Special Services Research Articles

Blood biomarker profiles in young-onset neurocognitive disorders: A cohort study.

Young-onset neurocognitive symptoms result from a heterogeneous group of neurological and psychiatric disorders which present a diagnostic challenge. To identify such factors, we analysed the Biomarkers in Younger-Onset Neurocognitive Disorders cohort, a study of individuals <65 years old presenting with neurocognitive symptoms for a diagnosis and who have undergone cognitive and biomarker analyses. Sixty-five participants (median age at assessment of 56 years, 45% female) were recruited during their index presentation to the Royal Melbourne Hospital Neuropsychiatry Centre, a tertiary specialist service in Melbourne, Australia, and categorized as either early-onset Alzheimer's disease (n = 18), non-Alzheimer's disease neurodegeneration (n = 23) or primary psychiatric disorders (n = 24). Levels of neurofilament light chain, glial fibrillary acidic protein and phosphorylated-tau 181, apolipoprotein E genotype and late-onset Alzheimer's disease polygenic risk scores were determined. Information-theoretic model selection identified discriminatory factors. Neurofilament light chain, glial fibrillary acidic protein and phosphorylated-tau 181 levels were elevated in early-onset Alzheimer's disease compared with other diagnostic categories. A multi-omic model selection identified that a combination of cognitive and blood biomarkers, but not the polygenic risk score, discriminated between early-onset Alzheimer's disease and primary psychiatric disorders (area under the curve ⩾ 0.975, 95% confidence interval: 0.825-1.000). Phosphorylated-tau 181 alone significantly discriminated between early-onset Alzheimer's disease and non-Alzheimer's disease neurodegeneration causes (area under the curve = 0.950, 95% confidence interval: 0.877-1.00). Discriminating between early-onset Alzheimer's disease, non-Alzheimer's disease neurodegeneration and primary psychiatric disorders causes of young-onset neurocognitive symptoms is possible by combining cognitive profiles with blood biomarkers. These results support utilizing blood biomarkers for the work-up of young-onset neurocognitive symptoms and highlight the need for the development of a young-onset Alzheimer's disease-specific polygenic risk score.

Utilization of healthcare services by young adults with first psychotic episodes at the FRITZ am Urban in Berlin considering the migration background

In Germany, there are hardly any studies that investigated the care pathways in the early course of psychosis and the duration of untreated psychosis (DUP) and took the migration background into account. The study examined whether young adults with (PwM) and without amigration background (PoM) who had afirst psychotic episode or first contact with the psychiatric care system within the last 5years differ in their utilization of care services and DUP. The data collection and post hoc analyses were carried out as apart of acohort study (84inpatients) at the Early Intervention and Therapy Center (FRITZ) in Berlin. The number of PwM (n = 38) who experienced afirst psychotic episode did not significantly differ from the comparison group (PoM, n = 46) in the utilization of healthcare services (p = 0.22). Neither the time until seeking help from the first service nor the number of contacts with healthcare services and DUP significantly differed between PwM and Pom. The PwM were predominantly young adults with agood education background who grew up in Germany. Users sought help at FRITZ relatively quickly, independent of their migration background, which supports further implementation of specialized early detection and intervention services in Germany. The results could be attributed to the selection of the study population. Further studies are needed that address people with lower education and low language skills. The early detection programs and awareness campaigns should be adapted to this target group.

No Sky Too High, No Sea Too Rough: Qualitative Investigation of Resilience and Suicide in Special Operations Forces Service Members.

To investigate resilience in American Special Operations Forces (SOF) personnel. A qualitative descriptive exploratory design was used to interview Special Forces and Navy SEAL participants about their perspectives on and experiences of resilience. Assumptions that high resilience inversely correlates with suicide risk in SOF drove our primary research questions and study focus. Questions were based on Holling's theory of ecological resilience. Participants provided insightful and detailed data of their resilience and were often self-effacing or self-critical. Responses indicated that although quite resilient, SOF personnel express their resilience in ways known to become pathological and precipitate suicidality if left undetected. Extracted subthemes indicated commitment to others over self and a nexus of trait variables linked to suicidality. Estimated neurotrauma from repetitive blast exposures should be incorporated in future models. Findings challenge prevailing beliefs that dysfunctional behaviors and suboptimal resilience drive SOF suicide. Results herein justify future research and changes to command postures and U.S. Department of Defense initiatives regarding relationships between and among variables of resilience, neurotrauma, and suicide in SOF. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

“Instructive, valuable and useful”: Soviet Intelligence Learns from German World War I experience in HUMINT

ABSTRACT In the late 1920s, Soviet intelligence launched an effort to learn the tradecraft of foreign secret services. Among the key facilitators of this process was Konstantin Zvonariov, a Latvian communist and senior Red Army intelligence officer. Focusing on the World War I experience of German human intelligence, he was able to draw useful lessons for his organization and the entire Soviet intelligence community. His intellectual enterprise was only superficially noticed by the historiography of the Russian special services. This article aims to fill this gap. It examines Zvonariov’s detailed study of the organization and activities of German HUMINT and speculates on whether his work was able to influence Soviet intelligence theory and practice in the 1930s and beyond. The article suggests further scholarly exploration of Zvonariov’s legacy in the Soviet and post-Soviet Russian intelligence communities.

The contributions of past immigration to current age-sex structures of immigrant populations in Australia

Not all immigrant populations are the same. In this article, we decompose the age-sex structures of immigrant populations in Australia and its major cities in 2021 by periods of entry. The results show a wide array of differences among immigrant populations, as well as across major cities where the vast majority of immigrants reside. Not surprisingly, we find that immigrant groups with a longer history of immigration to Australia have a more varied age-sex profile than those with a shorter history. However, even within each immigrant group, we find substantial differences across cities that reflect the influences of policy and the preferences of the immigrants. By illustrating how historical immigration streams across areas in Australia have produced different population age-sex structures, we are able to better understand why they are different and what specific services they may require.

Nursing Skills in the Care of Patients With Respiratory Stomas in Hospitals With and Without Advanced Practice Tracheostomy Service.

To identify whether there are differences in knowledge regarding the management of patients with respiratory stomas among nurses working in hospitals with an advanced practice tracheostomy service compared to those without it. Descriptive, cross-sectional, comparative, analytical survey study. The study was conducted from January to March 2023 in four tertiary care hospitals, two of which have an advanced practice tracheostomy service. A self-administered questionnaire was designed, consisting of 16 questions about nurses' specialised training in caring for tracheostomy patients. The study adhered to the STROBE checklist. Statistical analyses were performed using SPSS (24.0) from IBM. Nurses in hospitals with a dedicated tracheostomy service obtained a higher mean score (7.1/10) and demonstrated greater anxiety when managing patients with stomas (p < 0.001), as well as an increased willingness to undergo specific training (p = 0.017) to reduce their lack of self-confidence. A higher level of anxiety in the management of tracheostomised patients and a greater interest in receiving specific training have been observed among nurses in hospitals with advanced practice services (APTS), despite having greater training. Therefore, institutions should commit to incorporating advanced practice nurses and continuing education in the approach to ostomies among their professionals. Implementing ongoing training programmes and specific tracheostomy services or units in hospitals would enable nurses to provide high-quality care for patients with respiratory stomas. The study adhered to the STROBE checklist. Neither patients nor the public were involved in the design or conduct of this research. Nurses participated exclusively in data collection.

Intermodal practices between land transport and the hub of Lomé airport in Togo

All air travellers in Togo pass through Gnassingbé Eyadéma International Airport (AIGE: Aéroport International Gnassingbé Eyadema) of Lomé. To get in or out of the airport, they must use other means of land transport as part of an intermodal approach. The urban transport system in Lomé is disjointed, with no interconnection between the land transport hubs and the airport hub, making it extremely difficult for users to get to and from AIGE. It is true that there is a public transport service called SOTRAL, but it does not serve the airport, while the use of artisanal transports to access the airport is prohibited or very restricted. The aim of this study is to analyse intermodal practices between land and air transport in Great Lomé District. The methodological approach used is based on surveys of passengers at bus stations and AIGE, interviews with transport stakeholders, counts of feeder and distribution modes, and observation of practices in the field. The study shows that in the absence of a specific transport service to serve the main multimodal hubs such as the airport, travelers are bound to use their own means of transport or hire very expensive artisanal transports or private vehicles to get to the airport. To leave the airport, travelers make more use of the airport’s VIP private taxis (32%), which are very expensive on arrival. Those who do not want to hire the airport’s expensive private taxis are forced to walk 300 m with their parcels to pick up a city taxi at the side of the road.

Mental health risk in human services work across Europe: the predictive role of employment in various sectors

BackgroundHuman services occupations are highly exposed to mental health risks, thus psychosocial risk management is critical to assure healthy and safe working conditions, promote mental health and commitment, and prevent fluctuation of employees. However, still little is known about prominent psychosocial risk factors in various human services work.ObjectivesTo identify prominent psychosocial risk factors of mental health in human services occupations and to explore their individual and organizational correlates in 19 European countries.MethodsCross-sectional survey using data from the European Union's Labor Force Survey among 379,759 active employees in 19 European countries. First, a descriptive analysis was carried out to establish the prevalence of mental health risk factors. Then sociodemographic correlates of occupational mental health risk factors were assessed by means of Pearson's chi-squared test. Finally, correlations were explored between perceived psychosocial risk factors and human vs. non-human services occupations, as well as contextual variables by applying multilevel logistic and multinomial regression analyses.ResultsThe prevalence of mental health risk was 45.1%. Work overload (19.9%), dealing with difficult clients (10.2%), and job insecurity (5.8%) were the most prevalent mental health risk factors among European employees. We identified significant differences in the prevalence of mental health risks and specific mental health risk factors among employees according to sex, age, and educational attainment. The prevalence of mental health risks was significantly higher among women (47.0%, man: 43.3%), workers aged 35–50 years (47.5%, &amp;gt;50: 44.4%, &amp;lt;35: 42.3%), and those with the higher level of education (51.9%, secondary with diploma: 42.6%, elementary: 36.2%). Employees working in healthcare in Northern Europe were most likely to be exposed to mental health risks (AME = 0.717). Working in healthcare in Northern Europe was the strongest predictor of reporting work overload (AME = 0.381). Working in social care in Central and Eastern Europe was the strongest predictor of reporting dealing with difficult clients (AME = 0.303) as the most prevalent mental health risk factor.ConclusionUnderstanding the impact of employment in specific human services occupations on mental health and its specific occupational stressors are vital to improve mental health and safety at work and maintain high quality services.

Self-harm Behaviors in Adolescents: Knowledge and Risk Assessment Skill among Novice Nursing Officers

Abstract Background: Self-harm behavior is an important public health issue that needs to be addressed by general or specialized psychiatric health services at the earliest to bring down the negative impact on individuals, the community, and society at large. Aim: The present study was adopted to assess the effectiveness of a training program for nursing officers in handling self-harm behavior among adolescents. Materials and Methods: The study was conducted in the tertiary care hospital in Bengaluru. One group pretest and posttest research design was adopted. Forty consented newly recruited nursing officers who met the selection criteria were selected through a purposive sampling technique. The nurses’ knowledge and skill in assessing the risk of nonsuicidal self-injury (NSSI) in adolescents were measured using a knowledge questionnaire and risk assessment skill questionnaire, which were prepared by the researchers. The data were collected at the pre- and postintervention periods. The structured skill training program was administered in four consecutive days. Post-test was conducted 10 days after the training. Analyses were performed using the SPSS 26 version with t-test and Wilcoxon rank test to find the effectiveness of the structured skill training program. Results: Findings revealed that there were statistically significant changes in knowledge score and risk assessment skills on NSSI in adolescents among nursing officers, followed by the structured skill training program at P &lt; 0.05 level. However, no significant association was found between sociodemographic variables with knowledge level and risk assessment skills of the nurses. Conclusion: The study findings show that a structured skill training program was effective in improving the nurses’ knowledge and skill in assessing the risk of NSSI behaviors in adolescents among nursing officers. The study has implications for nursing practice, education, research, and administration.

Personal and behavioural factors that influence physical activity in women living with metastatic breast cancer: a qualitative interview study

BackgroundWomen living with metastatic breast cancer can benefit from physical activity. Presently, there is an absence of research outside of quantitative investigations on the benefits of structured programs. To enable effective physical activity advice and services, it is important to understand factors that may facilitate or prevent engagement. We therefore explored with women with metastatic breast cancer: (i) personal and behavioural factors that influenced physical activity, and (ii) the role of healthcare services in influencing engagement in being physically active.MethodsRecruitment took place at a metropolitan cancer centre from November 2019 to January 2020. Women living with metastatic breast cancer were asked to participate in semi-structured interviews about physical activity, covering health-specific factors, goals, barriers, enablers, and interests. Interviews were recorded, transcribed and thematically analysed.ResultsTwenty-three women completed the interview, with a median age of 60 years (IQR: 20) and median time since metastatic diagnosis of 3.3 years (IQR: 3.0). Physical activity ranged from regular participation in structured exercise to simple incidental activity. Seven themes organised into three categories were identified. The category ‘personal context’ incorporated themes on: (1) both cancer and non-cancer related health factors; (2) time, work and family factors; and (3) exercise history and preferences. The category ‘strategies for physical activity’ incorporated themes on: (4) self-efficacy, and (5) routine and incidental activity. The category ‘role of health and physical activity services’ incorporated themes on: (6) tailored education and services, and (7) specific metastatic cancer services and considerations.Conclusions Participants expressed diverse experiences with physical activity, with common notions on how physical activity is beneficial but difficult in which to adhere. Whilst some barriers to engagement in physical activity were unique to having cancer, many were not specific to metastatic breast cancer. For example, some participants emphasised specific considerations resulting from their disease, while others primarily reported on general factors such as being time-poor or having conflicting priorities. A patient-centred approach tailored to this group’s health and behavioural context may be effective for women who are currently inactive to engage in physical activity.

Normal Sınıflara Devam Eden Özel Gereksinimli Öğrencilerin Kaynaştırma Uygulamasına İlişkin Görüşleri ve Karşılaştıkları Sorunlar

Abstract The aim of this study is to examine the views of students with special needs who attend normal classes on the application of inclusion and the problems they encounter. Children have different developmental characteristics, learning styles and speeds from each other. These differences may be more pronounced in some children. Since general education services are insufficient in the education of such children, it is useful to use special education services. However, in recent years, students with special needs have been educated in general education classes without leaving their peers, using support special education services, that is, inclusion education has found wide application. Today, the most preferred inclusion education for children with special needs to be accepted in society, increase their adaptation to society and not be deprived of the educational environment they have the right to is the inclusion education that they can see in normal classrooms, which is considered the least restrictive environment for them. In a successful Decoupling education application, individuals with special needs have the opportunity to discover and develop their own abilities, as they will be educated among normal students. When the literature is examined, it has been seen that many studies have been conducted on inclusion education. These studies were conducted with teachers, teacher candidates, school administrators, children with normal development in order to determine their opinions and suggestions for inclusion education in general. the studies conducted with regard to students with special needs who personally benefit from inclusive education are quite limited. It is thought that inclusion students are the individuals who can most accurately convey the difficulties experienced in inclusion education, and therefore it was aimed to determine the views of students who are injured by inclusion education about inclusion education and the problems they encounter during inclusion education. Key Words: Students with Special Needs, Integration Practice, Classroom Environment

The impact of an All-Hazard mass casualty event on emergency department operations: A retrospective study.

Mass Casualty Events (MCI) which have a direct and persisting impact on the safety and well-being of an emergency department (ED) and its staff, secondary to specific targeting of the healthcare setting, represent a distinct and complex operational challenge. ED physicians may be faced with the prospect of providing ongoing patient care while simultaneously experiencing direct threats to their own health or physical safety. In our study we considered the unique operational challenges encountered, and management strategies adopted, by the ED staff and its leadership to an all-hazard MCI impacting an academic urban emergency department. We conducted a retrospective, observational study of data from a tertiary academic medical center of patients arriving to the ED during a protracted MCI lasting from May 11th to May 21st, 2021. No arriving patients were excluded from analysis. Patient demographics, ED resource utilization, throughput, disposition and other pertinent data were considered. Analysis was done of three distinct patient populations including the event-group (EG), a non-event-group (NEG) and a control group (CG). Descriptive statistics were used to evaluating observational findings. We reviewed the records of 8527 total patients presenting to the Shamir Medical Center ED during the event and control periods. Of those, 283 patients were identified as an EG consisting of casualties from the MCI. 3563 patients were identified as the NEG presenting with complaints not related to the event. Our CG consisted of the 4681 patients who presented in the two weeks prior to the MCI. EG patients were noted to have important characteristics including higher relative numbers of men n=173 (61.6%), higher CTAS triage acuities [n=10 (3.8%), classified as CTAS 1], and an increase utilization of specialty consultation and admission consistent with observed injury patterns, most notably for the orthopedic services [orthopedic consultations: n=126 (44.5%) / orthopedic admissions: n=13 (4.6%)]. Findings from our observational study suggested that in the absence of larger public health interventions a manmade MCI, with direct threats to an ED and its staff, could force EDs to concurrently address the unique clinical needs of two distinct patient populations while simultaneously needing to take measures to protect hospital staff. Additionally, a higher burden of patient volumes and clinical acuity are likely to be encountered by select specialty consultation services. Further studies could focus on quantitative analysis to better understand the operational impact of these types of events on both patients and staff.

Analysis of Urban Indian Organizations' Promotion of Cancer Services.

The burden of cancer remains elevated for American Indian/Alaska Natives (AI/AN) in the United States, particularly urban communities. Urban Indian Organizations (UIOs) are part of the Indian health care system for urban AI/AN populations to receive culturally competent care; therefore, it is important that UIOs convey the importance of cancer preventive and treatment options through their websites. The purpose of this study was to utilize the Indian Health Service (IHS) Office of Urban Indian Health Programs' official website to identify, analyze, and describe IHS funded UIOs offering cancer-related services. We utilized qualitative content analysis on UIOs with primary care service capabilities. After determination of UIOs, each eligible website was reviewed to determine if promotion of specific cancer related services was being done based on the following categories: primary prevention, cancer screening, cancer support, and information/technology services that focus on the social determinants of health. There is limited, vague, or outdated information on UIO websites regarding the type of cancer-related services and programs provided. We found that while twenty-one of thirty-four UIOs list any mention of cancer screenings, few mentioned specific testing capabilities for various cancers. In addition, the listing of support and preventative services was also limited with less than half of UIOs reporting on patient navigation services, among others. There is untapped potential in the utilization of websites for extending the impact of UIOs and their work with urban AI/AN populations in prevention, screening, and support of cancer patients in a culturally appropriate manner that can improve outcomes.

A Novel Approach to Research Synthesis with the Distillation and Matching Model: Application to the Prevention of Youth Social, Emotional, and Behavioral Problems.

It is difficult for consumers to access the evidence base for prevention programs to determine which models or practices have the strongest empirical support for improving youth social, emotional, and behavioral (SEB) outcomes within their specific service contexts. Researchers can address this evidence-to-practice gap through innovations in research synthesis. The Distillation and Matching Model (Chorpita et al., 2005), an approach to research synthesis developed for the mental health field, is designed to identify what works for whom and under what conditions via three steps. In this paper, we describe the Distillation and Matching Model and suggest that applying this approach to the prevention literature for youth SEB problems may help bridge the evidence-to-practice gap. The first step, distillation, involves identifying "practice elements," defined as the goal or general principle guiding a discrete practice (e.g., praise) targeting a specific domain of SEB outcomes. This step produces a standard set of terms for the individual practices used across the literature that are studied in isolation and comprise comprehensive intervention models. The second step involves identifying "common elements," or the practice elements found in studies that meet standards of methodological rigor and report significant improvements in youth SEB outcomes. The third step, "matching," is a method for matching common element profiles (combinations of common elements) to intervention and personal characteristics to identify what combinations of common elements work for whom and under what conditions. The Distillation and Matching Model can provide a method for researchers to generate actionable information about common elements that can be used to develop and evaluate tailored interventions.

Antibiotic prophylaxis for patients undergoing dental care: a multi-centre evaluation in community and hospital dental services.

Background Infective endocarditis (IE) is a life-threatening condition known to be associated with transient bacteraemia, the source of which can be the oral cavity. Scottish Dental Clinical Effectiveness Programme (SDCEP) 2018 implementation advice was introduced to provide practical guidance on National Institute for Health and Care Excellence Clinical Guideline 64 (2016) for management of patients at risk of IE undergoing dental treatment.Aims To assess current compliance with SDCEP's Antibiotic prophylaxis against infective endocarditis in six UK special care dentistry services.Method Four specific standards were set based on current guidance. Retrospective data were collected (from 01/01/2019 to 01/04/23) across six special care dentistry services in the UK, with an aim of 50 episodes of antibiotic prophylaxis (AP) in each service.Results In total, 248 episodes of care were included from dental services in London, East Surrey, Birmingham, Newcastle and North East England, Greater Glasgow and Clyde, and Newport (Wales). In 78% of episodes of care (n = 193), AP was administered to patients within SDCEP's special consideration sub-group. Additionally, 91% of patients outside the SDCEP sub-group had a justified reason recorded for AP. In all but three cases (99%), patients had an invasive dental procedure following AP. In 92% of cases, antibiotics were administered as per SDCEP 2018 advice.Conclusion Even with national implementation advice, this evaluation demonstrates inconsistencies in provision of AP throughout the UK. Practitioners prescribing and administering AP should remain aware of the changing aetiology of IE, as well as the reasons for and against prophylaxis, so that patients can make an informed decision.

Navigating the services maze: Assessing service needs, referrals, receipts, and child protective services re-report and foster care entry outcomes

BackgroundResearch shows that families involved with Child Protective Services (CPS) have diverse needs not fully met by service referrals and provision. Furthermore, it is still unknown whether the service provision gaps are linked to child safety and permanency outcomes. ObjectiveThis study aims to address this research gap by evaluating the rereport and foster care entry outcomes of child welfare services based on the needs, referrals, and receipt of services for families involved with CPS. Participant and settingThe National Survey on Child and Adolescent Well-being II (NSCAW II) was used for this study, excluding children with prior reports and those in foster care to focus on re-report and foster care entry outcomes, reducing the sample from 5872 to 2580 children. MethodsLogistic Regression analyses were performed to investigate the relationship between services needed, referred, and receipts and child welfare outcomes. The analyses were structured into three sets of models to explore different aspects of service engagement and its impact on child welfare outcomes. ResultsOur study shows that specific CPS services, particularly caregivers' needs for mental health and substance misuse services, significantly impact the likelihood of re-reporting and foster care placements. ConclusionMost families contacting the child welfare system receive only case management services if their report moves beyond investigation. Such an approach requires that services are available, acceptable, and of sufficient quality to meet needs. This paper highlights crucial disparities in service needs, referrals, and receipts among families engaged with CPS.

Characterizing the services provided by family physicians in Ontario, Canada: A retrospective study using administrative billing data.

Family physicians in Ontario provide most of the primary care to the healthcare system. However, given their broad scope of practice, they often provide additional services including emergency medicine, hospital medicine, and palliative care. Understanding the spectrum of services provided by family physicians across different regions is important for health human resource planning (HHRP). We investigated the services provided by family physicians in Ontario, Canada using a provincial physician database and administrative physician billing data from 2017. Billing codes were used to define 18 general services that family physicians may provide. We then evaluated variation in the services provided by different physicians based on the physicians' geographic location (north-urban, north-rural, south-urban, and south-rural) and career stage (i.e., years in practice). Ontario had 14,443 family physicians in 2017, with most practicing in urban communities in southern Ontario and only 6.5% practicing in any setting in northern Ontario. In general, rural physicians provided a greater range of services than their urban colleagues. Their practices most often included clinic medicine, mental health services, emergency medicine, palliative care, and hospital medicine. Physicians in urban southern Ontario and those at a more advanced career stage were more likely to provide a narrower range of services. Overall, our findings have the potential to shape HHRP, medical education curriculum development, and clinical services planning in Ontario and elsewhere. Moreover, our results provide policy- and decision-makers with a basis for integrating knowledge of the specific clinical services delivered by family physicians into their future planning, with the goal of ensuring a fit-for-purpose workforce able to meet community healthcare needs.

The economic burden of post-endoscopic retrograde cholangiopancreatography (ERCP) procedure infections in Italy.

The infections of multidrug-resistant organisms (MDROs) associated with duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedure have become a significant cause for concern, especially in fragile patients. While the clinical impacts of these infections are well-documented, their economic implications remain underexplored. This study assesses the incidence and economic burden of post-ERCP infections in Italy using an administrative database. We conducted a retrospective observational study using administrative databases from A.O.U. Città della Salute e della Scienza di Torino. The study included all patients who underwent their first inpatient ERCP between 2018 and 2021. Infections were identified using ICD-9-CM codes for Pseudomonas aeruginosa, Clostridium difficile, Escherichia coli, Klebsiella spp., and Staphylococcus aureus. A 1-year follow-up was defined in order to estimate healthcare resource utilization and related costs, including readmissions, drug prescriptions, and outpatient specialist and laboratory services. The study included 686 inpatient ERCP cases, an overall infection rate of 4.2% was observed. Higher infection rates were observed in women (4.6%), patients over 70 years old (4.6%), emergency admissions (5.1%), and transplant patients (19.1%). The average hospital stay doubled for infected patients (24.3 vs. 11.3 days; p=0.001). Post-ERCP infections led to a 28% increase in average costs (€12,256 vs. €9,561; p=0.048). With an annual volume of 25,000 ERCP procedures, post-ERCP infections in Italy contribute approximately €2.9 million in additional direct costs per year. Post-ERCP infections impose substantial financial burdens on the healthcare system, underscoring the critical importance of implementing cost-effective prevention strategies to mitigate this public health threat in Italy.

GENERATING VIDEO VISITS FOR RURAL OLDER VETERANS IN TELE-GERIATRIC MENTAL HEALTH SERVICES

Abstract Telehealth services increase access to specialty mental health services for rural older adults. Within the Veterans Health Administration (VHA), older Veterans are more likely to receive audio-only mental telehealth services compared with younger Veterans. Using a mixed methods approach, we examined the use of video telehealth services by geriatric mental health (GMH) providers in four regional VHA telehealth hubs. Between October 2022 and September 2023, 351 rural Veterans with a mean age of 75.1 years (SD = 8.8) received services from one or more GMH provider. Patients were mostly white (88.6%), males (95.4%) with high care needs (CAN = 81.6 out of 100, indicating highest need). Of the 1,440 encounters delivered, 49% were video to home, 27% were video to clinic, 19% were telephone, and 5% were e-consultation services. Through interviews with GMH providers, we identified technology-related barriers and solutions used to help rural Veterans be seen via video. Findings suggested that barriers to video services included lack of home internet and/or devices, poor connection, and audio or video issues. Solutions included using VHA resources to obtain iPads for patients who lacked connectivity/devices and prioritizing getting patients into local clinic when needed for video visits. Providers described utilizing the telehealth clinical technician to help overcome patient barriers and discomfort with digital technology through teaching patients and caregivers to use home telehealth software. With troubleshooting, use of resources and training, high quality video telehealth services can be delivered successfully to older rural Veterans and increase access to GMH care.

Juridical Analysis of the Impact of Online Application-Based Public Transportation of Motorcycle Taxis Regulation Policies (Case Study in Tangerang and surrounding areas)

It has been more than 14 years since motorized two-wheeled vehicles have been operating on the roads, through the "GOJEK" app, which can be downloaded from the Playstore. This has proven that this type of passenger and goods transportation can be an alternative solution for the community to become a primary source of income, thus improving family economies. It is now time for the government to provide a space for this new type of transportation to enter as a special transportation category with a "yellow" plate. The introduction of this new transportation system has created job opportunities for the wider community. From its establishment in 2010, starting with 10 people, it has grown to over 2 million people in 2024 who are now partners in the company. This system was also tested during the COVID-19 pandemic, which affected almost the entire world. Specifically in Indonesia, this type of transportation has proven to be very helpful. Operationally, this type of transport is relatively cheaper and highly affordable for its partners. One can imagine how many millions of people would lose their jobs if the government insists on not recognizing this type of transportation as a special transport fleet. It is referred to as special because: This type of fleet does not have a fixed base (such as a terminal) and usually operates from wherever, but currently, due to partner awareness, they gather at a specific point, becoming a gathering place for online motorcycle taxi partners. This type of fleet is similar to the commonly used vehicles on the road, with divided and separate routes. This type of fleet can go anywhere, which has become a point of contention for other vehicles that operate according to their designated routes. However, the presence of this type of fleet is already highly needed, and it is clearly proven that this type of transportation is more accessible to serve the community. Therefore, passengers do not need to walk far to use this transportation service. It is hoped that by officially recognizing this special transport service, it can improve safety and enhance the welfare of online motorcycle taxi partners across the country.