Reasons for hospital admissions among youth and young adults with cerebral palsy

Young NL, McCormick AM, Gilbert T, Ayling-Campos A, Burke T, Fehlings D, Wedge J. Reasons for hospital admissions among youth and young adults with cerebral palsy.

Objective

To identify the most common reasons for acute care hospital admissions among youth (age range, 13–17.9y) and young adults (age range, 23–32.9y) with cerebral palsy (CP).

Design

We completed a secondary analysis of data from the Canadian Institute for Health Information (CIHI) to determine the most frequently observed reasons for admissions and the associated lengths of stay (LOS).

Setting

Participants were identified from 6 children's treatment centers in Ontario, Canada.

Participants

Health records data from youth with CP (n=587) and young adults with CP (n=477) contributed to this study.

Interventions

Not applicable.

Main Outcome Measures

The most common reasons for hospital admission, relative frequencies of admissions for each reason, and mean LOS were reported.

Results

The analysis of CIHI records identified epilepsy and pneumonia as the top 2 reasons for admissions in both age groups. Both age groups were commonly admitted because of infections other than pneumonia and urinary tract infections (UTIs), gastrointestinal (GI) problems such as malabsorption, and mental illness. The reasons that were unique to youth included orthopedic and joint-related issues, other respiratory problems, and scoliosis. In young adults, mental illness was the third most common reason for admission, followed by lower GI or constipation problems, malnutrition or dehydration, upper GI problems, fractures, and UTIs.

Conclusions

This article provides important clinical information that can be used in the training of physicians and health care providers, and to guide future planning of ambulatory care services to support the clinical management of persons with CP over their lifespan.     

妇科应用信息本和个人考核本的体会

目的设立信息本和个人考核本,对身边发生的每件事、护理人员存在的问题和优点进行随时记录,通过有意识导向与控制,提高护理质量。方法对身边发生的每一件事情、护理人员存在的问题和优点进行随时记录。结果设立信息本为护理人员提供信息,使她们能够随时阅读,加强了护士长与护士间信息交流的互动,采用个人考核本能够对护理人员存在的问题和优点进行详细记录,通过有意识导向与控制,提高护理质量。结论设立信息本使护士长与护士间的沟通变得更加快捷、直接和有效,个人考核本的设立,能够对护士的问题和优点进行详细记录,使她们及时发现自己的长处和短处,并在此基础上取长补短,从而更加出色地完成本职工作,提高了护理质量。     

A systematic review of mentorship programs to facilitate transition to post-secondary education and employment for youth and young adults with disabilities

Purpose: Youth with disabilities experience barriers in transitioning to Post-Secondary Education (PSE) and employment. Mentorship programs provide a promising approach to supporting youth through those transitions. This paper aims to identify the effective components of mentorship programs and describe participants’ experiences. Method: We undertook a systematic review of mentorship interventions for youth and young adults with disabilities. We searched seven electronic databases for peer-reviewed articles published in English between 1980 and 2014. We included articles that examined mentorship interventions focused on PSE or employment outcomes among youth, aged thirty or younger, with physical, developmental, or cognitive disabilities. Results: Of the 5068 articles identified, 22 met the inclusion criteria. For seven mentorship interventions, at least one significant improvement was reported in school- or work-related outcomes. Mentorship programs with significant outcomes were often structured, delivered in group-based or mixed formats, and longer in duration (>6 months). Mentors acted as role models, offered advice, and provided mentees with social and emotional support. Conclusions: Evidence suggests that mentorship programs may be effective for helping youth with disabilities transition to PSE or employment. More rigorously designed studies are needed to document the impact of mentorship programs on school and vocational outcomes for youth with disabilities.

• Implications for Rehabilitation

• Mentorship interventions have the potential to effectively support youth with disabilities as they transition to post-secondary education and employment.

• Youth should consider participating in formal mentorship interventions, and clinicians and educators should encourage them to do so, to enhance social, educational, and vocational outcomes.

• When developing interventions, clinicians should consider incorporating the effective components (i.e. duration, content, format) of mentorship interventions identified in this paper. Future mentorship programs should also contain a rigorous evaluation component.

• Clinicians can help to create (build content, consult on accessibility), connect (youth to program, program to community agencies), and contribute to mentorship interventions.

     

A targeted testing program for tuberculosis control and prevention among Baltimore city's homeless population

OBJECTIVE: To identify cases of latent tuberculosis infection (LTBI) and improve access to TB treatment among the inner-city homeless. DESIGN: This is an intervention study describing the impact of a public health program on TB prevention and control. SAMPLE: The target population for the project was residents and recent graduates of a residential addictions recovery program in a faith-based, inner-city mission. INTERVENTION: Faculty and student nurses administered purified protein derivative (PPD) tuberculin skin tests and TB symptom assessments on site to homeless Mission residents. Residents testing positive for TB infection were referred to the local city health department for follow-up. Residents placed on prophylactic therapy received intensive tracking and coaching interventions to encourage adherence to the 9-month regimen. RESULTS: Ninety-eight percent of the target population was screened for LTBI. Ninety percent of residents requiring treatment for LTBI successfully accessed treatment services. Thirty-three percent of residents completed at least 6 months of treatment. CONCLUSION: The program demonstrated a modest improvement in treatment completion among the inner-city homeless when compared with local City Health Department treatment completion rates. This program demonstrates how a faith-based organization, an academic institution, and local government can successfully partner together to meet community needs.     

A scoping review of the experiences,benefits, and challenges involved in volunteer work among youth and young adults with a disability

Purpose: To develop a better understanding of the experiences of volunteer work among youth with disabilities. Method: A scoping review was undertaken to assess the benefits and challenges of volunteering among youth with disabilities. Comprehensive searches using six international databases were conducted. Eligible articles included: (a) youth aged 30 or younger, with a disability; (b) empirical research on the benefits or challenges of volunteering; (c) published in a peer-reviewed journal between 1980 and 2014. Results: Of the 1558 articles identified, 20 articles – involving 1409 participants, aged 12–30, across five countries – met the inclusion criteria. Studies linked volunteering to the development of human capital (i.e. practical experience, improved self-determination, self-confidence, coping), enhanced social capital (i.e. social and communication skills, social inclusion) and improved cultural capital (i.e. helping others, contributing to community). Many youth with disabilities also encountered challenges – including lack of accessible volunteer opportunities, difficulties arranging transportation, and negative attitudes from potential supervisors. Conclusions: Young people with disabilities are willing and able to volunteer, and they report benefits of volunteering; however, they face many challenges in finding suitable volunteer positions. More rigorous research is needed to understand the health and social benefits of volunteering and how it can help youth develop career pathways.

• Implications for Rehabilitation

• Clinicians, educators and parents should discuss the benefits of volunteering with youth with disabilities and assist them in finding placements that match their interests and abilities.

• Managers and clinicians should consider incorporating volunteering into vocational rehabilitation programming (i.e. addressing how to find placements and connecting youth to organisations).

• Clinicians should encourage youth to take part in social and extracurricular activities to help build their social skills and networks where they can learn about volunteer opportunities.

• Clinicians and educators should advocate on behalf of youth with disabilities among community organisations to help break down barriers and reduce misconceptions and negative attitudes by showcasing the abilities that youth with disabilities have to offer.

     

The need for sexual health information: perceptions and desires of young adults

PURPOSE: To ascertain young adults perceptions of previously received sexual health information and describe what types of information they would like to receive. STUDY DESIGN AND METHODS: In individual interviews, 55 young adults were asked questions regarding their perceptions of previously received sexual health information as well as their interests in receiving future information. Content analysis was used to categorize responses and identify categories. RESULTS: The majority of participants remember receiving information about sexually transmitted infections (STIs) primarily from classes in middle and high school. Less than half remembered receiving information about contraception or how to prevent STIs. The majority of participants did not feel that (or were uncertain about whether) past information influenced their current sexual practices. Of those who felt past education influenced them in changing sexual practices, an increase in awareness of their risk was the category most often cited. One-third of the participants responded that a culture of abstinence in the US explained why current educational programs failed. When asked to describe an ideal sexual health program, the most common answers were wanting a comfortable, "not scared" person to teach them more "nitty-gritty" information about STIs with "more details," what they could do to protect themselves, "how to get birth control," and "how the reproductive system works." CLINICAL IMPLICATIONS: Young adults have specific needs and interests when it comes to sexual health information. Research is necessary to see if development of specific interventions requested by young adults would result in higher levels of recall and ability to avoid dangerous sexual practices.     

信息支持护理对产妇健康知识及产后焦虑的影响

目的 探讨信息支持护理在产妇健康教育中的应用效果.方法 选取86例初产妇为研究对象,将其随机分为观察组和对照组,对照组采用常规健康教育,观察组在围产期加强综合信息支持,比较两组的产妇的健康知识知晓率、分娩结局及产后焦虑情况.结果 观察组的健康知识知晓率显著、分娩前主观选择阴道分娩的比例、实际阴道分娩率显著高于对照组(P＜0.05).观察组的产后出血量、新生儿窒息率及产后焦虑评分显著少于对照组(P＜0.05).结论 信息支持更能满足产妇对围产期健康知识的需求,增加产妇的分娩知识,改善分娩结局.     

A path analysis of Internet health information seeking behaviors among older adults

The Internet has emerged as an innovative tool that older adults can use to obtain health-related information. However, the relationships among predictors of Internet health information seeking behaviors (IHISB) in this population are not well understood. To fill this gap, this study examined the direct and indirect pathways of potential predictors of IHISB among older South Korean adults, using the modified Technology Acceptance Model 3. Participants were 300 older South Korean adults who had used the Internet to obtain health information within the past month. Data were collected via a self-report questionnaire and were analyzed through structural equation modeling. Two variables—prior experience and behavioral intention to use—had positive direct effects on IHISB. These findings imply that health care providers promoting IHISB among older adults should consider these individuals' prior experience with the Internet and their willingness to use the Internet as a source of health information.     

浅议建立医疗纠纷数据信息体系的可行性

日益增多的医疗纠纷已成为目前困扰各级医疗部门及患者的重要问题之一。因此，有必要尽快建立一个医疗纠纷数据信息体系，以适应新的《医疗事故处理条例》，缓解日益激化的医患矛盾，弥补现有调查数据的空白。由于具有政府上网工程框架的支持和成熟的网络技术条件，使这一信息体系的实现具有一定的可操作性。该体系的建立，将为卫生立法提供客观而公正的数据信息，有利于实现医疗事故处理“公开、公平、公正、及时、便民”原则，使医疗纠纷的处理走出困境。     

中青年原发性高血压患者教育依从性与医疗费用的相关研究

目的 探讨对中青年原发性高血压患者实施健康后,患者的依从程度与医疗费用之间的关系.方法 对140例中青年原发性高血压患者实施相同的科学的强化教育和个性化教育,用自行设计的依从性调查表进行评分,结果分为依从性好组(A组)和依从性差组(B组),比较两组患者的医疗费用情况.结果 A组患者文化程度、家庭经济收入、享受医疗保障程度高于B组(P＜0.05);A组药物费用显著高于B组(P＜0.01);并发症及住院总费用则显著低于B组(P＜0.01),两组监测费用比较差异无统计学意义;A组血压控制情况显著优于B组(P＜0.01).结论 对中青年原发性高血压患者进行健康知识教育提高其依从性,使长期医疗费用支出降低,血压得到很好的控制,减少了心、脑、肾并发症的发生,并提高了患者的生活质量.     

Development and use of a web-based data management system for a randomized clinical trial of adolescents and young adults

Recent advances in technology provide support for multisite, Web-based data-entry systems and the storage of data in a centralized location, resulting in immediate access to data for investigators, reduced participant burden and human entry error, and improved integrity of clinical trial data. The purpose of this article was to describe the development of a comprehensive, Web-based data management system for a multisite randomized behavioral intervention trial. Strategies used to create this study-specific data management system included interdisciplinary collaboration, design mapping, feasibility assessments, and input from an advisory board of former patients with characteristics similar to the targeted population. The resulting data management system and development strategies provide a template for other behavioral intervention studies.     

重症监护临床信息系统的应用和效果探讨

目的:介绍重症监护临床信息系统(ICIP系统)的临床应用和取得的成效。方法:统计并比较ICIP护理记录模式和手工护理记录模式的差异。结果:ICIP护理记录的质量明显高于手工记录,且ICIP护理记录耗费的时间明显减少。结论:ICIP系统的使用明显改进了ICU护理工作,简化了流程,大大缩短了护理记录时间,使护理工作真正做到了把护士还给患者。     

基于智能健康监测系统的社区居民健康状况及影响因素分析

目的 旨在调查社区居民健康状况,分析影响健康的相关因素。 方法 2019年4月—5月,采用描述性横断面研究,便利获取来自全国不同地区4 311例居民为研究对象,通过智能健康监测系统获取研究对象的健康数据,包括一般特征、健康行为及健康状况、广泛性焦虑障碍量表和抑郁症筛查量表测评结果。 结果 研究对象年龄为（29.25±11.88）岁,慢性病患病率为13.8%。存在焦虑者有1 480例（34.3%）,存在抑郁症状者有1 620例（37.6%）。吸烟率、饮酒率分别为12.2%、32.3%。年龄、文化程度、已婚、饮食规律性、上午加餐情况、以肉食为主、饮食偏咸、其他特殊饮食、饮酒频率、是否剧烈运动、焦虑程度、抑郁程度是慢性病患病情况的影响因素。结论 社区居民健康状况良好,普遍存在焦虑、抑郁,需重视心理健康。老年、已婚、进餐不规律、以肉食为主、饮食偏咸、其他特殊饮食、经常饮酒、无剧烈运动、抑郁和焦虑的社区居民易患慢性病,建议参考慢性病影响因素制订社区居民健康促进措施。     

Effect of a community-based participatory health literacy program on health behaviors and health empowerment among community-dwelling older adults: A quasi-experimental study

This study evaluated the effect of a community-based participatory health literacy program aimed at improving the health behaviors and health empowerment for older adults. A two-group pretest and posttest quasi-experimental design with surveys conducted at baseline (T₁), immediately after the intervention (T₂), and 6 months after the intervention (T₃). The intervention group (n = 94) attended a 12-week health literacy program; while the comparison group (n = 78) did not. The results demonstrated that intervention group had significantly better health behavior practices for weight control (OR = 3.71, 95% CI = 1.59–8.64), regular exercise (OR = 15.26, 95% CI = 1.92–121.13), and health information navigation (OR = 2.61, 95% CI = 1.16–5.84). Health empowerment was significantly higher in the intervention group than the comparison group (p < 0.01).This study suggests that integrating community-based participatory design is effective in improving some health behaviors and health empowerment in older adults over a short period.     

Use of electronic personal health records (PHRs) for complementary and alternative medicine (CAM) disclosure: Implications for integrative health care

ObjectivesTo test a hypothesis that patients' use of Internet-based personal health records (PHRs) will be positively related to their disclosure of their CAM use to medical doctors, controlling for covariates' effects (e.g., health, human capital, and demographics), and to examine the factors influencing patients' CAM use disclosures.DesignCross-sectional survey.MethodsWe analyzed data in a subsample of CAM users who used both the internet and healthcare services (n = 1457) from the Health Information National Trends Survey, a nationally representative study of U.S. adults (≥18), by using a multivariate logistic analysis.ResultsAmong the subsample, 52.7% disclosed their use of CAM to their doctors and 19.3% used PHRs. Both the bivariate (64.1% vs. 35.9%, p < 0.01) and multivariate (β = 0.558, SE = 0.220, OR = 1.75, p < 0.05) analyses revealed a positive relationship between PHR use and CAM use disclosure. Other significant factors for CAM use disclosure included being older, being a female, having insurance, and having regular source of care. Particularly, foreign-born adults had significantly lower odds of disclosing their CAM use than U.S.-born adults.ConclusionsWe found that patients' PHR use facilitated their disclosure of CAM use to medical doctors. To ensure integrative healthcare and integrative medicine in the healthcare sector and optimum care for patients, education for CAM users regarding PHR adoption is encouraged. Next-generation PHR designs should consider incorporating domains for CAM data that allow patients to store CAM data and also incorporating ‘intelligent' PHRs, whose contents can be converted into the patient's first language.     

人乳库智能信息管理系统的构建及应用研究

目的 构建人乳库智能信息管理系统,建立连接人乳捐赠者、管理者、受捐者三方的管理运行信息化平台,规范并优化流程,探索适合中国国情的人乳库管理方法.方法 构建人乳库智能信息管理系统,包括5个功能模块:捐赠者信息导入、需乳信息录入、捐赠人乳出入库信息管理、不良事件追踪、统计分析.比较系统应用前2019年7月—8月与系统应用后...     

The Affordable Care Act: Disparities in emergency department use for mental health diagnoses in young adults

BACKGROUND: There is little consensus as to the effects of insurance expansion on emergency department (ED) utilization for mental health purposes. We aimed to study the race specific association between the dependent coverage provision of the Affordable Care Act (ACA) and changes in young adults' usage of emergency department services for psychiatric diagnoses.