Social Care Systems Research Articles

The Transition to Adulthood From the Perspectives of Young People With Cerebral Palsy and Their Caregivers: A Systematic Literature Review.

The transition to adulthood can be a complex time in the lives of young people with cerebral palsy (CP). There is a lack of research examining this period from the perspectives of young people and their caregivers. The review sought to identify challenging experiences during the transition to adulthood from the perspectives of young people with CP and their caregivers and to examine factors that acted as barriers and enablers to positive transition outcomes. A systematic literature review of peer-reviewed, empirical studies was completed. Thirteen articles were extracted and analysed using a narrative synthesis approach. The findings identified challenges for the young people in the areas of independent living, sexuality and relationships, navigating health and social care systems, feeling different from their peers and increasing autonomy. Barriers contributing to negative experiences included overprotective parents and a lack of resources. Greater motor ability, supportive parents and knowledgeable healthcare practitioners enabled positive transition outcomes. The transition to adulthood presents multiple challenges as perceived by young people with CP and their caregivers. Both parties require greater support to address these challenges during this time. Further research is required to develop interventions that can support this transition experience.

Prevalence and Factors Associated With Depression and Depressive Symptoms Among Chinese Older Persons: An Integrative Review.

China is the country with the largest population of older persons. Depression is the most common mental health issue among older adults, a trend expected to increase as societies continue to age. With the global increase in depression and depressive symptoms among this demographic, the resulting disease burden poses a significant challenge to health and social care systems in China. To map, summarise and examine the empirical literature on the prevalence and factors associated with depression and depressive symptoms in Chinese older adults, an integrative literature review was conducted informed by the guidelines of Whittemore and Knafl. The literature search encompassed EMBASE, SCOPUS, CINAHL, Web of Science, PubMed, PsycINFO, SocINDEX, China National Knowledge Infrastructure Database and Wanfang Database. The review included 65 studies, 29 in English and 36 in Chinese. The reported prevalence of depression or depressive symptoms in Chinese older adults was 3.78%-84.3%. Based on the biopsychosocial model, the associated factors were clustered as follows: biological factors (physical health, disability, drug effects, gender, age, diets, physical activities), psychological factors (self-esteem, coping skills, trauma, emotions, beliefs, hobbies, lifestyle) and social factors (family relationships, peers, family circumstances, school, residential areas, social support, social structure). This review synthesised research on depression among older adults in China, highlighting varying prevalence across diverse geographical locations. Given the high prevalence among certain older Chinese cohorts, the early identification and assessment of the factors associated with depression is essential to reducing disease burden. The use of the biopsychosocial model provided a theoretical lens to examine depression in this population in an integrative and holistic way. Thus, furthering understanding of the factors that require close consideration in future research and practice innovations on depression in older persons.

Social Determinants of Health, Cardiovascular Health, and Mortality inSexual Minority Individuals in the United States.

Despite recent efforts to address health disparities regarding social determinants of health (SDOH), the intersection between SDOH and cardiovascular health (CVH) outcomes in sexual minority (SM) individuals remain largely underexplored. This study sought to investigate associations between SDOH profile and CVH and mortality outcomes among SM individuals in the United States. All participants aged≥18 years surveyed in the 2013 to 2017 National Health Interview Survey were included, except those with missing data on SM status, any CVH or SDOH domain, or any other covariate. SM status was self-reported and categorized as lesbian/gay, bisexual, or uncertain. Participants' SDOH profile was quantified using a 6-domain (economic stability, neighborhood/physical environment/social cohesion, community and social context, food, education, and health care system), 38-item score, with higher scores indicating greater social deprivation. CVH was adapted from the American Heart Association's Life's Essential 8 framework. Because detailed dietary data were unavailable, a 7-item (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical inactivity, inadequate sleep, and obesity) CVH score was used, with higher scores indicating worse CVH. Additionally, cardiovascular mortality was ascertained through the National Death Index using death certificate information. The study sample consisted of 57,182 participants, representing a population of 82,826,690 persons. A worse composite SDOH score was associated with a worse CVH score in both heterosexual (adjusted rate ratio: 1.14; 95%CI:1.13-1.15; P< 0.001) and SM individuals (adjusted rate ratio: 1.16; 95%CI: 1.12-1.20; P< 0.001), with associations appearing to be potentially stronger in the latter (Pinteraction=0.042). Subgroup analysis demonstrated consistent associations among gay/lesbian individuals and bisexual individuals, but not in those with other or uncertain sexual orientations. Further exploratory analysis showed that a worse composite SDOH score was significantly associated with higher risk of cardiovascular mortality in both heterosexual (adjusted HR: 1.17; 95% CI: 1.06-1.28; P = 0.002) and SM individuals (adjusted HR: 2.25; 95% CI: 1.24-4.08; P = 0.008), with associations being significantly stronger in the latter (P interaction = 0.006). An unfavorable SDOH profile was associated with worse CVH scores and higher cardiovascular mortality risk among SM individuals in the United States compared to their heterosexual counterparts.

Exploring professional development perceptions among health and social care educators: A cross-sectional study with cluster analysis.

This study aimed to evaluate Finnish educators' perceptions of their current level of continuing professional development and to identify distinct profiles in their competence development. The current health and social care system faces multiple challenges, including aging populations, cultural diversity and increasingly complex client needs. To implement new digital and interprofessional working methods, professionals must be highly competent and innovative. Educators' professional development is crucial for delivering high-quality education. The study used secondary analysis of a cross-sectional survey. The initial study developed the EduProDe scale and the study sample comprised 422 educators in health and social education. IBM SPSS Statistics version 25.0 was used for secondary statistical analysis. Descriptive statistics were calculated and the different groups among educators were based on the subdimensions of the EduProDe scale. The continuing professional development profiles were described using groups identified by K-means clustering. Based on educators´ responses to the EduProDe scale, they were clustered into three significantly different profiles: Experiencing Support for Continuous Learning (A), Needing Support for Continuous Learning (B) and Self-Directed Learners (C). The results show that health and social care educators are diverse learners. It's important to consider their individual characteristics, like education and work field, when planning professional development. In addition, the findings enhance the support for continuous learning from educators' superiors. Through this knowledge, organizations can consider factors beyond learning needs when planning professional development.

2672 Exploring stakeholders’ experiences implementing a navigation program for people living with dementia and their carers

Abstract Introduction Navigating dementia care is challenging, but patient navigation (PN) offers valuable support for this population. The ‘Navigating Dementia NB/Naviguer la démence NB’ program piloted a PN program in New Brunswick, Canada, targeting people living with dementia (PLWD) and their carers. The program aimed to assist participants in navigating health and social care systems, matching their needs with available services. Methods Navigating Dementia NB was co-developed by researchers, patient partners, and clinicians. This pilot program embedded six PNs in primary care clinics/centres across the province between July 2022 and July 2023. Using a mixed methods approach, participant surveys and interviews were used to explore program benefits and recommendations for improvement. Focus groups were used to explore facilitators and barriers to program development and implementation. Results There were 150 participants (PLWD and carer dyads) enrolled in the PN program who provided informed consent. Interviews were conducted with 36 PLWD and their carers. Focus groups were conducted with nine members of the research team and five patient navigators. Program benefits included: emotional support from navigators, provision of relevant information, and facilitating connections to appropriate services. Recommendations for improvement included: the need for PLWD and their carers to have access earlier in the patient journey and the need to reassess provincial policies related to home care support. Facilitators for implementing a PN program included: providing appropriate staff training and leveraging established connections within the health and social systems. Barriers included a compressed timeline and existing systemic issues to service access. Conclusions The findings suggest that embedding PN for PLWD in community based primary care can be done. The program was beneficial for PWLD and their caregivers/care partners. Future plans involve partnering with government to support the implementation and evaluation of a province-wide scale-up of the PN program for this population.

Dilemmas of solidarity of civic activists supporting displaced Ukrainians in a non-solidarian regime

&lt;p&gt;Civic actors working with marginalized and disadvantaged groups in society face conceptual and ethical dilemmas of how to define and rank human needs and vulnerabilities&lt;em&gt;.&lt;/em&gt; Our paper examines intervention reasonings in civic solidarity operations that have emerged in response to the arrivals of displaced Ukrainians to Hungary in 2022-23. Solidarians have strived to find spaces of action in a cemented authoritarian regime which normalizes visions and policy rationales of deservingness and social hierarchy against equality and plurality. We engaged with those solidarity actors who showed some or major degree of reflexivity&lt;em&gt; &lt;/em&gt;to the wider social, political, governance, and charity activism landscapes when considering their position and operational ethos. The mixed research methods generated ethnographic and discursive data which allowed to offer a practice centered interpretation of civic actors’ reasoning. The paper explores the dilemmas that civic actors faced when judging and prioritizing needs, responsibilities, and resources through relating or separating the conditions of their own society and people of migratory trajectories. We identified three perspectives through which civic solidarity actors articulated their normative and strategic dilemmas: the origin and nature of needs of the displaced people, the responsibilities in refugee assistance and broader social care system, and the inequality conditions in host society. We offer insights in how solidarity actors discernibly departed from pure humanitarianism and moved to concepts of horizontal interdependence, anti-discrimination, and layered human rights by applying their own emic vocabularies and grammar.&lt;/p&gt;

2671 A description of a patient navigator program for persons living with dementia in Canada

Abstract Introduction Receiving a dementia diagnosis can be overwhelming for persons living with dementia (PLWD) and their carers. Accessing information and home supports can be challenging. Having access to a Patient Navigation (PN) program is one way that may assist PLWD and their carers. Methods This study used a mixed methods design and involved the implementation of a Patient Navigation (PN) program in 6 primary care settings in New Brunswick, Canada, between July 2022–July 2023. PLWD/carers living in their own homes were eligible to enrol. Results There were 150 PLWD with a mean age of 76.4 (SD = 9.4) years and 51.4% were male. The majority (60.7%) were living in rural communities. Most (50.7%) had been diagnosed within the past 2 years with 50.7% having seen a specialist, most commonly a geriatrician. Almost all (88.7%) had a primary care provider; however, only 25.2% were connected to the social care system, and 19.8% were connected to the home care system. The most common reasons for enrolling were gaining access to social programs and home supports and seeking dementia specific information. The average number of goals per PLWD/carer was 3.79 (SD = 1.7). The average time in the program was 121.7 days (SD = 100.0) and 76.6% achieved their goals. The majority (84.0%) were somewhat to very satisfied with the PN program. Carers stated that with increased knowledge, access, and support there was a decrease in social isolation as well as improved confidence, which allowed PLWD to remain in the community longer. Conclusions Most PLWD/carers were connected to the health system, but the minority were connected to social and home care programs. Through connection to the PN program, carers increased their confidence; improved their knowledge; and increased their access to home supports and other care programs, allowing PLWD to remain in the community longer.

Exploring experiences of dementia post-diagnosis support and ideas for improving practice: A co-produced study.

It takes time to adjust to a diagnosis of dementia. Post-diagnosis support has an important part to play in navigating this transition. However, it is often scarce and variable according to location. This co-produced study explored experiences of support across the UK. The project was co-designed and implemented with people living with dementia. Five focus groups were attended by 18 people with dementia and 10 spouses from across the UK. The aim was to find out what support people currently received, what aspects they valued, and what they would like to see done differently. Most participants reported feeling abandoned after diagnosis, with little continuity of care. Many felt the burden of navigating post-diagnosis life was on them and their loved ones, with a perceived scarcity of support, and difficulties navigating the benefits system. Peer/voluntary support was seen as vital in promoting confidence, a source of relational support, and finding out crucial information relating to benefits, healthcare, and management of symptoms. Participants felt dementia was stigmatised, receiving less support than other medical conditions. Participants identified aspects of post-diagnosis support they valued, and collaborated on ideas for support structures and services they would like to see introduced. In concluding this study, we argue that post-diagnosis support services could be improved with the input of people living with dementia. This could reduce the burden on those receiving the diagnosis to find advice and support outside of health and social care systems. For future research, the financial implications of a dementia diagnosis have rarely been discussed and warrants further exploration.

Rehabilitation, reablement, and restorative care approaches in the aged care sector: a scoping review of systematic reviews

BackgroundAgeing populations are set to drive up demand for aged care services, placing strain on economies funding social care systems. Rehabilitation, reablement, and restorative care approaches are essential to this demographic shift as they aim to support independent function and quality of life of older people. Understanding the impact of these approaches requires nuanced insights into their definitions, funding, and delivery within the aged care context. This scoping review mapped and compared systematic review-level research on rehabilitation, reablement, and restorative care approaches within aged care with the aim of determining definitional clarity, key themes, and the professional groups delivering each approach.MethodsNine databases were searched (2012 to September 2023) to identify English-language systematic reviews on aged care-based rehabilitation, reablement and/or restorative care. Two reviewers independently screened studies following predetermined eligibility criteria. Only reviews reporting quality appraisal findings were eligible. Data charting and synthesis followed the Arksey and O’Malley approach and are reported according to PRISMA-ScR guidelines.ResultsForty-one reviews met inclusion criteria. Most (68%) reported on rehabilitation in aged care, and eight (20%) combined the approaches. Only 14 reviews (34%) defined the approach they described. Reviews centred on services for older people in the home or community (n = 15), across a mix of settings including community, hospital, and residential care (n = 10). Ten distinct themes highlight the importance of multidisciplinary teams, allied health, risk of falls, hip fracture, reduced functional independence, and specific types of interventions including physical activity, technology, cognitive rehabilitation, goal setting, and transition care. Most reviews described the role of occupational therapists (n = 22), physiotherapists (n = 20) and nurses (n = 14) with wider support from the multidisciplinary team. The quality of primary studies within the reviews varied widely.ConclusionsThis scoping review summarises the evidence landscape for rehabilitation, reablement, and restorative care approaches in the context of aged care. Despite their role in enhancing independence and quality of life for older people, policy, funding, and terminology variation means the evidence lacks clarity. This fragmented evidence makes it challenging to argue the effectiveness of one approach over another for older people in receipt of aged care services.Clinical trial numberNot applicable.

Exploring perceived barriers to palliative and end of life care provision in South-West England: bringing together the perspectives of professionals, patients, and families.

Palliative and End of Life care (PEoLC) in the United Kingdom (UK) is increasingly being reported as inadequate. This is occurring amidst a wider backdrop of health and social care systems facing unprecedented pressure, particularly as they recover from the long-term impact of the COVID-19 pandemic. This study aimed to explore the barriers to PEoLC faced by those providing and receiving care in South-West England (UK). This region of the UK brings its own set of unique challenges due to its rural and coastal location, an aging population, and a historical lack of research. An exploratory study was conducted which involved patients, families, and professionals who were providing and receiving PEoLC. A total of 13 qualitative focus groups were held with a total of 63 participants; 45 were health and care professionals and 18 were people toward the end of their life, family/carers and people who were bereaved. A range of barriers were identified for those providing and receiving PEoLC services. These were a lack of specialist palliative and EoL care resources (particularly in out-of-hours care); poor communication, collaboration and co-ordination across providers; inequalities in the access and provision of care; the impact of the COVID-19 pandemic; and a reluctance to have conversations about death and dying. This study brings together the voices of patients, family, and professionals from different settings in a geographical area of the UK. Understanding their experiences and perceived barriers to care is key to being able to develop and transform care. Ultimately, there is a need for a collaborative and co-ordinated approach across both practice and research, working toward what is important to those providing, and most importantly, those receiving care at the end of their lives.

Individual Factors Influencing the Use of Home- and Community-Based Care Services by Disabled Elderly Individuals in Urban Areas: Evidence from Beijing, China

China’s rapidly aging population necessitates a sustainable social care system. Although the majority of Chinese disabled older adults live in their communities, the utilization rate of home- and community-based care (HCBC) services has been low. Moreover, family members still take the main responsibility for the care of disabled older persons and generally suffer from the stress of caregiving. To increase the use of HCBC services by disabled elderly families, this study examined which individual characteristics of both elderly individuals and their primary family caregivers were related to HCBC service use among disabled urban elderly individuals in a regional sample from the 2018 to 2019 Beijing Precise Assistance Need Survey (n = 34,153). Logistic regression was used as the baseline model, and a simultaneous equation model was established to address the jointly dependent variables. The results show that the degree of disability of disabled older adults has no significant effect on their service use, whereas their worse health status played a significant role in predicting respite care service use. Working status, a longer period of caregiving, and poor health of caregivers all significantly predict a greater likelihood of service use by elderly individuals. Caregivers with burdened feelings predicted a decrease in the likelihood of elderly individuals using services. Our findings show that primary family caregivers have an important influence on disabled elderly people’s use of HCBC services, but service use is more likely to compensate for the lack of care and expertise provided by family caregivers than to reduce caregivers’ caregiving burden.

The Future Hospital in Global Health Systems: The Future Hospital Within the Healthcare System.

Future hospitals must be able to adapt in many ways to the changing demands on their roles and functions within evolving healthcare delivery infrastructures. These include changing population structures and needs, new models of healthcare provision, technological advances, and innovations in design, all while enhancing their environmental sustainability. This article sets out the issues that those determining healthcare policy and designing future hospitals must consider if they are to become and remain fit for purpose within the wider health and social care system. It also examines the need for, and challenges to, strategic healthcare planning, creating future hospitals that are sustainable, net-zero carbon organisations, and ensuring resilience in the face of a range of potential shocks. Future hospitals play a crucial role in healthcare worldwide, regardless of the country's income level. Hospitals cannot be viewed without broader health system changes, infrastructure, community and cultural factors, staffing and other considerations. We anticipate that future hospitals will enhance population health in all settings and support the move towards more consumer-centric healthcare. We urge clinical and policy planners to consider the factors discussed carefully to maximise the benefits.

Association Between Digital Front Doors and Social Care Use for Community-Dwelling Adults in England: Cross-Sectional Study.

Requests for public social care support can be made through an online portal. These digital "front doors" can help people navigate complex social care systems and access services. These systems can be set up in different ways, but there is little evidence about the impact of alternative arrangements. Digital front-door systems should help people better access services, particularly low-intensity services (high-intensity care is likely to require a full in-person assessment). This study aimed to investigate the association between 2 primary digital front door arrangements, easy-read information, and self-assessment tools provided on official websites, and the type of social care support that is offered: ongoing low-level support (OLLS), short-term care (STC) and long-term care (LTC). Information on front door arrangements was collected from the official websites of 152 English local authorities in 2021. We conducted a cross-sectional analysis using aggregated service use data from official government returns at the local authority level. The independent variables were derived from the policy information collected, specifically focusing on the availability of online digital easy-read information and self-assessment tools for adults and caregivers through official websites. The dependent variables were the rates of using social care support, including OLLS, STC, and LTC, across different age groups: the adult population (aged 18 and older), younger population (aged between 18 and 64 years), and older population (aged 65 and older). Multivariate regression analysis was used to examine the association between digital front door arrangements and access to social care support, controlling for population size, dependency level, and financial need factors. Less than 20% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system with about 25% (37/147) adopting digital self-assessment within their system. We found that local authorities that offered an integrated digital easy-read information format showed higher rates of using OLLS (β coefficient=0.54; P=.03; but no statistically significant association with LTC and STC). The provision of an online self-assessment system was not associated with service use in the 1-year (2021) cross-sectional estimate, but when 2 years (2020 and 2021) of service-use data were analyzed, a significant positive association was found on OLLS rates (β coefficient=0.41; P=.21). Notably, these findings were consistent across different age groups. These findings are consistent with our hypothesis that digital systems with built-in easy-read and self-assessment may make access to (low-intensity) services easier for people. Adoption of these arrangements could potentially help increase the uptake of support among those who are eligible, with expected benefits for their care-related well-being. Given the limited adoption of the digital front door by local authorities in England, expanding their use could improve care-related outcomes and save social care costs.

Emotional labour in child and family social work teams: a hybrid ethnography

ABSTRACT Achieving good outcomes for children and families engaged in the social care system relies upon a healthy, confident, and stable workforce. However, child protection social work has been identified as an emotionally demanding area of practice, linked to staff burnout and poor retention. This article draws on a hybrid ethnography of two child and family social work teams in England during the second wave of the COVID-19 pandemic. The findings identify the team as a vital source of support for social workers. Paradoxically, the team also identified a place of emotional insecurity where team members must perform emotions in a way that is compatible with their professional role. Through the trifocal lens of emotional labour and the dramaturgical metaphor of Setting, Roles, and Scripts, a novel conceptual framework of team support is presented.

Engaging Community Pharmacies in Promoting Outpatient Medication Safety - Identifying and Prioritizing Research Needs by Modified Nominal Group Technique.

Medication errors are one of the most endangering factors for patient safety, and they have become a key target for improvement in health- and social care systems worldwide. The most current development needs are related to outpatient care; however, up-to-date medication safety research and improvement activities have primarily focused on hospital environments. To promote medication safety in outpatient care, community pharmacies could be more effectively utilized. To identify the most central research needs, which would promote the use of community pharmacies in outpatient medication risk management and enhance collaboration between community pharmacies and other parts of the health- and social care system. The study applied a modified nominal group technique. A group of Finnish patient and medication safety experts (n=28) participated in the study and were divided into four nominal groups (incl. a pilot group). Data collection was conducted through electronic surveys and facilitated online group meetings. The collected data were analyzed using qualitative inductive thematic analysis and quantitative descriptive analysis by the van Breda technique. The final data comprised 83 research needs organized under five main themes with 22 subthemes. The most prioritized research needs covered all five main themes, which were: medication safety collaboration (final rank proportion 30%); medication care pathways (27%); operating processes of community pharmacies (17%); medication safety incident reporting (16%); and community pharmacy-based services improving medication safety (11%). The identified research needs for promoting outpatient medication safety by involving community pharmacies in medication risk management, covered a wide range of areas. Producing evidence about the effectiveness and cost-effectiveness of activities in these areas is particularly needed for practice development and policymaking, together with updating regulations supporting the implementation of the produced evidence.

A scoping review to examine health care professionals' experiences as family caregivers.

Health and social care systems must confront the challenge of supporting a growing elderly population and their caregivers. Family caregivers who are healthcare professionals are part of this context, but their caregiving experiences remain unclear. This scoping review explored the experiences of healthcare professionals who are also family caregivers for older adults. A scoping review methodology identified and summarized pertinent studies. Searches were conducted in Medline, Embase, PsycINFO, CINAHL, and AgeLine. We sought articles published from each journals' inception to October 19, 2023. Inclusion criteria were English-language studies about healthcare professionals caring for older adult family members. Diverse research designs were included. Data were extracted and synthesized according to key themes. The review included 19 studies, highlighting four themes. Studies were published between 1994 and 2019, with most studies published before 2017. The overarching theme was "Expectations," where healthcare professional family caregivers faced multifaceted expectations from themselves, their families, and the healthcare system. Expectations also highlights the dual role of participants as both caregivers and healthcare professionals This complex interplay led to a theme related to personal consequences, including stress, guilt, and potential burnout, but also positive aspects of the dual roles. Studies described how dual roles could enhance the quality-of-care healthcare professional caregivers provided to their family members. Finally, support needs were identified, emphasizing the importance of workplace accommodations and support from the healthcare system and peers. The experiences of healthcare professional family caregivers are shaped by unique expectations, resulting in both positive and negative consequences. The support needs of this group are multifaceted, requiring workplace accommodations and tailored support within the healthcare system. Further research is needed to delve deeper into the nuances of their experiences and develop targeted interventions to alleviate the stress and challenges they face in their dual roles. Understanding the evolving needs of healthcare professional family caregivers over time can inform support strategies along the caregiving trajectory.

Identifying the Factors Influencing the Completion of Institutional Detoxification Period Among Patients with Substance Use Disorder in Iraq

Background: Substance use disorders (USD) continue to be the primary cause of disability and early death, affecting the global criminal justice, social care, health, and welfare systems. Objectives: To identify the factors influencing the acceptance of patients with USD to complete the institutional detoxification period. Methods: This retrospective cohort study reviewed the medical records of the Al-Qanat Center for Social Rehabilitation, Baghdad, Iraq. The extraction chart was conducted from July 18 to August 26, 2024. It included patients who received mental services from SUD treatment programs during 2023. Results: The study included 470 patients with SUD. Most patients (95.5%) were male, with an average age of 26.85 years, 52.7% of them were single, 60.1% had low-income jobs, 61.1% had primary school degrees, and &gt;73.8% completed the treatment during the hospitalization period. Addicted women were significantly less likely to complete the detoxification period compared to men. The addicted patients who were more likely to complete the hospitalization period included those with younger age, longer hospitalization periods, and shorter duration of addiction. Methamphetamine (Crystal) was the most used substance (77.7%) by the admitted patients. Conclusion: The gender disparities in treatment completion of SUD highlight the need for gender-sensitive detoxification centers that account for societal factors and encourage family and community support to improve treatment engagement and outcomes. Developing new centers across the country’s provinces is pivotal to being more accessible for such patients.

The Representational Challenge of Integration and Interoperability in Transformed Health Ecosystems.

Background/Objectives: Health and social care systems around the globe are currently undergoing a transformation towards personalized, preventive, predictive, participative precision medicine (5PM), considering the individual health status, conditions, genetic and genomic dispositions, etc., in personal, social, occupational, environmental, and behavioral contexts. This transformation is strongly supported by technologies such as micro- and nanotechnologies, advanced computing, artificial intelligence, edge computing, etc. Methods: To enable communication and cooperation between actors from different domains using different methodologies, languages, and ontologies based on different education, experiences, etc., we have to understand the transformed health ecosystem and all its components in terms of structure, function and relationships in the necessary detail, ranging from elementary particles up to the universe. In this way, we advance design and management of the complex and highly dynamic ecosystem from data to knowledge level. The challenge is the consistent, correct, and formalized representation of the transformed health ecosystem from the perspectives of all domains involved, representing and managing them based on related ontologies. The resulting business viewpoint of the real-world ecosystem must be interrelated using the ISO/IEC 21838 Top Level Ontologies standard. Thereafter, the outcome can be transformed into implementable solutions using the ISO/IEC 10746 Open Distributed Processing Reference Model. Results: The model and framework for this system-oriented, architecture-centric, ontology-based, policy-driven approach have been developed by the first author and meanwhile standardized as ISO 23903 Interoperability and Integration Reference Architecture. The formal representation of any ecosystem and its development process including examples of practical deployment of the approach, are presented in detail. This includes correct systems and standards integration and interoperability solutions. A special issue newly addressed in the paper is the correct and consistent formal representation Conclusions: of all components in the development process, enabling interoperability between and integration of any existing representational artifacts such as models, work products, as well as used terminologies and ontologies. The provided solution is meanwhile mandatory at ISOTC215, CEN/TC251 and many other standards developing organization in health informatics for all projects covering more than just one domain.

Relationship Between the Use of Fitness Trackers and Smartwatches for Monitoring Physical Activity and the Sociodemographic Characteristics of Long-Term Care Residents During the COVID-19 Lockdown.

Background and Objectives: The use of wearable fitness technology is a trend nowadays and has significant potential in promoting an active lifestyle among long-term care (LTC) residents. The objectives of this observational study were to examine the use of fitness trackers and smartwatches for monitoring physical activity and to analyze the relationship between the use of these technological solutions and the sociodemographic characteristics of LTC residents during the COVID-19 lockdown. Materials and Methods: Face-to-face interviews were conducted with 198 LTC residents stationed in eleven organizational units that provide long-term accommodation services for older adults in the city of Zagreb in Croatia. LTC residents aged 65 and older who receive the 1st level of accommodation services in the social care system according to their functional ability and health status were included in this study. Results: During the COVID-19 lockdown, 19.19% of LTC residents used wearable activity trackers. Gender (p = 0.0411) and education level (p = 0.0485) were recognized as significant sociodemographic predictors regarding the use of fitness trackers and smartwatches for monitoring physical activity. An odds ratio for gender of 0.454 (95% CI: 0.213-0.969) indicates that women have a 54.6% lower chance of using fitness trackers and smartwatches then men. The odds ratio for the education effects of 0.050 (95% CI: 0.003-0.980) demonstrates that there is a 95% lower chance of using fitness trackers and smartwatches for individuals with only elementary education as opposed to university graduates. Conclusions: The sociodemographic differences of LTC residents regarding the use of fitness trackers and smartwatches require further research, but they are also an incentive for the implementation of these technological solutions to protect the health of older adults.

Estimating the effects of Basic Income schemes on mental and physical health among adults aged 18 and above in the UK: A microsimulation study

Basic Income is a largely unconditional, regular payment to all permanent residents to support basic needs. It has been proposed as an upstream health intervention by increasing income size and security. Modelling has quantified prospective effects on UK young people’s mental health. This paper extends this analysis to mental and physical health among adults aged 18+ using data from the 2021/22 Family Resources Survey and 12 waves (2009/11-2020/22) of Understanding Society to model the effects of three prospective schemes: 1) (£ per week) £50 per under-18, £75 per 18–64, £205 per 65+; 2) £75, £185, £205; 3) £100, £295, £295. We estimated effects on cases of depressive disorders (SF-12 MCS ≤45.6) and physical health problems (SF-12 PCS ≤50), quality-adjusted life years (QALYs) and willingness-to-pay value gained, as well as direct NHS, personal social services and patients’ associated costs savings regarding depressive disorders. Between 124,000 (95% CI: 86,000–150,000) and 1.005m (95% CI: 845,000–1.402m) cases of depressive disorders and 118,000 (70,000–156,000) to 1.042m (881,000–1.612m) cases of physical health problems could be prevented or postponed each year depending on the scheme. 129,000 (86,000–172,000) to 655,000 (440,000–870,000) QALYs could be gained, valued at £3.87bn (£2.58bn–£5.16bn) to £19.65bn (£13.21bn–£26.10bn). Estimated 2023 NHS and personal social services cost savings are between £126m (£88m–£154m) and £1.026bn (£872m–£1.432bn) assuming 50% of depressive disorders cases are diagnosed and treated at baseline. Estimating savings based on physical health problems is more difficult, but may reflect far greater related NHS and social care spend. Although non-income change impacts are not microsimulated, these findings indicate that Basic Income could provide substantial population health benefits, social return on investment and health and social care system savings. This gives policymakers and researchers an evidence base on which to base trial and policy design. Basic Income; Social determinants; Prevention; Upstream interventions; Microsimulation modelling.