Journal articles: 'Integrated health residence'

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Aveno, Arlene. "Community Involvement of Persons with Severe Retardation Living in Community Residences." Exceptional Children 55, no. 4 (January 1989): 309–14. http://dx.doi.org/10.1177/001440298905500404.

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A national survey was conducted with 294 community residential facilities (CRFs) serving adults with severe retardation. Respondents were asked to rate 38 community-based activities twice: one rating representing the activity involvement of the residents living in the CRFs, and one rating representing the perceived activity involvement of “average,” well-integrated community members. Nonhandicapped community members were perceived to have significantly more involvement in 30 activities than adults living in CRFs. Group home and foster home residents were perceived to be more involved in employment or day activities outside the residence, use of health care services, walking or wheelchair strolling for pleasure, and use of parks or zoos than nonhandicapped community members.

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Jacobs, Christine, Jay A. Brieler, Joanne Salas, Renée M. Betancourt, and Peter F. Cronholm. "Integrated Behavioral Health Care in Family Medicine Residencies." Family Medicine 50, no. 5 (May 2, 2018): 380–84. http://dx.doi.org/10.22454/fammed.2018.639260.

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Background and Objectives: Behavioral health integration (BHI) in primary care settings is critical to mental health care in the United States. Family medicine resident experience in BHI in family medicine residency (FMR) continuity clinics is essential preparation for practice. We surveyed FMR program directors to characterize the status of BHI in FMR training. Methods: Using the Council of Academic Family Medicine Educational Research Alliance (CERA) 2017 survey, FMR program directors (n=478, 261 respondents, 54.6% response rate) were queried regarding the stage of BHI within the residency family medicine center (FMC), integration activities at the FMC, and the professions of the BH faculty. BHI was characterized by Substance Abuse and Mental Health Services Agency (SAMHSA) designations within FMRs, and chi-square or ANOVA with Tukey honest significant difference (HSD) post hoc testing was used to assess differences in reported BHI attributes. Results: Program directors reported a high level of BHI in their FMCs (44.1% full integration, 33.7% colocated). Higher levels of BHI were associated with increased use of warm handoffs, same day consultation, shared health records, and the use of behavioral health (BH) professionals for both mental health and medical issues. Family physicians, psychiatrists, and psychologists were most likely to be training residents in BHI. Conclusions: Almost half of FMR programs have colocated BH care or fully integrated BH as defined by SAMHSA. Highly integrated FMRs use a diversity of behavioral professionals and activities. Residencies currently at the collaboration stage could increase BH provider types and BHI practices to better prepare residents for practice. Residencies with full BHI may consider focusing on supporting BHI-trained residents transitioning into practice, or disseminating the model in the general primary care community.

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Hiltunen, Anna-Maria, Iiris Hörhammer, Katariina Silander, Jaakko Kaikuluoma, and Miika Linna. "Integrating health service delivery for geriatric patients after hospital admission—A register study on the outcomes and costs." Health Services Management Research 33, no. 1 (November 26, 2019): 24–32. http://dx.doi.org/10.1177/0951484819887668.

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After a care episode in a hospital, elderly patients often face delays in transitions to permanent residence. Poor care coordination burdens both the patients and the healthcare system. Whereas different models for coordinating geriatric patients’ care and discharge planning have been developed, evidence on their cost-effectiveness remains scant. In this study, we evaluated the associations of an integrated care model on health and social care costs and service utilization among geriatric patients admitted to a hospital in a Finnish city with c. 68,000 citizens. Elderly patient cohorts admitted before (N = 709) and after (N = 364) the implementation of the integrated care model were compared restrospectively. The new model consisted of changes in regional care criteria, discharge planning, coordination between inpatient facilities, and the daily work of nursing staff. Patients treated in the new model spent, on average, 7.4 days less in institutionalized care during one year, and the total annual cost of care decreased by 967€ per patient. A regionally coordinated care pathway from hospital admission to permanent residence may improve the cost-effectiveness of elderly care. Coordination and monitoring of outcomes at regional level is essential to avoid fragmentation of care and suboptimization among different care providers serving the elderly.

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Shishebori, Davood, and Mohammad Saeed Jabalameli. "Improving the Efficiency of Medical Services Systems: A New Integrated Mathematical Modeling Approach." Mathematical Problems in Engineering 2013 (2013): 1–13. http://dx.doi.org/10.1155/2013/649397.

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Nowadays, the efficient design of medical service systems plays a critical role in improving the performance and efficiency of medical services provided by governments. Accordingly, health care planners in countries especially with a system based on a National Health Service (NHS) try to make decisions on where to locate and how to organize medical services regarding several conditions in different residence areas, so as to improve the geographic equity of comfortable access in the delivery of medical services while accounting for efficiency and cost issues especially in crucial situations. Therefore, optimally locating of such services and also suitable allocating demands them, can help to enhance the performance and responsiveness of medical services system. In this paper, a multiobjective mixed integer nonlinear programming model is proposed to decide locations of new medical system centers, link roads that should be constructed or improved, and also urban residence centers covered by these medical service centers and link roads under investment budget constraint in order to both minimize the total transportation cost of the overall system and minimize the total failure cost (i.e., maximize the system reliability) of medical service centers under unforeseen situations. Then, the proposed model is linearized by suitable techniques. Moreover, a practical case study is presented in detail to illustrate the application of the proposed mathematical model. Finally, a sensitivity analysis is done to provide an insight into the behavior of the proposed model in response to changes of key parameters of the problem.

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Bussu, Sonia. "Integrated care: learning from East London." British Journal of General Practice 68, suppl 1 (June 2018): bjgp18X697265. http://dx.doi.org/10.3399/bjgp18x697265.

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BackgroundDespite a growing body of literature on integrated, there remains a relatively small evidence base to suggest which elements of integrated care are most effective and how to implement them successfully. This might also be due to the fact that policy thinking around integrated care is struggling to translate into organisation change at the point of delivery. Better understanding of patterns of collaborations and integrated pathways is crucial to understand frontline staff’s OD needs and provide adequate support.AimThis paper focuses on the frontline level to assess progress towards integrated care in East London.MethodWe use admission avoidance (Rapid Response service) and discharge services (Discharge to Assess) as a lens to examine how frontline staff from secondary care, community health services and social service work together to deliver more integrated care. The study uses the Researcher in Residence (RiR), where the researcher is embedded in the in the organisations she is evaluating, as a key member of the delivery team.ResultsInitial findings suggest that while work on integrated care has enabled some level of collaborative working at strategic levels in partner organisations, on the frontline professionals are grappling with issues such as professional identity, professional boundaries, mutual trust and accountability, as new services and roles struggle to be fully embedded within the local health system.ConclusionThe paper sheds light on to the complexity on integrated care at the point of delivery. Better understanding of integrated care pathways is crucial to evidence patterns of collaboration across organisations; assess how these new roles and teams are embedding themselves within the local health economy; identify organisation development needs; and provide adequate support to frontline staff.

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Godinho, Myron Anthony, Md Mahfuz Ashraf, Padmanesan Narasimhan, and Siaw-Teng Liaw. "Community health alliances as social enterprises that digitally engage citizens and integrate services: A case study in Southwestern Sydney (protocol)." DIGITAL HEALTH 6 (January 2020): 205520762093011. http://dx.doi.org/10.1177/2055207620930118.

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South Western Sydney (SWS) is one of the fastest growing regions in the state of New South Wales (Australia). Much of the population live in local government areas (LGAs) with levels of disadvantage higher than the state average, with a predominance of non-communicable and chronic diseases that are typically associated with age-related and behavioural factors. This necessitates the management of social determinants of health through the integrated provision of primary and social care. The SWS Local Health District and Primary Health Network is exploring the potential of community health alliances (CHAs) as an innovative approach to support the provision of integrated health services. CHAs are a population health approach for addressing health challenges faced by people who share a common area of residence, sociocultural characteristic or health need, and are characterised by a shared mission, shared resource needs and acquiring/developing necessary organisational knowledge and skills. We explore how CHAs operate as social enterprises that utilise digital health and citizen engagement to deliver integrated people-centred health services (IPCHS) by conducting two case studies of CHAs operating in SWS: in Wollondilly and Fairfield LGAs. Using this approach, we aim to unpack the conceptual convergence that enables social enterprises to utilise digital health interventions and citizen engagement strategies to co-produce IPCHS with a view to developing theory and a framework for engaging digital citizens in integrated primary health care via social enterprise.

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Aderibigbe, Oluwakemi, Anthony Renda, and Christopher M. Perlman. "Factors Associated With Opiate Use Among Psychiatric Inpatients: A Population-Based Study of Hospital Admissions in Ontario, Canada." Health Services Insights 12 (January 2019): 117863291988863. http://dx.doi.org/10.1177/1178632919888631.

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Background: Use of opiates, including synthetic opioids, is associated with a number of negative consequences, including increased risk of opioid use disorders and other mental health conditions. However, studies are limited in examining patterns of opiate use among persons in inpatient psychiatry, particularly those that consider the relationship between pain and opiate use. Objective: This study examined the prevalence in the prior 12 months to admission and patterns of opiate use and pain in a population-based study of persons admitted to inpatient psychiatry in Ontario, Canada. Methods: We conducted retrospective cross-sectional study of 165 434 persons admitted to inpatient psychiatry between January 1, 2006 and December 31, 2017. Using data from the Resident Assessment Instrument for Mental Health, we examined prevalence and factors associated with opiate use in the prior 12 months by a number of patient characteristics, including demographics, mental and physical health status, concurrent substance use, pain severity and frequency, and health region of residence. Results: The prevalence of opiate use within 12 months of admission was 7.5%, between 17% and 22% among those experiencing daily pain, and 27% among persons with a primary substance use disorder. Multivariable analyses revealed strong associations among demographic and clinical variables with opiate use ( c = 0.91), including being of younger age, use of other substances, greater frequency and severity of pain, and health region of residence. Conclusion: The strong relationship between pain and opiate use in this population, and the regional variation in this pattern, supports the need for integrated care for mental illness and substance use, and therapeutic approaches to pain management that reduce risks of problems associated with substance use for persons with mental health conditions.

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Galako, T. "Expanding the Role of Primary Health Care in the Provision of Mental Health Services to the Population of the Kyrgyz Republic." European Psychiatry 41, S1 (April 2017): S606. http://dx.doi.org/10.1016/j.eurpsy.2017.01.954.

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Providing comprehensive, integrated services in the field of mental health in primary health care (PHC) is a component of the state mental health program for the population of the Kyrgyz republic (KR) in the 2017–2030 biennium. In order to develop an action plan in this area a situational analysis of resources of psychiatric care at PHC level was carried out. There was revealed a significant deficit of specialists, such as family doctors, mental health care professionals. In spite of the need for 3,300 family doctors, only 1706 work, and 80% of them are of retirement age.The results of a research showed a low level of knowledge and skills of family physicians for the early detection of mental disorders and provision of appropriate medical care. There are also a limited number of psychiatrists, especially in rural regions (77% of the required quantity).During recent years, there have been implemented significant changes in the system of mental health services, aimed at improving its quality, the approach to the place of residence of the patient and the prevalence of psychosocial services.Since 2016 in 8 southern regions in the Kyrgyz Republic has been introduced a new model for the provision of comprehensive health care services. Piloting this model involves psychosocial rehabilitation of patients with mental disorders, the help of mobile teams at the place of patient residence, as well as psychoeducation, training, and support to family doctors. These and other measures will help to optimise mental health care at PHC level.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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Mandell, Wallace, Victor Lidz, and James J. Dahl. "Experimental evaluation of a vocationally integrated therapeutic community." Therapeutic Communities: The International Journal of Therapeutic Communities 36, no. 3 (September 14, 2015): 173–85. http://dx.doi.org/10.1108/tc-06-2014-0021.

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Purpose – Retrospective studies of therapeutic community (TC) treatment for drug abuse found reductions in drug use, criminality, and increased work participation after treatment completion. These studies have also shown treatment benefits, even without completion, are correlated with days of stay in residential treatment. However, others have found that high rates of early leaving from TC treatment reduce the proportion of clients with positive outcomes, raise the total cost per treated client, and lower the treatment benefit-to-costs ratio. The purpose of this paper is to describe an experimental approach to raising the days in residential treatment using earlier vocational access for clients. Design/methodology/approach – The current study used a random assignment design to compare earlier integration of on-site vocational training in a vocationally integrated therapeutic community to off-site vocational training initiated after one year of residence in a traditional therapeutic community. Findings – The resulting data support the hypotheses that client expectations and early training in job skills increase rate of treatment affiliation, the proportion of clients having effective lengths of stay, and the rate of treatment completion. Research limitations/implications – Research limitations/implications include the difficulty of assuring unbiased selection and controlling treatment assignment and conditions. Practical implications – Practical implications of this research project are to support practitioners striving for longer, more effective lengths of stay, while at the same time attempting to reduce treatment time and increase effectiveness. Social implications – Social Implications of this project are to encourage social support for addiction treatment and emphasize the value of paired residential treatment and vocational education. Originality/value – The originality and value of this research project lies in the adoption of a working model at Phoenix House TC (in-house vocational preparation), which utilizes early in-house vocational education as a means to increase residential program participation, increase employment skills and prospects, and decrease overall length of treatment.

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Catalanotti, Jillian, David Popiel, Patrik Johansson, and Zohray Talib. "A Pilot Curriculum to Integrate Community Health Into Internal Medicine Residency Training." Journal of Graduate Medical Education 5, no. 4 (December 1, 2013): 674–77. http://dx.doi.org/10.4300/jgme-d-12-00354.1.

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Abstract Background Public health training has become an important aspect of residency education. The Institute of Medicine recommends public health training for all resident physicians, and internal medicine educational milestones include general public health skills. Objective We sought to integrate community health into internal medicine residency training by developing a community health elective (CHE) curriculum. Methods We developed a 2-week CHE curriculum for internal medicine residents, featuring facilitated discussion sessions, clinical experience at health centers targeting medically underserved populations, and a culminating presentation. We evaluated our pilot curriculum using pre-elective and postelective course surveys with Likert-type questions. Results Of 150 eligible residents, 32 (21%) enrolled in the elective. Nearly all participants (30 of 32, 94%) strongly agreed that learning about community health was an important part of their residency training. Residents' perceived competence at discharging hospital patients with follow-up at community health sites increased 13-fold after taking the elective (P < .001). There was no increase in reported likelihood to practice in an underserved community or in primary care. Conclusions The CHE addresses several Accreditation Council for Graduate Medical Education competencies and internal medicine Milestones and could be a replicable model for internal medicine residency programs that seek to provide community health training.

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Segal, Leonie, Ron Donato, Jeffrey Richardson, and Stuart Peacock. "Strengths and limitations of competitive versus non-competitive models of integrated capitated fundholding." Journal of Health Services Research & Policy 7, no. 1_suppl (July 2002): 56–64. http://dx.doi.org/10.1258/135581902320176485.

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Integrated budget-holding (fundholding) based on risk-adjusted capitation is commonly proposed as a central element of health system reform. Two contrasting models have been developed: the competitive model where fundholders or health plans compete for enrollees; and the non-competitive model, where plan membership is determined according to an objective attribute such as place of residence. Under the competitive model, efficiency is sought through consumer choice of plan. A range of regulatory elements may also be introduced to moderate undesirable elements of competition. Under the non-competitive model, efficiency is achieved through government regulation and the fact that the fundholder has continuing responsibility for the health of a defined population, supported by micro-management tools (such as quality assurance and selective payment arrangements). In theory, the non-competitive model encourages population-based health services planning. While both models assume risk-adjusted capitated funding, the requirements of any formula are more stringent under the competitive model. Economic theory, as well as documented health system experience, can help identify the relative strengths and limitations of each model. Concerns with the competitive model relate primarily to the capacity to develop robust risk adjusters for capitation sufficient to reduce the incentives for patient risk selection. Possible reductions in the quality of care are also a concern, compounded by difficulties for consumers in discriminating between plans. Efficiency under the non-competitive model requires a strong and appropriate regulatory/policy framework and effective use of micro-management tools. Funding equity objectives can be met through either model by the adoption of income-related contributions, but under the competitive model this may be compromised by incentives for the fundholders to select low-risk patients. Evidence drawn from regional fundholding in New South Wales (NSW, Australia), the US Veterans Health Agency and the literature on managed care in the USA illustrate these concerns. The problem of risk selection in the competitive model is a major theoretical concern, confirmed by the empirical evidence. This, together with concerns regarding other aspects of performance, suggests that the non-competitive model may be preferable, at least as an interim step in reform in public or mixed systems. Future research on this issue is clearly required.

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Caicedo-Velásquez, Beatriz, and María Clara Restrepo-Méndez. "The role of individual, household, and area of residence factors on self-rated health in Colombian adults: A multilevel study." Biomédica 40, no. 2 (June 15, 2020): 296–308. http://dx.doi.org/10.7705/biomedica.4818.

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Introduction: Self-rated health is strongly associated with morbidity and mortality. It is largely influenced by individual factors but also by individuals’ social surroundings and environment.Objective: To investigate individual, household, and locality factors associated with self-rated ealth in Colombian adults.Materials and methods: We conducted a cross-sectional multilevel study using data from national databases on 19 urban localities and 37,352 individuals nested within 15,788 households using a population-based survey. Given the natural hierarchical structure of the data, the estimates of self-rated health related to individual, household, and locality characteristics were obtained by fitting a three-level logistic regression.Results: The adjusted multilevel logistic models showed that at individual level, higher odds of poor self-rated health were found among older adults, persons from low socio-economic status, those living without a partner, with no regular physical activity, and reporting morbidities. At the household level, poor self-rated health was associated with households of low socioeconomic status located near noise sources and factories and in polluted and insecure areas. At the locality level, only poverty was associated with poor self-rated health after adjusting for individual and household variables.Conclusions: These results highlight the need for a more integrated framework when designing and implementing strategies and programs that aim to improve health conditions in urban populations in Latin America.

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Khan, Murad Moosa, Sadia Mahmud, Mehtab S. Karim, Mohammad Zaman, and Martin Prince. "Case–control study of suicide in Karachi, Pakistan." British Journal of Psychiatry 193, no. 5 (November 2008): 402–5. http://dx.doi.org/10.1192/bjp.bp.107.042069.

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BackgroundIn recent years suicide has become a major public health problem in Pakistan.AimsTo identify major risk factors associated with suicides in Karachi, Pakistan.MethodA matched case–control psychological autopsy study. Interviews were conducted for 100 consecutive suicides, which were matched for age, gender and area of residence with 100 living controls.ResultsBoth univariate analysis and conditional logistic regression model results indicate that predictors of suicides in Pakistan are psychiatric disorders (especially depression), marital status (being married), unemployment, and negative and stressful life events. Only a few individuals were receiving treatment at the time of suicide. None of the victims had been in contact with a health professional in the month before suicide.ConclusionsSuicide in Pakistan is strongly associated with depression, which is under-recognised and under-treated. The absence of an effective primary healthcare system in which mental health could be integrated poses unique challenges for suicide prevention in Pakistan.

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Seitz, Tamara, Kurt Stastka, Michael Schiffinger, Bela Rui Turk, and Henriette Löffler-Stastka. "Interprofessional care improves health-related well-being and reduces medical costs for chronic pain patients." Bulletin of the Menninger Clinic 83, no. 2 (June 2019): 105–27. http://dx.doi.org/10.1521/bumc_2019_83_01.

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This study evaluated whether patients with somatic symptom disorder, expressing chronic pain that could not be attributed to a medical condition, would benefit from an 8-week inpatient residence at a psychiatric ward. In the 1-year follow-up after termination the authors examined the extent to which the integrated treatment decreased patient costs. A total of 106 patients participated in the follow-up and reported a significant improvement in their general health (Cohen's d = 1.5–2.21), a decrease in impairment due to pain (d = 2.24), and a decrease in symptom severity (d = 1.29). They took fewer medications and sick days, reported fewer hospital stays and medical examinations, and consulted and changed physicians and outpatient clinics less often (d = 0.55–1.1). The average cost per patient was cut in half, down to є 80,000/$96,000 per year. From a clinical standpoint, group analysis that focused on aggression was the most effective intervention.

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Ricciardi, Joseph N., Sonya Woelfel Bouchard, James K. Luiselli, and Trudy Dould. "Integrated Behavioral Intervention and Person-Centered Therapy Within Community-Based Treatment of an Adult With Acquired Brain Injury." Clinical Case Studies 19, no. 2 (December 1, 2019): 133–44. http://dx.doi.org/10.1177/1534650119890925.

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We present the case of a 30-year-old woman who had acquired brain injury (ABI) and demonstrated clinically challenging behaviors (verbally abusive outbursts toward care providers and elopement) within her community-based group home. Following a baseline phase of evaluation, she collaborated with clinicians and care providers in developing a treatment plan that included personal goal setting, differential token reinforcement, communication training, graphic performance feedback, and reinforcement fading. During 10 months of intervention, clinically challenging behaviors steadily decreased from baseline levels and low-frequency occurrence was maintained at 3-, 6-, and 9-month follow-up assessments. As the result of treatment, the woman also avoided prior psychiatric hospitalizations, enjoyed more frequent access to pleasurable activities outside her residence, and enrolled in a college course. The study illustrates an effective person-centered therapy approach combined with behavioral intervention for persons who have ABI and experience community-living adjustment difficulties.

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Shrestha, Raksha, and Sarita Adhikari. "Factors Affecting Choice Of Health Care Facilities Among The Adults of an Urban Community." Medical Journal of Shree Birendra Hospital 20, no. 2 (September 6, 2021): 123–29. http://dx.doi.org/10.3126/mjsbh.v20i2.30777.

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Introduction: Health service delivery systems that are safe, accessible, high quality, people-centred, and integrated are critical for moving towards universal health coverage. World Health Organisation is supporting to improve the efficiency and effectiveness of health service delivery systems to all the population not only the patients. This study aims to identify the factors affecting the choice of health care facilities among the adults of an urban community and its association with the selected socio-demographic variables. Methods: A descriptive cross-sectional study was conducted among the community residence with 120 respondents using non-probability purposive sampling technique. Data was collected using semi-structured interview schedule that was analysed by using descriptive statistical methods such as frequency, percentage, mean, standard deviation and inferential statistics such as chi-square test. Result: The findings of the study revealed that majority (60.8%) of the respondents used private health care facilities and there was significant association of the choice of health care facility with the health care services related factors whereas no significant association was found with the selected socio-demographic variables. Conclusions: Based on the study findings, it concluded that various health care services related factors like availability, affordability, acceptability and accessibility factors tends to affect the choice of health care facility

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Naples, Jennifer G., Tracie Rothrock-Christian, and Jamie N. Brown. "Characteristics of Postgraduate Year 1 Pharmacy Residency Programs at Veterans Affairs Medical Centers." Journal of Pharmacy Practice 28, no. 4 (February 9, 2015): 425–29. http://dx.doi.org/10.1177/0897190014568386.

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Purpose: Although the characteristics of pharmacy postgraduate year 1 (PGY1) residency programs have been examined among large academic medical centers, there are no identified studies comparing the attributes of individual programs in the Veterans Affairs (VA) Health Administration System. The primary objective of this study was to describe and contrast characteristics of VA PGY1 residency programs. Methods: This was a cross-sectional survey of VA pharmacy residency programs. An online survey was distributed electronically to residency program directors of VA PGY1 residencies. Results: Responses from 33 (33%) PGY1 programs were available for the analysis. Programs reported growth over the previous 2 years and expected continued expansion. There was a wide variety of learning opportunities, although experiences were customizable based on residents’ interests. Notably, many programs allowed residents to seek rotations at other locations if specific experiences were not available on-site. Additionally, most programs had a mandatory staffing component and required residents to present the results of residency research projects. Conclusion: There is a high degree of variability among individual VA facilities with regard to the requirements and opportunities available to PGY1 pharmacy residents. This assessment is able to characterize the currently established residency programs and allows for an active comparison of programs in a nationally integrated health care system.

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Sarveswaran, Gokul, Yuvaraj Krishnamoorthy, Manikandanesan Sakthivel, Karthiga Vijayakumar, Shanthosh Priyan, Pruthu Thekkur, and Palanivel Chinnakali. "Preference for Private Sector for Vaccination of Under-Five Children in India and Its Associated Factors: Findings from a Nationally Representative Sample." Journal of Tropical Pediatrics 65, no. 5 (January 29, 2019): 427–38. http://dx.doi.org/10.1093/tropej/fmy071.

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Abstract Background Understanding the factors associated with private sector preference for vaccination will help in understanding the barriers in seeking public facility and also the steps to improve public–private partnership (PPP) model. Methods We analysed the recent National Family Health Survey-4 data (NFHS-4; 2015–16) gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. Results Weighted proportion of children receiving private vaccination was 10.0% (95% CI: 9.7–10.3). Children belonging to highest wealth quantile (adjusted Prevalence ratio; aPR-1.58), male child (aPR-1.07) urban area (aPR-1.11), not receiving anganwadi/Integrated Childhood Development Services (aPR-1.71) and receiving antenatal care in private sector was significantly associated with higher proportion of private vaccination. Conclusion Current study showed that 1 in 10 <5 years child in India received vaccination from private health facility. Preference for private health facility was found to be influenced by higher socio-economic strata, urban area residence and seeking private health facility for antenatal and delivery services.

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Najmah, Indah Purnama Sari, Tri Novia Kumalasari, and Sharyn Graham Davies. "FACTORS INFLUENCING HIV KNOWLEDGE AMONG WOMEN OF CHILDBEARING AGE IN SOUTH SUMATRA, INDONESIA." Malaysian Journal of Public Health Medicine 20, no. 1 (May 1, 2020): 150–59. http://dx.doi.org/10.37268/mjphm/vol.20/no.1/art.552.

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This study aims to provide detailed information on the role of the following social determinants (i.e. education, occupation, place of residence, marital and economic status) in the acquisition of HIV knowledge among women of childbearing age (15-49 years old). The study uses secondary data from the 2012 Indonesian Demographic and Health Survey (IDHS). The IDHS used a quantitative analytical approach with a cross-sectional study design and multi-stage stratified sampling. The sample included 1,335 women aged 15 to 49 years old living in South Sumatra Province, Indonesia. Descriptive analysis, ANOVA, and t-test and multiple logistic regressions were performed in this study. The results show one out of two women have little HIV knowledge. The more highly educated women were positively associated with a greater degree of knowledge related to comprehensive knowledge related to HIV (AOR: 3.7, 2.2-6.2, p.<0.05), HIV prevention (AOR:16.6, 1.8-153.9, p <0.05), transmission from mother to child (AOR:11.1, 3.3-36.9, p <0.05), HIV misconceptions (AOR:5.1, 1.1-23.1, p <0.05) and HIV services (AOR:5.7, 2.8-11.4, p < 0.05). In addition, the women lived in urban areas had more knowledge related to HIV prevention and transmission (AOR: 3.36, 1.8-6.2, p <0.05), and knowledge about mother-to-child of HIV transmission (AOR: 3.2, 1.8-5.5, p <0.05) compared to those who lived in rural areas. To conclude, education level was found to be the dominant factor associated with knowledge of HIV across all categories of knowledge after controlling by other determinants, age, marital status, working status and residence. HIV awareness and comprehensive HIV information among women who are considered to be in a low-risk group for HIV infection should be integrated with formal education as well as in maternal health services, particularly in rural areas.

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Payandeh, Shahram, and Eddie Chiu. "Application of Modified PageRank Algorithm for Anomaly Detection in Movements of Older Adults." International Journal of Telemedicine and Applications 2019 (March 11, 2019): 1–9. http://dx.doi.org/10.1155/2019/8612021.

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It is a well-known statistic that the percentage of our older adult population will globally surpass the other age groups. A majority of the elderly would still prefer to keep an active life style. In support of this life style, various monitoring systems are being designed and deployed to have a seamless integration with the daily living activities of the older adults while preserving various levels of their privacy. Motion tracking is one of these health monitoring systems. When properly designed, deployed, integrated, and analyzed, they can be used to assist in determining some onsets of anomalies in the health of elderly at various levels of their Movements and Activities of Daily Living (MADL). This paper explores how the framework of the PageRank algorithm can be extended for monitoring the global movement patterns of older adults at their place of residence. Through utilization of an existing dataset, the paper shows how the movement patterns between various rooms can be represented as a directed graph with weighted edges. To demonstrate how PageRank can be utilized, a base graph representing a normal pattern can be defined as what can be used for further anomaly detection (e.g., at some instances of observation the measured movement pattern deviates from what is previously defined as a normal pattern). It is shown how the PageRank algorithm can detect simulated change in the pattern of motion when compared with the base-line normal pattern. This feature can offer a practical approach for detecting anomalies in movement patterns associated with older adults in their own place of residence and in support of aging in place paradigm.

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Friedman, Carli. "Organizational Supports to Promote the Community Integration of People With Dual Diagnosis." Intellectual and Developmental Disabilities 59, no. 2 (April 1, 2021): 101–11. http://dx.doi.org/10.1352/1934-9556-59.2.101.

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Abstract One of the most common reasons people with intellectual and developmental disabilities (IDD) return to institutions is because of maladaptive behaviors. This study's aim was to examine the impact organizational supports can have on the community outcomes of people with dual diagnosis—those with IDD and psychiatric disabilities. We analyzed secondary Personal Outcome Measures interview data from 533 people with dual diagnosis. Findings revealed people with dual diagnosis were significantly more likely to have community outcomes present when they received individualized organizational supports. In addition, we found a number of disparities in organizational supports, including related to guardianship, communication method, and residence type. A more robust service system is necessary to ensure people with dual diagnosis are integrated into their communities.

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Crowder, Rachel, Rohan Van Der Putt, Ceri-Anne Ashby, and Andrew Blewett. "Deliberate Self-Harm Patients Who Discharge Themselves from the General Hospital Without Adequate Psychosocial Assessment." Crisis 25, no. 4 (July 2004): 183–86. http://dx.doi.org/10.1027/0227-5910.25.4.183.

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Abstract: Deliberate self-harm patients who leave the acute hospital environment before the completion of psychiatric assessment have an increased risk of subsequent self-harm. We considered the available data on 50 premature self-discharges identified prospectively in a general hospital with a well-developed integrated-care pathway for self-harm patients, and compared them to a control group. The self-discharge group was found to be more likely to have attempted self-poisoning without alcohol intoxication or other forms or combinations of self-harm, and an absence of identifiable previous self-harm or prior contact with local specialist psychiatric services. The two groups showed no difference in age, sex, or area of residence based on community mental health team sectors. It is proposed that these findings indicate hypotheses for further studies of why people leave the hospital without adequate assessment, and how service design could be improved in order to help them.

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Tello, Juan Eduardo, and Paola Bonizzato. "Social economic inequalities and mental health II. Methodological aspects and literature review." Epidemiology and Psychiatric Sciences 12, no. 4 (December 2003): 253–71. http://dx.doi.org/10.1017/s1121189x00003079.

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SummaryObjective - This study provides a framework for mental health inequalities beginners. It describes the methods used to measure socio economic inequalities and the inter-relations with different aspects of mental health: residence, mental health services organisation and main diagnostic categories. Method - Literature electronic-search on Medline, Psyclit, Econlit, Social Science Index and SocioSearch usingand relating the key-words inequalities, deprivation, poverty, socio-economic status, social class, occupational class, mental health for the period 1965-2002 (June). The articles selected were integrated with manual search (publications of the same authors, cross-references, working documents and reports of international andregional organisations). Results - Inequality is not an absolute concept and, mainly, it has been changing during the last years. For example, the integration and re-definition of variables that capture, in simple indices, a complex reality; the accent on social more than on economic aspects; the geo-validity and time-reference of the inequality's indices. Moreover, the inequalities could be the result of individual preferences, in this case, the social selectionand social causation issues will raise the suitability for a public intervention. Conclusions - Up to now, research has been mainly concentrated in describing and measuring health inequalities. For designing effective interventions, policy makers need to ground decisions on health-socioeconomic inequalities explanatory models.Declaration of Interestthis work was partly funded by the Department of the Public Health Sciences “G. Sanarelli” of the University of Rome “La Sapienza” and the Department of Medicine and Public Health of the University of Verona.

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Haq, Ainul, Ratry Ayunda, and Riris Lindiawati Puspitasari. "ANALYSIS OF HYGIENE AND SANITATION IN CHICKEN SLAUGHTERHOUSES IN JAMPANG VILLAGE, BOGOR REGENCY, WEST JAVA PROVINCE, INDONESIA." International Journal of Biosciences and Biotechnology 8, no. 2 (May 25, 2021): 12. http://dx.doi.org/10.24843/ijbb.2021.v08.i02.p03.

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This chicken slaughterhouse in Jampang Village is a home industry that is engaged in chicken slaughter. The problem in this research is the process of slaughtering chickens that do not meet the standards. The purpose of this study was to identify the hygiene and sanitation of chicken slaughterhouses. Data collection was done by filling out questionnaires and observations. The observation sheet is made based on SNI-01-6160-1999 concerning Poultry Slaughterhouses (Badan Standarisasi Nasional, 1999). The observation sheet was used to assess the hygiene and sanitation conditions using the scoring method. This study used descriptive statistics to analyze the abserved data. The scoring method is done by determining the weight for each variable and determining the value for each of the assessed aspects. The results showed that the workers were in good health. Not yet using boots, masks, aprons and headgear. The building is still integrated with the residence. The layout is not in line with the flow of the production process. Sewerage drain is readily available. The cage has never been washed using water and detergent. The conclusion is that the hygiene of the chicken cutters and the sanitation of the buildings still do not meet the requirements. The proposal for improvement is the health of chicken slicers and the use of equipment are things that need to be considered, the building must be separated from the residence, the layout should be improved in the direction of the production process, the building construction is made rodent-free, the chicken coop must be cleaned regularly with water and detergent.

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Minichiello, Vincent, Supriya Hayer, Bob Gillespie, Maureen Goss, and Bruce Barrett. "Developing a Mindfulness Skills-Based Training Program for Resident Physicians." Family Medicine 52, no. 1 (January 3, 2020): 48–52. http://dx.doi.org/10.22454/fammed.2020.461348.

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Background and Objectives: Resident physicians experience a high level of stress. Mindfulness meditation has been shown to offer medical students and physicians a healthier way to relate to daily stressors. We developed and pilot tested a mindfulness training program and assessed its impact on resident physician burnout and resilience. Methods: The residency program offered 17 family medicine residents a 10-hour mindfulness training over the course of 2 months in 2016. Residents were encouraged, but not mandated, to attend. Experienced Mindfulness-Based Stress Reduction teachers and a family physician/integrative health fellow cotaught the program. A research team qualitatively assessed deidentified, postintervention resident interviews. Residents completed four quantitative questionnaires preintervention, immediately postintervention, and 3 months postintervention. A t score was calculated to assess for statistical significance. Results: Three residents (18%) attended all five training sessions, seven residents (41%) completed at least four sessions, and 16 residents (94%) completed either one or two sessions. Eight residents completed the postintervention interview. Twelve, nine and 14 residents completed the four questionnaires at the three time points, respectively. Qualitative results identified multiple personal/professional benefits of participating in mindfulness training, and we found a statistically significant decrease in perceived stress and increase in mindful awareness from pre- to postintervention (P<.05). Conclusions: A resident physician mindfulness training program can be reasonably integrated into the residency schedule as part of the wellness curriculum required by the Accreditation Council for Graduate Medical Education. Preliminary results show potential for personal growth and positive changes in patient relationships.

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Munro-Kramer, Michelle, Lindsay Cannon, Jose Bauermeister, Yasamin Kusunoki, Quyen Ngo, and Rob Stephenson. "3032 MKit: Pilot Results of Primary Prevention Sexual Violence WebApp." Journal of Clinical and Translational Science 3, s1 (March 2019): 61. http://dx.doi.org/10.1017/cts.2019.143.

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OBJECTIVES/SPECIFIC AIMS: Sexual violence (SV) is a public health crisis. High rates of SV are observed among college-age youth, yet holistic interventions are currently lacking. The purpose of this study was to conduct a pilot feasibility and acceptability test of a WebApp, MKit, which translates a clinical life skills approach to influence the health and well-being of university students. METHODS/STUDY POPULATION: We randomized two residence halls at a public university in the Midwest into a control group (n=139) that received typical university programming around SV and healthy relationships, or an intervention group (n=122) receiving MKit and the usual SV programming. We used online surveys to assess acceptability, feasibility, and usability at 3- and 5-months. Focus groups were conducted with a subsample of participants at 5-months to further investigate safety. RESULTS/ANTICIPATED RESULTS: The mean number of uses of MKit was 2.84 in a 5-month period. The majority of intervention participants endorsed the acceptability and usability of MKit as easy to use, well integrated, accessible, and easy to learn quickly. There were no concerns regarding personal safety. DISCUSSION/SIGNIFICANCE OF IMPACT: MKit provides a promising resource platform to deliver messages regarding healthy relationships and SV within the university context. By delivering SV-related content through a holistic life skills approach, MKit may offer new opportunities to reach and engage a wide range of students on how to foster healthy relationships.

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Wang, Xuetao, Kate A. Salters, Wen Zhang, Lawrence McCandless, Deborah Money, Neora Pick, Julio S. G. Montaner, Robert S. Hogg, and Angela Kaida. "Women’s Health Care Utilization among Harder-to-Reach HIV-Infected Women ever on Antiretroviral Therapy in British Columbia." AIDS Research and Treatment 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/560361.

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Background. HIV-infected women are disproportionately burdened by gynaecological complications, psychological disorders, and certain sexually transmitted infections that may not be adequately addressed by HIV-specific care. We estimate the prevalence and covariates of women’s health care (WHC) utilization among harder-to-reach, treatment-experienced HIV-infected women in British Columbia (BC), Canada.Methods. We used survey data from 231 HIV-infected, treatment-experienced women enrolled in the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) study, which recruited harder-to-reach populations, including aboriginal people and individuals using injection drugs. Independent covariates of interest included sociodemographic, psychosocial, behavioural, individual health status, structural factors, and HIV clinical variables. Logistic regression was used to generate adjusted estimates of associations between use of WHC and covariates of interest.Results. Overall, 77% of women reported regularly utilizing WHC. WHC utilization varied significantly by region of residence (Pvalue<0.01). In addition, women with lower annual income (AOR (95% CI) = 0.14 (0.04–0.54)), who used illicit drugs (AOR (95% CI) = 0.42 (0.19–0.92)) and who had lower provider trust (AOR (95% CI) = 0.97 (0.95–0.99)), were significantly less likely to report using WHC.Conclusion. A health service gap exists along geographical and social axes for harder-to-reach HIV-infected women in BC. Women-centered WHC and HIV-specific care should be streamlined and integrated to better address women’s holistic health.

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Schwartz, B. S., Jonathan Pollak, Melissa N. Poulsen, Karen Bandeen-Roche, Katherine Moon, Joseph DeWalle, Karen Siegel, Carla Mercado, Giuseppina Imperatore, and Annemarie G. Hirsch. "Association of community types and features in a case–control analysis of new onset type 2 diabetes across a diverse geography in Pennsylvania." BMJ Open 11, no. 1 (January 2021): e043528. http://dx.doi.org/10.1136/bmjopen-2020-043528.

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ObjectivesTo evaluate associations of community types and features with new onset type 2 diabetes in diverse communities. Understanding the location and scale of geographic disparities can lead to community-level interventions.DesignNested case–control study within the open dynamic cohort of health system patients.SettingLarge, integrated health system in 37 counties in central and northeastern Pennsylvania, USA.Participants and analysisWe used electronic health records to identify persons with new-onset type 2 diabetes from 2008 to 2016 (n=15 888). Persons with diabetes were age, sex and year matched (1:5) to persons without diabetes (n=79 435). We used generalised estimating equations to control for individual-level confounding variables, accounting for clustering of persons within communities. Communities were defined as (1) townships, boroughs and city census tracts; (2) urbanised area (large metro), urban cluster (small cities and towns) and rural; (3) combination of the first two; and (4) county. Community socioeconomic deprivation and greenness were evaluated alone and in models stratified by community types.ResultsBorough and city census tract residence (vs townships) were associated (OR (95% CI)) with higher odds of type 2 diabetes (1.10 (1.04 to 1.16) and 1.34 (1.25 to 1.44), respectively). Urbanised areas (vs rural) also had increased odds of type 2 diabetes (1.14 (1.08 to 1.21)). In the combined definition, the strongest associations (vs townships in rural areas) were city census tracts in urban clusters (1.41 (1.22 to 1.62)) and city census tracts in urbanised areas (1.33 (1.22 to 1.45)). Higher community socioeconomic deprivation and lower greenness were each associated with increased odds.ConclusionsUrban residence was associated with higher odds of type 2 diabetes than for other areas. Higher community socioeconomic deprivation in city census tracts and lower greenness in all community types were also associated with type 2 diabetes.

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Farabi, Tasmia Jebin, Yamin Tauseef Jahangir, Afrin Ahmed Clara, Mohammad Hayatun Nabi, and Mohammad Delwer Hossain Hawlader. "Sexually Transmitted Infections among Street, Hotel, and Residence-Based Female Sex Workers in Dhaka, Bangladesh: Prevalence from Three HIV/STI Drop-in-Centers." Sexes 2, no. 1 (January 21, 2021): 69–78. http://dx.doi.org/10.3390/sexes2010006.

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Introduction: Considering a growing number of female sex workers (FSWs) in Bangladesh, there remains a greater need to reduce sexually transmitted infection (STI) rates, as lower social and cultural status cause FSWs to have less access to education, employment opportunities, and health care, including opportunities for HIV tests, counseling, and medical care. Methods: A cross-sectional study was conducted among 546 street, hotel, and residence-based FSWs. This current study aimed to identify the prevalence and to ascertain the associated risk factors among the FSW populations in Dhaka. Results: We found a majority of the participants were in the working age of more than 26 years for the FSW profession, with a mean age of 28 years. While the majority were unemployed (42.5%), alcohol abuse (p = 0.01) and drug dependency (p = 0.01) had an association, and inconsistency of condom use had a higher risk factor (AOR = 3.54) for a new STI case. Conclusions: FSW-oriented service platform should be integrated with health literacy interventions in urban and rural locations in Bangladesh. Understanding the differences in risk patterns and tailoring intervention will increase contraception use and lower STI cases and improve overall FSW quality of life.

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Roos, Leslie L., Sumit Gupta, Ruth-Ann Soodeen, and Laurel Jebamani. "Data Quality in an Information-Rich Environment: Canada as an Example." Canadian Journal on Aging / La Revue canadienne du vieillissement 24, S1 (2005): 153–70. http://dx.doi.org/10.1353/cja.2005.0055.

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ABSTRACTThis review evaluates the quality of available administrative data in the Canadian provinces, emphasizing the information needed to create integrated systems. We explicitly compare approaches to quality measurement, indicating where record linkage can and cannot substitute for more expensive record re-abstraction. Forty-nine original studies evaluating Canadian administrative data (registries, hospital abstracts, physician claims, and prescription drugs) are summarized in a structured manner. Registries, hospital abstracts, and physician files appear to be generally of satisfactory quality, though much work remains to be done. Data quality did not vary systematically among provinces. Primary data collection to check place of residence and longitudinal follow-up in provincial registries is needed. Promising initial checks of pharmaceutical data should be expanded. Because record linkage studies were “conservative” in reporting reliability, the reduction of time-consuming record re-abstraction appears feasible in many cases. Finally, expanding the scope of administrative data to study health, as well as health care, seems possible for some chronic conditions. The research potential of the information-rich environments being created highlights the importance of data quality.

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Consolazio, David, Rossella Murtas, Sara Tunesi, Federico Gervasi, David Benassi, and Antonio Giampiero Russo. "Assessing the Impact of Individual Characteristics and Neighborhood Socioeconomic Status During the COVID-19 Pandemic in the Provinces of Milan and Lodi." International Journal of Health Services 51, no. 3 (March 2, 2021): 311–24. http://dx.doi.org/10.1177/0020731421994842.

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Social inequalities in health are known to be influenced by the socioeconomic status of the territory in which people live. In the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic, this study is aimed at assessing the role of 5 area-level indicators in shaping the risk of contagion in the provinces of Milan and Lodi (Lombardy, Italy), namely: educational disadvantage, unemployment, housing crowding, mobility, and population density. The study area includes the municipalities at the origin of the first Italian epidemic outbreak. Data on COVID-19 patients from the Integrated Datawarehouse for COVID Analysis in Milan were used and matched with aggregate-level data from the National Institute of Statistics Italy (Istat). Multilevel logistic regression models were used to estimate the association between the census block-level predictors and COVID-19 infection, independently of age, sex, country of birth, and preexisting health conditions. All the variables were significantly associated with the outcome, with different effects before and after the lockdown and according to the province of residence. This suggests a pattern of socioeconomic inequalities in the outbreak, which should be taken into account in the eventuality of future epidemics to contain their spread and its related disparities.

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Hou, Andrew, Nikhil Goyal, Deborah Darnley-Fisch, Paul Edwards, and David Goldman. "Exploring the Benefit of an Integrated Ophthalmology Internship (PGY-1)—Perceived Preparedness and the Recommended Duration of Training." Journal of Academic Ophthalmology 12, no. 01 (January 2020): e57-e60. http://dx.doi.org/10.1055/s-0040-1709671.

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Abstract Objective The effective utilization of intern training for ophthalmology residency is undermined by its variability across postgraduate programs. As residency programs shift toward integrating the first postgraduate year (PGY-1) into the ophthalmology-training curriculum, there are no definitive guidelines to build upon. Methods This is a retrospective cross-sectional study of new second postgraduate year (PGY-2) ophthalmology residents. Residents were surveyed in their first 2 months of ophthalmology training. Residents were asked to self-assess preparedness for ophthalmology based on their PGY-1 curriculum. A survey was composed and modified from the Accreditation Council for Graduate Medical Education's assessment of resident training. The Wilcoxon's rank-sum test was used to evaluate survey differences between the transitional year (TY) versus preliminary internal medicine (IM) year and compare survey responses between residents who were below versus above optimal cut points for weeks of ophthalmic training. Results There were 72 PGY-2 residents who responded to blinded surveys collected from July to August of 2017 and 2018. Thirty-nine (54%) residents graduated from a TY, 28 (39%) from preliminary IM, 3 (4%) from preliminary surgery, and 2 (3%) from a categorical ophthalmology year. Both categorical ophthalmology and surgery year were excluded from training year comparison due to low sample size. Using weeks of ophthalmology training as the control variable, there were significant increases in preparedness for addressing the ophthalmic complaint (p = 0.003) with at least 8 weeks of clinical ophthalmology, ability to perform ophthalmic exam (p = 0.018) with at least 12 weeks, ophthalmology medical knowledge (p = 0.005) with at least 10 weeks, and proficiency with hospital electronic health record (p = 0.003) with at least 12 weeks. Conclusion While our study did not find significant differences in perceived preparedness for ophthalmology residency based on the type of PGY-1 programs completed, there were statistically significant associations for specific ophthalmology tasks. These findings suggested a potential merit of integrating 12 weeks of clinical ophthalmology training as a benchmark for resident preparedness.

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Mishra, Shraddha, and Sunil K. Guleri. "A cross sectional study conducted to assess knowledge and awareness regarding HIV/AIDS among attendees of integrated counselling and testing centre at Sagar, Madhya Pradesh." International Journal Of Community Medicine And Public Health 6, no. 9 (August 27, 2019): 3798. http://dx.doi.org/10.18203/2394-6040.ijcmph20193973.

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Background: Acquired immunodeficiency syndrome (AIDS) has emerged as one of most serious public health problem in the country. ICTC (integrated counseling and testing centre) provides a key entry point for the 'continuum of care in HIV/AIDS' for all segments of the population. This study was conducted to assess knowledge and awareness regarding HIV/AIDS among attendees of ICTC because awareness is only means to reduce prevalence of any disease in absence of availability of treatment and cure.Methods: The study was conducted among attendees of integrated counseling and testing centre who were visited at the centre for HIV testing. It was a cross-sectional, observational study and conducted at ICTC attached to Microbiology Department of Bundelkhand Medical College, Sagar.Results: Majority of study subjects (34.96%) had a relatively poor knowledge about HIV/AIDS. In spite of having awareness, the respondents had lack of complete knowledge about the root cause of HIV/AIDS and had misconceptions about the mode of transmission.Conclusions: Gender, education, residence, caste and socio-economic status showed the significant association with knowledge score regarding HIV/AIDS. IEC activities should be planned in local language incorporating locally derived data pertaining to various social norms, cultural beliefs and sensitivities of community.

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Schubert, Ingrid, Achim Siegel, Erika Graf, Erik Farin-Glattacker, Peter Ihle, Ingrid Köster, Dominikus Stelzer, et al. "Study protocol for a quasi-experimental claims-based study evaluating 10-year results of the population-based integrated healthcare model ‘Gesundes Kinzigtal’ (Healthy Kinzigtal): the INTEGRAL study." BMJ Open 9, no. 1 (January 2019): e025945. http://dx.doi.org/10.1136/bmjopen-2018-025945.

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IntroductionPatients often experience interface problems when treated by different specialists and in different healthcare sectors. Integrated care concepts aim to reduce these problems. While most integrated healthcare models focus on individual diseases, the integrated care model ‘Gesundes Kinzigtal’ applies a population-based approach and addresses the full spectrum of morbidities for a population defined by area of residence—the Kinzigtal. A special feature of the model is the joint savings contract between the regional management company and the statutory health insurers. The INTEGRAL study aims at assessing the effectiveness of ‘Gesundes Kinzigtal’ under routine conditions in comparison to conventional care over a period of 10 years in order to understand the benefits but also the potential for (unintended) harms.Methods and analysisDatabaseClaims data from statutory health insurance funds 2005–2015. The evaluation consists of a quasi-experimental study, with Kinzigtal as intervention region, at least 10 further regions with a similar population and healthcare infrastructure as primary controls and an additional random sample of insurees from the federal state of Baden-Württemberg as secondary controls. Model-specific and ‘non-specific’ indicators adopted from the literature and enriched by focus group interviews will be used to evaluate the model’s effectiveness and potential unintended consequences by analysing healthcare utilisation in general. Temporal trends per indicator in the intervention region will be compared with those in each control region. The overall variation in trends for the indicators across all regions provides information about the potential to modify an indicator due to local differences in the healthcare system.Ethics and disseminationEthic Commission of the Faculty of Medicine, Philipps-University Marburg (ek_mr_geraedts_131117). Results will be discussed in workshops, submitted for publication in peer-review journals and presented at conferences.Trial registration numberDRKS00012804.

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Landoll, Ryan R., Ronald M. Cervero, Jeffrey D. Quinlan, and Lauren A. Maggio. "Primary Care Behavioral Health Training in Family Medicine Residencies:." Family Medicine 52, no. 3 (March 6, 2020): 174–81. http://dx.doi.org/10.22454/fammed.2020.681872.

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Background and Objectives: Primary care behavioral health (PCBH) is a service delivery model of integrated care linked to a wide variety of positive patient and system outcomes. However, considerable challenges with provider training and attrition exist. While training for nonphysician behavioral scientists is well established, little is known about how to train physicians to work efficiently within integrated teams. Methods: We conducted a case study analysis of family medicine residencies in the military health system using a series of 30 to 45-minute semistructured interviews. We conducted qualitative template analysis of these cases to chart programs’ current educational processes related to PCBH. Thirteen individuals consisting of program directors, behavioral and nonbehavioral faculty, and residents across five programs participated in the study. Results: Current educational processes included a variety of content on PCBH (eg, treatment for depression, clinical referral pathways, patient-centered communication), primarily using a mix of didactic and practice-based placements. Resource allocation was seen as a critical contributor to quality. There was variability in the degree to which integrated behavioral health providers were incorporated as residency faculty, such that programs where these specialists were more incorporated reported more intentional curriculum development and health care systems-level content. Conclusions: While behavioral health content was well represented in family medicine residency curriculum, the depth and integration of content was inconsistent. More intentional and integrated curriculum accompanied faculty development and integration of behavioral health faculty. Future research should evaluate if faculty development programs and faculty status of behavioral scientists results in different educational or health care outcomes.

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Reuland, Colleen P., Jon Collins, Lydia Chiang, Valerie Stewart, Aaron C. Cochran, Christopher W. Coon, Deepti Shinde, and Dana Hargunani. "Oregon’s approach to leveraging system-level data to guide a social determinants of health-informed approach to children’s healthcare." BMJ Innovations 7, no. 1 (October 23, 2020): 18–25. http://dx.doi.org/10.1136/bmjinnov-2020-000452.

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BackgroundChildren’s health and healthcare use are impacted by both medical conditions and social factors, such as their home and community environment. As healthcare systems manage a pediatric population, information about these factors is crucial to providing quality care coordination.MethodsThe authors developed a novel methodology combining medical complexity (using the Pediatric Medical Complexity Algorithm) and social complexity (using available family social factors known to impact a child’s health and healthcare use) to create a new health complexity model at both the population-level and individual-level. System-level data from Oregon’s Medicaid Management Information Systems and Integrated Client Services database was analysed, examining claims data and service utilization, to calculate the health complexity of children enrolled in Medicaid/Child Health Insurance Program (CHIP) across Oregon.ResultsOf the 390 582 children ages 0 to 17 enrolled in Medicaid/CHIP in Oregon from July 2015 to June 2016, 83.4% (n=325 900) had some level of medical and/or social complexity and 22.1% (n=85 839) had health complexity (both medical and social complexity). Statistically significant (p<0.05) differences in health complexity were observed among attributed patients by Oregon’s 16 Coordinated Care Organizations, as well as by a child’s age, county of residence and race/ethnicity.ConclusionsGiven the high proportion of children with health complexity, these findings demonstrate that a large number of Medicaid/CHIP-insured children could benefit from targeted care coordination and differential resource allocation. Reports have been shared with state, county and health system leaders to drive work across the state. This paper describes the collaborative process necessary for other states considering similar work.

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Rosychuk, Rhonda J., Erik Youngson, and Brian H. Rowe. "Presentations to Emergency Departments for COPD: A Time Series Analysis." Canadian Respiratory Journal 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/1382434.

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Background. Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by progressive dyspnea and acute exacerbations which may result in emergency department (ED) presentations. This study examines monthly rates of presentations to EDs in one Canadian province.Methods. Presentations for COPD made by individuals aged ≥55 years during April 1999 to March 2011 were extracted from provincial databases. Data included age, sex, and health zone of residence (North, Central, South, and urban). Crude rates were calculated. Seasonal autoregressive integrated moving average (SARIMA) time series models were developed.Results. ED presentations for COPD totalled 188,824 and the monthly rate of presentation remained relatively stable (from 197.7 to 232.6 per 100,000). Males and seniors (≥65 years) comprised 52.2% and 73.7% of presentations, respectively. The ARIMA1,0,0×1,0,112model was appropriate for the overall rate of presentations and for each sex and seniors. Zone specific models showed relatively stable or decreasing rates; the North zone had an increasing trend.Conclusions. ED presentation rates for COPD have been relatively stable in Alberta during the past decade. However, their increases in northern regions deserve further exploration. The SARIMA models quantified the temporal patterns and can help planning future health care service needs.

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Buckner, Ayanna V., Leslie M. Beitsch, and Bernard D. Goldstein. "The Gulf Region Health Outreach Program – An integrated public health response to the Deepwater Horizon Oil Spill." International Oil Spill Conference Proceedings 2014, no. 1 (May 1, 2014): 215–24. http://dx.doi.org/10.7901/2169-3358-2014.1.215.

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ABSTRACT We describe the Gulf Region Health Outreach Program (GRHOP), a series of four integrated community-based projects designed to be embedded in and to complement the existing efforts undertaken by the public health community along the Gulf Coast. Funded from the Deepwater Horizon Medical Settlement, the GRHOP target beneficiaries are residents of 17 coastal counties and parishes in Louisiana, Mississippi, Alabama, and the Florida Panhandle. The GRHOP is unique in that it integrates projects focused on primary care, mental and behavioral health, environmental and occupational medicine, and training community health workers to help residents navigate the healthcare system and access needed care. We explore the evolution of the program, integration and collaboration among GRHOP projects, sustainability, and lessons learned. We also discuss how health professionals, public health organizations, and community groups, have come together, with lawyers from both the Plaintiff's Steering Committee and BP, to integrate their efforts toward the ultimate goal of bolstering evidence-based services and community resilience by increasing sustainable access to high-quality medical and mental and behavioral healthcare, increasing health knowledge among individuals, communities, and providers, and strengthening public health research infrastructure within an integrated public health program.

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Keeble, Eilís, M. Bardsley, Mary Alison Durand, Ties Hoomans, and Nicholas Mays. "Area level impacts on emergency hospital admissions of the integrated care and support pioneer programme in England: difference-in-differences analysis." BMJ Open 9, no. 8 (August 2019): e026509. http://dx.doi.org/10.1136/bmjopen-2018-026509.

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ObjectiveTo examine whether any differential change in emergency admissions could be attributed to integrated care by comparing pioneer and non-pioneer populations from a pre-pioneer baseline period (April 2010 to March 2013) over two follow-up periods: to 2014/2015 and to 2015/2016.DesignDifference-in-differences analysis of emergency hospital admissions from English Hospital Episode Statistics.SettingLocal authorities in England classified as either pioneer or non-pioneer.ParticipantsEmergency admissions to all NHS hospitals in England with local authority determined by area of residence of the patient.InterventionWave 1 of the integrated care and support pioneer programme announced in November 2013.Primary outcome measureChange in hospital emergency admissions.ResultsThe increase in the pioneer emergency admission rate from baseline to 2014/2015 was smaller at 1.93% and significantly different from that of the non-pioneers at 4.84% (p=0.0379). The increase in the pioneer emergency admission rate from baseline to 2015/2016 was again smaller than for the non-pioneers but the difference was not statistically significant (p=0.1879).ConclusionsIt is ambitious to expect unequivocal changes in a high level and indirect indicator of health and social care integration such as emergency hospital admissions to arise as a result of the changes in local health and social care provision across organisations brought about by the pioneers in their early years. We should treat any sign that the pioneers have had such an impact with caution. Nevertheless, there does seem to be an indication from the current analysis that there were some changes in hospital use associated with the first year of pioneer status that are worthy of further exploration.

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Martin, Ashley, and Sarah Manos. "66 Piloting a respectful challenges workshop in pediatric residency training." Paediatrics & Child Health 25, Supplement_2 (August 2020): e27-e28. http://dx.doi.org/10.1093/pch/pxaa068.065.

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Abstract Background Unaddressed conflict has been shown to negatively impact resident wellness and patient safety, and development of communication and conflict resolution skills are key competencies in medical education. While there are a number of existing communication training programs directed at healthcare providers, these can be costly and difficult to accommodate in an already packed curriculum. We developed a conflict resolution workshop to address local conflict scenarios facing our residents that could be integrated into our program curriculum at no cost. Objectives Evaluate resident satisfaction with the addition of a “respectful challenges” workshop to our training program’s academic curriculum. Design/Methods We designed a two- hour workshop for pediatric residents at our institution focusing on addressing conflict during residency training. A didactic lecture outlining different approaches was followed by three role-playing scenarios with coaching (conflict with another resident, allied health and faculty). The workshop was facilitated by a senior resident and faculty identified by residents as “approachable”. Residents (PGY1-4) were asked to evaluate the workshop’s content and effectiveness as well as their own comfort addressing conflict using pre and post-surveys with Likert scales. Results of the survey were analyzed using descriptive statistics. Results A total of 15 residents were involved in the workshop and completed the pre and post surveys. Eleven were female. Six indicated that they had some form of previous training in conflict management. All residents reported having experienced workplace conflict at least a few times per year, but most said they didn’t always address it (73%). Twelve (80%) thought it was either “quite” or “extremely important” that conflict resolution skills be taught in residency. All 15 residents felt that the scenarios represented real life and that the format was an appropriate way to discuss conflict in the workplace. The majority of residents felt the workshop helped them better understand their approach to conflict and allowed them to feel better prepared to face challenges in the future (14/15 and 11/15 rated as “quite” or “extremely”). Eighty percent of residents reported that they would feel more comfortable addressing workplace conflict after the workshop. Conclusion This concise workshop provided a foundation on conflict resolution for our residents. The use of role play and coaching during simulated scenarios was well received, and residents reported increased comfort approaching workplace conflict in the future. Further evaluation will be important to determine if residents translate these skills into practice.

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Chow, Hsin Han Elisha, Qian Hui Chew, and Kang Sim. "Spirituality and religion in residents and inter-relationships with clinical practice and residency training: a scoping review." BMJ Open 11, no. 5 (May 2021): e044321. http://dx.doi.org/10.1136/bmjopen-2020-044321.

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ObjectivesWith the increased emphasis on personalised, patient-centred care, there is now greater acceptance and expectation for the physician to address issues related to spirituality and religion (SR) during clinical consultations with patients. In light of the clinical need to improve SR-related training in residency, this review sought to examine the extant literature on the attitudes of residents regarding SR during residency training, impact on clinical care and psychological well-being of residents and SR-related curriculum implemented within various residency programmes.DesignA scoping review was conducted on studies examining the topic of SR within residency training up until July 2020 on PubMed/Medline and Web of Science databases. Keywords for the literature search included: (Spirituality OR Religion) AND (Residen* OR “Postgraduate Medicine” OR “Post-graduate Medicine” OR “Graduate Medical Education”).ResultsOverall, 44 studies were included. The majority were conducted in North America (95.5%) predominantly within family medicine (29.5%), psychiatry (29.5%) and internal medicine (25%) residency programmes. While residents held positive attitudes about the role of SR and impact on patient care (such as better therapeutic relationship, treatment adherence and coping with illness), they often lacked the knowledge and skills to address these issues. Better spiritual well-being of residents was associated with greater sense of work accomplishment, overall self-rated health, decreased burnout and depressive symptoms. SR-related curricula varied from standalone workshops to continuous modules across the training years.ConclusionsThese findings suggest a need to better integrate appropriate SR-related education within residency training. Better engagement of the residents through different pedagogical strategies with supervision, feedback, reflective practice and ongoing faculty and peer support can enhance learning about SR in clinical care. Future studies should identify barriers to SR-related training and evaluate the outcomes of these SR-related curriculum including how they impact the well-being of patients and residents over time.

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Ong, Chooi Peng, Cindy Shiqi Zhu, Desmond SL Ong, and Ying Pin Toh. "The ties that bind – Learning groups in family medicine residency." Asia Pacific Scholar 6, no. 1 (January 5, 2021): 125–27. http://dx.doi.org/10.29060/taps.2021-6-1/pv2228.

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Family medicine training encompasses the need to develop a diverse skillset and the ability to practice in different settings. During three years of training, family medicine residents from National University Health System (NUHS) rapidly transit through many hospital rotations with varying specialty-specific competency requirements. Throughout this period, each resident is rostered to run a half-day primary care clinic on the same day each week and is assigned a dedicated faculty member to supervise him during the session. Each faculty member is assigned up to four to six residents for the half-day sessions every week. There is a need to contextualise what is learnt in hospital to primary care, and to effectively integrate knowledge across disciplines. We describe here a tool that the NUHS family medicine residency has used to bring together faculty and residents of varying seniorities and locations for discussion, reflection, and growth.

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Khalid, Faraz, Abdul Sattar, Maria Petro Brunal, Wajeeha Raza, David Hotchkiss, and David Hotchkiss. "Tracking Pakistan’s Progress Towards Universal Health Coverage: An Empirical Assessment of Summary and Tracer Indicators and Their Associated Inequities (2001-14)." Pakistan Journal of Public Health 10, no. 1 (October 26, 2020): 60–68. http://dx.doi.org/10.32413/pjph.v10i1.434.

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Background: This study’s main objective was to examine the progress of provinces towards UHC using several tracer indicators (six for health service coverage and two for financial protection) from 2001 to 2014 and to assess inequities within provinces due to place of residence and economic status. Methods: For elaborate tracking, inequities were assessed for each indicator based on average annual rates of change and percentage changes in the gap between sub-population groups. For policy makers, spider radar graphs were generated to demonstrate UHC status in 2014, and a composite UHC index was created to show trends from 2001-14. Four Household Integrated Economic Survey data sets (2001-02, 2004-05, 2010-11, 2013-14), each with a sample size of about 15,000 households, were used for the analysis. Results: Overall, all four provinces made progress in their UHC index values over the study period. Coverage for most of treatment indicators remained below 70% and inequities existed among sub-population groups. Coverage of financial protection indicators remained above 90% for all the provinces across study duration and no substantial differences were found between and within provinces. Conclusion: Simultaneous monitoring of both dimensions of UHC enabled the authors to comment on the holistic picture of UHC status and data blind spots, and to avoid inappropriate interpretations about a single dimension. Higher level of financial protection with limited health services coverage was most likely due to non-utilization of health services and/or unmet health needs. The findings will likely serve as a baseline for tracking progress towards UHC at the sub-national level in the country.

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Souza, Fernanda Pinheiro Peixoto de, Lucas Dias Soares Machado, Kelly Fernanda Silva Santana, Rhavena Maria Gomes Sousa Rocha, Maria do Socorro Vieira Lopes, and Maria de Fátima Antero Sousa Machado. "Health promotion in multidisciplinary residency: Contributions to the training process." Journal of Nursing Education and Practice 7, no. 6 (January 20, 2017): 80. http://dx.doi.org/10.5430/jnep.v7n6p80.

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Approaching the knowledge of professionals of a multidisciplinary residency program in health contributes to the reflection and analysis of knowledge, with reflexes in the structuring of educational responses aimed at strengthening the effective movement of health promotion in this training modality. This study aimed to understand the knowledge that professionals in a multidisciplinary residency have about health promotion and know the perceptions that they have about the contributions of the residency training process for health promotion practices. This is an exploratory study with qualitative approach, carried out in the context of Integrated Health Residency Program of the School of Public Health of Ceará-ESP-EC, Ceará State, Brazil. Sixteen professionals who had been trained in the program were interviewed. Data from interviews were organized according to content analysis technique and with the support of ATLAS.ti software. Two categories were raised: 1) Health promotion: from information to empowerment; and 2) Multiple training moments: contributions to health promotion practices in Multidisciplinary Residency in Health. The knowledge of residents, inferred from the speeches, sometimes assumed a posture congruent with the theoretical-conceptual international principles of health promotion, strengthening its effectiveness in the country through the Multidisciplinary Residency in Health as a training modality, and sometimes revealed features still related only to the prevention of diseases. Residents demonstrated to be aware of the need to overcome the hegemonic model that considers health professionals as the sole holders of knowledge.

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Rathod, Mamta S., Anant N. Borde, Sarika P. Patil, Mukesh S. Bawa, Shriram Gosavi, Vikrant Pagar, Amol Kinge, and Sushant Chavan. "Undernutrition and its association with socio-demographic factors among pregnant women attending tertiary health care hospital in northern Maharashtra: a cross sectional study." International Journal Of Community Medicine And Public Health 6, no. 10 (September 26, 2019): 4456. http://dx.doi.org/10.18203/2394-6040.ijcmph20194512.

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Background: Maternal nutrition is one of the most important health and welfare problems among women in developing countries. Only limited research has been conducted on the prevalence and determinants of maternal nutritional status in Maharashtra. Particularly, data on the nutritional status of pregnant women are lacking. The aim of this was to assess prevalence and determinants of undernutrition among pregnant women attending antenatal care center.Methods: An institution based cross-sectional study was conducted during September to December, 2018. Randomly selected 303 pregnant women were included in the study. Nutritional status was estimated using mid-upper-arm circumference. Data on potential determinants of undernutrition were gathered using a structured questionnaire. Statistical analysis was done using logistic regression. p<0.05 at 95% confidence interval was considered as statistically significant.Results: Overall prevalence of under-nutrition among study participants was 21.8%. Using a logistic regression model, factors significantly associated with the under nutrition were rural residence (AOR=0.675; 95%CI 0.307-1.485), having less than three years duration of marriage (AOR=6.650;95%CI 2.268-19.501), living with joint family (AOR=4.128;95%CI 1.606-10.611), no utilization of family planning methods (AOR=0.319; 95%CI 0.131-0.775), less no. of ANC visit (AOR=3.253; 95%CI 1.342-7.888) and having less frequency of meal (AOR=0.319 (0.149-0.683). Remaining all factors like religion, education, occupation, family size, gravida, parity, consumption of iron and calcium tablet, getting USG done, anti-tetanus vaccination, support from family and husband were not found as significant risk factors for undernutrition.Conclusions: Integrated approach is must to combat malnutrition among pregnant women.

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Benavente Cuesta, María Hinojal, and María Paz Quevedo Aguado. "Autopercepción de Salud, Calidad de vida y Bienestar Psicológico en una muestra de mayores = Autoperception of Health, Quality of life and Psychological Well-being in a sample of major." REVISTA ESPAÑOLA DE COMUNICACIÓN EN SALUD 10, no. 1 (June 26, 2019): 21. http://dx.doi.org/10.20318/recs.2019.3993.

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La OMS (2015) afirma que existe un incremento del envejecimiento en la población mundial al que además se le añaden situaciones de discriminación por motivo de la edad. Estas actitudes negativas, constituyen arraigados estereotipos que perjudican no sólo a la sociedad sino también al propio mayor. Por este motivo, es preciso que todos los agentes sociales y sanitarios trabajen bajo el paradigma del Envejecimiento Activo, que aboga por una vejez integrada en un contexto de desarrollo y participación social. Objetivo: Analizar dos de los predictores implicados en este tipo de envejecimiento: la Autopercepción que tiene el propio sujeto sobre su salud y calidad de vida, y el Bienestar psicológico. Muestra: 91 sujetos (=74,07 años). Instrumentos: Cuestionario de Salud SF (36) y Escala de Bienestar Psicológico (Díaz et al., 2006). Resultados: Los participantes muestran una valoración muy satisfactoria de su percepción de salud aun reconociendo la presencia de dolor y situaciones de estrés, además se observan tendencias distintas según el lugar de residencia. Existen diferencias en las dimensiones del Bienestar psicológico según el Sexo y la forma de percibir la jubilación.Palabras clave: Autopercepción de salud; Calidad de vida; Bienestar psicológico; Envejecimiento; Envejecimiento Activo; Vejez.AbstractWHO (2015) states that there is an increase in ageing in the world population, which is further compounded by situations of age discrimination. These negative attitudes constitute entrenched stereotypes that harm not only society but also the elderly themselves. For this reason, all social and health actors need to work under the paradigm of Active Ageing, which advocates an integrated old age in a context of development and social participation. Objectives: To analyse the health self perception, quality of life and psychological welfare of the elderly, as well as to compare whether there are differences in relation to sex, place of residence (urban/rural) and how to perceive retirement. Methodology: Sample: 91 subjects (=74,07 years).Instruments: Health Questionnaire SF (36) and Psychological Welfare Scale (Díaz et al., 2006). Results: The participants show a very satisfactory assessment in their own perception of health and quality of life. In this respect, different trends are observed according to habitat, rural/urban, where the largest resides. On the other hand, there are also differences in the dimensions of psychological welfare according to the sex of the subjects and the way they perceive the fact of retirementKeywords: Autoperception of health; Quality of life; Psychological Well-being; Aging; Active Aging; Oldness

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Bintabara, Deogratius. "Addressing the huge poor–rich gap of inequalities in accessing safe childbirth care: A first step to achieving universal maternal health coverage in Tanzania." PLOS ONE 16, no. 2 (February 16, 2021): e0246995. http://dx.doi.org/10.1371/journal.pone.0246995.

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Introduction Despite skilled attendance during childbirth has been linked with the reduction of maternal deaths, equality in accessing this safe childbirth care is highly needed to achieving universal maternal health coverage. However, little information is available regarding the extent of inequalities in accessing safe childbirth care in Tanzania. This study was performed to assess the current extent, trend, and potential contributors of poor-rich inequalities in accessing safe childbirth care among women in Tanzania. Methods This study used data from 2004, 2010, and 2016 Tanzania Demographic Health Surveys. The two maternal health services 1) institutional delivery and 2) skilled birth attendance was used to measures access to safe childbirth care. The inequalities were assessed by using concentration curves and concentration indices. The decomposition analysis was computed to identify the potential contributors to the inequalities in accessing safe childbirth care. Results A total of 8725, 8176, and 10052 women between 15 and 49 years old from 2004, 2010, and 2016 surveys respectively were included in the study. There is an average gap (>50%) between the poorest and richest in accessing safe childbirth care during the study period. The concentration curves were below the line of inequality which means women from rich households have higher access to the institutional delivery and skilled birth attendance inequalities in accessing institutional delivery and skilled birth attendance. These were also, confirmed with their respective positive concentration indices. The decomposition analysis was able to unveil that household’s wealth status, place of residence, and maternal education as the major contributors to the persistent inequalities in accessing safe childbirth care. Conclusion The calls for an integrated policy approach which includes fiscal policies, social protection, labor market, and employment policies need to improve education and wealth status for women from poor households. This might be the first step toward achieving universal maternal health coverage.

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Deka, Sangeeta, Deepjyoti Kalita, Pratima Gupta, and Yogendra Pratap Mathuria. "A contemporary insight into the sero-epidemiology of Toxoplasma gondii infection in the foot-hills of Himalayas: A cross-sectional study from a tertiary care center in Northern India." Nepal Journal of Epidemiology 11, no. 1 (March 31, 2021): 937–48. http://dx.doi.org/10.3126/nje.v11i1.34228.

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Objective: Toxoplasma gondii (T. Gondii) infects 30-50% of the world human population with high diversity in geo-epidemiological data on its seroprevalence. Data on burden of toxoplasmosis and its determinants from remote and vulnerable regions of India are scarce. This study aimed to evaluate the prevalence of toxoplasma antibodies and factors associated with seropositivity among people from Uttarakhand and adjoining areas. Methods: Serum samples from 442 cases were tested for anti-Toxoplasma IgG and IgM antibodies by Enzyme-linked Immunosorbent Assay. Correlation of seropositivity with age, sex, place of residence, dietary habits, and co-morbidity were analyzed by binary logistic regression. Results: An overall Toxoplasma seropositivity of 36.88% [95% Confidence Interval (CI)=30.40–39.28] was observed. While anti-T. gondii IgG was present in 36.84% [95% CI=30.40–39.28], anti- T. gondii IgM was detected in 6.33% [95% CI=4.06–8.61]. The overall and IgG seroprevalence increased with age in both the genders and the slope was steeper after the age of 40 years [Adjusted Odds Ratio (AOR)=2.98, p-value=0.030]. The probability of seropositivity tended to be significantly higher in people from Uttarakhand in both the hilly region (AOR=5.61; 95%CI:[2.14-14.68]) and plains (AOR=5.14; 95%CI:[2.2-12.02]). Multivariable logistic regression analysis also showed that being rural residents (AOR=3.23; 95%CI:[1.67-6.23]) and presence of co-morbidity (AOR=8.64; 95%CI:[4.62-16.18]) were potential risk factors of Toxoplasmosis. Consumption of vegetarian diet was found to have a protective effect (AOR=0.46; 95%CI: [0.28-0.75]). Conclusion: Seroprevalence of T. gondii antibodies was relatively high in Uttarakhand, particularly in rural and hilly terrain, indicating a necessity for the implementation of integrated public health strategies to prevent and control toxoplasmosis in this region.

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Frank MD, Maria Gabriela, Cason Pierce MD, Noelle Northcutt MD, Joseph Walker Keach MD, Gerard Salame MD, and Rebecca Allyn MD. "The Master Clinician’s Elective: Integrating Evidence-Based Physical Examination and Point of Care Ultrasonography in Modern Clinical Medicine." POCUS Journal 5, no. 1 (July 6, 2020): 13–19. http://dx.doi.org/10.24908/pocus.v5i1.14225.

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Background: Many internal medicine residency programs have incorporated ultrasonography into their curriculum; however, its integration with physical examination skills teaching at a graduate medical level is scarce. The program’s aim is to create a reproducible elective that combines physical exam and bedside ultrasound as a method for augmenting residents’ knowledge and competence in these techniques with the ultimate goal of improving patient care. Methods: We designed and implemented a two-week elective rotation for senior internal medicine residents, combining evidence-based physical examination with diagnostic bedside ultrasonography. The rotation took place in an inpatient setting at Denver Health Hospital. Program evaluation data was collected data between February 2016 to March 2019. IRB approval was waived. Results: Since its inception in 2016, 19 residents completed the rotation. Residents performed a pre-test and a post-test under direct observation by course faculty. Each resident was measured on the ability to perform pre-determined physical exam and point-of-care ultrasound (POCUS) skills. In the pre-test, participants correctly performed an average of 40% of expected physical exam maneuvers and 32% of expected POCUS skills. At elective conclusion, all participants were effectively able to demonstrate the highest yield physical exam and ultrasound maneuvers. Discussion and Conclusion: An elective designed specifically to integrate POCUS and physical exam modalities improves the ability of resident physicians to utilize both diagnostic modalities.

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Chinzorig, Aida, Cooray, Nyamdorj, Mashbaljir, Osaka, and Garidkhuu. "Inequalities in Caries Experience Among Mongolian Children." International Journal of Environmental Research and Public Health 16, no. 20 (October 14, 2019): 3892. http://dx.doi.org/10.3390/ijerph16203892.

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Although inequalities in dental caries have been well-reported, there is only one Mongolian study on the association between socioeconomic status (SES) and caries experience, which was published ten years ago. This study aimed to determine the dental health status of Mongolian children living in urban and suburban areas of Ulaanbaatar city and examine its association with income and parental educational attainment. An oral examination was conducted by dentists and caries were measured as deft/DMFT indices. A questionnaire including demographic characteristics and socioeconomic status was completed by their parents or caregiver. Parental educational attainment and household income were used as the measures of SES. The relative index of inequality (RII) and slope index of inequality (SII) were employed to examine the association between SES on deft and DMFT after adjusting for covariates. Dental caries prevalence (those with deft/DMFT > 0) was 89.3% among the total number of participants. The mean deft/DMFT values for age groups 1–6, 7–12, and 13–18 were 5.83 (SD = 4.37, deft), 5.77 (SD = 3.31, deft/DMFT), and 3.59 (SD = 2.69, DMFT), respectively. Rather than residence area and parental educational attainment, significant caries experience inequality was observed in relation to income (RII 0.65 95%, CI 0.52 to 0.82, SII −2.30, 95% CI −4.16 to −0.45). A prevention strategy for lower socioeconomic groups and building integrated oral health surveillance to monitor epidemiological trends for further evaluation of its progress is necessary.

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Journal articles on the topic 'Integrated health residence'

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