Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Objectives This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards.Methods We implement a household fixed-effect panel data regression model,drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.Results The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households.Conclusions While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

Construction of Industrialization Development Model for"1+4+X"Community-Based Elderly Care in Gannan Old Revolutionary Base Area in the Context of Population Aging

In the context of controlling population development in a planned way,China entered an aging society in the early 21 st century.In this context,how to meet the needs of the elderly care and form an effective elderly care model has become a key problem to be solved urgently by local government departments.With the continuous advancement of the elderly care policy,the community-based elderly care has gradually become the mainstream and is in the stage of vigorous promotion.Taking the Gannan old revolutionary base area in Jiangxi Province as an example,this study puts forward"1+4+X"community-based elderly care model based on the policy system of community-based elderly care,the physical and mental health of the elderly,the material space and the construction of evaluation system,and explores how to promote the application of this community model efficiently in the form of industrialization,so as to drive the economic growth of the Gannan old revolutionary base area,promote the employment development and improve the community-based elderly care service.

Sleeping Conditions of Older Adults with Delirium Receiving Home Care

We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%;delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.

Determinants of Home Deliveries by Pregnant Mothers in Lumbo Chabbobboma Zone of Gwembe District in Zambia

Background: Home deliveries is still high globally at 42% WHO 2022, due to high home deliveries, maternal death is also high at 43% globally. In sub-Sahara region home deliveries still high. Giving birth at health facilities in most of sub-Saharan African countries Zambia inclusive is still a challenge whereby more than 51% of first-time mothers give birth at home and this gives a risk of high maternal and perinatal deaths. Therefore Reducing number of home deliveries is important to improve maternal and perinatal health issues. In this study, the aim was to investigate the determinants of home deliveries by pregnant mothers in the Luumbo zone of Gwembe district, Zambia. Purpose: Access to skilled care and facilities with capacity to provide emergency and newborn care is critical to reduce maternal death. In Zambia 42% of women still deliveries from home, suggesting a persistent challenge for women to seek, reach, and receive quality maternity care. This study aimed investigate the determinants of home deliveries by pregnant mothers in Luumbo zone of Gwembe district, Zambia. Methods: The study was conducted among postnatal mothers who came for postnatal care at 6 weeks in Luumbo Chabbobboma clinic in Gwembe district southern province of Zambia. This was a descriptive cross-sectional study where a Simple random sampling technique was used to select 105 women of childbearing age who attended postnatal and had a recent delivery. Data were collected using a researcher-administered structured questionnaire to identify determinants of home deliveries in Luumbo Chabbobboma zone. Data analysis was done using SPSS computer software version 27.0. Both descriptive and inferential (chi-square test) analyses were performed and statistical significance was taken at α ≤ 0.05. Results: The results show that 46 (43.8%) respondents were in the age bracket 20 - 29 years. Of the 105 respondents included in the study, 24 (22.9%) of them delivered from home. The results show that high maternal age (p = 0.03), occupation (p = 0.024), distance to the facility (p = 0.014), means of transportation (p = 0.023), multiparity (p = 0.01), timing and number of ANC visits (p Conclusion: From this population. The major reason why women still deliver at home was long distance to the nearest facility. To reduce maternal and perinatal mortality access to health facilities by pregnant women needs to be improved. There should also be active engagement of the traditional and religious institutions in the area.

ICARE理念对县级敬老院养老护理员失能照护能力及职业精神与态度的影响

目的探讨ICARE理念对县级敬老院养老护理员失能照护能力及职业精神与态度的影响。方法将2023年1—6月绵阳市4家县级敬老院的养老护理员作为研究对象,采用便利抽样法抽取其中两家的40名养老护理员作为观察组,另外两家的40名养老护理员作为对照组。对照组采用常规培训模式,观察组则在对照组基础上以ICARE理念为指引实施养老护理员培训。干预前后,对两组失能照护能力、职业精神与态度进行评价。结果干预前,两组失能照护能力、职业精神与态度比较差异无统计学意义。干预后,两组失能照护能力、职业精神与态度比较差异有统计学意义,观察组优于对照组。结论融入ICARE理念的养老护理员培训能提高养老护理员失能照护能力,转变其职业态度,有利于养老护理队伍整体水平提升。

Evaluation Items for Community-Based Health Care Focusing on Social Aspects: A Literature Review

The progressive aging of society has become a global concern, and is expected to lead to the development of effective, sustainable, person-centered, integrated community-based care systems. However, there is insufficient evidence regarding effective integrated community-based care. In particular, few studies have focused on social aspects of the community environment related to elderly health. This study aimed to consider social aspects as evaluation items, focusing particularly on social determinants from the perspective of community-dwelling people, to explore truly effective integrated community-based care to improve elderly health. The definition of social determinants means social cohesion in social and community contexts. A literature review of English articles published in peer-reviewed journals up to October 2019 was conducted using PubMed, MEDLINE, and CINAHL with the following search terms: “social cohesion,” “elderly health,” “mental health” and “community.” Identified articles were screened based on title and abstract, and selected articles were subjected to full-text assessment and critical review. All references cited in the selected articles were also reviewed. The following inclusion criteria were used: 1) studies targeting community-dwelling elderly people or community-dwelling people including elderly people as participants;2) studies with clear descriptions of social factors in the Methods section;and 3) studies with clear descriptions of health-related items in the Methods section. From the 21 articles analyzed, of which 9 articles defined social determinants as social cohesion in social and community context, 37 items were extracted as social aspects at the community level that reflect the perspective of residents. These items can be developed as evaluation items for community-based health care outcomes through consensus among community health care providers and further investigation.

Influence of Interrupted Childhood Biographies on Health Development: Evaluation of the Scientific Literature on the Example of Being Taken into Care*

Background: An interrupted family history, as is the case after taking someone into care, can complicate collecting family anamnesis data. In addition, the interrupted family history itself could be considered part of a person’s risk profile. Aim and methods: Literature analysis was conducted to examine whether there are scientific studies on health development after placement in out-of-home-care in order to recognise any existing medical characteristics that may be relevant for internal medical care. Results: There are few scientific publications on the health development of people after being placed in out-of-home-care. Direct reactions to the stress of being taken into custody include nausea and fever. However, effects that go beyond the acute situation and last into adulthood have also been described, such as AD(H)D, asthma, diabetes, cancer, hypertension and cardiovascular diseases (myocardial infarction, stroke), epilepsy and increased overall mortality in adulthood. Studies show that not only previous experience but also the stress of being taken into care is triggers for this. Conclusion: Information about a previous institutionalisation can hence be important for internal medical practice. The available scientific literature shows heterogeneous study methodology and no group of people with experience of out-of-home-placement has yet been scientifically accompanied for a long time period. Further studies on this could help to better weigh up the consequences of omitting and conducting an intervention for child/youth protection as well as to improve the medical care for this group of people.

Home visits in brain tumor patient: how nurse and family members cooperate in tumor patient's family self-care

Purposes： We reported the roles and fimctions of nurses in home visits for brain tumor patients using the family health assessment guide in the study. Methods： One patient of brain glioma was chosen as the case illustration. The nurses assessed the patients＇ situation, their families and living environment individually. All these factors were analyzed together. Results： The nurses then implemented their knowledge and skills to adopt different measures in different conditions, investigated the patients＇ health problems and carried out personalized effective actions. Conclusions： Nurses should put effort into community nursing to allow patients to live in a safe environment, to satisfy the health needs of human being and their needs for health knowledge, and enhance their self-care abilities.

Management of chronic heart failure:Role of home echocardiography in monitoring care programs

AIM:To identify a possible role of home echocardiography for monitoring chronic heart failure(CHF)patients.METHODS:We prospectively investigated 118 patients hospitalized during the last year for CHF who could not easily reach the pertaining District Healthcare Center.The patients were followed up with 2 home management programs:one including clinical and electrocardiographic evaluations and also periodic home echocardiographic examinations(group A),the other including clinical and electrocardiographic evaluations only(group B).RESULTS:At the end of the 18-mo follow-up no significant differences were observed between the 2 groups as regards the primary endpoint:rehospitalization occurred in 4 patients of the group A and in 6 patients of the group B;major cardiovascular events occurred in 2 and in 3 patients,respectively.No significant differences were observed with respect to the secondary endpoints:one vascular event appeared in both the groups,3 cardiovascular deaths occurred in group A and 2 in group B.No significant differences were observed between the 2 groups as regards the composite endpoint of death plus hospitalization.CONCLUSION:Home echocardiography for monitoring of CHF patients does not improve the cardiovascular endpoints.In our CHF patients,a low incidence of vascular events was observed.

Staff characteristics and care in Chinese nursing homes: A systematic literature review

The need for institutional long-term care(LTC)services,including nursing homes(NHs),is increasing in China's Mainland in part due to the aging population and changing family structures.In developing NH staff training programs,a review is needed to synthesize knowledge about staff and resident characteristics,and care provided in NHs.This systematic review aims to describe,in Chinese NHs,(1)NH staff characteristics and the care they provide,(2)resident characteristics and care needs,and (3)the role of family members.The 45 articles included in this review covered both urban and rural areas of China's Mainland.We found that staff in Chinese NHs were older and had lower education levels in comparison with those in western countries.Most direct caregivers in urban areas were migratory workers from rural area.Chinese NHs had few qualification standards for staff preparation for their roles in NHs.Also,functional levels of residents in Chinese NHs were higher compared to NH residents in western countries.In addition,family members played important roles in caring for NH residents.These findings suggest a need for staff development programs that tailor for lower educated NH staff and care needs of residents with widely varying levels in function from independent to bedbound in China's Mainland.The findings also suggest that staff qualification standards require critically policy development to improve the capacity of Chinese NHs to provide competent and safe care.

Assessment of Quality of Life, Family Function and Family Empowerment for Families Who Provide Home Care for a Child with Severe Motor and Intellectual Disabilities in Japan

Background: About 70% of Japanese children with severe motor and intellectual disabilities (SMID) live at home, and the number is increasing. Family members have an enormous burden of daily physical care for these children. A top priority is to understand quality of life (QoL), family function, and family empowerment to effectively support these families. We aimed to assess current living situations of families with a SMID child, and to reveal the relationships between QoL, family function, and family empowerment. Methods: Sixty-five family members from 34 families with a SMID child participated in this study. We assessed 5 parameters using the Japanese versions of the following instruments: World Health Organization Quality of Life 26 (WHOQOL26), Kinder Lebensqualitats Fragebogen (KINDL), Family Assessment Device (FAD), Family Adaptability and Cohesion Evaluation Scale KG-4 (FACESKG-4), and Family Empowerment Scale (FES). Correlation and multiple regression analyses were conducted;QoL score was the objective variable. Results: Participants included 54 parents (34 mothers, 20 fathers) and 11 siblings. The mean age of SMID children was 10.4 ± 5.03 years. Twenty-two children needed multiple types of medical care. The mean age of parents and siblings was 41.5 ± 6.16 years and 15.5 ± 2.35 years, respectively. The mean QoL score (3.28 ± 0.5) was similar to the Japanese average. The mean KINDL score (77.2 ± 12.1) was higher than those of previous studies. The mean FAD score was 1.97 ± 0.32. For FACEKG-4, the score of adaptability was correlated with WHOQOL score (r = 0.459, p < 0.05). The mean score of FES was 113.6 ± 14. As the result of multiple regression analysis, lower family FAD scores ([sb] = ?0.61, p < 0.01) indicated higher family function and greater age of participants (sb = 0.495, p < 0.01) was correlated with higher WHOQOL scores (F = 15.208, p < 0.01). Conclusions: Our results indicated that the individual QoL depended on the age of participants (equals the years of experience caring for a SMID child) and the recognition of family function as a whole. Thus, to improve family members’ QoL, we should focus on individuals and also approach the family as a whole.

Circumstances of falls and fall-related injuries among frail elderly under home care in China

This exploratory study investigated the circumstances of falls and fall-related injuries among frail elderly people under home care.A convenience sample of 500 frail elderly(60 e99 years old)from the Wanshoulu and Yuyuantan communities in Beijing's Haidian District during February 2013 and March 2014.Fall circumstances and related injuries were characterized by detailed interviews and questionnaires.The article reports the results of a study that the overall fall incidence was 41.5%,and higher for females than males.Falls mainly occurred in individuals who were over 80 years old(50.0%)and indoors(67.9%).The percentage of subjects who experienced a combined injury after the fall was 56.3%,whereas 19.0%fell causes a fracture.Approximately 35%of the subjects were hospitalized,and 27.6%of the subjects recovered more than 30 days.Results indicate that,falls in the frail elderly caused serious damage,and fall-related circumstances should be a great concern in this population.

Testing of the Content Validity of a Modified OPCq Instrument—A Pilot Study in Norwegian Home Health Care

Aim: To test the content validity of a modified Oulu Patient Classification instrument (OPCq), part of the RAFAELA Nursing Intensity and Staffing system in home health care (HHC) in Norway. Background: Due to the growing number of patients in HHC, a Patient Classification System (PCS) whereby the systematic registration of patients’ care needs, nursing intensity (NI) and the allocation of nursing staff can occur is needed. The validity and reliability of the OPCq instrument have been tested with good outcomes in hospital settings, but only once in an HHC setting. In this study, the OPCq is tested for the first time in HHC in Norway. Methods: A pilot study with a descriptive design. The data were collected through a questionnaire (n = 44). Both qualitative and quantitative analyses were used. Results: The OPCq fulfills the requirements for validity in HHC, but the manual may need some minor adjustments. Discussion: The OPCq seems to be useful for measuring nursing intensity in HHC. Staff training and guidance, high-quality technological solutions and that all technology works satisfactorily are important when implementing a new PCS. Further research is needed in regard to NI and the optimal allocation of nursing staff in an HHC setting.

The research of the community-home elderly long-term care service system

With the rapid development of the aging of the population, the demand of long-term care services in the elderly is growing. Because of family miniaturization, core, and currently limited social accumulation are difficult to meet the demand of the elderly in long-term care.Community provides the elderly long-term care services, and provides the elderly all kinds of household helping services. They just make up for the inadequacy of the family and society.And how to make the community elderly long-term care services become more suitable for the needs of the elderly at home, provide better service for the elderly, are our current problems to be solved.

Users’ Perception and Satisfaction of Current Situation of Home Health Care Services in Jordan

Background: The healthcare system in Jordan is evolving and has to continuously respond to the changing risk profile of the population. The purpose of this study was to examine perception of users and providers of the quality of home health care services. Methods: A descriptive design was used to collect data from a convenience sample of 82 users of home health care services. Results: Users had low to fair satisfaction (30.5% - 69.5%) about the quality of care provided, had moderate satisfaction (72.0% to 81.7%) about the information received, and had low to fair satisfaction about education related to goal of treatment and medication (46.4% - 53.3%). Users had high level of agreement (>70%) that health agencies provided interpersonal care. Conclusion: The ability of the frail people to choose from a variety of cost-effective long-term care services is limited.

Study of the Possible Use of a Home-Visit Nursing Interventional Lymphedema Care Program for Secondary Lymphedema in the Elderly at Home

Objective: This study aimed to clarify the possible use of and points to improve a home-visit nursing interventional lymphedema care program (plan) we developed. Methods: The subjects were visiting nurses with at least three years of home-visit nursing experience and experience with lymphedema care for the elderly at home. Semi-structured interviews were conducted, and the collected opinions were aggregated and summarized. Results: Based on interviews with nine subjects, opinions regarding the use of the program, such as “The assessment perspective at the time of introduction helps to grasp the needs for a wide variety of subjects”, and regarding points to improve, such as “It is necessary to set the duration and timing of the section considering the frequency of visits and degree of edema at the time of introduction” and “It is necessary to have a perspective concerning efforts to maintain motivation for care of the elderly and their families”, were aggregated. Discussion: The results of the interviews were generally useful for the structure and development of the program, care methods and content, and interventions for influencing factors. Consideration of setting the timing according to the degree of lymphedema, modification of the program’s development, development of a program that fully considers the degree of edema at the time of introduction and the acceptance of edema among the elderly, and the need to consider the care content that should be given priority were suggested as points for improvement.

Lifestyle Adjustment Process to Maintain Family Life for Mothers with Children Who Need Home Medical Care

This aim is to clarify lifestyle adjustment process to maintain family life for mothers with children who need home medical care. We conducted semi-structured interviews with the mothers of children who required home medical care comprising procedures such as suction of sputum and respiratory management over a period of several years since the initiation of home medical care, and analyzed the results using the modified grounded theory approach (M-GTA). We found the process to be composed of nine categories. Immediately after their child who required home medical care began living at home, mothers were concerned about the protection of their unstable child and, therefore, made care of the child a priority. However, they gradually started experiencing the need to engage services for the child in the course of their daily lives and live their lives with assistance. In the course of this new lifestyle, mothers began to regulate their fluctuating feelings and discover a new lifestyle for the family by making the father’s role clear and having him take on some responsibilities, such as dealing with people outside the household. As a result, once making home medical care consistent with the family’s lifestyle, even if this care was not at the same level as that provided while the child was hospitalized, mothers felt they found a way that allowed them to spend time with their other children. In addition, they began to perceive the necessity of maintaining their health, which is crucial to the child’s care. Overall, this facilitated incorporation of prospects for the family’s future life because they tended to pay more attention to their health and the health of their other children. Further, this contributed in coordination of the selection of services that would benefit the entire family, thereby maintaining the family’s lifestyle.

Orientation Program on the Care of Children Tracheostomized in the Home Environment

Objective: The aim of the study was to make a literature review on counseling and family education about the care with tracheostomy and develop a guidance booklet for parents about the cautions in handling tracheostomy tubes at home. Methods: This research is based on literature review from 1992 to 2012, realized from October of 2011 to August 2012, through the following databases: medline, lilacs, scielo and sibinet USP, with the elaboration of a guidance booklet for parents, about home care of tracheostomized children. Results: We elaborated a guidance booklet for parents, about the care of tracheostomized children and all were described according to literature review. Conclusion: According to the literature review family education in the care of tracheostomized children is essential so that caregivers have full autonomy to safely and effectively conduct the necessary techniques in their homes.

Contents of Care and Perception of Home Hospice Nurses Who Work at Visiting Medical Treatment Hospitals

Goal: The aim of this study was to examine the perception of nurses who worked at the clinic which proposed home hospice and contents of care to better understand home hospice and enhance home care. Methods: Six nurses who worked at the clinic where proposed visiting medical treatment participated voluntarily. They received one interview for approximately one hour, in which they narrated their perception of home hospice and content of nursing care. The narrative was recorded by an IC recorder and analyzed as contents analysis. This study was approved by the Ethical Board at St. Mary’s College. Results: About the content of nursing care, some categories were selected such as “Understanding a patient as a living person,” “Examining if a patient and caregiver live at ease,” or “Caring for a caregiver accepting a loved one’s death and care given at death.” Nurses perceived the theme as “Time and space for listening carefully,” the theme as “Feeling of responsibility and attractiveness of work,” the theme as the “Economics and manpower to continue home hospice,” the as a “Required connection between hospitals and home hospice clinics.” Conclusion: Visiting medical treatment nurses understand a patient and a family as living people based on intimate relationships, support them as the disease progresses, and connect to a visiting nurse station. They perceived that “patients can enjoy freedom;the nurses had responsibility and strong relationships. They felt the economic or man-power needs to continue and the requirement of a connection between hospitals and home hospice clinics.