Service Continuity Research Articles

Interventions to Maintain HIV/AIDS, Tuberculosis, and Malaria Service Delivery During Public Health Emergencies in Low- and Middle-Income Countries: Protocol for a Systematic Review

Background Although existing disease preparedness and response frameworks provide guidance about strengthening emergency response capacity, little attention is paid to health service continuity during emergency responses. During the 2014 Ebola outbreak, there were 11,325 reported deaths due to the Ebola virus and yet disruption in access to care caused more than 10,000 additional deaths due to measles, HIV/AIDS, tuberculosis, and malaria. Low- and middle-income countries account for the largest disease burden due to HIV, tuberculosis, and malaria and yet previous responses to health emergencies showed that HIV, tuberculosis, and malaria service delivery can be significantly disrupted. To date, there has not been a systematic synthesis of interventions implemented to maintain the delivery of these services during emergencies. Objective This study aimed to synthesize the interventions implemented to maintain HIV/AIDS, tuberculosis, and malaria services during public health emergencies in low- and middle-income countries. Methods The systematic review was registered in the international register for prospective systematic reviews. It will include activities undertaken to improve human health either through preventing the occurrence of HIV, tuberculosis, or malaria, reducing the severity among patients, or promoting the restoration of functioning lost as a result of experiencing HIV, tuberculosis, or malaria during health emergencies. These will include policy-level (eg, development of guidelines), health facility–level (eg, service rescheduling), and community-level interventions (eg, community drug distribution). Service delivery will be in terms of improving access, availability, use, and coverage. We will report on any interventions to maintain services along the care cascade for HIV, tuberculosis, or malaria. Peer-reviewed study databases including MEDLINE, Web of Science, Embase, Cochrane, and Global Index Medicus will be searched. Reference lists from global reports on HIV/AIDS, tuberculosis, or malaria will also be searched. We will use the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation—Confidence in Evidence from Reviews of Qualitative Research) approach to report on the quality of evidence in each paper. The information from the studies will be synthesized at the disease or condition level (HIV/AIDS, tuberculosis, and malaria), implementation level (policy, health facility, and community), and outcomes (improving access, availability, use, or coverage). We will use the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to report findings and discuss implications for strengthening preparedness and response, as well as strengthening health systems in low- and middle-income countries. Results The initial search for published literature was conducted between January 2023 and March 2023 and yielded 8119 studies. At the time of publication, synthesis and interpretation of results were being concluded. Final results will be published in 2025. Conclusions The findings will inform the development of national and global guidance to minimize disruption of services for patients with HIV/AIDS, tuberculosis, and malaria during public health emergencies. Trial Registration PROSPERO CRD42023408967; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=408967 International Registered Report Identifier (IRRID) PRR1-10.2196/64316

Work engagement, resilience and turnover intentions among nurses: a mediation analysis

IntroductionHealthcare organizations experience difficult challenges as a result of nursing staff turnover. This is because it not only interrupts continuity of service but also its financial implications.AimThe purpose of the study was to find out the effects of work engagement on nurses' intentions to leave their jobs while considering resilience as a mediating factor.MethodsThe study used a descriptive-analytical design using a survey questionnaire on nurses working in different healthcare settings. The Utrecht Work Engagement Scale, the Brief Resilience Scale, and the Turnover Intention Scale were among the validated scales that were employed. The hypothesized relations were tested using descriptive and mediation analyses at a significance of <0.05.ResultsThough the turnover intention (n = 3.83 ± 1.42) and the level of work engagement (n = 4.03 ± 1.32) among nurses were high, their level of resilience of nurses was average (n = 2.48, SD: 0.63). Resilience had a negative association with turnover intention (β = − 0.5699, p < .0001), and there was also a significant negative association between work engagement and turnover intentions among nurses with resilience mediating the relationship (β = -0.0367, p < .05).ConclusionDisengaged nurses are more likely to leave their jobs. Moreover, resilience acts as a mechanism through which work engagement influences turnover intentions. The study emphasizes the need to encourage work engagement among nurses to lessen intentions to leave the profession. Among factors that can improve work engagement and resilience to reduce turnover include conducting regular engagement assessments, fostering positive workplace cultures, employing flexible scheduling practices, and offering resources for personal and professional development.

Forging new paths in the development of community mental health interventions for people with mental illness at risk of criminal legal system contact

BackgroundIndividuals with serious mental illness (SMI) have disproportionately high rates of criminal legal system involvement. For many, this becomes a repeated cycle of arrest and incarceration. Treatments that address symptoms of mental illness are a critical component of the continuum of services for people with SMI in the legal system; yet on their own, psychiatric treatments have not been successful at reducing criminal legal system involvement for this population. Research suggests that criminogenic risk factors, the major drivers of criminal legal system involvement, are disproportionately prevalent among individuals with SMI. However, promising criminogenic-focused interventions have only just begun to be adapted for individuals with SMI. The proposed study will examine the capacity of Forging New Paths (FNP), a novel criminogenic-focused group intervention developed for individuals with SMI, to engage its primary and secondary outcomes when delivered in community mental health settings.MethodsThe proposed pilot study will engage a small-scale clinical trial comprising three cycles of FNP delivered in a community mental health center in a Southeastern state in the U.S. The anticipated total sample size is N = 72 and will consist of community-dwelling adults with SMI who have a moderate or higher criminogenic risk level and a history of criminal legal system contact. This study will examine the extent to which FNP is able to engage its primary (aggression and community tenure) and secondary (criminal attitudes and impulsivity) treatment outcomes.DiscussionFNP provides an important new service for community-based mental health settings to reduce criminal legal system involvement (and recidivism) among the individuals they serve with SMI.Clinical Trial RegistrationNCT06290648.

Factors affecting the utilization of continuum of maternal healthcare services: Evidence from rural areas using Andersen-Newman behavioral model

Factors affecting the utilization of continuum of maternal healthcare services: Evidence from rural areas using Andersen-Newman behavioral model

"I'm in the Care Orbit": Unveiling the Enabling Context of the HIV Care Continuum in People Living With HIV.

This study aimed to explore the enabling context of the HIV care continuum as perceived by people living with HIV and healthcare professionals. This qualitative study involved in-depth individual interviews with eight people living with HIV and group interviews with seven nurses and physicians. These interviews took place between March 5, 2021, and July 13, 2022. Thematic analysis was conducted. The main themes that emerged included "network of support and systems," "personal gains from the care continuum," "continuity and practicality of healthcare services," "presence of significant other(s)," and "social belonging." These themes were structured within the five levels of the socio-ecological model (system, individual, organizational, interpersonal, and community levels), and 10 subthemes were identified. With the integration of themes, the enabling context was compared to a "care orbit," indicating that people diagnosed with HIV start treatment at the system level and continue HIV care at other levels. In addition to primary support at the system level, the enabling context also includes individual commitment to care and regular health habits, hospital services, support from significant others, and community culture. Together, the context helps guide people living with HIV into the "orbit" of the care system.

Dual-Path Beam Tracking for Service Continuity of Ultra-Reliable and Low-Latency Communications

Dual-Path Beam Tracking for Service Continuity of Ultra-Reliable and Low-Latency Communications

PHYSICAL AND MENTAL HEALTH NEEDS OF OLDER ADULTS EXPERIENCING HOMELESSNESS: CHALLENGES AND INNOVATIONS IN CARE

Abstract Adults over the age of 50 are the largest growing demographic of individuals experiencing homelessness. They enter a continuum of housing services with a myriad of chronic and acute health conditions that have often been unaddressed due to sporadic and episodic care utilization primarily within emergency services. The compounding health impacts of chronic homelessness accelerate aging within this demographic. Housing services offer an opportunity to address unmitigated health issues. Housing services are seeking research and programmatic interventions to meet this need. This symposium will explore the physical and mental health needs of older adults experiencing homelessness across the continuum of housing services from shelter entry to permanent supportive housing though a variety of research methodologies. The first presenter (Souza) will present results of a study applying latent class analysis to administrative shelter services data to identify unobservable subgroups within the population of older adults living in shelter. The second presenter (Berg) will discuss the implementation of shelter-based care services to older adults with complex medical needs in a low barrier, harm reduction focused hotel shelter. The third presenter (Robinson) will describe a qualitative investigation examining barriers to mental health care for older adults in permanent supportive housing. The discussant (Tsai) will lead symposium attendees in a discussion of future considerations for research, policy, and practice to meet the needs of this growing demographic of older adults.

Navigating the Intersection of Digital Security, Resilience and Sustainability in Healthcare: A Theoretical Framework and Case Study of Ghana

This paper explores the intersection of digital security, resilience, and sustainability within healthcare systems, providing a theoretical framework and insights from a case study of Ghana. The findings reveal that integrating robust cybersecurity measures enhances the protection of sensitive patient data and ensures the reliability of clinical operations. These measures, supported by resilient infrastructures, mitigate disruptions and maintain service continuity, aligning healthcare systems with global ethical and security standards. The study further demonstrates that sustainable digital transformation strategies, such as adopting energy-efficient data centers and reducing reliance on paper-based workflows, significantly reduce environmental impacts while improving operational efficiency. These practices contribute to achieving Sustainable Development Goal 13 (Climate Action) and underscore the importance of aligning healthcare innovations with ecological stewardship. Lastly, the research highlights the critical role of environmental and social safeguards in fostering equitable healthcare digital transformation. Initiatives targeting compliance with environmental regulations and reducing digital disparities are shown to improve access to healthcare for underserved populations, advancing Sustainable Development Goal 10 (Reduced Inequalities). This study provides actionable recommendations for healthcare organizations and policymakers, emphasizing the need for secure, resilient, and sustainable digital ecosystems that enhance health outcomes while addressing global environmental and societal challenges.

Legal Protection for Notary Service Users in the Absence of an Appointed Holder of Notary Protocols Following the Notary's Death

The maintenance and storage of Notary protocols are critical responsibilities that must be managed meticulously due to their importance in ensuring the continuity of Notary services. This obligation is regulated through specific legal provisions, particularly in cases where a Notary has passed away. The Regional Supervisory Council holds the authority to appoint another Notary as the Protocol Holder of the deceased Notary. However, challenges arise when the MPD is unaware of the Notary's death or fails to appoint a Protocol Holder within the legal deadline. These lapses can disadvantage service users who require access to the deceased Notary's protocols, such as copies of deeds or other related documents. This study aims to analyze the responsibilities of the MPD in managing the protocols of deceased Notaries and to evaluate the legal protection available to service users. Utilizing a doctrinal research method with qualitative analysis of secondary data, this research highlights that the MPD is obligated to ensure the timely appointment of Protocol Holder Notaries. Failure to do so impedes public access to Notary services and compromises legal protection for users. To address these issues, the study recommends enhancing MPD supervision and procedural improvements, along with the enforcement of sanctions for negligence. Furthermore, service users are encouraged to seek legal remedies through the courts or supervisory councils to uphold their rights. Strengthening MPD performance and regulatory frameworks is essential for safeguarding public trust and ensuring effective legal protection.

Digital Finance in Algeria: Analyzing the Impact of COVID-19 on E-Banking Adoption

This study aims to analyze the impact of the COVID-19 pandemic on the development of electronic banking in Algeria, focusing on how the health crisis has accelerated the digital transformation of the banking sector and identify the challenges and opportunities associated with this transition in a specific Algerian context. The study uses a descriptive and analytical approach. It is based on statistical data to illustrate the evolution of electronic banking in Algeria. The analysis focuses on public policies, bank initiatives, and consumer behavior. The study reveals that the COVID-19 pandemic has significantly impacted the development of e-banking in Algeria. There has been a sharp increase in digital transactions, including bank transfers, electronic payments, and ATM withdrawals. Electronic banking has played a crucial role in ensuring the continuity of financial services during the lockdown periods. However, challenges persist in terms of security, financial inclusion, and the development of digital infrastructure.

Competitive Analysis of Cross-border E-commerce Business of Logistics Enterprises: The Case of Rookie Wrap Company

This paper discusses the competitiveness of logistics companies in cross-border e-commerce business, using Rookie wrap as an example. Through a comparative analysis of the development history, characteristics and comparison with other logistics companies (e.g., S.F.Holding Co.,Ltd), this paper summarizes the key factors affecting the competitiveness of logistics companies, including market size, revenue capacity, business diversification, growth rate, technological innovation and service innovation. It is found that Raiding Bird Wrapped, relying on the strong background of Alibaba Group, has a huge potential scale and influence in the field of e-commerce logistics, and actively lays out intelligent logistics and overseas markets. In contrast, SF has a more comprehensive business layout, including express delivery, supply chain management, e-commerce logistics and international business, showing a stronger anti-risk ability. The article points out that the key to enhance the competitiveness of logistics enterprises is to actively explore the market, increase market share, and adjust and optimize the business structure, focusing on the development of business strengths, while trying to expand new businesses. Through continuous technological innovation and service upgrading, logistics enterprises can consolidate their position in the fierce market competition and realize sustainable development.

Enhancing Patient Satisfaction by Healthcare Service Providers: A Systematic Literature Review

Aims: The aim of this study is to identify the primary determinants and emerging trends that influence patient experiences patient experiences. Study Design: Through a systematic review of scholarly literature, an investigation examines the pivotal elements that drive patient satisfaction outcomes in innovative healthcare service delivery contexts. Place and Duration of Study: The study was conducted in healthcare service innovation. The duration of the study around six months by analyzing articles published between 2019 and 2023 in Scopus-indexed academic journals. Methodology: Following the PRISMA guidelines, this study analyzed 54 peer-reviewed articles to examine the relationship between service quality, communication, digital transformation, physical environment, waiting time, and healthcare accessibility on patient satisfaction. Results: The findings emphasize the increasing trend toward patient-centered care and the integration of technology to improve service delivery. These results underscore the importance of continuous service improvement and innovation in healthcare to meet patient expectations and enhance satisfaction. The study concludes that addressing these key factors is essential for healthcare providers to achieve higher patient loyalty, better health outcomes, and a competitive advantage. Future study should focus on further integrating digital solutions and patient-centered approaches to drive improvements in customer satisfaction in healthcare settings. Conclusion: The review indicates that service quality, characterized by reliability, responsiveness, and empathy, is the most significant determinant of customer satisfaction. Communication between healthcare providers and patients is also identified as a critical factor, with clear and empathetic interactions significantly enhancing patient trust and satisfaction. Digital transformation, including telemedicine and electronic health records, emerges as a key innovation in improving service efficiency, reducing waiting times, and expanding access to care. The physical environment and waiting times are also noted as important contributors to patient satisfaction, influencing their overall experience in healthcare facilities.

Load-Balanced Dynamic SFC Migration Based on Resource Demand Prediction.

In network function virtualization, the resource demand of network services changes with network traffic. SFC migration has emerged as an effective technique for preserving the quality of service. However, one important problem that has not been addressed in prior studies is how to manage network load while maintaining service-level agreements for time-varying resource demands. Therefore, we propose the Resource Predictive Load Balancing SFC Migration (RP-LBM) algorithm in this paper. The algorithm uses CNN-AT-LSTM to predict VNF resource demands in advance, eliminating the delays associated with dynamic migrations and determining the optimal migration timing. It leverages the PPO algorithm's perceptual capabilities in complex environments to develop SFC migration strategies and ensure network load balancing. Additionally, it reduces the number of subsequent migrations and minimizes the service interruption rate. The simulation results show that the service interruption rate of the RP-LBM algorithm is on average 27.3% lower than that of the passive migration method. The PPO-based migration algorithm has lower SFC migration times and service interruption rates compared to the DQN algorithm, ensuring service continuity with low migration costs.

Preferences of continuous care service options for patients with venous leg ulcer development of attributes for discrete choice experiments.

Patients suffering from lower extremity venous ulcers typically undergo prolonged dressing changes, entailing extended treatment cycles and significant costs, creating an urgent need for effective continuous care. There is scarce literature reporting on the preferences and requirements for wound care within continuous care services for such conditions. Discrete choice experiments serve as an innovative method to elicit patient preferences, where the development of attributes and levels is a critically important process. To identify attributes and levels patients with venous leg ulcers consider when making decisions about continued care services for venous leg ulcers. In this study, we employed four steps to devise service features (i.e., attributes) and their potential manifestations (i.e., levels). Firstly, we conducted a systematic literature search with articles screened and content compiled by two researchers to identify possible service attributes. Secondly, we conducted in-depth interviews with patients suffering from venous leg ulcers to gather personal experiences and expectations for quality care, and used Nvivo11.0 for data management. Thirdly, focus group discussions were held to assess general viewpoints from various perspectives. Finally, expert meetings were organized to refine our research tools further. To narrow down the attributes to a manageable number for the discrete choice experiment, focus groups and expert meetings performed ranking exercises, calculating the average importance scores by dividing the total score by the number of participants and ranking attributes from highest to lowest average scores. Through literature reviews, qualitative data acquisition, expert meetings, and ranking exercises, a total of six attributes were finalized, each with two to three levels. The attributes included: 1) service cost (Ave score: 4.7); 2) Mode of service delivery (Ave score: 4.5); 3) Service type (Ave score: 4.4); 4) Consistency of caregiver (Ave score: 4.4); 5) Category of service providers (Ave score: 4.3); and 6) Appointment scheduling (Ave score: 4.3). These attributes encompassed key aspects related to wound care in the continuous care services for patients with venous leg ulcers. The mixed-methods approach adopted in this study has proven particularly suitable for identifying, refining, and selecting attributes and levels for discrete choice experiments. By leveraging the advantages and limitations of the four steps, and especially through qualitative data analysis, a more profound and comprehensive understanding of the attributes and levels was achieved. This approach has facilitated the practicality and accuracy in attribute construction, enhancing the overall efficacy of the DCE design.

THE PUBLIC ADMINISTRATION OF INFORMATION TECHNOLOGIES IN HEALTH CARE FIELD UNDER THE CONDITIONS OF MARTIAL STATE

In the conditions of martial state, the need for fast and accurate processing of large volumes of information, especially in the field of health care, is increasing. This is due to a lack of resources, an increase in the number of victims of military operations, displaced persons, the complication of access to medical services in connection with hostilities, the loss of individual specialists and information arrays, as well as increased risks for information security and the entire process of public management of information technologies in the health care field. The public administration of information technologies in health care is becoming critical to ensure the stability of healthcare services, support communications between healthcare facilities and government agencies, and effectively process and protect healthcare data. The analysis of scientific works on the issue of the public administration of information technologies in health care under the conditions of martial state is insufficiently researched. The article highlights the main challenges of the industry related to the war: ensuring the continuity of medical services, the appropriateness of public administration decision-making in conditions of limited access to open information, problems with logistics, and stable power supply, information protection and cyber security, shortage of qualified personnel; adopted management decisions, and information technology tools, which were used by authorities at the state and regional levels to respond to new challenges, were investigated. In the article, we are offered some recommendations for the further development and management of information technologies in the healthcare field. The main ones are further measures to strengthen cybersecurity, namely the widespread implementation of the Digital Competency Framework for Healthcare Workers in various areas, the implementation of modern information protection systems, the implementation of an information security policy, measures to legalize and update software, deepening the integration of mHealth into the existing eHealth system to enable rapid and remote collection of medical information and the introduction of artificial intelligence elements into healthcare management processes.

Five-year analysis of hospital complaints at a Japanese tertiary teaching hospital.

Patient complaint taxonomies strongly support the use of healthcare complaints as a powerful tool to improve the quality and safety of patient care. Hospitals use complaint data at the organizational level to address quality variation across service lines and departments. We applied a validated typology method to identify where the complaints occured and gained deeper insights about how they can be more effectively utilized to drive and implement continuous quality and service improvement activities within a tertiary hospital. We included all complaints and opinions from patients and their families over a 5-year period at a large tertiary teaching hospital in Japan. Two analysts categorized the opinions into complaints and gratitude expressions, with complaints classified using Reader etal.'s taxonomy. We performed statistical tabulations and determined the number of complaints across hospital sectors using the chi-squared test, residual analysis, and Cramer's V tests to check for significant correlations between the variables. A total of 6607 complaints and comments were received. Of these, 5401 related to the Clinical, Administrative, and Human Relations domains, respectively (11.1%, 56.1%, and 32.8%). At the domain level, the most common complaints are related to the Relationships domain in both the Medical and Nursing departments. However, a detailed analysis of the category levels demonstrated that the Medicine department received the most complaints in the Communication and Patient Rights category, whereas in the Nursing department, the Humanness/Caring and Patient Rights categories were the most common sources for complaints. The Administrative department complaints were mostly related to the Management domain, with the largest number of complaints related to the Institutional Issues category. We used a validated taxonomy to identify and address trends in patient complaints and identified the key hospital departments that required remedial improvement actions. All hospital departments received direct and targeted feedback on how to effectively improve the quality, safety and services of their clinical service lines.

Analysis of the crisis resilience of utilities in the ownership of municipalities in Hungary between 2006 and 2022

Hungary’s utility sector, encompassing district heating, water services, waste management, and public transport, has experienced notable shifts from municipal to privatized ownership and back to community control between 2006 and 2022. The purpose of this study is to assess the financial performance and crisis resilience of municipally owned utility companies in Hungary between 2006 and 2022, with a particular focus on the impact of state price regulation and the role of economic cycles. The regulation was intended to ensure service affordability but imposed significant constraints on financial flexibility and investment capacity. The study targeted a sample of Hungarian local government companies, with two distinguished periods (2006–2013 and 2014–2022), examining seven different financial indicators (formulas), e.g., EBITDA, ROA, etc., with variance analysis and correlation analyses. These revealed that while companies operated effectively during periods of economic growth, the post-2020 polycrisis, characterized by challenges such as the COVID-19 pandemic and rising energy prices, exposed vulnerabilities, especially in the district heating sector. Financial indicators, including EBITDA margin and liquidity ratios, showed mixed results, with profitability improving in certain sectors but liquidity and return on assets (ROA) declining, indicating stress on short-term solvency. The paper suggests that while price regulation maintained affordability, it limited the capacity for swift adaptation during crises. To enhance resilience, the study recommends incorporating more adaptive regulatory frameworks and investing in renewable energy and operational efficiency. These changes would help municipally owned utility companies better withstand economic fluctuations and maintain service continuity, contributing to long-term financial and service stability. AcknowledgmentProject no. TKP2021-NKTA-51 has been implemented with support from the Ministry of Culture and Innovation of Hungary from the National Research, Development and Innovation Fund, financed under the TKP2021-NKTA funding scheme.This study was done in Széll Kálmán Public Finance Lab of Ludovika University of Public Service, Budapest.

An Efficient Multi-Topology Construction Method for Scheduling Mobile Data Flows in Software-Defined Networking

In mobile networks, a content server can provide multiple services simultaneously to a mobile device, generating multiple data flows. As the device moves, the transmission path in the wired network may need to be switched to maintain service continuity. However, a single switching path may not be able to accommodate all the flows, potentially leading to congestion and a degraded user experience. To address this challenge, we propose a multi-topology routing-based mobile data scheduling method that dynamically switches flows across multiple paths to enhance flexibility and load balancing. The performance of this method is significantly influenced by the construction of logical topologies. Well-designed topologies provide high-bandwidth, low-latency paths to all possible destination nodes, while poorly designed topologies waste switch capacity and fail to achieve these goals. In this paper, we introduce an efficient multi-topology construction method for scheduling mobile data flows in software-defined networking (SDN). Our approach optimizes and balances transmission capacity for each destination node while adhering to the flow entry constraints of switches. Simulations demonstrate that our method consistently outperforms the single-path switching method and the other two multi-topology construction methods in terms of packet delay, packet loss rate, and network throughput, regardless of the device’s new location.

The impact of the COVID-19 pandemic on first-episode psychosis presentations in two early intervention in psychosis services.

To assess the impact of the COVID-19 pandemic on first-episode psychosis (FEP) presentations across two Early Intervention in Psychosis (EIP) services in Ireland, by comparing pre-pandemic and post-pandemic cohorts. A cross-sectional observational design with retrospective medical record review was employed. The study population comprised 187 FEP patients (77 in pre-pandemic and 110 in post-pandemic cohort). Outcomes measured included duration of untreated psychosis (DUP), FEP presentation numbers, referral sources, global assessment of functioning scores, inpatient admissions, substance misuse and service delivery methods. Statistical analyses utilised chi-square tests to assess categorical variables, Mann-Whitney U tests to compare non-normally distributed continuous variables and Kruskal-Wallis tests to examine interactions between categorical and continuous variables. A significant increase in FEP presentations was observed in the post-pandemic cohort (p = 0.003), with an increase in all urban areas and a decrease in the study's only rural area. The difference in DUP between cohorts was not significant. However, significant interaction between gender, cohort and DUP was shown (p = 0.008), with women in the post-pandemic cohort experiencing longer DUP (p = 0.01). A significant rise in telephone (p = 0.05) and video consultations (p = 0.001) offered was observed, in the post-pandemic cohort. A similar number of in-person appointments were attended across both cohorts. This study highlights the impact of the pandemic on FEP presentations, particularly rurally and regarding increased DUP among women. These findings underscore the need for flexible EIP services to respond to public health crises. Despite increased presentations, services adapted, maintaining service continuity through telehealth and modified in-person contact.

Loneliness and Social Isolation of Older Adults and Quality of Dyadic Relationships with Migrant Domestic Workers: A Mixed-Method Study.

Loneliness among older individuals is widespread globally, leading to increasing public health and policy concerns. Migrant domestic workers (MDWs) offer continuous services for older adults worldwide, recompensing for dwindling support from family members. The study objectives were to explain how the quality of dyadic relationships with MDWs is associated with older adults' loneliness and further explore older adults' perceived experiences of care by MDWs. Methods: A mixed-methods study was conducted from 2021 to 2023. Convenience and snowball samplings of older adults aged ≥60 living with MDWs were recruited by elderly community centers in Hong Kong for a survey, and purposive sampling of in-depth interviews followed. The survey comprised several well-validated scales assessing loneliness, perceived social networks, and the quality of dyadic relationships. Face-to-face in-depth interviews were audio-recorded and transcribed for preliminary content analysis. A total of 288 older adults participated in the first phase of the survey interviews. Among them, 19 joined the in-depth interviews in the second phase. Results: There is a high prevalence of loneliness among older adults being cared for by MDWs in Hong Kong. In addition, the results showed that social loneliness negatively and significantly correlated with perceived dyadic relationship quality and social network. Two major interrelated themes were identified along with eight subthemes: (1) established relational interaction with MDWs and (2) enjoyed functional assistance and support from MDWs. Conclusions: Our study findings illustrated that good dyadic relationships among MDWs and older adults enhance older adults' social connections and networking, alleviating loneliness and social isolation. Appropriate strategies are suggested to strengthen older adults' social support and improve the quality of dyadic relationships with MDWs, which may reduce loneliness among older adults.