Latent tuberculosis infection in health-care workers in the government sector in Brunei Darussalam:A cross-sectional study

Objective:Health-care workers(HCWs)are known to be at high risk for occupational biological hazards,and this includes exposure to mycobacterium tuberculosis(TB)which can result in either active or latent TB infection(LTBI).This study aims to provide an overview of the incidence of LTBI among HCWs in Brunei Darussalam,to examine associated risk factors,and to evaluate LTBI treatment compliance.Materials and Methods:This is a retrospective cross-sectional study which was conducted using data from January 2018 to December 2021,on notified cases of LTBI in HCWs which identified 115 cases.Demographic data,underlying medical conditions,and compliance to treatment were assessed through reviews of their electronic health records.Results:The incidence of LBTI was 14.6/year/1000 HCWs.The incidence rate reached a high of 24.6/1000 in 2020,and majority of cases were in the older age groups.There was good treatment acceptance and compliance(82.6%),and this was observed to be significantly higher in females than males(P=0.02).Conclusion:This study showed an average incidence of LTBI of 14.6/1000 HCWs over 4 years and high LTBI treatment acceptance(82.6%)and compliance.Emphasis on infection prevention and control measures in health-care settings and actions to increase awareness of LTBI are crucial interventions toward reducing the burden of LTBI.

Qualitative and semi-quantitative analysis of health-care pharmaceutical products using laser-induced breakdown spectroscopy

Laser-induced breakdown spectroscopy(LIBS) is a sensitive optical technique that is capable of rapid multi-elemental analysis. The development of this technique for elemental analysis of pharmaceutical products may eventually revolutionize the field of human health. Under normal circumstances, the elemental analysis of pharmaceutical products based on chemical methods is time-consuming and complicated. In this investigation, the principal aim is to develop an LIBS-based methodology for elemental analysis of pharmaceutical products. This LIBS technique was utilized for qualitative as well as quantitative analysis of the elements present in Ca-based tablets. All the elements present in the tablets were detected and their percentage compositions were verified in a single shot, using the proposed instrument. These elements(e.g., Ca, Mg, Fe, Zn, and others) were identified by the wavelengths of their spectral lines, which were verified using the NIST database. The approximate amount of each element was determined based on their observed peaks and the result was in exact agreement with the content specification. The determination of the composition of prescription drug for patients is highly important in numerous circumstances. For example, the exploitation of LIBS may facilitate elemental decomposition of medicines to determine the accuracy of the stated composition information. Moreover, the approach can provide element-specific, meaningful, and accurate information related to pharmaceutical products.

Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia

AIM To investigate health-care needs and their correlates among patients with remitted bipolar disorder(BD) compared to patients with remitted schizophrenia. METHODS Outpatients with BD(n = 150) and schizophrenia(n = 75) meeting clearly defined remission criteria were included in the study along with their relatives. Diagnostic ascertainment was carried out using the Mini International Neuropsychiatric Interview. Demographic and clinical details were recorded using structured formats. Residual symptoms were assessed using standardized scales. Health-care needs were assessed on two separate scales. The principal instrument employed to assess health-care needs was the Camberwell Assessment of Need-Research version(CAN-R). To further evaluate health-care needs we felt that an additional instrument, which was more relevant for Indian patients and treatment-settings and designed to cover those areas of needs not specifically covered by the CAN-R was required. This instrument with a structure and scoring pattern similar to the CAN-R was used for additional evaluation of needs. Patients' level offunctioning was assessed using the Global Assessment of Functioning Scale and their quality of life(QOL) using the World Health Organization Quality Of Life-BREF version in Hindi.RESULTS An average of 6-7 needs was reported by patients with BD as well as their relatives. Commonly reported needs were in the areas of economic and welfare needs, informational needs, social needs and the need for treatment. According to the CAN-R, both patients and relatives reported that more than 60% of the total needs were being met. However, over 90% of the needs covered by the additional evaluation were unmet according to patients and relatives. Needs in the areas of economic and welfare-benefits, information, company, daytime activities and physical health-care were largely unmet according to patients and relatives. Total, met and unmet needs were significantly higher for schizophrenia, but the most common types of needs were quite similar to BD. Relatives reported more needs than patients with certain differences in the types of needs reported. Level of patients' functioning was the principal correlate of greater total and unmet needs in both groups. Significant associations were also obtained with residual symptoms and QOL.CONCLUSION The presence of unmet needs in remitted patients with BD was an additional marker of the enduring psychosocial impairment characteristic of the remitted phase of BD.

Interpretation of WHO Guideline:Assessing and Managing Children at Primary Health-care Facilities to Prevent overweight and Obesity in the Context of the Double Burden of Malnutrition

Along with the transitions of social and economic development,dietary patterns and physical activity and life-styles,the prevalence of childhood overweight and obesity has increased at an astonishing rate in the past decades,and has become one of the most serious public health challenges.Meanwhile,the stunting rate has declined with slowly pace,while millions of young lives are still be threatened by wasting all over the word.The present situation of Double Burden of Malnutrition should be recognized clearly and addressed seriously,which refers to,the common presence of both obesity and underweight in the same populations,communities and even families.In order to provide guidance on the appropriate assessment and management of infants and children presenting to primary health-care facilities,to reduce the risk of overweight and obesity among children,the Guideline Assessing and Managing Children at Primary Healthcare Facilities to Prevent Overweight and Obesity in the Context of the Double Burden of Malnutrition was developed and released by WHO in 2017 using the procedures outlined in the WHO handbook for guideline development.The WHO Guideline(2017)is intended primarily for use in low-and medium-resource settings where both under-nutrition and obesity are prevalent.In this guideline,there are three prioritized speci c areas and questions for infants and children presenting to primary health-care facilities:anthropometric assessment,care of infants and children with acute or chronic malnutrition,and care of children who are overweight or obese.It is recommended that for infants and children aged<5 years presenting primary health-care facilities,weight and length/height should be measured and evaluate adequately,general nutrition and physical activity counselling should be provided for related caregivers and families,identi cation and appropriate management plan should be developed at primary health-care level.The discrepancies of the recommendation on the three prioritized areas in di erent guidelines are compared in this paper.All the related guidelines emphasize the important of anthropometric measurement and monitor of growth for primary care workers and suggest dietary and physical activity counselling for obese people.Almost all the guidelines provide recommendations on breastfeeding and continued feeding counselling from the aspect of improving the status of acute or chronic malnutrition.The setting condition should be carefully considered when taking the guidelines of di erent organizations and countries into application.

Planning and Design of Health-care Featured Town from the Perspectiveof“Aging Friendly”:A Case Study of Tangwan Town,Guixi City,Jiangxi Province

Under the background of current“aging”and“healthy China”,based on basic needs of theelderly for health care industry,combining the upsurge of featured town construction in China,basicproblems existing in current planning and construction of featured town are expounded and analyzed.Tangwan Town of Guixi City,Jiangxi Province is taken as the research object.Characteristics of theconstruction of health-care featured town and its existing problems are found,and planning strategy isproposed.The research aims to provide reference significance for planning and construction of suchfeatured towns,and promote the perfection of the theory of health-care town in China under agingbackground.

Health Care Personnel’s Attitude toward Hand Hygiene in Regard to the Prevention of Health-Care Associated Infections: A Cross Sectional Study at the University Hospital Pristine

Background: Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections, but health care worker compliance with optimal practices remains low in most settings. Objective: The main aim of this paper is to determine findings and start drafting policies in implementing them into practice after finding out nurses’ opinions, beliefs and attitudes toward hand hygiene (HH). Methodology and methods: A cross sectional descriptive and observational study during November 2009. Results: From the total number of 175 health care workers employed in this unit, 67 (38.3%) were observed regarding adherence to hand hygiene. Regarding the knowledge, practices and attitudes of the nurses, data were collected from 54 (50.0%) among 108 nurses in four intensive care units within the University Clinical Centre of Kosovo (UCCK). From research findings, it was concluded that hand hygiene compliance in the intensive care units was low (51.3%). Conclusion: Research results show the necessity of organizing multimodal programs with intensive care units of University Clinical Centre of Kosovo (UCCK) on increase of knowledge level on health-care associated infections (HAI).

Self-reported ischemic heart disease: Prevalence, sociodemographics, health behavior, health-care utilization, and quality of life

The aim of this study was to present the prevalence of self-reported Ischemic Heart Disease (IHD) based on a national population-based survey and to characterize people with self-reported IHD with respect to health behavior, risk factors, health-care services utilization and health-related HRQoL;further to compare people with self-reported IHD to those with other chronic illness and people without chronic illness. Based on the Danish Health Interview Survey 2005 (SUSY), a sample of 10,983 persons aged 35 years or older was examined. Data was collected through personal interviews (response rate = 66.7%) and self-administered questionnaires (51.5%). The sample was divided into three mutual exclusive groups: IHD;other chronic illnesses;and no chronic illness. The prevalence of IHD was 5.6% (5.2 - 6.0). The disease was more common in men than women, and the average age was 67.5 years. People with self-reported IHD were characterized as having poorer health behaviors;more risk factors: 40% smokers, 21% sedentary lifestyle, 26% obese;higher utilization of the health-care services;and poorer HRQoL. When compared to people with other chronic diseases, people with IHD continued to show the same characteristics. The IHD group had more problems affecting their daily lives than the other two groups. The issues that affected the people with IHD have also been shown to increase the load on the health-care system. Therefore, it is important to the patients, health-care, and society that the prevalence of IHD is reduced and the burden of disease is made a priority.

LSTM Based Neural Network Model for Anomaly Event Detection in Care-Independent Smart Homes

This study introduces a long-short-term memory(LSTM)-based neural network model developed for detecting anomaly events in care-independent smart homes,focusing on the critical application of elderly fall detection.It balances the dataset using the Synthetic Minority Over-sampling Technique(SMOTE),effectively neutralizing bias to address the challenge of unbalanced datasets prevalent in time-series classification tasks.The proposed LSTM model is trained on the enriched dataset,capturing the temporal dependencies essential for anomaly recognition.The model demonstrated a significant improvement in anomaly detection,with an accuracy of 84%.The results,detailed in the comprehensive classification and confusion matrices,showed the model’s proficiency in distinguishing between normal activities and falls.This study contributes to the advancement of smart home safety,presenting a robust framework for real-time anomaly monitoring.

Landscape Planning and Design of Rural Health-caring Tourist Bases

With the further deepening of rural revitalization strategies,rural construction and development has been attracting increasing attention,on this basis rural health-caring tourism has developed.This research,by following ecological and human-centered principles,adopted the renovation planning of Dacun Village,Fengcun Town in Deqing County,Zhaoqing City,tried to build Dacun Village into a rural healthcaring base that integrates the functions of serving for the aged,recreation,living,health care,tourism and vacation,and provided a new development mode uniting health care with rural tourism.

Scope of technology in health care, special focus on nursing

Integrating artificial intelligence(AI)into health care reshapes nursing practices and education,enhancing patient care and clinical processes.This article discusses the transformative potential of AI in nursing,from streamlining documentation and diagnosis using AI applications to the evolution of nursing.The utilization of AI in primary care through automated communication strategies and the emergence of humanistic AI solutions are explored.As nurses adapt to AI-driven health-care technologies,balancing present needs with future demands becomes imperative.AI provides substantial advantages,but it's crucial to address challenges to ensure the successful integration of technology in healthcare and maintain the delivery of high-quality patient care in our tech-driven healthcare environment.

A Community Health Service Architecture Based on the Internet of Things on Health-Care

In order to assure a real-time medical care for the elders who live alone or have a chronic disease and also to improve the responsiveness and quality of the community hospital, a community health service architecture was designed according to the Internet of Things on Health-Care. The users' body physiological and sports information can be collected intelligently by the health sensors at home and then the health information can be transmitted to the community health-care center through networks after information processing. The community doctors can provide a medical service on kinds of video, voice or email according to the users' process notes, test data and symptoms. Of course, doctors also can communicate and share their opinions with other specialist who is online. The key technology of this system is Internet of Things on Health-Care, which system can get users' health information actively and then make out intelligent decisions promptly and finally provide a more personal health service.

The Pathway of China’s Integrated Delivery System:Based on the Analysis of the Medical Consortium Policies

With the deepening of China’s health-care reform,an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system.For China’s integrated delivery system,a medical consortium plays an important role in integrating public hospitals and primary care facilities.The first medical consortium policy issued after the COVID-19 pandemic apparently placed hope on accelerating the implementation of a medical consortium and tiered health-care delivery system.This paper illustrates the possible future pathway of China’s medical consortium through retrospection of the 10-year process,changes of the series of policies,and characteristics of the policy issued in 2020.We considered that a fully integrated medical consortium would be a major phenomenon in China's medical industry,which would lead to the formation of a dualistic care pattern in China.

Predictors of Clostridium difficile infection severity in patients hospitalised in medical intensive care

AIM:To describe and analyse factors associated with Clostridium difficile infection(CDI)severity in hospitalised medical intensive care unit patients.METHODS:We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit(MICU)at a French university hospital.We include patients hospitalised between January 1,2007and December 31,2011.Data on demographics characteristics,past medical history,CDI description was collected.Exposure to risk factors associated with CDI within 8 wk before CDI was recorded,including previous hospitalisation,nursing home residency,antibiotics,antisecretory drugs,and surgical procedures.RESULTS:All included cases had their first episode of CDI.The mean incidence rate was 12.94 cases/1000admitted patients,and 14.93,8.52,13.24,19.70,and8.31 respectively per 1000 admitted patients annually from 2007 to 2011.Median age was 62.9[interquartile range(IQR)55.4-72.40]years,and 13(32.5%)were women.Median length of MICU stay was 14.0d(IQR 5.0-22.8).In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.The duration of diarrhoea was 13.0(8.0-19.5)d.In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.Prior to CDI,38patients(95.0%)were exposed to antibiotics,and 12(30%)received at least 4 antibiotics.Fluoroquinolones,3rdgeneration cephalosporins,coamoxiclav and tazocillin were prescribed most frequently(65%,55%,40%and 37.5%,respectively).The majority of cases were hospital-acquired(n=36,90%),with 5 cases(13.9%)being MICU-acquired.Fifteen patients had severe CDI.The crude mortality rate within 30 d after diagnosis was 40%(n=16),with 9 deaths(9 over 16;56.3%)related to CDI.Of our 40 patients,15(37.5%)had severe CDI.Multivariate logistic regression showed that male gender[odds ratio(OR):8.45;95%CI:1.06-67.16,P=0.044],rising serum C-reactive protein levels(OR=1.11;95%CI:1.02-1.21,P=0.021),and previous exposure to fluoroquinolones(OR=9.29;95%CI:1.16-74.284,P=0.036)were independently associated with severe CDI.CONCLUSION:We report predictors of severe CDI not dependent on time of assessment.Such factors could help in the development of a quantitative score in ICU’s patients.

Non-alcoholic fatty liver disease is not associated with a lower health perception

AIM: To examine the association between nonalcoholic fatty liver disease(NAFLD) and general health perception.METHODS: This cross sectional and prospective follow-up study was performed on a cohort of a subsample of the first Israeli national health and nutrition examination survey, with no secondary liver disease or history of alcohol abuse. On the first survey, in 2003-2004, 349 participants were included. In 2009-2010 participants from the baseline survey were invited to participate in a follow-up survey. On both baseline and follow-up surveys the data collected included: self-reported general health perception, physical activity habits, frequency of physician's visits, fatigue impact scale and abdominal ultrasound. Fatty liver was diagnosed by abdominal ultrasonography using standardized criteria and the ratio between the median brightness level of the liver and the right kidney was calculated to determine the Hepato-Renal Index.RESULTS: Out of 349 eligible participants in the first survey, 213 volunteers participated in the follow-up cohort and were included in the current analysis, NAFLD was diagnosed in 70/213(32.9%). The prevalence of "very good" self-reported health perception was lower among participants diagnosed with NAFLD compared to those without NAFLD. However, adjustment for BMI attenuated the association(OR = 0.73, 95%CI: 0.36-1.50, P = 0.392). Similar results were observed for the hepato-renal index; it was inversely associated with "very good" health perception but adjustment for BMI attenuated the association. In a full model of multivariate analysis, that included all potential predictors for health perception, NAFLD was not associated with the self-reported general health perception(OR = 0.86, 95%CI: 0.40-1.86, P = 0.704). The odds for "very good" self-reported general health perception(compared to "else") increased among men(OR = 2.42, 95%CI: 1.26-4.66, P = 0.008) and those with higher performance of leisure time physical activity(OR = 1.01, 95%CI: 1.00-1.01, P < 0.001, per every minute/week) and decreased with increasing level of BMI(OR = 0.91, 95%CI: 0.84-0.99, P = 0.028, per every kg/m^2) and older age(OR = 0.96, 95%CI: 0.93-0.99, P = 0.033, per one year). Current smoking was not associated with health perception(OR = 1.31, 95%CI: 0.54-3.16, P = 0.552). Newly diagnosed(naive) and previously diagnosed(at the first survey, not naive) NAFLD patients did not differ in their self-health perception. The presence of NAFLD at the first survey as compared to normal liver did not predict health perception deterioration at the 7 years follow-up. In terms of health-services utilization, subjects diagnosed with NAFLD had a similar number of physician's visits(general physicians and specialty consultants) as in the normal liver group. Parameters in the fatigue impact scale were equivalent between the NAFLD and the normal liver groups.CONCLUSION: Fatty liver without clinically significant liver disease does not have independent impact on selfhealth perception.

Epidemiological Characteristics of An Outbreak of Severe Acute Respiratory Syndrome in Dongcheng District of Beijing From March to May 2003

Objective To describe epidemiologic features of an outbreak of severe acute respiratory syndrome (SARS) in Dongcheng District, Beijing occurred in a period between March and May 2003. Methods Data of SARS cases notified from Dongcheng District Center for Disease Control and Prevention (CDC )and supplemented by other channels were collected. Clinicians and officials of local hospitals were interviewed in groups and medical records of fatal cases of SARS were reviewed to verify the diagnosis. Stored serum specimens of the patients were detected for IgG antibody against SARS Co-V by enzyme-linked immunosorbent assay (ELISA). All the data were input into dataset files by Microsoft Excel-2000 software and analyzed with SPSS version 10.0 software. Results Outbreak of SARS in Dongcheng District started on March 14, 2003 with a peak in mid- and late April, and dropped in early May. A total of 572 reported cases were collected during this period in Dongcheng District, Beijing, and 99 of them were excluded from SARS, because of diagnosis of common cold, regular pneumonia, measles and rubella, etc. Actually, 473 SARS cases, which included 390 (82.5%) probable cases and 83 (17.5%) suspect cases, were analyzed. About 90% of the probable cases were positive for IgG antibody. Attack rate of SARS in permanent residents of Dongcheng District was 28.3 per 100 000. Forty-one of them died, with a case-fatality rate of 8.7%. Persons were all susceptible to infection of SARS Co-V, with the highest proportion at ages of 20-50 years, which accounted for 68.7% of the total cases. Average age of the patients at their onset was 40.7 years. No gender difference in SARS cases was found. Number of SARS cases in health-care workers (HCWs) accounted for 18.0% and that in retired workers accounted for 15.4% of the total cases. Cases occurred in all 10 sub-districts of Dongcheng, with the highest in Beixinqiao and Andingmen Sub-districts. Totally, 230 of the 572 notified cases (40.2%) were hospitalized at local hospitals under the jurisdiction of Dongcheng District. Eighteen of 85 cases of SARS occurred in HCWs of local hospitals, accounting for 4.5% of the total number of HCWs working at wards caring for SARS patients or fever clinics. There were 34.7% of SARS cases without any histories of contact before the onset of the disease. Familial aggregation phenomena were observed in 41.8% of the cases and 18.1% of households. And 7.4% (attack rate ) of those exposed to SARS cases suffered from the illness during the periods of quarantine. Conclusions SARS appeared to be infectious in origin and caused outbreak in Dongcheng District, Beijing introduced by an imported case traveling from Hong Kong in a period between March and May 2003. People are all susceptible to infection of SARS Co-V, which mainly threatens the young adults and the middle-aged, as well as HCWs and the retired workers. The main mode of transmission is direct exposure to SARS patients in a near distance at hospitals or families via droplets spread. Prevention and control of SARS should be focused on early isolation of patients and quarantine for close contacts. Current available measures to prevent and control SARS are proved to be effective.

Extraction Process Optimization and Moisturizing Performance of Fucoidan from Sargassum fusiforme

[Objectives] The research aimed to optimize extraction process of fucoidan from Sargassum fusiforme( FSF) and study its moisturizing performance. [Methods]Extracting condition of FSF by cellulase hydrolysis-ultrasonic assisted extraction method was optimized. The influences of solvent p H,enzyme dosage,extraction temperature,cellulose hydrolysis time,ultrasonication time,and the ratio of material to liquid on FSF were investigated by single factor and orthogonal experiments. [Results] The optimum extraction conditions were as followings:p H,4. 5; enzyme dosage,1%; extraction temperature,40℃; cellulose hydrolysis time,2 h; ultrasonic time,15 min; and the ratio of material to liquid,1∶ 10( g∶ m L). Under the optimal condition,the extraction yield of FSF was 8. 50%,RSD = 2. 74%. The short-time hygroscopicity( within 8 h) of crude extract of fucoidan from S. fusiforme( CEFSF) was better than glycerin,butanediol,and sodium alginate,and the moisture retention capacity of 1% CEFSF aqueous solution was better than 1% butanediol or 1% sodium alginate,and was equal to 5% glycerin under relative humidity of 43% and 81%. The determination results of skin moisture content and transepidermal water loss rate( TEWL)showed that: 5% CEFSF solution had good moisturizing effect. [Conclusions]The research could provide certain reference for deep development of S. fusiforme.

A Mobile Cloud-Based eHealth Scheme

Mobile cloud computing is an emerging field that is gaining popularity across borders at a rapid pace.Similarly,the field of health informatics is also considered as an extremely important field.This work observes the collaboration between these two fields to solve the traditional problem of extracting Electrocardiogram signals from trace reports and then performing analysis.The developed system has two front ends,the first dedicated for the user to perform the photographing of the trace report.Once the photographing is complete,mobile computing is used to extract the signal.Once the signal is extracted,it is uploaded into the server and further analysis is performed on the signal in the cloud.Once this is done,the second interface,intended for the use of the physician,can download and view the trace from the cloud.The data is securely held using a password-based authentication method.The system presented here is one of the first attempts at delivering the total solution,and after further upgrades,it will be possible to deploy the system in a commercial setting.

Performance Evaluation of Healthcare Monitoring System over Heterogeneous Wireless Networks

The wide diffusion of healthcare monitoring systems allows continuous patient to be remotely monitored and diagnosed by doctors. The problem of congestion, namely due to the uncontrolled increase of traffic with respect to the network capacity, is one of the most common phenomena affecting the reliability of transmission of information in any network. The aim of the paper is to build a realistic simulation environment for healthcare system including some of the main vital signs model, wireless sensor and mesh network protocols implementation. The simulator environment is an efficient mean to analyze and evaluate in a realistic scenario the healthcare system performance in terms of reliability and efficiency.

Job satisfaction and organizational commitment among nurses working on temporary versus permanent jobs at a tertiary care teaching hospital,Uttarakhand,India

Objective:The objective of this study was to assess and compare job satisfaction and organizational commitment among nurses working on temporary versus permanent basis at a tertiary care teaching hospital,Uttarakhand,India.Materials and Methods:A total of 250 nurses(125 temporary and 125 permanent)were selected using stratified disproportionate random sampling techniques from a tertiary care teaching hospital.Sociodemographic datasheet,Job Satisfaction Survey scale,and Organizational Commitment scale were used to collect data.Results:The study results revealed that the job satisfaction score was significantly higher in permanent nurses(139.1±15.4)than in temporary nurses(131.3±12.2)(P<0.001).However,temporary nurses(85.2±14.4)were more committed toward organization than permanent nurses(80.0±16.0)(P<0.001).There was a significant association between nurses’job satisfaction and their gross salary(P<0.001)and their organizational commitment with the selected profession by own will(P<0.001).Conclusion:The present study concluded that majority of temporary and permanent nurses reported a moderate level of job satisfaction and organizational commitment.This study suggests enhancing employee satisfaction can improve organizational commitment.As well,this study’s findings can serve as a valuable foundation for designing policies to enhance organizational commitment in the future.

Family responsibility dynamics for young adults in transition to adult health care

Aim: To explore family responsibility dynamics, metabolic control, clinic attendance, and emergency admissions when young adults (YA) with type 1 diabetes transition to an adult hospital. Method: A longitudinal mixed method design with two study groups (parents, n = 28;YA intervention group, n = 23) and a YA comparison group (n = 20). Sample recruited from an outpatient diabetes centre. Demographic, clinic attendance, emergency admissions, biodata, and the Diabetes Family Responsibility Questionnaire (DFRQ) were completed on entry and sixmonths later as part of an 18-month trial of a diabetes transition coordinator (DTC). The selfreport DFRQ were analyzed using derived parent-child dyadic variables to explore differences at baseline and end of study using Wilcoxon Signed Rank Test. The relationship between metabolic control and the DFRQ patterns was explored using Spearman’s rho. Results: On completion of the study, the change in HBA1Cfor both adolescent groups was not significant but was less than ideal for 25% of adolescents in the study. The YA intervention group had significantly fewer missed appointments between them compared to the comparison group. The DFRQ indicated that the derived parent-child dyadic variable of task-discordance increased during the study. Conclusion: The clinically relevant diabetes-task dissonance between parents and young adults offers a challenge and a diagnostic opportunity for diabetes educators.