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.

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.

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.

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.

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.

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.

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.

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.

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.

Study on the quality of life and the factors influencing it in elderly patients

A society of advanced age is arriving with the increasing number of elderly patients. Little attention has been paid to the quality of life of elderly patients, which is decreasing gradually. This article aims to study the quality of life among elderly patients and explore the factors influencing it, in addition to exploring effective ways to improve the quality of life of elderly patients.

文旅融合背景下农家书屋康养服务策略研究——以攀枝花市农家书屋为例

乡村旅游、康养正成为一种新时尚和新业态,农家书屋作为乡村公共文化服务的重要窗口,开展涵盖健康、文化、旅游的康养服务是大势所趋。文章梳理农家书屋相关研究现状,介绍攀枝花市农家书屋康养服务的探索与实践,分析其面临的困境,提出加大政策扶持力度,促进健康规范发展;突出康养属性,丰富服务内容;注重挖潜增效,提高服务效能;精心塑造品牌,形成深度影响力;多渠道宣传,提升营销效果的农家书屋康养服务策略,以期为农家书屋深入开展康养服务提供参考。

走向健康现代化的战略转型与实现路径:从“三医”联动到健康治理

健康现代化是社会主义现代化的重要内容。面对健康脆弱性,公共健康治理面临着治理界限交互扩大、治理内容更迭扩展、治理进程压缩叠加等诸多挑战。秉持人民中心、生命至上、系统整合、全民参与的公共健康治理理念,中国在提升健康公平性方面探索出一条医保、医疗与医药协同改革的发展之路。新时代进一步提升健康福祉,需要从“三医”联动到健康治理,通过互助共享的健康保障战略、医防融合的健康支持战略、均衡协同的健康服务战略和多元合作的健康促进战略,实现全人群、全周期、全方位为特征的全民健康福祉。基于此,走向健康现代化的具体路径包括,依托健康资源配置体制、健康制度协同机制、健康服务递送体系和健康行动协同网络,最终促进资源互通、结构改革、服务融合和治理提升。

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.＂

基于PINCOM模型的我国农村地区县乡两级医生协作研究:以贵州仁怀为例

目的:对农村地区县乡两级医生间协作进行研究。方法:运用PINCOM理论模型,采用分层随机抽样方法对77名县级医生和70名乡级医生进行问卷调查,并对结果进行统计学分析。结果:两级医生总体协作水平不高,乡级医生对于与县级医生协作的需求高,两级医生相互了解信任不足,两级医生协作受到重视但缺乏配套政策和条件。结论:当前县乡两级医生协作处于萌芽阶段,合理的激励机制是促进两级医生协作的动力,基础条件建设是提高两级医生协作水平的基石。

中医药服务参与医养结合机构的困境与出路

随着中医药文化传播和健康老龄化观念普及,中医药逐渐开展医养结合发展模式研究。目前,中医药与养老产业融合尚不紧密,本文通过走访调查、政策分析、文献梳理等方法,揭示中医药参与医养行业实践现状及存在问题,探索具有中医药特色的医养结合模式。

如何促成医养结合?——英国经验与本土化启示

20世纪80年代,英国为解决其医疗和养老服务的主管部门分散且界限模糊,不同机构间服务内容割裂,难以应对老年人医疗和养老混合型需求等问题,开始探索建立医疗和护理服务合作体系。英国政府首先通过健全社区医疗卫生服务解决老年人长期住院问题,以划清“医”“养”边界;其次通过立法要求部门间协同合作,明确各方责任并进行预算合并;最后以具体项目聚集资源确保整合服务下沉社区。该体系让社区在地化养老模式得到发展,医疗资源配置效率显著提升,老年人的获得感显著增强,其成功的关键在于建立了以家庭医生为中心的多学科整合型服务网络、联合评估需求并进行部门间信息共享、建立共同基金和个人账户、提供出院后短期的衔接性服务、实施来自政府和消费者的双重监管。同时,改革也面临“成本病”问题、数字化和信息化转型以及医疗和照护业务转型中的问题。这些经验和挑战对我国的本土化启示是:顶层设计和下沉社区是调动各部门合作积极性的关键,综合评估需求是构建医养结合体系的基础,健全基层医疗卫生并建立具体的合作网络能够为其提供支撑,统一预算和支付是能够实现医养结合的重要保障。未来我国应通过转诊等建立医院和基层医疗机构之间的联系,各部门应综合评估医养需求并对信息共享,应建立以家庭医生为中心的服务支撑网络,探索建立医养结合服务基金并强调个人责任。