What is the impact of day care on older people with long-term conditions: A systematic review

There is a lack of robust evidence regarding outcomes for day care use among older people living with long-term conditions (LTCs). Day care is provided by independent, private and voluntary and charitable sectors. This systematic review aims to establish current evidence of outcomes for older people with LTCs attending day care services and outcomes on carers, across all service models. Narrative synthesis of quantitative and qualitative data was undertaken. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was carried out across eight electronic databases and reference lists of key journals between 2004 and October 2020 were searched. Searches returned 1,202 unique titles. Forty-five articles from 16 countries met the criteria on review of title, abstract and full article. There is limited evidence suggesting improved levels of perceived psychological health, quality of life, perceived general health, physical health and functioning for older people attending day care who have LTCs. The respite function of day care resulted in positive outcomes for carers. Studies evaluating outcomes for participants or carers were limited in quantity and quality. There is limited information regarding outcomes for day care attendance for older people with multiple LTCs from existing literature. Further research focusing on LTCs and day care attendance would benefit this field.     

我国居家老人对社区三类健康服务需求的影响因素分析

目的 综合分析我国居家老人对社区保健知识、精神蔚籍和上门看病送药三类健康服务需求的影响因素。方法 利用CLHLS2017—2018调查数据,运用SPSS 23.0软件进行统计分析,采用二元logistic回归分析方法,探寻我国居家老人对社区三类健康服务需求的影响因素。结果 我国居家老人社区三类健康服务（保健知识:χ2 = 935.263,P＜0.001;精神蔚籍:χ2 = 406.578,P＜0.001;上门看病送药:χ2 = 325.448,P＜0.001）的需求与供给差异显著;除居住地、退休前职业、地区和抑郁程度是影响居家老人对三类健康服务需求的共同因素之外,两周患病（否:OR = 1.282,95%CI:1.072～1.534,P = 0.007）、每年体检（是:OR = 1.19,95%CI:1.021～1.387,P = 0.026）以及高血压诊断（否:OR = 1.224,95%CI:1.045～1.433,P = 0.012）等也影响居家老人对保健知识的需求,居住方式（独居:OR = 1.321,95%CI:1.094～1.594,P = 0.004）也影响居家老人对精神蔚籍的需求,年龄（70～79岁:OR = 0.792,95%CI:0.649～0.966,P = 0.022）和每年体检（是:OR = 0.821,95%CI:0.716～0.941,P = 0.005）也影响居家老人对上门看病送药的需求。结论 建议社区卫生机构全方位开展对健康居家老人的保健知识宣传;重视对独居和抑郁居家老人的心理健康服务;权衡自身资源和居家老人的实际情况,逐步推进上门看病送药服务。     

“互联网+”居家养老服务需求意愿及影响因素研究

目的:以合肥市为例,基于老年人自身角度,对“互联网+”居家养老服务需求程度及影响因素进行探究方法;采用描述性统计方法探究老年人“互联网+”居家养老服务需求及接受现状;采用多元有序logistic模型从个体特征、社会环境特征、“互联网+”认知特征等三方面分析不同特征老人“互联网+”居家养老服务需求影响因素。结果:①老年人对于智能化养老需求意愿较高,但实际接受程度仍偏低。②年龄、文化程度、享受养老保险类型、“互联网+”居家养老服务认识了解程度,智能设备使用简易程度等会正向促进居家养老服务需求程度的提高。而户口所在地、当前养老现状满意程度、信息化养老服务费用等会负向影响居家养老服务需求程度的提高。结论:促进老年人生活质量进一步提高,应从增强“互联网+”居家养老服务模式普及率,尊重社区居民养老服务需求,坚持政府主导与市场融合,构建完善基础信息技术系统等方面入手。     

中医药服务对居民基层首诊意愿的影响研究

目的:通过研究山东省居民对中医药服务的认知及其对首诊意愿的影响,为推动分级诊疗提供理论依据。方法:采用多阶段系统抽样对山东17地市居民进行问卷调查。结果:在调查的2965名居民中,1922人(64.8%)表示优先选择基层医疗卫生机构就诊,281人(9.5%)表示不会在基层首诊,还有762人(25.7%)表示不确定。Logistic模型结果显示,收入水平,居住地附近是否有步行20分钟到达的基层医疗机构,是否信任中医药服务,是否利用过社区的中医药服务是影响居民基层首诊意愿的因素。结论:提高基层中医药服务水平,加大基层中医药宣传力度,营造良好的中医药文化氛围,可提高居民的基层首诊意愿,从而推动分级诊疗的实现。     

Internal models underlying grasp can be additively combined

Our ability to additively combine two learned internal models was investigated by studying the forces people generate when lifting objects with a precision grip. Subjects were required to alternately lift two objects of identical physical appearance but differing weight. Grip force scaling prior to lift-off was used to estimate the output of the internal model associated with each object. Appropriate internal models were formed when alternately lifting two objects of different weight. The objects were then combined by stacking them one upon the other, and the combined object was lifted. Results show that subjects can additively combine internal models of object dynamics but the sum is biased by a default estimate of the objects weight.     

Women's Health in Maternal and Child Health: Time for a New Tradition?

Objectives. The status quo in maternal and child health (MCH) focuses on obstetric health. An emerging alternative is to broaden the notion to reproductive health. An inclusive perspective encompasses women's health issues in MCH. The purpose of this paper is to further the debate on the relationship of women's health to MCH. Specific aims are (1) to describe activities promoting women's health in MCH and (2) to examine consequences of alternative perspectives for MCH research, services, and training. Method. To achieve the first objective, I discuss developments in a state health agency and pertinent documents from the MCH Section of the American Public Health Association. To address the second aim, I follow the Bush Policy Analysis Model of weighing the three paradigms against the following evaluative criteria: equity, efficiency, satisfaction, stigma, indirect effects, feasibility, sensitivity to class and race, and social responsibility. Results. The obstetric approach meets most criteria in a positive fashion; reproductive health satisfies criteria more positively and less equivocally. A women's health perspective bears the most potential for improving reproductive outcomes at this time, since no area of women's general health has been definitively shown to be irrelevant to reproduction (or vice versa). Conclusions: This analysis suggests that women's health should be incorporated more fully into the MCH field, as well as other areas of public health and medicine. Once research deficits have been addressed and the scope of reproductive health delineated more clearly, the alignment of women's health with MCH may be reevaluated.     

Symptoms in children of British and of Bangladeshi parents measured by the Rutter B2 questionnaire

Objectives. Bangladeshi children are less frequently referred to a child psychiatric clinic than their British peers. This study aimed to ascertain if teachers observed less psychological symptoms in Bangladeshi than British children.

Method. Teachers completed a Rutter B2 Scale on samples of 113 ‘Bangladeshi’ and 61 British children aged between 5 and 11 years.

Results. Teachers recognised less symptomatology in the Asian children than their British peers. This trend was significant in children under the age of 8, but there was no significant difference in those aged 8–11 years. Only 13% of Bangladeshi children were fully fluent in English.

Conclusions. Two alternate hypotheses are put forward to explain these findings: (a) because more of the younger children could not speak English and communicate freely with their teachers, their symptoms were not noted by teachers; (b) the symptoms of the older children were a response to the pressures both the children and families faced as new immigrants. This study clearly needs to be replicated with a larger sample and also with interviews with both children and parents in order to validate the Rutter B2 questionnaires as an appropriate measure of disturbance in Bangladeshi children. It should be replicated with validated assessments of the children's fluency in English. It is also important to discuss with Bangladeshi parents what support they would like from both the school and from child psychiatric services, to promote their children's psychological health.