Residential Care Research Articles

Promoting aged care COVID-19 and influenza vaccination through education of Australian residential aged care staff: A mixed methods project evaluation.

Vaccination coverage against COVID-19 and influenza among Australian aged care residents remains suboptimal, placing this vulnerable population at heightened risk of severe illness, frailty, and death. Health care professionals' recommendations significantly influence vaccination uptake. Aged care staff, with their unique proximity to residents, play a pivotal role in promoting vaccination. The aims of this study were to evaluate the acceptance of a vaccine education project and determine the impact on vaccine conversation confidence. This quality improvement project aimed to enhance aged care staff's knowledge and confidence in discussing vaccination with residents and their families. It included a 30-min face-to-face educational session for staff members of residential aged care facilities. The session featured a didactic component on COVID-19 and influenza vaccines, an interactive question and answer component, and role-play exercises to demonstrate effective vaccine conversation skills. Evaluation of the project involved participant survey data collected immediately after the sessions and then again at a delayed timepoint. Project developers, co-ordinators, and facilitators also provided feedback on their experience which was analysed through qualitative thematic analysis. The educational program was delivered to 27 facilities across 32 sessions, with 316 staff members attending (median session attendance: 9, IQR 8-13). 95.4% of attendees reported improved knowledge and skills, 95.8% reported increased confidence in vaccine conversations, and 94.2% would recommend the session to others. Qualitative feedback was positive, highlighting the adequacy of content and improved confidence in discussing vaccines. In-house, face-to-face education is a well-received method of delivering education to residential aged care staff. However, facilities in most need of education may be less proactive in seeking it out. Further research is needed to understand barriers to uptake of staff education and strategies for fostering a culture of quality improvement and ongoing learning within facilities.

Challenges of Dementia Care in a Regional Australian Hospital: Exploring Interventions to Minimise Length of Stay for Dementia Patients.

There are significant difficulties associated with the management of dementia patients in hospitals, leading to adverse patient outcomes, prolonged length of stay (LOS), strain on resources and high readmission rates. This study aimed to investigate these factors in the context of a regional hospital. This study retrospectively reviewed all dementia admissions in a publicly funded Australian regional hospital from January 2022 to December 2022. All admissions including an ICD-10 coded dementia diagnosis were assessed, and data extracted using the integrated electronic medical record. Overall, 257 bed Australian regional hospital in an area with a Modified Monash Model rating of 2. There were 105 dementia patients admitted within the study period. Dementia severity, LOS, consultation liaison (CL) psychiatry involvement, readmission rates, and discharge destinations. The LOS in patients with dementia was 23.3 (± 35.2) days compared to age-matched patients without dementia admitted in the same period with a LOS of 8.2 (± 4.7) days. Dementia patients who died in hospital had the longest acute LOS at 14.4 (± 8.8) days. Dementia patients who were admitted from their usual residential aged care facility had the longest maintenance LOS at 69 (± 83.3) days. This research contributes information to the current knowledge gap of dementia care in regional hospitals. Data from this study may help to inform the development of strategies for effective hospital-based dementia care and interventions.

Provision of dementia-specific care in nursing homes in North Rhine-Westphalia (Germany) – analysis of person-centered practices and related problems within a holistic multiple case study

BackgroundTo ensure high-quality care for residents living with dementia, recommendations for dementia-specific care do exist internationally as well as in Germany. Nevertheless, it remains unclear how dementia-specific care is currently provided and what can be derived from this for the improvement of dementia-specific care. Therefore, this study aimed to investigate the provision of dementia-specific care and related problems in German nursing homes.MethodsWe used a holistic multiple case design with a total of four cases. The cases were defined as care units in which residents living with dementia were cared for. For data collection, we used problem-centered face-to-face interviews, document analysis, and context questionnaires and analyzed all qualitative data inductively and deductively using content structuring qualitative analysis. To identify case-specific and cross-case patterns and themes, we focused on similarities and differences between the cases. The reporting followed the EQUATOR reporting guideline for organizational case studies.ResultsWe interviewed 21 professionals, 14 relatives and 8 residents living with dementia. Despite context-specific differences, we identified a variation of care practices and problems in applying person-centered, dementia-specific care in German nursing homes. In all cases, these belong to the following topics: 1) handling neuropsychiatric symptoms, 2) dealing with communication difficulties, 3) providing person-centered interaction and communication, 4) dealing with stress caused by experiencing dementia-specific symptoms and 5) using and sharing knowledge. Even though the problems were identified in all cases, we also found differences in the extent and perception of these problems across the analyzed cases.DiscussionDespite existing conceptual recommendations and described care practices in our study, the identified problems showed that current care practices are perceived as problematic and partly are not person-centered. This highlights that person-centered requirements in dementia-specific care are not yet adequately addressed and that there is a need to give greater consideration to the identified problems when developing interventions to improve quality of care. Furthermore, the identified context-specific differences in the extent and perception of these problems show that the designs of new care models should allow for more flexibility, so that written recommendations can be implemented in practice and adapted to given contexts.

By Their Side, Not on Their Chest: Ethical Arguments to Allow Residential Aged Care Admission Policies to Forego Full Cardiac Resuscitation.

We argue that Aged Residential Care (ARC) facilities should be allowed to create and adopt an informed "No Chest Compression" (NCC) policy. Potential residents are informed before admission that staff will not provide chest compressions to a pulseless resident. All residents would receive standard choking care, and a fully discussed advance directive would be utilized to determine if the resident wanted a one-minute trial of rescue breaths (to clear their airway) or utilization of the automatic defibrillator in case of arrest. The benefits of chest compressions for residents in ARC are dubious, and the burdens are high. For frail elderly people without a pulse, chest compressions are arguably unethical because the chance of benefit is minuscule, the procedure is violent, painful, and challenging to perform correctly, and procedures detract from a peaceful end of life. These burdens fall on residents, their families, ARC facilities providers, and society. We further argue that limitations on universal invasive resuscitation, such as advance directives, need to be more consistently sought and applied. The goals of an informed NCC policy are twofold: removing added suffering from a person's end-of-life experience and increasing ARC residents' understanding of the burdens of ineffective treatments for pulselessness.

Topical review: Challenges and solutions for eye care in long-term care.

The prevalence of visual impairment among individuals living in long-term care (LTC) is substantial, yet eye care is often disregarded and inadequately addressed. This neglect contributes to a decline in quality of life for residents. Thus, understanding the challenges faced by stakeholders in providing eye care for residents might suggest opportunities to improve eye health outcomes. This study aimed to identify factors influencing access to eye care services in LTC, focusing on key stakeholders including residents, family members, aged care staff, and eye care professionals. We included studies on vision/eye care-related challenges and/or management of eye conditions for people living in LTC facilities. We performed literature searches using Cochrane Database of Systematic Reviews, PubMed, CINAHL/EBSCO, EMBASE, APA PsycINFO, and Web of Science database. The search was limited to articles in English language, published between January 2013 and September 2023. Factors influencing the vision/eye care for residents were mapped to respective stakeholders, and we visualized how they interacted within the LTC system in providing eye care. Eleven studies were included in the review. We found that the challenges to appropriate eye care in LTC are present across all stakeholder groups. These challenges include limited awareness of eye health, logistical difficulties in coordinating and managing eye care within LTC settings, and negative beliefs and attitudes toward prioritizing eye care for residents. This review highlights that barriers to eye care in LTC communities exist at multiple levels and involve a range of stakeholders. In order to improve eye care, interventions should be at the system level, considering the influence of all key stakeholders rather than employing a targeted approach.

Rural Eye Care Access, Workforce Challenges and Opportunities: Perspectives of the Eye Health Workforce in Western Australia.

Rural residents face numerous barriers to accessing eye care services that contribute to disparities in eye health outcomes. This study aimed to explore the perspectives of the rural workforce on opportunities to improve patient access to eye care services, as well as understand the ways the workforce can be supported. Regional, rural and remote Western Australia. A qualitative descriptive approach was taken. Maximum variation and snowball sampling were used, and semi-structured interviews were conducted until data saturation. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis. Seventeen semi-structured interviews were conducted with six ophthalmologists, 10 optometrists and one non-clinician involved in delivering eye care services in rural Western Australia. Four major themes were identified. 'Access to care' pertained to barriers and facilitators of timely and appropriate eye care for rural residents. 'Need for collaborative care framework' between ophthalmology and optometry emerged as a key opportunity to decrease wait times and maximise efficiency of visiting services. 'Motivation to work in rural settings' and 'challenges of working in rural settings' suggested opportunities to support the workforce. This study finds that continued support through financial, personal, and professional means is important for workforce retention and satisfaction among eye care service providers in rural Western Australia. Although collaborative care models currently exist, the extent of collaboration between practitioners varies considerably. Further research is required on developing innovative, scalable and sustainable models of care to meet the eye care needs in rural Australia.

2832 Understanding the experiences of older residents required to relocate from one nursing home to another: a qualitative study

Abstract Introduction As a response to the increased demand for nursing home services for older adults, there are new initiatives include building larger nursing homes to accommodate greater numbers of residents. This initiative can be detrimental to those older residents who required to be relocated from their current nursing home to a new one. However, there is limited understanding about how older residents adapt to this relocation, particularly on how they tackle the various issues after relocation. Thereby hindering healthcare personnel to identify appropriate strategies to support older residents during the process of relocation. The aim of this poster is to present the experiences of older residents in the immediate period after relocating to a new nursing home. Method A descriptive qualitative approach was adopted. Purposive sampling was used to recruit twenty-four older residents, who were relocated from existing nursing home to a new nursing home, upon ethical approval was sought. Semi-structured interviews were conducted based on the ‘process of adjustment’ framework after consent was obtained. Each interview lasted for around thirty minutes and audio-recorded. Data were analysed using thematic analysis. Results Four themes were identified namely: adaptation to the new environment, interaction with other residents, interaction with healthcare personnel, and changes to their daily life. In particular, participants highlighted changes to their daily routines and interactions with others, but most of them expressed positivity about their relocation to the new nursing home. Conclusion The results illuminate the initial experiences of older residents required to relocate from their nursing ‘home’ to another with no choice. These findings will inform further interviews over time to help inform person-centred care for residents, the role of carers and service providers, and the care environment. Acknowledgement The work described in this paper was fully supported by Hong Kong Metropolitan University Research Grant (No. RD/2023/1.18).

Refractory Psychosis as a Red Flag for End of Life in Individuals With Dementia With Lewy Bodies: A Case Series and Re-analysis of Prior Qualitative Data.

Many individuals with dementia with Lewy bodies (DLB) die of disease-related complications, but predicting the end of life can be challenging. We identified a phenotype associated with approaching end of life. We present 4 exemplar cases where individuals with DLB experienced refractory psychosis before death. We reviewed codebooks and quotes from 3 studies regarding end-of-life experiences in DLB to identify experiences that aligned with this phenotype. In addition to the 4 cases, family caregivers in prior studies described prominent worsening of psychosis before death in some individuals with DLB. The worsening often occurred several months before death and was sometimes associated with rapid deterioration. Worsening psychosis was the prominent symptom and was not initially accompanied by cognitive or physical decline. In many cases, the refractory psychosis resulted in inpatient psychiatric hospitalization or residential care, but these scenarios were challenging because of the individual's behavior. Refractory psychosis in DLB, particularly out of proportion to other symptoms, may be a signal of approaching the end of life. More research is needed to understand this phenomenon and to develop effective and safe treatments for psychosis in DLB.

P-957. Introducing PrEP to Primary Care: A Resident-Focused Initiative

Abstract Background Despite studies showing that HIV pre-exposure prophylaxis (PrEP) dramatically decreases risk of HIV acquisition, it is only currently prescribed to 30% of those who could benefit. The buy in of primary care providers (PCPs), who have an essential role as preventionists, is critical for the most successful reach; however, studies have shown that PCPs often do not feel knowledgeable about PrEP or may be uncomfortable discussing sexual activity or HIV. We hypothesized that dedicated PrEP training for PCPs in a resident clinic would increase prescribing habits. Methods At an Internal Medicine residency clinic with 73 trainees in New Orleans, LA, a pre-intervention survey was distributed to gauge baseline PrEP knowledge and comfort in discussing sexual practices, HIV status and risk factors. Following the training, residents attended a one-hour PrEP training. A post-training survey then assessed interest and intent to prescribe PrEP. We abstracted primary care clinic records to evaluate PrEP prescribing outcomes post-training, from October 2023 to April 2024. Results Forty-four residents completed the pre-training assessment. Most indicated non-routine discussions regarding sexual practices (37/44, 84.1%) and HIV risk assessments (41/44, 93.2%). Many trainees reported being not at all familiar with PrEP indications (40.9%), medications (45.5%), or monitoring (81.8%). Most (61.4%) had never discussed PrEP with clients. 53/73 (72.6%) residents attended the educational session, and 26/73 (35.6%) completed the post-training survey. All of the residents who completed both indicated that the training was informative, and 20/21 (95.2%) reported willingness to prescribe PrEP. In the six months post-training, we found that 11 clients were successfully initiated on PrEP. One client was diagnosed with HIV on intake labs, and 3 clients were found to have sexually transmitted infections, all of whom were treated or referred for treatment. Conclusion The results of this initiative’s pre-training surveys highlight a lack of routine sexual health and HIV risk assessments in a resident primary care clinic, as well as deficiencies in education regarding HIV PrEP. Following training, residents began prescribing PrEP, demonstrating promise for scaling such educational programs. PrEP Primary Care Pocket Card A pocket card adapted from the CDC PrEP TRAIN module was provided to trainees in the resident clinic. Contains information regarding medications available, contraindications, side effects, laboratory monitoring (on back side), ICD-10 code, etc. Disclosures Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|Viiv Pharmaceuticals: Advisor/Consultant

P-1669. Effect of Antimicrobial Stewardship Program on Antibiotic Prescribing for Veterans Affairs Nursing Homes

Abstract Background The CDC strongly recommends nursing homes take resolute steps to improve antibiotic prescribing practices and reduce inappropriate use. This is because studies have shown that up to 70% residents of US nursing homes receive 1 or more courses of antibiotics in a year while 75% of these prescriptions may be unnecessary or inappropriate. Antibiotic stewardship programs (ASP) are committed to optimize treatment of infections and reduce adverse events by close monitoring, education, and preventing unsuitable use. We analyzed the effect of our ASP over antibiotic prescribing of four Veterans Affairs (VA) community living centers (CLC). Table 1. Methods Retrospective review of ASP notes in the year 2023- the inaugural year for ASP reviewing CLCs- addressing requests for restricted antibiotics over 4 CLCs at Northport VA campus. The 4 CLCs are structured nursing homes with a 139 total bed capacity with two long term residential care units, one mental health, and one combined subacute rehab/hospice. We compared antibiotic use as days of therapy (DOT)/1000 days, for total antibiotics use, and analyzing cephalosporins, fluoroquinolones anti-MRSA, anti-MSSA, for years of pandemic 2020-2022 vs. 2023. Figure 1a Results Comparing 2020-22 vs. 2023 there was a decrease in all antimicrobial use in the CLCs, from 142 DOT/1000 days to 88. In 2023 the ASP team reviewed 135 CLC requests for restricted antibiotics, and 56 E-advice requests for guidance. 10% of the requests were denied. See table 1. The most common request for E- advice was whether to treat asymptomatic bacteriuria with/or without presence of urinary catheter. Comparing 2020-22 vs. 2023 there was a decrease in cephalosporins use by DOT/1000 days, 29.3 vs. 10.8, P: 0.09. There was no difference in Fluoroquinolones 2.0 vs. 6.0 P: 0.953, anti-MRSA antibiotics, 7.02 vs. 4.04 P:0.348, anti MSSA 0.67 vs. 0.8 P: 0.574. See figures 1a/1b. Figure 2 shows a downward trend of C. difficile infections in our CLCs. Figure 1b Conclusion Our ASP was overall successful in decreasing antibiotic use in our CLCs, notably for cephalosporins, while keeping FQ and other antibiotics use low. We were successful in education and preventing antibiotics especially for asymptomatic bacteriuria. An equally important achievement for our program was the decreasing rate of C. difficile infections. Figure 2 Disclosures All Authors: No reported disclosures

Access to Transition Planning and Support for Young People Who Self‐Place When in Out‐Of‐Home Care: The Perspectives of Young People and Practitioners

ABSTRACTThis paper explores the experiences of young people in Queensland, Australia, under child protection orders who leave approved out‐of‐home care placements (e.g., foster; residential care) to stay in unapproved locations (e.g., sleeping on the streets; staying with friends, family/kin, or strangers). This phenomenon is commonly referred to as ‘self‐placing’. Young people who self‐place are at increased risk of homelessness, exploitation, contact with the justice system, and disconnection from support services, including education and health care. We argue that this disconnection from formal support impedes their access to transition care planning and support—factors internationally recognised as essential for enhancing outcomes for care leavers. Our paper draws on qualitative interviews with 11 young people with experience of self‐placing and focus group data involving 26 statutory child protection practitioners and 17 specialist non‐government practitioners. We describe the ways in which self‐placing was perceived to shape young people's access to, and practitioners' ability to provide, transition planning and support. We identify ongoing gaps and examples of good practice to inform more robust transition from care policies that are responsive to the needs of this marginalised cohort.

The Introduction of Extended Out‐of‐Home Care (OOHC) Until 21 Years in Australia: A Mapping of Policy, Legislation and Programs in Each Jurisdiction

ABSTRACTIt is increasingly recognised by global research that extending out‐of‐home care (OOHC) until at least 21 years of age is the policy reform most likely to advance improved outcomes for care leavers. In recent years, all eight Australian jurisdictions (States and Territories) have introduced forms of extended care programs. Yet, major variations remain between these jurisdictions in terms of the placement types covered, the levels of support and funding, and the terms and language used to describe their programs. This paper maps the existing policy developments in each jurisdiction and the level of program supports provided to care leavers aged 18–21 years. For each jurisdiction, we establish extended care eligibility and coverage, funding and adequacy, and the key terminology used. Our discussion of the commonalities and differences between the jurisdictions suggests that some sub‐groups of care leavers may need additional and specialised forms of support. They include most notably those exiting residential care and Aboriginal and Torres Strait Islander care leavers.

Understanding the consumer, carer and stakeholder experiences of residential respite care.

Residential aged care respite clients are vulnerable and prone to poor health-care outcomes. Improvements in the quality of care for this cohort are urgently needed. However, before proposing changes in care models, a nuanced understanding of relevant issues affecting respite care consumers and professionals is required. We aimed to explore perspectives of consumers, carers, health-care workers and aged care workers involved in residential respite care (RRC). We used purposive sampling to recruit respite consumers, their family members, residential aged care staff and health-care workers across metropolitan Melbourne for semi-structured telephone interviews and electronic surveys regarding RRC. Thematic analysis of interviews and surveys was performed. Twenty-three semi-structured in-depth interviews (five family members, four residential aged care staff, five general practitioners, two nurse practitioners, seven hospital staff) and 12 electronic surveys (five family members, three general practitioners, four hospital staff) were completed. Five key themes were identified: (1) reasons for using respite care vary; (2) expectations and understanding of respite care vary; (3) structural and funding factors influence the experience and quality of care; (4) care professionals often lack timely access to accurate health-care information; and (5) medical management and health-care needs of respite residents are complex. These findings from multiple stakeholders highlight several issues regarding the benefits of and problems with RRC, and the interfaces between the aged care and health-care sectors. Understanding these issues is pivotal in informing targeted and systemic interventions to improve RRC.

Association of Self-Perceived Fatigue, Muscle Fatigue, and Sleep Disorders With Cognitive Function in Older Adults: A Cross-Sectional Study.

Fatigue and sleep disorders are common geriatric conditions and are associated with an increased risk of cognitive decline. This study aimed to examine the relationships among self-perceived fatigue, objective muscle fatigue, sleep apnea risk, insomnia, and cognitive function, focusing on their associations with mild cognitive impairment (MCI). Cross-sectional study. The study involved 217 older adults (median age: 80years, 65.6% women) from 2 residential care facilities in Vienna, Austria. Cognitive function was assessed with the Mini-Mental State Examination. Sleep quality and disturbances were evaluated using the Athens Insomnia Scale (AIS) and STOP-BANG questionnaire. Subjective fatigue was measured with the Multidimensional Fatigue Inventory, and objective muscle fatigue through 2 rounds of 10 maximal handgrip strength tests, separated by a 1-hour rest. Multivariable regression models adjusted for age, sex, comorbidities, sleep medication, and total number of medications were used to analyze associations among fatigue, sleep disturbance, and MCI. Participants with MCI (n= 72) had significantly lower handgrip strength (median Fmax1: 18.75kg vs 23.44kg), higher muscle fatigue ratios (median: 1.40 vs 1.19), and poorer recovery ratios (median: 0.85 vs 1.01) compared with those without MCI (n= 145). Sleep disorders and fatigue measures were more common in those with MCI, with 80.6% reporting insomnia (AIS ≥6) compared with 21.4% in the cognitively intact group. Logistic regression showed that muscle fatigue combined with sleep apnea risk was associated with the highest odds of cognitive impairment (odds ratio [OR], 6.12; 95% CI, 2.77-13.51; adjusted OR, 3.02; 95% CI, 1.15-7.92). Recovery capacity showed a positive association with cognitive function (β= 0.150, P < .05). Sleep apnea, muscle fatigue, and reduced recovery capacity are significantly associated with cognitive decline in older adults. Assessing these factors may help in identifying individuals at risk of cognitive impairment.

Resonances of Feeling Alone: A Systematic Review Unveiling Older Persons' Loneliness and Its Mechanisms in Residential Care Facilities.

To review older persons' lived experiences and perceptions of loneliness in residential care facilities and characterise mechanisms underlying their experiences through a comprehensive loneliness model. A systematic review synthesising qualitative research on the experiences of loneliness among older people living in residential care facilities. This review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines with quality appraisal conducted using the Critical Appraisal Skills Programme checklist. Articles published in English (2014-2024) from CINAHL, PubMed, PsycINFO and Web of Science. Sixteen articles met inclusion criteria, representing 357 participants across 10 countries and regions. Three core themes of loneliness were identified: relational and individualised loneliness experiences, perception and emotional distress and the influence of context and cognitive processes in modulating loneliness. A conceptual model delineating the mechanisms of older residents' loneliness in residential settings was developed. This review highlights the influence of older persons' residential context and cognitive processes, particularly their perceptions, in triggering loneliness. The perceptions of reduced social control and insufficient social connections in residential settings exacerbate older persons' loneliness, precipitating distressing emotional responses and diminished quality of life. Residential care facilities have a crucial responsibility in establishing a supportive atmosphere conducive to positive social engagement for older residents. Future research must explore strategic transformations of older persons' perceptions through mechanistic targets and tailored care plans to reshape their social expectations within the context of residential care facilities, potentially mitigating loneliness. This review addresses the problem of understanding the mechanisms and experiences of loneliness among older persons in residential care facilities. The findings highlight the critical need for supportive social environments and targeted interventions in residential care settings to improve residents' well-being and quality of life globally. Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. No patient or public contribution.

Female Care Leavers’ Experiences of Transition into, Through, and Out of Residential Care Centres in South Africa

Informed by Schlossberg’s transition theory and discourse analysis, this paper investigates the transitional experiences of adolescents who have resided at one residential youth care centre known as the School of Industry in South Africa. Residential youth care centres aim to empower and support youth to cope with social and scholastic challenges. Drawing from the lived experiences of care leavers, the paper interrogates a School of Industry’s delivery of this mandate. The study adopted qualitative methodologies and utilised individual interviews involving ten purposively selected female care leavers aged 21-32. Findings indicate that transition is a complex phenomenon influenced by complicated family dynamics, unpreparedness, and lack of skilled personnel, as well as unsupportive reintegration processes by the schools of industry and referring government departments. The study recommends that families, schools of industry, and government departments work collectively towards improved policy and practice to guide youth care services in South Africa.

Evaluation of the effect of dental caries, oral hygiene, and treatment need on oral health-related quality of life among Turkish orphan children and adolescents

BackgroundThe oral and dental health and related quality of life of orphan children and adolescents—who are considered a vulnerable population—are critical for both individual and public health.ObjectivesThis study aimed to investigate the status of the dental caries, oral hygiene, and dental treatment needs among a group of Turkish male orphan children and adolescents, as well as their impact on oral health-related quality of life.MethodsA total of 112 orphan children and adolescents aged between 9 and 17 years living in a residential care facility in Istanbul, Türkiye, were involved in this cross-sectional study. A comprehensive examination was conducted on each individual, encompassing the assessment of dental caries using the decayed, missing, and filled teeth (DMFT/dft) index, oral hygiene using the debris (DI-S), calculus (CI-S), and simplified oral hygiene (OHI-S) indices, and dental treatment need using the treatment need index (TNI). Oral health-related quality of life was evaluated using the validated Turkish version of the Child Oral Health Impact Profile-Short Form (COHIP-SF-19). The relationship between oral health-related quality of life and explanatory variables was evaluated using a multivariable linear regression model.ResultsThe mean age of the participants was 12 ± 1.79 years. The mean DMFT score was 4.57 ± 3.42, and the mean OHI-S score was 1.4 ± 0.52. Participants had a mean COHIP-SF-19 score of 57.79 ± 14.11, with 25% requiring at least one tooth to undergo radical treatment. Multivariable linear regression analysis indicated that the DMFT score (p = 0.009) and the need for radical treatment (TNI code 6) (p < 0.001) had a statistically significant impact on oral health-related quality of life among orphan children and adolescents aged 13–17.ConclusionsThis study underscores that dental caries and the need for radical treatment significantly impact the oral health-related quality of life of orphan children and adolescents.

How is the specialist-primary palliative care model functioning for cancer patients in the current New Zealand health system?

Patient barriers to accessing hospice and palliative care (PC) have been well studied. Important, yet less investigated, is how cancer patients whose hospice referrals were not accepted are being cared for. This article aims to understand the referral process from PC providers' perspectives and the implications of the current palliative system for patients, families and health professionals. We conducted interviews with 28 healthcare professionals via Zoom. Participants worked in specialist and primary PC settings, such as hospices and aged residential care, and were based in seven Aotearoa New Zealand regions. We thematically analysed the interview transcripts. We identified four themes: the state of the PC system; communication issues; unmet needs and inequities; and managing care within the current system. The limited funding for PC and other health services is resulting in a decrease in PC services. The specialist-primary model of end-of-life supportive care in New Zealand is undermined by under-funding. The implications for cancer patients, their families/whānau and their healthcare professionals are moves towards a more biomedical model of PC, a reduction in training and unsustainable workarounds to manage care within the under-resourced system. Considering the ageing population, urgent action is needed.

Impacts of State COVID-19 Vaccine Mandates for Health Care Workers on Health Sector Employment in the United States.

Objectives. To assess the impact of state COVID-19 vaccine mandates for health care workers (HCWs) on health sector employment in the United States. Methods. Using monthly state-level employment data from the Quarterly Census of Employment and Wages between January and October 2021, we employed a partially pooled synthetic control method that accounted for staggered mandate adoption and heterogeneous treatment effects. We conducted analyses separately for the 4 health care subsectors-ambulatory health care services, hospitals, nursing and residential care, and social assistance-with an additional analysis of 2 industry groups-skilled nursing care and community care for the elderly-under the nursing and residential care subsector. We further explored possible heterogeneous impacts according to the test-out option availability. Results. Mandate impact estimates were statistically indistinguishable from zero. Results further ruled out a mandate-associated decrease in employment larger than 2.1% of premandate employment levels for the 6 health care domains examined and for states with no test-out option. Conclusions. State COVID-19 vaccine mandates for HCWs were not found to be associated with significant adverse impacts on health sector employment even in states without a testing alternative to vaccination. The findings support vaccine mandates as a viable preventive measure without material disruption to the health care workforce, including in times of public health emergencies. (Am J Public Health. Published online ahead of print January 23, 2025:e1-e5. https://doi.org/10.2105/AJPH.2024.307906).

Finding traces of everyday life in unusual places: looking beyond case files in German and Scottish residential child care

ABSTRACT Case records hold life-long significance for those who spent their childhoods in looked after care. Across Europe, public inquiries into the care and treatment of children in care have examined the content of records and have highlighted their limitations. This paper presents data from phase one of a wider study; ‘Archiving Residential Children’s Homes in Scotland and Germany (ARCH)’, which undertook content analysis of the archives of two residential settings, Aberlour and Freistatt. Findings highlight that records were kept and maintained not only by the institution but also for the institution. Despite this, children’s everyday lives were noticed and captured, albeit it often accidentally and incidentally. The ways in which these every day encounters were narrated and constructed suggest the power of the overarching ethos in place in the two settings and the adults’ orientations towards their role and purpose. Although different in tone and remit, both archives capture traces of daily life and tell us something about what a childhood in Freistatt or Aberlour might have been like. By examining the case recording practices in the past, we raise questions about what this means for contemporary social work and its responsibilities in relation to archiving children’s everyday childhoods.