2Quality care in pregnancy and childbirth is associated with good results for mother and baby. The provision of some home prenatal care units reduces the stressors associated with these pregnancies and improves maternal health. The present study aimed to investigate maternal Homecare for mothers and children in selected developed countries. In this review, all Persian and English articles and documents from 2006 to 2021 related to Homecare services for mothers and children were reviewed using the keywords “Home care,” “Maternal child health services,” and “Home birth” in selected countries in reputable databases, namely PubMed, Web of Science, Scopus, Google scholar, World Health Organization (WHO), and Science Direct. Articles that met the inclusion criteria were extracted and analyzed. The findings indicated that in selected developed countries, there are home delivery services and periodic regular home care of mother and child after delivery, a maternity manual, and a birth package with insurance coverage or free of charge. Therefore, it appears that incorporating home delivery options, along with the provision of infrastructure and postnatal care programs for mothers and children, into the Ministry of Health's plans is imperative to enhance the quality and contentment of mothers. These services should be regularly offered, either free of charge or with insurance coverage.

Introduction: The prevalence of Stroke disease and increased health care costs are in urgent need of reconsideration in the case of the best and most affordable way for care. This study is to investigate the cost-effectiveness of home care compared to hospital care for stroke patients in Tehran city.Method: This study is an analytical cross-sectional one that data of 52 stroke patients of Dam home care Institution and 52 patients of Imam Khomeini and Rasoul Akram hospital obtained from the Balance Sheet and other data sources, by using the SF36 questionnaire, the patient recovery rate was measured. For data analysis and T-test, SPSS software was used and p<0.05 was evaluated.Results: The lowest health care costs were related to the age group lower than 39 years and effectiveness maximum was related to the same group with a mean of 0.58. The lowest average hospital costs were related to the age group 40 - 59 years and effectiveness maximum was related to groups lower than 39 years.Conclusions: System of home care for stroke patients suitable alternative to hospitalization of patients in hospitals and this problem is due to a shortage of beds in Iran hospitals are more important and should be considered by policy makers.

Background: Preeclampsia (PE) is one of the leading causes of mortality and complications during pregnancy. It seems that usual prenatal care is not enough for these patients. They require more assistance, support, and guidance from health professionals, and home care is an effective strategy in this regard. Also, Iran has no official or compiled program for home care in high-risk pregnancy. This study was designed to explore the potential achievements and barriers of home care for mothers with PE. Methods: In this qualitative study with conventional content analysis, twenty-eight participants (mothers with PE, maternal health policy-makers, and health care providers) were selected through purposeful sampling with maximum variation. Data were collected through semi-structured interviews until saturation was achieved. Simultaneously, data analysis was performed using MXQDA software. Finally, the main categories were extracted. Results: Seven main categories were extracted. Three main categories for the potential achievement included “ family involvement in maternal care” , “ holistic maternal health promotion” , and “ improving utility of services” . The other four categories emerged for barriers included: “ more willingness to provide in-hospital medical care” , “ clients’ concerns about cultural issues” , “ providers` unwillingness to delivery home care” , and “ insufficiency of infrastructures for home care” . Conclusion: Paying attention to home care advantages, based on the socio-cultural context of the community, making effort to remove the barriers, and organizing home care infrastructures contribute to improvement in the quality of care in women with PE.

Background: Illness behavior refers to the ways of perceiving, assessing, and managing specifi c symptoms by an individual. Objectives: The present study aims to investigate illness behavior during the COVID-19 outbreak among Afghan people. Methods: The study is a thematic analysis conducted between May and September 2020. Data were collected purposefully through semi-structured telephone interviews with 17 infected people from the cities of Kabul, Bamian, and Balkh in Afghanistan. Results: As the participants believed, the COVID-19 outbreak in their country was a socio-political rather than a medical phenomenon. In this situation, the health system is unable to meet medical needs, and patients creatively take care of themselves at home with exercise, local soups, and oxygen therapy if needed. There were four themes explored, including de-hospitalization, healthcare-seeking behavior, social stigma, and the role of media. Conclusions: The illness behavior regarding disease outbreaks is a social rather than a clinical phenomenon. It includes depharmaceuticalization perceptions and activities. Therefore, healthcare systems are recommended to pay attention to the sociopolitical dimensions of illness behavior during such outbreaks.

Introduction: The provision of home health care services increases as a desirable option in western society. Previous studies indicate that health care professionals encounter ethically difficult situations when providing home care services. There is a lack of studies describing ethically difficult situations through observation. This study aimed to explore ethical issues experienced by healthcare staff when providing community home care services. Methods: Qualitative design, using the ethnographical approach. Data gathered as fieldwork in terms of memos, non-participant observation and informal interview with registered nurses (n=8), and nurse-assistants (n=4) during three weeks (in total 148 hours, 7am-5pm). Results: The result generated two main categories: 1) To balance stakeholders‟ requirements, and, 2) Strategy to deal with ethical issues. Coxing was used as a strategy to deal with ethically difficult situations in patient care. The results showed that the complexity of the ethical issues is often related to personal values and organisational impact. The staff experienced need for a structured approach to assist them in identifying, analysing, and resolving ethical issues that arise in clinical practice. Health care organisations, personnel and patients are disagreed about values and choices that could lead to the best course of actions. Conclusion: This study reveals that the ethically difficult situations in the context of community home care services are complex and are influencing the provision of care. The personnel enforced to find a balance between different expectations and from different stakeholders. To deal with these situations coaxing was used as a strategy for managing ethical issues.

Objectives Elderly people are at the highest risk for falling. In order to design and implement effective interventions and reduce the incidence of falling and its resulting injuries, the relative importance of each risk factor should be determined. This study aimed to determine how frequently different factors contribute to falls among the elderly served by one home health agency in Tehran. Methods & Materials This study was a descriptive-analytic and cross-sectional study. A total of 400 elderly were selected through random cluster sampling method from all 22 districts of Tehran City, Iran. The study data were collected through a researcher-made questionnaire of falling risk factors. The questionnaire consisted of two parts: first, demographic questions and second, questions related to falling in 7 dimensions (including 60 questions). The obtained data were analyzed in SPSS (V. 19) through descriptive and inferential statistics. Results In this study, female samples were 52. 5% of the participants (n=400) and the elderly mean± SD age was 78± 8 years. The total frequency of falling among the elderly was 28% (112 out of 400). Among the elderly who had fallen (n= 112), 64 (57. 1%) of them were female and their Mean± SD age was 80± 7. 5 years. About 82% of them fell down inside their homes, with these separate frequencies: bathroom (19. 6%), toilet (18%), bedroom (18%), and hall (16%). Parts of the body which were more frequently affected by falls in forms of injuries, bone fractures, dislocations, etc., were the pelvis (26. 8%), arms (22. 3%) and legs (19. 6%). Around 43. 8% of the falling among the elderly had led to hospitalization, 44. 9%, between 1 and 5 days, 36. 7% between 6 and 10 days, and 18. 4% between 11 and 15 days. The relationship between falls and the medical, lifestyle, or environmental risk factors was non-significant. Conclusion A high percentage of affected elderly were hospitalized after the incident, and among them a high percentage stayed in the hospital for a long time imposing considerable costs to the health system. Moreover, sensory and neuromuscular risk factors were the most frequent causes of falls which could be prevented by rehabilitation measures. Results showed that people who are afraid of falling have a higher risk of falling which requires adequate and special attention to this psychological risk factor.

Background  The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments (EDs). However, scientific evidence regarding the association between home-based healthcare services and ED uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for ED visits among patients receiving publicly-funded Homecare services.Methods  The personal demographic and medical information, caregiver characteristics, and behaviours related to Homecare services and ED visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated Homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned ED utilizations.Results  Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio [OR] = 1.33, 95% CI = 1.05 to 1.70), male caregiver (OR = 0.18, 95% CI = 0.05 to 0.66), duration of introducing Homecare services (OR = 0.97, 95% CI = 0.95 to 1.00), working experience of dedicated nurses (OR = 0.89, 95% CI = 0.79 to 0.99) and number of ED utilizations within previous past year before enrollment (OR = 1.54, 95% CI = 1.14 to 2.10) as significant determinants for unplanned ED visits.Conclusion  The present evidence may help government agencies propose supportive policies to improve access to integrated Homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent ED visits among patients receiving Homecare services.