standard Care Nonresponders

Objective: A subset of youth with chronic medical conditions, including T1D, are unresponsive to typical medical and behavioral health interventions, often resulting in avoidable acute health problems such as DKA. This study examines how youth with T1D who are unresponsive to standard care compare to similarly referred youth with other chronic medical conditions. Methods: Participants were referred by medical providers due to lack of response to standard care - as evidenced by avoidable ED visits and/or lab values chronically out of range - including 50 youth with T1D and 54 with other chronic medical conditions, such as cystic fibrosis, end-stage renal disease, and seizure disorder. Retrospective chart reviews collected presence and frequency of social risks. Mean age was 14.5 years; 48% were female; 85% were non-Hispanic White. Results: Social risk prevalence was high across medical conditions (see Figure).Youth with T1D were significantly more likely to have experienced multiple social risks, such as difficulty attending school, DHS involvement, and drug/alcohol abuse by youth and caregivers. Conclusions: When compared to youth struggling with self-management of other chronic conditions, youth with T1D experienced significantly higher prevalence and frequency of social risks. Interventions developed for this vulnerable population should include components that directly target these important social factors. Disclosure D.V. Wagner: None. A. Hartman: None. C. Jenisch: None. I. Guttmann-Bauman: None. H. El-Mansy: None. M.A. Harris: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Совершенствование психиатрической помощи как наиболее актуальной проблемы общественного здравоохранения

Mental disorders are an acute public health problem in the WHO European region, affecting 25% the entire population every year. WHO activities in the area of mental health promotion at the level of individuals and society as a whole are aimed at improving human mental well-being, preventing mental disorders, protecting human rights and caring for people with mental disorders. The WHO European Conference on Mental Health (2005), 66th Session of the World Health Assembly (2013), 63rd Session of the WHO European Regional Committee (2013) have focused on mental health. In the Kyrgyz Republic, the State policy to change the system of assistance to persons with mental disabilities, to establish a unified mental health service and to change the attitude of society towards mental health and the mentally ill is reflected in the National Program Mental health of the population of the Kyrgyz Republic for 2001–2010, the National Health Reform Program of the Kyrgyz Republic Den Sooluk for 2012–2018, for the Sustainable Development Goals up to 2030, adopted at the Summit by UN members, the Program for Mental Health Protection of the Population of the Kyrgyz Republic for 2018-2030. Given the negative trends in the mental health care system, an important element in addressing the shortcomings is the increased use of new institutional forms of mental health care, such as the Medical Rehabilitation Unit, Intensive Mental Health Care Unit, Psychiatric Dispensaries and Outpatient Psychiatric Rooms, in dispensary monitoring. Priority in the further development of psychiatric care should be given to the most effective and less costly forms of its provision, ahead of the development of outpatient level, inter-agency interaction and integration of psychiatric service with other levels of regional health and social protection.

Piperazine derivatives as dangerous abused compounds.

Piperazine derivatives are a group of compounds with a psychostimulant effect. They are an alternative to illegal drugs. They are being searched for recreational use due to their psychoactive and hallucinogenic effects. The high popularity of these compounds can be noticed all over the world due to easy purchase, lack of legal regulations and incorrect assessment of the safety of use. The recreational use of piperazine derivatives can often result in chronic and acute health problems and additionally with unpredictable remote effects. It is also common to take mixtures of psychoactive compounds. This hinders the correct diagnosis and treatment of patients with poisoning. The presented work is an illustration of the wide problem of piperazine derivatives abuse. The health effects and the possibility of identifying these compounds in preparations and biological material are described.

MLVA fingerprinting of Brucella melitensis circulating among livestock and cases of sporadic human illness in Egypt.

Brucella melitensis is a serious public health threat, with human infection exhibiting acute febrile illness and chronic health problems. The present study investigated the genetic diversity and epidemiological links of the important zoonotic bacterium B.melitensis in Egypt using multilocus variable-number tandem repeat analysis (MLVA-16) including eight minisatellite (panel 1) and eight microsatellite (panel 2, subdivided into 2A and 2B) markers. A total of 118 isolates were identified as B.melitensis biovar 3 by classical biotyping and Bruce-ladder assay. Although B.melitensis is primarily associated with infection in sheep and goats, most of B.melitensis isolates in this study were obtained from secondary hosts (cattle, buffaloes, humans and a camel) suggesting cross-species adaptation of B.melitensis to large ruminants in Egypt. The MLVA-16 scheme competently discriminated 70 genotypes, with 51 genotypes represented by single isolates, and the remaining 19 genotypes were shared among 67 isolates, suggesting both sporadic and epidemiologically related characteristics of B.melitensis infection. Matching of local genotypes with representatives of global genotypes revealed that the majority of Egyptian isolates analysed had a West Mediterranean descendance. As this study represents the first comprehensive genotyping and genetic analysis of B.melitensis from different sources in Egypt, the information generated from this study will augment knowledge about the main epidemiological links associated with this bacterium and will allow a better understanding of the current epidemiological situation of brucellosis in Egypt. Ultimately, this will help to adopt effective brucellosis intervention strategies in Egypt and other developing nations.

Junk Food Addiction Across Generations in Urban Karnataka, India

Background: Junk food consumption is progressing from being just an unhealthy life style habit to a full-fledged addiction.Objectives: To assess the health problems related to junk food habits; To assess the burden of addiction to junk food using a novel junk food addiction scale and to describe the alternate diets followed.Methodology: A cross-sectional study was conducted among people across three generations: Generation X, Millenials and Generation Z residing in urban Karnataka, India. Using convenient sampling, a sample size of 500 subjects were selected. Addiction to junk food was assessed by a novel Junk Food Addiction Scale developed for the study.Result: All 500 study subjects had consumed either junk/street/fast/instant food any time in the past 1 year. A total of 211 (42.2%) subjects reported acute health problem and 182 (36.4%) chronic health problems following junk food consumption. The burden of junk food addiction was found to be 80 (16%) [CI (95%): 13.32-18.68] of which majority 70 (14%) had mild addiction. The prevalence of different fad diets followed for 3 months or more was 137 (27.4%).Conclusion: Junk food addiction was observed in more than one tenth of the subjects. Majority had mild addiction and observed equally between Millennials and Generation Z. Obesity, habits and gadgets had independent effects on junk food addiction. More than one forth subjects followed fad diets. How to cite this article:Masthi NRR, Jahan A. Junk Food Addiction Across Generations in Urban Karnataka, India. J Commun Dis 2020; 52(1): 65-71. DOI: https://doi.org/10.24321/0019.5138.202008

Prediction of Recurrent Emergency Department Visits in Patients With Mental Disorders.

BackgroundPatients with mental disorders are more likely to be frequent emergency department (ED) users than patients with somatic illnesses. There is little information about recurrent ED visitors (≥four ED visits/year) due to mental health problems in Switzerland. Therefore, our aim was to investigate the prevalence of recurrent ED visits due to mental disorders and to determine which mental disorders and risk factors were associated with recurrent ED visits.MethodsIn a retrospective analysis, we investigated patients suffering from mental health problems between January and December 2015 who presented more than once in the ED of a tertiary care hospital. ED patients who sought out the ED due to mental disorders were grouped in a recurrent group with at least four ED visits per year or in a control group visiting the ED twice or three times within a year. The primary endpoint was to assess the prevalence of recurrent ED patients due to acute symptoms of mental disorders. As secondary endpoints, we investigated which mental disorders and risk factors were associated with recurrent ED visits.ResultOf 33,335 primary ED visits, 642 ED visits (1.9%) were by 177 visitors suffering from acute mental health problems. Forty-five (25.4%) of these 177 patients were recurrent ED visitors; 132 (74.6%) visited the ED twice or three times (control). Patients with personality disorders had a four-times higher risk (p = 0.011) of being a recurrent ED visitor. Recurrent ED visitors with mental disorders had significantly more in-house admissions (p < 0.001), self-mutilations (p < 0.001), acute drug toxicity (p = 0.007) and were more often persons of single status (p = 0.045). Although recurrent ED visitors more often had an outpatient general physician or psychiatrist, they visited the ED more frequently within office hours (p < 0.001).ConclusionA quarter of frequent ED users with mental disorders are recurrent ED visitors and were more likely to suffer from personality disorders. Recurrent ED visits are associated with higher rates of self-mutilation, acute drug toxicity, and a greater number of in-house admissions.

Does the Hospital Admission of Patients with Respiratory Disease Increase in Izmir When the PM10 Level is High?

Air pollution is caused by exhaust emissions from motor vehicles, fuel consumption for heating of residences, and especially emissions from industrial facilities around the world. The exposure to outdoor air pollution has been associated with acute and chronic health problems, from irritation to death. In this study, we aimed to determine whether air pollution increases the frequency of hospital admission and whether there is a difference between disease subgroups, age, and gender, in the 2-year period in Izmir province where - air pollution is increasing. Collection of health data for the project compiled by the Ministry of Health, in cooperation with the Izmir Provincial Health Directory Information Processing Department, and information obtained on the age groups, gender, admission time, and diagnosis of illness [International Classification of Diseases (ICD)10 code] on the residents of Izmir in 2016/2017. The daily numbers of patients with respiratory complaints and air pollution were found to be related. Both air pollution and the admission rate increase in the January-March period. In male patients, the risk of hospitalization increases for 1.14%. Males had a higher increase in the rate of diagnosis of chronic rhinitis (increase of 6.22%) than females who had an increase of 0.97%. It was observed that there was a 2.62% increase in the incidence of bronchiectasis, 2.53% in that of asthma, and 2.49% in that of dyspnea. There was a significant increase in respiratory diseases during the days when the air pollution was high, and this was observed as the upper respiratory tract infection and acute bronchitis in the young group and chronic respiratory diseases in the elderly group upon hospital admissions. The reduction of air pollutants and inhalation of clean air are the most important aspects in providing a healthier and longer life.

Air pollution levels linked to stroke risk

The link between air pollution exposure and risk of premature death is well known to epidemiologists—according to one study, in 2015 alone, air pollution killed about 4.2 million people worldwide. Two large studies from China have now provided further evidence of how such exposure increases the risk of specific and acute health problems. Most such studies have been done in high-income countries and used relatively small samples. The new studies, both led by researchers at Huazhong University of Science and Technology, focused on fine particulate matter pollution, or PM2.5. The first study, led by Yonghua Hu, investigated the relationship between daily PM2.5 concentrations and 8.83 million hospital admissions of people with cardiovascular disease in 184 Chinese cities between 2014 and 2017 (BMJ 2019, DOI: 10.1136/bmj.l6572). At the national level, an average increase of 10 μg/m3 in daily concentration of PM2.5 was associated with a 0.26% increase in hospital admissions on

Study of Glycation of Transferrin and its Effect on Biomarkers of Iron Status in Uncontrolled Diabetes Mellitus Patients

Introduction: Diabetes Mellitus (DM) is a metabolic condition linked by the inability to produce enough insulin and/or to respond to insulin. This can lead to a number of acute and chronic health problems. In erythrocytes, transferrin is the main source of iron. Alterations in transferrin glycation affect transferrin saturation because the affinity of transferrin for Fe3+ is extremely high but it decreases progressively with increasing glycation. Aim: To investigate the influence of uncontrolled diabetes on transferrin glycation and iron metabolism. Materials and Methods: A total of 136 samples from 3 groups of HbA1c levels (&lt;6.0% non-diabetic, 6.4-8% diabetic, &gt;8.0%-uncontrolled DM) were studied for the correlation pattern of iron with other variables. Chi square test and student’s t-test were performed to reveal the association between serum free iron levels and other variables with DM. Results: Serum iron has shown to be depleted significantly (p=0.02) along with percentage saturation (p=0.0006) with increase in diabetic severity. No significant differences were observed in serum ferritin in controlled DM and uncontrolled samples. Total Iron Binding Capacity (TIBC) was found to be significantly increased in uncontrolled DM samples (p=0.01). Abnormal transferrin was observed uncontrolled diabetes with subsequent depletion in transferrin, which in turn results in low serum iron, lower percentage saturation and high TIBC. Conclusion: Uncontrolled diabetes affects the glycation of transferrin also thus perturbating iron metabolism. The present study emphasises the need to monitor transferrin glycation status and iron deficiency anaemia in subjects with uncontrolled diabetes.

Nurses' activities and time management during home healthcare visits.

AimTo describe nurses’ activities and time management during HHC visits from the perspective of master’s‐level nursing students.BackgroundThe shift from community‐based hospitals to home‐based, person‐centred services for patients with a variety of acute or chronic health problems challenges nurses’ professional competence and time management during home healthcare visits.Design and methodsA cross‐sectional study in accordance with STROBE guidelines. Observation sheets (n = 196) from two municipal home healthcare organisations were analysed with descriptive quantitative analysis.Ethical issues and approvalWhile no external ethical committee evaluation was necessary for this quality improvement study, research ethical principles were followed.ResultsThe nurses spent 50% of each eight‐hour shift on indirect patient contact activities and about 38% on direct patient contact activities. The majority of activities underlying the home visits could be linked to long‐term illnesses: medication (57%), blood samples (23%), wound care (17%) or measurement of blood pressure (14%). Patient education was offered during only 3.5% of visits.LimitationsThe accuracy of the students’ observations is related to their individual capacity to objectively and selectively observe.ConclusionsThere were a number of activities conducted for the patient, to promote continuous intra‐ and interprofessional patient care, but fewer nursing activities conducted with the patient. To ensure integrated, person‐centred, safe patient care, vital reforms are needed.Relevance to clinical practiceThe appropriate balance between indirect and direct patient contact activities should be discussed intra‐ and interprofessionally, delineated and made explicit in nurses’ work plans and nursing documentation, alongside discussions pertaining to relevant resource allocation.

Improving Oral Health in Older Adults and People With Disabilities: Protocol for a Community-Based Clinical Trial (Good Oral Health).

BackgroundLow-income older adults experience disparities in oral health problems, including caries and periodontal disease, that can exacerbate already high levels of chronic and acute health problems. Behavioral interventions have been shown to improve oral health status but are typically administered in institutional rather than community settings. Furthermore, multiple simultaneous interventions at different levels in the locations where people live and work are likely to have more impact and sustainability than single interventions in clinical settings.ObjectiveThis paper outlines a protocol for conducting a bilingual 5-year community-based trial of a bilevel intervention that addresses community norms, beliefs, intentions, and practices to improve oral health hygiene of vulnerable older adults living in publicly subsidized housing. The intervention utilizes (1) a face-to-face counseling approach (adapted motivational interviewing [AMI]) and (2) resident-run oral health campaigns in study buildings.MethodsThe study’s modified fractional factorial crossover design randomizes 6 matched buildings into 2 conditions: AMI followed by campaign (AB) and campaign followed by AMI (BA). The total intervention cycle is approximately 18 months in duration. The design compares the 2 interventions alone (T0-T1), and in different sequences (T1-T2), using a self-reported survey and clinical assessment to measure Plaque Score (PS) and Gingival Index (GI) as outcomes. A final timepoint (T3), 6 months post T2, assesses sustainability of each sequence. The intervention is based on the Fishbein integrated model that includes both individual and contextual modifiers, norms and social influence, beliefs, attitudes, efficacy, and intention as predictors of improvements in PS, GI, and oral health quality of life. The cognitive and behavioral domains in the intervention constitute the mechanisms through which the intervention should have a positive effect. They are tailored through the AMI and targeted to building populations through the peer-facilitated oral health campaigns. The sample size is 360, 180 in each condition, with an attrition rate of 25%. The study is funded by National Institute of Dental and Craniofacial Research (NIDCR) and has been reviewed by University of Connecticut and NIDCR institutional review boards and NIDCR’s clinical trials review procedures.ResultsWhen compared against each other, the face-to-face intervention is expected to have greater positive effects on clinical outcomes and oral health quality of life through the mediators. When sequences are compared, the results may be similar but affected by different mediators. The arm consisting of the BA is expected to have better sustainability. The protocol’s unique features include the comparative effectiveness crossover design; the introduction of new emotion-based mediators; the balancing of fidelity, tailoring, and targeting; and resident engagement in the intervention.ConclusionsIf successful, the evaluated interventions can be scaled up for implementation in other low-income congregate living and recreational settings with older adult collectives.Trial RegistrationClinicalTrials.gov NCT02419144; https://clinicaltrials.gov/ct2/show/NCT02419144International Registered Report Identifier (IRRID)DERR1-10.2196/14555

The Business Case for Investing in Place-Based Public Health Initiatives

The Business Case for Investing in Place-Based Public Health Initiatives

What are women stressed about after birth?

Having a baby is associated with a variety of stressors, change, and adjustment. This study aimed to identify what women find stressful during the early postpartum period in contemporary Western society. Women (n=148) 6-12weeks postpartum wrote anonymously about a situation they found stressful as part of the Health after Birth Trial (HABiT) of expressive writing. Transcripts were analyzed for categories of stressors and cross-cutting themes. Five categories of stressors were identified. Stressors in pregnancy, labor, and the early postpartum period (49.3%) included physical and emotional difficulties, and insensitive treatment by health professionals. Stressors related to adjusting to life with a baby (35.8%) included difficulties coping with a new baby, parenting, juggling responsibilities, changes to physical health, and loneliness. Stressors related to the baby's health (32.4%) included infant digestive problems, acute health problems, long-term impact, and neonatal intensive care unit experiences. Stressors related to breastfeeding (23.7%) included pressure to breastfeed, feeling like a 'bad mum' for not breastfeeding, or wanting to breastfeed and not being able to. Other stressors related to changing relationships (18.2%): with their partner, children, and other family members. Cross-cutting themes that emerged in different stressor categories were women making negative self-appraisals (eg, a bad mum, failure), feeling guilty, and lack of support from others. Our findings emphasize the importance of exploring stressors and psychological well-being with women to provide support, help women's adjustment postpartum, and ensure interventions are offered when appropriate.