Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF).

BACKGROUND: The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care system in the United Kingdom. Addressing these unmet needs is becoming one of the urgent public health priorities. In order to develop effective solutions to address some of these needs, it is important first to understand the care and support needs of older people. METHODS: A scoping review was conducted, using the Arksey and O'Malley original and enhanced framework, to understand the care and support needs of older people, focusing on those living at home with chronic conditions in the UK. The search was conducted using five electronic data bases, grey literature and reference list checks. The WHO International Classification of Functioning, Disability and Health (ICF) framework was used to analyse and categorise the literature findings. RESULTS: Forty studies were included in the final analysis- 32 from academic literature and 8 from grey literature. The review highlighted that older adults faced a range of physical, social and psychological challenges due to living with chronic conditions and required care and support in three main areas: 1) social activities and relationships; 2) psychological health; and 3) activities related to mobility, self-care and domestic life. The review also highlighted that many older people demonstrated a desire to cope with their illness and maintain independence, however, environmental factors interfered with these efforts including: 1) lack of professional advice on self-care strategies; 2) poor communication and coordination of services; and 3) lack of information on services such as care pathways. A gap in the knowledge was also identified about the care and support needs of two groups within the older population: 1) older workers; and 2) older carers. CONCLUSIONS: The review highlighted that older people living with chronic conditions have unmet care needs related to their physical and psychological health, social life, as well as the environment in which they live and interact. Findings of this review also emphasized the importance of developing care models and support services based around the needs of older people.

The needs of people with dementia living at home from user, caregiver and professional perspectives: a cross-sectional survey.

BACKGROUND: Few reports have been published about differences in perspectives on perceived needs among community-residing people with dementia, their family caregivers, and professionals. The aim of this study was to compare these perspectives. METHOD: During 2006 and 2007, one-hundred and fifty two interviews of people with dementia and their caregivers about the needs of the person with dementia were performed by four professionals using The Camberwell Assessment of Need for the Elderly (CANE). Professionals' views on met and unmet needs of people with dementia were obtained for the total sample, family caregivers' perspectives were gained for 125 people with dementia, and people with dementia's views on their own needs were obtained for 125 persons with dementia. RESULTS: People with dementia reported fewer needs compared with the reports of their caregivers and the professionals. The most frequent unmet needs reported by people with dementia, caregivers and professionals were in the areas of daytime activities, company, and psychological distress; however, people with dementia rated psychological distress as the commonest unmet need. CONCLUSIONS: Since the priorities of people with dementia can be different from those of caregivers and professionals, it is important to consider all perspectives when making care plans. Thus, compliance with treatment of people with dementia and also their quality of life could be potentially improved by a more collaborative partnership with them.

[Effects of residents' care needs classification (and misclassification) in nursing homes: the example of SOSIA classification]. / Effetti della classificazione (e mis-classificazione) del case- mix nella rappresentazione dei bisogni degli ospiti delle Re- sidenze Socio-Assistenziali per Anziani non Autosufficienti (RSA): l'esempio della Scheda di OSservazione Intermedia dell'Assistenza (SOSIA).

Since 2003, the Lombardy region has introduced a case-mix reimbursement system for nursing homes based on the SOSIA form which classifies residents into eight classes of frailty. In the present study the agreement between SOSIA classification and other well documented instruments, including Barthel Index, Mini Mental State Examination and Clinical Dementia Rating Scale is evaluated in 100 nursing home residents. Only 50% of residents with severe dementia have been recognized as seriously impaired when assessed with SOSIA form; since misclassification errors underestimate residents' care needs, they determine an insufficient reimbursement limiting nursing home possibility to offer care appropriate for the case-mix.

Demand and supply-based operating modes--a framework for analyzing health care service production.

CONTEXT: The structure of organizations that provide services should reflect the possibilities of and constraints on production that arise from the market segments they serve. Organizational segmentation in health care is based on urgency and severity as well as disease type, bodily function, principal method, or population subgroup. The result is conflicting priorities, goals, and performance metrics. A managerial perspective is needed to identify activities with similar requirements for integration, coordination, and control. METHODS: The arguments in this article apply new reasoning to the previous literature. FINDINGS: The method used in this article to classify health care provision distinguishes different types of health problems that share generic constraints of production. CONCLUSIONS: The analysis leads to seven different demand-supply combinations, each with its own operational logic. These are labeled demand and supply-based operating modes (DSO modes), and constitute the managerial building blocks of health care organizations. The modes are Prevention, Emergency, One visit, Project, Elective, Cure, and Care. As analytical categories the DSO modes can be used to understand current problems. Several operating modes in one unit create managerial problems of conflicting priorities, goals, and performance metrics. The DSO modes are constructed as managerially homogeneous categories or care platforms responding to general types of demand, and supply constraints. The DSO modes bring methods of industrial management to bear on efforts to improve health care.

Effectiveness of a discharge-planning program and home visits for meeting the physical care needs of children with cancer.

GOALS OF WORK: The purpose of this study was to investigate the effectiveness of a discharge-planning program on helping caregivers meet the physical care needs of children with cancer. PATIENTS AND METHODS: This research is a quasi-experimental type of study in a pediatric oncology clinic at a university hospital in Izmir/Turkey. The control group had 25 and the experimental group had 24 patients with their caregivers. For the experimental group, discharge planning, discharge teaching, home visits, and telephone consultation were provided and has been planned to investigate the effectiveness of a discharge-planning program on helping caregivers meet the physical care needs of children with cancer between 0-18 years of age. MAIN RESULTS: In the third assessment, the number of patients that needed physical care needs in the experimental and control groups was decreased, and children in the experimental group had a lower number of physical care needs. A decreased number of unplanned admissions to the hospital at the first and third follow-up times, a decrease in unplanned admissions, and higher satisfaction rate were seen in the experimental group caregivers. CONCLUSIONS: A discharge-planning program and a hospital-based home care model had a very significant effect on the care needs of children with cancer and their caregivers. Our findings indicate that a discharge-planning program and a hospital-based home care model had a very significant effect on the care needs of children with cancer and their caregivers.

Defining an age cut-off for older offenders: a systematic review of literature.

PURPOSE: In the literature, 65 years is commonly used as the age to designate an older person in the community. When studying older prisoners, there is much variation. The purpose of this paper is to investigate how researchers define older offenders and for what reasons. DESIGN/METHODOLOGY/APPROACH: The authors reviewed articles on health and well-being of older offenders to assess terminology used to describe this age group, the chosen age cut-offs distinguishing younger offenders from older offenders, the arguments provided to support this choice as well as the empirical base cited in this context. FINDINGS: The findings show that the age cut-off of 50 years and the term "older" were most frequently used by researchers in the field. The authors find eight main arguments given to underscore the use of specific age cut-offs delineating older offenders. They outline the reasoning provided for each argument and evaluate it for its use to define older offenders. ORIGINALITY/VALUE: With this review, it is hoped to stimulate the much-needed discussion advancing towards a uniform definition of the older offender. Such a uniform definition would make future research more comparable and ensure that there is no ambiguity when researchers state that the study population is "older offenders".

COVID-19 Community Stabilization and Sustainability Framework: An Integration of the Maslow Hierarchy of Needs and Social Determinants of Health.

All levels of government are authorized to apply coronavirus disease 2019 (COVID-19) protection measures; however, they must consider how and when to ease lockdown restrictions to limit long-term societal harm and societal instability. Leaders that use a well-considered framework with an incremental approach will be able to gradually restart society while simultaneously maintaining the public health benefits achieved through lockdown measures. Economically vulnerable populations cannot endure long-term lockdown, and most countries lack the ability to maintain a full nationwide relief operation. Decision-makers need to understand this risk and how the Maslow hierarchy of needs and the social determinants of health can guide whole of society policies. Aligning decisions with societal needs will help ensure all segments of society are catered to and met while managing the crisis. This must inform the process of incremental easing of lockdowns to facilitate the resumption of community foundations, such as commerce, education, and employment in a manner that protects those most vulnerable to COVID-19. This study proposes a framework for identifying a path forward. It reflects on baseline requirements, regulations and recommendations, triggers, and implementation. Those desiring a successful recovery from the COVID-19 pandemic need to adopt an evidence-based framework now to ensure community stabilization and sustainability.

Construct validity of the Capacity Profile in preschool children with cerebral palsy.

The Capacity Profile (CAP) classifies additional care needs, subdivided into five domains of body functions (physical health, motor, sensory, mental, and voice/speech) of children with stable conditions. Construct validity of the CAP was established in 72 children (56 males, 16 females) with cerebral palsy (CP); median age 2 years 7 months, range 2 years 6 months to 3 years; 34 unilateral and 37 bilateral spastic-type CP, one dyskinetic-type CP. Gross Motor Function Classification System (GMFCS) classification was 24 in level I, eight in level II, 18 in level III, 14 in level IV, and eight in level V. All CAP domains were significantly associated (p<0.001) with the Functional Skills (rho=-0.42 to -0.85) and Caregiver Assistance scales (rho=-0.42 to -0.82) of the Dutch Paediatric Evaluation of Disability Inventory. The CAP-motor domain and GMFCS were strongly correlated (rho=0.91, p<0.001). Stepwise regression analysis demonstrated that the CAP domains contributed 74% to mobility (CAP-motor 66%, mental 6%, voice 2%); 75% to self-care (CAP-voice 61%, mental 12%, physical 2%); and 70% to social functionality (CAP-mental 68%, voice 2%). CAP demonstrated good construct validity in young children with CP. The independent contribution of CAP domains to daily function underscores the importance of comprehensive assessment with regard to all domains of body functions in heterogeneous conditions like CP.

Experience of health-related problems during house parties in the Netherlands: nine years of experience and three million visitors.

OBJECTIVE: The objective of this study was to report on a nine years of experience of providing medical support during house parties (raves) in the Netherlands, where they can be organized legally. DESIGN: This was a prospective, observational study of self-referred patients from 1997 to 2005. During raves, first aid stations are staffed with specifically trained medical and paramedical personnel. Self-referred patients were diagnosed, treated, and recorded using standardized methods. RESULTS: During a nine-year period with 219 raves occurred, involving approximately three million participants, 23,581 patients visited the first aid stations. The medical usage rate (MUR) varied from 59-170 patients per 10,000 rave participants. The mean age increased from 1997 to 2005 from 18.7 +/- 2.7 to 23.3 +/- 5.7 years. The mean stay at the first aid station was 18 +/- 46 minutes. Most health problems were mild. Fifteen cases of severe incidents were observed with one death. CONCLUSIONS: Unique data from the Netherlands demonstrate a low number of serious, health-related, short-term problems during raves.

Referral mode and pattern of malocclusion among patients attending the Lagos University Teaching Hospital, Lagos, Nigeria.

BACKGROUND: In Nigeria, the awareness of the dentition and its role in the overall facial beauty is increasing, especially in the urban areas. The purpose of this study was to assess the demand for orthodontic treatment and the pattern of malocclusion in patients attending the Lagos University Teaching Hospital, Lagos, Nigeria. METHOD: A 5-year retrospective study of 633 patients, 288 males (45.5%) and 345 females (54.5%) attending the orthodontic unit of the hospital. RESULTS: The patients seen ranged from 1 to 50 years with the most frequent age group being that of 12-17 years constituting 37.5% of the total patients seen. Adult patients made up 30.7% of attending patients. Self-referred patients constituted 64.1% of this population. Class I molar relationship was predominantly occurring seen in 76.7% of patients. Anterior segment crowding was recorded in 38.7% and 43.2% of the patients for the upper and lower arch respectively. Marked increase in overjet was observed in 32.2%. Overbite discrepancies were recorded with 26.2% of patients with deep bite and 11.2% of patients with anterior open bite. A history or ongoing oral habit was recorded in 61.8% of patients.

Burden of primary care-type emergency department presentations using clinical assessment by general practitioners: A cross-sectional study.

OBJECTIVE: To compare methods of assessment of the burden of primary care-type ED (PCTED) presentations against clinical assessment by general practitioners (GPs) in ED. METHODS: A cross-sectional study involving clinical assessment of patients presenting to four EDs in Western Australia. The GPs assessed patients who were likely to be discharged home from ED, and considered whether they could be managed in general practice. Patient presentations were defined by the GPs as: PCTED; PCTED if additional primary care resources were available; or not PCTED. RESULTS: GP researchers determined that 80% of patients assessed were PCTED presentations, with one-third of these considered PCTED presentations if additional resources were available. A high proportion of identified PCTED presentations included categories excluded by previous methods. Analysis of linked data found the cohort assessed to be of lower urgency, younger, and with a shorter length of stay than the average patient being discharged from ED. After accounting for potential bias, it is suggested that 20-40% of all ED presentations could be PCTED presentations. CONCLUSIONS: Previous methods determining the burden of PCTED presentations have not been validated. Many presentations excluded by previous methods were identified as manageable in general practice by GPs clinically assessing patients in ED. Improved validation of criteria used to identify PCTED presentations will enable appropriately designed interventions to reduce such events.

3Ts of low cure rate: taxonomy, themes and theory of low cure rate in Pakistan's TB control programme and gathering a 360-degree perspective through qualitative, in-depth interviewing approach.

OBJECTIVE: WHO recommends cure of tuberculosis (TB) as the best prevention strategy; however, information about factors associated with low cure rate in patients with drug-susceptible TB is limited in Pakistan. Therefore, the purpose of this study was to explore the factors that account for low TB cure rate. METHODOLOGY: The present qualitative study recruited diverse informants through purposive sampling to explore low cure rate situation in Badin between March and June 2017. Data were collected from clinicians, paramedics, lab technicians, district field supervisors, patients and treatment supporters through indepth and face-to-face interviews. Interviews were conducted in local languages (Urdu and Sindhi) and transcribed into English. Coding structure was developed inductively and applied on textual data to draw output at the levels of taxonomy, themes and theory, as proposed by Bradley et al. FINDINGS: Thirty-seven individuals consented to participate in this study and provided detailed account of the subject under enquiry. Review of interview data collected from a variety of informants resulted in the identification of four broad factors (taxonomy) that contributed to the situation of low cure rate in one of the districts implementing the public-private mix intervention. These factors were (1) health-seeking behaviour, (2) technical capacity of the healthcare provider, (3) managerial capacity of the healthcare provider, and (4) access to healthcare facility and services. Each factor is deconstructed into key dimensions (themes) that emerged from the dialogue between the interviewer and the respondents. Moreover, dimensions were exemplified through underlying concepts that correspond to theories for low cure rate. CONCLUSION: Change in programme reporting requirement has demeaned the significance of having cure as treatment outcome. Therefore, returning the focus to achieving cure status for TB cases will be beneficial for assessing the effectiveness of TB control efforts. In parallel to the care delivery system, a mechanism for disseminating disease-related and treatment-related information should be introduced.

A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers.

AIMS: To test the effectiveness of a discharge planning program for dyads of older stroke survivors and their family caregivers in Taiwan. BACKGROUND: Family caregivers of stroke survivors often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. However, little information could be found on discharge planning programs for caregivers of stroke survivors in Asian families. DESIGN: A randomised experimental design was used to explore the effects of a discharge planning program for 158 dyads of older stroke patients and their family caregivers. METHODS: The control group (n = 86 dyads) received only routine hospital discharge planning services and the experimental group (n = 72 dyads) received routine hospital discharge planning services plus the caregiver-oriented discharge planning program. Outcome variables were measured at baseline, before discharge and one month after hospital discharge. Variables were measured by the Nurse Evaluation of Caregiver Preparation Scale, Preparedness for Caregiving Scale, Caregiver Discharge Needs Satisfaction Scale and Perception of Balance between Competing Needs Scale. RESULTS: Caregivers in the experimental group had significantly better nurse evaluation and self-evaluation of preparation after the program than before, and greater satisfaction of discharge needs one month after discharge than before discharge. Caregivers in the experimental group had significantly better nurse evaluations and self-evaluations of preparation and better satisfaction of discharge needs after the program compared with the control group. However, no significant difference was found between caregiver groups in perceived balance of competing needs. CONCLUSIONS: This discharge planning program benefited family caregivers of older stroke patients during the transition from hospitalisation to one month after discharge. RELEVANCE TO CLINICAL PRACTICE: This caregiver-oriented discharge planning program, with its emphasis on individualised health education and home visits following discharge may improve caregivers' preparation and the satisfaction of their needs during the discharge transition.

[Needs of persons with mental disorders--definitions and literature review]. / Potrzeby osób z zaburzeniami psychicznymi--definicje, przeglad badan.

Failure of the deinstitutionalization process and a tendency of limitating health care costs on the basis of evidence based medicine initiated planning mental health services according to the clients' needs. Defining needs is difficult due to the complexity of the concept ofneeds, so numerous definitions of needs have been proposed. In the health care context a need is most often regarded as "the lack of health/wellbeing or the lack of access to care". Many clinical and population-based studies on needs were conducted in England and other well-developed countries. According to their results the most important are unmet needs, which correlate with unemployment, single status, low quality of life, low satisfaction with services and high social disability scores. Assessment of needs becomes a part of routine clinical practice and evaluation of mental health services. Results of such an assessment enables to fit the therapy and rehabilitation to the individual patient's needs which in consequence leads to a better therapeutic response and lower social disability. First Polish studies on needs of persons with different mental disorders indicate the social needs (company, intimate relationship and sexual expression) as the most often unmet from patient's point of view.

3D-QSARpy: Combining variable selection strategies and machine learning techniques to build QSAR models

Abstract Quantitative Structure-Activity Relationship (QSAR) is a computer-aided technology in the field of medicinal chemistry that seeks to clarify the relationships between molecular structures and their biological activities. Such technologies allow for the acceleration of the development of new compounds by reducing the costs of drug design. This work presents 3D-QSARpy, a flexible, user-friendly and robust tool, freely available without registration, to support the generation of QSAR 3D models in an automated way. The user only needs to provide aligned molecular structures and the respective dependent variable. The current version was developed using Python with packages such as scikit-learn and includes various techniques of machine learning for regression. The diverse techniques employed by the tool is a differential compared to known methodologies, such as CoMFA and CoMSIA, because it expands the search space of possible solutions, and in this way increases the chances of obtaining relevant models. Additionally, approaches for select variables (dimension reduction) were implemented in the tool. To evaluate its potentials, experiments were carried out to compare results obtained from the proposed 3D-QSARpy tool with the results from already published works. The results demonstrated that 3D-QSARpy is extremely useful in the field due to its expressive results.

Toward youth friendly services: a survey of young people in primary care.

BACKGROUND: The World Health Organization encourages the development of youth friendly services, yet little is known on how youth currently present in general practice. OBJECTIVE: To describe the perspectives, expectations, and service receipt of young people presenting to family doctors to inform the development of youth friendly services. DESIGN: Cross-sectional survey. PARTICIPANTS AND MEASUREMENTS: Consecutive young people attending 26 randomly selected practices were recruited in the waiting rooms. Standardized instruments were used to interview them before their consultation. RESULTS: Of 501 young people who were approached, 450 participated (91% participation rate). Most had respiratory (26%) or dermatological complaints (18%). When asked to assess their health status, 59% perceived they had neither a physical nor a mental illness. However, 43% stated they had fears about their health problem and 1 in 5 feared it could be life-threatening. Although only 10% presented with psychological complaints, 24% perceived they currently had a mental illness. The most common expectations were treatment (50%) and good communication (42%). Most youth were prescribed medication (60%), but 40% of those who received a prescription had not expected to receive a treatment. A follow-up appointment was offered to 57% of participants. CONCLUSIONS: This study identifies a gap between young people's perception of illness and their presentations to family doctors. It also highlights unexpected fears, and a mismatch between expectations and service receipt. These findings have implications for family medicine training and for clinical practice. They should inform the development of youth friendly services.

Is the British National Health Service equitable? The evidence on socioeconomic differences in utilization.

Is the British National Health Service (NHS) equitable? This paper considers one part of the answer to this: the utilization of the NHS by different socioeconomic groups (SEGs). It reviews recent evidence from studies on NHS utilization as a whole based on household surveys (macro-studies) and from studies of the utilization of particular services in particular areas (micro-studies). The principal conclusion from the majority of these studies is that, while the distribution of use of general practitioners (GPs) is broadly equitable, that for specialist treatment is pro-rich. Recent micro-studies of cardiac surgery, elective surgery, cancer care, preventive care and chronic care support the findings of an earlier review that use of services was higher relative to need among higher SEGs.

The associations of gender, sexual identity and competing needs with healthcare utilization among people with HIV/AIDS.

Studies report gender differences in medical service utilization among persons with HIV, although most compare women to heterogeneous groups of men. Competing needs for medical care of women may contribute to those differences. We examined prospectively the role that competing social, economic and health needs, such as caring for others, play in gender differences in hospital, ambulatory and emergency room (ER) visits. We considered sexual identity to study women, gay/bisexual men and heterosexual men in the most recent wave (n = 1,385) of the HCSUS, a nationally representative sample of persons with HIV/AIDS in care in the United States. We considered gay/bisexual men and heterosexual men separately because their different resources and social networks may lead to disparate service utilization. Multivariate regression showed that women were more likely than gay/bisexual men to be hospitalized, while women and gay/bisexual men were more likely than heterosexual men to use the ER without subsequent hospitalization. Controlling for competing needs eliminated neither difference but predicted hospitalization and ER use. Findings suggest that addressing competing needs could reduce unnecessary hospitalization and ER use for both genders. Furthermore, examinations of gender differences in service use should include sexual identity.