Positive health:An integrated quantitative approach in patients with chronic gastrointestinal and hepato-pancreatico-biliary disorders

BACKGROUND The concept of positive health(PH)supports an integrated approach for patients by taking into account six dimensions of health.This approach is especially relevant for patients with chronic disorders.Chronic gastrointestinal and hepatopancreatico-biliary(GI-HPB)disorders are among the top-6 of the most prevalent chronically affected organ systems.The impact of chronic GI-HPB disorders on individuals may be disproportionally high because:(1)The affected organ system frequently contributes to a malnourished state;and(2)persons with chronic GIHPB disorders are often younger than persons with chronic diseases in other organ systems.AIM To describe and quantify the dimensions of PH in patients with chronic GI-HPB disorders.METHODS Prospective,observational questionnaire study performed between 2019 and 2021 in 235 patients with a chronic GIHPB disorder attending the Outpatient Department of the Maastricht University Medical Center.Validated questionnaires and data from patient files were used to quantify the six dimensions of PH.Internal consistency was tested with McDonald’s Omega.Zero-order Pearson correlations and t-tests were used to assess associations and differences.A P value<0.05 was considered significant.RESULTS The GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general population.Regarding quality of life,participation and daily functioning,GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems,but depressive symptoms(in 35%)and malnutrition(in 45%)were more frequent in patients with chronic GI-HPB disorders.Intercorrelation scores between the six dimensions were only very weak to weak,forcing us to quantify each domain separately.CONCLUSION All six dimensions of PH are impaired in the GI-HPB patients.Malnutrition and depressive symptoms are more prevalent compared to patients with chronic disorders in other organ systems.

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders:A brief overview for paediatricians

‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.

Impact of Relaxation and Group Psycho-Education on Health Outcomes Using Integrated Care Models and Quality Improvement

The purpose of this Integrated Care Practice Change and Quality Improvement (ICPCQI) initiative was to evaluate the impact of wellness and relaxation and group psycho-education on health out-comes in an integrated care setting. Individuals diagnosed with mental illness and a co-occurring chronic medical condition participated in the ICPCQI initiatives which were run by peer support and wellness experts in an integrated care setting over the one-year project implementation period. Evaluation of outcome measures revealed an overall decline of 8.3% (p < 0.0001) and 7.3% (p < 0.0001) in the average systolic and diastolic blood pressure respectively. There was a 12.3% (p = 0.02) reduction on the average PHQ-9 scores. GAD-7 (p = 0.9) scores had a mean reduction of 1.5%. These preliminary results suggest that the evidence-based ICPCQI initiatives positively impact health outcomes among individuals with mental illness and chronic medical conditions.

Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya

Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.

An Integrated Rehabilitation Model: An Ideal Framework for Limiting Health Care Costs

The financial crisis has caused a severe limitation of resources for the public health service and rehabilitation. The proposal of integrated diagnosis and treatment in rehabilitation, involving the introduction of new therapeutic models alongside orthodox models, could lead to a reduction in health care costs through better patient compliance. In rehabilitative assistance in health care, the limiting of financial resources can be simplified, given its multifaceted nature and the need to integrate clinical experience with research. In addition, the phases of rehabilitative recovery do not focus on organ damage, but improved participation and the reduction of disability. For this reason, we have considered incorporating narrative based medicine (NBM) and Psycho-Neuro-Immuno-Endocrinology (PNEI) in the rehabilitation process through an empathetic approach, taking evidence based medicine (EBM) into account, thus creating a “framework” of reference. Managing patients through this “framework” would be a move towards an integrated model of care that could lead to a reduction in health care costs, given the aging population and the rise in patients with chronic pain. The decision to modify health care in rehabilitative assistance through a new “framework” will require time, organizational capacity and experimentation, but may represent the appropriate response for an improved quality of life for patients and a better allocation of resources.

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.

How to Integrate Palliative Care Into Primary Health Care

Integration of Palliative Care into Primary Health Care will have a substantial amount of positive impact on Health Care in Nakuru County,Kenya.Consequently,all aspects of Palliative Care should be given to more than 2/3 population that suffer from cancers and chronic illnesses which sometimes overflow to some acute conditions.While Palliative Care focuses on Holistic Care encompassing physical,psychological,social,and spiritual aspects to adults and children,Primary Health Care operates on the principles of equity,solidarity,universal access to services,multisectoral action,social justice,centralization,and community participation.Thus,there are similarities in Palliative Care and Primary Health Care putting into consideration that the latter is based on practical,scientifically sound and socially accepted methods and technology.It is affordable,universally accessible to individuals and families in the community.Universal Health Coverage ensures that all people and communities have access to promotive,preventive,curative,rehabilitative,and palliative health services they need,of sufficient quality to be effective while also ensuring that the use of these services does not expose the users to financial hardships.The 60%of the Nakuru County population are in need of Palliative Care services,but only about 20%access these services.They suffer from cancers,non-communicable diseases,dementia,and frailty.Geographical challenges,staff shortages,and lack of Palliative Care knowledge are the main barriers to provision of care.

The Integrated Study on Agritainment and the Industrial Economy of Keeping Good Health and Caring for the Senior

Based on the development prospect of the industry of keeping in good health and caring for the senior and practical exploration on the Lishui Citys construction of "Health Blessed Land" in Yangtze River Delta, the position, function and facing problems of agritainment in the system of industrial economy of keeping in good health and caring for the senior in Lishui City. From the view of the industry integration, this paper puts forward the new strategies of developing agritainment in terms of design concepts at the top level, guarantee conditions in the government, layout strategies stressing on resources, target assessment focusing on nourishing of life, the basic promoting connotation.

Exploration on the Implementation of the Integration of Medical and Preventive Model in China’s Primary Health Care Institutions

Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.

Primary care and mental health: Where do we go from here?

Primary care has been dubbed the“de facto”mental health system of the United States since the 1970s.Since then,various forms of mental health delivery models for primary care have proven effective in improving patient outcomes and satisfaction and reducing costs.Despite increases in collaborative care implementation and reimbursement,prevalence rates of major depression in the United States remain unchanged while anxiety and suicide rates continue to climb.Meanwhile,primary care task forces in countries like the United Kingdom and Canada are recommending against depression screening in primary care altogether,citing lack of trials demonstrating improved outcomes in screened vs unscreened patients when the same treatment is available,high false-positive results,and small treatment effects.In this perspective,a primary care physician and two psychiatrists address the question of why we are not making headway in treating common mental health conditions in primary care.In addition,we propose systemic changes to improve the dissemination of mental health treatment in primary care.

Validity and reliability of the complementary and integrative health assessment for practitioners scale: CIHAP_(TR)

Objective:This study aimed to evaluate the validity and reliability of the Complementary and Integrative Health Assessment for Practitioners Scale for Turkish society.Methods:This methodological study was conducted between May~June 2020.The participants were 132 health care practitioners including nurses,physicians,dietitians,physiotherap ists,and psychologists,who were working in 6 different hospitals,and 4 different provinces in Turkey.Content Validity Index,item scale correlations,confirmatory factor analysis were used to evaluate validity.Cronbach’s alpha and test-retest were use d to evaluate reliability.Results:CVI was 0.95(0.81-0.98).Factor loadings ranged from 0.381 to 0.913 and,item scale correlations ranged from 0.302 to 0.837.The Cronbach’s alpha value was found 0.93 in the current study.Intraclass Correlation Coeffic ient ranged from 0.82 to 0.96.Conclusion:CIHAP was found to be valid and reliable tool for Turkish society.

Wearable Healthcare and Continuous Vital Sign Monitoring with IoT Integration

Technical and accessibility issues in hospitals often prevent patients from receiving optimal mental and physical health care,which is essential for independent living,especially as societies age and chronic diseases like diabetes and cardiovascular disease become more common.Recent advances in the Internet of Things(IoT)-enabled wearable devices offer potential solutions for remote health monitoring and everyday activity recognition,gaining significant attention in personalized healthcare.This paper comprehensively reviews wearable healthcare technology integrated with the IoT for continuous vital sign monitoring.Relevant papers were extracted and analyzed using a systematic numerical review method,covering various aspects such as sports monitoring,disease detection,patient monitoring,and medical diagnosis.The review highlights the transformative impact of IoTenabled wearable devices in healthcare,facilitating real-time monitoring of vital signs,including blood pressure,temperature,oxygen levels,and heart rate.Results from the reviewed papers demonstrate high accuracy and efficiency in predicting health conditions,improving sports performance,enhancing patient care,and diagnosing diseases.The integration of IoT in wearable healthcare devices enables remote patient monitoring,personalized care,and efficient data transmission,ultimately transcending traditional boundaries of healthcare and leading to better patient outcomes.

Significant Differences in Elderly Health between Urban and Rural Communities: A Literature Review

This study aimed to examine measures pertaining to elderly health in urban versus rural settings, and to identify differences in the health of elderly people living in urban and rural communities through a literature review. An electronic literature search was performed using PubMed for English articles published in peer-reviewed journals up to August 2018, with the following search terms: “urban”, “rural”, “comparison of community”, “elderly health”, and “comparison of community health”. A total of 35 articles were extracted for a critical full-text review, and six articles that met the inclusion criteria were subjected to analysis. Measures related to elderly health in urban and rural communities were classified into the following three categories: functional abilities, health, and health perception. Five of the six articles described functional abilities (e.g., social function) and health (e.g., mental health, depression) as categories with significant differences in elderly health between urban and rural communities. The results suggest that elderly health measures related to social function and mental health or depression are more important outcome measures of effective person-centered integrated community care systems from the perspective of community characteristics. As there were only a few articles reporting on elderly health according to differences in environment between urban and rural communities, further investigation is globally warranted.

Integrated primary care-behavioral health program development and implementation in a rural context

Objective:Despite the known benefits of integrated primary care and behavioral health services,integrated behavioral health services have not been readily used in medical clinics in interior Alaska.With minimal resources,we recently developed an integrated primary care-behavioral health program in a medical clinic in interior Alaska to meet clinic and community needs.The objective of this study was to explore initial program outcomes and determine the feasibility of program development and implementation.Methods:We initially conducted a needs assessment for integrating behavioral health services into primary care.Program development was informed by specific clinic needs.Following program implementation,initial program outcomes were tracked with use of data from the electronic health record and patient and provider use and satisfaction surveys.The level of integration of primary care and behavioral health services was evaluated with the Practice Integration Profile.Results:A total of 188 patients were seen by behavioral health consultants during the initial pilot phase,including 44.0%referred for mental health symptoms,33.1%referred for physical health issues,and 22.3%referred for both mental and physical health issues.The initial program outcomes indicate modest clinical improvement(measured by the nine-item Patient Health Questionnaire)as well as patient and provider satisfaction with the model,and a moderate level of practice integration.Conclusion:On the basis of the initial findings,it appears that our integrated primary care-behavioral health program has the potential to serve an important role in addressing the behavioral health needs of the local population.Our implementation procedure and initial program outcomes suggest that such models are feasible in rural and small-scale settings with minimal overhead costs.

Policies towards implementation of positive changes and the introduction of integrated health care for health systems

1 Introduction Quality of life is influenced by health, education, environment, fairness and respect of public benefits by main stake holders of each country. A pre-summit policy roundtable report of the European Congress for Integrative Medicine （ECIM） 2015 Global Summit on Integrative Medicine and Healthcare held on September 26-27, 2015 in Greater Copenhagen, declared a call for strategic policies in support of integrated health care that would include a vision for setting up ＂an integrative medicine （IM） department in at least one hospital in every European country.＂

Deployment of Hash Function to Enhance Message Integrity in Wireless Body Area Network (WBAN)

Message integrity is found to prove the transfer information of patient in health care monitoring system on the human body in order to collect and communicate the human personal data. Wireless body area network (WBAN) applications are the fast growing technology trend but security and privacy are still largely ignored, since they are hard to achieve given the limited computation and energy resources available at sensor node level. In this paper, we propose simple hash based message authentication and integrity code algorithm for wireless sensor networks. We test the proposed algorithm in MATLAB on path loss model around the human body in two scenarios and compare the result before and after enhancement and show how sensors are connected with each other to prove the message integrity in monitoring health environment.

医护一体化模式对前庭外周性眩晕病人眩晕症状及负性情绪的影响

目的:探讨医护一体化模式对前庭外周性眩晕病人的眩晕症状、焦虑抑郁负性情绪的影响。方法:选取2022年10月—2023年3月某三级甲等医院耳鼻咽喉头颈外科行住院治疗的前庭外周性眩晕病人120例,随机分为对照组和试验组,每组60例。对照组实施常规诊疗护理工作模式,试验组实施医护一体化模式,干预2周后观察两组病人的眩晕、平衡状况和焦虑、抑郁负性情绪。结果:干预后两组病人眩晕、平衡状况较干预前均有所改善,两组病人眩晕障碍量表评分、Berg平衡量表评分比较差异均有统计学意义(P<0.05)。负性情绪方面,干预后两组病人较干预前均有所改善,试验组更早缓解了病人焦虑、抑郁情绪(P<0.05)。两组病人负性情绪干预2周后与1周后比较差异无统计学意义(P>0.05)。结论:将医护一体化模式应用于前庭外周性眩晕病人,能更早改善病人眩晕症状,缓解其负性情绪,加快病人康复。

Effect of sharing health messages on antenatal care behavior among women involved in microfinance-based self-help groups in Bihar India

Background:Bihar state in India has one of the highest rates of maternal and infant mortality in South Asia.Microfinance-based self-help groups(SHGs),involving rural women,are being utilized to improve maternal and child health practice and reduce mortality.SHG members receive information on key maternal and child health practices as well as encouragement for their practice.This study measures the association of health messaging to SHG members with their antenatal care(ANC)behaviors.Methods:The study was conducted in eight districts of Bihar in 2016.A three-stage cluster sampling design(with a random selection of blocks,villages,and SHGs)selected the sample of 1204 SHG members who had an infant child;of these,597 women were members of SHGs that received dedicated sessions on health messages,while 607 women belonged to SHGs that did not.To examine the impact of the health intervention on ANC practice,radius caliper method of propensity score matching controlled for various socio-demographic characteristics between the two groups.Results:Most of the interviewed women(91.5%)belonged to a scheduled caste or tribe.Nearly 44%of SHG members exposed to the health intervention were engaged in some occupation,compared to 35%of those not exposed to the intervention.After matching unexposed SHG women with exposed SHG women,no significant differences were found in their socio-demographic characteristics.Findings suggest that exposure to a health intervention is associated with increased likelihood of at least four ANC visits by SHG women(ATE=7.2,95%CI:0.76-13.7,p<0.05),consumption of iron-folic acid for at least 100 days(ATE=8.7,95%CI:5.0-12.5,p<0.001)and complete ANC(ATE=3.6,95%CI:2.3-4.9,p<0.001),when compared to women not exposed to the health intervention.Conclusions:The study shows that sharing health messages in microfinance-based SHGs is associated with significant increase in ANC practice.While the results suggest the potential of microfinance-based SHGs for improved maternal health services,the approach’s sustainability needs to be further examined.

康养体系整合性发展框架与实践路径

推进以预防失能、促进功能康复与改善、增强老年人生活自理能力为目标的康养体系建设,契合当前广大老年人及其家庭的需求,是补齐养老服务体系短板的重要举措。基于资源整合理念,通过分析建立康养体系的必要性,提出康养体系整合性发展框架,以老年人健康状况与失能等级为依据分层构建支持性、服务性和全要素三阶整合模型。康养体系整合性发展的实践路径包括注重制度保障,加强规范整合;建立联合机制,强化多主体整合;推行康养顾问,促进人才资源整合;运用数字赋能,实现服务整合。

基于微信平台的普外科医护一体化工作模式的应用效果

目的:探讨微信平台在普外科医护一体化工作模式中的应用效果。方法:选取2020年4月—9月山西省人民医院肝胆胰病区行腹腔镜胆囊切除术的病人120例,其中2020年4月—6月住院的60例病人为对照组,2020年7月—9月住院的60例病人为观察组。对照组采用传统医护小组责任制工作模式,观察组采用基于微信平台的医护一体化工作模式。对两组医生的医嘱遗漏率和耗材遗漏率、病人住院时间、住院费用、出院等候时间及医护患满意度等相关指标进行比较分析。结果:观察组医嘱遗漏率、耗材漏记率、住院时间、住院费用、出院等候时间均明显低于对照组(P<0.05);观察组医护人员工作满意度、出院病人满意度均明显高于对照组(P<0.05)。结论:普外科采取基于微信平台的医护一体化工作模式,既有利于降低病人住院时间、住院费用及出院病人等候时间,也能有效提高医疗质量和医护患满意度。