Routine Home Visits Research Articles

Technology-Assisted Mental Health Intervention Delivered by Frontline Workers at Community Doorsteps for Reducing Anxiety and Depression in Rural Pakistan: Protocol for the mPareshan Mixed Methods Implementation Trial.

There is a dearth of specialized mental health workforce in low- and middle-income countries. Use of mobile technology by frontline community health workers (CHWs) is gaining momentum in Pakistan and needs to be explored as an alternate strategy to improve mental well-being. The aim of this study is to assess the feasibility, acceptability, and usefulness of an app-based counseling intervention delivered by government lady health workers (LHWs) to reduce anxiety and depression in rural Pakistan. Project mPareshan is a single-arm, pre- and posttest implementation research trial in Badin District, Sindh, using mixed methods of data collection executed in 3 phases (preintervention, intervention, and postintervention). In the preintervention phase, formative qualitative assessments through focus group discussions and in-depth interviews assess the acceptability and appropriateness of intervention through perceptions of all concerned stakeholders using a specific interview guide. A REDCap (Research Electronic Data Capture)-based baseline survey using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 Scale (GAD-7) determines the point prevalence of depression and anxiety among consenting men and women older than 18 years. Individuals with mild and moderate anxiety and depression are identified as screen positives (SPs) and are eligible for mPareshan app-based intervention. Mental health literacy of health workers is improved through customized training adapting the World Health Organization's Mental Health Gap Action Programme guide 2.0. The intervention (mPareshan app) consists of tracking, counseling, and referral segments. The tracking segment facilitates participant consent and enrollment while the referral segment is used by LHWs to transfer severe cases to the next level of specialist care. Through the counseling segment, identified SPs are engaged during LHWs' routine home visits in 6 face-to-face 20-minute counseling sessions over 6 months. Each session imparts psychoeducation through audiovisual aids, breathing exercises, and coping skills to reduce stress. Clinical and implementation outcomes include change in mean anxiety and depression scores and identification of facilitators and barriers in intervention uptake and rollout. At the time of this submission (April 2024), we are analyzing the results of 366 individuals who participated in the baseline prevalence survey, the change in knowledge and skills of 72 health workers who took the mPareshan training, change in anxiety and depression scores of 98 SPs recruited for app-based counseling intervention, and perceptions of stakeholders pre- and postintervention gathered through 8 focus group discussions and 18 in-depth interviews. This trial will assess the feasibility of early home-based mental health screening, counseling, and prompt referrals by frontline health workers to reduce anxiety and depression in the community. The study findings will set the stage for integrating mental health into primary health care. Australian New Zealand Clinical Trial Registry ACTRN12622000989741; https://tinyurl.com/5n844c8z. DERR1-10.2196/54272.

Determinants of incomplete child vaccination among mothers of children aged 12-23 months in Worebabo district, Ethiopia: Unmatched case-control study.

In nations like Ethiopia, vaccination rates are low despite being one of the most effective public health treatments to protect infants from common infectious diseases that can be prevented by immunization. In Worebabo District, the reasons of the underutilization of vaccination programs are poorly understood. Therefore, this study aimed to identify determinants of incomplete childhood vaccination in the study setting. Community based unmatched case-control study was carried out among 441 mothers of children aged 12-23 months old (147 cases and 294 controls) in Worebabo District, Ethiopia from March 1-April 30, 2020. Using a multistage sampling process, mothers were chosen. Health professionals were trained to collect data using a pre-tested standardized questionnaire. Data entered into Epi Info version 7.2 and put through statistical analysis in SPSS version 23. Binary logistic regression was performed to determine the odds ratio with a 95%CL. A p-value of under 0.05 was estimated statistically significant. The study found that older moms (>35 years old) were more likely than younger mothers to fail to properly immunize their children (AOR = 2.4, 95% CI: 1.09, 5.28). In addition, mothers with incomplete vaccinations had lower knowledge of the benefits of vaccination (AOR = 2.02, 95% CI: 1.20, 3.39), Negative attitudes towards immunization (AOR = 4.9, 95% CI: 2.82, 8.49), less access to prenatal care (AOR = 3.68, 95% CI: 1.58, 8.54), home delivery (AOR = 5.47, 95% CI: 2.58)., 11.58), absent home visits (AOR = 3.56, 95% CI: 1.69, 7.48), and longer time to reach vaccination site (>1 h) (AOR = 10.07)., 95% CI: 1.75, 57.79) were found associated with mother incomplete vaccination of the child. Mothers being older age, less access to antenatal care services, place of home delivery, longer time to reach vaccination site, negative attitude and poor knowledge towards the benefit of vaccination were associated with mothers' incomplete vaccination of the child. Therefore, health professionals should inform and counsel mothers about the advantages of childhood immunization as well as the consequences of incomplete or not vaccination of children at the time of the facility visit and by community health workers during the routine home visit.

Barriers and facilitators for referring women with positive perinatal depression screening results in China: a qualitative study

BackgroundTimely screening and referral can improve the outcomes of perinatal depression (PND). However, uptake rates of referral after PND screening are low in China and the reasons are unclear. The aim of this article is to explore the barriers and facilitators for referring women with positive results of PND screening in the Chinese primary maternal health care system.MethodsQualitative data were collected from four primary health centers located in four different provinces of China. Each of the four investigators conducted 30 days of participant observations in the primary health centers from May to August 2020. Data were collected via participant observations and semi-structured in-depth interviews with new mothers who had positive results of PND screening, their family members, and primary health providers. Two investigators analyzed qualitative data independently. A thematic analysis was conducted, and data were framed using the social ecological model.ResultsA total of 870 hours of observation and 46 interviews were carried out. Five themes were identified: individual (new mothers’ knowledge of PND, perceived need to seek help), interpersonal (new mothers’ attitudes towards providers, family support), institutional (providers’ perception of PND, lack of training, time constraints), community (accessibility to mental health services, practical factors), and public policy (policy requirements, stigma).ConclusionsThe likelihood of new mothers accepting PND referral is related to factors in five areas. Intervention strategies can be developed around these themes and may include educating new mothers and their families about PND, training primary health providers to improve their awareness of condition and indication for referral, building mental health support in routine postpartum home visits, and providing support through mobile technology.

Feasibility and acceptability of home-based neonatal hyperbilirubinemia screening by community health workers using transcutaneous bilimeters in Bangladesh

BackgroundUniversal screening for neonatal hyperbilirubinemia risk assessment is recommended by the American Academy of Pediatrics to reduce related morbidity. In Bangladesh and in many low- and middle-income countries, there is no screening for neonatal hyperbilirubinemia. Furthermore, neonatal hyperbilirubinemia may not be recognized as a medically significant condition by caregivers and community members. We aimed to evaluate the acceptability and operational feasibility of community health worker (CHW)-led, home-based, non-invasive neonatal hyperbilirubinemia screening using a transcutaneous bilimeter in Shakhipur, a rural subdistrict in Bangladesh.MethodsWe employed a two-step process. In the formative phase, we conducted eight focus group discussions with parents and grandparents of infants and eight key informant interviews with public and private healthcare providers and managers to explore their current knowledge, perceptions, practices, and challenges regarding identification and management of neonatal hyperbilirubinemia. Next, we piloted a prenatal sensitization intervention and home-based screening by CHWs using transcutaneous bilimeters and evaluated the acceptability and operational feasibility of this approach through focus group discussions and key informant interviews with parents, grandparents and CHWs.ResultsFormative findings identified misconceptions regarding neonatal hyperbilirubinemia causes and health risks among caregivers in rural Bangladesh. CHWs were comfortable with adoption, maintenance and use of the device in routine home visits. Transcutaneous bilimeter-based screening was also widely accepted by caregivers and family members due to its noninvasive technique and immediate display of findings at home. Prenatal sensitization of caregivers and family members helped to create a supportive environment in the family and empowered mothers as primary caregivers.ConclusionAdopting household neonatal hyperbilirubinemia screening in the postnatal period by CHWs using a transcutaneous bilimeter is an acceptable approach by both CHWs and families and may increase rates of screening to prevent morbidity and mortality.

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Occupational Exposures in the Homecare Environment: Piloting an Observation Tool

The population of home healthcare workers (HHCWs) is rapidly expanding. Worker tasks and the unique home care environments place the worker at increased risks of occupational exposures, injury, and illness. Previous studies focusing on occupational exposures of HHCWs are limited to self-reports and would benefit from direct observations. The purpose of this study is to describe the occupational hazards observed in the unique work environment of home healthcare. HHCWs and home care patient participants were recruited from one home care agency in the Midwest to be observed during a routine home visit. This cross-sectional study used a trained occupational health nurse for direct observation of the occupational setting. Standardized observations and data collection were completed using the Home Healthcare Worker Observation Tool. The observer followed a registered nurse and occupational therapist into 9 patient homes observing visits ranging from 22 to 58 minutes. Hazards observed outside of and within the home include uneven pavements (n = 6, 67%), stairs without railings (n = 2, 22%), throw rugs (n = 7, 78%), unrestrained animals (n = 2, 22%), dust (n = 5, 56%), and mold (n = 2, 22%). Hand hygiene was observed prior to patient care 2 times (22%) and after patient care during 5 visits (56%). Observations have identified hazards that have the potential to impact workers’ and patients’ health. The direct observations of HHCWs provided opportunities for occupational safety professionals to understand the occupational exposures and challenges HHCWs encounter in the home care environment and begin to identify ways to mitigate occupational hazards.

Social Restrictions and the COVID-19 Pandemic in Families of Special Students

Working with special education is diving into an ocean of diverse and stimulating behaviors, challenging us daily and, the pandemic made us review routines, change attitudes and use more creativity. This experience report, in a context of insertion of psychologists in a multidisciplinary team, Unified Health System (SUS), in the modality of Special Schools (APAEs), approaches the psychological clinical experience, during the exercise of technical and ludic activities with the clientele and their respective families. It deals with two APAEs, in the Southwest Region of the State of Paraná-BR. This is a small sample, a differentiated work with specific psychological tools, involving the whole educational context. The goal here is to give visibility to a clientele that is sometimes marginalized, excluded and hidden in a fog of distorted beliefs and values, and how psychology contributes. We work with an inclusive methodology between school and family, in the Conversation Round format, with a theoretical focus on Cognitive-Behavioral Therapy and Systemic Approach. A brief context of the routine before and during the pandemic (COVID-19) is presented, which behaviors emerged and how they experience the current context. The preventive importance, of the psychological health program with the inclusion of families since 2016, to face the restrictions and social isolation is evidenced. Two cases of overcoming difficulties in the midst of the pandemic (COVID-19) are presented, converging with the theme of the National Week of the Person with Multiple and Intellectual Disabilities 2020 (Protagonism potentiates and materializes social inclusion). There were tense moments, program changes, methodological reinventions (Social Networks) mainly at the beginning of the pandemic. School, teams, and families started to communicate, mainly, through the cell phone (WhtsApp), with the teams making routine home visits, mobilized on different fronts, to provide all the help and guidance possible. We conclude this report with satisfactory results that, despite all the restrictive social suffering, the apaean families of the two schools, up to the present date (August/2021), had no losses and were able to adapt to the new reality: remote classes.

Wheelchair satisfaction among elderly Arab and Jewish patients – a cross-sectional survey

Purpose To evaluate patient satisfaction with their wheelchairs among Jewish and Arab older adults. Materials and method A cross-sectional study based on personal interviews. Participants were confined to a wheelchair (WC) Level 3. The Quebec User Evaluation of Satisfaction (scales 1–5) evaluated patient satisfaction. T test evaluated differences between continuous variables and or a Fisher’s exact test between categorical variables. The contribution of background variables to the overall satisfaction with the wheelchair and related service was evaluated by multivariate regression. Results A total of 74 Jewish and 24 Arab (mean age 78.4 ± 14.1), participated in the study. The overall satisfaction score was moderate/high (3.97 ± 0.8) with no difference between the groups. The most important items for all participants were WC safety, comfort and weight. Participants from the Arab sector were less educated, had higher BMI and were less satisfied with the chair dimensions. Conclusions A WC Level 3 may be effective and meets most of the basic needs of both Jewish and Arab patients at older ages. Higher BMI may result in difficulty to adopt to WC dimensions and can explain the less satisfaction of Arab patients with this component. A routine initial phone call follow-up is recommended to all patients after receiving a wheelchair. Those with problems will be scheduled for home visit. It is recommended to perform a study that will include more types of assistive devices and other groups of patients. Implication For Rehabilitation Apparently, despite lack of home visit follow-up, overall satisfaction with wheelchaires is relatively high. Therefore, initial phone calls may be monitored to all patients and home visits may be scheduled only for those unsatisfied with their chair. Converting a home visit to phone call can reduce the costs associated with routine home visits for all patients as is currently the case in some counties. This counts for both Jewish and Arab patients.

Effects of a health education program targeted to Chinese women adhering to their cultural practice of doing the month: A randomized controlled trial

Background“Doing the month” is a prevalent Chinese postpartum custom which is believed to restore health after delivery. However, some traditional practices are potentially harmful for women's health. ObjectivesTo examine the effect of an evidence-based health education program on Chinese postpartum women's adherence to traditional practices of doing the month and the effect of adherence to doing the month on maternal physiological and psychological health. MethodsA randomized controlled trial was conducted. During December 2016-July 2017, we recruited postpartum women at a tertiary hospital. Women randomized to the intervention group received evidence-based health education within 1 week after returning home and received a second visit 1 month later. The control group received routine postpartum home visits. Adherence to doing the month was measured by the Adherence to Doing-the-Month Practices questionnaire (ADP). Maternal physical health was measured by the Chair Stand Test and Postpartum Symptom Checklist. Maternal psychological health was measured by the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics, t-test, and chi-squared test were used to analyze the differences in scores and symptoms of the two groups. ResultsWe recruited 124 eligible postpartum women and 108 of them (54 intervention group, 54 control group) completed this study. The ADP score of the intervention group was significantly lower than that of the control group (p < 0.001). The number of participants in the experimental group with poor appetite and indigestion was significantly lower than that of control group. No significant differences were found in numbers of symptoms and average EPDS scores between the 2 study groups (p > 0.05). ConclusionsEvidence-based health education can reduce postpartum women's adherence to some traditional practices of doing the month and improve women's physical health.

Evaluating the Effectiveness of Planned Discharge Program in the Quality of Life of Gastrointestinal Cancer Patients Undergoing Chemotherapy: A Clinical Trial Study

Background: Considering recent economic challenges, the short-term hospitalization of cancer patients for routine chemotherapy, and the lack of routine home visits for cancer patients in Iran, the quality of life of these patients after discharge can be a source of concern. Objectives: This study aimed to determine the effect of a planned discharge program on the quality of life of gastrointestinal cancer patients undergoing chemotherapy in hospitals of Zahedan University of Medical Sciences. Methods: This clinical trial was conducted in 2018 on gastrointestinal cancer patients undergoing chemotherapy in hospitals affiliated to the Zahedan University of Medical Sciences. The sample was selected by convenience sampling, and the participants were randomly assigned into two groups of intervention (n = 45) and control (n = 45). The intervention was performed in three 45 to 60-minute sessions and sending text messages, which were based on the patients’ identified problems and needs for the intervention group. Data collection tools included the QLQ-C30 questionnaire and a demographic characteristics form. Data were analyzed by SPSS V. 21 software using descriptive and analytical statistical tests. Results: The mean scores of the patients’ quality of life increased on most of the functional subscales and global health/quality of life in the intervention group. In the control group (routine care), however, no significant difference was observed in most functional subscales of quality of life. There was a significant change in the mean severity of symptoms in the intervention group so that the severity of symptoms decreased after the intervention. In the control group, there was a significant difference in the mean severity of symptoms before and after the intervention so that the severity of symptoms increased in most cases. Conclusions: Home visits of cancer patients are not in routine care after discharge in Iran, and they are not covered by insurance companies. Thus, home visits are expensive. However, in areas where the economic index is low, and patients have little access to smartphones, the planned discharge program can be a suitable method to increase the quality of life of cancer patients.

Treatment outcomes for elderly patients in Thailand with pulmonary tuberculosis

Abstract Background Elderly patients with pulmonary tuberculosis are less likely to achieve treatment success than younger patients, and patients aged ≥60 years have a substantial increase in mortality. Objectives To compare treatment outcomes over 2 periods during the transition of Thai national tuberculosis (TB) reporting systems and determine treatment success rates and mortality for elderly patients in TB treatment-care settings in Thailand. Methods Retrospective cohort study of all records of elderly patients extracted from 2 national TB databases in Thailand: the TB Case Management (TBCM) database of the National TB Program (2014–2015) and the database of the National Health Security Office (NHSO; 2010–2011). Results There were 8,301 elderly patients with TB in the TBCM cohort and 11,869 in the NHSO cohort. Overall treatment success rates were 78.5% for patients in the TBCM cohort and 87.5% for patients in the NHSO cohort. High success rates for treatment were found for those aged 60–69 years: 91.1% in 2010–2011 and 85.0% in 2014–2015. High mortality was reported for patients aged ≥90 years: 34.6% in 2010–2011 and 50.0% in 2014–2015. Conclusions Compared with the NHSO historical cohort, success rates for treatment were lower and death rates were higher in the TBCM cohort. Because NHSO enforced intensive case monitoring and follow-up while TBCM has no such mechanism, the estimates from the TBCM database may be less accurate for TB circumstances in Thailand. Frequent routine home visits may ensure more complete treatment-care information and support, and increase the treatment success rate in the elderly.

I Developed a Professional Attitude at the University, but Among the Poor Families I Developed Personality

The Brazilian Curriculum Guidelines for Undergraduate Nursing Courses have gradually encouraged home visits in differently realities by advocating the training of reflective and critical professional skills with regard to multiples dimensions of health of the human beings. Based on this justification, the objective of this study was to understand the meaning of the home visits for Brazilian nursing student in poor families. The Grounded Theory approach was used in this study. Data collection was performed between December 2017 and July 2018 through interviews with students and newly graduated nurses who are working in the Primary Health Care and carry out routine home visits. The meaning of home visits to poor families by a nursing student resulted in an intensive personal and professional (re)organization process: “I developed a professional attitude at the university, but among the poor families I developed personality”. Initially the students demonstrated uncertainty, disappointment and frustration, but soon as they take up the challenge, the nursing students rethink concepts, practices, types of personality and social responsibility. It is concluded that regular curricular activities with poor families have the possibility of extending the life expectancy of families and transcending the academic knowledge limits of students'.

Knowledge and practices regarding the prevention of tetanus among adults of resettlement colony of Delhi, India

Background: Community awareness about tetanus immunization schedules and its importance in preventing tetanus is very low. Aim: This community-based, cross-sectional study was conducted to assess the knowledge, attitude, and practices about tetanus toxoid (TT) immunization among the general population in a resettlement colony of East Delhi. Materials and Methods: Stratified random sampling was done. There were five blocks and 50 participants were taken from each block randomly. The study was explained to the prospective participants during routine home visits. The study was conducted over a 3-month period from November 2017 to January 2018. Adult residents of the urban resettlement colony, of either sex, who gave written informed consent to participate in the study, were interviewed at their homes, at a time convenient to them, using a semi-structured proforma, and their responses were recorded and analyzed using the SPSS version 20. Results: Of the 250 participants enrolled, 230 persons who were willing to respond were included. The mean age was 35.9 years. 68.3% of the participants were female and 31.7% were male. Awareness of tetanus immunization regarding injury shows that only 52.1% of the respondents knew about the need of tetanus injection after injury beside other measures such as medicine and bandage. This knowledge was significantly associated with education. Majority (85.6%) of the respondents did not know the correct schedule of tetanus prevention immunization schedule in children. Only 30.8% of the participants knew that diphtheria and tetanus toxoid prevents tetanus. Conclusions: Sustained and focused health education efforts are necessary to combat misconceptions regarding TT immunization.

Managing the Elephant in the Room: What Home Health Care Nurses Do and Don’t Do to Support Productive Interaction

Background/Problem: Quality therapeutic communication and relationships are key to delivering effective integrated care management ICM, known to promote health and wellness for elders with multiple chronic conditions MCC, disability, and depression. HHC nurses are in a unique position to establish these relationships because they communicate and engage with elders during routine home visits, often as the sole provider of care. A major barrier to nurse-pt. communication is the high prevalence of untreated comorbid illness/depression interfering with patients’ abilities to collaborate and engage in self-care. Further, therapeutic communication skills empathetic are rarely practiced by nurses, instead they use task-oriented, directive, and controlling communication. Not surprisingly, these types of communication barriers persist in HHC, since the quantity and quality of communication training is almost nonexistent, nor mandated by policy. The in-depth analysis of nurse communication data from observation home visits by this team, found a pervasive underutilization of nurse engagement in therapeutic relationships. Consequently, elders in this study felt insecure and alienated, engaged less in self-care, and experienced more mental distress, which was not expressed/explored. Nurses, experienced similar ambivalent feelings and distress because they lacked the confidence and skill to adequately deal with patients competing demands. This unspoken but shared mental distress and upset led to a parallel process in which both nurses and patients experienced discomfort difficult to express in words – the proverbial elephant in the room. These unaddressed conversational gaps in communication diminished nurses' abilities to therapeutically engage patients in mutual problem solving and self-care action plans. Design: The purpose of this 3-part qualitative descriptive study is to illuminate nurse-patient communication occurring during nurse visits to elders with MCC, depression, disability. Methods: The analysis part 3 focused on 338 transcribed audio-recorded communication incidents in an attempt to shed light on the dynamics underlying nurse-patient relationships; addressing: a common contextual visit features; b what nurses do and don't do to support productive interactions; c therapeutic communication: managing the “elephant in the room.” Findings: Three categories of communication emerged: 1 Connections: 72% social conversations, setting focused agendas, patient assessment, and directive guidance. 2 Disconnections: 25% missed opportunities to engage in patient-centered communication and patient-expressed concerns; impeding productive therapeutic interactions. 3 Therapeutic Communication: 3% active listening, prompting patient expression, and verifying nurse’s perception of patient's messages, nurse-patient collaboration on actions plans. Communication categories highlighted how nurse-patient relationships, typically involve close interpersonal connections, but are susceptible to conversational shifts that create periodic disconnections within HHC episodes. There is much that nurses do to support productive interactions over the course of managing demanding agendas and establishing positive patient-centered connections. Lessons Learned, Future Research: Evidence from this study, was used to develop and pilot-test an educational on-line course, designed to enhance nurses' ICM skills and build capacity in therapeutic communication to improve mental/physical health. This course will be a foundational part of a feasibility test of a nurse-led ICM intervention, for elders with MCC- INSPIRE Interactive Nursing Support to Promote Integrated care for elders REcieving HHC designed to prevent disability worsening and improve psychosocial health.

A mental health home visit service partnership intervention on improving patients' satisfaction

AimsTo investigate a partnership intervention of the community-based and hospital-based home visit to improve patients' satisfaction. MethodsA time series quasi-experimental quantitative design was used. The experimental group had “partnership intervention”, while the control group maintained routine home visits. Patient satisfaction was measured pre-intervention, six months and 12 months after the partnership intervention. ResultsSix and 12 months after partnership intervention, in the experimental group, items related to stabilizing disease conditions, improving daily living abilities, enhancing communication ability and providing relevant resources were significantly higher than pre-intervention. However, 12 months after the intervention, the influence of the intervention became weaken. ConclusionsThe partnership intervention can significantly improve patients' satisfaction with home visit service.

Integrating a public health and human rights approach into mental health services for Palestinians in the Gaza Strip

BackgroundIn the context of violations of human rights and insecurity, the Gaza Community Mental Health Programme (GCMHP) provides mental health services and psychosocial interventions that match local cultural and social norms. The GCMHP uses a community mental health approach to promote the psychological wellbeing of the people living in the Gaza Strip and advocate on mental health issues. MethodsThe GCMHP provides preventive and therapeutic care to a broad public health spectrum of Gazan society. Services are provided in terms of preventative public health at the primary, secondary, and tertiary levels. Data reported here are from 2014–16. FindingsFor primary prevention, our services include advocacy, public awareness, and media campaigns aimed at raising awareness about and preventing common mental disorders and behavioural difficulties in children. 35 878 people are estimated to have benefited from these programmes. The GCMHP also provides psychological first aid and crisis intervention to vulnerable persons and a free telephone counselling service. About 12 943 persons have received individual sessions, and 2590 persons have received telephone counselling. The GCMHP also provides training to enhance the skills of professionals of local organisations working in mental health and psychosocial services. 3557 people have attended these programmes. As secondary prevention, the GCMHP offers individual and group psychotherapy, and routine home visits are provided for torture survivors and individuals and families exposed to cumulative trauma. 11 713 individuals have received such services. As tertiary prevention, rehabilitation services including physiotherapy and occupational therapy are provided to help patients regain their role as active members of the community. 398 people have received these services. InterpretationA public health-oriented approach to mental health services fits the socioecological model that locates individuals and families within the context of their community, religious-cultural context, and social, economic, and political systems. With social responsibility embedded as a core value, the GCMHP seeks to restore psychological wellbeing in citizens of the Gaza Strip. FundingNone.

The influence of a mental health home visit service partnership intervention on the caregivers' home visit service satisfaction and care burden.

To investigate a community-based and hospital-based home visit partnership intervention in improving caregivers' satisfaction with home service and reducing caregiver burden. The community-oriented mental healthcare model prevails internationally. After patients return to the community, family caregivers are the patients' main support system and they also take the most of the burden of caring for patients. It is important to assist these caregivers by building good community healthcare models. A longitudinal quasi-experimental quantitative design. The experimental group (n=109) involved "partnership" intervention, and the control group (n=101) maintained routine home visits. The results were measured before the intervention, 6 and 12months after the partnership intervention. Six months after the partnership intervention, the satisfaction of the experimental group was higher than the control group for several aspects of care. Although the care burden was reduced in the experimental group, there was no significant difference between the two groups. This study confirms that the partnership intervention can significantly improve caregiver satisfaction with home services, without reducing the care burden. The community-based and hospital-based mental health home visit service partnership programme could improve the main caregiver's satisfaction with the mental health home visit services, while the reduction in care burden may need government policies for the provision of more individual and comprehensive assistance.

Knowledge, attitude and practices about tetanus toxoid immunisation amongst general population of an urban semi-slum area: a cross-sectional interview-based study from Western India

Background: Members of the public are frequently unaware of tetanus immunisation schedules and its importance in preventing tetanus. This community-based, cross-sectional, complete enumeration, interview-based study was conducted to assess the knowledge, attitude and practices about tetanus toxoid immunisation amongst the general population in an urban semi-slum area located about 30 kms from Mumbai city in Western India.Methods: Respondents comprised adult residents of either sex, who gave written informed consent to participate in the study. After obtaining approvals, the study was explained during routine home visits and the respondents were interviewed at a time convenient to them. A direct face-to-face interview was conducted using a semi-structured proforma and their responses were recorded and statistically analysed.Results: Of the 161 participants (90 males; 71 females), 16.15% were illiterates. 95.65% thought that a single tetanus toxoid injection was adequate to prevent tetanus while none knew that pregnant women are immunised to protect newborns against tetanus. 67.08% were unaware about the need for maintaining cold chain for storage of tetanus toxoid. 96.89% had received only one injection of tetanus toxoid, irrespective of the type of injury or previous immunisation status. The belief that an adult requires tetanus toxoid after every injury exhibited education-wise significant difference (p=0.02).Conclusion: Sustained and focussed health education efforts are necessary to combat misconceptions regarding tetanus toxoid immunisation.

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30‐ and 60‐Day Hospitalization: The Depression Care for Patients at Home Cluster‐Randomized Trial

To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization. Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams). Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone. Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306). The Depression CARE for PATients at Home (CAREPATH) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted telephone conferences with team supervisors every 2 weeks. Hospitalization while receiving home health services was assessed using data from the home health record. Hospitalization within 30 days of starting home health, regardless of how long recipients received home health services, was assessed using data from the home care record and research assessments. The relative hazard of being admitted to the hospital directly from home health was 35% lower within 30 days of starting home health care (hazard ratio (HR) = 0.65, P = .01) and 28% lower within 60 days (HR = 0.72, P = .03) for CAREPATH participants than for participants receiving EUC. In participants referred to home health directly from the hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, P = .001) for CAREPATH participants. Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services.

Home Visits: Advancing Pediatric Training by Preserving Past Traditions.

* Abbreviations: ACGME — : Accreditation Council for Graduate Medical Education CSHCN — : children with special health care needs HCH — : home-centered health After a short ride from resident clinic, we drove into 1 of the city’s low-income housing complexes. Walking up to the third floor of a dilapidated building and noticing the flimsy railing, we realized our anticipatory guidance on child proofing the home must also include outdoor areas. In fact, it was the motivation to see just how appropriate our recommendations were for families living in urban poverty that led us to join a community outreach worker on a routine home visit. When we arrived at apartment 3A, Janelle and her daughter Mia were warmly awaiting us. We followed them into a small living room where Mia, the fearless 2-year-old, quickly went back to her favorite game of jumping off the furniture. The sight of an easily accessible open window with no screen gave us pause, and we suggested several ways to prevent Mia from accidently falling out. Janelle, a first-time mom, thanked us for the advice. She soon became more relaxed and began speaking candidly about the importance of supporting her daughter. In the less personal atmosphere of a clinic examination room, the interaction with a young mother might not reveal the parent’s strengths, but by visiting Janelle in her home environment and watching her interactions with Mia, we could appreciate just how committed she was. Just over half a century ago, 40% of physician–patient encounters were in the home.1 It was … Address correspondence to Igor Shumskiy, MD, Boston Medical Center, 720 Harrison Ave, Boston, MA 02118. E-mail: igor.shumskiy{at}childrens.harvard.edu