Primary Care Mental Health Services in Finland, a hidden Lynchpin of Psychiatric Re-hospitalisation

RESUMO:O reinternamento psiquiátrico é um fenómeno multifacetado, determinado por diversos fatores e frequentemente apontado como um resultado negativo. Investigar os cuidados de saúde ambulatórios, incluindo os Cuidados de Saúde Primários, pode proporcionar mais informações sobre o reinternamento psiquiátrico. O presente estudo retrospectivo incluiu dados do HILMO - Registo dos Cuidados Sociais e de Saúde, assim como do AvoHILMO - Registo dos Cuidados de Saúde Primários a Doentes Ambulatórios. Os dois objetivos principais do estudo abrangeram a pesquisa sobre o reinternamento psiquiátrico no contexto finlandês e a análise do uso dos Cuidados de Saúde Primários utilizando um estudo de coorte. O estudo de coorte 6 (N=16.814 adultos) compreendeu pessoas com experiência em regime de internamento psiquiátrico no ano de 2012. Esperava-se que serviços de Cuidados de Saúde Primários mais variados pudessem ter um impacto mais protetor em casos de reinternamento psiquiátrico. A taxa média de reinternamento foi de 40%, variando entre distritos hospitalares, desde 28% no hospital Kymenlaakso até 54% no hospital Länsi-Pohja. O índice de reinternamento hospitalar esteve correlacionado com o tempo de estadia, parte do estudo de coorte em distritos hospitalares e aspectos de tipo de serviço. As consultas nos Cuidados de Saúde Primários uma semana depois da alta mostraram uma correlação negativa com a densidade populacional, com áreas de menor densidade populacional possuindo um maior nível de consultas nos cuidados primários durante essa semana. As consultas de saúde mental tiveram mais frequentemente lugar em centros de saúde primários, enquanto outras especialidades privilegiaram o cuidado domiciliar como meio de contato. Houve uma forte correlação positiva entre a probabilidade de atendimento em cuidados de saúde primários no prazo de uma semana depois da alta e o número de profissionais de saúde mental incluído na equipe de Cuidados de Saúde Primários. Diferenças na utilização de serviços entre os vários distritos hospitalares foram evidentes. O presente estudo mostra como pessoas com perturbações mentais suficientemente graves para requerer hospitalização, acedem aos cuidados ambulatórios, particularmente aos Cuidados de Saúde Primários. O melhoramento dos Cuidados de Saúde Primários através do aumento da diversidade de profissionais e dos tipos de serviços disponíveis estaria em consonância com as recomendações atuais para cuidados de saúde mental mais holísticos ou centrados na pessoa.ABSTRACT:Psychiatric re-hospitalisation is multifaceted, determined by many factors, and often highlighted as a negative outcome. Investigating outpatient care including primary care can further insights of psychiatric re-hospitalisation. The retrospective register based study included data from the HILMO Care Register for Health Care, and the AvoHILMO Register for Outpatient Visits in Primary Care encompassing two main objectives, investigating psychiatric re-hospitalisation in the Finnish context, and exploring the use of primary care by the study cohort. The study cohort (N= 16 814 adults) comprised of people with experience of psychiatric inpatient care in 2012. More diverse primary care services were expected to have protective impacts on psychiatric re-hospitalisation. The average re-hospitalisation rate was 40%, varying between hospital districts with Kymenlaakso Hospital District at 28% and Länsi-Pohja Hospital District at 54%. Re-hospitalisation rate correlated with length of stay, share of study cohort in hospital district, and aspects of service type. Primary care visits within a week following discharge were seen to correlate negatively with population density, areas with lower population density having a higher level of a primary care visit within a week. Mental health care visits were more likely to take place at the primary care centre, with other specialities having more home based care means of contact. There was a strong positive correlation between likelihood of being seen within a week within primary care, and amount of Mental Health Care Assistants included in the primary care workforce. Differences in service use between the hospital districts was apparent, the current study illuminating how people with mental health disorders severe enough to require hospitalisation access outpatient care, particularly primary care. Further developing primary care by developing the diversity of the workforce and types of services available would be in line with current recommendations for more holistic or person centred mental health care

Waiting for a kidney from a deceased donor: an interpretative phenomenological analysis

Demand for kidneys from deceased donors far outstrips supply. Despite this, there appears to be little research that focuses solely on the experience of waiting for a kidney from a deceased donor. This study uses the qualitative methodology Interpretative Phenomenological Analysis (IPA) to explore the lives of 10 people on the transplant list, with the aims of illuminating the potential psychological challenges those on the list may face during this time, and providing information to help clinicians more fully support such people in the future. Two themes connected to the experience of waiting – adjustment to the uncertainty of waiting and thinking about receiving a kidney from a living donor – are presented here. Participants describe a sense of confusion and uncertainty around life on the list, and discuss their strategies for dealing with this. Novel complexities around the ambiguous challenge of receiving an organ from a deceased donor are revealed. It is recommended that healthcare teams provide a forum for this patient group to work through these feelings of confusion and ambiguity

POWER DEVELOPED BY THE MIDFOOT JOINT DURING RUNNING WITH AND WITHOUT SHOES

The purpose of this study was to remedy the lack of knowledge about the function of the midfoot joint during the propulsion phase of running and to assess the effect of footwear on this function compared to running barefoot. A valid model of the rearfoot was identified and 12 healthy male subjects performed five trials each of running with and without shoes while data was collected with a ten-camera and single force plate motion capture system. Analysis of the results showed that the midfoot joint generated 39% of total power from the foot region during barefoot running. This reduced to 25% when shoe-wearing as a result of a reduction in range of motion at the midfoot joint. The findings may have implications for running efficiency and injury but both these conjectures need further study

Virtual Access: A New Framework for Disability and Human Flourishing in an Online World

While many commentators have noted the wealth and class disparities that emerge from the digital divide, disability adds another important lens through which to consider questions of access and equity. Online accessibility for disabled people has fallen prey to the same assumptions and impediments that led to the Americans with Disabilities Act (“ADA”) addressing disability access in the offline world. Addressing these shortcomings requires a significant conceptual shift in our understanding of “access,” even among disabled people. Offline, the sidewalk or doorway hindered access to those who needed assistance walking or moving. Today’s virtual sidewalks and doorways complicate access in fundamentally different but no less important ways.This Article reframes the legal, normative, and theoretical dimensions of the intersection of disability and online access to suggest a more granular approach than those provided by existing judicial and scholarly interventions. Our approach includes three recommendations. First, we suggest greater attention to online analogues for offline legal categories that create different zones for human interaction: public forums, public accommodations, non-public spaces, and what one of us has termed “private public forums”—the privately owned venues that functionally replace the public forum, especially online. Second, contrary to the approach adopted in some jurisdictions, we propose eliminating any requirement of a physical nexus between an online site and an in-person operation. Third, we recommend directing most regulatory requirements toward three kinds of commercial entities whose power, influence, and design functionality best position them to remedy existing gaps in online disability access, which we call design services, communication platforms and online mediators. Design services provide browsers, operating systems, and website design tools and templates. Communication platforms connect individual users through social media and other sharing mechanisms. Online mediators aggregate information to connect customers with product and service providers. If these three kinds of companies can set design norms for individual websites and apps, much of the framework for disability access will be in place. But as we will explain, not all individual users can or should be forced to incur compliance costs related to website and application design—some small sites are properly exempted from such oversight. For this reason, we suggest that design services make disability access the baseline; that communication platforms and online mediators implement accessibility once they reach certain size or revenue thresholds; and that certain users be permitted to opt out of disability access features

Medical tourism in Thailand: a cross-sectional study.

OBJECTIVE: To investigate the magnitude and characteristics of medical tourism in Thailand and the impact of such tourism on the Thai health system and economy. METHODS: In 2010, we checked the records of all visits to five private hospitals that are estimated to cover 63% of all foreign patients. We reviewed hospital records of foreign patients and obtained data on their countries of origin, diagnoses and interventions. We surveyed 293 medical tourists to collect demographic characteristics and information on their expenditure and travelling companions. To help understand the impact of medical tourism on the Thai health system, we also interviewed 15 hospital executives and 28 service providers from the private hospitals. FINDINGS: We obtained 911,913 records of hospital visits, of which 324,906 came from 104,830 medical tourists. We estimated that there were 167,000 medical tourists in Thailand in 2010. Of the medical tourists who attended our study hospitals, 67,987 (64.8%) came from the eastern Mediterranean region or Asia and 109,509 (34%) of them were treated for simple and uncomplicated conditions - i.e. general check-ups and medical consultations. The mean self-reported non-medical expenditure was 2750 United States dollars. According to the hospital staff interviewed, medical tourism in 2010 brought benefits to - and apparently had no negative impacts on - the Thai health system and economy. CONCLUSION: We estimate that the total number of medical tourists visiting Thailand is about 10% of previous national government estimates of 1.2 million. Such tourists appear to bring economic benefits to Thailand and to have negligible effects on the health system