Community Care System Research Articles

Newborn hearing screening programme based on an integrated hospital and community care system. Results of the first 4 years of activity

Since January 2012, babies born in the province of Modena, Italy, have routinely undergone hearing testing as part of a two-stage screening programme. Newborn hearing screening (NHS) has been based on an integrated hospital and community care system and this study aims to assess screening coverage, referral rates, the prevalence, type and extent of hearing loss several years into the programme. Data were collected from January 1, 2012 to December 31, 2015. Coverage was over 99% in all five facilities of the province. The ratio of “fails of the screening” to the total number of infants tested varied over the period from 1.2% to 0.9% in the third level facility, and from 0.8% to 0.4% in the other four. Although hearing loss was mainly associated with dysmorphic\\syndromic diseases or a family history of hearing loss, some 23% of cases were identified with no known risk factors.We highlight the importance of the NHSP and the need for strong support from healthcare administrators to ensure high coverage. This is especially true since although the prevalence of hearing loss was higher among infants with audiological risk factors, several cases of hearing loss were found in newborns with no known risk factors.

Natural Product Emerging as Potential SARS Spike Glycoproteins-ACE2 Inhibitors to Combat COVID-19 Attributed by In-Silico Investigations

COVID-19 is a pandemic infectious disorder that emerged as a major outbreak for the community and health care system across the globe. Since the currently available drug therapeutics available for COVID-19 are prone to provide symptomatic and supportive relief, which has invited the entire scientist of all over the nations to investigate therapeutic drug candidates accompanied by anti-COVID-19 activity. The recognition of ACE2 mediated entry of SARS-CoV-2 encouraged us to investigate natural products as a potential inhibitor of the SARS spike glycoprotein-Human ACE2 complex. Using the strategy of molecular docking, we have assessed berberine, indigo blue, β-sitosterol, glycyrrhizin, indirubin, hesperetin, bicylogermacrene, β-caryophyllene, chrysophanic acid, rhein, curcumin, and eugenol for their inhibitory activity towards SARS spike glycoprotein-Human ACE2 complex. We have investigated including indigo blue, glycyrrhizin, β-sitosterol, indirubin, bicylogermacrene, curcumin, hesperetin, rhein, berberine with an affinity of -11.2, -10.9. -10.1, -9.8, -9.5, -9.3, -9.2, -9.1 and -9.0 kcal/mol respectively as in silico inhibitors of SARS spike glycoprotein-Human ACE2 complex which can vitalize the researchers for in-vivo assessment of these natural products.

A decade of public long-term care insurance in South Korea: Policy lessons for aging countries

South Korea proactively introduced public long-term care insurance (LTCI) in 2008 when older people were only about one-tenth of the total population. At that time, Korea switched from a tax-based, local-government-operated LTC program targeting low-income older people to the current universal public LTCI run by the National Health Insurance Service, the single public insurer. The LTCI program provides a comprehensive package of home- and institution-based care mainly targeting older people who need assistance in daily living. Over the past decade, the program has continued to expand its population and service coverage: older people in high need have been covered, and an infrastructure for service provision has been established. Future agendas include financial sustainability, care coordination, and the role of local governments. Korea’s experiences suggest having an LTCI separate from the NHI has the benefit of potential de-medicalization of LTC, which, in turn, creates challenges for the coordination of health care and LTC. A centralized LTCI system with a single payer has the benefit of bigger risk-pooling, but this may become a barrier to designing integrated community care systems at the local level. There is a tradeoff between population coverage, benefits/cost coverage, and fiscal sustainability.

A systematic review of crime/violence and substance use prevention programs

Crime/violence is a ubiquitous problem in the United States, resulting in a number of negative outcomes. Given the negative impacts of crime on communities, Thrive in the 05 is a crime/violence prevention initiative striving to decrease crime/violence through a targeted place-based approach. There is a strong connection between crime/violence and substance use and Thrive in the 05 community members elected to implement a crime/violence prevention program that also targeted substance use. The purpose of the current systematic review was to review evaluations and descriptions of crime/violence interventions that also address substance use in order to inform the intervention selected by Thrive in the 05 . Following AMSTAR guidelines, the authors systematically searched 12 databases and found 73 articles that fit the inclusion criteria. Forty articles evaluated crime/violence and substance use prevention programs implemented in the community, schools, justice system, or health care system and 19 articles described programs implemented in these milieus. The majority of studies were implemented in schools, highlighting the need for additional programs targeting high risk adults. There is a need for researchers to collect multiple sources of data and engage in more randomized controlled trials. Finally, community-based prevention efforts should collect data from law enforcement personnel. • Most crime/violence and substance use interventions are implemented in schools. • Additional communitybased crime/violence and substance use interventions are needed. • More RCT's of crime/violence and substance use interventions are needed. • Multiple sources of data should be collected to assess crime/violence interventions.

The Impact of COVID-19 on Health Care, Education, and Persons With Disabilities in Kenya

The Impact of COVID-19 on Health Care, Education, and Persons With Disabilities in Kenya

Sociocultural Barriers to Early Diagnosis of Autism Spectrum Disorder


 
 
 Objective: To qualitatively explore community, family, and health care system barriers to early diagnosis of autism spectrum disorder (ASD) in children. Study Design: A phenomenological qualitative approach was used to explore mothers' experiences of receiving ASD diagnosis for their children. Place and Duration of Study: The study was conducted at Autism Resource Centre Islamabad, from March 2018 to August 2018. Materials and Methods: In-depth qualitative interviews of eight mothers of children diagnosed with ASD, who were above 36 months of age. Results: Using thematic analysis, three major themes were identified as barriers in reaching ASD diagnosis i.e. parent's lack of knowledge and misperceptions of ASD; health care system issues like undefined pathway to care, dissatisfaction with medical or associated professionals, delays due to structural and process barriers; and family factors such as stigma around mental health and disability, family denial and financial constraints. Conclusion: Additional educational outreach to families, de-stigmatization of ASD, streamlining the ASD diagnostic process, and providing additional support to parents of at-risk children may decrease delays in ASD diagnosis among children.
 
 

S0270 Repeat Endoscopies in Patients With Suboptimal Bowel Prep in a Safety Net Setting

INTRODUCTION: Colorectal cancer is the 3rd leading cause of death in the US. Colonoscopy is the most commonly used diagnostic tool in our arsenal and more than 15 million are performed annually in the US. In 2012, The US Multi-Society Task Force on Colorectal Cancer guidelines for the first time mentioned poor preparation and recommended repeat examination within 1 year in most cases of poor bowel preparation. METHODS: We performed a retrospective review of inpatient and outpatient electronic health records at Dell Seton Medical Center and CommUnityCare (CUC), a large safety net health care system in Austin, Texas to describe rates of inadequate bowel preparation. We identified 1709 eligible patients between ages 50 and 75 within the safety net system who had evidence of colonoscopy within the past 10 years. 204 of 1709 (12%) patients had suboptimal bowel prep, identified as fair or poor. Each chart was reviewed to determine what the recommended interval was for repeat testing was, whether it was performed, and whether any further intervention was necessary. RESULTS: Of the 204 patient who had suboptimal prep, 109 (53%) were deemed to be in need of a colonoscopy or fecal immunochemical test (FIT) as no follow-up was done.Those patients were classified into increased risk (personal or family history of CRC, adenomatous polyps or polyps with dysplasia or FIT positive) or average risk (no risk factors). Average risk patients were sent FIT test kits, while increased risk patients were contacted and scheduled for colonoscopies. Of the 109, 67 (61%) were deemed to need FIT testing, 24 (22%) were in need of colonoscopies now, 9 (8%) were in need of colonoscopies in the future, 6 (5%) patients were out of CUC system, and 3 (3%) were >75 years old and over age of recommended screening. Of the 41 patients overdue for colonoscopy that we were able to contact, 4 (0.1%) of those patients were found with cancer or high-grade dysplasia. CONCLUSION: Healthcare providers must be aware of patients with poor bowel prep, particularly in a safety net setting. Poorly prepared colons result in a longer cecal intubation time, a lower cecal intubation rate, higher adenoma miss rate (AMR), as well as increase in total costs to healthcare system. Therefore, gastroenterologists should develop a call back or a reminder system and should educate patients about need for repeat colonoscopies in those poor prep.Figure 1.: Schematic Representation of Follow-up for Patients with History of Poor Prep Colonoscopy.

An Investigation Study on the Role and Performance Ability of Physical Therapists in the Community Care System for Elderly

An Investigation Study on the Role and Performance Ability of Physical Therapists in the Community Care System for Elderly

Long-Term Care System in Korea

Korea is a country with unexpectedly fast ageing speed, which gives burden on caregivers of older adults. Thanks to long-term care insurance and national health insurance system, most people who need long-term care are currently staying in long-term care facilities like nursing homes and long-term care hospitals. However, new project of integrated community care system is under trial implementation. This review demonstrates perspectives on Korean long-term care system from the past to the future.

Cultural adaptation of self-management of type 2 diabetes in Saudi Arabia (qualitative study).

BackgroundSaudi Arabia is continuously working on developing its health care system, however with the high prevalence of type 2 diabetes and comorbidities, such as cardiovascular diseases, self-management education programmes are essential. As part of a planned series of studies to develop a culturally sensitive type 2 diabetes self-management programme, this study explores the need versus barriers and facilitators relevant to implementing a national programme for type 2 diabetes self-management education within the community and health care system in Saudi Arabia.MethodsA qualitative methodology was used to explore the views of a multidisciplinary group of diabetes health professionals and adult patients with type 2 diabetes. The views of nine health professionals working at a specialised diabetes care centre were gathered at two focus groups (four and five) that included doctors, nutritionists, health educators and nurses. Individual interviews with 12 patients with type 2 diabetes (six females and six males) attending the centre were also carried out. Recurring themes through the translated transcripts were studied and treated by the research group under pre-set protocols.ResultsFocus groups with health professionals revealed three main themes. 1. Resources: availability of resources and how they impacted on performance and patients’ care; 2.Familiarity with self-management education programmes: educating patients and raising awareness among them; and 3. Lifestyle: patients’ lifestyle and how it could affect their compliance with self-management programmes. Interviews with patients also revealed three main themes. 1. Habits: post diagnosis changes in patients’ attitudes and behaviours towards diet and physical activity; 2. Health education: awareness of managing type 2 diabetes through health centre advice or self-education; and 3. Culture and society: a lack of cultural or social support created by some social practices or conventions.ConclusionThe findings from this study highlight a gap in type 2 diabetes care system that can be breached through the development of a Saudi specific self-management programme for type 2 diabetes. The identified barriers and facilitators can be used for adapting a self-management programme to the Saudi context. However, initial training is needed for local health professionals to understand the mechanisms of self-management programmes. Such programmes will need to infiltrate to the society, and the patients’ families, in particular to tackle the rising prevalence of type 2 diabetes in Saudi Arabia and provide a friendlier, more supportive environment for the current patients to self-manage their diabetes.

한국, 일본의 노인복지시설과 지역사회 돌봄 시스템 현황 및 향후과제 분석

한국, 일본의 노인복지시설과 지역사회 돌봄 시스템 현황 및 향후과제 분석

Nepal

In Nepal, there is a scarcity of population-wide mental health services in most parts of the country. Mental health services are concentrated in a few hospitals located in the big cities; consequently, there is a huge gap between the number of people with the need for mental health care and those actually receiving services. In response to this, Transcultural Psychosocial Organization (TPO) Nepal was formed in 2005, with the aim of providing psychosocial and mental health services through development of a community based, culturally appropriate, and sustainable mental health care system (www.tponepal.org). I joined TPO Nepal as a translator in 2007. I shifted my work from translator to clinician after completing a post-graduate diploma in counseling psychology from Tribhuvan University, Kirtipur, Nepal. Furthermore, I have been trained in several specific psychotherapies and interventions such as art therapy and cognitive behavioural therapy. Since then I have been involved in multiple projects as a counselor, trainer, and clinical supervisor that aim to integrate mental health services into primary and community care systems. As task-sharing has widely been advocated to minimise the tremendous treatment gap of mental health care in settings like Nepal, in this letter, I share my experiences in training and supervision of community health-care workers by using a task-sharing approach.

Characteristics of older adults living with HIV accessing home and community care services in British Columbia, Canada

ABSTRACT Over half of people living with HIV (PLHIV) engaged in care in British Columbia (BC) are age ≥50. The public home and community care (HCC) system offers formal support that PLHIV may turn to as they age, but little is known about access specific to PLHIV. Using data from the STOP HIV/AIDS cohort, which includes linked treatment and demographic records for PLHIV accessing care in BC, we compared older PLHIV (defined as those age ≥50) who did and did not access HCC services. We estimated adjusted odds ratios (aORs) for factors associated with HCC service utilization using logistic regression. This study included 5,603 PLHIV age ≥50, 837 (14.94%) of whom accessed any HCC service between 2005 and 2015. Services most commonly used were community nursing (8.98%, n = 503) and rehabilitation (7.73%, n = 433). Those who received HCC were more likely to be female (aOR = 1.56, 95% CI = 1.24, 1.98), have a history of injection drug use (aOR = 1.88, 95% CI = 1.57, 2.25), have a higher Charlson comorbidity score (aOR = 1.11, 95% CI:1.07, 1.15) and to have visited a general practitioner in the past year (aOR = 2.17, 95% CI = 1.77, 2.67). Approximately 15% of older PLHIV have accessed HCC, but the extent of potential unmet need for these services requires further research.

A Study on the Problems of Mental Health Welfare Law and the Improvement of Community Deinstitutionalization

최근 취약계층의 사회정착 지원을 위한 ‘커뮤니티케어(community care)’가 사회적 화두로 떠오르며, 지역사회 돌봄체계 확립이 강조되고 있다. 「정신보건법」의 시행은 정신질환자들이 오히려 병원이나 시설에 장기간 입원해 있는 등 시설의 수용화 라는 비판을 받게 되었다. 이에 2017년 ‘탈원화’ 및 ‘정신질환자 자율성 존중’을 핵심으로 「정신건강복지법」으로 새롭게 개정되어, 본인 동의 없이 강제 입원하는 것을 막고, 입원기간에 대한 제한 규정을 마련하였으며, 정신질환자들이 지역사회에서 정착해 살아갈 수 있도록 하는 서비스를 적극적으로 추진할 수 있도록 하고 있다. 본 연구에서는 개정법의 시행으로 인해 정신질환자가 자립하여 지역사회로 유입된 환자의 수가 높아졌다는 긍정적 측면도 있지만, 퇴원 후 치료를 적절하게 받을 수 있는 시설이 충분히 준비되지 않은 상태에서 탈원화가 시작되었음을 지적하며, 퇴원 후 정신질환자들이 지역사회에서 함께 살아갈 수 있도록 하는 다음과 같은 방안을 제안하였다. 첫째, 사회복귀시설의 확대와 지역별 편차를 해결하고, 취약지역에 대한 점검이 필요하다. 둘째, 국가가 정신질환자의 자립생활 및 지역사회 통합을 위한 적극적인 지원과 전달체계 구축, 전문인력 양성 등의 책임 주체가 되어야 한다. 셋째, 퇴원 후 정신질환자를 돌볼 가족이 없는 경우 건강과 돌봄 서비스를 연계해 제공하는 주거지원 등의 통합적인 정책이 필요하다. 마지막으로, 퇴원 후의 관리를 보다 구체적으로 제도화하여 정신질환자가 퇴원 이후에도 지역사회에서 치료를 지속적으로 받을 수 있도록 해야 할 것이다.Recently, community care to support social topic of vulnerable groups has emerged as a social topic, and the establishment of community care system is emphasized. The implementation of the 「Mental Health Law」 has been criticized for the fact that a people with mental illness are staying in hospitals and facilities for a long time. In 2017, it was newly revised to the 「Law on the Improvement of Mental Health and the Support for Welfare Services for Mental Patients」 with the focus on deinstitutionalization and respect for autonomy of mental patients . It prevents forced hospitalization without consent, has established restrictions on the hospitalization period, and actively promotes services that allow mental patients to settle in their communities. This study also shows that the implementation of the revised law has increased the number of patients with mental illness who have become independent and have reintegrated into the community. In addition, we proposed the following plan to enable patients with mental illness to live together in the community after discharge. First, it is necessary to expand social rehabilitation facilities, resolve regional deviations, and examine vulnerable areas. Second, the state should be responsible for active support and establishing a delivery system for patients independence and community integration, and the training of care experts. Third, if there is no family to care for the mental patients after discharge, an integrated policy such as housing support that provides health and care services is necessary. Finally, it is necessary to institutionalize out-patient care so that patients can continue to receive treatment in their communities after discharge.

Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic

ImportanceThe rapidly expanding novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has challenged the medical community to an unprecedented degree. Physicians and health care workers are at added risk of exposure and infection during the course of patient care. Because of the rapid spread of this disease through respiratory droplets, health care workers who come in close contact with the upper aerodigestive tract during diagnostic and therapeutic procedures, such as otolaryngologists–head and neck surgeons, are particularly at risk. A set of safety recommendations was created based on a review of the literature and communications with physicians with firsthand knowledge of safety procedures during the COVID-19 pandemic.ObservationsA high number of health care workers were infected during the first phase of the pandemic in the city of Wuhan, China. Subsequently, by adopting strict safety precautions, other regions were able to achieve high levels of safety for health care workers without jeopardizing the care of patients. The most common procedures related to the examination and treatment of upper aerodigestive tract diseases were reviewed. Each category was reviewed based on the potential risk imposed to health care workers. Specific recommendations were made based on the literature, when available, or consensus best practices. Specific safety recommendations were made for performing tracheostomy in patients with COVID-19.Conclusions and RelevancePreserving a highly skilled health care workforce is a top priority for any community and health care system. Based on the experience of health care systems in Asia and Europe, by following strict safety guidelines, the risk of exposure and infection of health care workers could be greatly reduced while providing high levels of care. The provided recommendations, which may evolve over time, could be used as broad guidance for all health care workers who are involved in the care of patients with COVID-19.

7. Primary Health Care and the Integrated Community Care System

7. Primary Health Care and the Integrated Community Care System

<b>A study on design method of questionnaire survey in Integrated Community Care System</b>

<b>A study on design method of questionnaire survey in Integrated Community Care System</b>

Reducing Violent Incidents between Police Officers and People with Psychiatric or Substance Use Disorders

This article describes evidence-based strategies designed to reduce the prevalence of police encounters with people in behavioral crisis (PBCs) and to make such encounters less dangerous for all parties when they do occur. Some of these strategies are implemented by law enforcement, including gun violence restraining orders and the training of officers to provide time, distance, and cover during encounters with PBCs. Other strategies involve broader systems of community care, including assertive community treatment for people with serious psychiatric disorders, and critical time interventions for individuals leaving incarceration or inpatient psychiatric care. Broader adoption of such strategies should both reduce the risk of police shootings of PBCs as well as improve the effectiveness and well-being of police officers.

Concept analysis of "Gojo" (mutual help)

Objective The purpose of this study is to redefine "Gojo" (mutual help) among residents and explore measures to develop it Gojo in the integrated community care system. In 2000, long-term care insurance accelerated Japan's movement toward an aging society, thus increasing the importance of Gojo. This study aims to clarify the conceptual definition it has come to acquire in recent years and explore ways it can be developed in comprehensive community systems.Methodology Rodger's evolutionary concept analysis was utilized in the study. A keyword research was done using the term "Gojo" in the Japan Medical Abstracts Society (Ichushi Web) and CiNii Articles databases. The search period was from 2000 to 2016 (search date: August 30, 2016) and the database search formula was set to "Gojo/TA". Thirty documents were selected through random sampling and a total of 32 documents were selected for analysis, including landmark documents. A qualitative analysis was conducted on three frameworks: attributes (i.e., characteristics of Gojo), antecedents (i.e., factors affecting Gojo), and consequences (i.e., expected results for Gojo). These three frameworks represent how Gojo is used, the events occurring before it, and the events resulting from it, respectively.Results The characteristics of Gojo were found to include "experiences of empathy toward residents' daily need for support," "awareness about the residents' efforts to support each other," and "interaction among residents who support other's daily needs." The factors affecting Gojo were identified to be "the need for daily life support beyond what self-help, social solidarity care, and governmental care can provide"; "interchange among residents"; "sharing needs for daily life support among residents"; and "a resident-led public system that promotes mutual support." Gojo's expected results were "a solution for residents' needs of daily support"; "promotion of self-help awareness"; "providing them with a role to enhance their purpose in life"; and "encouraging exchanges and relations between them."Conclusion Gojo was defined as "the interaction between local residents who support their daily needs, have an empathic experience of the need for daily life support, and have the desire to support each other." In addition, the following points were suggested as measures necessary to expand Gojo. The residents must have sympathy for other residents who need daily life support, understand the benefits of supporting each other, and have a public support system, even if Gojo is led by the residents.

Survey Report on the Efforts to Engage Dental Professionals in the Development of the Integrated Community Care System

Survey Report on the Efforts to Engage Dental Professionals in the Development of the Integrated Community Care System