Integration Of Health Services Research Articles

Information technology-supported integrated health service for older adults in long-term care settings

BackgroundTo examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients.MethodsWe applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention.ResultsWe screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37–4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41–8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24–3.16, p = 0.0042), and number of PIMs use (ꞵ = − 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20–1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75–2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups.ConclusionsThe information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization.Trial registrationClinical Research Information Service, KCT0004360. Registered on 21 October 2019.

Intersectoral health interventions to improve the well-being of people living with type 2 diabetes: a scoping review protocol

IntroductionIntersectoral collaboration is a collaborative approach between the health sectors and other sectors to address the interdependent nature of the social determinants of health associated with chronic diseases such as...

Psychiatric morbidity among patients on treatment for tuberculosis at a tertiary referral hospital in Western Kenya.

Mental disorders account for nine percent of the overall global burden of disease and are among the top ten leading causes of disability. Mental illness and tuberculosis share risk factors including poverty, overcrowding, stigma, poor nutrition, substance use and retro-viral disease co-infection. Presence of mental illness in tuberculosis delays health-seeking, affects drug adherence, increases cost of treatment, prolongs disease duration, lowers quality of life, and increases mortality. Early diagnosis, linkage, and treatment of psychiatric morbidity among patients with tuberculosis would improve outcomes for both. This study thus aimed to determine the prevalence and factors associated with psychiatric morbidity among patients on treatment for tuberculosis at a low- middle- income country. A cross-sectional study carried out at the tuberculosis clinic at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. 367 participants on TB treatment were interviewed using Mini-International Neuropsychiatric Interview (MINI) tool. The key outcome was presence of psychiatric illness. Pearson's Chi-square and logistic regression were used to assess relationships at bivariate and multivariate level respectively. Majority of the respondents were male (61.3%) and overall median age was 33 years. About half of participants (48.5%) had at least one psychiatric illness. Common disorders were alcohol use disorder (30.3%), depression (23.4%), substance use disorder (12.8%) and suicidality (8.2%). Odds of 'any psychiatric illness' were increased by being male (aOR = 1.92; P = 0.04), being separated or divorced (aOR = 6.86; P = 0.002), using alcohol (aOR = 3.2; P<0.001), having been previously treated for tuberculosis (aOR = 2.76; P = 0.01), having other medical comorbidities (aOR = 4.2; P = 0.004) and family history of mental illness (aOR = 2.4; P = 0.049). Almost half of the patients on treatment for tuberculosis had at least one psychiatric illness. Introduction of protocols for screening for mental illness and integration of mental health services with tuberculosis care would aid prompt diagnosis, referral, and quality of care.

Changes in mental health stigma among healthcare professionals and community representatives in Northern Sri Lanka during an mhGAP intervention study.

Research indicates that exposure to conflict, natural disasters, and internal displacement can increase mental health conditions. Since the end of the civil conflict within Sri Lanka, the country has worked to increase access to mental health services to meet the needs of conflict-affected populations, however, gaps remain. To address this, integration of mental health services into primary care can reduce the strain on growing specialized care. As part of a larger study primary care practitioners (doctors), public health professionals (nurses, midwives), and community representatives (teachers, social workers) were trained to deliver mental health services in primary care across the heavily impacted Northern Province. The aim was to reduce mental health stigma among enrolled healthcare workers and community representatives by 50%. Stigma was measured across all participant groups at six time points: pre- and post- initial training at baseline, pre- and post- refresher training 3-months after initial training, and pre- and post- refresher training 6-months after initial training. Results indicate a small improvement in average stigma scores at the 6-month refresher point for primary care practitioners, and no meaningful difference in average scores across time points for public health professionals or community representatives. World Health Organization mhGAP training appears to reduce stigma among primary care practitioners and could be an effective strategy to counteract mental health stigma in low resource settings. Future research should investigate underlying mechanisms of stigma reduction to improve delivery of mental health services in primary care and community settings.

Nurturing an organizational context that supports team-based primary mental health care: A grounded theory study.

The expansion of the Patient-Centred Medical Home model presents a valuable opportunity to enhance the integration of team-based mental health services in primary care settings, thereby meeting the growing demand for such services. Understanding the organizational context of a Patient-Centred Medical Home is crucial for identifying the facilitators and barriers to integrating mental health care within primary care. The main objective of this paper is to present the findings related to the following research question: "What organizational features shape Family Health Teams' capacity to provide mental health services for depression and anxiety across Ontario, Canada?" Adopting a constructivist grounded theory approach, we conducted interviews with various mental health care providers, and administrators within Ontario's Family Health Teams, in addition to engaging provincial policy informants and community stakeholders. Data analysis involved a team-based approach, including code comparison and labelling, with a dedicated data analysis subcommittee convening monthly to explore coded concepts influencing contextual factors. From the 96 interviews conducted, involving 82 participants, key insights emerged on the organizational contextual features considered vital in facilitating team-based mental health care in primary care settings. Five prominent themes were identified: i) mental health explicit in the organizational vision, ii) leadership driving mental health care, iii) developing a mature and stable team, iv) adequate physical space that facilitates team interaction, and v) electronic medical records to facilitate team communication. This study underscores the often-neglected organizational elements that influence primary care teams' capacity to deliver quality mental health care services. It highlights the significance of strong leadership complemented by effective communication and collaboration within teams to enhance their ability to provide mental health care. Strengthening relationships within primary care teams lies at the core of effective healthcare delivery and should be leveraged to improve the integration of mental health care.

Acceptability of Tele-mental Health Services Among Users: A Systematic Review and Meta-analysis

BackgroundMental disorders are currently a global public health concern, particularly after the coronavirus disease 2019 (COVID-19) pandemic. Mental health services gradually transitioned to teleservices, employing various methods like texting and videoconferencing. This meta-analysis aimed mainly to quantify the acceptability of tele-mental health services among both beneficiaries and providers. Secondary objectives included quantifying the usability of and satisfaction with these services.MethodsWe conducted a systematic search of the following databases PubMed Central, SAGE, Google Scholar, Scopus, Web of Science, PubMed Medline, and EBSCO according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022.ResultsOut of 3366 search results, 39 studies fully met the inclusion criteria. The pooled acceptability of tele-mental health services among beneficiaries was [71.0% with a 95% confidence interval (CI) of 63.0 − 78.5%, I2 = 98%]. Using meta-regression, four key factors contributed to this heterogeneity (R2 = 99.75%), namely, year of publication, type of mental disorder, participant category, and the quality of included studies. While acceptability among providers was [66.0% (95%CI, 52.0 − 78.0%), I2 = 95%]. The pooled usability of tele-mental health services among participants was [66.0% (95%CI, 50.0 − 80.0%), I2 = 83%]. Subgroup analysis revealed statistically significant results (p = 0.003), indicating that usability was higher among beneficiaries compared to providers.ConclusionsThe study highlighted a high acceptability of tele-mental health services. These findings suggest a promising outlook for the integration and adoption of tele-mental health services and emphasize the importance of considering user perspectives and addressing provider-specific challenges to enhance overall service delivery and effectiveness.

P105 Healthcare use by women with Joint hypermobility and Ehlers-Danlos syndromes in Northumberland

Abstract Background/Aims In 2017, the diagnosis of Joint Hypermobility Syndrome was withdrawn and combined with hypermobile form of Ehlers-Danlos syndrome (hEDS). International Consortium on Ehlers-Danlos syndromes proposed new clinical criteria for hEDS and it recommended the concept of Hypermobility Spectrum Disorders (HSDs) when these criteria are not met. None of these three diagnostic terms JHS, HSD and hEDS fully explain the complexity of this heterogenous condition as the criteria do not take into account many co-morbidities such as anxiety, autism, ADHD, bowel and bladder issues, pregnancy complications, dysautonomia, allergies, and more. Health services are organised on the assumption that it is a benign musculoskeletal condition. Health burden from both joint hypermobility and the associated co-morbidities is not known as these patients are usually discharged after episodic care by most services that work in silos. Hence we sought to measure the pattern and costs of secondary NHS healthcare use in this patient group. Methods Using primary care clinical systems from 30 of 36 GP surgeries in Northumberland (approximately 300,000 total population), we determined the number of people with SNOMED codes synonymous to hypermobility; ‘Benign joint hypermobility’ or ‘Hypermobility syndrome’ was the code recorded in 90% of patients, with less than 10% coded as EDS or subtypes. For the purpose of statistical analysis, we grouped all under the newer diagnostic terms hEDS/HSD. RAIDR, the UK’s leading health intelligence tool, was used to compare secondary healthcare activity and costs between patients with and without hEDS/HSD in Northumberland. Results Prevalence of hEDS/HSD in GP records was 4.4 per 1000. Women of childbearing age are affected more than men (Male : Female ratio 3:1). Hospital admissions to General Medicine, Obstetrics &amp; Gynaecology, Surgery, and Orthopaedics were significantly higher in women with hEDS/HSD. Outpatient attendances to Rheumatology, Physiotherapy, Orthopaedics, and Obstetrics &amp; Gynaecology were also higher in women. Male patients with hEDS/HSD where younger than female patients; they presented more often to mental health, physiotherapy and paediatric outpatients compared to those without hEDS/HSD. The cost of secondary care treatment per patient with hEDS/HSD during 2022 was £932.37 compared to £731.88 in those without. For 1,302 patients with diagnoses synonymous with hEDS/HSD, the total additional cost for A&amp;E, Acute Inpatient and Outpatients in 2022 was £261,037. This excludes mental healthcare costs, although there were around twice the number of appointments. Conclusion We found a diagnosed prevalence of hEDS/HSD of one in 227 people in Northumberland. These patients have a significantly higher usage of secondary care, and thereby a higher average healthcare utilisation cost. The next steps would be expansion of this study, along with more in-depth analysis of reasons for secondary healthcare usage. This should inform commissioning of appropriate integrated health services for people with these complex conditions. Disclosure V. Saravanan: None. E. Reinhold: None. J. Demmler: None. I. Loughran: None. B. Frankel: None.

Implementation of Integrated Health Service and Promotion Posts for Non-Communicable Diseases (NCDs) to Improve Knowledge, Anthropometric and Nutritional Counseling Skills of Adolescent Cadres in Schools

Non-communicable diseases (NCDs) risk factors include changes in the lifestyle of adolescents with unhealthy diets tend to fast food, lack of activity and exercise, increased stressors, and exposure to environmental conditions that are not conducive to health. Establishing NCDs Integrated Health Service and Promotion Post is an efficient and effective control strategy aiming at early detection of NCDs risk factors. Empowerment of peer counsellors as Integrated Development Post cadres is expected to become agents of change and detect NCDs risk factors in schools. This research determines the effectiveness of implementing an adolescent-Integrated Development Post in schools to increase the adolescent cadre’s knowledge, anthropometric skills, and nutritional counseling. It is an experimental design with one group pre-post test at one of the high schools in Semarang City. Integrated Development Post cadres are peer counselors selected according to the criteria of 10% of the total number of students (36 people) from 11th grade. Differences in knowledge scores, anthropometric skills, and nutritional counseling of cadres were analyzed using the Paired T-test. The cadre’s knowledge scores increased from 50.55 to 70.11; anthropometric skills include weighing from 61.67 to 98.98, measuring height from 54.63 to 94.25, and nutritional counseling from 72.92 to 86.71. Paired T-test results show a &lt;em&gt;p&lt;/em&gt;-value &amp;lt; 0.05. Integrated Development Post effectively increases cadre’s knowledge scores, anthropometric skills, and nutritional counseling. It can also detect risk factors to prevent and control NCDs in the school.

Towards Evidence-based Care: Promoting Cognitive Well-being of Older People

The article by Mamayson and Lacanaria 1 in Acta Medica Philippina summarized the available evidence on the effects of cognitively stimulating activities (CSA) on the overall cognitive functioning of older people with mild cognitive impairment(MCI). Aside from the new evidence, it also provided insights on how the findings of study will inform the nursing profession in terms of clinical practice, leadership and policy, research, and education.&#x0D; Utilizing a meta-analysis of three randomized controlled trials (RCTs), the authors reported that cognitive training using CSA improves overall cognitive function among older people with MCI. 1 Calligraphy, cognitive, and language trainings werethe cognitively stimulating activities included in the reviewed RCTs which were conducted over the past years in Hong Kong, China, and Greece, respectively. The authors acknowledged that such activities are effective and practical, inexpensive, non- pharmacological approaches to slow down cognitive decline. 1 The strength of the paper is the inclusion of good methodical quality studies and only RCTs which are considered gold standard for evaluating the effectiveness of interventions. However, the authors emphasized that the interpretation of study results requires caution. This is due to the small number of studies reviewed which limits the generalizability of the findings.&#x0D; Older people with mild cognitive impairment are at increased risk of dementia since aging is a primary predictor of MCI progression to dementia. 2 The Global Action Plan on the Public Health Response to Dementia 2017-2025 outlined the growing consensus on protective measures which can reduce the risk of cognitive decline and dementia. These measures include healthy lifestyle (e.g., physical activity, balanced diet, smoking, and alcohol cessation), management of hypertension and diabetes, social engagement, and promotion of cognitively stimulating activities and learning. 3 These are aligned with the recommendations of the Lancet Commission which emphasized that dementia prevention is about policy and individuals. Preventive actions require both public health strategies and individually-tailored interventions. 4&#x0D; In the Philippines and as mandated by the Republic Act No. 9994 or also known as the Expanded Senior Citizens Act, the Department of Health (DOH) in coordination with relevant stakeholders shall institute a national health program andprovide an integrated health service for senior citizens. 5 The DOH developed the Health and Wellness Program for Senior Citizens 6 and several policies on the care of older people 7,8 . Specific policies relevant to cognition include the 2022 Omnibus Health Guidelines for the Elderly. The guidelines contain the conduct of cognitive stimulation therapy by a psychologist or mental health specialist for people with cognitive decline who may benefit from cognitive stimulation. 7 The implementation of this specific guideline is challenging due to the limited number of health workforce. In particular, there are only approximately 1600 psychologists and 500 psychiatrists serving about 110 million Filipinos. 9&#x0D; In the era of and prior to the introduction of evidence-based practice, nurses are one of the major key players in the care of older people. The study of Mamayson and Lacanaria added evidence which will be useful in guiding the current and future professional nursing practice. 1 Nurses can promote cognitive wellness by educating the older patient, family members, and the community on the importance of engaging in appropriate cognitively stimulating activities and the potential benefits of these non-pharmacological approaches. The recommendations on the incorporation of the findings into the gerontology courses, introduction of certification programs for dementia and MCI care specialists, and advocating for policy changes call for action. These recommendations can be put into action in close coordination with the right stakeholders. The involvement of key national government agencies namely Commission on Higher Education, Professional Regulation Commission, Department of Health, National Commission of Senior Citizens, as well as academic institutions, and professional societies such as the Philippine Nurses Association, Gerontology Nurses Association of the Philippines, and the Philippine Society of Geriatrics and Gerontology is crucial.&#x0D; The research recommendations outlined by Mamayson and Lacanaria highlighted the conduct of future studies with larger samples, longer follow ups, less language restrictions, and more rigorous analysis. 1 It is notable that no local study oncognitively stimulating activities that was cited or included in the review. Given this, the country should strengthen local evidence generation to develop age-, gender-, culturally-sensitive, and responsive interventions. The most recent NationalUnified Health Research Agenda of the Philippines included geriatric health and tailoring novel mental health interventions to different life-stages as priority topics. 10 This is an opportunity for professional societies, academe, and research institutions to pursue research, contribute to the local evidence base, promote cognitive well-being, and ultimately, improve the care and quality of life of older Filipinos.

Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam.

The prevalence of common perinatal mental disorders in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps have been identified at all levels. This paper explores constraints to the integration of maternal and mental health services at the primary healthcare level and the implications for the health system's responsiveness to the needs and expectations of pregnant women with mental health conditions in Vietnam. As part of the RESPONSE project, a three-phased realist evaluation study, we present Phase One findings which employed systematic and scoping literature reviews, and qualitative data collection (focus groups and interviews) with key health system actors, in Bac Giang province, Vietnam, to understand the barriers to maternal mental healthcare provision, utilisation, and integration strategies. A four-level framing of the barriers to integrating perinatal mental health services in Vietnam was used in reporting findings, which comprised individual, socio-cultural, organisational, and structural levels. At the socio-cultural and structural levels, these barriers included: cultural beliefs about the holistic notion of physical and mental health, stigma towards mental health, biomedical approach to healthcare services, absence of comprehensive mental health policy, and a lack of mental health workforce. At the organisational level, there was absence of clinical guidelines on the integration of mental health in routine antenatal visits, a shortage of staff, and poor health facilities. Finally, at the provider level, a lack of knowledge and training on mental health was identified. The integration of mental health into routine antenatal visits at the primary care level has the potential help to reduce stigma towards mental health and improve health system responsiveness by providing services closer to the local level, offering prompt attention, better choice of services, and better communication while ensuring privacy and confidentiality of services. This can improve the demand for mental health services and help reduce the delay of care-seeking.

Komunikasi Kesehatan Mental untuk Menciptakan Kepuasan Pengguna Telemedicine

Communication through mobile apps is still looking for a better form, how to be carried out effectively, and how to be well received by the audience. One of the mobile apps widely used by the public today is telemedicine, which offers the integration of various health services. In health communications, the message sent by the doctor is proven to affect patient satisfaction. However, no studies on user satisfaction with telemedicine regarding mental health have been found. One telemedicine service in Indonesia is Halodoc, which provides psychological consultation and mental health articles. This study seeks to prove whether the quality of psychological consultation messages and mental health articles affects Halodoc user satisfaction. Concepts used are health communication, communication psychology, interpersonal communication, message quality, and customer satisfaction. With the quantitative method, this research sampling technique was purposive sampling. Questionnaires were distributed through Google Docs to 100 male and female respondents over 17 years old who had psychological consultations and read mental health articles through Halodoc in the last six months. With all the significant values being 0,000, this study finds out the effect of message in psychological consultation (0,461), mental health articles (0,469), and both together (0,560) on telemedicine user satisfaction.

Exploring Effective Approaches: Integrating Mental Health Services into HIV Clinics in Northern Uganda.

Integrating mental health services into HIV clinics is recognized as a promising strategy. However, the literature reveals gaps, particularly in the unique context of Northern Uganda, where factors such as historical conflict, stigma, and limited resources pose potential barriers. This qualitative study, conducted between October and November 2023, employed a phenomenological design. The study involved primary healthcare facilities across diverse urban and rural settings, focusing on healthcare providers, village health teams, and service users. A purposive sampling approach ensured diverse demographics and perspectives. In-depth interviews and focus group discussions were conducted, with healthcare providers and service users participating individually, and village health teams engaged in group discussions. Thematic analysis was employed during data analysis. Findings revealed a predominance of females among healthcare providers (18 of 30) and service users (16 of 25), as well as in VHTs. Average ages were 33.4 (healthcare providers), 38.5 (service users), and 35.1 (VHTs). Most healthcare providers (15) held diplomas, while 12 service users and 4 VHTs had certificates. The majority of healthcare providers (n=20) and 4 VHTs had 6-10 years of experience. Thematic analysis highlighted three key themes: benefits of integrated mental health services, implementation challenges, and the role of community engagement and cultural sensitivity. This study contributes valuable insights into the integration of mental health services into HIV clinics in Northern Uganda. The perceived benefits, challenges, and importance of cultural sensitivity and community engagement should guide future interventions, fostering a holistic approach that enhances the overall well-being of individuals living with HIV/AIDS in the region. Policymakers can use this information to advocate for resource allocation, training programs, and policy changes that support the integration of mental health services into HIV clinics in a way that addresses the identified challenges.

Improving Access to Care Through Youth-Focused Virtual Sexual Health Navigation

PurposeGender and sexually diverse adolescents and young adults in Baltimore City, Maryland, are disproportionately impacted by HIV. The Virtual and Online Integrated Sexual Health Services for Youth program is a health navigation program which combines virtual sexual health service delivery and health navigation to link youth at risk for HIV acquisition to HIV testing/prevention and sexual healthcare services. MethodsYouth between 13 and 26 years old and residing in the Baltimore area were eligible to participate in the program. Demographic and engagement data from 238 youth (average age 21.4, SD = 2.5) who requested navigation were collected and recorded in a Health Insurance Portability and Accountability Act (HIPAA)-secure medical database and examined for associations between demographics, referral source, and the number of navigational services to which they were linked. Focused populations were defined as residents of high HIV prevalence zip codes who identify as sexual and gender diverse youth. ResultsReceipt of navigational services was significantly associated with self-identifying as sexually diverse. A multivariate regression revealed a significant association between the count of navigational services a youth was linked to and recording one's sexual orientation, identifying as a cisgender male, and residing in a high HIV-prevalence zip code. DiscussionVirtual health navigation has the potential to engage priority populations, including sexual and gender diverse youth. By refining linkage and identification approaches to health navigation, future outreach attempts can be tailored to support vulnerable communities, with the potential to improve sexual healthcare access.

Operationalizing the Consolidated Framework for Implementation Research to build and support the lived experience workforce in direct health service provision.

The involvement of people with lived experience (LEX) workers in the development, design, and delivery of integrated health services seeks to improve service user engagement and health outcomes and reduce healthcare gaps. Yet, LEX workers report feeling undervalued and having limited influence on service delivery. There is a need for systematic improvements in how LEX workforces are engaged and supported to ensure the LEX workforce can fully contribute to integrated systems of care. This study aimed to operationalize the Consolidated Framework for Implementation Research (CFIR) using a rigorous scoping review methodology and co-creation process, so it could be used by health services seeking to build and strengthen their LEX workforce. A systematic literature search of four databases was undertaken to identify peer-reviewed studies published between 2016 and 2022 providing evidence of the inclusion of LEX workers in direct health service provision. A descriptive-analytical method was used to map current evidence of LEXworkers onto the CFIR. Then, co-creation sessions with LEX workers (n = 4) and their counterparts-nonpeer workers (n = 2)-further clarified the structural policies and strategies that allow people with LEX to actively participate in the provision and enhancement of integrated health service delivery. Essential components underpinning the successful integration of LEX roles included: the capacity to engage in a co-creation process with individuals with LEX before the implementation of the role or intervention; and enhanced representation of LEX across organizational structures. The adapted CFIR for LEX workers (CFIR-LEX) that was developed as a result of this work clarifies contextual components that support the successful integration of LEX roles into the development, design,and delivery of integrated health services. Further work must be done to operationalize the framework in a local context and to better understand the ongoing application of the framework in a health setting. People with LEX were involved in the operationalization of the CFIR, including contributing their expertise to the domain adaptations that were relevant to the LEX workforce.

The Application and Ethical Issues of Digital Mental Health Services

The widespread popularity of digital technology has brought about significant changes in the treatment of mental health problems. Traditional mental health services can no longer meet the needs of society for mental health, and digital mental health services are developing vigorously. Digital mental health services have shown significant advantages in rapid diagnosis, improving mental health, and improving mental service efficiency. This article outlines the development and application of mental health services so far. On the basis of describing the various uses of digital psychological intervention measures, it focuses on the ethical issues faced by the current application of digital mental health services, such as privacy and data security caused by Big data, potential ethical risks caused by digital technology, insufficient clinical verification, imperfect market regulations and professional threats to psychological workers. To ensure the rational and compliant use of digital technology in the field of mental health, this article discusses the ethical problem- solving directions of current digital mental health services from three levels: technical policies, ethical norms and systems, and social individuals, in order to promote the integration of digital technology and mental health services and improve the quality and efficiency of digital mental health services.

East Meets West: Effect of Acupuncture on Lactation and Maternal Quality of Life.

Objective: To evaluate the impact of acupuncture as part of a traditional Chinese medicine (TCM) treatment plan on lactation and maternal well-being in pump-dependent mothers of hospitalized neonates during the first 30 days after delivery. Study Design: This single-center study was conducted in a level IV regional neonatal intensive care unit with access to integrative health services. Sixty-six mothers were prospectively enrolled in two nonparallel groups: (1) Standard lactation support and (2) standard lactation support augmented with acupuncture. Daily pump volumes were documented. Participants completed a quality-of-life (QOL) survey at baseline and neonatal day of life 30. A linear model was constructed, adjusting for increased milk production over time. Results: Acupuncture was associated with increased milk production at all time points: Day 10 (p = 0.0002), day 14 (p < 0.0001), day 21 (p < 0.0001), and day 30 (p < 0.0001). Acupuncture was associated with an increase in three of five QOL components: psychological/child's health (p = 0.0006), family/friend relationship (p = 0.0006), and health/functioning (p = 0.02). Conclusion: Mothers receiving acupuncture reported enhanced milk supply and improved QOL. The limited sample size restricts the broad applicability of the results; nonetheless, this study paves the way for further research on the advantages of merging Eastern and Western treatments to enhance human lactation.

REVIEW AND INTEGRATION OF MENTAL HEALTH AND SUBSTANCE USE SERVICES IN PUBLIC HEALTH INITIATIVES

The intersection of mental health and substance use presents a complex challenge for public health initiatives globally. This review delves into the critical review and integration of mental health and substance use services within public health frameworks. Understanding the intricate relationship between mental health disorders and substance abuse is pivotal in designing effective interventions and policies. The review examines existing literature, policies, and programs aimed at addressing mental health and substance use disorders within public health initiatives. It highlights the interconnectedness of these issues and the need for integrated approaches that consider the biopsychosocial aspects of individuals' well-being. Furthermore, it explores the prevalence of comorbidity and the implications it poses for treatment outcomes and resource allocation. Integration of mental health and substance use services into public health initiatives involves the collaboration of various stakeholders, including healthcare providers, policymakers, community organizations, and individuals with lived experiences. Strategies such as co-location of services, cross-training of professionals, and implementation of evidence-based practices are essential for fostering synergy and enhancing service delivery. Moreover, the review discusses the importance of destigmatizing mental health and substance use disorders to facilitate help-seeking behavior and access to care. Public awareness campaigns and educational initiatives play a crucial role in challenging misconceptions and promoting a culture of acceptance and support. This review underscores the significance of reviewing and integrating mental health and substance use services within public health initiatives. It advocates for a holistic approach that addresses the complex needs of individuals while striving for equity, accessibility, and quality in service provision.&#x0D; Keywords: Mental Health, Healthcare, Public Health, Services, Cross-training, Review.

Reconceptualizing transnational knowledge transfer in mental health services: Reflection upon the postcolonial era

Knowledge transfer in global mental health services has long been depicted from Western perspectives. This article destabilizes this discourse through a conceptual model that integrates the top-down approach (macro postcolonial context, meso transnational knowledge transfer and micro mental health programmes) and the bottom-up approach (the roles of transcreation in reconfiguring micro mental health intervention, meso mental health services integration and macro policy advocacy and reform). This article raises social workers’ awareness of ongoing development of mental health services from a decolonizing perspective, and guides social work research and practice to continue the decolonization of global mental health services.

Community-embedded follow-up management intervention for geriatric primary care: a mixed-methods study of an integrated health services model

BackgroundTo propose a community-embedded follow-up management model to provide health services for elderly patients with osteoporosis who live alone.MethodsResearchers randomly selected 396 people with osteoporosis living alone from five communities in Nantong, China, for the study. These participants were randomly assigned to control and intervention groups. Twenty-four community physicians in five communities provided professional support based on a community-embedded follow-up management model. Participants completed quantitative questionnaires at baseline and after the 6-month follow-up intervention, and some participants underwent semi-structured face-to-face interviews. The primary outcome is the effectiveness of the community-embedded follow-up management model in improving the quality of life of elderly patients with osteoporosis living alone. Based on an objective quantitative assessment, the qualitative study explains and adds essential components of this community-based follow-up management model.ResultsThe quantitative study showed that scores in physical functioning, ability to perform daily activities, self-efficacy, and mental status were significantly improved in the intervention group compared to the control group (p < 0.05). The most significant improvements were found in “mental status” (p = 0.012) and “self-care skills” (p = 0.003). The qualitative study reported the essential elements of a community healthcare model for older people living alone with osteoporosis, including professional support, personalized services, social support, and empowerment.ConclusionsCommunity-embedded follow-up management meets the need for elderly patients with osteoporosis living alone. It helps to improve health perception, promote physical and mental health, and optimize the quality of life in this population. Personalized services and professional support are two major contributing factors to effective embedded follow-up management in the community.

Implementation of Web Based (Sisrute) Application Patient Referral From Public Health Center in Pamekasan

Health service referrals are a form of health service that regulates the delegation of duties and responsibilities for health services with the aim of healing and restoring the patient's health status. One important aspect in human life is health referrals which require fast, practical, efficient and accurate and reliable information. The purpose of this study was to determine to what extent the implementation of the web-based community health center patient referral application (SISRUTE) in Pamekasan can overcome obstacles in medical referrals, making it easier for health workers to optimize health services. The method used in this research is a qualitative approach which is defined as a research procedure that produces descriptive data which aims to reveal the in-depth meaning behind a phenomenon. Data were collected using Purposive Sampling with in-depth interview techniques by asking 13 questions consisting of 8 nurses and 5 midwife accompanied by 1 Triangulator, head of the Pamekasan district referral department. Data collection techniques use observation, interviews, documentation and case studies. From the results of this research it is known that the implementation of the use of the integrated referral system application (SISRUTE) in Pamekasan district for individual health service referrals can improve the quality, coverage, effectiveness and efficiency of integrated health services with the help of supporting facilities and infrastructure as well as the ability of human resources to operate, and with the web referral application, health workers feel that it is very helpful in speeding up patient referrals to the next level of health facilities.