Outpatient Mental Health Services in Mozambique: Use and Treatments.

To describe current outpatient mental health service use and treatments in Mozambique, the authors reviewed registry entries for 2,071 outpatient psychiatric visits at the Beira Central Hospital in Sofala Province from January 2012 to September 2014. Service use was most common for schizophrenia, followed by epilepsy, delirium, and organic behavioral disorders. Only 3% of consultations for schizophrenia were first-visit patients. Treatment seeking among women was more likely for mood and neurotic disorders and less likely for substance use disorders and epilepsy. First-generation antipsychotics, most often paired with promethazine, dominated treatment regimens. Evidence-based reforms are needed to improve identification of mood disorders and broaden care beyond severe mental disorders.

Barriers to reporting child maltreatment: do emergency medical services professionals fully understand their role as mandatory reporters?

BACKGROUND: Child maltreatment is underreported in the United States and in North Carolina. In North Carolina and other states, mandatory reporting laws require various professionals to make reports, thereby helping to reduce underreporting of child maltreatment. This study aims to understand why emergency medical services (EMS) professionals may fail to report suspicions of maltreatment despite mandatory reporting policies. METHODS: A web-based, anonymous, voluntary survey of EMS professionals in North Carolina was used to assess knowledge of their agency's written protocols and potential reasons for underreporting suspicion of maltreatment (n=444). Results were based on descriptive statistics. Responses of line staff and leadership personnel were compared using chi-square analysis. RESULTS: Thirty-eight percent of respondents were unaware of their agency's written protocols regarding reporting of child maltreatment. Additionally, 25% of EMS professionals who knew of their agency's protocol incorrectly believed that the report should be filed by someone other than the person with firsthand knowledge of the suspected maltreatment. Leadership personnel generally understood reporting requirements better than did line staff. Respondents indicated that peers may fail to report maltreatment for several reasons: they believe another authority would file the report, including the hospital (52.3%) or law enforcement (27.7%); they are uncertain whether they had witnessed abuse (47.7%); and they are uncertain about what should be reported (41.4%). LIMITATIONS: This survey may not generalize to all EMS professionals in North Carolina. CONCLUSIONS: Training opportunities for EMS professionals that address proper identification and reporting of child maltreatment, as well as cross-agency information sharing, are warranted.

The Effects of Advanced Practice Nurses (APNs) as Intensivists in a Surgical Intensive Care Unit (SICU) on Patient Outcomes, Healthcare Charges, and APN Intensivist Services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD= 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M= 3.27, SD = 3.32), t (202) = 1.02, p= .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU.

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives:Objectives To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods:We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field.Selection criteria:We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis:Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed.Main results:Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months’ follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months’ follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the serviceAuthors’ conclusions:There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries. 

The cost of a minimum essential food basket in the Republic of Ireland: Study for six household types.

A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. - See more at: http://www.safefood.eu/Publications/Research-reports/The-cost-of-a-healthy-food-basket.aspx#sthash.RiBpj5no.dpuf A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. - See more at: http://www.safefood.eu/Publications/Research-reports/The-cost-of-a-healthy-food-basket.aspx#sthash.RiBpj5no.dpuf A Minimum Essential Standard of Living (MESL) is derived from a negotiated consensus on what people believe is a minimum standard. It is a standard of living that meets an individual’s or a household’s physical, psychological and social needs. This is calculated by identifying the goods and services required by different household types in order to meet their needs. While an MESL is based on needs, not wants, it is a standard of living below which nobody should be expected to live. This report focuses on food, one of the 16 elements of the Minimum Essential Standard of Living (MESL) data. It is based on a methodology called Consensual Budget Standards (CBS). The report is presented in the context of increasing concerns about the issue of food poverty in the Republic of Ireland (ROI) and an increase in the number of people reporting that they do not have enough money to buy food. Recent data from The Organisation for Economic Co-operation and Development (OECD) have shown that the number of people believing they cannot afford food doubled from 4.2% in 2008 to 9% in 2014. Data from Eurostat show that in 2013, food and non-alcoholic beverage prices in Ireland were 17% higher than the EU average. Moreover, research by Carney and Maitre, using data from the Survey on Income and Living Conditions (SILC), found that one in ten people are living in food poverty in Ireland. Food poverty is defined as the inability to have an adequate and nutritious diet due to issues of affordability and access to food. This has related effects on health, culture and social participation. The 2013 data from the Survey on Income and Living Conditions (SILC) show that 1.4 million people, almost 31% of the population, suffer from deprivation. This means that they are unable to afford two items from a list of 11 very basic items (of which one is not being able to eat a meal with meat, chicken, fish or a vegetarian equivalent every second day). The highest levels of deprivation are experienced by lone parents (63%), unemployed people (55%) and people not at work because of illness or disability (53%). The experience of the Vincentian Partnership for Social Justice (VPSJ) is that expenditure on food tends to be one of the least important considerations when households are dealing with competing demands on an inadequate income. - See more at: http://www.safefood.eu/Publications/Research-reports/The-cost-of-a-healthy-food-basket.aspx#sthash.RiBpj5no.dpuf

F-1 Food Assistance Program State Summary, May 2016

The Food Assistance Monthly Participation Report is a monthly summary of Food Assistance program participation, statewide and for each Iowa county. Breakouts are reported for participants also in the FIP program, those only receiving Food Assistance, and those that are receiving economic assistance under other programs (primarily Medicaid). This report may also be known as the F-1 Report.

Modeling Hospital Readmissions in Dalarna County, Sweden

Unplanned hospital readmissions increase health and medical care costs and indicate lower the lower quality of the healthcare services. Hence, predicting patients at risk to be readmitted is of interest. Using administrative data of patients being treated in the medical centers and hospitals in the Dalarna County, Sweden, during 2008 – 2016 two risk prediction models of hospital readmission are built. The first model relies on the logistic regression (LR) approach, predicts correctly 2,648 out of 3,392 observed readmission in the test dataset, reaching a c-statistics of 0.69. The second model is built using random forests (RF) algorithm; correctly predicts 2,183 readmission (out of 3,366) and 13,198 non-readmission events (out of 18,982). The discriminating ability of the best performing RF model (c-statistic 0.60) is comparable to that of the logistic model. Although the discriminating ability of both LR and RF risk prediction models is relatively modest, still these models are capable to identify patients running high risk of hospital readmission. These patients can then be targeted with specific interventions, in order to prevent the readmission, improve patients’ quality of life and reduce health and medical care costs.

F-1 Food Assistance Program State Summary, June 2016

The Food Assistance Monthly Participation Report is a monthly summary of Food Assistance program participation, statewide and for each Iowa county. Breakouts are reported for participants also in the FIP program, those only receiving Food Assistance, and those that are receiving economic assistance under other programs (primarily Medicaid). This report may also be known as the F-1 Report.

F-1 Food Assistance Program State Summary, July 2016

The Food Assistance Monthly Participation Report is a monthly summary of Food Assistance program participation, statewide and for each Iowa county. Breakouts are reported for participants also in the FIP program, those only receiving Food Assistance, and those that are receiving economic assistance under other programs (primarily Medicaid). This report may also be known as the F-1 Report.

F-1 Food Assistance Program State Summary, May 2016

The Food Assistance Monthly Participation Report is a monthly summary of Food Assistance program participation, statewide and for each Iowa county. Breakouts are reported for participants also in the FIP program, those only receiving Food Assistance, and those that are receiving economic assistance under other programs (primarily Medicaid). This report may also be known as the F-1 Report.

Jatropha cultivation in Malawi and Mozambique: impact on ecosystem services, local human well-being, and poverty alleviation

Jatropha-based biofuels have undergone a rapid boom-and-bust cycle in southern Africa. Despite strong initial support by governments, donors, and the private sector, there is a lack of empirical studies that compare the environmental and socioeconomic impacts of Jatropha’s two dominant modes of production: large plantations and smallholder-based projects. We apply a rapid ecosystem services assessment approach to understand the impact of two Jatropha projects that are still operational despite widespread project collapse across southern Africa: a smallholder-based project (BERL, Malawi) and a large plantation (Niqel, Mozambique). Our study focuses on changes in provisioning ecosystem services such as biofuel feedstock, food, and woodland products that can have important effects on human well-being locally. Qualitative information is provided for other regulating and cultural ecosystem services. Although at this stage no impact is tremendously positive or negative, both projects show some signs of viability and local poverty alleviation potential. However, their long-term sustainability is not guaranteed given low yields, uncertain markets, and some prevailing management practices.

F-1 Food Assistance Program State Summary, May 2016

The Food Assistance Monthly Participation Report is a monthly summary of Food Assistance program participation, statewide and for each Iowa county. Breakouts are reported for participants also in the FIP program, those only receiving Food Assistance, and those that are receiving economic assistance under other programs (primarily Medicaid). This report may also be known as the F-1 Report.

F-1 Food Assistance Program State Summary, June 2016

The Food Assistance Monthly Participation Report is a monthly summary of Food Assistance program participation, statewide and for each Iowa county. Breakouts are reported for participants also in the FIP program, those only receiving Food Assistance, and those that are receiving economic assistance under other programs (primarily Medicaid). This report may also be known as the F-1 Report.

F-1 Food Assistance Program State Summary, June 2016

The Food Assistance Monthly Participation Report is a monthly summary of Food Assistance program participation, statewide and for each Iowa county. Breakouts are reported for participants also in the FIP program, those only receiving Food Assistance, and those that are receiving economic assistance under other programs (primarily Medicaid). This report may also be known as the F-1 Report.

F-1 Food Assistance Program State Summary, July 2016

The Food Assistance Monthly Participation Report is a monthly summary of Food Assistance program participation, statewide and for each Iowa county. Breakouts are reported for participants also in the FIP program, those only receiving Food Assistance, and those that are receiving economic assistance under other programs (primarily Medicaid). This report may also be known as the F-1 Report.