Communal Health Research Articles

Georgia Health Care Providers’ Experiences With Community Public Health Clients

Community health and human services workers play an integral role in communal public health. They are especially integral to meeting the needs of patients who are often on the margins of society. While we often conduct research from the perspective of the end-user – the patient or the client – we do not hear the voices of health and human services professionals with the same regularity. The purpose of this study is to examine the healthcare needs of public health patients from the perspective of community health providers in two Georgia counties. Through this case study, utilizing qualitative data garnered through three focus groups with the local public health department’s employees and affiliated human services providers as part of their quintennial Community Health Needs Assessment (CHNA), we call attention to several individual and systemic issues providers have identified as worthy of concern. These include health seeking information and behaviors of their clients, as well as the role of health insurance and health access for improved physical, mental, and sexual health. Systemically, providers identify the challenges of status, stigma, and consumer perceptions in the access and quality of care certain segments of the population receive and how provider bias can impede wellbeing. Although the CHNA data collection took place prior to the COVID-19 pandemic, our examination of the data took place during the height of the pandemic. As such, in this paper, we also provide practical implications and future directions for public health and human services providers who have endured the pandemic and sought to meet their patients’ needs during unprecedented circumstances.

“Music as Method” in Marshallese Community-driven Research and Outreach during the COVID-19 Pandemic

This essay centers on the sound- and music-based methodologies of the Marshallese Educational Initiative (MEI) in terms of “community-driven research” that began in the first year of the COVID-19 pandemic when the virus was taking a massive toll on the community. The MEI is a nonprofit based in Springdale, Arkansas, which is home to the largest diasporic Marshallese community in the continental US. The first part analyzes the MEI’s COVID-19 informational materials on their website from an audiovisual perspective. Although mitigating the day-to-day consequences of COVID-19 took a necessary priority, the MEI educational programmers were determined to examine the long-term consequences of social distancing (as community disenfranchisement) in a transpacific context and the negative media representation of Marshallese regarding COVID-19 cases. Consequently, they came up with a project called “Songs of Our Atolls,” that would facilitate intergenerational communication and combat negative stereotyping. The second part explores the “Songs” project from its inception to grant application to realization through the activism of Marshallese youth musicians (MARK Harmony). Based on interviews and my remote participation, I examine the studio-based outreach to elders through which the band engaged in conversations and intergenerational learning (through songs) in ways that maintained social proximity while keeping physical distance in culturally appropriate ways. The third part offers a critical assessment of potential directions for the “Songs” project, including bidirectional learning, that dovetails with part one of the essay, whereby the band would work on collaborative public service announcements with other youths and elders, which is a method inspired by Youth to Youth in Health (an organization in the Marshall Islands). My conclusion sums up the ethical importance of paying attention to sound and music in terms of communal health and situating these transpacific forms of culturally appropriate information dissemination and intergenerational learning in the broader diaspora.

Up for the task? Local health authorities and communal health in Germany

AimPublic health depends on effective structures at all administrative levels. Focusing on the case of Germany, this study assesses the capabilities of local health authorities and how these organisations fulfil their role within the communal health structures.Subject and methodsGerman local health authorities; Explorative online survey.ResultsLocal health authorities face some organisational deficiencies (mostly in expertise) in living up to their role within communal health structures. Despite these challenges, they do engage in exchange with municipalities and get involved in programmes and public health surveillance.ConclusionTo strengthen public health and increase the effectiveness of health administrative structures, it would be wise to provide the necessary resources at the local level and to reassess the scope and mandate of local health authorities.

Priority directions for the development of regional health care centers conducting organ transplantation


 
 
 to form a medical and social substantiation of priority areas for the development of re- gional health care centers conducting organ transplantation. For the achievement of the goal, the funda- mental scientific methods of analysis, synthesis, aggregation, interpretation of scientific data, as well as systemic analysis, were put in place. Medical and sociological follow-up of 411 patients was carried out in the clinic at the Institute of Heart of the Ministry of Health of Ukraine, 453 doctors – anesthesiologists in the communal health departments of the Ministry of Health of Ukraine and 417 doctors – neuropa- thologists in the community health departments of the Ministry of Health of Ukraine. The analysis of the forms of state statistical and expert evaluation of the structural and organizational activities of the
 
 
 
 basic system of donation and organ transplantationin Ukraine was carried out. Ananalysis of the state of regional health care centers conducting transplantations and an expert assessment of the structural and organizational storage activities of the system of donation and organ transplantation in Ukraine showed that the National Strategy for the Development of Donation and Organ Transplantation has not been developed, funding and material and technical base, and professional training of regional healthcare. There are no developed and officially approved national protocols and clinical guidelines for organ transplantation, qualification characteristics for transplant-coordinators. The mentality of organ donation and transplantation in the country is not at a high level. The analysis of the forms of national statistical ranks howed that diseases of the circulatory system are the leading cause of premature death and disability in the population of Ukraine, which determines their significant medical, social and so- cio-economic significance. A sociological study conducted among patients made it possible to establish that the prevailing cultural perceptions of Ukrainians currently do not create positive precedents for the development of donation based on the solidarity system of “organ testament”. A sociological study conducted among doctors – neuropathologists showed that the awareness of neuropathologists about the modern possibilities of transplantology is weak, there is not enough knowledge about the technique of donor organ transplantation, and there is no positive motivation for organ donation. The identified problems confirmed that the conditions in which health care providers conduct transplants work, in- creasing the volume of transplants that contribute to the preservation of public health, and often life, is problematic. The study contributed to the formation of priority are as for the development of regional health care providers conducting organ transplantation.
 
 
 
 
 

Postgraduate training of neurosurgeons. From a five-month specialization to a six-year residency. Past. The present day. Future

ResumeNeurosurgery training in the countries of the European Union, America and Asia lasts from 5 to 7 years and involves acquiring knowledge not only in clinical, but also in scientific activities. Taking into account the need to use high-tech methods for the treatment of neurosurgical diseases, the duration of 3-year internship training, as is customary in Ukraine, is insufficient. The analysis of historical and modern approaches to teaching neurosurgery by professional communities in the USA and the European Union allows for the development of a modern training program in the specialty "neurosurgery" in terms of content and duration. The sample training program at the residency was reviewed after all comments and suggestions were received and approved at the meetings of the Department of Neurosurgery of the Shupyk National Healthcare University of Ukraine, the State Institution «Romodanov Neurosurgery Institute NAMS of Ukraine» and the Ukrainian Neurosurgical Association by a group of experts in the specialty «Neurosurgery».It is important to select candidates for residency ‒ successful study, knowledge of a foreign language, taking into account communication skills. The order for residency is determined by the Ministry of Health of Ukraine, no more than 10 residents can be applied per year, regardless of the form of payment. After completing the residency, 2 years of work experience in state or communal health care institutions, military hospitals is mandatory.It is to justify the need for quality training of neurosurgeons in accordance with the standards of the European Union. The introduction of a single standard for the training of neurosurgeons in Ukraine, which takes into account the best domestic and foreign experience, will make it possible to raise the level of domestic neurosurgery and integrate it into the world system of medical education. A significant increase in the length of training in a neurosurgery residency (up to 6 years) is necessary for the full-fledged development of a specialist neurosurgeon.

Flavokawain mitigates ovalbumin (OVA)-induced asthma by regulating NLRP3 inflammasome and inflammatory markers: In-vitro and in-vivo models

BackgroundAsthma is the most prevalent chronic inflammatory ailment, which has major communal health implications for both adults and children worldwide. Flavokawain is a chalcones present in kawa plant extracts. They have anti-inflammatory, antioxidant, anti-cancer, antimicrobial, and other activities. MethodsIn the present investigation, the potential of flavokawain on the IL-4-induced 16HBE cell line and the ovalbumin (OVA)-induced mouse model was analyzed. ResultsThe findings revealed that the IL-4-induced 16HBE cell line treated with flavokawain reduced cell apoptosis and increased cell proliferation. The NLRP3 inflammasome activity was suppressed by flavokawain. The level of immune cells was increased in the asthmatic mice, which was effectively reduced by the treatment with flavokawain. IgE, eotaxin, TNF-α and TXB levels were decreased by the flavokawain treatment in the asthmatic mice. Imbalances in Th1 and Th2 cytokines were effectively modulated by the flavokawain treatment in the asthmatic mice. The balance between the Th1 cytokines (IL-12 and IFN-γ) and the Th2 cytokines (IL-4, IL-5, IL-6, and IL-13) was maintained by flavokawain. The histopathology study of lungs revealed that the thickness of the airway membrane and inflammatory cell infiltration was reduced by the flavokawain, which indicates the decrease in inflammation. ConclusionThese findings recommend that flavokawain can be used as a potent candidate to treat asthma in the future.

Social Determinants of Health, Prenatal Maternal Stress, and Earlier Birth During the COVID-19 Pandemic.

During the COVID-19 pandemic, pregnant women, especially those from socioeconomically disadvantaged and marginalized groups, experienced unprecedented stress. Prenatal stress and social determinants of health (SDoH) such as lower education and lack of a relationship partner are known to contribute to earlier birth. However, whether SDoH and stress independently contribute or whether the harmful impact of SDoH is mediated by stress is unknown. Moreover, the contributions of these factors has not been investigated in the context of a communal health crisis such as the COVID-19 pandemic. To examine these processes, we used a longitudinal cohort of 2,473 women pregnant during the COVID-19 pandemic who reported a live birth. We compared structural equation models predicting gestational age at birth from SDoH (race/ethnicity, education, financial security, health insurance, relationship status, and lifetime abuse) and from prenatal maternal stress related and unrelated to the COVID-19 pandemic. Results indicate that the association of SDoH with earlier birth was partially mediated by prenatal stress. These findings help uncover mechanisms explaining health disparities in the U.S. and highlight the need to address both SDoH and the stress that these factors produce in under-resourced and marginalized communities.

Students' Knowledge and Willingness Towards COVID-19 Vaccination, University of Bohol

The COVID-19 pandemic has gripped the world, necessitating a collective response. As vaccination emerges as a critical tool in the battle against the virus, this research explores the knowledge and willingness of allied medical students at the University of Bohol toward COVID-19 vaccination. With 839 students enrolled for the second semester of the academic year 2021-2022, a representative sample of 286 students was selected. Utilizing a standardized questionnaire, the study assessed knowledge levels and willingness to vaccinate among students from the College of Nursing, Pharmacy, Midwifery, and Physical and Occupational Therapy departments. Results indicate a moderate knowledge level (composite mean = 2.84), with awareness of preventive measures and the existence of a vaccine. Positive attitudes towards vaccination, emphasizing communal health responsibility and trust in healthcare providers, were evident. However, concerns about potential side effects were relatively low. Demographic analyses revealed age and sex-based variations in knowledge and willingness, emphasizing the need for tailored educational initiatives. Notably, there was no significant correlation between knowledge and willingness, underscoring the multi-faceted nature of individuals' attitudes toward vaccination. These findings provide crucial insights for public health strategies, urging targeted educational campaigns and emphasizing nuanced approaches for different demographic groups. The study contributes valuable perspectives for refining vaccination programs and addressing the evolving challenges posed by the ongoing COVID-19 pandemic.

An Intersectional Approach to Hepatitis B

Hepatitis B is a chronic condition, primarily associated with hepatitis B viral infection in early life. The failure of prevention and appropriate management can lead to subsequent liver cirrhosis and cancer. Hepatitis B most commonly affects people born in Asia and Sub-Saharan Africa and their global diasporas. The physical, psychological, and social impacts of hepatitis B are strongly influenced by sex and gender. Inequities in access to timely, sensitive diagnosis and effective management arise from interactions between structural inequalities related to race, ethnicity, Indigenous/settler status, class, and geography. The biomedical response to hepatitis B has led to advances in prevention, diagnosis, and treatment, but many affected communities have explanatory health belief models that differ from that of biomedicine. We argue that an intersectional approach, led by affected people and communities, can integrate biomedicine with the lived experience and social context that give purpose to and shape all personal, communal, clinical, and public health responses to hepatitis B. This approach has the potential to enable a consciously equitable, effective response to the biopsychosocial complexities of hepatitis B, improve the health and wellbeing of people living with hepatitis B, and reduce hepatitis B-associated mortality.

‘If there is joy… I think it can work well’: a qualitative study investigating relationship factors impacting HIV self-testing acceptability among pregnant women and male partners in Uganda

ObjectivesSecondary distribution of HIV self-test (HIVST) kits from pregnant women attending antenatal care (ANC) to their male partners is shown to increase HIV couples testing and disclosure, and is being...

Midterm Maelstrom: Public Health Legal Impacts of Election 2022.

Among the morass of critical issues impacting the results of the midterm elections in 2022 were core public health issues related to health care access, justice, and reforms. Collectively, voters' communal health and safety concerns dominated outcomes in key races which may shape national, state, and local legal approaches to protecting the public's health in the modern era.

Moscow City Finances in the 1950s–1980s: Dynamics and Structure of the Local Budget

This article studies the changes in the structure and dynamics of the capital’s budget in the late Soviet period (1950s–1980s). The authors refer to materials of the Department of Finance of the Moscow Government kept in the Central State Archives of Moscow, as well as published in the 1950s–1970s collections of documents of the Executive Committee of the Moscow City Council of Deputies, dedicated to the budget estimates of Moscow. On their basis, the authors created an electronic database Moscow Budget in the 1950s–1980s, which was used to make all the calculations necessary for the analysis. The authors conclude that the budget of the capital was constantly growing and was in surplus, and in terms of per capita expenditures it occupied the 4th–6th places among the regions of the RSFSR. It focused on the development of urban infrastructure and, first of all, residential development. In absolute terms, the budget of Moscow in the period under review increased 11 times. In per capita terms, it grew 5.6 times. The most important items of expenditure for the capital were housing and communal services, education, and health care. At the same time, in the structure of the capital’s budget, fixed sources of income (including local ones) were gradually being replaced by regulated incomes transferred from higher budgets, which made the city dependent on them.

МЕДИЧНІ ТА РЕАБІЛІТАЦІЙНІ ЗАКЛАДИ ЯК СУБ’ЄКТИ ПРАВА

The legal position of institutions in the field of health care and rehabilitation was studied. The main trends of reforming the sphere of functioning of health care institutions are defined, their main types, organizational and legal forms and forms of ownership are characterized. The peculiarities of the activity of state health care institutions, which are business entities belonging to the state sector of the economy and the management of such institutions is carried out exclusively by the state in accordance with the principles of domestic and foreign policy, are considered. The procedure for the formation and operation of communal enterprises that carry out their activities on a non-commercial basis is analyzed, that is, medical institutions that work as communal non-commercial enterprises independently carry out their economic activities, which are aimed at achieving relevant economic, social and other results and without the goal of making a profit. It is noted that the network of state and communal health care institutions is formed taking into account the development plans of hospital districts, the needs of the population in medical care, the need to ensure the proper quality of such care, timeliness, accessibility for citizens, effective use of material, labor and financial resources. It was noted that private health care institutions are not limited in the choice of organizational and legal form. Key words: medical institution, rehabilitation care institution, hospital district, state medical institution, communal medical institution, private medical institution, state medical institution.

Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy by Guy Geltner

Reviewed by: Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy by Guy Geltner Sally Mayall Brasher Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy. By Guy Geltner. (Philadelphia: University of Pennsylvania Press. 2019. Pp. x, 320. $65.00. ISBN: 9780812251357) In Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy, Guy Geltner challenges the received wisdom regarding public health in the pre-modern world that suggests early urban governments were, at worst, self-interested and indifferent to the health of their citizens or, at best, simply unable to understand the correlation between health and public policy, at least until the Industrial Revolution or possibly at the earliest as a reaction to the Black Death. Geltner encourages the reader to reexamine these assumptions and their theoretical models as well as the selective evidence on which they are based. Using urban statutes and court and fiscal records from north and central Italy between 1250 and 1500, Geltner argues that civic authorities in these urban areas understood the need for promoting health and well-being among the citizenry as a means of maintaining political control. By considering both normative and descriptive sources, he is also suggesting that, in addition to being employed earlier than generally thought, communal health initiatives were also more effective than previously understood. Geltner frames his study using Michel Foucault’s theory of biopolitics as applied to the eighteenth century (regulating private behaviors for the public good). Geltner employs the term “health-scaping” to the actions of urban governments which he defines as “the physical, social, legal, administrative, and political process of providing urban environments with the means to promote residents’ health” (p. 20). He argues that if one looks broadly at the policies of the medieval urban governments, including monitoring activities and regulating behavior in areas such as waste disposal, animal conduct, and proto-industrial waste, it is possible to see a conscious effort at health-scaping and the creation of preventative public policy that was consistently and effectively enforced well before the Industrial Revolution. After a general introduction to the theoretical construct for his arguments and a consideration of the breadth of archival sources for public health regulation, the main body of the book outlines findings for three case-studies from Lucca, Bologna, and Pinerolo. The study primarily focuses on these cities’ roads officials, viarii, fango, and comparii, respectively, who were tasked with maintaining the infrastructure and policing communal activities along the public roads with regard to sanitation and safety. Geltner provides an exhaustive study of the statutes for the employment, regulation, and activity of these officials. Beyond prescriptive statutes, he also finds detailed records of assignments, building and labor expenses, violations, fines, and witness accounts, which testify to the commitment and effectiveness of the efforts of the officials. Geltner’s last chapter suggests the possibility of applying his methodology even further chronologically and geographically, citing, for example, ancient Roman policy efforts and those of other non-western civilizations in order to “fundamentally [End Page 193] alter the prevalent narrative of public-health history and thereby interrogate an entrenched paradigm of Euro-American modernity” (p. 144). While commendable, and opening many avenues for further exploration, some of the suggested analysis presents too great a methodological stretch for his argument. Also, Geltner’s focus on intentional efforts of the civic authorities in health-scaping overlooks the fact that this effort was also driven, in part, by popular communal demand. Individual citizens, tertiary religious orders, nascent private hospitals, and other civic constituents actively sought a civic response to communal need forcing the hand of civic authorities in many cases. These slight critiques do not detract from the overall importance of Geltner’s work, and Roads to Health is an important addition to the recent body of scholarship that is reassessing the evolution of health care and social assistance in urban areas of medieval Europe. In this highly readable study, Geltner successfully proves that health-scaping was indeed a civic value already fully entrenched in urban Italy in the high Middle Ages. Sally Mayall Brasher Shepherd University Copyright © 2023 The Catholic University of America Press ...

Water Purification by Green Synthesized Nanomaterials.

Water pollution is one of the important causes of human fatality in the world, particularly in underdeveloped or developing countries. Moreover, with rapid industrialization and urbanization, the problem of water pollution is posing a severe threat to health and livelihood. The pollutants found in water are of varied nature and depend on the source of the water. Several techniques have so far been adopted to purify contaminated water. All the techniques have one or the other disadvantages, limiting their applications on large scale, sustainability, and long-term usage. The advances in the field of nanoscience and technology have opened a new horizon for replacement/improvement of conventional ways with more efficient methods. Presently, green synthesized nanomaterials are being used for water purification. Plant extracts and microbes are being used to synthesize nanomaterials, which are used as catalysts, adsorbents and membranes for water purification. Nanomaterial-based techniques could create problems for the environment due to various chemicals used in their production step, thus defeating the ultimate purpose. In this regard, green nanomaterials can prove to be extremely useful both in terms of sustainability and efficiency. This review illustrates various ways of how green nanomaterials can be utilized for water remediation and summarizes the recent work done in this emerging research area.

Positive Impact on Public Perception toward Commune Health Stations (CHSs) in Rural Areas of Tyuen Quang Province, Vietnam, Following the Application of the Development Program for the Capacity-Building of CHSs.

This study aims to discover whether or not the capacity-building intervention through implementing the "Rural Area Development Program" in Tuyen Quang province, in partnership with the Korea International Cooperation Agency (KOICA) and the Vietnamese Department of Health", would positively affect the perception of the public toward the communal health stations (CHSs). To address this, three specific indicator-related satisfaction levels were examined regarding the infrastructure, the professional skills, and the service attitude of the medical personnel of the three CHSs toward outpatients. This cross-sectional study was conducted with 100 participants from three rural CHSs (Binh Yen, Vinh Loi, and Thang Long Communes). As a researcher-directed survey, a structured questionnaire was adopted to gauge the outpatient satisfaction levels in relation to the three indicators from the CHS medical milieu toward the patients and the medical services received. Descriptive and inferential analyses were performed to determine the perceptions of outpatient satisfaction relating to the three indicators. A higher satisfaction rate was found (overall 89-100% descriptive data with three indicators, as well as significant satisfaction differences in inferential data based on F-ratio and p-value) between the three regions with the three indicators, and two major data showed that the commune with a higher or more significant satisfaction rate or difference was Binh Yan > Vinh Loi > Thang Long. Collectively, this study clearly indicates the positive impact of CHSs capacity-building by implementing the Development Program in Tuyen Quang province with KOICA in relation to the public perception toward CHSs through significantly increased satisfaction levels-specifically, the infrastructure, the professional skills, and the service attitude of the medical milieu from the three CHSs toward outpatients.

Management of regional development projects in the context of post-war reconstruction needs

In quarantine restrictions and active hostilities in most territories of Ukraine, the problems of activating the processes of virtual adaptation of enterprises, organizations, and institutions to new working conditions have become more acute. Moreover, it contributed to the acceleration of digital transformation processes, the transition of a significant part of workers to the remote format, the broader use of means of intellectual work, and the development of various management and remote communication programs. It is worth mentioning that in connection with the war of the Russian Federation against Ukraine, which is currently ongoing, most regional strategies, projects, and programs need to be updated, considering the current data on the economic, social, and ecological state of the territories after the victory, the final assessment of the damage and destruction. The paper considers the process of managing regional development projects in the context of the need for the post-war reconstruction of Ukraine. The study showed that in the structure of projects financed from the DFRD, most of them are aimed at the development of education (about 50% of all projects), sports (an average of 15%), housing, and communal services (10%), health care (12%), transport and road infrastructure (5%). Only a little share of projects (1.5%) has a creative direction. The principles of regional management are described, which should be transformed into criteria for selecting regional and territorial development projects that will be financed from the state budget, the budgets of territorial communities, and in the form of public-private partnerships. It was emphasized that the government of Ukraine created the Fund for the Restoration of Ukraine, funds to which all those interested in a quick victory and restoration of economic potential can transfer funds. It was determined that the search for additional resources for implementing local projects could become important in reconstructing regions on the ground. It was emphasized that necessary conditions for activating these processes are the creation of conditions for the development of small businesses and the imperative of state guarantees for investors, donors, and financial institutions in financing risky projects. It has been determined that there is a need to improve the qualifications of local authorities, self-government, and businesses regarding the possibilities of attracting various sources of funding for business projects and the requirements for them, as well as improving the skills of project management. Keywords: project, management of regional development projects, post-war reconstruction.

Do parental cognitions during pregnancy predict bonding after birth in a low-risk sample?

Parental bonding to their infant is important for healthy parent-infant interaction and infant development. Characteristics in the parents affect how they bond to their newborn. Parental cognitions such as repetitive negative thinking, a thinking style associated with mental health issues, and cognitive dispositions, e.g., mood-congruent attentional bias or negative implicit attitudes to infants, might affect bonding. To assess the influence of cognitive factors on bonding, 350 participants (220 pregnant women and their partners) were recruited over two years by midwives at the hospital and in the communal health care services. Participants were followed throughout the pregnancy and until the infant was seven months old as a part of the Northern Babies Longitudinal Study. Both mothers and fathers took part. First, we measured demographics, repetitive negative thinking, attentional bias, and implicit attitudes to infants during pregnancy, as predictors of bonding two months postnatally. Second, we also measured infant regulatory problems, and depressive symptoms at two months postnatally as predictors of parents' perception of infant temperament at five months. Robust regression analyses were performed to test hypotheses. Results showed that mothers and fathers differed on several variables. Parity was beneficial for bonding in mothers but not for fathers. Higher levels of mothers' repetitive negative thinking during pregnancy predicted weaker bonding, which was a non-significant trend in fathers. For fathers, higher education predicted weaker bonding, but not for mothers. Mothers' perception of their infant temperament at five months was significantly affected by bonding at two months, but for fathers, their depressive symptoms were the only significant predictor of perceived infant temperament. In conclusion, for mothers, their relationship with their infant is essential for how they experience their infant, while for fathers their own wellbeing might be the most important factor. Health care providers should screen parents' thoughts and emotions already during pregnancy to help facilitate optimal bonding.

Dental care at commune health center in Cai Be district, Tien Giang province: Practical implications

Objective: To analyze the status of dental care activities, including prevention and treatment of dental conditions at 09 health commune stations in Cai Be district, Tien Giang province in the period of 2016 - 2018. Methods: The study used a cross-sectional design (using qualitative and secondary data), to conduct, 18 in-depth interviews with administrators of 1 district health center, 3 commune health stations, 3 medical staff in charge of oral diseases, 8 patients, and 3 school medical staff. Thematic analysis was used, and quantitative data were analyzed with descriptive statistics Findings: Communication activities for dental care were carried out annually; all patients were consulted and educated on oral health and prevention measures for oral and dental diseases. All 09 commune health stations have medical staff in charge of oral diseases; however, their professional qualifications are limited. Usually, they are not dentists but dentomaxillofacial physicians, or even nurses in some stations. All 09/09 commune health stations do not have staff that are trained on dental care at hospitals. Conclusions and recommendations: Dental care at the commune level has a number of limitations, requiring further development of human resources, technical support, communication activities, and oral care supervision at communal health stations and schools.

The Future of Tourism in the Anthropocene

This article undertakes a comprehensive review of tourism's impacts on social-ecological systems and the use of the local to global commons. It examines a wide range of issues from climate change and air travel to biodiversity loss, pollution, and overtourism. It reinforces that tourism in modernity has pursued a dominant growth-driven paradigm of development and market expansion that is unsustainable. The review raises critical questions about how to move forward in the Anthropocene, where climate change is an existential threat to which travel and tourism must adjust. We offer directions for knowledge creation to develop nature-positive tourism that decouples from greenhouse gas emissions and seeks the regeneration of natural capital and communal health and well-being. This direction includes rethinking the purposes and values of tourism by addressing equity and ethical issues. It also calls for inclusivity of diverse worldviews and knowledge systems, including traditional and Indigenous knowledge. Such a pluralistic paradigm replaces the unsustainable modernist tourism paradigm that has dominated its evolution. We conclude with suggestions for research to advance nature-positive tourism.