Long-term Health Care Research Articles

The costs of chronic pain-Long-term estimates.

Chronic pain is a condition with severe impact on many aspects of life, including work, functional ability and quality of life, thereby reducing physical, mental and social well-being. Despite the high prevalence and burden of chronic pain, it has received disproportionally little attention in research and public policy and the societal costs of chronic pain remain largely unknown. This study aimed to describe the long-term healthcare and work absence costs of individuals with and without self-identified chronic pain. The study population were participants in two Norwegian population health studies (HUNT3 and Tromsø6). Participants were defined as having chronic pain based on a self-reported answer to a question on chronic pain in the health studies in 2008. Individuals in the study population were linked to four national register databases on healthcare resource use and work absence. In our study, 36% (n = 63,782) self-reported to have chronic pain and the average years of age was 56.6. The accumulated difference in costs between those with and without chronic pain from 2010 to 2016 was €55,003 (CI: 54,414-55,592) per individual. Extrapolating this to the entire population suggests that chronic pain imposes a yearly burden of 4% of GDP. Eighty per cent of the costs were estimated to be productivity loss. Insights from this study can provide a greater understanding of the extent of healthcare use and productivity loss by those with chronic pain and serve as an important basis for improvements in rehabilitation and quality of care, and the education of the public on the burden of chronic pain. This was the first study to estimate the economic burden associated with chronic pain in the general population using linked individual-level administrative data and self-reported survey answers. We provide calculations showing that annual costs of chronic pain may be as high as €12 billion or 4% of GDP. Findings from this study highlight the need for a greater understanding of the substantial healthcare use and productivity losses among individuals with chronic pain.

Disease Trends in Children and Adolescents in Japan: A Retrospective Observational Study Using the Nationwide Claims Data for 2012-2016.

This study aimed to clarify diseases that occur more frequently by age and identify the peaks and trends of each disease from infancy to adolescence for early detection and treatment. This retrospective observational study was conducted using Japan's National Database of Health Insurance Claims Specific Health Checkups from January 2012 to December 2016. Using peak ages and trends in the number of patients, we grouped diseases by the International Classification of Diseases chapters. Although diseases that peaked during infancy were the most common (10 disease chapters), other diseases peaked at school-going age and adolescence. Diseases in four chapters peaked during adolescence and continued to increase toward the age of 18. These four chapters included mental, behavioral, and neurodevelopmental disorders; diseases of the nervous system; the genitourinary system; and pregnancy, childbirth, and the puerperium. Childhood-onset diseases can affect long-term health and healthcare needs, and timely screening and guidance based on disease trends can provide an effective intervention. To establish a child healthcare system that provides preventive support for children and adolescents' physical, psychological, and social health, further research is needed to comprehensively understand the issues per age and developmental stage.

Food Processing and Nutrition Strategies for Improving the Health of Elderly People with Dysphagia: A Review of Recent Developments.

Dysphagia, or swallowing difficulty, is a common morbidity affecting 10% to 33% of the elderly population. Individuals with dysphagia can experience appetite, reduction, weight loss, and malnutrition as well as even aspiration, dehydration, and long-term healthcare issues. However, current therapies to treat dysphagia can routinely cause discomfort and pain to patients. To prevent these risks, a non-traumatic and effective treatment of diet modification for safe chewing and swallowing is urgently needed for the elderly. This review mainly summarizes the chewing and swallowing changes in the elderly, as well as important risk factors and potential consequences of dysphagia. In addition, three texture-modified food processing strategies to prepare special foods for the aged, as well as the current statuses and future trends of such foods, are discussed. Nonthermal food technologies, gelation, and 3D printing techniques have been developed to prepare soft, moist, and palatable texture-modified foods for chewing and swallowing safety in elderly individuals. In addition, flavor enhancement and nutrition enrichment are also considered to compensate for the loss of sensory experience and nutrients. Given the trend of population aging, multidisciplinary cooperation for dysphagia management should be a top priority.

Experience and perceptions of Social Prescribing interventions; a qualitative study with people with long-term conditions, link workers and health care providers

Background Long-term conditions (LTC) are a leading cause of reduced quality of life and early mortality. People with LTC are living longer with increasing economic and social needs. Novel patient centred care pathways are required to support traditional medical management of these patients. Social Prescribing (SP) has gained popularity as a non-medical approach to support patients with LTC and their unmet health needs. The current focus group study aims to explore the experiences and perceptions to SP interventions from the perspective of people with long-term conditions, link workers, healthcare providers and community-based services. Methods Six toeight participants will be recruited into three specific 60 to 90 minute focus groups relative to their role as a patient, link worker and community-based service. 8 to12 participants with a Health care provider and GP background will be interviewed individually online. The participants within these focus groups and semi-structured interviews will be invited to provide opinions on what factors they think are important to the successful implementation of a SP service from their respective stakeholder positions. The data will be recorded and exported to NVivo software for further analysis using Thematic Reflexive analysis methods. Coded categorical data will inform emerging themes from which a narrative summary will be consolidated and presented for dissemination. Conclusion The conclusions made from this study will help inform the next study, which will aim to develop a pilot SP service for patients with long-term musculoskeletal conditions as part of an overall larger project.

An integrative systematic review of nurses' involvement in medication deprescription in long-term healthcare settings for older people.

Deprescription of medications for older people in long-term care settings is crucial to enhance medication safety by reducing polypharmacy and minimizing related adverse events. Nurses as the member of the multidisciplinary healthcare team can support deprescription initiatives, but there is a gap in comprehensive knowledge about their roles. To investigate the role and contribution of nurses in deprescribing medications within the multidisciplinary pharmaceutical care context of long-term healthcare for older people. A systematic review utilizing an integrative approach was performed. Multiple databases were searched, including PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest and Embase, focusing on studies published in English from 2014 to 2024. The preliminary search yielded 4872 studies, which were then refined to 32 qualitative and quantitative studies chosen for data analysis and narrative synthesis. Thematic comparisons and analysis led to the creation of meaningful categories integrating the studies' findings to meet the review's objective. The review findings were classified into categories: 'necessity and benefits of deprescribing', 'multidisciplinary collaboration for deprescribing', 'nurse role in deprescribing', 'identified challenges to deprescribing', 'involvement of older people and families in deprescribing'. They illustrated and exemplified various aspects of nurses' roles and contributions in deprescription initiatives within the multidisciplinary pharmaceutical care team, such as support for reducing doses, discontinuing medications or transitioning to safer alternatives, as well as factors influencing this process. The main dimensions of nurses' roles and contributions in deprescription initiatives encompass monitoring, communicating and educating. Challenges to nurses' active participation in deprescribing, such as the need for increased knowledge, confidence and inclusion in team discussions, should be addressed through education, training and changing attitudes. These steps are essential for improving the safety of medication deprescribing in long-term care settings. The review was registered under PROSPERO ID: CRD42023486484, and can be accessed at crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486484.

Correlation Between CT Density, Incidence, Mortality, and Mortality-to-Incidence Ratio in Central Nervous System Cancers: An Exploratory Analysis of Global Data.

Cancers of the central nervous system (CNS) pose a significant burden, despite their relatively low incidence compared to other types of cancers. The mortality-to-incidence ratio (MIR) is a crucial indicator of long-term survival and healthcare system performance. Computed tomography (CT) plays a crucial role in the screening, diagnosis, and monitoring of brain tumors, enabling early intervention and treatment. This study aimed to explore the relationship between CT density, CNS cancer incidence, mortality, and MIR to investigate regional variations in CT utilization and their impact on CNS cancer mortality rates. Changes in MIR, referred to as δMIR, were calculated based on data from 2012 and 2018. CT density data for the year 2013 were retrieved from the Global Health Observatory data repository. The association between variables was analyzed using Spearman's rank correlation coefficient. Analysis of data from 107 countries revealed a positive association between CT density and both CNS cancer incidence and mortality. However, a trend was observed between CT density and MIR. These findings suggest that in countries with greater accessibility to CT imaging, CNS cancer cases may be detected earlier and lower mortality rates can be achieved. Our research contributes to the understanding of the impact of CT imaging on the management and outcomes of CNS cancers. It informs healthcare strategies and resource allocation to improve patient care.

Long term cost outcomes among commercially insured patients undergoing bariatric surgical procedures.

Bariatric procedures have become safer in recent years, warranting new data on long-term costs. This study examined the impact of bariatric procedures on a person's long-term healthcare costs up to 10years and if it differed by socio-economic status (SES). This retrospective observational study compared the downstream health care cost of patients with obesity who had undergone bariatric surgery (BS) between 2009 and 2018 to a 1:1 matched group of members with obesity but no surgery. 167,764 individuals from administrative claims data with an obesity diagnosis were included; 83,882 in the BS group and 83,882 in the non-surgical group. In follow-up years 2-10, the BS group was associated with lower total medical healthcare cost compared to the non-surgical group (cost ratios ranged 0.85-0.93, p values<0.05). When stratifying the BS group by SES quartiles, there were no significant cost differences by SES (cost ratios ranged from 0.96 to 1.05, most p values>0.05). BS was associated with lower long-term follow-up medical cost and cost savings appeared similar among the SES quartiles in the BS group. The study results may help policy makers and employers in designing benefits and extending coverage for bariatric surgical procedures.

Impact of functional independence and sociodemographic factors on post-stroke discharge destination in a super-aged rural community in Japan.

Objective: This study aimed to clarify the factors influencing the discharge destination of stroke patients in a super-aged rural community in Japan, focusing on functional independence and sociodemographic factors. Patients and Methods: We enrolled patients recovering from stroke with supratentorial lesions who were admitted to our convalescent rehabilitation hospital. The motor components of the Functional Independence Measure (FIM-motor) were assessed for each patient at admission and discharge as explanatory variables. An increase in the FIM-motor scores during hospitalization was also recorded. Additionally, sociodemographic data such as sex, age, and clinical characteristics, such as type of stroke, history of stroke, days from stroke onset to transfer to our convalescent rehabilitation hospital, total duration of hospital stay including acute care, number of co-resident household members, living with a spouse, and number of children were collected. As target values, discharge outcomes were categorized into two groups: returning home and going to a nursing home. Logistic regression analysis was performed. Results: The study sample comprised 160 patients (mean age ± standard deviation, 74.80 ± 12.19 years). Of these, 114 were discharged to their homes, and 46 were transferred to nursing homes. The results of multivariate logistic regression analysis indicated that higher FIM-motor scores at discharge, greater number of co-resident household members, and living with one's spouse were the most powerful predictors of a higher probability of returning home. Conclusion: This study demonstrated that functional independence levels and the number of co-resident household members were crucial factors in predicting the discharge destination of patients after stroke in a super-aged rural community in Japan. These findings imply that for older patients with lower functional independence, supportive social networks are essential for home discharge, offering clues for providing long-term healthcare in super-aged rural communities worldwide.

Assessing patient satisfaction among COVID-19 survivors in Northeast India: a cross-sectional study.

This study investigates patient satisfaction among COVID-19 survivors in Northeast India, motivated by the unique long-term healthcare needs of survivors and the critical role of patient satisfaction in assessing and enhancing healthcare quality. By focusing on this underexplored region, the research aims to uncover insights that can guide improvements in patient-centered care and healthcare service delivery in similar contexts. The study was conducted using a Simple Random Sampling technique. Data were collected through telephone interviews using a semi-structured questionnaire, including the Patient Satisfaction Questionnaire-18 (PSQ-18) for analysis. The PSQ-18 yielded seven subscale scores representing different dimensions of patient satisfaction. Statistical analysis using SPSS software was conducted to summarize socio-demographic characteristics, medical history, and patient satisfaction levels, employing both descriptive and inferential statistics. The results indicated a high acceptance of COVID-19 vaccination, with the majority of participants having received both doses. Patient satisfaction with healthcare services is generally positive, particularly in aspects related to doctor-patient communication and medical care quality. However, there are notable concerns regarding the affordability and timeliness of care. Regional variations across states, as well as factors like education and income, significantly influence patient satisfaction levels. The study revealed generally good patient satisfaction levels in Northeast India. However, challenges in healthcare affordability and timeliness persist, influenced by regional disparities and socio-economic factors. Targeted interventions are needed to improve healthcare in the region.

Chapter 11 - The health economics of cell and gene therapies

The health economics of cell and gene therapies is complex; due to resource-intensive manufacturing, high prices are required for commercial viability that are challenging for healthcare systems to accommodate. Despite high prices, cell and gene therapies can provide value when they deliver substantial clinical benefits and displace long-term healthcare costs compared with existing treatment options. In this chapter, the cost utility approach of economic evaluation is discussed, focusing on the considerations that occur more commonly in cell and gene therapies compared to conventional medicines, how these considerations create challenges in interpreting the evidence and coming to conclusions on value, and what tools exist for understanding the level of decision uncertainty. A summary of the economic evaluation of onasemnogene abeparvovec for spinal muscular atrophy is provided as a real-world example that features the considerations discussed.

A quality perspective on the ideal of coherent care pathways for patients with complex, long-term healthcare needs. A policy document analysis

Background: Policy documents’ rhetoric emphasize coherent care pathways as an expression of integrated and person-centred care in healthcare services for persons with complex long-term needs. Various measures are introduced to achieve these ideals. Norwegian policy highlights personal responsibility for one professional as a coordinator, cross-sectional individual care plans, services provided by multidisciplinary teams, formal collaboration structures between primary and specialized care, and implementation of different types of pathway organization. Policy documents rarely specify how quality in terms of goal achievement is to be understood, assessed, or evaluated. It has proved difficult to show outcomes of the measures as well as whether they contribute to achievement of the ideals. &#x0D; Theoretical framework: Four quality paradigms have been demonstrated as a common basis for assessing quality in integrated care: the empirical paradigm which focus on measuring reality, the reference paradigm where care is evaluated according to models or frameworks, the reflective paradigm where quality cannot be defined, just discussed. And finally, the emergence paradigm where all stakeholders explore and co-create new solutions together.&#x0D; Aim: To analyse how ideals of coherent care pathways are described in policy documents, and how they resonate with different quality paradigms. &#x0D; Methods: An analysis of two central Norwegian policy documents is in process. The meaning of ‘care pathway’ is interpreted in the context of each paragraph, and categorized according to which quality paradigm(s) is considered relevant. &#x0D; Preliminary results and discussion: The concept ‘coherent care pathways’ is used as an expression of, and as an argument for, a variety of models, care organization, care values, and desirable patient experiences related to process-oriented care. Achievement of coherent care pathways for persons with long-term complex healthcare needs, can therefore imply different types of “success”. &#x0D; One type of model is standardized clinical pathways. Here quality is defined as timely accomplishments of defined tasks. This is in accordance with the empirical paradigm. In the Norwegian coordination reform, care pathways is defined as the chronological chain of events that make up the patient's encounters with various parts of the health and care services. In good pathways these events are put together in a rational and coordinated way to meet the patient's various needs. Pathway in this meaning must be evaluated in perspective of the individual patient’s situation, considering the degree of predictability and the prerequisites for planning during the process. This in accordance with the emergence paradigm.&#x0D; Van Kemenade, van der Vlegel et al. (2019, 2020, 2021, 2022) have introduced the quality paradigms in analysis of, and recommendations for, integrated care research, to show different understandings and values at play in a patient case, and to propose a new definition of integrated care. In this paper we intend to discuss how conceptualizations of coherent care pathways in policy documents has consequences for how quality can be understood and evaluated. And further, that we can draw relevant knowledge from this of benefit to discussions and plans for realizing the measures and the ideals of integrated person-centred care. &#x0D; Keywords: Care pathways, integrated care, person-centred care, quality paradigms.

Comprehensive Standardized Assessment for Information Continuity: What Does the Workforce Need

Introduction: Older adults living with frailty and multimorbidity interact with multiple care providers across different health settings increasing the risk for fragmented care and information discontinuity. Information discontinuity results in workforce inefficiencies and adverse health events, including duplication of assessment and diagnostics, medication errors and increased health service use. Standardized assessments potentiate integrated care by communicating consistent measures of health information between health care sectors and providers. InterRAI assessments facilitate integration through promoting a common language and aligning successive assessments across the care continuum.&#x0D; Description: We used a pragmatic case example of a theoretical medically-complex older adult to illustrate effective use of interRAI standardized assessments throughout the health care journey. The interRAI suite of instruments spans across the age continuum, from pediatrics to geriatrics, and is designed to be used across diverse care settings, including community services, primary care, home care, long-term care, acute care, inpatient and community mental health, and palliative services. The case example represents one patient’s assessment findings, derived from standardized assessment instruments, such as the contact assessment, home care assessment and long-term care facility assessment. Automated and embedded risk algorithms are generated as outputs from the assessment, acting as decision support tools to inform care planning for clinical, functional, and social support needs. Process schematics depict potential workflows, where instruments can guide care strategies and facilitate the flow of information between the care team members.&#x0D; Discussion: Integrating elements such as using a common language, standardized assessment items, and embedded decision support algorithms, can support effective communication and collaboration in the care of older adults between clinical settings. Risk algorithms and scales support real-time identification of care issues, with standardized assessment items allowing for changes in health status to be easily recognized. Operationalizing a suite of standardized assessment instruments across the health system offers advantages for the individual including improved continuity of care, as well as for organizations and the system through use of a consistent measurement of health metrics between health providers and sectors, and evaluating health system performance. Successful adoption of comprehensive assessment tools to support integration requires training, stakeholder engagement and time to embed work and care processes into practice.&#x0D; Conclusion: Standardized language and algorithms used in interRAI comprehensive assessments can increase capacity for integration and continuity of care across the full spectrum of health sectors and settings. Findings from this pragmatic case example demonstrate real-world application and utility of standardized assessments to support an integrated workforce.

Quality of life of elderly users of long-term health care in and outside the institution

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction. &amp;lt;/strong&amp;gt;Long-term care is series of health and social care services provided at home or in an institutional environment to people with reduced functional capacity. Even though it is known that the quality of life (QoL) of elderly is on a lower level when compared to younger people, there is a small amount of information about QoL of long-term health care patients. The aim of our study was to determine the difference in QoL, depression, anxiety and stress of longterm health care users placed in and outside the institution.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; This cross-sectional study included 100 long-term healthcare users, divided in two groups. First group consisted of 50 respondents from primary level of health care and second group consisted of 50 residents of nursing home. The research was conducted in the period from June to July 2022. A general socio-demographic questionnaire, SF-36 health questionnaire for estimating the QoL and the scale of depression, anxiety and stress (DASS-21) were used as instruments in this study.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Results. &amp;lt;/strong&amp;gt;Respondents who were institutionalized had significantly lower values of domains and summary scores of QoL compared to respondents whose health care took place outside of institutions, where the difference was observed in physical health summary score (37.67&amp;amp;plusmn;6.20% vs. 50.39&amp;amp;plusmn;10.74%, p&amp;amp;lt;0.001), and the mental health summary score (44.87&amp;amp;plusmn;11.82% vs. 51.83&amp;amp;plusmn;16.01%, p =0.015). Respondents who received long-term health care institutionally had significantly (p=0.011) more mild anxiety (12%) and moderate anxiety (34%) compared to respondents who received long-term health care outside the institution (4% vs. 14%).&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusion. &amp;lt;/strong&amp;gt;Our results showed that residents of nursing home had significantly worse physical and mental functioning, as well as more frequent occurrence of anxiety symptoms compared to users of longterm health care placed outside institutions, in home environment.&amp;lt;/p&amp;gt;

Rational Design of Flexible Mechanical Force Sensors for Healthcare and Diagnosis.

Over the past decade, there has been a significant surge in interest in flexible mechanical force sensing devices and systems. Tremendous efforts have been devoted to the development of flexible mechanical force sensors for daily healthcare and medical diagnosis, driven by the increasing demand for wearable/portable devices in long-term healthcare and precision medicine. In this review, we summarize recent advances in diverse categories of flexible mechanical force sensors, covering piezoresistive, capacitive, piezoelectric, triboelectric, magnetoelastic, and other force sensors. This review focuses on their working principles, design strategies and applications in healthcare and diagnosis, with an emphasis on the interplay among the sensor architecture, performance, and application scenario. Finally, we provide perspectives on the remaining challenges and opportunities in this field, with particular discussions on problem-driven force sensor designs, as well as developments of novel sensor architectures and intelligent mechanical force sensing systems.

A social profile of deaths related to sickle cell disease in India: a case for an ethical policy response.

India accounts for 14.5 percent of the global SCD newborns, roughly over 42,000 a year, second to sub-Saharan Africa. Despite the availability of cheap diagnostic and treatment options, SCD remains a largely neglected disease within healthcare policy and practice. Epidemiological modeling based on small, often dated, regional studies (largely from sub-Saharan Africa) estimate that between 50 and 90 percent of affected children will/die before the age of 5 years. This premise, coupled with targets of reducing under 5 mortality (SDG 4), privileges public health interventions for screening and prevention of new births, undermining investments in long-term health and social care. This paper presents a retrospective, descriptive analysis of the socio-demographic profile of 447 patients diagnosed with sickle cell or sickle-beta thalassemia, who died following admission at a tertiary care entre in India. We used anonymized hospital records of 3,778 sickle cell patients, admitted in pediatric and adult/medical wards between January 2016 and February 2021. A majority of hospital deaths occurred in the second and third decades of life, following a hospital admission for a week. The overall mortality during 2016-2019 was 14% with little gender difference over time. Contrary to our expectations, the number of hospital deaths did not increase during the first year of the COVID-19 pandemic, between 2020 and 2021. The conclusion highlights the importance of longitudinal, socio-demo-graphic data on deaths as providing important insights for identifying ethical policy interventions focused on improving SCD outcomes over time, reducing inequities in access to care, and preventing what might be considered "excess" deaths.

THE ROLE OF COMMUNITY COLLEGES IN TRAINING HEALTH CARE WORKERS FOR AN AGING POPULATION

Abstract The aging population in the U.S. has resulted in an increased need for healthcare workers in multiple health settings (e.g., home healthcare, nursing homes, hospitals, medical laboratories). Community colleges play an important role in educating healthcare workers that are critical to an aging population. Many of these occupations focus on home healthcare, empowering adults to remain at home rather than in a long-term care setting. This session will focus on novel ways that community colleges are effectively addressing workforce needs in multiple settings, including hospitals, home healthcare, long-term care, and medical laboratories. A panel of community college and university gerontology and education professionals representing GSA’s Community College and the Aging Workforce Interest Groups will share the innovative ways in which they are addressing the needs of an aging population. Yamashita and Narine will discuss the current and future demand for employees in healthcare occupations, especially those in long-term and home healthcare settings, and will focus on careers that do not require a bachelor’s degree. Velazquez’s presentation will focus on the impact COVID had on training healthcare workers in healthcare related occupations and how one community colleges adapted their curriculum. Cummins et al. will discuss a study that focused on the role literacy, numeracy, and problem-solving skills play in community college students’ success in the classroom and the healthcare workplace, focusing on employer interviews. Finally, Kaur will discuss the role Hillsborough Community College plays in training medical laboratory scientists and in providing employees for critical medical services to an aging society This is a collaborative symposium between the Aging Workforce and Community College Interest Groups.

THE RELATED FACTORS ON HEALTH DEFICIENCIES IN NATIONAL NURSING HOMES USING PANEL LARGE DATASET

Abstract Health deficiencies are considered scientific research outcomes and should be reported as mandatory for all Medicare-Medicaid nursing homes (NHs). However, health deficiencies have been a concern for several decades. Previous studies have focused on regulatory deficiencies or used nurse staffing variables as control variables. This study investigated health deficiencies in relation to nurse staffing, facility size, and ownership across all Center for Medicare and Medicaid NHs in the United States. This study used secondary data analysis using Payroll-based Journal Daily Nurse Staffing data, Area Resource File, and LTCFocus. Data were merged with federal Medicare/Medicaid provider IDs as the basic unit of analysis for the 2019 fiscal year. A total of 7,802 NH data were analyzed using Poisson regression. The average total weighted health deficiencies survey score was 66.12. The average bed size was 114.02, where 74% were profit NHs. The average hours per resident day (HPRD) for each nurse staffing was as follows: 0.57 registered nurses, 0.86 licensed practical nurses, and 2.16 certified nurse aides. As total HPRD increases by 1 unit (exponential 0.83), it is likely that health deficiencies decrease by 17%. The bed size less than 60 (exponential 0.87) and not-for-profit NHs (exponential 0.09) was related with decreased health deficiencies of 13% and 91%. The worsened residents’ acuity was related with 2% more health deficiencies (exponential = 0.98). This large dataset analysis shows that professional nurse staffing is associated with superior NH quality of care with fewer deficiencies and supports the need for age-friendly long-term healthcare systems.

Long-term Care Insurance and Health and Perceived Satisfaction of Older Chinese: Comparisons Between Urban/Rural Areas, Chronic Conditions, and Their Intersectionality.

Evidence of the impact of long-term care insurance (LTCI) on health and well-being has predominantly come from developed countries. China officially launched its city-level LTCI policy in 2016. Recent evidence in China has shown that having an LTCI program contributes to positive health. However, it is unclear whether such positive policy effects were attributed to policy announcement or implementation effects, and whether the policy effects vary by locality, chronic conditions, and their intersectionality. This study examines whether there are longitudinal health benefits for older Chinese who are participating in LTCI, particularly considering their city location (urban/rural), whether they have chronic conditions, and the intersectionality. Following the Andersen Behavioral Model, health and satisfaction outcomes of 9253 adults aged 60+ years were extracted from the 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). Individual data were linked to census socioeconomic data with city-level characteristics and LTCI policy variable. Multilevel lagged regression models investigated the impact of LTCI policy on health and satisfaction with health services, after controlling for baseline individual- and city-level covariates. Of 125 cities in the dataset, 21 (16.8%) had adopted LTCI. These city inhabitants had significantly better self-rated health and higher satisfaction relative to cities without LTCI policies when environmental- and personal-level characteristics were modeled. Health benefits of LTCI were stronger after policy announcement and were particularly observed among rural older adults and those with chronic conditions. Results also suggest that LTCI's positive effects on satisfaction spill over to middle-aged adults. Expanding coverage and eligibility to LTCI for all older Chinese could improve health and well-being.

Self-Charging, Breathable, and Antibacterial Poly(lactic acid) Nanofibrous Air Filters by Surface Engineering of Ultrasmall Electroactive Nanohybrids.

Despite the great promise in the development of biodegradable and ecofriendly air filters by electrospinning of poly(lactic acid) (PLA) nanofibrous membranes (NFMs), the as-electrospun PLA nanofibers are generally characterized by poor electroactivity and smooth surface, challenging the exploitation of electrostatic adsorption and physical interception that are in need for efficient removal of pathogens and particulate matters (PMs). Herein, a combined "electrospinning-electrospray" strategy was disclosed to functionalize the PLA nanofibers by direct anchoring of highly dielectric BaTiO3@ZIF-8 nanohybrids (BTO@ZIF-8), conferring simultaneous promotion of surface roughness, electret properties (surface potential as high as 7.5 kV), and self-charging capability (∼190% increase in tribo-output voltage compared to that of pure PLA). Benefiting from the well-tailored morphology and increased electroactivity, the electrospun-electrosprayed PLA/BTO@ZIF-8 exhibited excellent PM-capturing performance (up to 96.54% for PM0.3 and 99.49% for PM2.5) while providing desirable air resistance (only 87 Pa at 32 L/min) due primarily to the slip flow of air molecules over the nanohybrid protrusions. This was accompanied by excellent antibacterial properties (99.9% inhibition against both Staphylococcus aureus and Escherichia coli), arising presumably from the synergistic effects of enhanced reactive oxygen species (ROS) generation, plentiful ion release, and surface charges. Our proposed strategy opens up pathways to afford exceptional combination of high-efficiency and low-resistance filtration, excellent antibacterial performance, and mechanical robustness without sacrificing the biodegradation profiles of PLA NFMs, holding potential implications for efficient and long-term healthcare.

Entrepreneurship in care for elderly people with dementias: situated responses to NPM-based healthcare reforms in the Netherlands

BackgroundDespite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate “healthcare entrepreneurship”, it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer’s disease.MethodsA four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have.ResultsThe study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship – two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level.ConclusionGovernmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients' mental disease and ultimate passing.