Community Health Centers Research Articles

Patterns of Acute Ischemic Stroke Treatment from 2010 to 2020: An Evolving Landscape in Stroke Management Following Thrombectomy Trials.

Population-based studies on stroke can help guide the care of patients with acute ischemic stroke (AIS) by providing health care communities with information regarding the current usage of stroke treatments. It remains unclear how rapidly new techniques, particularly endovascular stroke treatment (EST), are being adopted and whether there is any disparity in their availability. Although studies using the National Inpatient Sample (NIS) have been conducted, updated studies over a longer period may provide further insights. This study aimed to understand patterns of AIS treatment, discharge disposition, in-hospital mortality, and mean length of stay (LOS) for each modality from 2010 to 2020 using the NIS database. This retrospective longitudinal study was conducted using NIS data from 2010 to 2020. Patients were categorized into groups based on whether they received intravenous recombinant tissue plasminogen activator (rt-PA), EST, both rt-PA and EST (combined therapy), or supportive care alone. Demographic, socioeconomic, regional, insurance, and hospital data were also obtained. The primary outcome was the proportion of patients receiving each modality, whereas the secondary outcomes were in-hospital mortality, mean LOS, and discharge disposition. The usage rates increased (p < 0.001) in all groups between 2010 and 2020 (rt-PA: 5.09% to 8.39%, EST: 0.31% to 4.40%, and rt-PA+EST: 0.46% to 1.09%). The highest increase in usage was observed for EST, with a thirteen-fold increase. Mortality decreased from 2010 to 2020 in all groups (rt-PA: 8.45% to 3.54%, EST: 25.22% to 12.50%, and rt-PA+EST: 21.12% in 2010 to 9.30%) (p < 0.001). Combination therapy demonstrated the greatest improvement, with an 11.2% reduction in absolute mortality. Mean LOS was reduced for patients who received rt-PA (6.8 to 4.8 days), EST (9.3 to 8.9 days), and combined therapy (10.0 to 8.3 days) (p < 0.001) over the study period. The proportion of patients discharged to home increased for rt-PA (29.01% to 41.85%), EST (14.13% to 17.70%), and combined therapy (12.89% to 24.29%) (p < 0.001). Overall, stroke treatment usage was higher among the higher income groups, regardless of race. Higher usage was also observed for Whites in the West and Hispanic ethnicities in the South and West. Regardless of income or treatment method, utilization rates were lower for Black patients. Utilization rates were lower for Black patients with Medicare, Medicaid, or self-pay than for White patients. Our study demonstrated that endovascular stroke treatment continues to expand, leading to better outcomes for mortality, LOS, and home discharge. Despite these positive patterns, there are visible inequities across regions, income status, and races.

Is Chinese Medicine Facing a Potential Workforce Crisis in Australia? Demographic Changes in the Profession over the Last Decade.

Background: As a prominent part of complementary and alternative medicine, Chinese Medicine (CM) has proved its strengths in treating a diverse range of acute and chronic medical conditions and is at present recognized in 196 countries and territories worldwide. In 2012, Australia regulated the CM profession under the National Regulation and Accreditation Scheme (NRAS) by legislation and reports quarterly demographic information about individual CM practitioners so to ensure public interest, although research examining the change of CM workforce in Australia has been scarce. Objective: This study aims to investigate the construction of the CM workforce in Australia and more importantly, evaluated its development in the last decade to capture the trajectory and trend in the present period and future potential changes. Methods: Data were sourced from the Australian Health Practitioner Regulation Agency (AHPRA) annual reports and the Chinese Medicine Board of Australia (CMBA) registration statistics from 2012 to 2023. A descriptive analysis was conducted with demographic variables, including profession, age, and gender, and chi-square tests and linear regression modeling were carried out to assess the variations between regions and across years. Results: The population of CM practitioners in 2022/2023 stagnated with slight decrease to 4,823, in contrast to the increase rate of 2.9% in the whole health care community. The number of young CM registrants (<35 y) shrank by 37.5% from 691 in 2012 to 432 in 2023. In comparison with other health care professions, CM comprises the smallest proportion of the population aged younger than 25 (0.2%) and the largest proportion aged older than 65 years (16.2%), advancing into an aging era. Conclusions: This study indicates a worrying potential decline in CM workforce in Australia, which is likely to be further exacerbated by the lack of new graduates and rise of median age among practitioners. Meanwhile, continued advancement in Western medicine technology and standards requires substantial efforts to increase both a better understanding of CM and demonstration of its efficacy. Furthermore, greater effort is needed to recruit and educate new young CM practitioners in Australia and to broaden the international training pipeline for a sustainable development of CM practice.

A Collective Action Formation to Address Mental, Emotional, and Behavioral Health in Schools: The District 87 Wellness Collaborative

The District 87 Wellness Collaborative is a multi-dimensional, interprofessional initiative in the Midwest region of the United States that was co-designed to facilitate collaboration, civic engagement, and partnerships among university scholar-practitioners, community agencies, and school administrators and personnel. The primary aims of the Wellness Collaborative are to develop, enhance, and extend school initiatives that address mental, emotional, and behavioral health outcomes of school-age children, their families, and the education workforce. The Wellness Collaborative is composed of disciplinary expertise in kinesiology, school counseling and psychology, social work, nursing, geography, and community health. Broader campus and community partners include specialists from civic and community engagement offices, extension services, and healthcare providers. This ecologically framed initiative supports strategic and system-level change within the district (system) and individual schools (sub-systems). It addresses complex school-level organizational factors (i.e., environment, norms, organizational culture, incentives, etc.) that influence wellness behaviors that affect school and physical education workforce professionals.

Peningkatan Pengetahuan Dan Praktik Ibu Balita Tentang Komposisi Dan Informasi Nilai Gizi Makanan Kemasanan

Public awareness and ability to read food labels is still very low. A National Consumer Protection Agency survey stated that 6.7% of people in Indonesia pay attention to the completeness of food labels. One of the Messages of Balanced Nutrition is reading food labels. S1 Nutrition Study Program STIK Sint Carolus together with Nutritionists from the Galur Supporting Community Health Center provided counseling to mothers of toddlers on the topic "Let's Check the Coins (Composition and Nutritional Value Information) on Food Packaging" to 20 mothers of toddlers who visited the Posyandu. Counseling participants are given an identity and pretest form to fill out. The first session included material on definitions and food labels, and the second session provided material on how to read composition and nutritional value information. The third session involved practicing reading packaged food and conducting questions and answers and filling in the posttest form. After 3 days of providing material, monitoring and evaluation was carried out via Whatsapp. Based on the results of statistical analysis, 55% of mothers were classified as lacking knowledge during the pretest. However, it increased after nutrition education was carried out to 95% of mothers who were classified as well informed. The results of the Wilcoxon analysis show that there is a difference in knowledge between before and after counseling with p-value = 0.007. The results of monitoring and evaluation from 5 mothers, 100% of mothers had paid attention to food labels on packaging, especially composition and nutritional information. There has been a change in practice in reading food labels. Keywords: food labels; knowledge; nutrition information; nutrition counseling

Waiting for Care and Community Organizing for Serious Health-Related Suffering in Kerala, India.

We explore the temporalities that shape and alleviate serious health-related suffering among those with chronic and terminal conditions in Kerala, India. Drawing on ethnographic fieldwork between 2009 and 2019, we examine the entanglements between waiting for care within dominant institutions and the community organizing that palliates this waiting. Specifically, people navigate multiple medical institutions, experience loneliness and abandonment, loss of autonomy, and delays and denials of recognition as they wait for care. Community palliative care organizations offering free, routine, home-based care provide samadhanam (peace of mind) and swatantrayam (self-determination) in lifeworlds mired with chronic waiting. We document how community care sustains an alternative politics of shared time, untethered from marketized notions of efficiency and productivity toward profits. In so doing, we cast in high relief community healthcare imaginaries that alleviate serious health-related suffering and reconfigure Global North-centric perspectives.

The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016-2022).

Family functioning plays a critical role in childhood disruptive behavior disorders (The Family Journal, 2003, 11(1), 33-41; Research in Nursing and Health, 2016, 39(4), 229-243). Yet, there is limited research on the impact of evidence-based family strengthening interventions on improving family cohesion as a protective factor among children experiencing behavioral challenges. To address this gap, we analyzed data (N = 636) from the SMART Africa-Uganda study (2016-2022), a cluster randomized clinical trial testing an evidence-based family-strengthening intervention called Amaka Amasanyufu (translated as "Happy Families" in the local language). Children aged 8-13 and their caregivers were recruited from 26 public primary schools that were randomized to: (1) control condition receiving generalized psychosocial literature (10 schools), (2) intervention delivered via parent peers (eight schools), and (3) intervention delivered via community healthcare workers (eight schools). Children completed the family cohesion questionnaire at baseline, 8 weeks, 16 weeks, and 6 months post-intervention completion. The intervention effectiveness was evaluated via a three-level logistic mixed effects model with pairwise comparisons across study conditions within each time point. Participants in the parent-peer intervention group had greater odds of being in the higher family cohesion group than participants in the control group at 8 weeks (OR = 3.24), 16 weeks (OR = 1.88) and 6 months (OR = 2.07). At 8 weeks, 16 weeks, and 6 months, participants in the community health worker group had 3.98, 2.08, and 1.79 times greater odds of being in the higher family cohesion group than participants in the control group, respectively. Our findings strengthen the evidence base for Amaka Amansayufu as an effective intervention that can be utilized in SSA to improve family cohesion in families with children experiencing behavioral challenges.

Barriers to intention to adopt telemedicine: The interplay between exposure, trust, and convenience

Telemedicine is an emerging option to improve patients’ medical outcomes and overcome health disparities. The technology is a cost-effective alternative to in-person medical treatments and can supplement medical care to alleviate stress on the medical infrastructure in the upcoming decade. This study uses survey methods to investigate the patient population’s intention to use telemedicine and assess the influence of different variables on telemedicine usage choices. Findings show that loss of income, trust in physicians, and time lost reduce intention to use telemedicine. The results carry implications for the healthcare industry, lawmakers, social workers, community activists, and family caregivers who bear the burden of helping loved ones with everyday tasks.

Leveraging Project ECHO to Implement a Suite of Substance Use Learning Communities for Statewide Impact.

Overdoses and alcohol consumption rose during the pandemic. However, uptake of practices which reduce mortality (eg, medications for opioid use disorder, harm reduction practices) remains insufficient. Provider training and telementoring is needed to ensure sufficient capacity for treating substance use disorders (SUDs) with evidence-based practices. The Project ECHO (Extension for Community Healthcare Outcomes) model involves the use of web technologies to deliver didactic and case-based learning through a panel of experts to build such competency in a community of learners. Project ECHO was leveraged to implement a statewide telementoring center of addictions-focused ECHO programs, including programming in prescribing, harm reduction, recovery support services, collaborations with first responders, and systems-level challenges. Participants represented health and behavioral health disciplines practicing across the state of Texas in metropolitan and rural areas. Learners were administered: (1) an online registration form that inquired about basic demographics, (2) a post-session survey at the conclusion of each session capturing satisfaction and likelihood to implement, and (3) annual surveys measuring changes in knowledge and self-efficacy. Attendance and other learner data were stored and extracted from the partner relationship management database: iECHO. Training programs were attended by 968 learners, with an average of 48 learners per session. Geographic reach included 47 Texas cities. Post-training survey results indicated high rates of learner satisfaction, with an average rating of 4.68 on a 5-point Likert-like scale. Annual surveys indicated improvements in provider knowledge and self-confidence across all programs. Early results indicate robust uptake, wide geographic reach, high learner satisfaction, and provider knowledge and confidence gains. This preliminary evidence supports the use of the ECHO model as a potential tool for scaling comprehensive SUD telementoring centers to meet workforce development needs over large geographic areas.

Research with Black Communities to Inform Co-Development of a Framework for Anti-Racist Health and Community Programming.

The effects of systemic racism were exacerbated and amplified throughout the COVID-19 pandemic. The resurgence of the "Black Lives Matter" movement in North America brought awareness to the public, especially white people, of the impacts of systemic racism in society and the urgent need for large-scale and institutional anti-racism work. In collaboration with a local Community Health Centre, this research focused on identifying priority areas for tailored and co-developed anti-Black racism interventions in health services and community programming, as well as examining how purposeful relationships can be created with African, Caribbean, and Black (ACB) communities in London, Ontario. Semi-structured interviews were conducted in either French or English with nine formal or informal leaders from London's ACB communities. Interpretive description methodology guided analysis and interpretation. Participants indicated that anti-Black racism is ever-present in the community and in their lives, with systemic racism causing the most harm. Racism should be addressed by creating ACB-specific services, and education for non-Black communities; increased representation, inclusion, and engagement of ACB people within organizations, especially in leadership roles, are essential. A framework based on study findings to guide how organizations can develop authentic and purposeful relationships with ACB communities is presented. Organizations will continue to perpetuate systemic racism unless they actively seek to be anti-racist and implement strategies and policies to this end. The proposed framework can guide partnerships between health and community organizations and ACB communities, and support co-development of strategies to address anti-Black racism.

Implementation of a clinically integrated breastfeeding peer counselor program.

Reflecting disparities across the US, in 2015 publicly insured patients of the NorthShore Community Health Center (NSCHC) in Evanston, Illinois had lower breastfeeding rates than commercially insured patients. We used the Replicating Effective Programs framework to describe the design and implementation of a clinically-integrated breastfeeding peer counseling (ci-BPC) program to address these disparities. Patient focus groups and surveys informed program design, and a multidisciplinary clinical support team developed workflows that integrated the breastfeeding peer counselor (BPC) into the clinic and the postpartum unit. ci-BPC improved breastfeeding intensity and duration by providing every NSCHC patient with (1) prenatal lactation education; (2) hands on lactation care in the hospital; and (3) on-demand postpartum support. Total cost per patient was $297-386. The program was sustained after demonstrating potential cost-savings. An evidence-based, multidisciplinary collaboration resulted in a sustainable clinically integrated breastfeeding peer counseling program that improved breastfeeding outcomes.

Design and Rationale of the Cardiometabolic Health Program Linked with Community Health Workers and Mobile Health Telemonitoring to Reduce Health DisparitieS (LINKED-HEARTS) Program.

Hypertension and diabetes are major risk factors for cardiovascular diseases, stroke, and chronic kidney disease (CKD). Disparities in hypertension control persist among Black and Hispanic adults and persons living in poverty in the United States. The "LINKED-HEARTS Program" (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS"), is a multi-level intervention that includes home blood pressure (BP) monitoring (HBPM), blood glucose telemonitoring, and team-based care. This study aims to examine the effect of the LINKED-HEARTS Program intervention in improving BP control compared to enhanced usual care (EUC) and to evaluate the reach, adoption, sustainability, and cost-effectiveness of the program. Using a hybrid type I effectiveness-implementation design, 428 adults with uncontrolled hypertension (systolic BP ≥ 140 mm Hg) and diabetes or CKD will be recruited from 18 primary care practices, including community health centers, in Maryland. Using a cluster-randomized trial design, practices are randomly assigned to the LINKED-HEARTS intervention arm or EUC arm. Participants in the LINKED-HEARTS intervention arm receive training on HBPM, BP and glucose telemonitoring, and community health worker and pharmacist telehealth visits on lifestyle modification and medication management over 12 months. The primary outcome is the proportion of participants with controlled BP (<140/90 mm Hg) at 12 months. The study tests a multi-level intervention to control multiple chronic diseases. Findings from the study may be leveraged to reduce disparities in the management and control of chronic diseases and make primary care more responsive to the needs of underserved populations.

Pemberdayaan Masyarakat Melalui Penerapan Metode Ovitrap dan Budidaya Tanaman Pengusir Nyamuk Sebagai Upaya Penanganan Demam Berdarah Dengue (DBD) di Kelurahan Tanjung Mas Kota Semarang

This service activity aims to increase the knowledge and skills of community members in handling dengue hemorrhagic fever through the ovitrap method and cultivating mosquito-repellent plants. The method of implementing this service uses empowerment with socialization and practical activities. This service establishes a partnership with Dian Nuswantoro University (UDINUS) in the form of Assisted Village Partners, Semarang City Health Service, and Bandarharjo Community Health Center providing support in the form of mentoring and speakers, and the Forest Plant Certification and Seedling Center (BSPTH) providing support in the form of 100 eucalyptus plant seeds. The evaluation instrument for this activity uses a pre-test and post-test. This service data analysis technique uses descriptive analysis. The results of this service show that community members have the knowledge and skills to deal with dengue hemorrhagic fever through the ovitrap method and cultivating mosquito-repellent plants in Tanjung Mas Village. This is proven by residents participating in the process of making Ovitrap tools and planting mosquito-repellent plants. There was a change in community knowledge from before the counseling was carried out to after the counseling was carried out (the score before the counseling was 35, and the score after the counseling was 50).

Growth and impact of Project ECHO for workforce development in age-friendly care.

Use of the Project ECHO® (Extension for Community Healthcare Outcomes) model in geriatrics has increased dramatically largely because of the Health Resources and Services Administration-funded Geriatrics Workforce Enhancement Programs (GWEP) utilizing it as a key tool for age-friendly, interprofessional workforce development. This manuscript describes the scope and impact of geriatrics ECHOs under the GWEP. A survey of GWEPs was conducted to measure the reach, foci, evaluation methods, and other characteristics of ECHO networks. All 48 (100%) GWEPs responded to the survey, and 30 (63%) reported using ECHO. GWEP ECHOs have both rural and urban-underserved reach across the United States, and their hub teams include many health professions. Age-friendly care is incorporated through multiple methods and is taught across foci including primary care, dementia, long term care, and novel topics. GWEP ECHOs have many academic and community partners including Area Agencies on Aging, and reach varied health professions, trainees, and caregivers. Geriatrics ECHOs collect outcomes across the evidence continuum including the community-level outcome of Age-Friendly Health System designation. The ECHO model has been widely adopted by GWEPs as a key approach for workforce training in age-friendly care. Project ECHO is a valuable tool to expand interprofessional training for the geriatrics workforce, particularly for interprofessional teams in rural and underserved areas.

Mixed-method evaluation study of a targeted mass drug administration of long-acting anti-malarials among children aged 3 months to 15 years in the Bossangoa sub-prefecture, Ouham, Central African Republic, during the COVID-19 pandemic

BackgroundIn 2020, during the COVID-19 pandemic, Médecins Sans Frontières (MSF) initiated three cycles of dihydroartemisin-piperaquine (DHA-PQ) mass drug administration (MDA) for children aged three months to 15 years within Bossangoa sub-prefecture, Central African Republic. Coverage, clinical impact, and community members perspectives were evaluated to inform the use of MDAs in humanitarian emergencies.MethodsA household survey was undertaken after the MDA focusing on participation, recent illness among eligible children, and household satisfaction. Using routine surveillance data, the reduction during the MDA period compared to the same period of preceding two years in consultations, malaria diagnoses, malaria rapid diagnostic test (RDT) positivity in three MSF community healthcare facilities (HFs), and the reduction in severe malaria admissions at the regional hospital were estimated. Twenty-seven focus groups discussions (FGDs) with community members were conducted.ResultsOverall coverage based on the MDA card or verbal report was 94.3% (95% confidence interval (CI): 86.3–97.8%). Among participants of the household survey, 2.6% (95% CI 1.6–40.3%) of round 3 MDA participants experienced illness in the preceding four weeks compared to 30.6% (95% CI 22.1–40.8%) of MDA non-participants. One community HF experienced a 54.5% (95% CI 50.8–57.9) reduction in consultations, a 73.7% (95% CI 70.5–76.5) reduction in malaria diagnoses, and 42.9% (95% CI 36.0–49.0) reduction in the proportion of positive RDTs among children under five. A second community HF experienced an increase in consultations (+ 15.1% (− 23.3 to 7.5)) and stable malaria diagnoses (4.2% (3.9–11.6)). A third community HF experienced an increase in consultations (+ 41.1% (95% CI 51.2–31.8) and malaria diagnoses (+ 37.3% (95% CI 47.4–27.9)). There were a 25.2% (95% CI 2.0–42.8) reduction in hospital admissions with severe malaria among children under five from the MDA area. FGDs revealed community members perceived less illness among children because of the MDA, as well as fewer hospitalizations. Other indirect benefits such as reduced household expenditure on healthcare were also described.ConclusionThe MDA achieved high coverage and community acceptance. While some positive health impact was observed, it was resource intensive, particularly in this rural context. The priority for malaria control in humanitarian contexts should remain diagnosis and treatment. MDA may be additional tool where the context supports its implementation.

Prevalence of non-communicable disease risk factors among nursing staff in a low and middle-income country: A cross-sectional digital survey-based study.

To assess the prevalence of non-communicable disease risk factors among the nursing staff and educate them on prevention. Nursing staff is integral to the Indian community healthcare systems. Recent studies report a high prevalence of non-communicable diseases in Indian nursing staff. Therefore, data on the prevalence of non-communicable disease risk factors among nursing staff are crucial for education on prevention. A cross-sectional digital survey-based study. We invited 4435 nursing staff to attend our online survey. We used a customized questionnaire for data collection, including a digitized version of the Community-Based Assessment Checklist form. A score of >4 was considered high risk and warranted screening. Among 682 nursing staff who attended, 70% had never undergone screening for non-communicable diseases. The prevalence of non-communicable disease risk factors was significantly higher in male nursing staff. In addition, logistic regression analysis showed that age, tobacco and alcohol use, increased waist circumference, physical inactivity and family history of non-communicable diseases were significant risk factors among nursing staff. The study findings suggest that the nursing staff have suboptimal self-health concerns on non-communicable diseases. This situation warrants continued medical education, awareness campaigns on adopting a healthy lifestyle and health promotion.

Optimizing pediatric periprocedural pain management part I-Evolving ethics and topical anesthetics.

Pediatric procedure-related pain management is often incompletely understood, inadequately addressed, and critical in influencing a child's lifelong relationship with the larger health care community. We highlight the evolution of ethics and expectations around optimizing periprocedural pain management as a fundamental human right. We investigate the state-of-the-art of topical anesthetics, reviewing their mechanisms of action and providing comparisons of their relative safety and efficacy data to help guide clinical selection. In total, this two-part review offers a combination of conventional approaches and innovative techniques that should be used multimodally-in series and in parallel-to help optimize pain management and provide alternatives to sedation medication and general anesthesia.

Using a customer discovery process to enhance the potential dissemination and scalability of a family healthy weight program for rural communities and small towns

AimCustomer discovery, an entrepreneurial and iterative process to understand the context and needs of potential adoption agencies, may be an innovative strategy to improve broader dissemination of evidence-based interventions. This paper describes the customer discovery process for the Building Healthy Families (BHF) Online Training Resources and Program Package (BHF Resource Package) to support rural community adoption of an evidence-based, family healthy weight program.MethodsThe customer discovery process was completed as part of a SPeeding Research-tested INTerventions (SPRINT) training supported by the U.S. Centers for Disease Control and Prevention. Customer discovery interviews (n=47) were conducted with people that could be potential resource users, economic buyers, and BHF adoption influencers to capture multiple contextual and needs-based factors related to adopting new evidence-based interventions. Qualitative analyses were completed in an iterative fashion as each interview was completed.ResultsThe BHF Resource Package was designed to be accessible to a variety of implementation organizations. However, due to different resources being available in different rural communities, customer discovery interviews suggested that focusing on rural health departments may be a consistent setting for intervention adoption. We found that local health departments prioritize childhood obesity but lacked the training and resources necessary to implement effective programming. Several intervention funding approaches were also identified including (1) program grants from local and national foundations, (2) healthcare community benefit initiatives, and (3) regional employer groups. Payment plans recommended in the customer discovery interviews included a mix of licensing and technical support fees for BHF delivery organizations, potential insurance reimbursement, and family fees based on ability to pay. Marketing a range of BHF non-weight related outcomes was also recommended during the customer discovery process to increase the likelihood of BHF scale-up and sustainability.ConclusionsEngaging in customer discovery provided practical directions for the potential adoption, implementation, and sustainability of the BHF Resource Package. However, the inconsistent finding that health departments are both the ideal implementation organization, but also see childhood obesity treatment as a clinical service, is concerning.

Training on Determining Beyond Use Date (BUD) on Pharmacy Practice at Surabaya Health Vocational School

All drugs must be injected immediately after being prepared because the life of the drug can be shorter and it no longer refers to the Expiration Date (ED). If the medicine is not injected immediately, then to maintain the quality of the medicine before the BUD limit is to give the medicine vial a mark of the date and time the medicine was prepared and it must be stored according to storage requirements. The method used theoretical presentation, question/answer, discussion and practice offline in one of Surabaya Health Vocational School classrooms. The results are the community service activities through training on determining the Beyond Use Date (BUD) in Pharmacy practice at the Surabaya Health Vocational School received a positive response and the participants were very enthusiastic. It is hoped that there will be special standards established by the Surabaya Health Vocational School to help provide understanding regarding determining the Beyond Use Date (BUD) in the pharmaceutical practice and further collaboration with the Health Service, Community Health Center or Hospital on an ongoing basis.

Care, connection, and social distancing: The challenges of baby loss during the COVID-19 pandemic in Aotearoa New Zealand

ProblemThe COVID-19 pandemic hindered access to routine healthcare globally, prompting concerns about possible increases in pregnancy loss and perinatal death. BackgroundPUDDLES is an international collaboration exploring the impact of the COVID-19 pandemic on parents who experience pregnancy loss and perinatal death in seven countries, including Aotearoa New Zealand. AimTo explore parents’ experiences of access to healthcare services and support following baby loss during the COVID-19 pandemic in Aotearoa New Zealand. MethodsWe conducted in-depth, semi-structured interviews with 26 bereaved parents, including 20 birthing mothers, and six non-birthing parents (one mother and five fathers). Types of loss included 15 stillbirths, four late miscarriages, and one neonatal death. Participant ethnicities were broadly representative of Aotearoa New Zealand’s multi-ethnic society. Data were analysed using Template Analysis. FindingsAnalysis revealed five themes relating to pandemic impact on bereaved parent’s experiences. These were: ‘Distanced and Impersonal care’; ‘Navigating Hospital Rules’; Exclusion of Non-birthing Parents; ‘Hindered Access to Social Support’; and ‘Continuity of Relational Care’. DiscussionThe COVID-19 pandemic exacerbated isolation of bereaved parents through perceived impersonal care by healthcare professionals and restrictions on movement hindered access to social and cultural support. Compassionate bending of the rules by healthcare professionals and community postnatal visits by continuity of care midwives following the bereavement appeared to be mitigating factors. ConclusionSocial isolation is an added challenge for parents experiencing baby loss during a pandemic, which may be mitigated by flexible and compassionate care from healthcare professionals, especially continuity of care midwives.

Exploring Awareness and Understanding of Breast Cancer Risk Factors, Screening, and Treatment among Females in Pakistan

Purpose: Breast cancer is a pressing concern in Pakistan, ranking as the second leading cause of death among women. Despite its increasing incidence, it often lacks adequate attention from policymakers and healthcare professionals. This oversight could have severe consequences. To effectively tackle this health crisis, a thorough understanding of breast cancer's prevalence, risk factors, diagnosis, treatment, and outcomes in Pakistan is crucial. Methodology: To assess the level of awareness and understanding of breast cancer among women, this study was conducted. A cross-sectional survey was conducted in the outpatient department of Fauji Foundation Hospital, Rawalpindi, involving 350 female patients. Data were collected using a pre-structured questionnaire and analyzed using SPSS Version 16.0. Findings: Descriptive statistics were used, and the results were expressed as percentages and presented graphically. The study found that 70% of women were aware of breast cancer. Furthermore, 74% of the patients were married, and 87% had children. Knowledge about signs, symptoms, diagnosis, and treatment of breast cancer was relatively high among the women surveyed. However, only 23% of women had knowledge about performing breast self-examinations, and 18% had heard about mammography. This study provides valuable insights into breast cancer awareness and prevention behaviors among women in Pakistan, with significant implications for theory, policy, and practice. The findings highlight gaps in knowledge and awareness, particularly regarding breast self-examinations and mammography screenings. Unique Contribution to Theory, Policy and Practice: Policy implications stemming from the study results include the need for targeted awareness campaigns, educational programs, and screening initiatives to improve breast cancer awareness and preventive behaviors among women in Pakistan. Policymakers should allocate resources towards these efforts and integrate breast cancer education into existing healthcare services and community outreach programs to ensure widespread dissemination of information and access to screening services.