The Organization of Diagnosis, Care and Funding for Specific Learning and Developmental Disorders (SLDD): A French Regional Experimental Protocol

Introduction: Access in France to early diagnosis and care for the most severe, but infrequent, Neurodevelopmental Disorders (NDD), autism spectrum disorder and global developmental delay, in children aged 0–7 was improved through measures implemented in 2019. However, there are no such measures for specific learning disorders (SLD), attention, motricity and language disorders (SLDD), despite their annual incidence of between 5 and 8%.Method: We describe the design of a new type of organization and financing of care for SLDD including evaluation procedure, as well as other factors, mainly at the prevention level that will contribute to local and national policy for this frequent health problem. This in response to a national call for projects, commonly called Article 51, targeted innovation in healthcare delivery and funding in the context of medium-term national reform. This provides project stakeholders with the opportunity to set up and implement “bottom-up” projects, mainly using local professionals. A joint initiative by the regional Health Authorities of the Occitanie region, the French Social Security system and a non-profit Association (Occitadys) proposed an experimental new structure of NDD care and funding.Discussion: We here discuss the design of this experiment that aims, over two to three years, to alleviate families' financial burden of care and establish a regional three-tier care system with respect to evaluation, re-education and rehabilitation care. Our approach may benefit SLDD health-care planning, and addresses the questions of prevention, early detection and care-design for families, taking local and socioeconomic disparities into account.

Accessing HIV care may lead to earlier ascertainment of comorbidities in health care clients in Khayelitsha, Cape Town

Successful antiretroviral rollout in South Africa has greatly increased the health of the HIV-positive population, and morbidity and mortality in PLHIV can increasingly be attributed to comorbidities rather than HIV/AIDS directly. Understanding this disease burden can inform health care planning for a growing population of ageing PLHIV. Anonymized routine administrative health data were analysed for all adults who accessed public health care in 2016–2017 in Khayelitsha subdistrict (Cape Town, South Africa). Selected comorbidities and age of ascertainment for comorbidities were described for all HIV-positive and HIV-negative healthcare clients, as well as for a subset of women who accessed maternal care. There were 172 937 adult individuals with a median age of 37 (IQR:30–48) years in the virtual cohort, of whom 48% (83 162) were HIV-positive. Median age of ascertainment for each comorbidity was lower in HIV-positive compared to HIV-negative healthcare clients, except in the case of tuberculosis. A subset of women who previously accessed maternal care, however, showed much smaller differences in the median age of comorbidity ascertainment between the group of HIV-positive and HIV-negative health care clients, except in the case of chronic kidney disease (CKD). Both HIV-positive individuals and women who link to maternal care undergo routine point-of-care screening for common diseases at younger ages, and this analysis suggests that this may lead to earlier diagnosis of common comorbidities in these groups. Exceptions include CKD, in which age of ascertainment appears lower in PLHIV than HIV-negative groups in all analyses suggesting that age of disease onset may indeed be earlier; and tuberculosis for which age of incidence has previously been shown to vary according to HIV status.

Innovative Multidisciplinary Care Models Provided via Telehealth During the COVID Pandemic

Integrated and collaborative care lead to better care. Addressing the behavioral and mental health care needs of patients results in better health outcomes. Interdisciplinary and multi-disciplinary approaches to health care delivery yield more effective health care planning. A holistic approach to healthcare sees the individual as more than the sum of diseases. Research studies have supported these assertions and yet, in actual practice, they are often more aspirational than actualized. The COVID-19 pandemic has made it even more difficult to implement collaborative care delivered by varied professional disciplines. This symposium describes efforts to provide more holistic and multidisciplinary care in the primary care geriatrics practice of the Dept. of Geriatrics & Palliative Medicine, Icahn School of Medicine. This New York City practice has 4,500 patients with diverse backgrounds and a median age of 85. In the first paper, Baharlou and her colleagues describe the establishment of an IMPACT collaborative care depression model in the middle of the COVID-19 pandemic. It was adapted to be provided by telephone and uses a different psychosocial intervention than is usually implemented. Hinrichsen and Leipzig outline the successful integration of Cognitive Behavioral Therapy for Insomnia into geriatrics primary care to improve insomnia in older adults and deprescribe sleep medications. Munoz and her colleagues describe the ALIGN program which is an interdisciplinary team effort, informed by the social determinants of health framework, to facilitate access to an array of services delivered virtually because of the pandemic.

Future prevalence of type 2 diabetes – a comparative analysis of chronic disease projection methods

Background: Accurate projections of the future number of people with chronic diseases are necessary for effective resource allocation and health care planning in response to changes in disease burden. Aim: To introduce and compare different projection methods to estimate the number of people with diagnosed type 2 diabetes (T2D) in Germany in 2040. Methods: We compare three methods to project the number of males with T2D in Germany in 2040. Method 1) simply combines the sex- and age-specific prevalence of T2D in 2010 with future population distributions projected by the German Federal Statistical Office (FSO). Methods 2) and 3) additionally account for the incidence of T2D and mortality rates using partial differential equations (PDEs). Method 2) models the prevalence of T2D employing a scalar PDE which incorporates incidence and mortality rates. Subsequently, the estimated prevalence is applied to the population projection of the FSO. Method 3) uses a two-dimensional system of PDEs and estimates future case numbers directly while future mortality of people with and without T2D is modelled independently from the projection of the FSO. Results: Method 1) projects 3.6 million male people with diagnosed T2D in Germany in 2040. Compared to 2.8 million males in 2010, this equals an increase by 29%. Methods 2) and 3) project 5.9 million (+104% compared to 2010) and 6.0 million (+116%) male T2D patients, respectively. Conclusions: The results of the three methods differ substantially. It appears that ignoring temporal trends in incidence and mortality may result in misleading projections of the future number of people with chronic diseases. Hence, it is essential to include these rates as is done by method 2) and 3).

Eye Disorders Spectrum: A Tertiary Hospital Pediatric Ophthalmology Clinic Based in Ethiopia

Background: Epidemiological studies to determine the pattern of eye disorders among children are important for proper health care planning and management. This study aimed to document the spectrum and frequency of eye diseases of children who attended the pediatric ophthalmology clinic of a tertiary teaching hospital Addis Ababa, Ethiopia. Methods: A cross sectional and convenient sample of 1237, male and female children (16 years and below) with ocular disorders presenting for the first time and those children with settled diagnosis coming for follow up visit between June 1, 2018 to May 31, 2019 were included in the study. Data on age at presentation, sex and diagnosis were collected and analyzed. Eye disorders were classified into various categories. Children were grouped into four age groups. Ratios, percentages and chi square associations were calculated. P< 0.05 was considered statistically significant.Results: Of the children 60% were male. The mean age (standard deviation) of the children was 4.26 (+4.1) years. Patients aged 0–5 years old were the largest group constituting 70.5%. Ocular motility imbalances were the most common ocular disorders seen (32.8 %), followed by childhood cataract (18.4%) and infection and inflammation of eye and adnexa (8.3%). Ocular motility imbalances were recorded more frequently and statistically significant (p < 0.001) among 1­ 5 years age group. Within the childhood cataract category, congenital cataract was more prominent (7.1%). Within the infection and inflammation category, cornea/ sclera infections were more common (3.7%). Conclusions: The study highlights common eye disorders seen in children in a specialized hospital ophthalmic clinic. Ocular motility imbalance, childhood cataract, and infection and inflammation of the eye and adnexa, were the most common occurring disorders. Early presentation was common, and males were more affected than females.

Including people with intellectual disabilities in the development of their own positive behaviour support plans

Purpose People with intellectual disabilities are not routinely involved in the assessment of their behaviours that challenge, as this is often completed by a proxy respondent and the health-care professional. This is contrary to guidance stating that everyone should be involved in the planning of their care. This paper aims to show how health-care professionals can support people with intellectual disabilities to engage in the assessment of their behaviours that challenge and the subsequent development of their own positive behaviour support (PBS) plans. Design/methodology/approach A non-systematic review of the existing literature on improving the engagement of people with learning disabilities in health-care planning, and specifically PBS planning, was undertaken. Appropriate papers were included in this paper. Findings There are several evidence-based methods to improve people’s engagement in the assessment of their own behaviours that challenge and then the development of their PBS plans. These methods are discussed in terms of their application to supporting people to communicate and involving them in the process of developing a valid and meaningful PBS plan. This is a relatively new focus within the literature, and further research should focus on increasing engagement in the process, as well as monitoring how co-production affects PBS outcomes. Originality/value This paper summarises some of the approaches used to support people with intellectual disabilities to engage in the assessment of their behaviours that challenge and the development of their own PBS plans. This should encourage health-care professionals to consider how to use alternative and augmentative communication strategies to facilitate co-production in their own clinical practice.

Hospital preparedness during epidemics using simulation: the case of COVID-19

This paper presents a discrete event simulation model to support decision-making for the short-term planning of hospital resource needs, especially Intensive Care Unit (ICU) beds, to cope with outbreaks, such as the COVID-19 pandemic. Given its purpose as a short-term forecasting tool, the simulation model requires an accurate representation of the current system state and high fidelity in mimicking the system dynamics from that state. The two main components of the simulation model are the stochastic modeling of patient admission and patient flow processes. The patient arrival process is modelled using a Gompertz growth model, which enables the representation of the exponential growth caused by the initial spread of the virus, followed by a period of maximum arrival rate and then a decreasing phase until the wave subsides. We conducted an empirical study concluding that the Gompertz model provides a better fit to pandemic-related data (positive cases and hospitalization numbers) and has superior prediction capacity than other sigmoid models based on Richards, Logistic, and Stannard functions. Patient flow modelling considers different pathways and dynamic length of stay estimation in several healthcare stages using patient-level data. We report on the application of the simulation model in two Autonomous Regions of Spain (Navarre and La Rioja) during the two COVID-19 waves experienced in 2020. The simulation model was employed on a daily basis to inform the regional logistic health care planning team, who programmed the ward and ICU beds based on the resulting predictions.

Trauma care during the COVID-19 pandemic in the Netherlands: a level 1 trauma multicenter cohort study

Purpose The coronavirus (COVID-19) pandemic has caused major healthcare challenges worldwide resulting in an exponential increase in the need for hospital- and intensive care support for COVID-19 patients. As a result, surgical care was restricted to urgent cases of surgery. However, the care for trauma patients is not suitable for reduction or delayed treatment. The influence of the pandemic on the burden of disease of trauma care remains to be elucidated. Methods All patients with traumatic injuries that were presented to the emergency departments (ED) of the Amsterdam University Medical Center, Location Academic Medical Center (AMC) and VU medical center (VUMC) and the Northwest Clinics (NWC) between March 10, 2019 and May 10, 2019 (non-COVID) and March 10, 2020 and May 10, 2020 (COVID-19 period) were included. The primary outcome was the difference in ED admissions for trauma patients between the non-COVID and COVID-19 study period. Additionally, patient- and injury characteristics, health care consumption, and 30-day mortality were evaluated. Results A 37% reduction of ED admissions for trauma patients was seen during the COVID-19 pandemic (non-COVID n = 2423 and COVID cohort n = 1531). Hospital admission was reduced by 1.6 trauma patients per day. Fewer patients sustained car- and sports-related injuries. Injuries after high energetic trauma were more severe in the COVID-19 period (Injury Severity Score 17.3 vs. 12.0, p = 0.006). Relatively more patients were treated operatively (21.4% vs. 16.6%, p < 0.001) during the COVID-19 period. Upper-(17.6 vs. 12.5%, p = 0.002) and lower extremity injuries (30.7 vs. 23.0%, p = 0.002) mainly accounted for this difference. The 30-day mortality rate was higher during the pandemic (1.0 vs. 2.3%, p = 0.001). Conclusion The burden of disease and healthcare consumption of trauma patients remained high during the COVID-19 pandemic. Results of this study can be used to optimize the use of hospital capacity and anticipate health care planning in future outbreaks.

Paediatric admissions to a hospital in the United Arab Emirates

A prospective study was designed to assess the types of illness which resulted in hospital admission in Al-Ain, United Arab Emirates, and the background to the admission. The majority of children were admitted for the management of a respiratory condition, particularly asthma. Infections were the next major cause of hospital care. Management of the complications of thalassaemia was also an important reason for admission. The recognition of the importance of this disorder is necessary for future health care planning in the United Arab Emirates. The majority of children were regarded as having a disorder of medium severity at the time of their admission. The results are discussed in light of a similar United Kingdom study

Highly specialized dental care in Ukraine in the conditions of transformation of the healthcare system of Ukraine

The gradual transformation of the health care system from April 1, 2020 impacted the reform of secondary (specialized) health care. Planning a model of hospital network transformation should take into account the needs of the population and ensure the creation of a multidisciplinary hospital with a focus on a patient. The article analyzes the human resources and infrastructure of medical institutions that provide dental care, including multidisciplinary hospitals. The main aspects that need to be taken into account when planning the transformation of the hospital network considering the interdisciplinary interaction of dentists, maxillofacial surgeons with general practitioners to improve the quality of care are also identified.