New Forms Of Care Research Articles

Innovative approaches in discussions of diabetes among healthcare sector actors in Germany.

The dramatic growth in the rate of diabetes prompts serious debates about awareness, early diagnosis, and care interventions. This Viewpoint aims to explore, from the perspectives of healthcare sector representatives, what challenges and difficulties they face in dealing with diabetes and how these can be overcome. We applied the World Café method for group discussions, which enabled us to bring together 50 stakeholders. They identified challenges at institutional and structural levels under the concepts of awareness, digitalisation, and new forms of care and shared their suggestions for feasible solutions. We learned there is a need for a diabetes map of Germany to identify risk groups and that hybrid solutions should be implemented for treatment, care, prevention, and early diagnosis, considering digital infrastructure. Also, the demand for digital innovation in the healthcare system raised concerns about information transparency and data management.

Persistent inequities in maternal mortality in Latin America and the Caribbean, 1990–2019

BackgroundDespite the resources and personnel mobilized in Latin America and the Caribbean to reduce the maternal mortality ratio (MMR, maternal deaths per 100 000 live births) in women aged 10–54 years by 75% between 2000 and 2015, the region failed to meet the Millenium Development Goals (MDGs) due to persistent barriers to access quality reproductive, maternal, and neonatal health services.MethodsUsing 1990–2019 data from the Global Burden of Disease project, we carried out a two-stepwise analysis to (a) identify the differences in the MMR temporal patterns and (b) assess its relationship with selected indicators: government health expenditure (GHE), the GHE as percentage of gross domestic product (GDP), the availability of human resources for health (HRH), the coverage of effective interventions to reduce maternal mortality, and the level of economic development of each country.FindingsIn the descriptive analysis, we observed a heterogeneous overall reduction of MMR in the region between 1990 and 2019 and heterogeneous overall increases in the GHE, GHE/GDP, and HRH availability. The correlation analysis showed a close, negative, and dependent association of the economic development level between the MMR and GHE per capita, the percentage of GHE to GDP, the availability of HRH, and the coverage of SBA. We observed the lowest MMRs when GHE as a percentage of GDP was close to 3% or about US$400 GHE per capita, HRH availability of 6 doctors, nurses, and midwives per 1,000 inhabitants, and skilled birth attendance levels above 90%.ConclusionsWithin the framework of the Sustainable Development Goals (SDGs) agenda, health policies aimed at the effective reduction of maternal mortality should consider allocating more resources as a necessary but not sufficient condition to achieve the goals and should prioritize the implementation of new forms of care with a gender and rights approach, as well as strengthening actions focused on vulnerable groups.

When health services research becomes important

‚Dear health services researchers, we have finally achieved what we have been working for.‘ With these enthusiastic words, Prof Dr Wolfgang Hoffmann, Chairman of the German Network for Health Services Research (DNVF), opened the 22nd DKVF, which took place at the Urania in Berlin at the beginning of October. The reason for his delight was the fact that - Hoffmann continued - the Innovation Committee recommends the transfer to standard care for 17 projects from the first and second funding waves of the new forms of care, but above all that the results of care research - including those of the ‚WiZen‘ innovation fund project, which was able to demonstrate the superiority of initial therapy in the primary treatment of cancer patients in certified centres - form an evidence base for the recommendations of the government commission for hospital reform. However, this is also precisely what the DNVF Chairman reminded the research community gathered at the German Congress for Health Services Research. Since health services research is now systemically relevant, this not only entails growing responsibility, but also has serious consequences: ‚Health services research now has critics.‘ Because, according to Hoffmann: ‚Our results, recommendations and priorities are now more likely to have consequences, they affect care providers, shift the balance of power and change financial flows.‘

Editorial: Recognising new partners and activities in older peoples’ care but also potential burdens in new forms of care and research

Editorial: Recognising new partners and activities in older peoples’ care but also potential burdens in new forms of care and research

Assessing needs-based supply of physicians: a criteria-led methodological review of international studies in high-resource settings

BackgroundMany health systems embrace the normative principle that the supply of health services ought to be based on the need for healthcare. However, a theoretically grounded framework to operationalize needs-based supply of healthcare remains elusive. The aim of this paper is to critically assess current methodologies that quantify needs-based supply of physicians and identify potential gaps in approaches for physician planning. To this end, we propose a set of criteria for consideration when estimating needs-based supply.MethodsWe conducted searches in three electronic bibliographic databases until March 2020 supplemented by targeted manual searches on national and international websites to identify studies in high-resource settings that quantify needs-based supply of physicians. Studies that exclusively focused on forecasting methods of physician supply, on inpatient care or on healthcare professionals other than physicians were excluded. Additionally, records that were not available in English or German were excluded to avoid translation errors. The results were synthesized using a framework of study characteristics in addition to the proposed criteria for estimating needs-based physician supply.Results18 quantitative studies estimating population need for physicians were assessed against our criteria. No study met all criteria. Only six studies sought to examine the conceptual dependency between need, utilization and supply. Apart from extrapolations, simulation models were applied most frequently to estimate needs-based supply. 12 studies referred to the translation of need for services with respect to a physician’s productivity, while the rest adapted existing population-provider-ratios. Prospective models for estimating future care needs were largely based on demographic predictions rather than estimated trends in morbidity and new forms of care delivery.ConclusionsThe methodological review shows distinct heterogeneity in the conceptual frameworks, validity of data basis and modeling approaches of current studies in high-resource settings on needs-based supply of physicians. To support future estimates of needs-based supply, this review provides a workable framework for policymakers in charge of health workforce capacity planning.

Patient access – Zugang zu Innovationen in der Onkologie

Compared to other European countries, Germany has a large number of innovative therapy options for the treatment of patients with cancer. Currently, the main challenge in care is to be able to offer these options at the right time to all patients, regardless of their place of residence and treatment setting, who could benefit from innovative therapies. Clinical trials are often the first opportunity for controlled access to oncology innovation. Reducing bureaucratic processes and increasing transparency about currently recruiting trials is imperative to allow more patients early access across sectors. The concept of decentralized clinical trials and (virtual) molecular tumor boards is also appropriate to allow more patients potential trial inclusion. The best possible use of a growing number of innovative and cost-intensive diagnostic and therapeutic options for a wide variety of patient-specific situations requires low-threshold transsectoral exchange, i.e., communication between (certified) oncological competence centers and physicians across the broad spectrum of medical care, who are expected to simultaneously treat the large number of German cancer patients in everyday care and cover the entire range of the increasingly complex oncological therapy landscape. DIFFERENT ACCESS IN THE REGIONS: The overdue implementation of digital options for cross-sector collaboration is an absolute prerequisite for giving patients who live farther away from a competence or study center access to innovations that are not available at their place of residence or treatment. OPTIMIZED ACCESS TO INNOVATIVE CARE: The development and testing of new forms of care requires the participation of all those responsible for the care process in order to jointly improve structural conditions, create sustainable incentives and provide the necessary capacities. The basis for this is an ongoing, concerted provision of evidence on the care situation, e.g. in the context of statutory cancer registration and clinical registries at oncology centers.

Trauma rehabilitation : Implementation and challenges

The current state of posttraumatic rehabilitation in Germany is on the one hand shaped by the efforts of the primary care providers in the acute setting to transfer patients as soon as possible to rehabilitation in accordance with the requirement for acontinuous chain of rehabilitation. On the other hand, there are still important treatment gaps due to a lack of options, specialized structures and financing. This has the consequence that severely injured patients sometimes experience substantial difficulties, setbacks and delays on their way back to social participation. This article presents the various phases of rehabilitation and the existing challenges in order to guarantee the universally acknowledged demand for acontinuous rehabilitation chain. Reference is made to the missing structures and simultaneously to the necessary continuity of the processes, the quality assurance and the financial prerequisites for new forms of care. This is exemplified by how the continuum of posttraumatic rehabilitation of the German statutory accident insurance with the successful reintegration of trauma victims in work and social life could be amodel for insured persons of the statutory health insurance and the German pension fund. The scientific societies of trauma surgery and rehabilitation medicine also promote the model of a differentiated trauma rehabilitation and sustain the idea of atrauma rehabilitation network to increase the chances of the severely injured for the best possible quality of life and social participation.

POS0380 EFFECTIVENESS OF REMOTE CARE INTERVENTIONS: A SYSTEMATIC REVIEW INFORMING THE 2022 EULAR POINTS TO CONSIDER FOR REMOTE CARE IN RHEUMATIC AND MUSCULOSKELETAL DISEASES

BackgroundWhile the number of patients with rheumatic musculoskeletal diseases (RMDs) is increasing worldwide, there is no adequate increment in the number of health care professionals, leading to the urgent need for new forms of care to take pressure from health care systems.1 2 Telehealth comprises a number of different types of interventions with the scope of performing certain steps of care, ranging from diagnostics to follow-up visits, in a remote manner. The use of remote care is heterogenous and guidance is needed to optimize the combination with conventional face-to-face (F2F) visits.ObjectivesTo perform a systematic literature review (SLR) on different outcomes of remote care compared to F2F care, its implementation into clinical practice and to identify drivers and barriers in order to inform a task force formulating the European Alliance of Associations for Rheumatology (EULAR) Points to Consider for remote care in RMDs.MethodsProspective, retrospective, and qualitative studies testing different types of remote care in patients with RMDs were included. Medline, Embase and the Cochrane Library were searched through February 28th, 2021. Two reviewers independently performed standardized data extraction, synthesis, and risk of bias assessment.ResultsA total of 2,240 references were identified. Forty-seven studies, consisting of 26 randomized controlled trials, 8 prospective cohort studies, 8 cross sectional studies, and 5 qualitative studies were included.Fifty-one percent of the studies involved patients with inflammatory RMDs, including rheumatoid arthritis, and spondyloarthritis, while 49% were on patients with non-inflammatory conditions, such as osteoarthritis and fibromyalgia. Remote monitoring (n=35) was most frequently studied, with telephone/video calls being the most common mode of delivery (n=30). Thirty-four studies investigated outcomes of remote care in comparison to F2F care. The most frequently assessed outcomes concerned efficacy and user perception of remote care, with 34% and 21% of studies, respectively, reporting superior results for the remote care intervention.Time savings and flexibility were reported as major drivers, while inadequate technical knowledge and concerns in data security were the main barriers to implementing remote care. Implementation of remote care methods into clinical practice was not reported by the included studies. The main limitations were the heterogeneity of outcomes and interventions, and the substantial risk of bias (50% of studies with high risk of bias).ConclusionStudies on remote care reported similar to partially better results compared to F2F care concerning efficacy, and user perception outcomes, with the limitation of heterogeneity and considerable risk of bias.

Experiences with Innovation Fund healthcare models in primary care: aqualitative study amongst German general practitioners.

The Innovation Fund was set up in 2015 with the aim of improving medical care in the German statutory health insurance system. Primary care needs to be involved in testing interventions and new forms of care for effectiveness and inclusion in standard care. There has so far been hardly any research on how far Innovation Fund models accommodate the primary care setting, or on the experience general practitioners have had with these models. Between September 2021 and January 2022, 36semi-standardized individual interviews were performed with general practitioners who had already participated in Innovation Fund projects. Eleven regional physician networks in Rhineland-Palatinate, Hesse, North Rhine-Westphalia, and Schleswig-Holstein were involved in the recruitment process. Most of the interviewees associated the Innovation Fund with potential and opportunity including intensification of application-oriented healthcare research, independent financing, and general healthcare involvement. Even so, many general practitioners were unsure as to how far primary care in particular would stand to benefit from the Innovation Fund in the long term. Amostly positive balance was drawn from participation in care models-benefit of intervention as well as cost-benefit ratio. However, some also reported hurdles and stress factors such as documentation requirements and disruption in everyday office routine. Innovation Fund projects will need to be suitable for general practitioners especially regarding medical decision-making leeway, limits to documentation requirements, preserving established office routine, greater involvement in research planning, and improvements to the primary care setting to encourage willingness to participate in Innovation Fund projects amongst general practitioners.

Breastfeeding in times of COVID-19: a scoping review.

to identify how the COVID-19 pandemic has influenced postpartum women in breastfeeding. a scoping review, with a search in seven databases. Studies available in full, in English, Portuguese or Spanish, published from December/2019-April/2021 were included. The analysis was carried out by categorizing common themes. 25 studies were included, grouped into five categories, presenting the influence of the pandemic: in the routine of breastfeeding care, evidencing preventive measures against COVID-19; in breastfeeding rates, highlighting changes in dietary practices; in the support network for breastfeeding, indicating a lack of service care; in the postpartum women's emotions, with predominance of concern and stress; in the use of technology to support breastfeeding, with teleservice facilitating care. the COVID-19 pandemic has influenced new forms of care, in the offer and duration of breastfeeding, in emotional health and in the support network fragility. It is expected to contribute so that health professionals provide care with greater assertiveness in the face of this new situation.

Caring for Older People in the Post-Soviet Space: The Case of Russia

In this article, we analyze eldercare in the post-Soviet space on the example of Russia. Our research questions are: How transforming the care arrangements of older adults in the post-soviet state? How do the transforming care arrangements affect the agency of the elderly? The materials for the analysis were qualitative interviews with older people, social workers, and experts from Russia (N= 31), as well as statistics and legal acts. The care arrangements of older adults are undergoing significant transformations, which we can express in two distinct trends. The first is the drift away from a state and family monopoly of caring for the older people to a mixed model. New forms of care and providers are emerging: NGOs; business organizations; foster families for older people; specially equipped apartments; private nursing homes The informal care sector is developing thanks to paid caregivers from among neighbors, migrants (both external and internal). The second trend is that in practice, care can often be “layered” in nature. Relatives, public services, non-profit organizations, paid staff can take care of the same person at the same time. These trends expand the repertoire of care scenarios and make the choice more flexible for the older person and increase their agency.

Introduction: Shifting Attention

In recent years, attention has become a matter of increasing public concern. New digital technologies have transformed human attention materially and discursively, reorganizing perceptual practices and inciting debates about them. The essays in this special issue emerged from a set of panels focused on attention at the 4S conference in New Orleans in 2019. They are all, in various ways, concerned with shifts among attention’s many meanings: between payment and care, instinct and agency, or vulnerability and power. Drawing on Science and Technology Studies (STS) sensibilities, these pieces examine how scientific and technical actors are invested in theorizing and capturing attention, while simultaneously engendering new forms of care, resistance, and critique. At a moment where the attention economy appears to be in transformative crisis, this collection maps a set of incipient directions that ask us to pay attention to not only attention itself but also to the many sociotechnical settings where experts and publics are shifting attention’s meaning and value.

Lessons for Employing Participatory Design When Developing Care for Young People with Cancer: A Qualitative Multiple-Case Study.

Purpose: Participatory design (PD) is a collective creative design process involving designers and nondesigners. There is limited reporting on the experience of using PD for adolescent and young adult (AYA) care. This study summarizes lessons from employing PD to develop care for AYAs with cancer.Methods: A qualitative multiple-case study method was conducted of three PD processes addressing food (FfC), intimacy and sexuality (I&S), and integrative medicine (IM) in caring for AYAs with cancer.Results: Local key stakeholders, who were exposed to a problem and had not been successful at solving it individually, were recruited to “dream” together. Through this synergy, a shared understanding of the problem and a joint mission emerged to find a solution. PD tools were used to develop a problem definition. An open mind and explorative research helped to understand the problems, and stakeholders were managed such that idea-sharing and learning were enabled. Designers translated ideas into prototypes. The PD process was prolonged due to the hierarchical hospital environment, business considerations, and additionally required evidence. The FfC program produced an effective new food service for the whole hospital. The I&S initiative developed a podcast, two articles, and a prototype website. The IM project developed a pilot study.Conclusions: For a PD process to successfully develop care for AYAs, one needs to use designers and skilled people, PD tools, and an open-ended approach to visualize and materialize new forms of care. Furthermore, recruitment and facilitation techniques help leverage knowledge and create a synergy in a democratic environment between stakeholders.

MO211FORMALIZATION AND DEVELOPMENT OF A NEPHROLOGY ELECTRONIC CONSULTATION (ECONSULT) IN COVID-19 PANDEMIC

Background and AimsDue to COVID-19 pandemic we must continue attending in our hospital consultations and, at the same time, avoid transfers and visit that involve risks to our patients. For this reason, we implemented new forms of care. Mainly electronic consultation (eConsult) using institutional email as way of contact between Primary Care Providers (PCPs) and nephrologist, trying to decrease in-person visit.ObjectiveTo analyze the results of the creation in June 2020 of a Nephrology electronic consultation in our hospital.MethodRetrospective observational study of eConsults made to our department, which serves a population of 200.000 people, with total of 9 primary care centers. The study period was June 10, 2020 to December 31, 2020. We have studied the number of eConsults, response time, type of consult made, problem resolution and subsequent follow up.ResultsOf 141 workdays, in 61 days (43%) there was eConsult, total 80 eConsults, mean 1.3 and median 1 daily (range 1 to 3). All primary care centers used this communication way, as well as 50 PCPs. Median response time for eConsult was 1 day (range 1-4). 55% patient was male, mean age 70.8 years (SD 13.9) (range 16-95 years). 64% it was his first assessment for Nephrology. The most frequent causes of eConsult: increase of creatinine (41.3%), uncontrolled blood pressure (12.5%), sodium and potassium disturbances (11.3%), treatment adjustment (11.3%) and changes in previous appointment (8.8%). After assessment eConsult, to 55% of patients was treatment adjustment, 22.5% were converted to an in-person visit, 11% they didn´t need any action but only 1 patient was referred to the emergency room. 44% patient is subsequent follow up by PCPs, 39% by nephrologist, 15% joint assessment PCP and nephrologist and 2% by other specialists. Only 2 patients (2.5%) made second eConsult.ConclusionThe eConsult is an important help to PCPs to solve doubts quickly, avoid unnecessary the travels to hospital the patients, treatment adjustment above all in control of hypertension an ionic disturbance, and guide in handling of chronic kidney disease. The diffusion and empowerment of this type of consultation in a next future may decrease, partly, the usual saturation of face-to-face visit and optimize the patient population being seen by nephrologist.

Missing the human connection: A rapid appraisal of healthcare workers’ perceptions and experiences of providing palliative care during the COVID-19 pandemic

Background: During infectious epidemics, healthcare workers are required to deliver traditional care while facing new pressures. Time and resource restrictions, a focus on saving lives and new safety measures can lead to traditional aspects of care delivery being neglected. Aim: Identify barriers to delivering end-of-life care, describe attempts to deliver care during the COVID-19 pandemic, and understand the impact this had on staff. Design: A rapid appraisal was conducted incorporating a rapid review of policies from the United Kingdom, semi-structured telephone interviews with healthcare workers, and a review of mass print media news stories and social media posts describing healthcare worker’s experiences of delivering care during the pandemic. Data were coded and analysed using framework analysis. Setting/Participants: From a larger ongoing study, 22 interviews which mentioned death or caring for patients at end-of-life, eight government and National Health Service policies affecting end-of-life care delivery, eight international news media stories and 3440 publicly available social media posts were identified. The social media analysis centred around 274 original tweets with the highest reach, engagement and relevance. Incorporating multiple workstreams provided a broad perspective of end-of-life care during the COVID-19 pandemic in the United Kingdom. Results: Three themes were developed: (1) restrictions to traditional care, (2) striving for new forms of care and (3) establishing identity and resilience. Conclusions: The COVID-19 pandemic prohibited the delivery of traditional care as practical barriers restricted human connections. Staff prioritised communication and comfort orientated tasks to re-establish compassion at end-of-life and displayed resilience by adjusting their goals.

Effectiveness of Smartphone-Based Cognitive Behavioral Therapy Among Patients With Major Depression: Systematic Review of Health Implications.

BackgroundDepression is often associated with rapid changes in mood and quality of life that persist for a period of 2 weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for health care systems. At the same time, comprehensive limitations in physical, psychological, and social dimensions are observed for patients with depression, which significantly reduce their quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care have been determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential due to its reach and easy accessibility. Low socioeconomic groups, which are always difficult to reach for public health interventions, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison with standard care.ObjectiveThe objective of this review was to identify and summarize the existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and to present the health implications of smartphone-based cognitive behavioral therapy of considered endpoints.MethodsA systematic literature review was conducted to identify relevant studies by means of inclusion and exclusion criteria. For this purpose, the PubMed and Psyndex databases were systematically searched using a search syntax. The endpoints of depressive symptoms, depression-related anxiety, self-efficacy or self-esteem, and quality of life were analyzed. Identified studies were evaluated for study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified.ResultsThe studies examined in this review reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50% (4/8) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem, and quality of life.ConclusionsNo clear implications of smartphone-based cognitive behavioral therapy could be established. Evidence for the treatment of depression using smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mobile health intervention studies.

Competência em saúde mental na perspectiva de profissionais de saúde que atuam em Centro de Atenção Psicossocial (CAPS)

Historicamente, a saúde mental foi marcada pelo clássico modelo psiquiátrico, permeado de violência e preconceitos. Com a Reforma Psiquiátrica (RP), construiu-se um novo modelo de cuidado psicossocial que contrastava o modelo existente. Nesse sentido, o Centro de Atenção Psicossocial (CAPS) veio como dispositivo estratégico para o fortalecimento da RP, com um aspecto mais humano, com novas formas de cuidado que permitiram a construção de novos conhecimentos e práticas. Objetivo: Identificar as competências dos profissionais de saúde mental no CAPS. Métodos: Pesquisa exploratória com abordagem qualitativa. A coleta de dados utilizou a técnica do grupo focal. Para analisar os dados utilizou-se a análise de dados interpretativa. O campo para o estudo foram os nove CAPS do município de Goiânia-GO que fazem o atendimento à população com transtorno mental e/ou o uso de álcool e outras drogas. Participaram da pesquisa dezesseis (16) profissionais de saúde, que atuam pelo menos há um ano CAPS, dentre eles: médico psiquiatra, psicólogo, assistente social, professor de educação física, musicoterapeuta, arteterapeuta, farmacêutico, terapeuta ocupacional, fonoaudiólogo. Resultados: A maioria dos profissionais que participaram do estudo são mulheres e a faixa etária foi de 35-69, sendo que todos os profissionais são efetivos do município. Desse estudo obteve-se quatro categorias temáticas: Formação e Educação Permanente; Trabalhador (características pessoais e satisfação do trabalhador do CAPS); Institucionalização do CAPS e Processo de trabalho, revelando que a institucionalização das práticas preconizadas no âmbito da atenção psicossocial sugere que a qualidade do atendimento em saúde mental pode estar relacionada com o modelo de atendimento existente no serviço, que reforça a atuação coletiva e não necessariamente em um conjunto de competências inerentes ao indivíduo, ou seja, que independente das competências pessoais, ou da formação desse profissional, ou da capacitação/educação continuada que o mesmo venha a receber, ele deverá desenvolver essas práticas de acordo com o que o serviço preconiza.

Eine Genealogie sorgender Sicherheit: Sorgeregime von der Antike bis zum Anthropozän

This article proposes an alternative genealogy of security by exploring the nexus of security and care from antiquity to the present. In Greek and Roman antiquity, securitas – literally ‚carefree’ – designated a state of inner peace. With the rise of Christianity, pastoral power introduced a new regime of securing care. The pastoral care for the soul is supposed to secure salvation, whereas Christian Caritas established new forms of care for those in need (Fursorge). Modern biopolitical dispositives of security continued this tradition of care for others with the means of modern welfarism. Security dispositives organized new forms of social care (Sozialfursorge) and became increasingly concerned with the security of supply (Versorgungssicherheit) of vital infrastructural services. Since the second half of the twentieth century, a new form of care for the environment has emerged. The precautionary principle (Vorsorgeprinzip) seeks to prevent irreversible environmental change, whereas new environmental disposal and remediation practices (Entsorgung) cope with the residuals of industrial modernity. The genealogy shows the wide variety and historical flexibility of forms of security care. Conceptually the paper argues that, in contrast to sovereign and statist security technologies like the police and the military, securing care represents a positive, yet nevertheless problematic form of security. This provides new insights for a critique of security.

Clinical Dental Care: Is There a Risk of SARS-CoV2 Infection?

Today, visit the Dental Care Clinic may increase the risk of SARS-CoV2 [1], infection, caused by exposure of salivary fluids to aerosol generators, which are common in dental equipment. According to the Occupational Safety and Health Administration (OSHA), dentists and their staff are placed in the category of a very high risk of exposure, as dentists work near the patient's oral cavity [2]. In addition, dental procedures involve the use of rotating instruments such as handpieces and scalers, which generate aerosols. Therefore, a better understanding of the transmission mechanisms, clinical features and testing methods of the virus is needed to help form protocols for dental practices to identify cases and prevent further spread of infection to patients and dental staff. Although biosecurity protocols have been developed that attempt to minimize the possibility of infection, it is not certain whether they prevent transmission of the infection [3,4]. So, what should be done? Are the dentists and patients who use these protocols safe? Finding options that go beyond the simple search for biosecurity barriers [5], for example, the use of digital tools, which are currently used successfully for distance education [6], could replace conventional activities such as consultation and patient monitoring. A dentist usually uses one appointment to take a medical history, another appointment for dental treatment and one more appointment to monitor the evolution of symptoms [2]. Thus, instead of visiting the dentist three times for treatment, with the development and use of digital applications, only one visit would be made for the dental procedure. The disadvantage of digital tools is the reduced time to develop and maintain a positive relationship between the doctor and the patient and to require an adequate Internet service and audio and video equipment to facilitate its use. Dentists must adapt quickly to new forms of care, responding to demand in a responsible manner and understanding that it is not just a matter of providing a solution to an oral health problem, but also helping to mitigate the possibility of infection.

Psychosocial rehabilitation as an essential area of psychiatric care targeting the social recovery of mentally ill patients

ABSTRACTThis paper deals with the problems of psychosocial rehabilitation and social recovery of patients with schizophrenia spectrum disorders and severe social incompetence lasting throughout their lifetime which defines the classification of these disorders in the group of ‘most highly disabling illnesses’ (up to 40%). New forms of care, proven to be effective, are discussed. The paper presents the organizational principles and possibilities for implementing a psychosocial rehabilitation system right across the country.