Care Medical Center Research Articles

The Fermi problem: Estimation of potential Billing losses due to Undercoding of Florida Medicare data

Billing issues are more commonplace than most healthcare professionals, including pharmacists, even realize. Undercoding—or billing outpatient visits for a lower level of service than may be justified—leads to decreased reimbursement, but almost no data captures what is being sacrificed, especially at the state level. Using publicly available data from the National Ambulatory Medical Care Survey and Centers for Medicare and Medicaid Services, we attempt to approximate just how much Medicare reimbursement is lost annually to undercoding in Florida. We also discuss the hidden dangers of undercoding, including how it could hinder the ability of clinical pharmacists to build sustainable clinical services and contribute to the broader healthcare team.

Career prospects for ophthalmologists under 49years old : Asurvey in Germany from 2022

The need for care in ophthalmology is constantly increasing due to demographic changes. The study analyzed the current professional situation and future prospects of ophthalmologists under 49years old. The survey of members of the German Association of Ophthalmologists (Berufsverband der Augenärzte Deutschlands) and the German Ophthalmologic Society (Deutsche Ophthalmologische Gesellschaft) was conducted in 2022. All members under the age of 49years received an online questionnaire on the current professional situation as well as future perspectives (desired working hours, form of organization). The results of the survey were additionally compared with the 2016 survey of the German Association of Ophthalmologists. Asimilar questionnaire was used at that time. Atotal of 1014 people participated in the survey (62.7% women, mean age 39.3 ± 8years, 75.6% specialists). The response rate to the survey was 25%. Specialist practice from0 to 5years showed ahigher number of employed ophthalmologists (21% self-employed vs. 32% employed); over time the number of self-employed ophthalmologists increased (6-10years: 40%, > 10years: 59.3%). Overall, 46% of women were employed in apractice compared with 33% of men. Of the self-employed specialists, 95.9% said they planned to work in the same type of employment in 10years as currently. Regarding ophthalmologists' career future, the other employment types showed adesire to move to independent practice. Compared to the 2016 survey, gender differences related to the current type of employment were evident. The number of self-employed women decreased from 43% to 26% and self-employed men decreased from 63% to 39%. The number of ophthalmologists in ambulatory healthcare centers was doubled compared to 2016. Ophthalmologists reported similar future perspectives at both survey times. The results of the survey of ophthalmologists under 49years in Germany showed similar perceptions as in 2016. It became clear that the desire to be self-employed in 10years is very high; however, ophthalmologists expected large practices or medical care centers to prevail in the market. The number of self-employed doctors is decreasing and the desire for self-employment is difficult to realize.

Hormonal and Metabolic Factors Influence the Action of Progesterone on the Endometrium of Women with Polycystic Ovary Syndrome.

Hormonal and metabolic factors may influence endometrial quality and interfere with the action of progesterone. Therefore, the aim of our study was to address this issue. Participants were recruited from an outpatient reproductive endocrinology clinic at an academic tertiary medical care centre. All subjects underwent endometrial biopsy (EB) in the follicular phase of the cycle prior to treatment. Thereafter, they were treated with micronized progesterone (400 mg/day × 10 days intravaginally) from days 14-28 of the next cycle. A second EB was performed between days 21-24 of the cycle (the second phase). The metabolic and hormonal serum levels were evaluated during the implantation window. EB samples were analysed using light microscopy for histomorphometric analysis. The endometrium of women with Polycystic Ovarian Syndrome (PCOS) in the second phase demonstrated a uniform surface epithelium with less leukocyte infiltration and an absence of apoptotic figures compared to the control group. (p < 0.021). The thickness of the surface epithelium in the second phase of the PCOS group correlated positively with free and bioavailable testosterone values. The number of stromal cells increases with increasing insulin levels. Our results suggest that histomorphometric abnormalities of the endometrium persist and are linked to androgen and insulin levels despite progesterone supplementation in PCOS.

Patients’ Satisfaction With the Quality of Emergency Medical Care Service in the Example of Osh City

The article presents a study on patients’ satisfaction with the quality of emergency ambulance medical care service in Osh city. Improving the patients’ satisfaction with the quality of medical care is a key goal of any healthcare organizations. Identifying and resolving the problems (shortcomings) in conducting emergency medical care to people in timely manner is one of the effective mechanisms in quality improvement of the medical care system. An analysis is made of the findings of a survey of population views on the state and the quality of emergency (ambulance) medical care center of Osh city, on the work of it’s the dispatch unit (call center) and on the level of its technical/equipment capacity. The survey shows the prevalence of women (65.8%) who are actively using the service of emergency medical care. Among the respondents, 24% expressed their dissatisfaction with the work of dispatch unit “103”, and 37% of patients have responded that they are unsatisfied with the work of the ambulance, and 40% of the respondents were expressed their dissatisfaction with the level of technical/equipment capacity and medications provided by the ambulance unit. Among the other reasons for patients’ dissatisfaction were the lack of information provided on medical condition of the patients, the overall inadequate medical assistance provided by the emergency ambulance service, and lack of professional attitude or rude behavior toward the patients. To evaluate the quality of the work of ambulance service, the study underlines the necessity of developing and implementing a standardized questionnaire for the patients which allows to identify shortcomings and develop recommendations to the problems of the ambulance service.

War in Ukraine and dialysis treatment: human suffering and organizational challenges.

In January 2021, there were 9648 patients in Ukraine on kidney replacement therapy, including 8717 on extracorporeal therapies and 931 on peritoneal dialysis. On 24 February 2022, foreign troops entered the territory of Ukraine. Before the war, the Fresenius Medical Care dialysis network in Ukraine operated three medical centres. These medical centres provided haemodialysis therapy to 349 end-stage kidney disease patients. In addition, Fresenius Medical Care Ukraine delivered medical supplies to almost all regions of Ukraine. Even though Fresenius Medical Care's share of end-stage kidney disease patients on dialysis is small, a brief narrative account of the managerial challenges that Fresenius Medical Care Ukraine and the clinical directors of the Fresenius Medical Care centres had to face, as well as the suffering of the dialysis population, is a useful testimony of the burden imposed by war on these frail, high-risk patients dependent on a complex technology such as dialysis. The war in Ukraine is causing immense suffering for the dialysis population of this country and has called for heroic efforts from dialysis personnel. The experience of a small dialysis network treating a minority of dialysis patients in Ukraine is described. Guaranteeing dialysis treatment has been and remains an enormous challenge in Ukraine and we are confident that the generosity and the courage of Ukrainian dialysis staff and international aid will help to mitigate this tragic suffering.

Напрями ефективізації публічної політики підвищення якості медичного обслуговування населення в Україні

The article emphasizes the urgency of forming and implementing a public policy of improving the quality of providing medical services to the population. The purpose of the study is the scientific substantiation of the methodological and applied principles of the streamlining of the public policy of improving the quality of medical care of the population in Ukraine. It is shown that carrying out the medical reform in Ukraine actualizes the problem of improving the quality of medical care for the population, especially at the local level; for territorial communities, this means, first of all, the formation of an integral system of medical care, which will cover its primary and secondary links and will allow to simplify the access of residents of the territory of the community to quality medicine. The development strategies of the regions of the Ukrainian Carpathians were analyzed, and on this basis it was proved that in Ukraine, at the regional and local levels, quite significant attention within the framework of public policy is paid to medicine in general and, in particular, to the improvement of the quality of medical care of the local population. The modern processes of transformation of the domestic system of providing medical services to the population are characterized, namely trends that reflect the fact that the health care system began to noticeably lose its stability during the spread of the COVID-19 pandemic, and with the unfolding of the full-scale Russian war on Ukraine, it experienced colossal shocks due to the transfer of part of medical workers to serve the needs of the army, migratory losses of personnel, increased burden on the industry due to a large number of injured civilians and military personnel, as well as a new wave of forced migrants. The directions of the public policy of improving the quality of medical care for the population in Ukraine were defined and substantiated, namely, the initialization of the infrastructural part of the health care reform; creation of a single coordination center based on the center of emergency medical care and disaster medicine; development of regulations regarding vulnerable population groups, including IDPs, in the context of obtaining the necessary medical and rehabilitation assistance; activation of work with international funds; ensuring rotation of medical and social workers at meeting points for IDPs.

Some aspects of the organization and analysis of the performance of the orthodontic service in Ryazan and the Ryazan region

Conducting a retrospective analysis of the indicators of orthodontic care provided in Ryazan and the Ryazan region from 1999 to 2017. During the study, institutions providing orthodontic care were divided into three levels of dental organizations. Level 1 medical care centers provide assistance to residents of districts of the region, the results of the work of clinics located in 2 districts of the region were analyzed for the period since 2005 to 2017. Level 2 StMO includes state dental clinics and private dental clinics in the city of Ryazan, where you can get orthodontic care. The work of state structures was analyzed from 1999 to 2011 with a step of 3 years, from 2011 to 2017. - yearly. Level 3 SMEs include specialized departments of universities, where only consultative and diagnostic assistance is provided. An analysis was made of the orthodontic pathology with which the patients treated, as well as an analysis of the orthodontic equipment used for treatment during the study period. The prevalence of AFA among the child population of the region's districts is at the level of 80.10±0.68%, fixed equipment is used 3 times more often in level 1 SMO than in level 2 SMI, and removable equipment is used only 10-20% less often. in the SMC and levels 1 and 2, the main part of the contingent is the child population (97.7-99.1% and 67.82-0.63%, respectively), but in the region for this type of assistance, the appealability among patients over 18 years of age is 10% less than in the city. The data obtained indicate the need for changes in the structure of orthodontic care. It is required to allocate at least 2 rates of an orthodontist in each district to provide assistance to the population living in the Ryazan region.

Effect of Medical Fee Schedule Revisions on the Expansion of Nutritional Support Teams in Japan: An Interrupted Time-series Analysis.

In 2018, the fee schedule for nutrition support teams (NSTs) in Japanese hospitals was changed. The change was intended to encourage more hospitals to establish NSTs, and this study aims to investigate whether this change had the desired effect. Specifically, we will look at the proportion of hospitals with NSTs before and after the 2018 revision to see if there was a significant increase in the number of hospitals with NSTs. The study analyzed administrative data from 10 Japanese prefectures dating from June 2015 to September 2021 using an interrupted time-series design. The analysis focused on all acute care hospitals within these prefectures and measured the percentage of hospitals with NSTs. Subgroup analyses were conducted based on hospital size and functions. In April 2018, the intervention, a fee schedule revision, was implemented. We analyzed 1,471 acute care hospitals. Immediately after the intervention, the percentage of hospitals with NSTs increased by 4.59% (95% CI = 3.92%, 5.26%) and by 0.66% (95% CI = 0.57%, 0.75%) quarterly thereafter. We observed a marked increase in NST formation among large-sized (20.9%), medium-sized (28.0%), and highly acute care hospitals (hospitals with emergency medical care centers and intensive care units, 22.3% and 23.6%, respectively). We also noted a moderate increase among hospitals with convalescent rehabilitation units (10.1%) and a modest increase among small-sized hospitals (6.9%). Relaxation of the NST fee requirement increased the proportion of hospitals with NSTs in Japan, especially among larger and highly acute care hospitals.

Role of education and income on disparities of time-to-treatment initiation and its impact on cervical cancer survival.

In India, cervical cancer is the second-leading cause of cancer incidence among women. Socioeconomic factors play a vital role in cervical cancer survival. This study assessed the role of education and income on disparities in time-to-treatment initiation (TTI) and its impact on cervical cancer survival. This was a retrospective facility-based record study conducted among newly treated cervical cancer patients registered in a tertiary medical care center in Mumbai between 2014 and 2016. Adjusted hazard ratio with a 95% confidence interval was reported. In total, 1947 cervical cancer patients with a mean age of 52.89 (±10.55) years were included. The average number of days for TTI among highly educated patients was 27 versus 35 days for patients with no formal education. An increasing trend in survival was observed as education levels shift from no formal to higher education category (75.54%, 77.30%, and 85.10%, P = 0.01). All cause mortality was lower in cervical cancer patients with secondary education and above than illiterates (hazard ratio [HR] = 0.63, P < 0.01), among those with higher income (HR = 0.78, P = 0.04) than lower income and among who started on treatment within 30 days (HR = 0.90, P = 0.29) than patients who started treated after 30 days. Inferior survival is found for cervical cancer patients with lower education and income and who initiated treatment after 30 days. Hence, it is important to improve awareness and screening activities, especially among the lower socioeconomic groups, for early diagnosis and better treatment outcomes.

지방자치단체 출자출연기관 자본잠식에 관한 연구

This study analyzes the capital erosion ratio and trend by dividing local government invested and contributed companies by type (by investment, contribution) using financial report data from the Ministry of Public Administration and Safety during 2014-2020. In 2020, 39 out of 92 invested companies, 39 (42.4%) had no capital erosion, 25 (27.2%) had more than 0% and less than 50%, 11 (12.0%) had more than 50% but less than 100%, and 7 (18.5%) had full capital erosion (100% and above). Therefore, there are 18 institutions with partial and complete erosion, with 19.5% of all invested companies suffering capital erosion. It seems necessary to determine the cause of capital erosion and prescribe for future capital erosion mitigation.&#x0D; In the case of contributed companies, 603 (90.1%) out of 669 total contributed companies in 2020, had no capital erosion. However, 43 companies (6.4%) suffer 0% and less than 50%, 10 (1.5%) of partial erosion, and 13 (1.9%) of 100% or more of full capital erosion. Therefore, 23 contributed companies (3.4%) are suffering from either partial or full capital erosion, which seems to be relatively good compared to invested companies.&#x0D; As a result of classifying and analyzing contributed companies by sub-type, the largest proportion of capital erosion companies (71%) is medical care center. The type with the highest proportion of institutions capital-infested after medical centers is credit guarantee companies (55%). Both types have the characteristic that the size of capital is relatively larger than other contributed companies. Conversely, the type with a low proportion of capital erosion is female youth institutions, only about 4% of institutions showing capital erosion.

Medical and social justification of the financial and economic condition of the MNP «Rohatyn Center of Primary Medical and Sanitary Care» before and after the introduction of the hospital district

Medical and social justification of the financial and economic condition of the MNP «Rohatyn Center of Primary Medical and Sanitary Care» before and after the introduction of the hospital district

A clinical pharmacological evidence-based analytical research study on the clinical pharmacokinetic dose-dependent correlation of oral haematinics with the obstetric and gynaecological global anaemic patients’ recovery rate

Background: The goal of iron therapy is to repair the haemoglobin deficit and replenish storage iron. Oral haematinics are the treatment of choice, due to their higher effectiveness, higher safety, higher ease of administration, higher patient compliance, better accessibility, no occurrence of nosocomial infections and lower cost. This analytical evidence-based clinical research was conducted for the molecular pharmacokinetic study of the pharmacological response and adherence of the patients to oral haematinics, in global tertiary medical care centres.Methods: 100 anaemic patients, who were treated for moderate iron-deficiency anaemia, were prescribed oral haematinics, such as, ferrous ascorbate, ferrous sulphate, ferrous fumarate and ferric ammonium citrate, containing 60 mg of elemental iron, once to thrice daily, with or after meals, according to the progress of the disease, treatment regimen scheduling, occurrence or non-occurrence of adverse drug reactions and prognosis of the patient. The pharmacokinetic dose-dependent percentage recovery rate of the patients on 1st (30th day), 2nd (60th day) and 3rd (90th day) months and follow-up (105th day) visits, was finally deduced from the patients’ recovery features of symptoms and signs, and the confirmatory laboratory investigations recordings, with the efficacy and safety evaluation findings.Results: During the oral haematinics treatment, the pharmacokinetic dose-dependent percentage recovery rate of the patients was 29% on 30th day, 62% on 60th day, 93% on 90th day and 100% on 105th day of treatment.Conclusions: All the oral haematinics treated global anaemic patients had shown 100% recovery rate in tertiary medical care centres.

Особенности проведения медицинской эвакуации пациентов в условиях временного ограничения на федеральном уровне полетов гражданской авиации, в том числе из-за рубежа

Summary. The aim of the study is to analyze and to substantiate alternative ways of solving problematic issues of medical evacuation of patients and casualties in conditions of temporary restriction of civil aviation flights. Materials and research methods. Materials of the study: practical experience of the specialists of the Center of sanitary aviation and emergency medical care of “Zashchita” Disaster Medicine Center of Federal Medical Biophysical Center named after A.I.Burnazyan of the Federal Medical and Biological Agency of Russia, as well as LLC “Medaero-Service”; statistical data on the field work of teams of the Center of sanitary aviation and emergency medical care on medical evacuation of patients from closed airspace areas; data from the official websites of the Federal Air Transport Agency, of Government and Ministry of Foreign Affairs of the Russian Federation, of Border Service, of Federal Tourism Agency, and assistance companies; electronic database of regulatory legal documents. Research methods: analytical, method of direct observation, comparison, description. Results of the study and their analysis. Results of the study, characterizing the problematic issues of medical evacuation of patients and victims in conditions of temporary restriction of civil aviation flights regime, are presented. The main ways of optimization of medical evacuation of patients and victims at the federal level during the period of air traffic limitation have been suggested and substantiated.

Detection of early cardiac disease manifestation in propionic acidemia - Results of a monocentric cross-sectional study.

In propionic acidemia (PA) myocardial involvement is common and includes development of cardiomyopathy, life-threatening acute heart failure, and acquired long-QT syndrome. We sought to investigate which echocardiographic parameters of left ventricular systolic and diastolic function indicate early cardiac disease manifestation in PA. This is a prospective observational study (cross-sectional design) in a Tertiary Medical Care Center. Individuals with confirmed PA were enrolled and the following cardiac investigations were performed in all study individuals: echocardiographic measurements of systolic and diastolic left ventricular (LV) function (LV fractional shortening (LV-FS), LV ejection fraction by biplane modified Simpson's (LV-EF), mitral annular plane systolic excursion (MAPSE), LV global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE), pulsed Doppler analyses of mitral valve (MV) inflow velocities (MV E/A) and MV deceleration time (DT-E), tissue doppler imaging (TDI) of the mitral annulus (MV E/e'), and LV myocardial performance index (LV-MPI). LV and left atrial (LA) diameters were assessed. 12‑lead electrocardiograms (ECG) were recorded and corrected QT intervals (QTc) calculated. Clinical phenotype and laboratory parameters at the time of cardiac investigation were assessed. Besides descriptive analyses we analyzed frequency, onset, and combinations of echocardiographic and ECG data as well as their correlations with clinical and biochemical findings. The effects of 'age at visit' and LV functional parameters on QTc were analyzed with multiple regression. A total of 18 patients with confirmed PA were enrolled. Median age at PA onset was 6 days (range 1-357 days). Median age at visit for cardiac evaluation was 13.1 years (range 0.6-28.1 years). LV-GLS was abnormal in 72.2%, LV-EF in 61.1%, MAPSE in 50%, MV E/e' in 44.4%, LV-MPI in 33.3%, LV-FS in 33.3%, and MV E/A in 27.8%. In cases with normal or near normal LV-FS, LV-GLS was pathological in 5/10, LV-EF in 4/10, and MAPSE in 3/10. The probability of developing LV dysfunction - systolic and diastolic - increases with age. LV-MPI is a reliable parameter to indicate systolic LV-dysfunction in combination with a dilated LV, i. e. dilated cardiomyopathy (DCM) in PA. Multiple regression reveals a significant positive association between LV diameters and QTc. Abnormal LV-GLS significantly correlates with reduced muscle strength, muscle tone and/or abnormal gross motor function. Our data suggests a high prevalence of cardiac disease manifestation in PA, considerably higher than in previous studies, where only LV-FS was used to assess LV function. Usage of advanced echocardiographic techniques, such as LV-GLS assessment, may allow for early detection of subtle LV dysfunction in PA, and may lead to timely cardiac treatment but also consideration of liver transplantation to prevent development of manifest cardiac complications.

A Novel Multi-Objective Learning Algorithm for Disease Identification and Classification in Electronic Healthcare System

Data is a commodity in today’s electronic world, and massive amount of data is being generated in many fields. Medical files and disease-related data are two types of data in the healthcare industry. This electronics health data and machine learning methods would enable us all to evaluate vast amount of data in order to uncover hidden patterns in disease, offer individualized treatment to the patients, and anticipate disease progression. In this paper, a general architecture for illness prediction in the health industry is proposed. The Internet of Things (IoT), as a helpful model wherein reduced electronics body sensors and smart multimedia medical equipment, are used to enable remote monitoring of body function, plays a critical role, particularly in areas when medical care centers are few. To tackle these challenges, we have proposed Deep Reinforcement Learning with Gradient-based Optimization (DRL with BRO) model for various disease detection and classification such as skin disease, lung disease, heart, and liver disease. Initially, the IoT-enabled data are collected and stored in the cloud storage. After that, the medical decision support system based DRL with the GBO model classifies various diseases. The maximum classification accuracy with the minimum delay is the multi-objective function and finally, the proposed study satisfies the objective functions. Based on the experimental study, the proposed method offers good results than other existing methods.

Use of lacosamide in children: experience of a tertiary medical care center in Brazil.

Lacosamide (LCM) is a third-generation anti-seizure drug approved in Europe and the United States, either as a monotherapy or adjunctive therapy, to treat partial-onset seizures in adults, adolescents, and children. In Brazil, LCM is licensed for treatment only in patients older than 16 years of age. To evaluate a cohort of children presenting with refractory epilepsy who received LCM as an add-on therapy and observe the response and tolerability to the LCM treatment. A retrospective cohort study conducted in a tertiary health care facility, which included 26 children, aged up to 16 years, who presented with refractory epilepsy and received LCM as an add-on treatment. The follow-up visits were scheduled every 3 months until 9 months of treatment with LCM. After 3 months of LCM administration, in 73.1% of the children, there was a reduction of > 50% in the frequency of seizures, and this clinical improvement was maintained in most patients (73.9%) for the following 9 months. Mild (such as, somnolence and behavioral changes) or severe (seizure worsening) adverse effects were observed in two and three children respectively. Among responders to LCM, there was a higher prevalence of males, fewer concomitant anti-seizure drugs, and lower percentage of patients using sodium channel blockers. Lacosamide should be considered as an early treatment option in pediatric patients with refractory epilepsy, mainly focal seizures.

Metabolic syndrome and the immunogenicity of Pfizer–BioNTech vaccine: a cross-sectional study in Japanese healthcare workers

BackgroundThe clustering of metabolic abnormalities may weaken vaccine-induced immunity, but epidemiological data regarding SARS-CoV-2 vaccines are scarce. The present study aimed to examine the cross-sectional association between metabolic syndrome (MetS) and humoral immune response to Pfizer–BioNTech vaccine among the staff of a research center for medical care in Japan.MethodsParticipants were the staff (aged 21–75 years) of the National Center of Global Health and Medicine who had completed the second dose of Pfizer–BioNTech vaccine 1–3 months before the survey. MetS was defined according to the Joint Interim Statement. SARS-CoV-2 spike immunoglobulin G (IgG) antibody was measured using quantitative assays. Multivariable linear regression was used to estimate the geometric mean titers (GMT) and geometric mean ratio (GMR) of IgG titers, relative to MetS status.ResultsOf 946 participants who received the second vaccine dose, 51 (5.4%) had MetS. Those with MetS had a significantly lower IgG titer (GMT 4125; 95% confidence interval [CI], 2885–5896) than those without MetS (GMT 5348; 95% CI, 3914–7309); the GMR was 0.77 (95% CI 0.64–0.93). Taking those having no MetS component as reference, fully adjusted GMR (95% CI) for those having 1, 2, 3 or ≥ 4 components was 1.00 (0.90, 1.11), 0.89 (0.77, 1.04), 0.86 (0.68, 1.10) and 0.61 (0.45, 0.82), respectively (P trend = 0.024).ConclusionResults suggest that having MetS and a greater number of its components are associated with a weaker humoral immune response to the Pfizer–BioNTech vaccine.

Availability of Physical Rehabilitation Facilities for People with Disabilities in Iran: A Comparative Study on Universal Health Coverage.

Iran, like many other countries, has committed to providing universal and equal access to health care and rehabilitation for people with disabilities by joining the Convention on the Rights of People with Disabilities. Thus, this study aimed to examine the availability of rehabilitation facilities on national and sub-national levels. This cross-sectional study was conducted between May and December 2019. The data of rehabilitation facilities including infrastructure and rehabilitation workforce in health system settings were obtained using rehabilitation master list. The data were collected from the Vice-Chancellor for the Treatment Ministry of Health and Medical Education, the Rehabilitation of the State Welfare Organization, and Licensing and Planning the Medical Council in the 32 provinces of Iran and analyzed using Excel version 2016. On the national level, the following situation was found: in inpatient settings: 1.1 beds per million population; in outpatient settings: physiotherapy 42.6, optometry 16.4, audiology 10.5,occupational therapy 8.2, speech therapy 8.1, orthotic & prosthetic 4.5, physical medicine & rehabilitation 3.8 centers; day-care centers 11.7 and rehabilitation centers 1.3 centers, community-based rehabilitation (CBR): 15.9 units, rehabilitation home care 2 centers, rehabilitation nursing home care 1.6 centers and medical rehabilitation home care 0.3; Long-term care centers: residential care 4.1 centers per million population. Regarding rehabilitation work force: physiotherapists 84, speech therapists 34.8, occupational therapists 32.5, optometrists 31.2, audiologists 27.9, prosthetists and orthotists 10.3 therapists and physical medicine & rehabilitation 5.1 specialists per million populations. On the sub-national level, there were no outpatient rehabilitation centers in 12 of the provinces and the distribution of day rehabilitation centers in the rich provinces was 10 times higher. The number of CBR units, rehabilitation home care and rehabilitation nursing home were 40, 22, and 23 times higher in rich provinces than in poor provinces, respectively and there were no medical rehabilitation home care centers in 21 provinces. Regarding long-term care, the residential care centers in the richest province were 8 times higher. According to the WHO report and the rehabilitation expert panel, it was concluded that the number of rehabilitation facilities including rehabilitation centers and workforce was limited in Iran and that the available centers were also poorly distributed in the provinces of the country. This made it difficult for people to have fair access to rehabilitation services. It appears that health policymakers should pay special attention to further developing rehabilitation facilities.

Experiences of Professionals Ensuring the Protection of Children from Violence

Violence leaves long-lasting scars on children's lives and protecting children from violence remains an important and pressing issue for researchers, public policy makers and public service professionals. This article aims to reveal the experiences of professionals who ensure the protection of children from violence. The following tasks have been set: first, to define a theoretical approach to the practical protection of children from domestic violence; second, to determine the peculiarities of ensuring the protection of children from violence by means of analysis of the experience of specialists. The study used semi-structured interviews. The research in municipality N revealed that various specialists from state and non-governmental institutions are involved in the process: psychologists, child protection specialists, social workers, social educators, employees of medical institutions, mobile teams, police representatives and children's day care centers. The study results showed that one of the most significant positive aspects of ensuring the protection of children from post-reform violence is an established case management position and having a mobile team. The following advantages of providing mobile team support tools have emerged: identifying the initial difficulties of family members and a thorough, in-depth analysis of the problem across a wide range of areas of life; intensive involvement of professionals in assisting the family and the child. The study highlighted the main work challenges that professionals have to overcome: quality assurance at work, emotional experiences at work, the need for psychological support, the ability to manage stressful situations, working with problem adolescents, parental aggression and the reluctance of children and parents to accept help. There are various obstacles in implementing the assistance plan for professionals (unopened investigation, lack of services and availability of services) and therefore it is necessary to find ways to overcome these obstacles.

The Impact of the COVID-19 Pandemic on Perinatal Loss Experienced by the Parental Couple: Protocol for a Mixed Methods Study.

BackgroundAt the beginning of 2020, mothers and fathers who experienced perinatal events (from conception to pregnancy and postpartum period) found themselves facing problems related to the emergency caused by the COVID-19 pandemic and the associated difficulties for health care centers in providing care. In the unexpected and negative event of perinatal loss (ie, miscarriage, stillbirth, and neonatal death) more complications occurred. Perinatal loss is a painful and traumatic life experience that causes grief and can cause affective disorders in the parental couple—the baby dies and the couple’s plans for a family are abruptly interrupted. During the COVID-19 pandemic, limited access to perinatal bereavement care, due to the lockdown measures imposed on medical health care centers and the social distancing rules to prevent contagion, was an additional risk factor for parental mental health, such as facing a prolonged and complicated grief.ObjectiveThe main aims of this study are as follows: to investigate the impact of COVID-19 on mothers and fathers who experienced perinatal loss during the pandemic, comparing their perceptions; to evaluate their change over time between the first survey administration after bereavement and the second survey after 6 months; to examine the correlations between bereavement and anxiety, depression, couple satisfaction, spirituality, and sociodemographic variables; to investigate which psychosocial factors may negatively affect the mourning process; and to identify the potential predictors of the development of complicated grief.MethodsThis longitudinal observational multicenter study is structured according to a mixed methods design, with a quantitative and qualitative section. It will include a sample of parents (mothers and fathers) who experienced perinatal loss during the COVID-19 pandemic from March 2020. There are two phases—a baseline and a follow-up after 6 months.ResultsThis protocol was approved by the Ethics Committee of Psychological Research, University of Padova, and by the Institutional Ethics Board of the Spedali Civili of Brescia, Italy. We expect to collect data from 34 or more couples, as determined by our sample size calculation.ConclusionsThis study will contribute to the understanding of the psychological processes related to perinatal loss and bereavement care during the COVID-19 pandemic. It will provide information useful to prevent the risk of complicated grief and psychopathologies among bereaved parents and to promote perinatal mental health.International Registered Report Identifier (IRRID)DERR1-10.2196/38866