Community Caregivers’ Experiences and Programmatic Strategies to Improve Active Case Finding in Community Tuberculosis Care in Botswana 2016-2021

Background: The community tuberculosis care program was started to reduce the impact of TB and increase successful treatment outcomes, thus contributing to meeting WHO targets on TB. According to the Botswana Ministry of Health, community tuberculosis care was introduced with the main goal of reducing tuberculosis-related morbidity and mortality among communities through the expansion of direct observed therapy and community involvement to community settings. The community caregivers were to support tuberculosis patients throughout their treatment period until they were cured or had completed their treatment. Settings: Two major cities of Botswana, Francistown and Gaborone, with more than twenty-two health clinics offering tuberculosis care. Objective: To investigate community caregivers’ experiences and identify programmatic strategies to improve active TB case findings under the community TB care (CTBC) program in Botswana during 2016-2021. Methods: We adopted a descriptive qualitative research design, followed by convenience purposive sampling. We obtained consent and interviewed 40 participants who met the inclusion criteria, 16 out of 73 in Gaborone and 24 out of 38 from Francistown. Results: We interviewed 40 caregivers with a mean age of 43.4 years. Accepting the caregiving role was identified as the main experience by more than two thirds of the caregivers. While at least more than two-fifth felt obligated to care for the patient at home due to personal relations. More than half of the respondents found caregiving difficult or frustrating due to some challenges encountered during the caregiving role. Behavioral modifications were suggested under different subthemes as strategies to improve active case finding. [-rId13-]Conclusion: Acceptance was the major experience in CTBC. Intensification of known programmatic strategies was suggested by caregivers to improve tuberculosis active case finding in CTBC.

Study on Community Care Needs and Influencing Factors of the Urban Elderly in Shandong Province, China

Objective: To understand community care needs of the urban elderly in Shandong Province. To analysis the influencing factors and community care needs of the urban elderly in Shandong Province. Methods: Shandong Province was divided into four levels according to the level of economic development, multi-stage stratified cluster random sampling method was used. Each city collected the old aged 60 years or older served by 5 community health service centers. A total of 3390 questionnaires were distributed, the recovery rate was 100%, it had 3363 effective questionnaires, and an effective rate was 99.20%. SPSS17.0 software was used for univariate and multivariate analysis. Results: Analysis results show that, the influencing factors of community care needs of health promotion dimension have medical time (t = 3.239, P = 0.001) and EQ-5D score (t = 9.104, P - 6.239, P - 17.276, P - 3.762, P - 8.341, P Conclusions: Community care needs of the urban elderly in Shandong Province are at a medium level and have many influencing factors, the scores of each dimension from high to low are health promotion, disease care and disease prevention. In community nursing work, we should meet the care needs of the elderly, we need to enhance elderly self-care and safety awareness and promote the physical and mental health of the elderly.

Survey and Analysis of Community Care Service in Cities and Towns from the Perspective of Internet

With the aging of the social population,community care has become another important care model between home care and institutional care.In order to fully understand the social cognition and demand of"Internet+community care",the project team conducted a questionnaire survey in accordance with the research objectives.The survey concluded that the public are still dependent on the traditional care,and do not know much about"Internet+community care",but are willing to try."Internet+community care"can not only enrich and innovate the care model,but also effectively solve the problems of limited pension resources and mismatch between supply and demand.It is conducive to promoting the realization of high-quality and efficient services for the aged.

Lessons learned from the hospital to home community care program in Singapore and the supporting AI multiple readmissions prediction model

In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home(H2H)program that has been operating since 2017.In this follow on practice and policy article,we further elaborate on Singapore's H2H program and care model,and its supporting AI model for multiple readmission prediction,in the following ways:(1)by providing updates on the AI and supporting information systems,(2)by reporting on customer engagement and related service delivery outcomes including staff‐related time savings and patient benefits in terms of bed days saved,(3)by sharing lessons learned with respect to(i)analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants,(ii)balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables,and(iii)the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems,(4)by highlighting how this H2H effort supported broader Covid‐19 response efforts across Singapore's public healthcare system,and finally(5)by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards.For the convenience of the reader,some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.

Corroborative Activities and Recognition Between Community Comprehensive Care Unit’s Nurses and Care Managers in Supporting Discharge of Elderly from Hospital - A Secondary Publication

Objective: The purpose of this study was to clarify the collaborative activities and mutual recognition between community comprehensive care unit nurses (Ns) and care managers (CM) in supporting the discharge of the elderly from the hospital. Methods: A total of 300 nurses working in community comprehensive care wards and 360 care managers working in B City in A Prefecture were surveyed using an anonymous self-administered questionnaire. Results: The highest percentage of responses regarding necessary collaborative activities with multiple professions in supporting hospital discharge were the same for Ns and CMs. The items regarding practice with the highest percentages were “relationship as a team” for Ns, and “user-centered awareness” for CM. While these professionals were willing to share information about their patients’ lives after discharge, the percentage of those explaining their expertise was low. It is thought that collaborative activities focusing on these aspects would lead to more appropriate discharge support.

Advances in diagnosis and management of chronic heart failure in China： reference limits of N-terminal-pro-B-type natriuretic peptide, pharmacal management, and community care

Heart failure,the final outcome of various heart diseases,has an increasingly high prevalence in China.Diagnosis,medical treatments,and community managements of heart failure are substantial clinical challenges.N-terminal-pro-B-type natriuretic peptide （NT-proBNP） is a useful biomarker for diagnostic and prognostic predictions in heart failure patients;however,the levels of reference value in normal Chinese populations are lacking.The usage of classic Western medicines has greatly improved;furthermore,the treatment pattem of the integration of Western treatments and traditional Chinese medicine （TCM） is also widely explored.Moreover,community managements of heart failure have been paid more attention and the long-term mechanism is being built.Here,we summarize the range of reference values of NT-proBNP in normal Chinese subjects,current therapies including Western treatments and especially TCM,as well as community care among people with chronic heart failure patients in China.Keywords：chronic heart failure; N-terminal-pro-B-type natriuretic peptide; pharmacology; community care

An Association Pattern of Constituent Factors of the Elder Care Community in China

With the development of the aging society in China,the contradiction between the growing old people and the shortage of the elder care community has been increasingly sharp.How to reasonably and effectively establish the elder care community becomes a problem that demanding prompt solution in China.This paper,starting from the most basic constituent factors of the elder care community,namely the concept,the configuration and the service,analyzes 6 types of the concept,redefines the type of the building configuration of the elder care community,and explains the types and levels of the service,which aims to guide the elder care community to deal with the relationship between the 3 factors with a view to providing a reference for the architectural design and standard preparation in the elder care community.

Mandibular advancement devices in the treatment of obstructive sleep apnea and snoring in community dental care: A pilot study on self-reported sleep quality

Background: The high efficacy of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) patients is sometimes limited because of intolerance. Mandibular advancement devices (MAD) are proven to be efficient in treating mild to moderate sleep apnea and snoring. We examined patients who had been treated in Community Dental Care with a titrable Herbst-type MAD. The aim of the study was to evaluate the quality of sleep based on self report. Methods: A questionnaire was mailed to patients (n = 184) who had received treatment for OSA or snoring between 2007 and2010 inthe Helsinki Health Centre Oral Care Unit. The patients were referred to the clinic for primary treatment, or because another treatment modality had failed. Results: Of the respondents (n = 142, 78.4%), OSA had been diagnosed in 74%, while the MAD was applied for snoring to the remaining. Among all respondents, 78.4% had worn the MAD at least three nights per week. With the MAD in situ, sleep was felt significantly less disrupted (p < 0.001) and more restorative (p < 0.001), and snoring was markedly reduced (p < 0.001). Daytime tiredness was also markedly less frequent (p < 0.001). Conclusions: Treatment with a MAD improved perceived sleep quality and awoke alertness in mild and moderate OSA patients and in snorers. This study supports such treatment to be initiated and monitored in community dental care.

Changes and Development of Home and Community Based Elderly Care Service Policies in China

This paper analyzes the current situation of the development of home and community based elderly care service in China,points out the existing problems,and puts forward improvement measures,aiming to deepen the understanding of HCBS and promote the theoretical research and practice of community home-based elderly care service.

The Research of Social Organizations Participating in the Urban Community Aged Care＇ s Problems--Base on the City of Shanghai in China

With the deepening of China＇s aging population, the conmmnity aged care gradually become endowment new options. Social organization for its own characteristics, play an important role in participating in community aged care. But the extent to which the current social organizations to participate in the community aged care is still very low, the reason is mainly affected by the community aged care access mechanism. Article in the Shanghai community, for example, starhng fiom the present situation of the current social organizations to participate in the community aged care, analysis of the problems arising fi-om the social organizations in the community aged care, probe into its reasons in access mechanism, put forward the corresponding countermeasures and Suggestions, encourage social organizations play an effective role in the community aged care.

Construction of Xi'an ecological old-age care community in the new urbanization

The new urbanization is an important carrier of ecological civilization construction, and ecological old-age care is the concrete manifestation of the perfect combination of the two, the proper meaning of the new urbanization connotation and an inevitable trend of its development. Based on the analysis of the connotation and relationship between the new urbanization and ecological old-age care, together with the current situation and existing problems of the current nursing institutions and ecological old-age care in Xi'an area, this paper discusses the major issues that should be noticed when constructing the ecological old-age care community in Xi'an and three main construction modes.

Meta-analysis of the willingness rate of community home-based care in China

Objective:To systematically evaluate the willingness rate of the community to provide for the aged at home and analyze its influencing factors.Methods:By searching the CNKI,VIP,Wanfang,we collected literature on the willingness of the elderly in the community to provide for the aged from 2011 to 2021,extracted the data,and evaluated the quality of the included literature.Then,CMA 2.0 software was used for Meta-analysis.Results:A total of 13 articles were included in this study,and 16,402 people over 60 years old were surveyed,1782 people were willing to provide for the aged at home in the community,with a total willingness rate of 11%(95%CI:9%to 26%).The results of subgroup analysis showed that there was a statistically significant difference in the community home care willingness rate of elderly people with different gender,education levels,marital status,monthly income,living alone,the number of children,and residence(P<0.05).There was not any statistically significant difference in the willingness rate of the elderly with different ages,chronic diseases,self-care ability,and loneliness(P>0.05).Conclusion:The overall willingness rate of the elderly in the community of the elderly is relatively low in China.Gender,education level,marital status,monthly income,living alone,number of children,and residence are factors affecting the prediction of community elderly will.

Optimization Strategies of Beijing Elderly Care Service Stations Based on Questionnaire Survey Method: A Case Study of Zhanlan Road Street of Xicheng District

4 elderly care service stations in Zhanlan Road Street,Xicheng District,Beijing are selected,and questionnaires are designed and distributed to the surrounding elderly population to understand their needs and satisfaction with the station environment.By observing elderly care service stations on site,the characteristics,obstacles,and shortcomings of the environment are recorded,and relevant data are collected and analyzed,such as the characteristics of the elderly population being interviewed,the planning and design data of the station environment,and the distribution of service facilities.The overall characteristics of the spatial environment of elderly care stations are summarized,and renovation measures and optimization suggestions are provided for the current shortcomings,thereby providing some basis for the spatial design of community elderly care service stations in the future.

Assessment of Contributions of Community Tuberculosis Intervention to Tuberculosis Case Detection and Treatment Outcome in Two States in Nigeria

Background: Nigeria, one of the high burden Tuberculosis countries, has developed various intervention strategies to ensuring universal access to quality-assured tuberculosis diagnosis and treatment. However, low case detection and unsuccessful treatment outcome still remains a serious challenge in most states. Community Tuberculosis care was born against this background in 2010 as a complementing front to combat the challenges, bringing directly observed treatment short-course strategy beyond the clinic settings to the door steps of patients. This study evaluates the contributions of the intervention to Tuberculosis case detection and treatment outcomes in two states in Nigeria. Materials and Method: A retrospective study with multistage sampling technique was employed to review 23,241 presumptive Tuberculosis cases enrolled for management between 2014-2017. Chi-square (χ2) test was used for test of association between the independent variables and the main outcomes of the study, with statistical significance set at p-value of 5%. Results: The annual percentage increase for both states was 24.7%, 189.8% and 114.5% in the study group as against 5.2%, 44.6% and 65.6% in control group. Overall, 23.8% were bacteriologically positive (either AFB or Gene-Xpert MTB/Rif) and 1.4% were clinically evaluated to be positive, while 74.8% were bacteriologically negative. Of the total 5861 cases treated, successful treatment rate of the patients in the study group was 88.6% as compared to 76.1% in the control group. The relationship between the referral system from communities where the intervention program was implemented and the case detection/treatment outcome was statistically significant (OR 95% CI = 3.15, 2.95 - 3.35). Conclusion: The community level Tuberculosis intervention led to significantly better case detection and treatment outcome when compared to the conventional approach (p ≤ 0.05). Therefore, full community engagement should be advocated as a major strategy for End Tuberculosis planed by WHO since the patients are found in the community and not in the health facilities.

Research on the Small - scale and Multi - functional Community Endowment Model

Pension as a part of＂Healthy China＂ has been elevated to the national strategic level. Our country has entered the aging period of rapid development. China is ＂running＂ into an aging society, aging population growth to enhance the pension demand, China＇s current pension model development difficult, difficult to cope with the rapidly growing demand for retirement. Therefore, the establishment of a comprehensive, multi-functional new facility after all, a community of embedded retirement pension to meet the requirements of sustainable development options. The Japanese government＇s main push small-scale multi-function Pension House is a good example of pension services, its mode of operation consistent with China＇s National Day. Thus, summarizing and analyzing the experience of Japan, while the status quo of the development of social pension, to explore a Chinese-style pension service model of innovation. To resolve some of the difficulties of the current development of China＇s current pension model, led by China＇s pension services out of the woods.

Analysis of home care-based multi-level old-age service system

With the deepening of China＇s aging, China＇s social pension problem more obvious each day, and gradually become the focus of attention of the whole society. On the one hand, China entered the aging society, old-age needs to grow exponentially. The sixth national census shows that in our country, the population aged 60 and 13.26% of the total population over the total number of 179 million, 65 years and older the proportion of 8.87% of the total population, the absolute number of nearly 120 million. Hundreds of millions of older age groups will produce a growing demand for care services, which is the original old-age service system and the whole economic and social development is a huge pressure. On the other hand, with the economic and social transformation, the traditional model of family pension has been unable to adapt to the profound changes in modem employment, family structure, the concept of retirement, since most parts of China, ＂old before getting ricE＂ the situation, how to solve the elderly the pension problem is related to the overall situation of China＇s economic and social development, related to the overall situation of building a harmonious society in China. Under current national conditions, the emphasis on the development of a single individual body to meet the growing demand for pension service is not realistic, we must mobilize the enthusiasm of all aspects of the element, multi-service integration of resources subject to their commitment to a different responsibilities and tasks provide a full range of care services according to different types, different levels of the actual needs of the older age groups. On the aging problem is that the whole community to face, you need to multi-government body, families, communities, institutions combine effectively starting from the actual needs of the elderly population, according to the financial assistance, life care, spiritual consolation three set the specific needs of services, through a government-led, home-based care services, community care services for the core and supplementary services for institutions focused on pension and other means to provide a full range of pension services.

Perfect Shanghai Community Support Mechanism importance

With the aging of our population is growing significantly, pension issues are also increasingly prominent in the family pension, social pension and retirement communities, and retirement communities have both advantages and both have their own characteristics and become an effective means to solve the pension problem, Shanghai is currently analyzing the situation and problems of the pension on the basis of the Shanghai community care services continue to improve mechanisms to forward the healthy and orderly development of Shanghai pension service mechanism.

Impact of community public health care on treatment effect,health cognition,and self-management in patients with type 2 diabetes

BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T2DM).Based on conven-tional nursing methods,community home care has important clinical significance in controlling blood sugar and disease progression.AIM To explore the impact of community public health nursing on treatment effect,health cognition,and self-management in patients with T2DM.METHODS One hundred patients with T2DM were selected as the research subjects.The patients were divided into either a conventional nursing group or community nursing(CN)group using the random number table method.The conventional nursing group(50 cases)received routine care,while the CN group(50 cases)received community public health care in addition to routine care as that for the conventional nursing group.The rate of excellent and good blood glucose control,fasting blood glucose before and after care,2-h postprandial blood glucose,health cognition,and self-management ability,and patient satisfaction were compared between the two groups.RESULTS The CN group had a higher rate of excellent blood sugar control than the conventional nursing group(88%vs 70%,P<0.05).Before care,there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients(P>0.05).After nursing,fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups,and both blood glucose levels in the CN group were lower than those of the conventional nursing group(P<0.05).Compared with the scores before care,the cognitive level score for diabetes and self-management ability score improved after care in both groups.The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group(P<0.05).The overall satisfaction of the CN group was better than that of the conventional nursing group(98%vs 86%,P<0.05).CONCLUSION Community public health care based on conventional care of T2DM can achieve better blood sugar control,and improve patients’health cognitive level and self-management ability.

Study on the application Of long-term nursing insurance In community pension Of Shanghai

In twenty-first Century. the speed of population aging in China was accelerated, the growth of the disabled populationaccelerated and the demand for the existing long-term care service was challenging. It is imminent to establish a system that can meet the long-term care needs of the disabled population, As a pilot city of long-term care insurance. Shanghai has a Fund for the long-term care insurance system. To compare and analyze the related elements of raising, service content and payment, combined with the experience ol long-term nursing insurance in foreign countries, and considering its application in community pension, it has certain reference significance for the design of long-term nursing insurance system in China.

Nurses’ Perceptions of Patient Safety in Community Mental Health Settings: A Qualitative Study

Mental health care has moved from hospital settings to community mental health settings, and there is a need to explore the perceptions of patient safety among registered nurses working in this field. Patient safety is to include everyone and to be the goal in all aspects of health care. The aim of the study was to explore registered nurses’ perceptions of patient safety in community mental health settings for people with serious mental illness. The study was qualitative and descriptive in nature and interviews were carried out during spring 2012, with seven registered nurses working in community mental health settings for people with serious mental illness in five municipalities in the middle of Sweden. The sampling was purposive and data were analysed using qualitative content analysis. The findings showed that the registered nurses understood patient safety as providing support to people with serious mental illness in regaining and maintaining health through good treatment and respecting self-determination and avoiding coercion. The terms of daily living in small community mental health settings within the a large community health care organization, communication, sufficient knowledge of psychiatric disabilities among people in the residents’ network, and national laws and regulations, all had implications for patient safety. The registered nurses perceived patient safety as involving a wide range of issues that in other areas of care are more often discussed in terms of quality of care. Determining the boundaries of patient safety in community mental health settings for people with serious mental illness can be a first step in establishing workable routines that ensure safe patient care.