["Wellness Bubbles" for caregivers, a way to improve the quality of life at work]

Improving the well-being at work of caregivers is a major challenge for our healthcare system. Both global and local solutions must be proposed. At the Marie-Lannelongue hospital, located in the Paris region, a structure dedicated to the well-being of caregivers at work, the "Bubble", has been set up. How does it work and what are its beneficial effects? How have the professionals received it? Is it an example to follow? These are some of the questions that a survey has enabled us to answer.

Lifestyle, vulnerability to stress and prevailing health conditions of ambulatory older patients in a care facility

Background

Lifestyle and vulnerability to stress are major determinants of age-related health outcomes.

Objectives

To assess the lifestyle and health states of older adults, and evaluate their personality-related vulnerability to stress, to enable improved and targeted health promotional activities.

Methods

A hospital record review and a purposive cross-sectional study was conducted among 200 respondents who were ≥ 50 years old, and visited the General Hospital Oyo, South-western Nigeria. Descriptive statistics was performed using SPSS version 21. Analysis of vulnerability to stress was performed by the addition of scores from Marshal's personality stress prone test. Lifestyle were measured by frequencies and Chi-Square tests, while presence of chronic diseases was measured by respondents' past prescriptions, from the hospital case notes. P < 0.05 was considered statistically significant.

Results

A total of 200 respondents participated in the study. Majority, 156 (78.0%) were 50-59 years old and self-employed 96 (46.0%). Ninety-three (46.5%) smoked, 65 (32.3%) consumed alcohol, 128 (64.0%) had periodic exercise and 67 (33.3%) experienced insomnia. Majority (60.5%) were vulnerable to stress, and this was significantly associated with age (P=0.001), marital status (P=0.021), body weight (P=0.05), occupation (P=0.002) and income (P=0.002). From the retrospective study, most frequently prescribed drugs were anti-hypertensives 225 (69.7%), vitamins/minerals (49.5%), sedatives 158 (48.9%) and analgesics 158 (48.9%) respectively.

Conclusion

Periodic exercise, alcohol use, and smoking were reported at varying degrees. High prevalence of vulnerability to stress and use of anti-hypertensives were also observed, and vulnerability to stress was associated with selected socio-demographics. These findings reinforce the need for routine education of this category of populace on healthy lifestyle for improved health.

Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends

Background

The adoption of telehealth services has been a challenge in rural communities. The reasons for the slow adoption of such technology-driven services have been attributed to social norms, health care policies, and a lack of infrastructure to support the delivery of services. However, the COVID-19 pandemic–related shutdown of in-person health care services resulted in the usage of telehealth services as a necessity rather than a choice. The pandemic also fast-tracked some needed legislation to allow medical cost reimbursement for remote examination and health care services. As services return to normalcy, it is important to examine whether the usage of telehealth services during the period of a shutdown has changed any of the trends in the acceptance of telehealth as a reliable alternative to traditional in-person health care services.

Objective

Our aim was to explore whether the temporary shift to telehealth services has changed the attitudes toward the usage of technology-enabled health services in rural communities.

Methods

We examined the Medicaid reimbursement data for the state of Alabama from March 2019 through June 2021. Selecting the telehealth service codes, we explored the adoption rates in 3 phases of the COVID-19 shutdown: prepandemic, pandemic before the rollout of mass vaccination, and pandemic after the rollout of mass vaccination.

Results

The trend in telemedicine claims had an opposite pattern to that in nontelemedicine claims across the 3 periods. The distribution of various characteristics of patients who used telemedicine (age group, gender, race, level of rurality, and service provider type) was different across the 3 periods. Claims related to behavior and mental health had the highest rates of telemedicine usage after the onset of the pandemic. The rate of telemedicine usage remained at a high level after the rollout of mass vaccination.

Conclusions

The current trends indicate that adoption of telehealth services is likely to increase postpandemic and that the consumers (patients), service providers, health care establishments, insurance companies, and state and local policies have changed their attitudes toward telehealth. An increase in the use of telehealth could help local and federal governments address the shortage of health care facilities and service providers in underserved communities, and patients can get the much-needed care in a timely and effective manner.

Using the Water and Sanitation for Health Facility Improvement Tool (WASH FIT) in Zimbabwe: A Cross-Sectional Study of Water, Sanitation and Hygiene Services in 50 COVID-19 Isolation Facilities

The availability of water, sanitation and hygiene (WASH) services is a key prerequisite for quality care and infection prevention and control in health care facilities (HCFs). In 2020, the COVID-19 pandemic highlighted the importance and urgency of enhancing WASH coverage to reduce the risk of COVID-19 transmission and other healthcare-associated infections. As a part of COVID-19 preparedness and response interventions, the Government of Zimbabwe, the United Nations Children's Fund (UNICEF), and civil society organizations conducted WASH assessments in 50 HCFs designated as COVID-19 isolation facilities. Assessments were based on the Water and Sanitation for Health Facility Improvement Tool (WASH FIT), a multi-step framework to inform the continuous monitoring and improvement of WASH services. The WASH FIT assessments revealed that one in four HCFs did not have adequate services across the domains of water, sanitation, health care waste, hand hygiene, facility environment, cleanliness and disinfection, and management. The sanitation domain had the largest proportion of health care facilities with poor service coverage (42%). Some of the recommendations from this assessment include the provision of sufficient water for all users, Menstrual Hygiene Management (MHM)- and disability-friendly sanitation facilities, handwashing facilities, waste collection services, energy for incineration or waste treatment facilities, cleaning supplies, and financial resources for HCFs. WASH FIT may be a useful tool to inform WASH interventions during the COVID-19 pandemic and beyond.

[Time, a lever for change]

Race against time, interruptions, operating room tardiness, handover times… Expressions such as these show the significance of time in health professionals' everyday working lives. Health care facilities are no exception. In these structures, time is necessary to accomplish organisational transformation projects for the benefit of patients and users.

The cream-skimming effect in China's health care services: A mixed methods study

OBJECTIVE

One of the greatest inequities in China's health care service is that between senior cadres, high-level bureaucrats, and the general public in terms of hospital access and payment. We aim to demonstrate this inequity and to explore its connection with the regional inequity of different levels of health care facilities.

METHODS

In a content analysis of official websites of provincial health bureaus and national top hospitals, we determine whether senior cadres enjoy priority in health services with fewer payments. Then, we employ multiple regression analyses to explore the correlation of the local economy, the local population as well as the regional power and different levels of health care facilities.

RESULTS

The content analysis suggests that senior cadres indeed enjoy priority in health care services. According to the regression results, the local population has a positive correlation with every level of health care facilities except the highest one, which is responsive only to the local power index.

CONCLUSION

We demonstrate a demand-side cream-skimming effect in China's health care service. Senior cadres have taken the 'cream', the best services, and the individual inequity between senior cadres and the general public is related to the regional inequity of different-level health care facilities.

[The management of violence in a general hospital]

In the face of situations of aggression and violence, Versailles general hospital (78) reinforced its measures. These included training which was put in place to start a wide-ranging debate on aggression, tensions, conflicts, situations of violence and organisational factors. The process resulted in an evolution of health care professionals' practices.

Acute morbidity profile and treatment seeking behaviour among people residing in an urban resettlement colony in Delhi, India

Background

Rapid urbanization has resulted in increased burden of communicable and non-communicable diseases, especially among urban poor population. In the absence of a well-functioning three tier health care system in urban India, health needs of urban poor are rarely fulfilled. The objective of this study was to assess primary health care services utilization pattern and its associated selected socio-demographic determinants in an urban population of Dakshinpuri Extension, South-east district of Delhi.

Materials and Methods

A community based cross-sectional study was done from November 2013 to November 2014 with a sample size of 440 households through simple random sampling. Information was obtained regarding the socio-demographic characteristics and morbidity pattern of all the members of household in the preceding one year of the conduct of the present study through a pretested semi structured interview schedule. Association of various socio-demographic characteristics with primary and secondary health care facilities utilisation was studied with bivariate and multivariate logistic regression.

Results

In this study, 42% of the household members suffered from acute illnesses and symptoms in the preceding one year. Secondary/tertiary health care facilities were approached mostly for seeking treatment. Majority of the household members sought treatment from private health care facilities. Significantly higher utilisation of secondary/tertiary health care facilities was found by head of households and household members who are married.

Conclusion

Primary health care system needs to be revamped to improve healthcare delivery among urban population. Strategies to decongest secondary/tertiary health care facilities in urban India needs focus.

[Simulation in health care, a partnership between a training institute and a health care facility]

A system of collaboration around simulation, between a health care facility and a training institute, has been put in place. It has enabled the challenges for both institutions to be identified, thereby confirming the need to continue this project. In this context, interprofessionalality and intergenerationality are key elements.

Bypassing Primary Care Facilities for Childbirth: Findings from a Multilevel Analysis of Skilled Birth Attendance Determinants in Afghanistan

INTRODUCTION

The objective of this study was to assess the association between health facility characteristics and other individual/household factors with a woman's likelihood of skilled birth attendance in north-central Afghanistan.

METHODS

Data from a 2010 household survey of 6879 households in 9 provinces of Afghanistan were linked to routine facility data. Hierarchical logistic regression models were used to assess determinants of skilled birth attendance.

RESULTS

Women who reported having at least one antenatal visit with a skilled provider were 5.6 times more likely to give birth with a skilled attendant than those who did not. The odds of skilled birth attendance were 84% higher for literate women than those without literacy skills and 79% higher among women in the upper 2 wealth quintiles than women in the poorest quintile. This study did not show any direct linkages between facility characteristics and skilled birth attendance but provided insights into why studies assuming that women seek care at the nearest primary care facility may lead to misinterpretation of care-seeking patterns. Findings reveal a 36 percentage point gap between women who receive skilled antenatal care and those who received skilled birth care. Nearly 60% of women with a skilled attendant at their most recent birth bypassed the nearest primary care facility to give birth at a more distant primary care facility, hospital, or private clinic. Distance and transport barriers were reported as the most common reasons for home birth.

DISCUSSION

Assumptions that women who give birth with a skilled attendant do so at the closest health facility may mask the importance of supply-side determinants of skilled birth attendance. More research based on actual utilization patterns, not assumed catchment areas, is needed to truly understand the factors influencing care-seeking decisions in both emergency and nonemergency situations and to adapt strategies to reduce preventable mortality and morbidity in Afghanistan.

Selection of empirical antibiotics for health care-associated pneumonia via integration of pneumonia severity index and risk factors of drug-resistant pathogens

BACKGROUND/PURPOSE

The pneumonia severity index (PSI) both contains some risk factors of drug-resistant pathogens (DRPs) and represents the severity of health care-associated pneumonia. The aim of this study was to investigate whether the PSI could be used to predict DRPs and whether there were risk factors beyond the PSI.

METHODS

A retrospective observational study enrolled 530 patients with health care-associated pneumonia who were admitted from January 2005 to December 2010 in a tertiary care hospital.

RESULTS

A total of 206 patients (38.9%) had DRPs, of which the most common was Pseudomonas aeruginosa (24.3%). The incidence of DRPs increased with increasing PSI classes (6.7%, 25.5%, 36.9%, and 44.6% in PSI II, III, IV, and V, respectively). An analysis of the risk factors for DRPs by PSI classes revealed that wound care was associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in PSI V (p = 0.045). Nasogastric tube feeding (odds ratio, 3.88; 95% confidence interval, 1.75-8.60; p = 0.006), and bronchiectasis (odds ratio, 3.12; 95% confidence interval, 0.66-14.69; p = 0.007) were risk factors for DRPs in PSI III and IV. The area under the receiver operating characteristic curve progressed from 0.578 to 0.651 while integrating these risk factors with PSI classes.

CONCLUSION

The findings suggested that PSI plus risk factors predicted the risk of DRPs. PSI II had a low risk of DRPs and could be treated as community-acquired pneumonia. Antibiotics of PSI III and IV with risk factors could be targeted DRPs. PSI V with wound care had a higher risk of MRSA, and empirical anti-MRSA antibiotics could be added.

Health care facilities resilient to climate change impacts

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator's guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change.