Comprehensive Health Care Approach Research Articles

Person-centred interventions for problem gaming: a stepped care approach

BackgroundProblem gaming is reported by approximately 1–3% of the population and is associated with decreased health and wellbeing. Research on optimal health responses to problem gaming remains limited. This study aimed to identify and describe the key components of a person-centred approach to interventions for problem gaming for individuals who voluntary seek assistance.MethodsOnline interviews were conducted with 20 adults (90% male; Mage = 23y) currently seeking help for problem gaming. The interview protocol was guided by a health care access framework which investigated participants’ experiences and needs related to accessing professional support. Transcripts were analysed in NVivo using qualitative content analysis to systematically classify participant data into the themes informed by this framework.ResultsParticipants had mixed views on how the negative consequences of problem gaming could be best addressed. Some indicated problems could be addressed through self-help resources whereas others suggested in-person treatment with a health professional who had expertise in gaming. Participants described the essential components of an effective health service for problem gaming as including: valid and reliable screening tools; practitioners with specialist knowledge of gaming; and access to a multimodal system of intervention, including self-help, internet and in-person options that allow gamers to easily transition between types and intensity of support.ConclusionA comprehensive health care approach for interventions for problem gaming is in its infancy, with numerous service access and delivery issues still to be resolved. This study highlights the importance of involving individuals with gaming-related problems in developing solutions that are fit for purpose and address the spectrum of individual preferences and needs. These findings recommend a stepped healthcare system that adheres to evidence-based practice tailored to each individual and the implementation of standard assessment and routine outcome monitoring.

Domiciliary Alzheimer visiting in Down syndrome pilot project: Preliminary results

AbstractIntroductionPeople with Down syndrome (DS) are at ultra‐high risk of developing Alzheimer’s disease (AD). A comprehensive health care approach is needed to enable an early diagnosis and an individualized follow up. The Alzheimer‐Down Unit developed a health plan which is offered to every adult with Down syndrome in Catalonia and which includes annual neurological and neuropsychological assessments together with clinical support and social counseling when needed. Within this plan, the “Domiciliary Alzheimer Visiting in Down syndrome” (DAVIS) pilot project adds domiciliary visits to bring closer this plan to those candidates who are not able to come to our site. In the present study, we analyze the preliminary results of this project.MethodsPilot observational cross‐sectional study. We contacted occupational centers /residences which included users with Down syndrome and we organized the visit of a neurologist and a neuropsychologist from our team. Candidates and their caregivers were informed about the health plan and those who accepted to participate were assessed. According to their cognitive status, they were classified into 3 groups: without cognitive impairment (aDS), prodromal AD (pDS) or AD dementia (dDS). Subsequently, a physically present or telephonic follow‐up visit, together with the option of collaborating with Primary Care, was offered. Participation in biomarkers research projects was also proposed.ResultsBetween October 2018 and December 2019 we assessed 92 participants (mean age 42.5, 48.9% males) classified as aDS (77.1%), pDS (4.4%) or dDS (18.5%). The 67.4% and the 28.3% of the participants were recruited to continue with the physically present or telephonic follow‐up, respectively. A 10.9% of the participants agreed to collaborate on research projects.ConclusionsThe DAVIS pilot project facilitates the dissemination of our comprehensive health plan for adults with DS in Catalonia. Its clinical application allows the diagnosis of new cases of AD and brings closer research to the adult population with DS. The DAVIS pilot project emphasizes the need of social and health care improvements for adults with DS; however, an extended DAVIS project will generate solid data to influence on health policy and, potentially, to improve the people with DS and their caregivers quality of life.

Sociopolitical determinants of international health policy.

For decades, two opposing logics have dominated the health policy debate: a comprehensive health care approach, with the 1978 Alma Ata Declaration as its cornerstone, and a private competition logic, emphasizing the role of the private sector. We present this debate and its influence on international health policies in the context of changing global economic and sociopolitical power relations in the second half of the last century. The neoliberal approach is illustrated with Chile's health sector reform in the 1980s and the Colombian reform since 1993. The comprehensive "public logic" is shown through the social insurance models in Costa Rica and in Brazil and through the national public health systems in Cuba since 1959 and in Nicaragua during the 1980s. These experiences emphasize that health care systems do not naturally gravitate toward greater fairness and efficiency, but require deliberate policy decisions.

HIV and noncommunicable diseases (NCDs) in Latin America: a call for an integrated and comprehensive response.

The life expectancy of people living with HIV has dramatically improved with the much increased access to antiretroviral therapy. Consequently, a larger number of people living with HIV are living longer and facing the increased burden of noncommunicable diseases (NCDs). NCDs and HIV infection share common epidemiologic and sociodemographic characteristics that influence their outcomes, which may be difficult to address in the relatively weak health systems of the region. Data on the prevalence and interactions of NCDs and HIV in Latin American countries remain very limited, which hinders their governments' ability to make informed decisions about health care policies. Therefore, there is an urgent need to develop a research agenda that will be the basis for an integrated and comprehensive health care approach to HIV and NCD comorbidities in Latin America.

Determinantes sociopolíticos de las políticas internacionales de salud

For decades, two opposing logics dominate the health policy debate: A comprehensive health care approach, with the 1978 Alma Ata Declaration as its cornerstone, and private competition logic, emphasizing the role of the private sector. We present this debate and its influence on international health policies in the context of changing global economic and sociopolitical power relations. The neoliberal approach is illustrated with Chile’s health sector reform in the 1980s and the Colombian reform since 1993. The comprehensive ‘public logic’ is shown through the social insurance models in Costa Rica and in Brazil, and through the national public health systems in Cuba since 1959, and in Nicaragua –during the 1980s. These experiences emphasize that health (care) systems do not naturally gravitate towards greater fairness and efficiency, but that they require deliberate policy decisions.

Prevention of mother to child transmission lay counsellors: Are they adequately trained?

South Africa's high prevalence of human immunodeficiency virus (HIV) infected women requires a comprehensive health care approach to pregnancy because of the added risk of their HIV status. As a result of the shortage of health care workers in South Africa, lay counsellors play important roles in the prevention of mother to child transmission of HIV (PMTCT). There is no standardization of training of lay counsellors in South Africa, and training varies in length depending on the training organisation. The study aimed to investigate the training of lay counsellors by analysing their training curricula and interviewing lay counsellors about their perceptions of their training. A two phase research method was applied. Phase one documented an analysis of the training curricula. Phase two was semi-structured interviews with the participants. Purposive sampling was undertaken for this study. The total sample size was 13 people, with a final sample of 9 participants, determined at the point of data saturation. The research was qualitative, descriptive and contextual in design. The curricula analysed had different styles of delivery, and the approaches to learning and courses varied, resulting in inconsistent training outcomes. A need for supervision and mentorship in the working environment was also noted. The training of lay counsellors needs to be adapted to meet the extended roles that they are playing in PMTCT. The standardization of training programmes, and the incorporation of a system of mentorship in the work environment, would ensure that the lay counsellors are adequately prepared for their role in PMTCT.

The Consultation-Liaison Psychiatry, an effective process between heart and sexuality

Erectile dysfunction (ED) is now considered as a marker of vascular diseases. Psychiatric disorders and psychosocial factors may increase ED. Therefore, the latest recommendations prescribe to look for these factors. There is definitely some evidence connecting psychosocial factors, ED and vascular diseases. However, the role of these factors and their relationship in the emergence of depressed mood and ED is still debatable. Consultation-Liaison Psychiatry contributes to an integrative and comprehensive health care approach for patients with cardiovascular diseases. Moreover, Consultation-Liaison Psychiatry intervention takes place in both primary and secondary prevention. Consequently, Consultation-Liaison Psychiatry is used to perform an in-depth assessment of the in-patient psychiatric status, in a dimensional approach or a categorical approach. Typical issues to consider during the interview might include: major psychiatric disorder, side effects of toxic and medical/surgical conditions or treatments, specific personality traits, psychological functioning. Then the consultation-liaison psychiatrist can supply appropriate diagnostic and therapeutic information to medical colleagues. However, these propositions highly depend on the somatic conditions and psychological functioning and coping strategies of the patient. We consider that there is a need for special expertise, provided by the consultation-liaison psychiatrist, in the management of complex problems involving psychological and physical issues. Thus, Consultation-Liaison Psychiatry is a great medical speciality, which enables the medical and psychosocial approaches to improve bio-psychosocial outcomes of the patients. A multidisciplinary and collaborative approach is highly recommended for ED, a prototype of the case complexity. Integrating the sexuality theme in the care programs for patients with cardiovascular disease, for example therapeutic education could be very useful for the patients, as well as the promotion of the multidisciplinary works.

Comparisons of Causes of Death and Mortality Rates Among HIV-Infected Persons

Comparisons of death-related variables during the 3 eras were performed. The number of deaths declined over the study period, with 987 deaths in the pre-HAART era, 159 deaths in the early HAART era (1997-1999), and 78 deaths in the late HAART era (2000-2003) (P < 0.01). The annual death rate peaked in 1995 (10.3 per 100 patients) and then declined to <2 deaths per 100 persons in the late HAART era (P < 0.01). The proportion of deaths attributable to infection decreased, but infection remained the leading cause of death in our cohort, followed by cancer. Of those who died, there was an increasing proportion of non-HIV-related deaths (32% vs. 9%; P < 0.01), including cardiac disease (22% vs. 8%; P < 0.01) and trauma (8% vs. 2%; P = 0.01) in the post-HAART versus pre-HAART era. Despite the absence of intravenous drug use and the low prevalence of hepatitis C coinfection in our cohort, an increasing proportion of deaths in the HAART era were attributable to liver disease, although the numbers are small. Despite increasing concerns regarding antiretroviral resistance, the death rate among HIV-infected persons in our cohort continues to decline. Our data show a lower death rate than that reported among many other US HIV-infected populations; this may be the result of open access to health care. A shift in the causes of death toward non-HIV-related causes suggests that a more comprehensive health care approach may be needed for optimal life expectancy; this may include enhanced screening for malignancy and heart disease as well as preventive measures for liver disease and accidents.

Recognizing and Responding to Adolescent Depression

We have seen that depression is increasingly recognized as a problem which affects adolescents as well as adults. Race by itself is not a factor which increases vulnerability to depression, but the multitude of sociodemographic, biological, and personal factors contributing to the development of depression are not fully understood. Research is needed to better understand how these factors interact in order to better develop prevention strategies and treatment modalities. With regard to treatment, adolescents are truly underserved. There is an awkward fit between the traditional mental health system and the developmental needs of adolescents. Unlike the majority of depressed adults who receive some treatment from general practitioners and medical clinics, adolescents do not tend to visit their pediatricians when they are depressed. One proposed solution is the adolescent comprehensive health care clinic providing a holistic approach to assessment, early intervention, and collaborative treatment between primary provider and mental health worker. Data from our adolescent program suggest that this approach has been successful in dealing with the problem of depression, especially in its early stages. Again, more research is needed to support these preliminary findings, but we believe that the adolescent comprehensive health care approach can be an effective, efficient way of addressing the health needs, mental and physical, of our teens at risk. Federal money for research must be made available, liberalization of health insurance must occur, and state-sponsored services must be developed so that these programs can be made more effective and can be brought to more of the adolescents who need them.