Systematic Health Assessment Research Articles

Ensuring effective communication when undertaking a systematic health assessment

An important element of the role of the learning disability nurse is to support service users to maintain their health, particularly in relation to the early detection of health issues and timely access to appropriate treatments. One way of achieving this is by undertaking a systematic health assessment, of which effective communication is a central component in terms of identifying the person’s communication needs and using appropriate communication methods to meet those needs. Effective communication can engage the person in the assessment process as well as identifying their own experience of their health. This article explains the importance of using a systematic approach to health assessment and describes various elements of communication involved in this process. The authors include a fictional case study to outline how a systematic health assessment works in practice and the range of communication skills nurses may use to engage service users in the process.

Automatic assessment of dairy cows' rumen function over time and links to feed changes and milk production

A 3-dimensional (3D) vision-based system was previously designed to automatically estimate the rumen motility of individual cows. This longitudinal study aimed to explore the associations between 3D vision-based rumen function assessment and dairy cow feed changes and milk production on a commercial farm. The 3D vision system was attached to an automatic milking robot to estimate the ruminal contraction frequency and rumen fill in 42 lactating cows during each milking event for 66 d. Additionally, we collected data on milk production, milk composition, general health, and changes in feeding practices. The 3D vision system showed that half the cows displayed a drastic decrease in the estimated rumen fill when all cows began grazing. The grazing and decreased rumen fill were also associated with herd-level milk fat depression. Over the 66 d, one cow was detected with reduced milk production and suspected rumen dysfunction by the farmer. The 3D vision system, however, identified this cow as having sudden decreases in estimated ruminal contraction frequency and rumen fill 4 d before detection by the farmer. In this longitudinal study, the 3D vision-based rumen function assessment system showed potential as a useful management-supporting tool for dairy farmers. The system, however, requires further validation with more cows of various breeds and ages. We suggest validating the 3D vision system with rumen boluses, quantified adjustments in feeding practices, more cases with ruminal dysfunction, and systematic health assessments for future studies.

A Mental Health Profile of 900 Newly Arrived Refugees in Denmark Using ICD-10 Diagnoses

(1) Background: Recognizing mental health problems in newly arrived refugees poses a challenge. Little is known of the mental health profile of refugees currently arriving in Northern Europe. (2) Method: In total, we included 900 adult (≥18 years old) refugees arriving in Aarhus, Denmark, between 1 January 2014 and 1 January 2020. All participants accepted an offer of a voluntary systematic health assessment from the municipality in Aarhus, including a mental health screening. (3) Results: Within this cohort, 26% (237/900) of the participants were referred to the Department of Psychiatry, Aarhus University Hospital, 24% (212/900) were in contact with the department and 21% (185/900) received ≥1 psychiatric diagnosis. Within the subpopulation referred (n = 237), 64% (152/237) were diagnosed with post-traumatic stress disorder (PTSD) (DF431), 14% (34/237) with neurotic, stress-related and somatoform disorders (F40–F48) and 13% (30/237) with major mood disorders (F30–F39). Among the participants referred to the Department of Psychiatry and participants receiving a diagnosis, we found an overrepresentation of participants originating from the Southern Asian region (Pakistan, Afghanistan and Iran) and with an age above 44 years. (4) Conclusion: We found a high prevalence of both referrals and psychiatric diagnoses in newly arrived refugees. Attention to psychiatric conditions in refugees and systematic health assessments during resettlement are needed.

Is there a need of health assessments for resettling refugees? A cross-sectional study of 1431 refugees who arrived in Denmark between 2014 and 2018

BackgroundRefugees have increased health risks due to factors related to their country of origin, the migration itself and the receiving country. Based on systematic general health assessments of newly arrived refugees, we aimed to study the characteristics with regard to background, migration and health needs. MethodsAll refugees (children/adolescents and adults) arriving in Aarhus, Denmark from 1 January 2014 to 1 November 2018 were offered a general health assessment by a doctor including: medical history, a physical examination and blood samples. ResultsA cohort of 1431 (of 1618 invited, (88.4%) participants accepted the health assessment. The most commonly found health conditions in children were vitamin D deficiency (28.3%), elevated serum-IgE (34%) and lack of immunity against vaccine-preventable diseases (measles 20.1%, polio 3.9%). In adults, vitamin D deficiency (34.6%), IgE elevation (30%), latent tuberculosis (20.3%) and symptoms of PTSD (15.9%) were most prevalent. We found participants from Southern Asia (Iran, Afghanistan and Pakistan) to be overrepresented with regard to vitamin D deficiency, vitamin B12 deficiency and symptoms of PTSD. Furthermore, we found that origin in Africa was associated with latent tuberculosis. In total, 63.8% of examined refugees had one or more health problems requiring further testing, treatment or follow-up. ConclusionsA comprehensive health assessment among recently arrived refugees showed multiple health issues to address, and demonstrates the need of systematic health assessments for resettling refugees.

Health Care Needs in School-Age Refugee Children.

Most European countries have systematic health assessments of refugees with a main focus on infectious diseases. The aim of this study was to describe the broader health care needs identified in newly settled refugee children in a school health setting. The study population consisted of all 609 recently settled Non-European refugee and asylum-seeking children in the age range 6–15 years who were enrolled in the schools of Malmö, Sweden during the autumn semester of 2015, of which 265 had arrived in Sweden unaccompanied. The data were collected in a structured routine intake interview by an experienced school nurse. Almost half of the children had obvious untreated caries. For the unaccompanied children, prominent mental health needs were present in almost one in three. Previously unidentified vision and/or hearing problems were identified in one in ten and around 5% had a daily medication, and 4.5% of the unaccompanied children and 1.2% of the accompanied children were judged to be in need of immediate care and were referred accordingly. Newly settled refugee children in northern Europe have considerable health care needs apart from communicable diseases. School health services have a unique platform to identify and initiate this care.

Infectious disease testing of UK-bound refugees: a population-based, cross-sectional study

BackgroundThe UK, like a number of other countries, has a refugee resettlement programme. External factors, such as higher prevalence of infectious diseases in the country of origin and circumstances of travel, are likely to increase the infectious disease risk of refugees, but published data is scarce. The International Organization for Migration carries out and collates data on standardised pre-entry health assessments (HA), including testing for infectious diseases, on all UK refugee applicants as part of the resettlement programme. From this data, we report the yield of selected infectious diseases (tuberculosis (TB), HIV, syphilis, hepatitis B and hepatitis C) and key risk factors with the aim of informing public health policy.MethodsWe examined a large cohort of refugees (n = 18,418) who underwent a comprehensive pre-entry HA between March 2013 and August 2017. We calculated yields of infectious diseases stratified by nationality and compared these with published (mostly WHO) estimates. We assessed factors associated with case positivity in univariable and multivariable logistic regression analysis.ResultsThe number of refugees included in the analysis varied by disease (range 8506–9759). Overall yields were notably high for hepatitis B (188 cases; 2.04%, 95% CI 1.77–2.35%), while yields were below 1% for active TB (9 cases; 92 per 100,000, 48–177), HIV (31 cases; 0.4%, 0.3–0.5%), syphilis (23 cases; 0.24%, 0.15–0.36%) and hepatitis C (38 cases; 0.41%, 0.30–0.57%), and varied widely by nationality. In multivariable analysis, sub-Saharan African nationality was a risk factor for several infections (HIV: OR 51.72, 20.67–129.39; syphilis: OR 4.24, 1.21–24.82; hepatitis B: OR 4.37, 2.91–6.41). Hepatitis B (OR 2.23, 1.05–4.76) and hepatitis C (OR 5.19, 1.70–15.88) were associated with history of blood transfusion. Syphilis (OR 3.27, 1.07–9.95) was associated with history of torture, whereas HIV (OR 1521.54, 342.76–6754.23) and hepatitis B (OR 7.65, 2.33–25.18) were associated with sexually transmitted infection. Syphilis was associated with HIV (OR 10.27, 1.30–81.40).ConclusionsTesting refugees in an overseas setting through a systematic HA identified patients with a range of infectious diseases. Our results reflect similar patterns found in other programmes and indicate that the yields for infectious diseases vary by region and nationality. This information may help in designing a more targeted approach to testing, which has already started in the UK programme. Further work is needed to refine how best to identify infections in refugees, taking these factors into account.

Learning Clinical Assessment and Interdisciplinary Team Collaboration in Primary Care. MOOC for Healthcare Practitioners and Students.

Novel ways to build sufficient capacity to meet the need for competent healthcare providers in primary care are in strong demand. We developed a massive, open, online course (MOOC) to introduce and promote clinical skills development for healthcare workers (physicians, nurse practitioners, nurses, and nurse aids) and students in healthcare education (medical students and master and bachelor students in nursing) focusing on systematic health assessment and strengthening clinical decision making in primary care. Results from the pilot supports that the MOOC was relevant and highly useful for the participants, and has potential to contribute to interdisciplinary collaboration and discussions.

Children in out-of-home care are at high risk of somatic, dental and mental ill health.

The Swedish Social Board has implemented a support strategy to guide out-of-home care for children, which translates as children's needs in focus (CNIF) and includes a systematic health assessment. It was fully introduced into the Skåne province in 2012 and our study covered the first four years of the CNIF health assessments, from 2012 to 2015. We studied children aged 0-17 years in out-of-home care who had been referred by social workers for a CNIF health assessment, using their medical records to investigate both their health and the value of the health assessments. From 2012 to 2015, only 409 (6%) of the 11 413 children in out-of-home care were referred for health assessments. Their health issues included depression and anxiety (29%), poor dental health (30%), seeking medical care for traumatic injuries (36%), previous contact with child psychiatry services (38%) and missed medical appointments (36%), dental appointments (36%) and child health programme appointments (39%). In addition, 10% of the girls and 9% of the boys were obese. This study found high levels of wide-ranging health issues. Despite national Swedish guidelines and policies, only 6% of the children in out-of-home care were referred by social workers for a CNIF health assessment.

Older people in the emergency department: a literature review

Emergency departments (EDs) play a unique role in healthcare systems throughout the world by providing acute interventions for older patients with acute/emergency and multiple health problems. The aim of this review was to identify studies that focused on older patients admitted to EDs and to determine the reasons for the visits. The literature review was based on a comprehensive search of electronic databases. Inclusion criteria were original research written in English; published 2002-2012; focused on older people; reasons for ED visit; and factors that affect the discharge process and those associated with a repeat ED visit. Other literature reviews and studies unrelated to the ED context, and studies examining patients aged ≥65 years, were excluded. Content analysis was performed. Twenty-five studies were identified and critically evaluated. The highest proportion of older people visited the ED because of multiple health conditions. The reasons for the visits were cardiovascular, mental health, musculoskeletal and abdominal conditions; adverse drug reactions; dermatological, neurological and respiratory conditions; poor health status; accidents; and the influence of time factors such as time of day, week or season. Factors that affected the discharge process were unresolved problems, health risk identification, aftercare instructions, medication prescribed at discharge and patient's residence before ED admission. Factors associated with repeat ED visits were sociodemographic characteristics, social problems, health problems, need for systematic health assessment, healthcare service use and inadequacy of care provided. The current review showed that older people are the main population visiting EDs; important factors required for planning and providing nursing care for older people in EDs were identified. More research is needed to determine how EDs support older people and their families. The findings of the current review identified that older people visit ED quite often because of different reasons. Discharge process and repeat visits may be influenced by various factors. To ensure quality nursing care in ED nurses need to be aware why do older people visit the ED, what factors may influence discharge and what factors are associated with repeat ED visits.

A systematic health assessment of indian ocean bottlenose (Tursiops aduncus) and indo-pacific humpback (Sousa plumbea) dolphins incidentally caught in shark nets off the KwaZulu-Natal Coast, South Africa.

Coastal dolphins are regarded as indicators of changes in coastal marine ecosystem health that could impact humans utilizing the marine environment for food or recreation. Necropsy and histology examinations were performed on 35 Indian Ocean bottlenose dolphins (Tursiops aduncus) and five Indo-Pacific humpback dolphins (Sousa plumbea) incidentally caught in shark nets off the KwaZulu-Natal coast, South Africa, between 2010 and 2012. Parasitic lesions included pneumonia (85%), abdominal and thoracic serositis (75%), gastroenteritis (70%), hepatitis (62%), and endometritis (42%). Parasitic species identified were Halocercus sp. (lung), Crassicauda sp. (skeletal muscle) and Xenobalanus globicipitis (skin). Additional findings included bronchiolar epithelial mineralisation (83%), splenic filamentous tags (45%), non-suppurative meningoencephalitis (39%), and myocardial fibrosis (26%). No immunohistochemically positive reaction was present in lesions suggestive of dolphin morbillivirus, Toxoplasma gondii and Brucella spp. The first confirmed cases of lobomycosis and sarcocystosis in South African dolphins were documented. Most lesions were mild, and all animals were considered to be in good nutritional condition, based on blubber thickness and muscle mass. Apparent temporal changes in parasitic disease prevalence may indicate a change in the host/parasite interface. This study provided valuable baseline information on conditions affecting coastal dolphin populations in South Africa and, to our knowledge, constitutes the first reported systematic health assessment in incidentally caught dolphins in the Southern Hemisphere. Further research on temporal disease trends as well as disease pathophysiology and anthropogenic factors affecting these populations is needed.

Children and young people in out-of-home care: are GPs ready and willing to provide comprehensive health assessments for this vulnerable group?

Children living in out-of-home care because of abuse or neglect are among the most vulnerable in Australia. In 2005 the Royal Australasian College of Physicians highlighted the need for increased attention to the health of such children and recommended regular health assessment. This qualitative study explored the views of a purposive sample of 20 GPs about what would influence GP willingness and readiness to undertake comprehensive health assessments for children entering out-of-home care. Ethical concerns, training, professional development needs, medico-legal issues, workforce and financial pressures and communication problems with the child protection sector were among key factors identified. Professional values about continuity of health care for children emerged as a new issue with important policy implications. This is the first in-depth study in Australia of GP perspectives about systematic health assessments for children in child protection and sheds new light on the low GP uptake of such assessments for at-risk population groups.

Systematic health assessment: A case study

Shelley Peacock explains how to conduct a systematic health assessment and ensure that all important questions are considered

Registered nurses' descriptions of their health assessment practices.

The delivery of health-care services in Australia is undergoing many changes. The move towards home-based acute care has precipitated a review of many nursing care practices. An important consequence of these changes is the need for registered nurses to be adequately equipped to conduct systematic health assessments. This descriptive study used a questionnaire designed to elicit short-answer responses in order to investigate how registered nurses described their health assessment practices and what type of data they collected. The findings indicate that respondents possess divergent conceptualizations of health assessment, and that they predominately use health assessment data to support medical therapies. Discussion focuses on the implications of these findings for nursing practice.