Need For Comprehensive Care Research Articles

Multidrug-resistant infection following snakebite envenoming: A case report

Snake Bite Envenoming (SBE) is a major under-appreciated medical and public health problem causing significant mortality and morbidity, particularly among rural dwellers throughout the tropics. Occasionally, snakebite may lead to important complications such as amputation, blindness resulting from spitting cobra (Naja nigricollis) induced venom ophthalmia, foetal loss, wound infection, tetanus and scarring with potential for malignant transformation. Here, we report a case of a 13 year old student bitten by a snake whose bite site became infected with multidrug resistant Methicillin Resistant Staphylococcus aureus (MRSA). He was bitten on the neck, in the night while sleeping on his bed. The bite site suppurated, the skin underwent necrosis and began to discharge thick brownish pus necessitating surgical exploration to drain deep-seated abscesses. The patient survived the acute phase after receiving intravenous polyvalent anti-snake venom (EchiTab-Plus(R)) and intravenous Levofloxacin in addition to wound care. The case stresses the need for comprehensive care of victims of snakebite. This care should be multidisciplinary, and health care workers should be educated on snakebite wound care and management.

Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions

BackgroundThe aim of this study was to describe patterns among people who inject drugs (PWID), risk-related behaviours and access to methadone treatment, in order to design a large-scale intervention aiming to end the HIV epidemic in Haiphong, Vietnam. MethodsA respondent-driven sampling (RDS) survey was first conducted to identify profiles of drug use and HIV risk-related behaviour among PWID. A sample of PWID was then included in a one-year cohort study to describe access to methadone treatment and associated factors. ResultsAmong the 603 patients enrolled in the RDS survey, 10% were female, all were injecting heroin and 24% were using methamphetamine, including 3 (0.5%) through injection. Different profiles of risk-related behaviours were identified, including one entailing high-risk sexual behaviour (n=37) and another involving drug-related high-risk practices (n=22). High-risk sexual activity was related to binge drinking and methamphetamine use. Among subjects with low sexual risk, sexual intercourse with a main partner with unknown serostatus was often unprotected. Among the 250 PWID included in the cohort, 55.2% initiated methadone treatment during the follow-up (versus 4.4% at RDS); methamphetamine use significantly increased. The factors associated with not being treated with methadone after 52 weeks were fewer injections per month and being a methamphetamine user at RDS. ConclusionHeroin is still the main drug injected in Haiphong. Methamphetamine use is increasing markedly and is associated with delay in methadone initiation. Drug-related risks are low but sexual risk behaviours are still present. Comprehensive approaches are needed in the short term.

Neurologic Diseases and Sleep.

Sleep disorders and neurologic illness are common and burdensome in their own right; when combined, they can have tremendous negative impact at an individual level as well as societally. The socioeconomic burden of sleep disorders and neurologic illness can be identified, but the real cost of these conditions lies far beyond the financial realm. There is an urgent need for comprehensive care and support systems to help with the burden of disease. Further research in improving patient outcomes in those who suffer with these conditions will help patients and their families, and society in general.

Emergency department use by people with HIV in Ontario: a population-based cohort study.

Emergency department use may reflect poor access to primary care. Our objective was to compare rates and causes of emergency department use between adults living with and without HIV. We conducted a population-based study involving Ontario residents living with and without HIV between Apr. 1, 2011, and Mar. 31, 2012. We frequency matched adults with HIV to 4 HIV-negative people by age, sex and census division, and used random-effects negative binomial regression to compare rates of emergency department use. We classified visits as low urgency or high urgency, and also examined visits for ambulatory care sensitive conditions. Hospital admission following an emergency department visit was a secondary outcome. We identified 14 534 people with HIV and 58 136 HIV-negative individuals. Rates of emergency department use were higher among people with HIV (67.3 v. 31.2 visits per 100 person-years; adjusted rate ratio 1.58, 95% confidence interval [CI] 1.51-1.65). Similar results were observed for low-urgency visits. With the exception of hypertension, visit rates for ambulatory care sensitive conditions were higher among people with HIV. People with HIV were also more likely than HIV-negative individuals to be admitted to hospital following an emergency department visit (adjusted odds ratio 1.55, 95% CI 1.43-1.69). Compared with HIV-negative individuals, people with HIV had high rates of emergency department use, including potentially avoidable visits. These findings strongly support the need for comprehensive care for people with HIV.

Characterization of people with venous ulcer assisted at the primary health care

Background: The venous ulcer is a severe public health problem that requires proper care and skilled professionals. Objective: To characterize, as the sociodemographic, health and assistance aspects, adults and elderly with venous ulcers treated with the primary health care. Methods: A cross-sectional survey conducted in primary health care of Natal, Rio Grande do Norte, Brazil, from February to September/2014 with structured interview compound of sociodemographic and bio-physiological measures. The research followed the ethical precepts. Results: Of the total, 61.4% were aged greater or equal to 60 years old. Among the elderly, women predominated (p=0.011), with a partner (p=0.025), primary education (p=0.016), no occupation (p<0.001), non-alcoholic (p=0.029), with diabetes mellitus (p=0.002) and hypertension (p=0.001). As for the health and assistance aspects, there was a tendency of worse outcomes among the elderly. Conclusion: There was a majority of elderly women, without occupation, with a partner, low income, comorbidity, venous ulcer time more than one year, recurrence and pain. It was evident the need for comprehensive care to people with venous ulcers, especially the elderly. &nbsp

Playful intervention with chronically-ill children: promoting coping

Chronic diseases can adversely affect the development process of children. This qualitative, action-research study had the aim to analyze the effects of activities in the manual "Como H6spede no Hospital" (As a patient in the hospital) on the coping process of children with chronic diseases. Study participants included six children and adolescents aged seven to 13 years, who suffered from a chronic disease. Data were collected in the pediatric clinic of a public hospital in the Brazilian state of Paraíba, through participant observation and individual sessions with activities from the manual. Data interpretation followed the principles of thematic analysis. The activities from the manual encouraged participants' search for information about their disease and treatment, and increased their interest and participation in their health care process, thereby contributing to better coping. The study points to the need for comprehensive care for children with chronic diseases.

Management of Acute Ischemic Stroke

Acute stroke affects about 800,000 patients annually in the US and is the leading cause of disability. It is a complex condition with multiple causes and requires comprehensive but rapid evaluation by stroke specialists working in institutions with well-organized stroke systems of care. Acute stroke treatment is focused on early revascularization with intravenous tPA for those with strokes under 3 hours duration or intra-arterial therapy for most others and those who cannot receive tPA. The latter is evolving rapidly with the advent of stent-retriever embolectomy devices that are poised to revolutionize stroke treatment. Recanalization is associated with neurological recovery in 33-50 % of patients. This also means that many patients may have devastating and life-threatening brain injury, which highlights the need for comprehensive care for the prevention and treatment of medical complications, management of cerebral edema and intracerebral hemorrhage.

Impact of community-based support services on antiretroviral treatment programme delivery and outcomes in resource-limited countries: a synthetic review

BackgroundTask-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment (ART) scale-up in high-HIV-prevalence, resource-limited settings. The dearth of systematic scientific evidence on the contributory role and function of these forms of community mobilisation has rendered a formal evaluation of the published results of existing community support programmes a research priority.MethodsWe reviewed the relevant published work for the period from November 2003 to December 2011 in accordance with the guidelines for a synthetic review. ISI Web of Knowledge, Science Direct, BioMed Central, OVID Medline, PubMed, Social Services s, and Sociological s and a number of relevant websites were searched.ResultsThe reviewed literature reported an unambiguous positive impact of community support on a wide range of aspects, including access, coverage, adherence, virological and immunological outcomes, patient retention and survival. Looking at the mechanisms through which community support can impact ART programmes, the review indicates that community support initiatives are a promising strategy to address five often cited challenges to ART scale-up, namely (1) the lack of integration of ART services into the general health system; (2) the growing need for comprehensive care, (3) patient empowerment, (4) and defaulter tracing; and (5) the crippling shortage in human resources for health. The literature indicates that by linking HIV/AIDS-care to other primary health care programmes, by providing psychosocial care in addition to the technical-medical care from nurses and doctors, by empowering patients towards self-management and by tracing defaulters, well-organised community support initiatives are a vital part of any sustainable public-sector ART programme.ConclusionsThe review demonstrates that community support initiatives are a potentially effective strategy to address the growing shortage of health workers, and to broaden care to accommodate the needs associated with chronic HIV/AIDS. The existing evidence suggests that community support programmes, although not necessarily cheap or easy, remain a good investment to improve coverage of communities with much needed health services, such as ART. For this reason, health policy makers, managers, and providers must acknowledge and strengthen the role of community support in the fight against HIV/AIDS.

Providing comprehensive care to children living with human immunodeficiency virus in Senegal

As pediatric antiretroviral drugs become more available in resource-limited settings, the need for comprehensive care that takes into account the holistic needs of families becomes more pressing. Synergie pour l'Enfance's community-based treatment for children in two suburban districts of Dakar, Senegal serves as a case study of how to deliver integrated services to children infected with human immunodeficiency virus as a complement to a national antiretroviral access program. From June 2004 to December 2006 Secure the Future funded the Synergie intervention, which enrolled 126 children. The four areas of activity funded included strengthening human and material resources, enrolling children in the program, dispensing medical care and providing educational and psychosocial support. This case study derives from external midterm and final evaluations commissioned by Secure the Future to assess the program's process, achievements and sustainability, using documentation review and individual interviews. The key components of success were training service providers, providing free access to drugs and accompanying medical services and transport, strengthening the family environment, and assisting with school enrollment and fees. Responding to community stigma and the effect of disclosure on children remained major challenges.

Staging intervention and meeting needs in early psychosis

Staging intervention and meeting needs in early psychosis

Review of 64 cases of death in children with Prader–Willi syndrome (PWS)

Several deaths have been reported in children with Prader-Willi syndrome (PWS) following treatment with growth hormone (GH). We collected all of the reports of deaths in PWS children, both in treatment and non-treatment groups, analyzed the causes of the death and compared the two groups. We conducted an exhaustive search for reports using bibliographic databases, toxicology pharmacovigilance databases, and personal communications. Sixty-four PWS children (42M/22F) aged from a few days to 19 years were identified, 28 received GH treatment. Our results show that respiratory disorders were the most common cause of death (respiratory insufficiency or infections) which were reported in 61% of the children (68% in GH-treated and 55.5% in -untreated patients). We found no significant differences in gender, prevalence of obesity or prevalence of sleep apnea, between the patients treated with GH and the untreated patients. Nevertheless, most of the deaths in GH-treated children (75%) occurred during the first 9 months after the initiation of GH treatment. Our analysis shows the high frequency of respiratory infections in both GH-treated and -untreated PWS children. The first 9 months of GH treatment seems to be a high-risk period emphasizing the need for comprehensive care before and during GH treatment.

Care of older people from a multi‐professional perspective: Learning on the web

The European population has undergone important changes during past decades with increased life expectancy and a falling birth rate. The high proportion of older people and the vulnerability related to ageing will in the next century demand more multidisciplinary and innovative approaches towards their care. This was the main rationale for the construction of a web‐based course. Another reason was that many students are not able to leave their homes to study abroad. The aim of the course was to provide an option for students in different programmes and for experienced health professionals to increase their mutual understanding about older people and their need for comprehensive care. The internet offered several health professionals with their different perspectives a place to meet and communicate. Lecturers who had advanced knowledge about specific areas in the countries could present their views, and the course participants could share knowledge about relevant articles, research and personal experiences as well as share their experiences with professionals from more than one culture, which is usually not the case when going abroad. By working together in international groups, the students said that they had learned to analyse shared attitudes and differences between countries, and how cultural and geographical circumstances could affect quality of life for older people. The students and the teachers felt that that a multi‐professional and intercultural approach had increased their knowledge of the various and changing living conditions for older people in different societies.

Mobility difficulties are not only a problem of old age.

Lower extremity mobility difficulties often result from common medical conditions and can disrupt both physical and emotional well-being. To assess the national prevalence of mobility difficulties among noninstitutionalized adults and to examine associations with demographic characteristics and other physical and mental health problems. Cross-sectional survey using the 1994-1995 National Health Interview Survey-Disability Supplement (NHIS-D). We constructed measures of minor, moderate, and major lower extremity mobility difficulties using questions about ability to walk, climb stairs, and stand, and use of mobility aids (e.g., canes, wheelchairs). Age and gender adjustment used direct standardization methods in Software for the Statistical Analysis of Correlated Data (SUDAAN). Noninstitutionalized, civilian U.S. residents aged 18 years and older. National Health Interview Survey sampling weights with SUDAAN provided nationally representative population estimates. An estimated 19 million people (10.1%) reported some mobility difficulty. The mean age of those with minor, moderate, or major difficulty ranged from 59 to 67 years. Of those reporting major difficulties, 32% said their problems began at aged 50 years or younger. Adjusted problem rates were higher among women (11.8%) than men (8.8%), and higher among African American (15.0%) than whites (10.0%). Persons with mobility difficulties were more likely to be poorly educated, living alone, impoverished, obese, and having problems conducting daily activities. Among persons with major mobility difficulties, 30.6% reported being frequently depressed or anxious, compared to 3.8% for persons without mobility difficulties. Reports of mobility difficulties are common, including among middle-aged adults. Associations with poor performance of daily activities, depression, anxiety, and poverty highlight the need for comprehensive care for persons with mobility problems.