Home Visits Research Articles

Paramedic-Assisted Community Evaluation After Discharge: The PACED Intervention

ObjectivesEarly rehospitalization of frail older adults after hospital discharge is harmful to patients and challenging to hospitals. Mobile integrated health (MIH) programs may be an effective solution for delivering community-based transitional care. The objective of this study was to assess the feasibility and implementation of an MIH transitional care program. DesignPilot clinical trial of a transitional home visit conducted by MIH paramedics within 72 hours of hospital discharge. Setting and ParticipantsPatients aged ≥65 years discharged from an urban hospital with a system-adapted eFrailty index ≥0.24 were eligible to participate. MethodsParticipants were enrolled after hospital discharge. Demographic and clinical information were recorded at enrollment and 30 days after discharge from the electronic health record. Data from a comparison group of patients excluded from enrollment due to geographical location was also abstracted. Primary outcomes were intervention feasibility and implementation, which were reported descriptively. Exploratory clinical outcomes included emergency department (ED) visits and rehospitalization within 30 days. Categorical and continuous group comparisons were conducted using χ2 tests and Kruskal-Wallis testing. Binomial regression was used for comparative outcomes. ResultsOne hundred of 134 eligible individuals (74.6%) were enrolled (median age 81, 64% female). Forty-seven participants were included in the control group (median age 80, 55.2% female). The complete protocol was performed in 92 (92.0%) visits. Paramedics identified acute clinical problems in 23 (23.0%) visits, requested additional services for participants during 34 (34.0%) encounters, and detected medication errors during 34 (34.0%). The risk of 30-day rehospitalization was lower in the Paramedic-Assisted Community Evaluation after Discharge (PACED) group compared with the control (RR, 0.40; CI, 0.19–0.84; P = .03); there was a trend toward decreased risk of 30-day ED visits (RR, 0.61; CI, 0.37–1.37; P = .23). Conclusions and ImplicationsThis pilot study of an MIH transition care program was feasible with high protocol fidelity. It yields preliminary evidence demonstrating a decreased risk of rehospitalization in frail older adults.

Care in the Community: A COVID-19 initiative to reduce hospital re-presentations among community-dwelling people.

The COVID-19 pandemic has had a substantial impact on the utilisation of hospital and emergency department (ED) services. We examined the effect of a rapid response service on hospital re-presentations among people discharged from the ED and short-stay wards at a tertiary referral hospital. This retrospective cohort study compared 112 patients who completed the Care in the Community program with 112 randomly selected controls. Both cases and controls were discharged from hospital between September 2020 and June 2021. Intervention patients were evaluated by a multidisciplinary team, who implemented a goal-directed program of up to 4-weeks duration. Logistic regression, negative binomial regression and Cox proportional hazards regression were used to evaluate outcomes at 28 days and at 6 months. The median time between referral and the first home visit was 3.9 days. In adjusted analyses, the intervention reduced hospital re-presentations at 28 days (odds ratio: .40, 95% confidence interval (CI): .17-.94) and lengthened the time to the first hospital re-presentation (hazard ratio: .59, 95% CI: .38-.92). Although the intervention did not reduce the total number of hospital re-presentations at 6 months (adjusted incidence rate ratio: .73, 95% CI: .49-1.08), it reduced total time spent in hospital by 303 days (582 vs. 885). This study is among the first to investigate the effect of a community-based intervention on hospital re-presentations during the COVID-19 pandemic. It provides evidence that a sustainable 4-week intervention is associated with reduced hospital re-presentations and time spent in hospital.

Interventions for intimate partner violence during the perinatal period: A scoping review: A systematic review.

Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes. This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes. We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed. Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included. We used standard methodological procedures expected by The Campbell Collaboration. In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes. The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.

The effect of multiple nursing interventions on physical activity and health promotion in the elderly: A randomized controlled trial

Health promotion and physical activity practices for the elderly are important but still not sufficient. This study aimed to determine if the effects of education through home visit, mobile application (Google Fit), group walking, and phone reminder interventions on health promotion and physical activity in the elderly. The study has a randomized controlled design with pretest-posttest interventions and a control group. The study sample consisted of 66 elderly individuals, 33 of whom were assigned to the intervention group and 33 to the control group by randomization. Multiple nursing interventions, including education through home visit, mobile application (Google Fit) use, group walking, and phone reminder messages, were implemented by the researcher in line with Pender's Health Promotion Model. The first month score of the intervention group participants on the healthy lifestyle habits subscale was higher than that of the control group participants (all p-values < 0.05). The effect size was 0.577 (high effect size) and the confidence interval was 0.085-1.07. It can be recommended that interventions with reminders and repetitions regarding healthy lifestyle behaviors to health promotion in the elderly be planned.

Home-based transitional cardiac telerehabilitation in older adults post coronary artery bypass grafting: A randomized controlled trial

This randomized controlled trial evaluated the effectiveness of a 12-week home-based transitional cardiac telerehabilitation (Hb-T-CTR) program on health-related quality-of-life and therapeutic self-care in older adults’ post-Coronary Artery Bypass Grafting (CABG). The intervention group (n = 57) underwent Hb-T-CTR, incorporating preoperative counseling, postoperative education, a culturally adapted video, home visits, and telephone counseling, while the control group (n = 61) received standard care. Using the Coronary Revascularization Outcome Questionnaire and the Sidani Doran Therapeutic Self-Care Measure, data were collected at three time points. Results showed significant improvements in overall scores for both health-related quality of life (t1=3.386, P = 0.001; t2=4.224, P < 0.001) and therapeutic self-care (t1=7.104, P < 0.001; t2=4.242, P < 0.001) in the intervention group compared to controls. This telehealth approach provides convenient and accessible rehabilitation services for older adults’ post-CABG and highlights the importance of integrating Hb-T-CTR into routine care for personalized rehabilitation. This study underscores the potential of telehealth tools in overcoming barriers and enhancing patient-centered interventions.

Benefits of a family-based care transition program for older adults after hip fracture surgery

BackgroundHip fracture (HF) in older adults is strongly associated with a greater decline in their activities of daily living (ADLs) and health-related (HRQoL). The present study aimed to evaluate the effects of a family-based care transition program (FBCTP) on ADLs, HRQoL and social support in this age group after HF surgery.MethodsA quasi-experimental design was conducted on 100 older adults who had undergone HFS and were selected by convenience sampling and allocated to the IG (n = 50) and the CG (n = 50). Data were collected utilizing the Barthel Index, the 12-item Short Form Health Survey (SF-12), and the Multidimensional Scale of Perceived Social Support. The FBCTP was delivered in-hospital education sessions, home visit, and a follow-up and telephone counselling session. The data were collected at three stages, including the baseline, four weeks after discharge, and eight weeks later. The level of statistical significance was set at 0.05.ResultsThe results of the study indicated that the effects of time and group on the increase in ADLs were 15.2 and 36.69 (p < 0.000), respectively, following the completion of the FBCTP. Furthermore, time and group were found to have a positive effect on HRQoL, with an increase of 2.82 and 5.60 units, respectively (p < 0.000). In this context, time and group also interacted in the IG compared to the CG, with scores increasing by 1.86 units over time (p < 0.000). Although the study results indicated that social support improved by 1.98 units over time (p < 0.000), the effects of group alone and the time × group interaction were not statistically significant. This indicates that the program was not effective in accelerating social support.ConclusionConsequently, nurses, policymakers, and planners engaged in geriatric healthcare may utilize these results to enhance the health status of this age group following HFS.

Folate deficiency in pregnancy and the risk of preterm birth: A nested case-control study.

Preterm birth (PTB) and its complications are important public health problems. Its aetiology is multifactorial and involves both modifiable and non-modifiable factors. Among the modifiable risk factors, micronutrient deficiencies, including maternal folate deficiency, are increasingly being studied in PTB. In this study, we estimated the prevalence of folate deficiency during pregnancy and examined its association with PTB among rural Bangladeshi women. We conducted a nested case-control study using data from a population-based cohort of 3000 pregnant women who were enrolled between 8 and 19 weeks of gestation following ultrasound confirmation of gestational age. Sociodemographic, epidemiologic, clinical, and pregnancy outcomes data were collected through home visits, while blood samples were collected at enrolment and 24-28 weeks of gestation during pregnancy. We included all women who delivered preterm (defined as live births <37 weeks of gestation) as cases (n = 235) and a random sample of women having a term birth as controls (n = 658). The main exposure was folate concentrations in maternal serum during 24-28 weeks of pregnancy. We categorised women into folate deficient (<3 ng/mL) and not deficient (≥3 ng/mL). We then performed multivariable logistic regression analysis to examine the association between maternal folate levels and PTB, adjusting for relevant covariates. Thirty-eight per cent of the enrolled pregnant women were folate deficient. Maternal serum folate deficiency was significantly associated with PTB (adjusted OR (aOR) = 1.73; 95% confidence interval (CI) = 1.27-2.36). The risk of PTB was also higher among women who were of short stature (aOR = 1.83; 95% CI = 1.27-2.63), primiparous (aOR = 1.60; 95% CI = 1.15-2.22), and had exposure to passive smoking (aOR = 1.54; 95% CI = 1.02-2.31). The prevalence of folate deficiency was high among pregnant women in rural Bangladesh, and folate deficiency was significantly associated with an increased risk of preterm birth.

Analysing the dropout patterns of individual children in Nepal: relationship between school dropout and grade repetition/entrance age

PurposeUsing longitudinal data of children in Nepal, this study examines the relationships between dropouts, grade repetition and the causes of dropout, such as entrance age, to derive concrete recommendations to improve the basic education completion rates in Nepal, one of the targets of Sustainable Development Goal 4 (SDG4).Design/methodology/approachThe data for this study were drawn from school records kept in the target schools, home visit surveys and interviews with principals and teachers. After comparing the repetition experience and the frequency of repetitions between graduates and dropouts, the study analysed the dropout patterns of individual children. The study then examined the effects of repetition and entrance age on children’s schooling.FindingsThe results identified a large group of children who dropped out of school without any repetition, with only 15.9% of the children repeating a grade immediately before dropping out. The findings indicated that harsh family environments, being overage and low educational expectations were factors in sudden dropout.Originality/valueCollecting longitudinal data is difficult in developing countries, and few studies use such data. The question of access to education has been re-ignited by the COVID-19 pandemic; this study used longitudinal data to thoroughly analyse children’s dropout patterns and provide specific recommendations that will contribute to the achievement of SDG4.

The impact of patient registration on utilisation and quality of care: a propensity score matching and staggered difference-in-differences analysis of a cohort of 16,775 people with type 2 diabetes

BackgroundIn 2012, Luxembourg introduced a Referring Doctor (RD) policy, whereby patients voluntarily register with a primary care practitioner, who coordinates patients’ health care and ensures optimal follow-up. We contribute to the limited evidence base on patient registration by evaluating the effects of the RD policy.MethodsWe used data on 16,775 people with type 2 diabetes on oral medication (PWT2D), enrolled with the Luxembourg National Fund from 2010 to 2018. We examined the utilisation of primary and specialist outpatient care, quality of care process indicators, and reimbursed prescribed medicines over the short- (until 2015) and medium-term (until 2018). We used propensity score matching to identify comparable groups of patients with and without an RD. We applied difference-in-differences methods that accounted for patients’ registration with an RD in different years.ResultsThere was low enrolment of PWT2D in the RD programme. The differences-in-differences parallel trends assumption was not met for: general practitioner (GP) consultations, GP home visits (medium-term), HbA1c test (short-term), complete cholesterol test (short-term), kidney function (urine) test (short-term), and the number of repeat prescribed cardiovascular system medicines (short-term). There was a statistically significant increase in the number of: HbA1c tests (medium-term: 0.09 (95% CI: 0.01 to 0.18)); kidney function (blood) tests in the short- (0.10 (95% CI: 0.01 to 0.19)) and medium-term (0.11 (95% CI: 0.03 to 0.20)); kidney function (urine) tests (medium-term: 0.06 (95% CI: 0.02 to 0.10)); repeat prescribed medicines in the short- (0.19 (95% CI: 0.03 to 0.36)) and medium-term (0.18 (95% CI: 0.02 to 0.34)); and repeat prescribed cardiovascular system medicines (medium-term: 0.08 (95% CI: 0.01 to 0.15)). Sensitivity analyses also revealed increases in kidney function (urine) tests (short-term: 0.07 (95% CI: 0.03 to 0.11)) and dental consultations (short-term: 0.06, 95% CI: 0.00 to 0.11), and decreases in specialist consultations (short-term: -0.28, 95% CI: -0.51 to -0.04; medium-term: -0.26, 95% CI: -0.49 to -0.03).ConclusionsThe RD programme had a limited effect on care quality indicators and reimbursed prescribed medicines for PWT2D. Future research should extend the analysis beyond this cohort and explore data linkage to include clinical outcomes and socio-economic characteristics.

Current status and the urgent need for a geriatric healthcare system in a super-aged society

Background: The Korean healthcare system is ill-equipped to manage geriatric diseases, even though we are on the verge of becoming a super-aged society.Current Concepts: In Korea’s delivery of healthcare system, which is centered on subspecialty care from primary to tertiary care, older adults with multiple chronic diseases are forced to receive fragmented care from multiple doctors. In medical education and residency programs, even the most fundamental concepts of geriatrics are misunderstood, and geriatricians receive inadequate training. Consequently, along with the rapidly growing elderly population, elderly patients with complex health problems, frailty, and dysfunction are deprived of the opportunity to achieve healthy aging by taking multiple medications and suffering from geriatric syndromes caused by fragmented medical care.Discussion and Conclusion: Establishing a system for training geriatricians and strengthening geriatric education is necessary to ensure existing specialists can assign them the role of primary care geriatricians. Additionally, person-centered, integrated geriatric care that requires appropriate management of various complex diseases, as well as maintenance of function and frailty prevention, will be possible by establishing a geriatric healthcare system that ranges from frailty prevention, polypharmacy management, and home visits in primary healthcare to multidisciplinary geriatric care and transitional care in tertiary healthcare. Implementing this strategy as early as possible will help older adults age well and reduce the caregiving burden in later life. This could also ease concerns regarding physician shortages induced by the rapidly growing elderly population.

Epidemiological characteristics of fatal drowning and related factors in children in Zhejiang Province, 2022

Objective: To understand the epidemiological characteristics of fatal drowning in children in Zhejiang Province in 2022, analyze factors such as the swimming ability of children, the caregiver behavior at drowning site, types of first aid personnel and methods of first aid of unintentional fatal drowning and provide evidence for targeted intervention. Methods: Using the "Survey Form of Fatal Drowning Case in Children" designed by National Center for Chronic and Non-communicable Disease Control and Prevention of the China CDC, we collected case information of children aged 0-17 years who died due to drowning in Zhejiang in 2022 from medical history/death investigation records, telephone interviews, and home visits. Results: A total of 341 fatal drowning cases in children occurred in Zhejiang in 2022 and 330 cases were investigated (96.77%). The male to female of the cases was 2.33∶1, most cases were aged 15-17 years and 0-4 years, and 54.24% of fatal drowning cases occurred in children from other provinces. In the drowning cases, 83.33% were unintentional ones, and the proportion of intentional fatal drowning cases in children increased with age. Fatal drowning cases mainly occurred in open natural water bodies and public water storage facilities. More fatal drowning cases occurred in open natural water bodies in older children, while more fatal drowning cases occurred in public water storage facilities in younger children. In 275 children who died due to unintentional drowning, 73.09% could not swim, and only 1.09% were fully supervised by adults within an arm's length. First aid personnel, mainly medical staffs, bystanders and adult caregivers, were present for 47.63% fatal drowning cases. The proportion of the cases who had cardiopulmonary resuscitation as the first aid within 5 minutes was 2.18%. Conclusions: Drowning poses a serious threat to children's lives and there are differences in reasons and locations of fatal drowning in children in different age groups in Zhejiang Province in 2022. It is necessary to conduct to interventions to improve children's swimming skills, strengthen effective adult care and conduct health education about field first aid of drowning to reduce the incidence of drowning and related deaths in children.

Effects of home-based EEG neurofeedback training as a non-pharmacological intervention for Parkinson's disease

ObjectivesAberrant movement-related cortical activity has been linked to impaired motor function in Parkinson's disease (PD). Dopaminergic drug treatment can restore these, but dosages and long-term treatment are limited by adverse side-effects. Effective non-pharmacological treatments could help reduce reliance on drugs. This experiment reports the first study of home-based electroencephalographic (EEG) neurofeedback training as a non-pharmacological candidate treatment for PD. Our primary aim was to test the feasibility of our EEG neurofeedback intervention in a home setting. MethodsSixteen people with PD received six home visits comprising symptomology self-reports, a standardised motor assessment, and a precision handgrip force production task while EEG was recorded (visits 1, 2 and 6); and 3 × 1-hr EEG neurofeedback training sessions to supress the EEG mu rhythm before initiating handgrip movements (visits 3 to 5). ResultsParticipants successfully learned to self-regulate mu activity, and this appeared to expedite the initiation of precision movements (i.e., time to reach target handgrip force off-medication pre-intervention = 628 ms, off-medication post-intervention = 564 ms). There was no evidence of wider symptomology reduction (e.g., Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III Motor Examination, off-medication pre-intervention = 29.00, off-medication post intervention = 30.07). Interviews indicated that the intervention was well-received. ConclusionBased on the significant effect of neurofeedback on movement-related cortical activity, positive qualitative reports from participants, and a suggestive benefit to movement initiation, we conclude that home-based neurofeedback for people with PD is a feasible and promising non-pharmacological treatment that warrants further research.

Using tele-paramedicine to conduct in-home fall risk reduction after emergency department discharge: Preliminary data.

Older adults discharged from our emergency department (ED) do not receive comprehensive fall risk evaluations. We conducted a quality improvement project using an existing Community Tele-Paramedicine (CTP) program to perform in-home fall risk assessment and mitigation after ED discharge. High falls-risk patients, as defined by STEADI score >4, were referred for a CTP home visit by community paramedics supervised virtually by emergency physicians. Home hazards assessment, Timed Up and Go test (TUG), medication reconciliation, and psychosocial evaluation were used to develop fall risk mitigation plans. Outcomes assessed at 30 days post ED-discharge included: completed CTP visits, falls, ED revisits, hospital admissions, and referrals. Between November 2022 and June 2023, 104 (65%) patients were discharged and referred to CTP. The mean age of enrolled patients was 80 years, 66% were female, 63% White, 79% on Medicare or Medicaid, most lived with a family member (50%) or alone (38%). Sixty-one (59%) patients received an initial CTP visit, 48 (79%) a follow-up visit, and 12 (11%) declined a visit. Abnormal TUG tests (74%), home hazards (67%), high-risk medications (36%), or need for outpatient follow-up (49%) or additional home services (41%) were frequently identified. At 30 days, only one of the CTP patients reported a fall, one patient had a fall-related ED visit, and one patient was admitted secondary to a fall. A quality improvement initiative using CTP to perform fall risk reduction after ED discharge identified areas of risk mitigation in the home where most falls take place. Further controlled studies are needed to assess the impact of CTP on clinical outcomes important to patients and health systems.

EHealth early intervention programs to support premature parents transitioning from NICU to home on parental and infant outcomes: a systematic review protocol.

This review aims to assess the effectiveness of eHealth early intervention programs in supporting premature infants and their parents transition from neonatal intensive care units (NICUs) to home and the impact of such programs on parental and infant outcomes. The literature has shown the benefits of eHealth early intervention programs to support premature infants and their parents after discharge from NICUs. Parents have reported benefits such as enhanced user-friendliness, increased confidence in infant care, satisfaction, and knowledge acquisition. However, the effectiveness of these programs on parental and infant outcomes remains unclear. This review will consider studies that assess any early intervention program using eHealth to support premature infants and their parents after discharge from NICU. The programs may be initiated during hospitalization or within the first month of discharge. The programs will include interventions that use eHealth components (eg, teleconsultation), either alone or in combination with face-to-face interventions (eg, home visits). This review will consider parental outcomes, including stress, anxiety, competence, and satisfaction, as well as infant outcomes, including health service utilization and cognitive, motor, and social development. This review will follow the JBI methodology for systematic reviews of effectiveness. The search strategy will aim to find both published and unpublished quantitative studies in English, Spanish, and Portuguese, without any geographical or cultural limitations. Two reviewers will independently perform study selection, critical appraisal, and data extraction. The results will be accompanied by a narrative synthesis. If possible, a meta-analysis will be conducted and the Summary of Findings will be presented using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. PROSPERO: CRD42023444721.

Forgotten interventions to promote relational health to prevent child maltreatment

Harsh parenting and intimate partner violence increased during the pandemic. However, pediatrician-led evidence-based models that link primary care, home visiting, and child maltreatment prevention have been neglected, despite C. Henry Kempe’s successful programs from 1971 to 1973. The Kempe randomized trial included comprehensive pediatric follow-up by a single physician and a lay health visitor whenever indicated, and/or weekly visits by a public health nurse in the home 50 years ago. The interventions responded to abnormal parenting practices and early warning signs during pregnancy, labor and delivery, and postnatally and reduced the hospitalization for serious injuries among those 2 years old. The Kempe trial was not cited in many publications but only 402 times in Google Scholar in October 2023. Kempe's call for promoting emotional health and parent bonding 40 years ago was echoed in the American Academy of Pediatrics’ Bright Futures and Policy Statements on Promoting Relational Health in 2021. Relational health is a strengths-based approach, which can promote safe, stable, and nurturing relationships, buffer adversity, and build resilience. Screening for relational health should be integrated into Obstetric and Pediatric Care, and home visitation should become linked to primary care as a basic health benefit. Pediatric care must be transformed based on the evidence in the Kempe trial, focus on promoting primary prevention and trusted relationships from pregnancy on, and engage community resources to address unmet social needs, enabling integrated behavioral health, and changing financial incentives that now prioritize procedures and crisis interventions over cognitive services and prevention. The education and training of future pediatricians needs to emphasize the importance of relational health in the family, and the moment is now to collaborate and implement these forgotten interventions.

Can postpartum depression be prevented with care provided to primiparae using Levine's Conservation Model?: A single-blind randomized controlled trial

The aim of the researchers of this study was to investigate the effectiveness of care given in line with Levine's conservation model in reducing the risk of postpartum depression. There were 56 participants in the experimental group and 56 participants in the control group. To reduce postpartum depression, a nursing care program was created by examining the theoretical structure of Levine's Conservation Model. Seven home visits were paid and a nursing care program was implemented. The first four home visits were paid once a week and the remaining three home visits were paid every 15 days. The women were given trainings on different subjects during each home visits. All the trainings were given in accordance with each conservation model. During the fourth home visit, the researcher who was a Pilates instructor taught the puerperae how to do Pilates exercises by demonstrating the exercises. It was determined that in the puerperae in the experimental group, sleep quality improved, that their postpartum fatigue decreased and energy increased, and that their risk of developing postpartum depression decreased. Holistic care given based on Levine's Conservation model improves symptoms of insomnia, fatigue and depression in postpartum women. Levine's Conservation model can be used in routine care to reduce physical, psychological and social problems experienced by women in the postpartum period.

The Role of the Dentist in Home Care for the Older People: A Narrative Review of the Literature

Objective; This study aimed to discuss the role of dentists in providing home care to older people. Methodology; Studies on the role of the dentist in the oral health of older people living at home were reviewed. The search terms used included: home care, domiciliary care, older people, and oral health. Inclusion criteria comprised articles published in Scielo and Google Scholar databases. The article was categorized to provide a clear exposition of the information. Results; Home Care (HC) in Brazil evolved from an informal practice initiated by sanitary agents in the early 20th century to a structured service with the creation of the Unified Health System (UHS) in 1988. The UHS established programs such as the Family Health Program, which integrated home visits by doctors and nurses, and later incorporated HC in three levels (HC1, HC2, HC3) to address different care complexities. The role of dentists in HC includes promoting oral health, treating urgenties, guiding caregivers, and performing clinical procedures, which are essential for the quality of life of the older people. This approach requires specific handling techniques and professional adaptation, focusing on prevention and less invasive treatments, considering the biopsychosocial health of patients. Conclusion: Home Care Services are crucial, with dentists providing care that includes the prevention and promotion of oral health. HC promotes humanized and comprehensive care, positively impacting the well-being of the older people. Long-term effectiveness depends on prevention, caregiver education, and professional adaptations.

COVID-19 in Scottish care homes: A metapopulation model of spread among residents and staff

The movement of populations between locations and activities can result in complex transmission dynamics, posing significant challenges in controlling infectious diseases like COVID-19. Notably, networks of care homes create an ecosystem where staff and visitor movement acts as a vector for disease transmission, contributing to the heightened risk for their vulnerable communities. Care homes in the UK were disproportionately affected by the first wave of the COVID-19 pandemic, accounting for almost half of COVID-19 deaths during the period of 6th March – 15th June 2020 and so there is a pressing need to explore modelling approaches suitable for such systems. We develop a generic compartmental Susceptible - Exposed - Infectious - Recovered - Dead (SEIRD) metapopulation model, with care home residents, care home workers, and the general population modelled as subpopulations, interacting on a network describing their mixing habits. We illustrate the model application by analysing the spread of COVID-19 over the first wave of the COVID-19 pandemic in the NHS Lothian health board, Scotland. We explicitly model the outbreak’s reproduction rate and care home visitation level over time for each subpopulation and execute a data fit and sensitivity analysis, focusing on parameters responsible for inter-subpopulation mixing: staff-sharing, staff shift patterns and visitation. The results from our sensitivity analysis show that restricting staff sharing between homes and staff interaction with the general public would significantly mitigate the disease burden. Our findings indicate that protecting care home staff from disease, coupled with reductions in staff-sharing across care homes and expedient cancellations of visitations, can significantly reduce the size of outbreaks in care home settings.

Effectiveness of the SETIA (Self Empowering Woman, Empathy, Trust, Intimate and Affection) program in enhancing exclusive breastfeeding in Indonesia

The sustainability of breastfeeding remains a challenge for primiparous mothers. Empowering women through home visits by midwives needs to be enhanced to ensure the continuity of breastfeeding. This research aimed to compare the effectiveness of the SETIA (Self-Empowering Women, Empathy, Trust, Intimacy, and Affection) program with a standard program in assisting primiparous mothers to breastfeed their babies after one month. A total of 50 primiparous participants were divided into two groups through simple random sampling. The standard group received four home visits, while the SETIA group received five home visits within one month postpartum. The breastfeeding competency variable was evaluated after one month using the World Health Organization (WHO) instruments and interviews about exclusive breastfeeding. The variables were analyzed using comparative statistics. The results showed no significant difference between the standard and SETIA groups, with Mann-Whitney U values of 253.5 and Wilcoxon values of 578.5 (p-value=0.086, α&lt;0.05). However, there is evidence that the intervention group managed breastfeeding problems better, and more mothers continued breastfeeding after one month. Therefore, the authors suggest more frequent home visits to help new mothers adapt to their breastfeeding roles, especially in the first week after birth. Further research is needed to assess exclusive breastfeeding after six months in both groups.

Prevalence, trends, and specialized palliative care utilization in Taiwanese children and young adults with life-limiting conditions between 2008 and 2017: a nationwide population-based study

BackgroundPrevious studies have shown a growing need for pediatric palliative care, but there is a lack of knowledge in many countries concerning prevalence of service use among children and young adults with life-limiting conditions. This study aimed to estimate (1) the annual prevalence of children and young adults with a life-limiting condition, and (2) their specialized palliative care and other healthcare utilization.MethodsData from the Health and Welfare Data Science Center in Taiwan were used. All children and young adults aged 0–25 years recorded in inpatient or outpatient data, and infants aged < 1 year in death data with a life-limiting condition diagnostic code from 2008 to 2017 were recruited. Poisson regression was used to estimate the crude and adjusted relative risk of prevalence of life-limiting conditions with 95% confidence intervals, adjusted for age and sex, and to evaluate the trend in prevalence of each life-limiting diagnostic groups, in specialized palliative care and other service use.ResultsData contained 236,250 individuals with a life-limiting condition, of which oncological and congenital abnormalities were the most common. There was an annualized increase over 10 years in the prevalence of life-limiting conditions of 36.4%, from 45,311 cases (59.4 per 10,000 population) to 52,226 cases (81.0 per 10,000 population), with the highest prevalence in individuals aged 21–25 years. All diagnostic groups showed significant increases in prevalence (p < .001) with the exception of oncology, circulatory, and “other” group. Specialized palliative care services, including family consultation, shared care, home visits have increased in use over time (p < .001), while inpatient hospice has slightly decreased. The highest prevalence of healthcare use was for traditional Chinese medicine (237.1 per 1,000 population in 2017), but this decreased over time (p < .001).ConclusionsDue to a growing trend towards multidisciplinary care, healthcare professionals and policymakers must engage and take action to expand specialized palliative care and integrate delivery of other healthcare services. Traditional Chinese medicine having a decreasing slope, yet still the highest prevalence of use, needs further attention.