Needs Assessment Research Articles

Prevalence of pediatric surgical problems among east African refugees: estimates from a cross-sectional survey using random cluster sampling

ImportanceSurgery is a foundational aspect to high functioning health care systems. In the wake of the Lancet Commission on Global Surgery, previous research has focused on defining the burden of surgical conditions among a pediatric population, however these studies often fail to include forced migrant or refugees. The goal of this study was to estimate the prevalence of pediatric surgical conditions among refugees in east Africa.MethodsWe used the previously validated Surgeons OverSeas Assessment of Surgical Need (SOSAS) that utilizes cross-sectional design with random cluster sampling to assess prevalence of surgical disease among participants aged 0 to 18 years in Nyarugusu refugee camp, Tanzania. We used descriptive and multivariable analyses including an average marginal effects model.ResultsA total of 1,658 participants were included in the study. The mean age of our sample was 8.3 ± 5.8 years. A total of 841 participants (50.7%) were male and 817 participants (49.3%) were female. A total of 513 (n = 30.9%) reported a history or presence of a problem that may be surgical in nature, and 280 (54.6%) of them reported the problem was ongoing or untreated. Overall, 16.9% had an ongoing problem that may be amenable to surgery. We found that increasing age and recent illness were associated with having a surgical problem on both our multivariable analyses.ConclusionTo our knowledge, this is the first and largest study of prevalence of surgical conditions among refugee children in sub-Saharan Africa. We found that over 16% (one-in-six) of refugee children have a problem that may be amenable to surgery. Our results provide a benchmark upon which other studies in conflict or post-conflict zones with refugee or forced migrant populations may be compared.

Radiographic Predictors of Shunt Dependency in Intracranial Hemorrhage With Intraventricular Extension.

BackgroundIntracranial hemorrhage (ICH) may be complicated by intraventricular hemorrhage (IVH) and hydrocephalus, which can require the placement of a ventriculoperitoneal shunt (VPS). ICH and IVH risk scores using radiographic and clinical characteristics have been developed but utilization for assessment of future need for VPS placement is limited.MethodsThis is a single-institution retrospective review for patients with primary ICH with IVH from 2018-2020. Initial CTs and charts were analyzed to determine ICH, IVH, LeRoux and Graeb scores, Evans’ index, ICH and IVH volumes, and comorbidities. Outcomes including Glasgow coma scale (GCS), National Institute of Health Stroke Scale (NIHSS), length of stay, and shunt placement were evaluated with bivariate correlations, t-tests, chi-squared tests, and receiver operating characteristic (ROC) curves (p=0.05).ResultsA total of 130 patients were included of which 102 underwent full treatment beyond hospital day one. VPS placement was significantly associated with longer length of stay (p<0.001), discharge NIHSS (p=0.001), arrival Evans’ index (p<0.001), IVH (p=0.033), LeRoux (p=0.049), but not comorbidities, ICH score, or admission GCS. When treated beyond hospital day one, Evans’ index (p<0.001), IVH volume (p=0.029), Graeb (p=0.0029), IVH (p=0.004), Slice (p=0.015), and Leroux scores (p=0.006) were associated with shunt placement of which an Evans’ index of 0.31 or greater had highest sensitivity and specificity (area under the ROC curve (AUC) 0.81, sensitivity 81%, specificity 0.76).ConclusionsThe higher the Evans’ index, Graeb, IVH, Slice, and LeRoux scores on admission, the higher the risk of shunt dependency in patients undergoing full treatment beyond hospital day one. Admission imaging scores significantly predict the development of shunt dependence and may be considered in treatment.

Assessment, management, and incidence of neonatal jaundice in healthy neonates cared for in primary care: a prospective cohort study

Jaundice caused by hyperbilirubinaemia is a common phenomenon during the neonatal period. Population-based studies evaluating assessment, management, and incidence of jaundice and need for phototherapy among otherwise healthy neonates are scarce. We prospectively explored these aspects in a primary care setting via assessing care as usual during the control phase of a stepped wedge cluster randomised controlled trial.We conducted a prospective cohort study embedded in the Screening and TreAtment to Reduce Severe Hyperbilirubinaemia in Infants in Primary care (STARSHIP) Trial. Healthy neonates were included in seven primary care birth centres (PCBCs) in the Netherlands between July 2018 and March 2020. Neonates were eligible for inclusion if their gestational age was ≥ 35 weeks, they were admitted in a PCBC for at least 2 days during the first week of life, and if they did not previously receive phototherapy. Outcomes were the findings of visual assessment to detect jaundice, jaundice incidence and management, and the need for phototherapy treatment in the primary care setting.860 neonates were included of whom 608 (71.9%) were visibly jaundiced at some point during admission in the PCBC, with 20 being ‘very yellow’. Of the latter, four (20%) did not receive total serum bilirubin (TSB) quantification. TSB levels were not associated with the degree of visible jaundice (p = 0.416). Thirty-one neonates (3.6%) received phototherapy and none received an exchange transfusion. Five neonates did not receive phototherapy despite having a TSB level above phototherapy threshold.Jaundice is common in otherwise healthy neonates cared for in primary care. TSB quantification was not always performed in very jaundiced neonates, and not all neonates received phototherapy when indicated. Quality improvement initiatives are required, including alternative approaches to identifying potentially severe hyperbilirubinaemia.Trial registration: NL6997 (Dutch Trial Register; Old NTR ID 7187), registered 3 May 2018.

Multi-Sector Assessment and Client-Perception of Social Need at Long-Term Follow-Up of a Group-Randomized Trial of Community-Engaged Collaborative Care for Adults with Depression.

Understanding client perceptions of need for underlying social determinant support may improve services for depression care. This secondary analysis examines perceptions of “social needs” related to housing and employment, financial, and legal (EFL) concerns among individuals with depression. Data were analyzed from Community Partners in Care, a randomized comparative effectiveness trial of multi-sector collaborative care for depression among a sample of people who were predominantly racial/ethnic minorities and low-income. Adults with depression (n = 980) in both interventions were surveyed at 36-month follow-up for (1) being asked about and (2) having social needs for housing or EFL concerns. In multivariate models, life difficulty and mental health visits in non-healthcare sectors predicted being asked about housing and EFL. Lower social determinants of health-related life satisfaction increased the odds of having unmet housing and EFL needs. These findings underscore the role of non-healthcare organizations as community resources for depression care and in screening and addressing social needs.

Patient-reported distress and problems among elderly patients with hematological malignancy in Korea.

Treatment for hematological malignancies (HMs) and functional decline associated with age can cause distress in elderly patients with HMs. However, information about the nature and effects of distress in this population is scarce. Therefore, this study examined the level of distress, its source, and the practical/familial/physical/emotional problems among elderly patients with HMs. We conducted a cross-sectional study of patients with HMs aged ≥ 65years who visited an outpatient clinic at a tertiary medical center in Korea between November 2019 and March 2020. Patient-reported distress and problems were measured using the distress thermometer (DT) and 39-item Problem List by the National Comprehensive Cancer Network. Descriptive statistics, χ2 test or Fisher's exact test, and multivariate logistic regression analyses were conducted (N = 132). In total, 62.1% of patients had moderate to severe distress (DT score ≥ 4), experiencing an average of nine problems. Significant sources of distress on multivariate logistic analysis included problems with transportation, depression, and constipation, accounting for 47% of distress variance. Most patients had physical (97.0%) or emotional problems (79.5%). Among these, fatigue (60.6%), worry (59.8%), tingling (59.8%), difficulty with mobility (47.0%), and memory/concentration (40.2%) were the most frequently reported problems. Elderly patients with HMs have a high burden of distress, which is affected by different sources, compared with younger patients with solid tumors. Thus, in this population, assessment and management of distress need to be conducted considering the unique features of their source and burden. Further research on distress should consider the cancer type and population age.

Early orthodontic treatment of malocclusion in the mixed dentition

Children in the mixed dentition grow rapidly, and various types of malocclusion often appear in this period. At the same time, there are many environmental factors affecting the development of the occlusion at this stage. Functional abnormalities related to lip, tongue, articulation and breathing, and impacted teeth should be actively intervened and blocked to avoid the continued development of the deformity. Appropriate orthopedic devices should be used in patients with skeletal malocclusion, if necessary, for growth modification and the influence of congenital factors and the prognosis of treatment should be fully evaluated. Over-intervention of the temporary malocclusions in the mixed dentition should be avoided. In conclusion, early orthodontic treatment in the mixed dentition requires a comprehensive assessment of the treatment need, risks, timing, cost and the ultimate benefit of the patient. The timing of orthodontic treatment is not the sooner the better. The indications must be strictly controlled, and the necessity and limitations must be carefully considered.

Assessment of the Family Caregiver Needs for Patient with Cancer regarding Palliative Care

Assessment of the Family Caregiver Needs for Patient with Cancer regarding Palliative Care

Care Needs Profiles and Their Association with Caregiver Strain among Community-Dwelling Older Adults with Cognitive Impairment

Introduction: This study examined distinct profiles of met and unmet care needs among community-dwelling older adults with cognitive impairment and their association with caregiver strain. Methods: Latent class analysis and multivariable regression were applied to data from 266 caregivers of older Singaporeans, aged 60 years and above, with cognitive impairment. Care needs were evaluated by caregivers using the Camberwell Assessment of Need for the Elderly. Caregiver strain was measured by the Zarit Burden Interview. Results: Four need profiles were identified: (1) no need (38% of caregivers), (2) met social and memory needs (29%), (3) no social and met memory needs (17%), and (4) unmet social and memory needs (16%). The unmet social and memory needs profile was associated with a higher level of caregiver strain, compared to the no need profile. Discussion: A person-centered approach captured heterogeneity in the care needs of community-dwelling older adults with cognitive impairment. Policymakers should develop tailored interventions based on need profiles that may help reduce caregiver strain.

Assessment of orthodontic borderline treatment need: A comparison of two aesthetic indices

ObjectiveTo compare a new “guide for borderline orthodontic need” (GBON) with the “aesthetic component” (AC) of the IOTN in assessing borderline cases (dental health component DHC 3), and to compare reliability and opinions of orthodontists on the use of each index.Materials and methodsCross-sectional population descriptive study. Ninety-four qualified orthodontists assessed 30 borderline malocclusions according to the GBON and AC indices and completed a questionnaire.ResultsKappa analysis showed GBON and AC to have similar intra-examiner reliability (K = 0.64 and 0.60 ,respectively). Cronbach’s alpha inter-examiner reliability analysis showed GBON and AC to have similar, acceptable reliability (α = 0.7 and 0.9 ,respectively). There was only fair agreement between GBON and AC in terms of the number of malocclusions deemed as needing treatment (AC threshold 6). Analysis of specific occlusal traits revealed that reverse overjets were deemed as needing treatment according to AC but not anterior open bites. Both traits were assessed as needing treatment according GBON. Despite a lack of familiarity with GBON, assessors found GBON easier to use and more appropriate in assessing borderline malocclusions.ConclusionsBoth GBON and AC had good and similar inter- and intra-examiner reliability. There was substantial agreement on treatment need between GBON and AC but only when the AC threshold is reduced to 4. GBON was more able to identify malocclusal traits in need of treatment than AC. GBON was found to be easier to use and considered more appropriate than AC in judging DHC 3 malocclusions.

Assessment of Supportive Care Needs, Satisfaction and Quality of Life among Breast Cancer Survivors.

Assessment of Supportive Care Needs, Satisfaction and Quality of Life among Breast Cancer Survivors.

Needs of forensic psychiatric patients with schizophrenia in five European countries

AimsThe purpose was to compare the frequency of needs of patients with schizophrenia in forensic services across five European countries as assessed by both the patients and their care staff.MethodsPatients with schizophrenia and a history of significant interpersonal violence were recruited from forensic psychiatric services in Austria, Germany, Italy, Poland and England. Participants’ needs were assessed using the Camberwell Assessment of Needs—Forensic Version (CANFOR). Multiple linear regression analyses were used to identify predictors of numbers of needs.ResultsIn this sample, (n = 221) the most commonly reported need according to patients (71.0%) and staff (82.8%) was the management of psychotic symptoms. A need for information was mentioned by about 45% of staff and patients. Staff members reported a significantly higher number of total needs than patients (mean 6.9 vs. 6.2). In contrast, staff members reported a significantly lower number of unmet needs than patients (mean 2.0 vs. 2.5). Numbers of total needs and met needs differed between countries. Unmet needs as reported by patients showed positive associations with the absence of comorbid personality disorder, with higher positive symptom scores and lifetime suicide or self-harm history. Significant predictors of unmet needs according to staff were absence of comorbid personality disorder and higher positive as well as negative symptom scores according to PANSS.ConclusionsStaff rated a significantly higher number of total needs than patients, while patients rated more unmet needs. This indicates that patients’ self-assessments of needs yield important information for providing sufficient help and support.

The Turkish version of the Camberwell Assessment of Need for the Elderly: A validity and reliability study.

The present study attempted to adapt and validate the Turkish version of the Camberwell Assessment of Need for the Elderly (CANE-T). The data of this methodological study were collected from 610 older people who volunteered between September 10 and December 15, 2019. The SPSS 20 and LISREL software were used to perform reliability (internal reliability, parallel forms reliability/equivalent forms, and test-retest reliability) and validity (exploratory factor analysis and confirmatory factor analysis) analyses for the CANE-T. The Kaiser-Meyer-Olkin test revealed the sampling adequacy to be 0.72. After deleting four items (psychological distress, behavior, alcohol, and money) with a factor loading below 0.30 from the dataset, it was found that the scores on the scale explained 55% of the total variance. Besides, the confirmatory factor analysis revealed the following fit indices: p < 0.05, root mean square error of approximation (RMSEA)=0.08, root mean square residuals (RMR)=0.07, standardized root mean square residual (SRMR)=0.07, goodness-of-fit index (GFI)=0.88, and adjusted goodness-of-fit index (AGFI)=0.84. Concerning reliability, Cronbach's α values were calculated to be 0.78 for 'Physical Needs', 0.74 for 'Psychophysiological Needs', 0.75 for 'Security Needs', 0.75 for 'Social Needs', and 0.75 for 'Health Needs'. Overall, it was concluded that the 20-item five-factor CANE-T is a valid and reliable tool to measure the needs of older adults in the Turkish context.

Why did China’s mental health law have a limited effect on decreasing rates of involuntary hospitalization?

BackgroundChina’s Mental Health Law (MHL) implemented in 2013 required increased consideration of the rights of people with mental illness and was expected to lead to a reduction in involuntary hospitalization (IH). This study aimed to examine the rates and correlates of IH in a large psychiatric hospital in Guangzhou from 2014 to 2017 after the implementation of MHL and a structured assessment of the need for IH.MethodsUnduplicated electronic medical records concerning all inpatients admitted to the hospital with a primary psychiatric diagnose were examined. Diagnostic, sociodemographic and socioeconomic data were used to identify correlates of IH using bivariate chi-square tests followed by logistic regression analysis.ResultsOf 10, 818 hospitalized patients, there was a significant but small increase, from 71.6 to 74.9% in rates of IH in the years after a structured assessment of need for IH was implemented. Logistic regression analysis showed IH was positively associated with being younger, having a local residence, and a diagnosis of bipolar disorder, schizophrenia spectrum disorders or a substance abuse disorder as compared to those diagnosed with major depressive disorder.ConclusionsIH did not decrease over the first four years after the implementation of China’s MHL and a structured assessment in 2013 perhaps, reflecting the initiation of a systematic assessment of the need for IH and the relatively low number of psychiatric beds in this area.

Health-Related Needs of Older Adults in Rafsanjan County, Kerman, Iran

Objectives The need for meeting the needs of the elderly to promote active aging among them is becoming more important. For appropriate planning in this field, accurate needs assessment is necessary. In this regard, this study aims to investigate the health-related needs of the elderly in Rafsanjan county, Kerman, Iran. Methods &amp; Materials This cross-sectional study was conducted on 267 older people in Rafsanjan county in 2020 who were randomly selected from among six comprehensive health centers. A demographic form and the Camberwell Assessment of Need for the Elderly questionnaire were completed and data were analyzed in SPSS v. 26 software. Results The highest frequency of unmet needs in terms of psychological needs was psychological distress (12.3 %); in terms of physical needs, it was memory (9.3 %); and in terms of environmental needs, it was accommodation (5.2%). The highest frequency of met needs was related to physical needs in terms of medication (67.5%) and physical health (64%). The most unnecessary needs were related to psychological needs in terms of receiving benefits, drinking alcohol, deliberate self-harm and accidental self-harm. The highest rate of received help from unofficial sources was in the field of psychological distress (0.4%), and highest rate of received help from official sources were the fields of accommodation and physical health (0.4%). Conclusion The elderly in Rafsanjan county need more help in the field of psychological and physical needs. Therefore, attention should be paid to these needs in policy-making and executing programs in the field of elderly care.

Assessment of Crop Water Demand and Irrigation Water Supply in a Run-off-the-river Based Canal System

Proper assessment of irrigation water need for a canal command is required for long term planning and management of water resources. The present study was carried out in the Phulnakhara distributary command of the Puri main canal system distributed in Cuttack and Khurda districts of Odisha. During Kharif season, the Phulnakhara distributary command receives more than the required amount of irrigation water. However, during Rabi season, the canal does not flow at its full supply level as a result of which the total irrigation demand of the canal command area is not met leading to lower cropping intensity and poor crop productivity. The year-wise highest irrigation water demand in Kharif season was found to be 48646195 m3 during 2015-16 and the lowest was 22291100 m3 in 2017-18. Whereas the highest Kharif irrigation supply at the head regulator was 43402176 m3 during 2015-16 and the lowest was 29831328 m3 during 2013-14. The highest Rabi irrigation water demand was found to be 21700766 m3 during 2008-09 and the lowest was 9570257 m3 in 2017-18. Whereas the highest Rabi irrigation supply at head regulator was 26379648 m3 during 2008-09 and the lowest was 615168 m3 during 2009-10. As evident, there is a mismatch between the supply and demand in both the seasons and it is more prominent in the Rabi season. In order to bridge this gap, conjunctive use of canal water with groundwater is found to be a promising solution.

Retraction: Ferrari Aggradi, CR, Falcier, E, Lizio, A, et al. Assessment of respiratory function and need for non-invasive ventilation in a cohort of patients with myotonic dystrophy type 1 followed at one single expert centre. The Clinical Respiratory Journal. 2022; 1- 13. (https://doi.org/10.1111/crj.13516).

The above article, published online on 27 June 2022 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editors in Chief, Professor Paul Jones and Professor Yuanlin Song and John Wiley and Sons Ltd. The retraction has been agreed due to an error with the publisher and author which caused a duplicate of the article to be published on 27 June 2022. The correct version of the article is to be found at: Carola R. Ferrari Aggradi, Elisa Falcier, Andrea Lizio, Alice Pirola, Jacopo Casiraghi, Alice Zanolini, Elena Carraro, Luca Mauro, Fabrizio Rao, Elisabetta Roma, Antonino Iannello, Elisa De Mattia, Andrea Barp, Sara Lupone, Valentina Gatti, Cristina Italiano, Valeria A. Sansone, "Assessment of Respiratory Function and Need for Noninvasive Ventilation in a Cohort of Patients with Myotonic Dystrophy Type 1 Followed at One Single Expert Center", Canadian Respiratory Journal, vol. 2022, Article ID 2321909, 11 pages, 2022. https://doi.org/10.1155/2022/2321909.

The development and application of a chairside oral health risk and need stratification tool in general dental services

ObjectiveTo describe the development and application of the Assessment of Clinical Oral Risks and Needs (ACORN) stratification tool based on a traffic light system in National Health Service (NHS) general dental services (GDS) Wales, UK. Materials and methodsThis was a secondary analysis of routinely-collected dental care data. All courses of treatment provided in dental practices participating in NHS GDS Reform Programme between July 2018 and September 2019, in which an ACORN assessment and age were recorded were included in the analysis. ResultsA total of 236,490 subjects contributed 339,933 courses of treatment during the study period. ‘Amber’ and ‘red’ ACORN outcomes were associated with more courses of treatment per annum than ‘green’ outcomes. Outcomes indicating an increased risk of decay or other dental problems were associated with a greater likelihood of several operative treatment items. Patients at greater risk of poor periodontal health were more likely to receive extractions and dentures than low-risk patients. Patients were most likely to either remain in the same ACORN outcome categories or move to a healthier state between assessments. ConclusionMore research is required to understand the utility of the ACORN tool in risk communication and behaviour change.

Debatable issues of need assessment in the context of providing social support measures to families with children

The article is devoted to the problems of implementing the introduced mechanism of comprehensive assessment of need for the purpose of assigning benefits to women who have been medically registered in early pregnancy, payments for children aged 3 to 7 years, from 8 to 17 years. It is emphasized that the need to form an integrated system of targeted provision to families with children is long overdue, as well as the change in the parameters of the definition of low-income. The comparison of the average per capita income of a family with the subsistence minimum in this context is not representative. The legal structure of a comprehensive need assessment has significant advantages. Thus, the «zero income» rule not only encourages employment (employment) on a systematic basis, but also removes uncertainty regarding the assessment of a particular circumstance as objectively preventing a family from getting out of a state of need. At the same time, the author notes a number of contradictions and gaps of the mentioned norms, which confirms the analysis of judicial practice.

Assessment of Respiratory Function and Need for Noninvasive Ventilation in a Cohort of Patients with Myotonic Dystrophy Type 1 Followed at One Single Expert Center.

Introduction Respiratory insufficiency is one of the main causes of death in myotonic dystrophy type 1 (DM1). Although there is general consensus that these patients have a restrictive ventilatory pattern, hypoventilation, chronic hypercapnia, and sleep disturbances, the prevalence of respiratory disease and indication for the effects of noninvasive ventilation (NIV) need to be further explored. Objectives To describe respiratory function and need for NIV at baseline and over time in a cohort of adult patients with DM1. Methods A total of 151 adult patients with DM1 were subjected to arterial blood gas analysis, sitting and supine forced vital capacity (FVC), peak cough expiratory flow (PCEF), nocturnal oximetry, and maximal inspiratory pressure and expiratory pressure (MIP/PEP). Results On first assessment, 84 of 151 had normal respiratory function (median age: 38 years, median BMI: 23.9, and median disease duration: 11 years); 67 received an indication to use NIV (median age: 49 years, median BMI: 25,8, and median disease duration: 14 years). After a median time of 3.85 years, 43 patients were lost to follow-up; 9 of 84 required NIV; only 17 of 67 with the new NIV prescription were adherent. Conclusions We provide additional data on the natural history of respiratory function decline and treatment adherence in a relatively large cohort of well-characterized patients with DM1. A high proportion (28%) was lost to follow-up. A minority (11%) required NIV, and only 25% were treatment adherent, irrespective of specific demographics and respiratory features. Our results also confirm previous findings, showing that age, disease duration, and higher BMIs are predisposing factors for respiratory impairment.

Exploring the relationships between composite scores of disease severity, seizure-freedom and quality of life in Dravet syndrome

BackgroundIn Dravet syndrome (DS), a rare epileptic and developmental encephalopathy, the effectiveness of a new treatment is predominantly measured in terms of seizure frequency. However, this may not fully capture the impact of a treatment on the broader aspects of the syndrome and patients’ health-related quality of life (HRQoL). Using a previously published survey which collected data from DS patients and their carers on the broader manifestations of their syndrome, their HRQoL, and their experience of seizures, this study created composite measures of symptom severity to offer new perspectives on the multifaceted aspects of this rare condition.MethodsSurvey responses on the severity of physical and psychosocial symptoms were combined with independent assessments of disability and care need, to generate three composite symptom scores assessing the manifestations of DS (physical, psychosocial and care requirements). Variation in HRQoL was investigated in multiple regression analyses to assess the strength of association between each of these composite measures and three forms of seizure measures (seizure frequency, days with no seizures and longest interval without seizures), as experienced over a 4- and 12-week period.ResultsComposite scores were calculated for a cohort of 75 primarily paediatric patients who were enrolled in the study. Strong associations were found between each of the three composite symptom scores and each of the three seizure measures, with the regression coefficient on symptom score highly significant (p ≤ 0.001) in all nine comparisons. Separate regressions using predictors of HRQoL (Kiddy KINDL and Kid KINDL) as the dependent variable were inconclusive, identifying only behavioural/attention problems and status epilepticus as significant predictors of HRQoL.ConclusionsThese results allow the development of a composite score that may be useful in developing a clinical understanding of the severity of DS for an individual patient and establishing their treatment goals. Where measurement of long-term sequalae of disease is not feasible, such as clinical trials, correlation of the composite score with experience of seizures and seizure-free periods may allow a better contextualisation of the results of short-term assessments.Trial registrationGerman Clinical Trials Register (DRKS), DRKS00011894. Registered 16 March 2017, http://www.drks.de/ DRKS00011894.