Endoscopy demand among county people in southeast China:A cross-sectional study

Objective The popularization of gastroenteroscopy and the introduction of comfortable medical care have further promoted the growth of people's demand,especially the demand for painless endoscopy.This cross-sectional study aims to investigate the current situation and change in county people's demand for endoscopy to promote the development of endoscopy centers in county hospitals in southeast China.Methods From October to December 2021,patients and their family members who came to the Gastroenterology Department in Suichang County People's Hospital of Zhejiang Province were randomly selected to complete the questionnaire.A total of 838 valid questionnaires were collected.Additionally,the original software data of the Endoscopy Center were sampled and retrieved(from October to December every year from 2018 to 2021)for statistical analysis of real-world data.Those who would choose painless endoscopy the next time in the valid questionnaires were included in the painless endoscopy group,while those who would choose ordinary endoscopy the next time were included in the ordinary endoscopy group.Results The stepwise forward binary logistic regression model analysis showed that,patients with“secondhand smoke exposure”were more willing to choose painless endoscopy(OR=1.459,95%CI:1.050-2.028,p=0.025).However,patients with an education level of“primary and below”and“junior high school”,and patients who are suffering from“currently experiencing abdominal distension”,were more willing to choose ordinary endoscopy(OR=0.270,95%CI:0.149-0.488,p<0.001;OR=0.528,95%CI:0.330-0.845,p=0.008;OR=0.536,95%CI:0.334-0.861,p=0.010).Patients with previous experience in painless endoscopy tended to choose painless endoscopy the next time,while patients with previous experience in ordinary endoscopy tended to choose ordinary endoscopy the next time(χ^(2)=140.97,p<0.001).From 2018 to 2021,the proportion of painless endoscopy has increased yearly(p<0.001).Most patients indicated that they would“regularly review gastroenteroscopy”(477/838,56.9%).Conclusions With Suichang County of Zhejiang Province as the representative,the demand for painless endoscopy for people's gastrointestinal cancer detection in southeast China has been increasing yearly.The development of endoscopy centers in county-level hospitals can basically meet the demand growth.Meanwhile,advanced concepts such as comfortable medical care and regular follow-up are gradually popularized at the grassroots level in southeast China.

Advance care planning readiness for Chinese older people:An integrative review and conceptual framework

Advance care planning is a process of discussion in which patients can communicate their end-of-life care preferences to family members and health care providers for consideration.Readiness for advance care planning is a patient's preparedness to engage in advance care planning.This review aims to develop the conceptual framework for advance care planning readiness for Chinese older people.The current knowledge from the published studies was identified and synthesized by an integrative review.The conceptual framework was developed based on the social-ecological model and the theory of planned behavior.The factors from the social environment/community,health care professionals,and individual/family layers were defined.These factors may influence an individual's medical decision-making,which in turn triggers individual behavioral mechanisms that arise from interactions between motivations,attitudes,and beliefs.Relevant factors should be considered when assessing the behavior of personnel engaged in advance care planning or formulating appropriate intervention measures to improve advance care planning par ticipation in China.This framework can be used to guide studies that explore how the social/familial/individual factors predict the readiness for advance care planning among Chinese older people,and to design intervention studies to test the effect of family function on the readiness for advance care planning.

A descriptive-comparative study of medications used by older people prior to and following admission to a continuing care facility

Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at particularly high risk of polypharmacy, as they tend to receive many prescriptions over time and from different care providers. Continuing-care facility admission presents an excellent opportunity for a comprehensive medication review. A research study was conducted to describe and compare medications taken by community-dwelling seniors prior to and following admission to a continuing-care facility. This pilot project involved data being gathered from the charts of deceased residents, as required by a University Health Research Ethics Board, who had been cared for at one large local continuing-care facility. The facility administrators also approved this study, in part to evaluate their policy to conduct a medication review for all new residents within six weeks of entry. This study revealed a slight but statistically significant reduction in the number of medications following this review. Other issues such as medication interactions and required dosage changes were addressed by this medication review. Although this study was confined to one continuing-care facility and a small number of residents, the findings suggest medication reviews would be beneficial upon admission to all continuing-care facilities, and annually perhaps through other means for older persons living in the community.

Clarifying Problems with Emergency Healthcare Systems in Japanese Long-Term Care Facilities for Older People

Background: Long-term care facilities for older people play an important role as alternatives to family care in an aging society. This study aimed to assess staffing problems linked to emergency healthcare for residents of these facilities, and to investigate the relationship between these problems and the characteristics of the facilities. Methods: The study surveyed managers of long-term care facilities for older people in a Japanese urban area between September and December 2014. The type of care facility, the number of staff and any problems providing or accessing emergency healthcare for the residents were evaluated. Multiple logistic regression analysis was used to explore the factors common to facilities reporting staffing problems linked to emergency healthcare of residents. Results: In total, 321 long-term care facilities were eligible for this study and 226 (70%) returned the questionnaire. We compared the characteristics of facilities reporting and not reporting staffing problems in emergency healthcare of residents. The type of care facility was significantly associated with staffing problems in emergency healthcare of residents both during the day (p < 0.01) and at night (p = 0.04). The facilities most likely to report problems were group homes for older people with dementia, because of staffing shortages. Conclusions: Problems in emergency healthcare systems in Japanese long-term care facilities for older people varied by type of care facility. Our data underscore the need for telemedicine and consideration of mergers between smaller facilities such as group homes for older people with dementia.

People-Centered Care: Concept Analysis

Purpose: This study aims to clarify the definition, attributes, antecedents, and consequences of the concept of people-centered care (PCC). Method: Rogers and Knafl’s evolutionary method was used to analyze the concept of People-centered care. The cords such as “Attributes,” “Antecedent,” and “Consequences” were extracted on the coding sheet. The extracted contents of each of the “Attributes,” “Antecedent,” and “Consequences” from the created coding sheets were summarized as codes, and similar codes were categorized. Result: We included 33 studies in the analysis. As a result of the analysis, we identified four attributes (the subject is people, approaches to improving and enhancing health issues, relationships as a basis for partnership building, and behavioral attitudes for building partnerships), four antecedents (changes in social conditions, increasing people’s ownership of their health, health issues in modern society, and care in a variety of settings), and three consequences (achieving goals set by the people themselves, self-transformations of both people and healthcare providers, and social transformations). Discussion: Based on the analysis results, PCC was defined as “an initiative in which people step forward and partner with health care providers to improve and enhance health issues in individuals and communities.” In various social and individual changes, the realization of PCC is expected to result in the achievement of goals set by the people themselves together with health care providers and the transformation of individuals and society.

Guided Care护理对接受体外受精-胚胎移植的肥胖型多囊卵巢综合征不孕患者的干预效果

目的 评价Guided Care护理方案对接受体外受精-胚胎移植(IVF-ET)助孕的肥胖型多囊卵巢综合征(PCOS)患者的干预效果。方法 选择2022年1—12月在河南省人民医院生殖中心接受IVF-ET助孕的74例肥胖型PCOS患者作为研究对象,按随机数表法分为观察组(37例)和对照组(37例)。对照组患者接受常规护理,观察组在常规护理基础上接受Guided Care护理。比较两组患者治疗依从性、生活方式及焦虑程度。结果 Guided Care护理可提高患者的就医及服药依从性,改善其生活方式,降低患者的焦虑程度(P<0.05)。结论 Guided Care护理方案可以改善肥胖型PCOS患者的治疗依从性及其生活方式,降低患者的焦虑程度。

Determination of a Cut-Off Point of a Scale for Achievement Motive in Geriatrics That Predicts the Frequency of Undertaking Instrumental Activities of Daily Living in Community-Dwelling Elderly People

Background: Among elderly people, rehabilitation is important for reducing the risk of falls and hospitalization and to maintain an independent life for longer. Motivation is a factor for elderly people to lead an active daily life and leave home more frequently. Purpose: The purposes of this study were to determine the optimal cut-off point in the Scale for Achievement Motive in Geriatrics (SAMG) that could identify individuals as inactive or active, based on the Frenchay Activities Index (FAI), and to compare characteristics between active and inactive groups classified by the cut-off point. Methods: A cross-sectional study of 285 community-dwelling elderly people measured SAMG and FAI and physical function. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC) that was the optimal cut-off point for the SAMG total score, with the associated sensitivity and 1-specificity when compared with the FAI results. Demographic parameters and physical function were compared between two groups defined by cut-off point. Results: The AUC was 0.78, the optimal cut-off for SAMG total score for indicating inactivity was ≤48, the sensitivity was 77.98% and the 1-specificity was 75.00%. The group with SAMG score >48 was characterized by a significantly higher proportion of women, fewer people sharing a house, and participation in more hobbies. Discussion: A cut-off point of 48 in the SAMG could be a predictive index of motivation toward goals for individuals with inactive daily activities. The group with score higher than the cut-off was characterized by more women, fewer people living together, and more hobbies than the group with lower scores.

Virtual Nursing Using Deep Belief Networks for Elderly People (DBN-EP)

The demand for better health services has resulted in the advancementof remote monitoring health, i.e., virtual nursing systems, to watch and supportthe elderly with innovative concepts such as being patient-centric, easier to use,and having smarter interactions and more accurate conclusions. While virtual nursing services attempt to provide consumers and medical practitioners with continuous medical and health monitoring services, access to allied healthcare expertssuch as nurses remains a challenge. In this research, we present Virtual NursingUsing Deep Belief Networks for Elderly People (DBN-EP), a new framework thatprovides a virtual nurse agent deployed on a senior citizen’s home, workplace, orcare centre to help manage their health condition on a continuous basis. Using thismethod, healthcare providers can assign various jobs to nurses by utilizing a general task definition mechanism, in which a task is defined as a combination ofmedical workflow, operational guidelines, and data gathered from a remotelymonitored virtual nursing system. Practitioners are in charge of DBN-EP andmake treatment decisions for patients. This allows a DBN-EP to act as a personalized full-time nurse for a client by carrying out practitioner support activitiesbased on information gathered about the client’s health. An electronic PersonalHealth Record (ePHR) system, such as a specialized web portal and mobile apps,could provide such patient information to elderly person family members and carecentres. We created a prototype system using a DBN-EP system that allows traditional client applications and healthcare provider systems to collaborate. Finally,we demonstrate how this system may benefit the elderly through a result anddebate.

Why Is Case Management Effective? A Realist Evaluation of Case Management for Frail, Community-Dwelling Older People: Lessons Learned from Belgium

Despite many attempts to evaluate the effectiveness of case management for frail older people, systematic reviews including experimental designs show inconsistent results. Starting from the view that case management is a complex intervention occurring in multilayered realities, we conducted a realist evaluation of case management in Belgium, where this type of intervention is new. Realist approaches are particularly well suited to evaluate complex interventions as they seek to investigate iteratively the literature and empirical data to uncover mid-range theories underpinning the intervention under study. As such, realist evaluations are works in progress which provide tools to describe how, why and for whom an intervention is supposed to work. In this paper, we describe two mid-range theories that can explain why case management can help frail older people to remain at home, through the lens of capacity and social support.

Exploring the Care Experience of a Comprehensive Geriatric Assessment Team in the Management of Debilitating Syndromes in Older People

This study was conducted to investigate the clinical effects of applying the integrated geriatric assessment team approach on the care of elderly patients with debilitating syndromes.This study was conducted in Xi’an Jiaotong University hospital from January 2021 to January 2022.Around 50 patients with the geriatric debilitating syndrome were selected and retrospectively were analyzed,and psychiatrists,geriatric nurses,pharmacists,medical specialists,physiotherapists,and dieticians were selected to form a comprehensive geriatric assessment team.The patients were then assessed,a treatment plan was developed,and care was provided according to the actual situation,and the effectiveness of the clinical intervention was analyzed.This study demonstrated that,of the 50 patients in this study,the longest hospital stay was 15 days,while the shortest was 4 days,and the average length of stay was 10.23±4.37 days.Around 40 of the patients were able to eat on their own and consume food as prescribed,with a compliance rate of 80%,showing the effectiveness rate of the geriatric assessment team.In summary,the use of a comprehensive geriatric assessment team to treat and care for patients with debilitating syndromes in the elderly is an effective way,and this can significantly improve the life quality of the patients.

一种菊酯类复合剂对黑胸散白蚁体内CarEs和Ca-ATPase活性的影响

以黑胸散白蚁ReticulitermeschinensisSnyder为试验材料 ,研究了一种白蚁防治复合剂中的主要成分对白蚁体内羧酸酯酶 (CarEs)和钙 腺苷三磷酸酶 (Ca ATPase)的影响。结果表明 :氯菊酯在终浓度为 1 6 6× 10 - 4mol·L- 1 以下时 ,对羧酸酯酶无明显抑制作用 ;八氯二丙醚和壬基酚聚氧乙烯醚在此浓度下都对羧酸酯酶表现出明显抑制作用 ,其IC50 分别为 7 114 8× 10 - 5mol·L- 1 和 7 3373× 10 - 4mol·L- 1 ;氯菊酯对Ca ATPase表现出较强抑制作用 ,IC50 为 5 11× 10 - 7mol·L- 1 。认为Ca AT Pase是黑胸散白蚁体内拟除虫菊酯类杀虫剂作用的主要靶标之一。

基于GIS的养老设施空间分布合理性研究--以长春市九台区为例

文章选取长春市九台区作为老龄化的典型社区为研究对象,通过实地调研了解养老设施的现状分布和老年人对养老设施的需求,以养老设施POI数据与GIS空间分析相结合,对养老设施的数量、规模和公共服务设施的可达性进行空间分布合理性研究。结果表明,九台区的养老设施数量相对较少,丰富度较低,不同街道的需求配置差异较大。文章尝试为进一步推动吉林地区养老设施空间布局提供参考建议。

Quality of life and hope in elderly people with cancer

The aim of this study was to describe the charac-teristics in Quality of Life (QoL) and hope in eld-erly people newly diagnosed with cancer, and to compare the results for those who survived six months after diagnosis with those who did not. The design of the study was a quantitative study in-cluding drop-out analysis. Data were collected pro-spectively from a group of 101 older people with cancer. The core questionnaire EORTC QLQ-C30 was used to measure QoL and Nowotny’s Hope Scale (NHS) was employed to measure hope. Par-ticipants who died within six months of diagnosis had significantly lower QoL and had more com-plaints about symptoms compared to those who survived. However, hope did not differ significantly between those who died and those who survived. Despite lower QoL score among those who died they were able to deal with their difficult situation and maintain hope in late life. This capacity seems to be an important component of hope in the elderly;thus it is essential to strengthen hope.

Stigma and Discrimination against People Living with HIV and AIDS in Malawi

A study was conducted to explore stigma and discrimination among people living with HIV and AIDS who were on home based care in the Lilongwe district of Malawi. The study design was descriptive through sectional and utilized qualitative data collection and analysis method. Fifteen people living with HIV and AIDS, aged between 15 and 60 years were purposively sampled from three organizations, which were: Light House, National Association for people living with HIV and AIDS in Malawi and Lilongwe Diocese. Qualitative data were collected using an open ended interview guide during in-depth face to face interviews with the participants. The data were analysed using ATLAS. ti 5.0. Results show that all the participants were facing stigma and discrimination because they were living with HIV and AIDS. Distant relatives were the main source of stigma and discrimination followed by friends and church members. Most participants indicated that they felt they were discriminated because HIV infection is associated with bad behaviours such as prostitution or promiscuity. However some of them complained that they contracted the virus from their married partners and hence they did not deserve to be stigmatized or discriminated against. Results show that there is a need for creation of awareness among community members on the transmission of HIV and the need for home based care for the chronically ill people living with HIV and AIDS.

Living Arrangement of Older People: A Study of Community Living Elderly from Nepal

Background: Aging has caused changes in the structure of families that raises reflections on the sustainability of the traditional models of family care for older adults. The aim of this article is to analyze the situation of living arrangements of Nepalese older people. Methods: This study is a secondary analysis of structured interview data collected by the Central Department of Population Studies at Tribhuvan University (TU) via a cross-sectional survey of community-dwelling persons aged 60+ in the Pharping area of Kathmandu. For this study, there were 1326 valid responses. Results: Findings show over four-fifths of respondents (81.3%) were living with family members, far more than with a spouse only (11.6%), alone (6.2%), and others (0.9%). The proportion of Populace residing alone tends to increase with the increase in age of respondents;more widowers tend to live alone compared to those in marital unions;more elderly males without living children tend to live alone compared to those who have at least one living child. The sex of the respondents, marital status, ethnicity, income situation, and feeling of insecurity have significant differences in the living arrangement of older people in this study. Conclusion: Traditionally, Nepalese older adults are contented to live with their family members. The government of Nepal should promote the traditional living arrangements of older people through some incentives providing for family members taking care of their senior citizens.

Recently acquired hepatitis C virus infection among people living with human immunodeficiency virus at a university hospital in Taiwan

BACKGROUND Little is known about the engagement in hepatitis C virus(HCV)care and completion of HCV treatment in people living with human immunodeficiency virus(HIV)(PLWH)who have HCV coinfection in the Asia-Pacific region.Examining the HCV care cascade can identify barriers to the completion of HCV treatment and facilitate achievement of HCV micro-elimination in PLWH.AIM To investigate the care cascade of incident HCV infections among PLWH in Taiwan.METHODS PLWH with incident HCV infections,defined as HCV seroconversion,were retrospectively identified by sequential anti-HCV testing of all archived blood samples at National Taiwan University Hospital between 2011 and 2018.All PLWH with incident HCV infections were followed until December 31,2019.The care cascade of HCV examined included all incident HCV-infected patients,the percentages of anti-HCV antibodies detected by HIV-treating physicians in clinical care,plasma HCV RNA load tested,HCV RNA positivity diagnosed,referral to treatment assessment made,anti-HCV treatment initiated,and sustained virologic response achieved.Those who had HCV seroconversion during the interferon(IFN)era(2011–2016)and the direct-acting antiviral(DAA)era(2017–2018)were analyzed separately.The duration of HCV viremia—from the date of seroconversion to viral clearance by treatments or until the end of observation—and the incidence of sexually transmitted infections(STIs)during the HCV viremic period were estimated.RESULTS During the study period,287 of 3495(8.2%)PLWH(92.3%being men who have sex with men)who were HCV-seronegative at baseline developed HCV seroconversion by retrospective testing of all archived blood samples.Of the 287 incident HCV infections,277(96.5%)had anti-HCV antibodies detected by HIV-treating physicians,270(94.1%)had plasma HCV RNA determined and 251(87.5%)tested positive for HCV RNA.Of those with HCV viremia,226(78.7%)were referred to treatment assessment,215(74.9%)initiated anti-HCV treatment,and 202(70.4%)achieved viral clearance.Compared with that in the IFN era,the median interval from HCV seroconversion by retrospective testing to detection of HCV seropositivity by HIV-treating physicians was significantly shorter in the DAA era{179 d[interquartile range(IQR)87-434]vs 92 d(IQR 57-173);P<0.001}.The incidence rate of STIs in the DAA vs the IFN era was 50.5 per 100 person-years of follow-up(PYFU)and 38.5 per 100 PYFU,respectively,with an incidence rate ratio of 1.31(95%confidence interval 0.96-1.77),while the duration of HCV viremia was 380 d(IQR 274-554)and 735 d(IQR 391-1447)(P<0.001),respectively.CONCLUSION While anti-HCV therapies are effective in achieving viral clearance,our study suggests more efforts are needed to expedite the linkage of PLWH diagnosed with incident HCV infections to HCV treatment.

Tackling Addiction with Integrated Care

Addiction is recognised as one of the chronic illnesses, often leading to medical, psychological, economic, and social problems, making multi-dimensional care for these people within the existing system a challenge. This loads an already loaded primary and secondary care system. The Verslavingskoepel Kempen (VKK) is an initiative to answer this challenge as it aims to integrate the care provided by the zeroth to third-line care around addiction treatment. Zeroth refers to the care and support provided by the human context of the patients, such as family and peers. This extends the integrated care model that is suggested by the WHO. The aim of the dissertation is firstly, to identify the organizational aspects crucial for the success of the network. The Findings show that success is confirmed by participating local communities when highlighting the importance of the intramural connection between their community social services and professionals, hospitals, and experience holders. All interviewees recognize collateral and process leadership with resources emerging from different partners and without hierarchical management. The second aim considers whether success must be attributed to the instrumental organizational aspects of the collaboration or the values of the different caregivers. The Findings show that in this network the organizational aspects and the caregivers’ values are complementary. The third aim is to develop conclusions on the transferability of the network model. This is confirmed;however, the governmental policy is not accompanied by a funding system within the institutionalized remuneration and reimbursement structure. It makes the initiative dependent on the motivation of partner organizations to participate financially, raises doubt about the sustainability of the initiative, and sets conditions for as well as limitations on transferability.

Tackling Addiction with Integrated Care

Addiction is recognised as one of the chronic illnesses, often leading to medical, psychological, economic, and social problems, making multi-dimensional care for these people within the existing system a challenge. This loads an already loaded primary and secondary care system. The Verslavingskoepel Kempen (VKK) is an initiative to answer this challenge as it aims to integrate the care provided by the zeroth to third-line care around addiction treatment. Zeroth refers to the care and support provided by the human context of the patients, such as family and peers. This extends the integrated care model that is suggested by the WHO. The aim of the dissertation is firstly, to identify the organizational aspects crucial for the success of the network. The Findings show that success is confirmed by participating local communities when highlighting the importance of the intramural connection between their community social services and professionals, hospitals, and experience holders. All interviewees recognize collateral and process leadership with resources emerging from different partners and without hierarchical management. The second aim considers whether success must be attributed to the instrumental organizational aspects of the collaboration or the values of the different caregivers. The Findings show that in this network the organizational aspects and the caregivers’ values are complementary. The third aim is to develop conclusions on the transferability of the network model. This is confirmed;however, the governmental policy is not accompanied by a funding system within the institutionalized remuneration and reimbursement structure. It makes the initiative dependent on the motivation of partner organizations to participate financially, raises doubt about the sustainability of the initiative, and sets conditions for as well as limitations on transferability.