Place Of First Contact Research Articles

Refugees in European grassroots football

Since 2015-2016, when the European continent underwent an unprecedented peak in demands for asylum, grassroots football clubs have been at the forefront in offering refugees a place of first contact with their new host society. The perception of the impact that their initiatives may have had on their target population is however almost exclusively based on some widely shared basic assumptions drawn from anecdotal evidence and, marginally, on a small body of literature grounded in local studies of ethnographic nature. The article recapitulates the inception and implementation of an original mixed-method research survey within the framework of two successive practice-oriented projects led by civil society actors and supported by the ERASMUS+ Sport funding scheme. Following a literature review, it describes the survey design, analyses the findings, and discusses the added value and limits of this research focused on the principal target group of volunteers in European grassroots football.

Referral pathway in primary PCI - delays depend on the origin

Abstract Background Ischaemic heart disease is the single most common cause of death and its frequency is increasing. The mortality in patients presenting with an acute coronary syndrome with ST-elevation (STEMI) is associated with many factors such as the time delay to treatment, which comprises primary angioplasty (pPCI) or fibrinolysis. Therefore, treatment delays should be recorded systematically and audited, so as to improve standard of care. Purpose To analyse the response time and delays in the emergent coronary referral pathway for our centre, taking into consideration the place of first contact. Methods Primary data for this study was obtained by evaluating consecutive patients from the year 2015 to 2021, admitted for pPCI in our centre in the context STEMI. Time variables were collected for all patients – schematically represented in Figure 1. Statistical analyses were performed using IBM SPSS Statistics for Windows Version 27.0. Results We included a total of 1452 cases of pPCI with a median patient age of 64 years and 75,3% male. Over 7 years of pPCI were analysed and median times are displayed in table 1. We found that ECG median delays were significantly lower in the emergency first responders (EFR) group when comparing to PCI Centre group (11,0 vs 22,0; p<0,001), primary care physicians group(11,0 vs 23,0; p<0,001) and non-PCI Centre group (11,0 vs 28,0; p<0,001). Futhermore, median diagnostic delay was significantly lower in the EFR group compared to non-PCI centre group (28,0 vs 62,0; p<0,001) and primary care physician group (28,0 vs 59,0; p<0,001), as well as in the PCI Centre group compared to the non-PCI Centre group (30,0 vs 62,0; p<0,001) and to primary care physician group (30,0 vs 59,0; p<0,001). Conclusions Our data displays a clear heterogeneity in care which has an impact in the ischaemic time of STEMI patients. There seems to be a significant difference between the primary point of contact being the primary care physicians or a non-PCI centre when compared to our centre or the EFR, especially when it comes to the diagnostic timings. Hence, strategies must be developed to increase diagnostic sensibility and accuracy of STEMI patients throughout our geographical region.Time variable schemeTime according to groups

,,It overtook my body and soul": The experience of individuals receiving health-promoting service, of psychological trauma and health-related problems

Accumulating evidence shows that those having experienced psychological trauma have increased risk of complex health problems. In primary health care health-promoting services are offered to individuals with complex health problems, based on an individualized approach. Trauma focused approach in healthcare help individuals increase quality of life after psychological trauma. Trauma focused services are important to help improve quality of life after psychological trauma. To examine the experience of psychological trauma and health-related problems in individuals receiving health-promoting services. Qualitative research based on the Vancouver School of phenomenology. Participants were ten, five male and five female, selected through health-promoting services. Two interviews were taken with each participant. The ACE questionnaire was used, as a screening tool for childhood psychological trauma, combined with interview-frame with open questions. The results were divided into six main themes: Experience of trauma; Repeated trauma; Childhood neglect; Health-related problems in child- and adulthood; Psychiatric problems in child- and adulthood; Processing and trauma-focused approach. Participants had experienced conciderable trauma as well as complex health problems in child- and adulthood. It is of importance that healthcare professionals pay attention to psychological traumas in relation to complex health problems to provide support for recovery. Primary health care is the first place of contact within the health care system and therefore it is important that patients' experience of trauma is taken into account. It is key to identify the signs of lifetime trauma in relation to health problems and focus the care according to the individual needs of the patient.

Robust capacity planning for accident and emergency services

Accident and emergency departments (A&E) are the first place of contact for urgent and complex patients. These departments are subject to uncertainties due to the unplanned patient arrivals. After arrival to an A&E, patients are categorized by a triage nurse based on the urgency. The performance of an A&E is measured based on the number of patients waiting for more than a certain time to be treated. Due to the uncertainties affecting the patient flow, finding the optimum staff capacities while ensuring the performance targets is a complex problem. This paper proposes a robust-optimization based approximation for the patient waiting times in an A&E. We also develop a simulation optimization heuristic to solve this capacity planning problem. The performance of the approximation approach is then compared with that of the simulation optimization heuristic. Finally, the impact of model parameters on the performances of two approaches is investigated. The experiments show that the proposed approximation results in good enough solutions.

PARENTS’ EDUCATIONAL ACHIEVEMENT AND OCCUPATIONAL STATUS AS PREDICTORS OF STUDENTS’ ACHIEVEMENT IN ENGLISH LANGUAGE IN ESAN WEST LOCAL GOVERNMENT AREA, EDO STATE, NIGERIA

The home is the first place of contact with children, especially the child’s parents which invariably has a way of influencing the children. This study, therefore, examined parent’s educational achievements and occupational status as predictors of students’ achievement in English. The sample for the study is 120 Senior Secondary II students randomly selected in Esan West Local Government Area of Edo state. Two instruments were used for the study. The first instrument is titled “Parents’ Educational Achievement and Occupational Status Questionnaire (PEAOSQ)”, while the second is the English Language Achievement Text (ELAT). These instruments were used to collect data. Findings revealed that parents’ educational achievement significantly accounted for 12.9% of the variation in students’ achievement in English language while parents’ educational attainment and occupational status accounted for only 1.9% of the total variance in English achievement. Furthermore, both parents’ educational achievement and occupational status significantly accounted for 11.2% of the total variation in English achievement. Based on the findings, it was recommended amongst others that parents should enhance themselves through the available adult education programmes in the local government area and state. Article visualizations:

Knowledge and Sociodemographic Determinants of Emergency Management of Dental Avulsion among Parents in Kuwait: A Cross-Sectional Study

Objectives: The aim of this study was to evaluate the knowledge of first aid measures for a permanent tooth avulsion among parents in Kuwait and to assess the effect of different sociodemographic characteristics. Materials and Methods: A cross-sectional study was conducted among 554 parents who visited 5 dental specialty centers in Kuwait. Parent sociodemographic data and responses to avulsion management questions were collected through a self-administered questionnaire. Descriptive and binary logistic regression analyses were used for data analysis. Results: In the 554 responses from patients, gaps were identified in the following areas: replantation (199, 35.9%), cleaning of the tooth (182, 32.9%), and transport media (84, 15.2%). Most parents demonstrated satisfactory knowledge levels regarding the urgency to seek professional help (391, 70.6%) and the first place of contact after the injury (525, 94.8%). Having previous information on emergency management of dental avulsion was a significant predictor of good knowledge (OR 2.138, 95% CI 1.347-3.395, p = 0.001). Of the 544 parents, 99 (17.8%) had received information on dental avulsion management: 30 (30.3%) from the Internet, 19 (19.2%) from books, 12 (12.1%) from television, 6 (6%) from smart phone applications, 2 (2%) from newspapers, and 30 (30.3%) from other sources. Conclusion: In this study, parents in Kuwait did not have adequate knowledge of emergency management for dental avulsion. Future educational campaigns on dental avulsion are urgently needed to educate parents.

A Profile of Common Morbidities among Elderly Rural Indian Population

Understanding health problems among elderly and health-seeking behavior is prerequisite for proving comprehensive geriatric care to them. The study was undertaken to document the prevalence of common morbidities among elderly rural population A community based cross sectional study was conducted on the census population aged 60 years & above residing permanently in the rural field practice area of Katihar Medical College using predesigned and pretested questionnaire with clinical assessment of morbidity status assessed using criteria of primary care by WONCA International Classification Committee. Gastro intestinal was most common disorder which constituted 51.04 percent of total study population. Osteoarthritis was present in 49.65 percent of total study population. Cardiovascular problems were seen in 41.29 percent population. Total respiratory morbidity (ARI, Asthma, and COPD) was seen in 41 percent of total study population. Total neurological morbidity (Epilepsy, Hemiplegia & Parkinsonism) was found in only 2.5 percent of total study population. Non-specific Generalized weakness was found in 22.73 percent of population. Diabetes mellitus was recorded only in 9.51 percent of population. Majority of the study population were Independent according to the total scores obtained from instrument of Activities of Daily living (ADL), which is 91.18 percent of the total participant. Almost 9 percent elderly needs some assistance. The present study showed that Government health facility was the most frequent (54.06%) first place of contact for health care among elderly. Only 22.97 percent of population went to private physician. 7.88 percent visited AYUSH, 5.10 percent Quacks & 9.98 percent used self-medication. The present study identified a high prevalence of morbidities in elderly age. It also pointed out various socio-demographic, nutritional, and environmental modifiable risk factors which can be tackled by effective behavior change communication of the community supported models as practiced in the developed countries.

The characteristics, management, and aftercare of patients with suicide attempts who attended the emergency department of a general hospital in northern Taiwan

BackgroundSuicide is a serious public health problem worldwide. The emergency department (ED) is often the first place of contact with medical and mental health care for suicidal patients. This study aimed to determine the characteristics, management, and aftercare of patients who attempted suicide and then were taken to the ED of a general hospital in Taipei, Taiwan. MethodsOur study was a cross-sectional retrospective study that consecutively recruited patients with suicide attempts attended to the ED of a general hospital from June 2004 to May 2005. The patients' medical information and records pertaining to their emergency visit were subsequently reviewed. ResultsOverall, 481 persons were recruited into our study. The male:female ratio of total surviving attempters was approximately 1:4 and the average age was 33.6 [standard deviation (SD) 12.3] years. The most frequently observed general characteristics from which participants suffered were mental illness (73.1%) and interpersonal problems (76.1%). Nearly all patients (91.7%) received ED on-site psychosocial assessments from social workers (SWs) and psychiatrists in 84.2% and 53.4% of cases, respectively. Less than half of patients (45.1%) were referred to psychiatric outpatient aftercare, and only 26.1% contacted the psychiatric outpatient clinics after discharge from the ED. The stated reasons for psychiatric outpatient referral were associated with interpersonal problems, current psychiatric illness, the ED on-site psychiatrist consultation, and admission to medical, surgical, or psychiatric wards. However, individuals with interpersonal problems, previous psychiatric intervention, and ED on-site psychiatrist consultation were significantly more likely to attend outpatient psychiatric aftercare. ConclusionIndividuals who harmed themselves had a high rate of psychiatric morbidity and interpersonal problems. However, their adherence to psychiatric outpatient aftercare was low. Improved identification of the needs of patients with suicidal tendencies who did not attend outpatient services will have implications for future services provided to this patient population, and will better enable medical personnel to most effectively assist in suicide attempt interventions.

ANALISIS KEPUASAN PASIEN TERHADAP MUTU PELAYANAN DI TPPRJ DI RUMAH SAKIT BHAKTI WIRA TAMTAMA SEMARANG PERIODE TAHUN 2011

Background. Place of registration of outpatients is often regarded as a place of registration, even though this is the place of first contact occurs between patients with officers as the beginning of a ministry. TPPRJ need to be placed on the officer who has a good competency, security services, as well as providing comfort and enjoyment. therefore, researchers wanted to find out patient satisfaction for the quality of service at the TPPRJ about competence officers, security services, as well as the comfort and enjoyment in the hospital. Method. Type of research used is descriptive, with a survey method and study population were patients who enroll in TPPRJ in 2011 with a sample of 98 patients. This research instrument using quisioner with interviews, primary data obtained from quisioner, processed and analyzed descriptively. Result. Results obtained from the research results on aspects of staff competence highest patient satisfaction in terms of officer performance is 92.85%, on the security aspects of patient care the highest satisfaction in terms of security of injury does not occur at the registration counter is equal to 97.95%,on the aspect of comfort and enjoyment of the highest patient satisfaction of service in terms of state of the waiting room in the registration that is equal to 89.79% Conclusion. Of patient opinion about what caused the dissatisfaction of patients in the tpprj then the suggestion that the authors give is more nimble workers in providing care for patients, the TPPRJ more concerned about the ease and speed of service procedures, as well as on the tpprj attention to patient safety while queuing at the counter registration Key words: patient satisfaction, quality of service, TPPRJ.

Reply to queries raised on the article 'the pathway to psychiatric care'.

Byline: Jitendra. Trivedi, A. Jilani Sir, We are happy to receive critical appraisals and queries regarding our editorial article 'Pathway to psychiatric care' published in the Indian Journal of Psychiatry in the year 2011, [sup][1] as it gives us crucial opportunity to further elaborate important unexplored issues regarding mental health in developing nations with particular reference to India. While drafting the above article, we did explore the reality about the existence of a pathway of care in developing nations, including India. It was clear that the government has been creating a structural hierarchical system of health care, which provides a pathway from first point of contact within the community to the tertiary level of specialty hospitals. Though the psychiatric facilities are not available in the beginning of these hierarchal health care systems, e.g., sub-center/primary health center (PHC), but they are able to make sound referrals of patients suffering from psychiatric disorders to the higher level of hierarchy where psychiatric facilities are available, e.g., district hospitals and specialty institutions. With increasing emphasis of government on rural hospitals, more and more specialists are available there. In fact, many state governments make it mandatory for medical doctors and post-graduates to work in rural areas after their education is over. By applying the proposed definition of a pathway of care, [sup][2] a patient getting in the contact with sub-center/PHC being referred to an appropriate place of psychiatric facility without delay will fulfill the concept of a pathway of care, i.e., entry at one point, which gives right directions for getting help at appropriate psychiatric facility significantly reduces the delay in the recognition and initiation of proper management, hence a better outcome. The so-called lacunae in the health care system of developing nations are that unlike gating system in health care of well-developed western countries, [sup][3],[4] a patient suffering with any kind of illness (psychiatric or otherwise) of any severity is free to walk directly for consultation to higher hierarchal level of health care without need of a referral from lower level of hierarchal health care system. This does not mean that pathway does not exist but only that gating is absent. In one aspect, this is better and beneficial not only for psychiatric patients who can easily get help from a specialist health center at the time of emergency without losing the crucial time in getting the referral order from the place of first contact, i.e., sub-center/PHC but also for ease of access where many people still don't use PHCs. Admittedly, this pathway of care where any person is free and permitted to directly consult a specialist, can get overburdened with those patients who do not need emergency care or specialist care and should have been easily managed at a lower level of health care. The way to approach an appropriate place of psychiatric care or other specialist care in developing nations is not always in a sequential manner of hierarchy of the health care system. Hence, the pathway, though not as well-structured or gated as in the West, does exist. The writer [sup][5] seems oblivious of the major attempts by the Government of India. However, our point was not about what the government does but about whether and how community avails itself of the services provided by the government. For the past two decades, realizing the prevalence of severe psychiatric disorders (half of which do reside in the developing nations), the World Health Organization (WHO) and National Mental Health Program (NMHP) in India have been promoting the psychiatric services even at the lower hierarchal level, i.e., PHC for easy and early access within community. [sup][6] Majority of developing nations, including India are implementing the WHO guidelines, for example, the Government of India has initiated the District Mental Health Program (DMHP) under the NMHP for remote and rapid access of psychiatric facility. …

La filière de soin des suicidants aux urgences

In France, a suicide attempt is recorded every 40 seconds, and a death by suicide occurs every 40 minutes. Suicide is the primary cause of mortality in people aged between 15 and 45 years. Suicidal tendencies have been identified as a major public health issue since the 1990s. Mental illnesses (including depression, schizophrenia, and addictions) as well as any personal and family history of suicidal behaviour are major risk factors. Identification and treatment of people in a suicide crisis and/or making a suicide attempt can help prevent repeated suicide attempts. Recommendations for good practice make a hospital, and in particular the emergency departments, a requisite location where a multidisciplinary approach is available. This leads to the need to organize a care process from reception to guidance based on an evaluation in three steps: physical, psychological, and social. The implementation of hospital care and/or intensive outpatient follow-up needs to be adjusted to match each situation. Training general practitioners in detection and treatment of suicidal patients and/or those suffering from depression is critical. Training is also necessary for teams in the emergency departments and in the crisis services with specialisation in handling suicidal adolescents or elderly people in some of them. The emergency wards are also, in a large number of cases, the first place of contact with a psychiatric. The quality of welcoming initial cares, relationships between the nursing staff and carers within the hospital and between the downstream organisations will determine to what extent the patients being treated will continue their treatment, will ensure the continuity of care, and will help to prevent repeated attempts.

Elevated serum dipeptidyl peptidase IV activity in patients with chronic tonsillitis

Palatine tonsils represent the first place of contact for a variety of antigenic substances present in air and food. Upon antigen stimulation, the interactions between T and B lymphocytes in the tonsil are known to depend on the expression of different co-stimulatory molecules, including proteolytic ectoenzymes. Dipeptidyl peptidase IV (DPP IV) and aminopeptidase N (APN), as T lymphocyte co-stimulatory molecules, participate in the regulation of the immune response during inflammation. In this study, the serum and lymphocyte enzymatic activity of DPP IV and APN was investigated in 32 patients, 13 with recurrent tonsillitis (RT) and 19 with tonsillar hypertrophy (TH), before and one month after tonsillectomy. The enzymatic activity of DPP IV and APN in tonsillar lymphocytes and serum was determined kinetically at 37 degrees C using Gly-Pro-p-nitroanilide (for DPP IV) and Ala-p-nitroanilide (for APN) as chromogenic substrates. Significantly higher serum DPP IV and APN activities (P<0.001) were found in TH patients compared with those with RT before tonsillectomy. DPP IV activity in TH patients was also elevated compared with the control of the same age (P<0.001), whereas the activity of APN was the same as the control group. The activity of both enzymes was the same as of controls after tonsillectomy. In addition, the results show that DPP IV and APN activities in serum decrease significantly with age. Tonsillar lymphocytes demonstrated a wide range of DPP IV and APN activities without significant differences between the investigated groups. An increased serum DPP IV activity was observed in TH patients compared with both RT patients and controls before tonsillectomy. After tonsillectomy, all activities were similar. The results suggest that serum DPP IV activity may have potential as a diagnostic marker for patients with TH.