Health & Social Care in the Community最新文献

The correlation between adverse childhood experiences (ACEs) and both diabetes mellitus (DM) prevalence and comorbidity is an underexplored research area in China. Understanding the mechanisms by which this relationship might be attenuated or mitigated is crucial. This study examines the correlation between ACEs and DM, including its comorbidities, and assesses whether lifestyle factors mediate this relationship in a Chinese population. Data were obtained from the 2023 Psychological and Behavioural Survey of Chinese Residents (PBICR-2023), a nationwide cross-sectional survey. The sample included 27,322 adults. Regression models evaluated the associations between ACEs, DM, and comorbidities, adjusting for potential confounders. Mediation effects of lifestyle (sleep quality, smoking, diet and physical activity [PA]) were tested using Sobel–Goodman tests, with mediation weights quantified via Karlson–Holm–Breen (KHB) decomposition. The results show that, compared with no ACEs, exposure to 1, 2, 3 or ≥ 4 ACEs was significantly associated with higher DM risk. ACEs were also positively correlated with comorbidity among DM patients. Lifestyle mediated the ACE–DM association, with sleep quality having the strongest effect (11.86%), followed by smoking (3.90%), dietary habits (2.96%) and PA (1.11%). For comorbidity, smoking was the only significant mediator (10.20%). Diabetes prevention strategies should address childhood adversities and promote healthier lifestyles.

The family physician plays an important role in the primary care system in many countries and regions; however, it is still in its infancy in China for many reasons. To help develop the family physician service, we investigated the behaviors of physicians and community residents in the context of signing the service contract with an evolutionary game model and explored the impact of some factors on the equilibrium. The result shows that the professionalization of family physicians, the service publicity, the basic salary for full-time family physicians, and service diversity are instrumental in the development of family physician service. The result further indicates that financial incentives can have a restricted effect on encouraging physicians to work full-time, that is, a moderate amount of subsidy might be better than no subsidy or too large. Our work will help decision makers better understand the interaction between physicians and community residents and launch policies to promote family physician service in countries such as China.

Multimorbidity (having more than one long-term condition) is common for people with dementia and leads to increased healthcare needs and poorer outcomes for those individuals and also their informal carers. In the United Kingdom, part of the management of comorbidities occurs through annual long-term condition reviews in primary care. To date, there has been little research on the experiences of people with dementia and their informal carers with regard to these reviews. A qualitative study of people with dementia and informal carers recruited across England was undertaken, exploring their experiences of long-term condition reviews in primary care. Semistructured interviews with 16 participants (two people with dementia, 10 informal carers, and 2 informal carer/people with dementia dyads) were conducted via telephone, and the principles of reflexive thematic analysis were used to analyze the data. We identified four main themes from the data: (1) What matters to people (identifying and meeting both medical and holistic needs), (2) the experience of the review (the wide range of experiences), (3) the importance of communication (the desire for better communication), and (4) the involvement of people with dementia and carers in decisions (their wish to be involved, the lack of opportunity for this, and how this reduces shared decision-making and patient-led care). Our findings suggest that current long-term condition reviews are frequently not meeting the needs of people with dementia and their informal carers. Initial strategies to improve long-term condition review should include ensuring that patients and informal carers (including informal carers of people with dementia in residential homes) are able to participate in the reviews. Further research with key stakeholders is now needed to improve our understanding of current organizational and clinician perspectives and to aid in optimizing long-term condition reviews.

Across the globe, stark disparities exist in several indicators of maternal and child health, demonstrating that the chances of survival for mothers and children are ultimately determined by where they are born and live. Sustainable and effective strategies for removing the barriers to safe and affirmative motherhood and childhood are therefore urgently required. This paper examines a community-based intervention for improving maternal and child health outcomes in a predominantly rural area of the KwaZulu-Natal province of South Africa. The central aim of the research was to explore the views and experiences of both community members and the health workers involved in the collaborative health intervention between two nongovernmental organisations—Humana People-to-People and the Nelson Mandela Children’s Fund—in the five-year period between 2017 and 2021. In this paper, focus is directed specifically at the health workers, fifteen of whom were recruited to participate in semistructured face-to-face interviews. These primary data, together with a range of secondary data sources, revealed the importance of community empowerment for enhancing the community’s health. Nine domains for evaluating the nature and extent to which community empowerment is facilitated in the context of a community development programme were thus identified and applied to the analysis of the data. The paper shows that the intervention was successful in at least six of the nine domains of community empowerment. The remaining three domains, which together facilitate long-term sustainability of the benefits of a community intervention such as this, were insufficiently addressed and therefore raise concerns about the possible effects on the community’s health in the future.

People living in rural Australia experience poorer health outcomes and have reduced access to health services compared with people living in metropolitan areas. Despite guidelines supporting consumer involvement in research, there is low involvement of rural people in health and medical research. Australia’s first Rural Health Consumer Panel (RHCP), established in 2022, assists researchers in gaining a deeper understanding of rural and regional Australians’ perspectives on health and healthcare. Data are collected from panel members via annual online healthcare surveys and community-based research. This paper presents preliminary findings from two cross-sectional online health surveys (Registration Survey and Health Survey #1) including demographic characteristics and current health status of panel members, interactions with healthcare professionals in the past 12 months and consumers’ experience of accessing healthcare. Currently, the RHCP has over 190 members. Panel members are aged between 18 and 84 years and reside in a rural location across Australia. Findings reveal that 90% of panel members reported having a past or current health condition, with 77% of panel members reported having two or more health conditions. Panel members consulted a range of health providers in the past 12 months but often encountered barriers in accessing health services. For those who experienced barriers in accessing a health provider, cost, wait times and distance were most frequently reported. The results of the first two RHCP health surveys have highlighted important issues in rural healthcare, allowing us to identify research priorities and direction for further development of the panel. Findings will be used in collaboration with rural health consumers, rural health services, academic institutions and industry partners to drive improvements in healthcare policy and delivery.

This article examines the implementation of a social innovation designed to improve access to end-of-life care in depopulating rural areas of Eastern Poland. The initiative tested an integrated model of home-based support for chronically and terminally ill individuals, combining an interdisciplinary home hospice care team, locally embedded support networks, and a newly introduced role: the Dependent Care Coordinator (KOOZ). The study draws on multimethod field research conducted over several years, including staff surveys, semistructured interviews, sociometric analysis, and secondary data from patient needs assessments. Findings show that the model substantially expanded the scope and flexibility of home hospice services, strengthened coordination between health and social care actors, and reduced the burden on medical staff through the involvement of caregivers and the KOOZ. At the same time, the implementation revealed systemic barriers, including workforce shortages, institutional fragmentation, and cultural resistance to palliative and psychological support. The article contributes to the evidence base on integrated rural care, demonstrating both the potential of community-based social innovation and the structural constraints that limit its scalability and long-term sustainability.

Inadequate interprofessional collaboration presents a challenge when older adults transition from hospital to home care, as this process involves multiple health and social care professionals. To address this, the Swedish Care Coordination Act (CCA) was introduced in 2018, which altered the procedures for care planning and redistributed responsibilities among health and social care actors. This article explores how hospital discharge policies shape the landscape of collaborative care planning for older adults by studying the framing of problems and solutions related to the CCA. Policy documents related to the legislation were analysed by drawing on concepts developed in framing theory, specifically the sense-making of different policy interests and the overall policy storytelling. The analysis shows one main problem description, named ‘waiting time’ for patients, and three frames defining causes, blame and solutions: the outdated legislation frame, the healthcare involvement frame and the bureaucracy frame. The main problem and the outdated legislation frame unified the political ambitions with the interests of local and regional policy actors, while the healthcare involvement frame and the bureaucracy frame were based on interests deriving from the municipalities and the regional councils, respectively. The policy storytelling was based on taking the policy actors’ interests and perceptions of blame into account, making it possible to merge the different objectives. In conclusion, the frames were largely derived from the professional actors’ interests, assigning interprofessional collaboration difficulties to professional deficits rather than working conditions and resource allocation. The patient perspective was essentially absent from all three frames, which may contribute to upholding professional control of the discharge process. The findings suggest that it is vital to consider the neglected aspects of patient participation and working conditions when creating hospital discharge policy.