Community-based Facilities Research Articles

The Effects of a Movement-to-Music (M2M) Intervention on Physical and Psychosocial Outcomes in People Poststroke: A Randomized Controlled Trial

ObjectiveTo investigate the effects of a 12-week movement-to-music (M2M) intervention on physical and psychosocial outcomes in people poststroke. DesignTwo-arm randomized controlled trial. SettingA community-based fitness facility. ParticipantsParticipants (N=47) with stroke between 18 and 65 years old were randomized to M2M (n=23) or waitlist control (n=24). InterventionsParticipants in M2M completed 3 60-minute exercise sessions per week for 12 weeks. Controls received biweekly educational newsletters via mail. Main Outcome MeasuresPrimary outcomes included Six-Minute Walk Test (6MWT, in meters), Five Times Sit-to-Stand Test (FTSST, in seconds) and Timed Up and Go (TUG, in seconds). Secondary outcomes were self-reported measures using Patient-Reported Outcomes Measurement Information System Fatigue and Pain Interference Short Form 8a. Outcomes were collected at baseline and postintervention. Analyses involved descriptive statistics and adjusted linear mixed models. ResultsMixed models adjusted for the respective baseline values and demographic variables showed that M2M participants had longer 6MWT distance (least square mean difference [LSM], 14.5; 95% confidence interval [CI], −12.9 to 42.0), more FTSST time (LSM, 2.0; 95% CI, −4.5 to 8.5), and less fatigue (LSM, −3.0; 95% CI, −7.2 to 1.2) compared with controls postintervention. When controlling for baseline TUG and demographic variables, there was a larger increase in 6MWT distance (LSM, 37.9; 95% CI, −22.7 to 98.6), lower FTSST time (LSM, −6.1; 95% CI, −18.5 to 6.2), and decrease in fatigue (LSM, −6.5; 95% CI, −13.1 to 0.2) in the M2M group compared with controls. Moderate effect sizes were observed for improving 6MWT (d=0.6), FTSST (d=−0.6), and fatigue (d=−0.6). There was no group difference in change in TUG time and pain interference, with trivial effect sizes (d=−0.1). ConclusionM2M may be a valuable exercise form for adults with stroke. Future studies are needed to determine optimal exercise doses for improving health and function in this population.

Characterization of Nonphysician Health Care Workers’ Burnout and Subsequent Changes in Work Effort

Burnout is a pervasive, unrelenting problem among health care workers (HCWs), with detrimental impact to patients. Data on the impact of burnout on workforce staffing are limited and could help build a financial case for action to address system-level contributors to burnout. To explore the association of burnout and professional satisfaction with changes in work effort over 24 months in a large cohort of nonphysician HCWs. This longitudinal cohort study was conducted in Rochester, Minnesota; Scottsdale and Phoenix, Arizona; Jacksonville, Florida; and community-based hospitals and health care facilities in the Midwest among nonphysician HCWs who responded to 2 surveys from 2015 to 2017. Analysis was completed November 25, 2020. Burnout, as measured by 2 items from the Maslach Burnout Inventory, and professional satisfaction. The main outcome was work effort, as measured in full-time equivalent (FTE) units, recorded in payroll records. Data from 26 280 responders (7293 individuals aged 45-54 years [27.8%]; 20 263 [77.1%] women) were analyzed. A total of 8115 individuals (30.9%) had worked for the organization more than 15 years, and 6595 individuals (25.1%) were nurses. After controlling for sex, age, duration of employment, job category, baseline FTE, and baseline burnout, overall burnout (odds ratio [OR], 1.53; 95% CI, 1.38-1.70; P < .001), high emotional exhaustion at baseline (OR, 1.54; 95% CI, 1.39-1.71; P < .001), and high depersonalization at baseline (OR, 1.40; 95% CI, 1.21-1.62; P < .001) were associated with an HCW reducing their FTE over the following 24 months. Conversely, satisfaction with the organization at baseline was associated with lower likelihood of reduced FTE (OR, 0.73; 95% CI, 0.65-0.83; P < .001). Findings were similar when emotional exhaustion (OR per 1-point increase, 1.12; 95% CI, 1.10-1.16; P < .001), depersonalization (OR per 1-point increase, 1.10; 95% CI, 1.06-1.14; P < .001) and satisfaction with the organization (OR per 1-point increase, 0.83; 95% CI, 0.79-0.88; P < .001) were modeled as continuous measures. Nurses represented the largest group (1026 of 1997 nurses [51.4%]) reducing their FTE over the 24 months. This cohort study found that burnout and professional satisfaction of HCWs were associated with subsequent changes in work effort over the following 24 months. These findings highlight the importance of addressing factors contributing to high stress among all HCWs as a workforce retention and cost reduction strategy.

Socioecological Factors Associated with an Urban Exercise Prescription Program for Under-Resourced Women: A Mixed Methods Community-Engaged Research Project.

One strategy to promote physical activity (PA) is for health care providers to give exercise prescriptions (ExRx) that refer to community-based facilities. However, facilitators and barriers specific to urban programs in the US for under-resourced women are unknown. Thus the purpose of this formative research was to explore ExRx barriers and facilitators specific to US under-resourced women to inform future intervention targets and strategies. This mixed-methods community-engaged research was conducted in partnership with an urban women’s only wellness center that exchanged ExRx for free access (1–3 months). Qualitative semi-structured interviews and validated quantitative questionnaires (SF-12, International Physical Activity Questionnaire, Physical Activity Self-Efficacy, Physical Activity Stage of Change, and Barriers to Physical Activity, Social Support for Exercise, and Confusion, Hubbub, and Order Scale) were administered by phone and guided by the socio-ecological model. ExRx utilization was defined as number visits/week divided by membership duration. Means and percentages were compared between ≥1 visit/week vs. <1 visit/week with t-tests and chi-square, respectively. Women (n = 30) were 74% Black, 21–78 years of age, 50% had ≤ high school diploma, and 69% had household incomes ≤45,000/year. Women with ≥1 visit/week (n = 10; 33%) reported more education and higher daily activity, motivation, number of family CVD risk factors and family history of dyslipidemia compared with <1 visit/week. Facilitators among women with ≥1 visit/week were “readiness” and “right timing” for ExRx utilization. Barriers among women with <1 visit/week (n = 20; 67%) were “mismatched expectations” and “competing priorities”. Common themes among all women were “sense of community” and “ease of location”. ExRx utilization at an US urban wellness center may be dependent on a combination of multi-level factors including motivation, confidence, peer support, location and ease of access in under-sourced women. Additional resources may be needed to address mental and/or physical health status in additional to physical activity specific programming.

Feasibility of Rapid Case Ascertainment for Cancer in East Africa: An Investigation of Community-Representative Kaposi Sarcoma in the Era of Antiretroviral Therapy

BackgroundRapid case ascertainment (RCA) refers to the expeditious and detailed examination of patients with a potentially rapidly fatal disease shortly after diagnosis. RCA is frequently performed in resource-rich settings to facilitate cancer research. Despite its utility, RCA is rarely implemented in resource-limited settings and has not been performed for malignancies. One cancer and context that would benefit from RCA in a resource-limited setting is HIV-related Kaposi sarcoma (KS) in sub-Saharan Africa. MethodsTo determine the feasibility of RCA for KS, we searched for all potential newly diagnosed KS among HIV-infected adults attending three community-based facilities in Uganda and Kenya. Searching involved querying of electronic medical records, pathology record review, and notification by clinicians. Upon identification, a team verified eligibility and attempted to locate patients to perform RCA, which included epidemiologic, clinical and laboratory measurements. ResultsWe identified 593 patients with suspected new KS. Of the 593, 171 were ineligible, mainly because biopsy failed to confirm KS (65%) or KS was not new (30%). Among the 422 remaining, RCA was performed within 1 month for 56% of patients and within 3 months for 65% (95% confidence interval: 59 to 70%). Reasons for not performing RCA included intervening death (47%), inability to contact (44%), refusal/unsuitable to consent (8.3%), and patient re-location (0.7%). ConclusionsWe found that RCA ― an important tool for cancer research in resource-rich settings ― is feasible for the investigation of community-representative KS in East Africa. Feasibility of RCA for KS suggests feasibility for other cancers in Africa.

Stakeholders\u2019 perspectives on training over the counter medicine sellers and Community-based Health Planning and Services facilities to dispense antibiotics in Ghana

BackgroundDispensing of antibiotics by over the counter medicine sellers (OTCMS) is a major driver of inappropriate use and resistance in low and middle income countries. Recent studies in Ghana revealed the need to consider training OTCMS and Community-based Health Planning and Services (CHPS)/health posts to dispense some antibiotics. Feasibility of training OTCMS and CHPS to dispense some antibiotics was explored in this study.MethodsThis was an explorative study involving 10 in-depth interviews (IDIs) among staff of Ghana health services (GHS), pharmacy council and the association of OTCMS at the district and regional levels. Next, findings were presented to the Ghana Antimicrobial Resistance (AMR) platform for further discussions at the national level. Five IDIs were also performed among selected members of the AMR platform as a follow-up on emerging issues. Data were thematically analysed and presented as narratives with quotes to support the findings.ResultsTwo opposing views were found in our study. Leadership of OTCMS and GHS staff at the district health directorate supported the suggestion that OTCMS and CHPS should be trained to dispense specific antibiotics because they are already dispensing them. The leadership of OTCMS explained that some of their members are experienced and could be trained to improve their practices. In contrast, participants from pharmacy council, GHS in the region and national AMR platform generally alluded that OTCMS and CHPS should not be trained to dispense antibiotics because their level of education is inadequate. GHS personnel from the region further explained that training OTCMS could further compromise inappropriate antibiotic use in the context of already weak regulation enforcement. GHS and pharmacy council in the region rather suggested that OTCMS and CHPS should focus on public health education on disease prevention and appropriate antibiotic use.ConclusionsThere is general lack of consensus among stakeholders on whether OTCMS and CHPS should be trained to dispense specific antibiotics. Further stakeholder engagement is required to carefully consider this suggestion as views on feasibility differ. Ministries of health and healthcare agencies in Ghana and LMIC should improve access to approved health services to improve antibiotic use in rural settings.

Research on functional space of community-based medical-nursing combined facilities for the aged in small cities

ABSTRACT The aging of the population is accelerating. In China, the relationship between the differences in aged care and medical resources is being explored, but there is a lack of research on the aged care and medical needs of older people in the community and the functional space of aged care institutions. In this paper, questionnaires, interviews and observations were conducted with older adults over 60 years of age in a small urban community. Statistical methods were used to analyze their real needs in terms of living and health requirements. The results showed that 1) The number of members in the whole family was significantly associated with the choice of home care model. 2) There was a high demand for day care, emergency stations and home services among the seniors in the community. 3) Watching television, drinking tea, and growing vegetables and flowers were the most popular activities among the seniors. 4) There was a high demand for nursing services, medical services and medical equipment among the seniors in the community. Conclusion. Family service station, ornamental room, tea room, vegetable garden and healthy green environment should be the most basic functional spaces. Professional medical places for the seniors should be provided in the community.

The Connection between Motivation and Job Significance among Academically Trained Employees: A Case Study of Workers in Out-of-Home Settings

Side by side with awareness of the rights of people with disabilities, attention is now focusing on the caregivers of people with intellectual and developmental disabilities (IDD) and on how they enhance the quality of life of this population group. In community-based residential facilities, these care workers provide people with IDD with training and support in activities of daily living, educational and social activities, and a wide range of medical and psychological treatments. Despite the challenges and significance of this work, there is a shortage of high-quality personnel. The current study examined the association between motivation and perceived meaning in one’s job and satisfaction and intention to leave among care workers in out-of-home facilities for people with IDD. The sample included 79 care workers with post-secondary education employed at out-of-home facilities of the Welfare Ministry, in non-managerial roles as direct caregivers, counselors, and coordinators, in Northern Israel. The main finding of the study is low motivation and satisfaction. In addition, a positive association was found between work motivation and satisfaction with the workplace, and a negative association between satisfaction with the work itself, and intention to leave the workplace. No significant association was found between finding meaning in one’s job and satisfaction with the work. The study sheds light on this important yet understudied area. Although it is very important to place skilled educated personnel in caregiving roles among the disabled in general and those with IDD living in out-of-home facilities in particular, it is also necessary to strengthen the ties between academic education and actual reality of working in the field with people with disabilities.

Activity-based therapy in the community for individuals living with spinal cord injury or disease: qualitative interviews with clinicians

Purpose Activity-based therapy (ABT) is a restorative approach that promotes neurological recovery below the level of injury in individuals with spinal cord injury or disease (SCI/D). This study sought to understand how ABT and its associated technologies were being used in community-based facilities across Canada. Methods One to two participants from ten community-based ABT facilities completed a semi-structured interview that queried types of technologies or techniques used in ABT, and barriers and facilitators to providing ABT for individuals with SCI/D. Interviews were audio-recorded and transcribed verbatim, and analyzed using an interpretive description approach to identify themes and categories. Results The overarching theme that emerged was that ABT in the community is a client-centered approach characterized by variety in techniques, clinicians, and clientele. The researchers identified three categories within this theme: characteristics of ABT in the community, perceived challenges, and a need for advocacy. Participants advocated for earlier implementation, increased education, and reduced costs of ABT to address the challenges with implementation and accessibility. Conclusions The use of ABT and its associated technologies varied across participating community-based facilities in Canada, despite a consistent focus on client goals and well-being. Addressing system-level limitations of ABT may improve implementation and accessibility in Canada. Implications for rehabilitation Activity-based therapy (ABT) is a group of interventions targeting recovery of sensory and motor function below the level of injury in individuals with spinal cord injury or disease (SCI/D). ABT in the community emphasizes a client-centered approach and is characterized by variety in techniques, clinicians, and clientele. Participants advocated that earlier implementation, reduced costs, and increased education will help overcome barriers to providing ABT, ultimately assisting to facilitate neurorecovery in individuals with SCI/D. Challenges in implementation, accessibility, and knowledge of ABT exist, highlighting a need to explore and address system-level limitations in Canada.

Locating Community-Based Comprehensive Service Facilities for Older Adults Using the GIS-NEMA Method in Harbin, China

Abstract Local governments and scholars in China have recently proposed and developed community-based comprehensive service facilities for older adults in response to population aging and greater s...

Cost-effectiveness implications of increasing the efficiency of the extended-release naltrexone induction process for the treatment of opioid use disorder: a secondary analysis.

In a US randomized-effectiveness trial comparing extended-release naltrexone (XR-NTX) with buprenorphine-naloxone (BUP-NX) for the prevention of opioid relapse among participants recruited during inpatient detoxification (CTN-0051), the requirement to complete opioid detoxification prior to initiating XR-NTX resulted in lower rates of initiation of XR-NTX (72% XR-NTX versus 94% BUP-NX). This was a retrospective secondary analysis of CTN-0051 trial data, including follow-up data over 24-36weeks. Eight community-based, inpatient-detoxification and follow-up outpatient treatment facilities in the United States. A total of 283 participants randomized to receive XR-NTX. Efficiency was estimated using a multivariable generalized structural equation model to explore simultaneous determinants of XR-NTX induction and induction duration (detoxification+residential days). Cost-effectiveness was estimated from the health-care sector perspective and included expected costs and quality-adjusted life-years (QALYs). Treatment site was the only modifiable factor that simultaneously increased the likelihood of XR-NTX induction and decreased induction duration. Incorporating the higher predicted probability of XR-NTX induction, and fewer predicted days of detoxification and subsequent residential treatment into the cost-effectiveness framework, reduced the incremental average 24-week total cost of XR-NTX treatment from $5317 more than that of BUP-NX (P=0.01) to a non-statistically-significant difference of $1016 (P=0.63). QALYs gained remained similar across arms. Adopting an efficient model of extended-release naltrexone initiation could result in extended-release naltrexone and buprenorphine-naloxone being of comparable economic value from the health-care sector perspective over 24-36weeks for patients seeking treatment for opioid use disorder at an inpatient detoxification facility.

Rapid testing requires clinical evaluation for accurate diagnosis of dengue disease: A passive surveillance study in Southern Malaysia.

BackgroundDengue fever is the most common mosquito-borne infection worldwide where an expanding surveillance and characterization of this infection are needed to better inform the healthcare system. In this surveillance-based study, we explored the prevalence and distinguishing features of dengue fever amongst febrile patients in a large community-based health facility in southern peninsular Malaysia.MethodsOver six months in 2018, we recruited 368 adults who met the WHO 2009 criteria for probable dengue infection. They underwent the following blood tests: full blood count, dengue virus (DENV) rapid diagnostic test (RDT), ELISA (dengue IgM and IgG), nested RT-PCR for dengue, multiplex qRT-PCR for Zika, Chikungunya and dengue as well as PCR tests for Leptopspira spp., Japanese encephalitis and West Nile virus.ResultsLaboratory-confirmed dengue infections (defined by positive tests in NS1, IgM, high-titre IgG or nested RT-PCR) were found in 167 (45.4%) patients. Of these 167 dengue patients, only 104 (62.3%) were positive on rapid diagnostic testing. Dengue infection was significantly associated with the following features: family or neighbours with dengue in the past week (AOR: 3.59, 95% CI:2.14–6.00, p<0.001), cutaneous rash (AOR: 3.58, 95% CI:1.77–7.23, p<0.001), increased temperature (AOR: 1.33, 95% CI:1.04–1.70, p = 0.021), leucopenia (white cell count < 4,000/μL) (AOR: 3.44, 95% CI:1.72–6.89, p<0.001) and thrombocytopenia (platelet count <150,000/μL)(AOR: 4.63, 95% CI:2.33–9.21, p<0.001). Dengue infection was negatively associated with runny nose (AOR: 0.47, 95% CI:0.29–0.78, p = 0.003) and arthralgia (AOR: 0.42, 95% CI:0.24–0.75, p = 0.004). Serotyping by nested RT-PCR revealed mostly mono-infections with DENV-2 (n = 64), DENV-1 (n = 32) and DENV-3 (n = 17); 14 co-infections occurred with DENV-1/DENV-2 (n = 13) and DENV-1/DENV-4 (n = 1). Besides dengue, none of the pathogens above were found in patients’ serum.ConclusionsAcute undifferentiated febrile infections are a diagnostic challenge for community-based clinicians. Rapid diagnostic tests are increasingly used to diagnose dengue infection but negative tests should be interpreted with caution as they fail to detect a considerable proportion of dengue infection. Certain clinical features and haematological parameters are important in the clinical diagnosis of dengue infection.

Identification and treatment of viral hepatitis C in persons who use drugs: a prospective, multicenter outreach study in Flanders, Belgium

BackgroundTargeted screening for hepatitis C viral (HCV) infection is not yet widely executed in Belgium. When performed in people who use drugs (PWUD), it is mainly focused on those receiving opiate agonist therapy (OAT). We wanted to reach out to a population of difficult to reach PWUD not on centralized OAT, using non-invasive screening as a bridge to re-integration in medical care supported by facilitated referral to a specialist.MethodsThis was a prospective, multicenter cohort study in PWUD not enrolled in a centralized OAT program in a community-based facility in Limburg or OAT program in a community-based facility in Antwerp, Belgium, from October 2018 until October 2019. Two study teams recruited participants using an outreach method at 18 different locations. Participants were tested for HCV antibodies (Ab) by finger prick, and risk factors were assessed through a face-to-face questionnaire. Univariate analyses were used to assess the association between HCV Ab and each risk factor separately. A generalized linear mixed model was used to investigate the association between the different risk factors and HCV.ResultsIn total, 425 PWUD were reached with a mean age of 41.6 ± 10.8, and 78.8% (335/425) were men. HCV Ab prevalence was 14.8% (63/425). Fifty-six (88.9%) PWUD were referred, of whom 37 (66.1%) were linked to care and tested for HCV RNA. Twenty-nine (78.4%) had a chronic HCV infection. Treatment was initiated in 17 (58.6%) patients. The adjusted odds for HCV Ab were highest in those with unstable housing 6 months before inclusion (p < .001, AOR 8.2 CI 95% 3.2–23.3) and in those who had ever shared paraphernalia for intravenous drug use (p < .001, AOR 6.2 CI 95% 2.5–16.0).ConclusionsAn important part tested positive for HCV. Treatment could be started in more than half of the chronically infected referred and tested positive for HCV-RNA. Micro-elimination is necessary to achieve the World Health Organization goals by 2030. However, it remains crucial to screen and link a broader group of PWUD to care than to focus solely on those who inject drugs.Trial registration: clinicaltrials.gov NCT04363411, Registered 27 April 2020—Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04363411?term=NCT04363411&draw=2&rank=1

Trends in the Use of Residential Settings Among Older Adults.

As the U.S. population ages, the prevalence of disability and functional limitations, and demand for long-term services and supports (LTSS), will increase. This study identified the distribution of older adults across different residential settings, and how their health characteristics have changed over time. A cross-sectional analysis of older adults residing in traditional housing, community-based residential facilities (CBRFs), and nursing facilities using 3 data sources: the Medicare Current Beneficiary Survey (MCBS), 2008 and 2013; the Health and Retirement Study (HRS), 2008 and 2014; and the National Health and Aging Trends Study, 2011 and 2015. We calculated the age-standardized prevalence of older adults by setting, functional limitations, and comorbidities and tested for health characteristics changes relative to the baseline year (2002). The proportion of older adults in traditional housing increased over time, relative to baseline (p < .05), while the proportion of older adults in CBRFs was unchanged. The proportion of nursing facility residents declined from 2002 to 2013 in the MCBS (p < .05). The prevalence of dementia and functional limitations among traditional housing residents increased, relative to the baseline year in the HRS and MCBS (p < .05). The proportion of older adults residing in traditional housing is increasing, while the nursing facility population is decreasing. This change may not be due to better health; rather, older adults may be relying on noninstitutional LTSS.

Balancing HIV testing efficiency with HIV case-identification among children and adolescents (2-19 years) using an HIV risk screening approach in Tanzania.

To optimize HIV testing resources, programs are moving away from universal testing strategies toward a risk-based screening approach to testing children/adolescents, but there is little consensus around what defines an optimal risk screening tool. This study aimed to validate a 12-item risk screening tool among children and adolescents and provide suggested fewer-item tool options for screening both facility out-patient and community populations by age strata (<10 and ≥10 years). Children/adolescents (2–19 years) with unknown HIV status were recruited from a community-based vulnerable children program and health facilities in 5 regions of Tanzania in 2019. Lay workers administered the screening questions to caregivers/adolescents; nurses enrolled those eligible for the study and tested all participants for HIV. For each screening item, we estimated sensitivity, specificity, positive predictive value and negative predictive value and associated 95% confidence intervals (CI). We generated a score based on the count of items with a positive risk response and fit a receiver operating characteristic curve to determine a cut-off score. Sensitivity, specificity, positive predictive value (PPV; yield) and number needed to test to detect an HIV-positive child (NNT) were estimated for various tool options by age group. We enrolled 21,008 children and adolescents. The proportion of undiagnosed HIV-positive children was low (n = 76; 0.36%; CI:0.29,0.45%). A screening algorithm based on reporting at least one or more items on the 10 to 12-item tool had sensitivity 89.2% (CI:79.1,95.6), specificity 37.5% (CI:36.8,38.2), positive predictive value 0.5% (CI:0.4,0.6) and NNT = 211. An algorithm based on at least two or more items resulted in lower sensitivity (64.6%), improved specificity (69.1%), PPV (0.7%) and NNT = 145. A shorter tool derived from the 10 to 12-item screening tool with a score of “1” or more on the following items: relative died, ever hospitalized, cough, family member with HIV, and sexually active if 10–19 years performed optimally with 85.3% (CI:74.6,92.7) sensitivity, 44.2% (CI:43.5,44.9) specificity, 0.5% (CI:0.4,0.7) PPV and NNT = 193. We propose that different short-tool options (3–5 items) can achieve an optimal balance between reduced HIV testing costs (lower NNT) with acceptable sensitivity. In low prevalence settings, changes in yield may be negligible and NNT may remain high even for an effective tool.

Fitness to drive practices among non-driver trained occupational therapists in an Australian community-based rehabilitation setting.

Driving is a valued occupation given the independence and freedom it provides. Safe driving performance can be impacted by medical conditions, change in functional status and ageing processes. Occupational therapy driver assessors (OTDAs) provide invaluable driving recommendations; however, this requires specialist training for the therapist and is costly for clients. The number of OTDAs is not expected to meet the growing demand for expert services in this area, and little is known about the practices that non- OTDAs use to assist clients with returning to driving. The aims of this study were to investigate the practices of non-OTDAs in a community-based rehabilitation setting in Australia with respect to knowledge, confidence and skills in assessments, recommendations and outcomes for clients as part of the return to driving process. A descriptive study including medical record audits between April and September 2019 and staff surveys were completed at a large metropolitan community-based rehabilitation facility. Descriptive statistics and thematic analysis were used to summarise data. A total of 102 client medical records were audited, and 13 clinician surveys were completed. Medical record audits identified that return to driving was not consistently addressed by occupational therapists. Clinician surveys outlined a lack of knowledge and confidence of return to driving processes and available assessment tools to guide this process. All occupational therapists have an ethical obligation to address driving as an activity of daily living; however, non-OTDAs report that they are not equipped for this role. This may negatively impact on driver safety, independence and overall health and well-being of clients in community-based rehabilitation. Further research is indicated to develop evidence-based driving resources to support best practice of non-OTDAs.

Do ecotourism sites enhance rural development in Ghana? Evidence from the Wechiau Community Hippo Sanctuary Project in the Upper West Region, Wa, Ghana

ABSTRACT Globally, ecotourism has become an important component of the tourism sector, partly because it serves as an essential source of livelihood for local communities. The Wechaiu Community Hippo Sanctuary Project (WCHSP) is one of the community-based ecotourism facilities in Ghana with the potential to accelerate development of the area. Studies have investigated the sustainability of the project and the levels of participation in the management of the project. However, these studies have seldom investigated the benefits and costs of the WCHSP to the surrounding communities. Using a concurrent mixed-method involving 206 survey respondents and 13 in-depth interviews, the study found that the development of the resource has led to improved social, economic, health and infrastructural needs of the people but also noted that the resource has indirectly introduced some levels of hardships to the communities due to loss of livelihoods. The policy and practical implication of the study are discussed.

359 Tailoring of Cognitive Behavior Therapy for Insomnia for Patients with Kidney Failure Undergoing Hemodialysis: The SLEEP-HD Study

Abstract Introduction Patients with kidney failure treated with hemodialysis (HD) frequently report insomnia symptoms. Cognitive-behavior therapy for insomnia (CBT-I) is a first line treatment for insomnia but there are unique issues surrounding kidney failure and HD that impact patients’ ability to access CBT-I and follow standard treatment recommendations. This presentation describes CBT-I protocol modifications made to address these issues as part of an ongoing multi-center clinical trial testing the efficacy of telehealth CBT-I compared to trazodone or medication placebo control. Methods CBT-I protocol modifications were made prior to starting the SLEEP-HD randomized trial based upon unique clinical considerations for HD patients, e.g., irregular sleep-wake scheduling that HD treatment demands, and napping during HD sessions or afterwards due to post-HD treatment fatigue. Participants in the SLEEP-HD study are undergoing thrice-weekly maintenance hemodialysis for &amp;gt;3 months and have baseline Insomnia Severity Index scores &amp;gt;10 with sleep disturbances &amp;gt;3 nights/week for &amp;gt;3 months. Participants randomized into the modified CBT-I protocol receive six weekly sessions, delivered by trained CBT-I therapists (1 MSW, 1 PhD) face-to-face via a HIPPA-compliant video telehealth platform. Participants keep a daily sleep diary throughout the CBT-I treatment period. Results To date, 91 patients (mean age=56.5 years [SD=14.7], 48.4% female) recruited from community-based dialysis facilities in Seattle and Albuquerque have been randomized into the SLEEP-HD study (n=31 CBT-I). Forty-eight percent of CBT-I clients have chosen to conduct their telehealth sessions during dialysis with the remainder choosing a different location. CBT-I adaptations include therapists developing weekly bed restriction recommendations based on non-dialysis treatment days; allowing shifts in dialysis day “bed window” scheduling for patients with very early or very late dialysis schedules so long as a consistent total time in bed in maintained; and including napping during early/late dialysis sessions as part of the allowable bed window duration. Treatment modifications were also designed to accommodate the diverse socioeconomic circumstances of dialysis patients, including housing instability, which can impact adherence to some standard stimulus control and bed restriction CBT-I recommendations. Conclusion It is feasible to deliver CBT-I via telehealth to HD patients but modifications to standard protocols are required. Support (if any) This work was supported by PHS grant 5R01AG053221.

Health Literacy, Health Confidence, and Simulation: A Novel Approach to Patient Education to Reduce Readmissions.

Purpose/Objectives: The vision for this project was to create an inpatient education intervention to better prepare patients with chronic medical conditions for more effective self-management after discharge using a Skills Simulation Experience and focused one-on-one structured education format in a circuit-based intervention. As an interdisciplinary intervention, the health care team presents standardized education in a circuit training presentation to allow for one-on-one interaction with health care professionals, using multiple teaching/learning strategies, to assist the participant in acquiring or reinforcing skills needed to successfully self-manage his or her conditions postdischarge. Primary Practice Setting(s): West Suburban Medical Center (WSMC) is owned by Pipeline Health and is located on the west side of Chicago, IL. WSMC is a 118-year-old community-based teaching facility that has collaboration with a local Federally Qualified Health Center, providing clinic space on-site as well as clinical rotations for OB/GYN. WSMC serves 2 very diverse neighborhoods, Oak Park, IL, home of Frank Lloyd Wright and Ernest Hemingway, and the Austin neighborhood of Chicago, which ranks 11th out of the 77 Chicago communities in violent crime. Findings/Conclusions: Data collected included the following: Implications for Case Management Practice:

Community-based exercise programs and cancer-related fatigue: a systematic review and meta-analysis.

To explore the prevalence of cancer-related fatigue (CRF) within community-based exercise programs and to determine the overall impact that participation in community-based exercise programs have on CRF. Literature searches were performed in March and updated in April of 2020. Studies that were community-based in adult cancer populations and reported CRF outcomes were included. Mean and standard deviations for CRF from 12 studies were extracted in order to compute a pooled effect size via a random effects model. An overall percentage was computed to discern how many community-based exercise programs reported CRF. Sample sizes varied among studies with most patients being middle-aged with breast cancer in the post-treatment setting. Most programs implemented aerobic + resistance exercise training interventions (~77%). Only ~42% of programs identified in the review reported CRF outcomes. The random effects model produced a pooled effect size of 0.30 (p < 0.001). Fewer than half of the identified community-based exercise programs reported CRF outcomes (~42%). Of those that did, the random effects model revealed a small yet significant impact on improving CRF after exercise participation, though more research is certainly needed in this area. This review produced promising preliminary evidence for the impact of community-based exercise programs on CRF. As exercise interventions transition to community-based facilities, patients should feel confident that these programs will continue to assist in managing CRF that is commonly experienced across the cancer continuum.

Development of Stunting Early Detection Kit for Children under Two Years: Validity and Reliability

This study aimed to determine validity and reliability of the new developed Stunting Early Detection Kit (SEDEK). This study was a cross-sectional study. A total sample of 30 children under two years from a Posyandu in Seyegan, Yogyakarta, was involved in the study. Every child was measured using SEDEK and infantometer-WHO Length for Age Growth Chart as the gold standard to find out its validity. Validity was determined by sensitivity, specificity, and predictive value. Reliability in this study was measured by intra-rater reliability, by comparing the first measurement and the second measurement from a rater using SEDEK. The intra-rater reliability determined using the Intraclass Correlation Coefficient (ICC). The results showed no significant difference between length measurements using SEDEK and the gold standards (p>0.05). The SEDEK sensitivity was 80%, specificity 85%, positive predictive value 72.7%, negative predictive value 89.5%. SEDEK reliability is demonstrated by ICC of 0.781. However, this study suggest that the current SEDEK version has not met the required sensitivity and positive predictivevalue of more than 80% so that it can be used as a detection tool. Further research is needed to improve the quality of SEDEK so that the SEDEK improved version can be used at the community-based health facilities level.