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1.
Introduction
Contemporary mental services delivery is moving towards cost-effective community based as opposed to institutionalized care (Harrison, Alam & Mashall, 2001). Domiciliary mental health care is one example of such service that is being promoted in developed countries. Domiciliary mental health care refers to the delivery of mental health services in the home for purposes of restoring and maintaining the health of clients when they are in acute state (Campbell, 1996). This paper highlights successes and lessons learnt in the domiciliary mental health care approach that St. John of God Community Services is implementing in the northern city of Mzuzu.Objectives of the program
The broad objective of domiciliary mental health care in Mzuzu service is to provide an alternative community based mental health care to clients with mental health problems in the city of Mzuzu and its environs through care delivery, family education, community participation and alleviation of stigma associated with psychiatric admission.Strategies
Strategies used in the program include provision of nursing care to clients in their homes; mobile clinics and mental health education to family members and the entire community.Successes
Some successes of this cost-effective initiative include attainment of optimum level of functioning by 275 clients since establishment in 2006; reduced recovery period when compared with those in residential unit; family/community involvement, reduced stigma associated with admission to a psychiatric hospital and the freedoms enjoyed whilst in the homes.Challenges
The biggest challenge is that some carers do not cooperate and prefer that their client be managed in the hospital even when client is less problematic at home.Conclusion
Domiciliary mental health care is cost-effective and feasible in Malawi provided families are given support within their communities. 2011 Sep; 23(3): 99–103.Increasing the Capacity of Health Surveillance Assistants in Community Mental Health Care in Zomba District — Interim Findings of an Education Intervention
Jerome Wright, Dr Stephanie Common, Dr Felix Kauye, and Mr Chikayiko ChiwandiraAuthor information Copyright and License information Disclaimer“Zomba Link”, Harrogate, UK and Zomba Mental Hospital, Zomba, MalawiCopyright notice 相似文献2.
Background
A wide range of health problems has been reported in elderly post-stroke patients.Aim
The aim of this study was to analyse the prevalence and timing of health problems identified by patient interviews and scrutiny of primary health care and municipality elderly health care records during the first post-stroke year.Methods
A total of 390 consecutive patients, ≥65 years, discharged alive from hospital after a stroke event, were followed for 1 year post-admission. Information on the health care situation during the first post-stroke year was obtained from primary health care and municipal elderly health care records and through interviews with the stroke survivors, at 1 week after discharge, and 3 and 12 months after hospital admission.Results
More than 90% had some health problem at some time during the year, while based on patient record data only 4–8% had problems during a given week. The prevalence of interview-based health problems was generally higher than record-based prevalence, and the ranking order was moderately different. The most frequently interview-reported problems were associated with perception, activity, and tiredness, while the most common record-based findings indicated pain, bladder and bowel function, and breathing and circulation problems. There was co-occurrence between some problems, such as those relating to cognition, activity, and tiredness.Conclusions
Almost all patients had a health problem during the year, but few occurred in a given week. Cognitive and communication problems were more common in interview data than record data. Co-occurrence may be used to identify subtle health problems. 相似文献3.
Background
Hepatitis B virus (HBV) infection is an important occupational risk in health care workers (HCW). In spite of HBV vaccine availability in Armed Forces, the high prevalence of HBV infection in HCW continues to be a problem. The study was undertaken to study the HBV vaccine-compliance among HCW.Methods
A cross-sectional study was conducted at a tertiary care hospital. HCW were requested to fill up the pre set questionnaire to assess the HBV vaccination coverage.Result
Amongst 254 HCW, only 57.7% were vaccinated against HBV. The vaccine compliance was lowest among housekeeping professionals. The mean age at vaccination was high (30.5 years). Amongst the vaccine non-compliant subjects, 34.3% were above 30 years of age. 32.2% HCW completed primary vaccination after spending more than 10 years in the profession. Accessibility of HBV vaccine, knowledge and perception of HBV risk were important factors in vaccine non-compliance.Conclusion
Due to low and delayed HBV vaccine-compliance, HCW continue to be at the risk of occupational HBV. Health education highlighting occupational risk of HBV, accessibility of vaccine and mandatory vaccination of HCW is recommended to increase HBV vaccine compliance among HCW.Key Words: Health care workers, Hepatitis B virus, Occupational risk, Hepatitis B vaccine 相似文献4.
5.
SN Mhango A Kalimbira B Mwagomba 《Malawi medical journal : the journal of Medical Association of Malawi》2015,27(2):41-44
Objective
To determine the prevalence of overnutrition and undernutrition among neuropsychiatric inpatients and outpatients at Zomba Mental Hospital in Zomba, Malawi.Methods
In this analytical cross-sectional study (n = 239), data were collected from psychiatric patients who were either inpatients (n = 181) or outpatients (n = 58) at Zomba Mental Hospital, which is the largest mental health facility in Malawi. Information was collected about patient demographics, anthropometric data, dietary information, and tobacco and alcohol use, among other variables. Data were entered and analysed in SPSS 16.0 (SPSS Inc., Chicago, IL, USA). Means were generated and compared between male and female patients, and between inpatients and outpatients.Results
The study recruited 158 male and 81 female patients, with mean ages of 31.24 ± 11.85 years and 33.08 ± 15.18 years (p = 0.328), respectively. Male patients were significantly taller (165.27 ± 7.25 cm) than female patients (155.30 ± 6.56 cm) (p < 0.001); were significantly heavier than females (60.02 ± 10.56 kg versus 55.64 ± 10.53 kg); and had a significantly lower mean body mass index (BMI) than females (21.87 ± 3.21 vs. 23.01 ± 3.78) (p = 0.016). Overweight and obese patients comprised 17.6% of the participants, and 8.8% were underweight. There were no significant differences in the prevalence of overweight, obesity, and underweight between male and female participants, or between inpatients and outpatients.Conclusion
Our study—the first one of its kind in Malawi—characterised the anthropometry of neuropsychiatric patients at a major metal health facility in Malawi, and has shown a high proportion of overweight patients and a notable presence of underweight patients among them. Being overweight or obese is a risk factor for metabolic disorders. Being underweight may aggravate mental illness or disturb the effect of medication. There is need, therefore, to include nutrition screening and therapeutic or supplementary feeding as part of a comprehensive care and treatment plan for neuropsychiatric patients. 相似文献6.
H Mhozya D Bintabara S Kibusi E Neilson BC Mpondo 《Malawi medical journal : the journal of Medical Association of Malawi》2015,27(4):125-127
Background
Late presentation and delayed treatment initiation is associated with poor outcomes in patients with HIV. Little is known about the stage at which HIV patients present at HIV clinics in Tanzania.Aim
This study aimed at determining the proportion of HIV patients presenting with WHO clinical stages 3 and 4 disease, and the level of immunity at the time of enrollment at the care and treatment center.Methods
A retrospective cross-sectional study was conducted among 366 HIV-infected adults attending HIV clinic at Mwananyamala Hospital in Dar es Salaam, Tanzania. Data were obtained from the care and treatment clinic database.Results
Late stage disease at the time of presentation was found in 276 (75.4%) of the patients; out of whom 153 (41.8%) presented with CD4 count <200 cells/ul and 229 (62.6%) presented with WHO clinical stage 3 or 4 at the time of clinic enrollment. Strategies to improve early diagnosis and treatment initiation should be improved. 相似文献7.
Objective
To determine doctors'' and nurses'' attitudes and beliefs about treating patients with type 2 diabetes with less than ideal glycaemic control while receiving maximal oral treatment in primary care.Design
Focus groups.Setting
Primary care.Participants
Four focus groups of 23 GPs and practice nurses.Results
General practice was thought to be the best setting for managing all patients with type 2 diabetes but there were concerns about a lack of resources and unfamiliarity with starting insulin. Issues around compliance were extensively discussed; the “failing diabetic” had dual meanings of failing glycaemic control and failing compliance and effort by both patient and doctor. Although views about insulin therapy differed, patients were understood to be resistant to starting insulin, representing for them a more serious stage of diabetes, with fears of needles and hypoglycaemia.Conclusion
The role of diabetes specialist nurses working in primary care will be crucial in managing such patients to improve knowledge, for extra resources, for their experience of insulin use, and to change attitudes. 相似文献8.
Background
Chronic respiratory conditions are increasingly becoming a cause of health concern with India attributing 11% of its mortality due to non-communicable diseases to chronic respiratory conditions. Chronic bronchitis and asthma take a large toll in terms of morbidity. Lesser number of studies have mentioned their counts of these conditions affecting women in rural area and therefore the present study was conducted with the objectives of determining the prevalence and correlates of chronic obstructive pulmonary diseases (COPD) in an area of a primary health centre in rural central India.Methods
A cross-sectional study was conducted in 24 villages of the study area. Women aged 40 years or more were interviewed using the IUATLD questionnaire. Chronic bronchitis was measured by using the standard criteria for chronic bronchitis, that is, “Presence of cough with expectoration for more than 3 months in a year for the past two or more years”.Results
Prevalence of chronic bronchitis among women was found to be 2.7%. Factors like older age, presence of a cattle shed within house premises, storage of fertilizers inside house, history of allergy, past history of pulmonary tuberculosis emerged as significant correlates of chronic bronchitis.Conclusions
The present study provides an insight into the prevalence of chronic bronchitis among rural women exposed to several epidemiological determinants and an opportunity to address the modifiable risk factors. 相似文献9.
Thomas D. Sequist Theresa Cullen Howard Hays Maile M. Taualii Steven R. Simon David W. Bates 《J Am Med Inform Assoc》2007,14(2):191-197
Objectives
There are limited data regarding implementing electronic health records (EHR) in underserved settings. We evaluated the implementation of an EHR within the Indian Health Service (IHS), a federally funded health system for Native Americans.Design
We surveyed 223 primary care clinicians practicing at 26 IHS health centers that implemented an EHR between 2003 and 2005.Methods
The survey instrument assessed clinician attitudes regarding EHR implementation, current utilization of individual EHR functions, and attitudes regarding the use of information technology to improve quality of care in underserved settings. We fit a multivariable logistic regression model to identify correlates of increased utilization of the EHR.Results
The overall response rate was 56%. Of responding clinicians, 66% felt that the EHR implementation process was positive. One-third (35%) believed that the EHR improved overall quality of care, with many (39%) feeling that it decreased the quality of the patient–doctor interaction. One-third of clinicians (34%) reported consistent use of electronic reminders, and self-report that EHRs improve quality was strongly associated with increased utilization of the EHR (odds ratio 3.03, 95% confidence interval 1.05–8.8). The majority (87%) of clinicians felt that information technology could potentially improve quality of care in rural and underserved settings through the use of tools such as online information sources, telemedicine programs, and electronic health records.Conclusions
Clinicians support the use of information technology to improve quality in underserved settings, but many felt that it was not currently fulfilling its potential in the IHS, potentially due to limited use of key functions within the EHR. 相似文献10.
Background
The phenomenon of “Military Family Syndrome” has been hotly debated. Mental disorders are however, important causes of morbidity in the armed forces.Methods
A cross sectional study was carried out on 600 randomly selected troops and families in a large military station. General Health Questionnaire 12 (GHQ-12) was used as a screening test for neuroses. Neuroses was defined as score of three and above on the GHQ-12.Result
Overall prevalence of neuroses was 31.34% with 95% confidence interval between 27.41% and 35.55%. Gender did not have any effect on prevalence of neuroses nor did marital status. The soldiers in the age group of 25-36 years were most affected. Neuroses was more common in the lower ranks and among troops who belonged to arms. Among wives, age, rank and type of service (whether from arms or services) of husband were not associated with neuroses.Conclusion
There is a need for preventive psychological services in the armed forces. Leadership and man-management sensitive to changing needs of the soldier should be promoted.Key Words: Neuroses, Armed forces, General health questionnaire 12 相似文献11.
Qing Zeng-Treitler Sergey Goryachev Tony Tse Alla Keselman Aziz Boxwala 《J Am Med Inform Assoc》2008,15(3):349-356
Objectives
Effective health communication is often hindered by a “vocabulary gap” between language familiar to consumers and jargon used in medical practice and research. To present health information to consumers in a comprehensible fashion, we need to develop a mechanism to quantify health terms as being more likely or less likely to be understood by typical members of the lay public. Prior research has used approaches including syllable count, easy word list, and frequency count, all of which have significant limitations.Design
In this article, we present a new method that predicts consumer familiarity using contextual information. The method was applied to a large query log data set and validated using results from two previously conducted consumer surveys.Measurements
We measured the correlation between the survey result and the context-based prediction, syllable count, frequency count, and log normalized frequency count.Results
The correlation coefficient between the context-based prediction and the survey result was 0.773 (p < 0.001), which was higher than the correlation coefficients between the survey result and the syllable count, frequency count, and log normalized frequency count (p ≤ 0.012).Conclusions
The context-based approach provides a good alternative to the existing term familiarity assessment methods. 相似文献12.
Objective
The aim of this study was to examine the reasons why primary care doctors undertake postgraduate diploma studies in a mixed private/public Asian setting.Methods
Twenty four past or current postgraduate diploma students of the family medicine unit (FMU) of the University of Hong Kong participated in three focus group interviews. A structured questionnaire was constructed based on the qualitative data collected and was sent to 328 former applicants of postgraduate diploma studies at FMU.Results
“Upgrading medical knowledge and skills” and “improving quality of practice” were two of the factors that most of the respondents considered to be significant in motivating them to undertake postgraduate diploma studies. “Time constraint” and “workload in practice” were however the most significant demotivating factors. Financial issues were more seriously considered by the junior than the senior doctors. To be able to “expand patient base and/or number” was considered to be a significant factor by the private doctors who were also keen to “improve communication and relationship with patients”.Conclusion
These findings suggest that there are mixed reasons for primary care doctors to undertake postgraduate diploma studies. Course organisers should take into consideration these various reasons in planning their programmes. 相似文献13.
J Roberts D Sealy H Hopp Marshak L Manda-Taylor P Gleason R Mataya 《Malawi medical journal : the journal of Medical Association of Malawi》2015,27(4):145-150
Background
Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization''s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake.Methods
A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites.Results
Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve.Conclusions
The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed. 相似文献14.
J B Mwambene A S Muula J C Leo 《Malawi medical journal : the journal of Medical Association of Malawi》2013,25(2):45-49
Background
Education is important in improving economies and creating literate, self-reliant and healthy societies. However, hunger is a barrier to basic education in Malawi. Hunger is also associated with a number of health risk behaviours, such as bullying, suicide ideation and unhygienic behaviours that may jeopardize the future of children. There are, however, limited data on the prevalence and associated factors of hunger among school children in Malawi.Methods
The study used data from the Malawi Global School-Based Health Survey conducted in 2009 to estimate the prevalence of self-reported hunger within the last 30 days among primary and secondary school age group. It also assessed the association between self-reported hunger and some selected list of independent variables using frequency distribution, chi-squared test and logistic regression.Results
A total of 2359 students were available for analysis. The overall self-reported prevalence of hunger within the last 30 days was 12.5% (18.9% (172) in the rural and 8.3% (115) in urban areas; and 11.9%(123) for male and 12.5(148) for female children). In the final analysis, geographical location, eating fruits, having been bullied, suicide ideation, and washing hands with soap were significantly associated with hunger.Conclusion
Hunger in both primary and secondary school children in Malawi is a major social problem. The design of school feeding programmes aimed to reduce hunger should incorporate the factors identified as associated with hunger. 相似文献15.
Background
A patent foramen ovale (PFO) is strongly associated with cryptogenic stroke (CS), neurological and other phenomena. The reported prevalence of PFO varies according to the imaging technique used and population studied.Purpose
To measure prospectively, the prevalence of PFO in a cohort of consecutive patients attending for routine “coronary” CT angiography using standard, everyday coronary protocols including low-dose prospective ECG gated studies.Methods
Standard coronary imaging protocols were used. PFOs were graded according to the classification of Williamson et al.1Results
261 patients were studied. A PFO was identified in 22.6% (11.5% grade 1 (closed flap), 6.5% grade 2 (open flap) and 4.6% grade 3 (open flap with jet)). A further 6.1% had an atrial septal aneurysm.Conclusions
The prevalence of all grades of PFO (22.6%) and open flap PFO (11.1% = grade 2 and 3) with this technique compares with 24.3% by trans-oesophageal echocardiography (TOE) and 14.9% by saline contrast echocardiography (SCE)2, 3 Further comparative studies are required but we believe an open flap PFO or ASA should be identified and recorded during cardiac CT. This approach may identify those at risk of cryptogenic stroke as well as avoid unnecessary tests in stroke patients. 相似文献16.
Robert C Wu Vivian Lo Dante Morra Brian M Wong Robert Sargeant Ken Locke Rodrigo Cavalcanti Sherman D Quan Peter Rossos Kim Tran Mark Cheung 《J Am Med Inform Assoc》2013,20(4):766-777
Background
Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness.Objectives
To describe the effects of different communication interventions and their problems.Design
Prospective observational case study using a mixed methods approach of quantitative and qualitative methods.Setting
General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals.Participants
Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards.Methods
Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010.Results
We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories.Conclusions
Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems. 相似文献17.
18.
“Not all my friends need to
know”: a qualitative study of teenage patients,privacy, and social media
Background
The literature describes teenagers as active users of social media, who seem to care about privacy, but who also reveal a considerable amount of personal information. There have been no studies of how they manage personal health information on social media.Objective
To understand how chronically ill teenage patients manage their privacy on social media sites.Design
A qualitative study based on a content analysis of semistructured interviews with 20 hospital patients (12–18 years).Results
Most teenage patients do not disclose their personal health information on social media, even though the study found a pervasive use of Facebook. Facebook is a place to be a “regular”, rather than a sick teenager. It is a place where teenage patients stay up-to-date about their social life—it is not seen as a place to discuss their diagnosis and treatment. The majority of teenage patients don''t use social media to come into contact with others with similar conditions and they don''t use the internet to find health information about their diagnosis.Conclusions
Social media play an important role in the social life of teenage patients. They enable young patients to be “regular” teenagers. Teenage patients'' online privacy behavior is an expression of their need for self-definition and self-protection. 相似文献19.
Objective
This study sought to explore physician organizations’ adoption of chronic care guidelines in order entry systems and to investigate the organizational and market-related factors associated with this adoption.Design
A quantitative nationwide survey of all primary care medical groups in the United States with 20 or more physicians; data were collected on 1,104 physician organizations, representing a 70% response rate.Measurements
Measurements were the presence of an asthma, diabetes, or congestive heart failure guideline in a physician organization’s order entry system; size; age of the organization; number of clinic locations; type of ownership; health maintenance organization market penetration; urban/rural location; and presence of external incentives to improve quality of care.Results
Only 27% of organizations reported access to order entry with decision support for chronic disease care. External incentives for quality is the only factor significantly associated with adoption of these tools. Organizations experiencing greater external incentives for quality are more likely to adopt order entry with decision support.Conclusion
Because external incentives are strong drivers of adoption, policies requiring reporting of chronic care measurements and rewarding improvement as well as financial incentives for use of specific information technology tools are likely to accelerate adoption of order entry with decision support. 相似文献20.
Watcharawit Rassami Mayura Soonwera 《Asian Pacific Journal of Tropical Biomedicine》2012,2(11):901-904