Comprehensive Health Care Center Research Articles

Effect of health education on oral hygiene and gingival status of persons living with HIV attending comprehensive care centres in Nairobi, Kenya

The study aimed to describe the effect of an oral health education intervention on oral hygiene status and gingival inflammation among persons with HIV attending two comprehensive healthcare centres in Nairobi, Kenya. This was a quasi-experimental study of 195 participants (with 102 in the intervention group, and 93 serving as the control group) who were selected using stratified random sampling. The data were collected at baseline, at three months (review 1), and at six months (review 2) using an interviewer-administered World Health Organization clinical examination form. The prevalence of plaque among the participants in the intervention decreased from 70.6% to 18.6%, with a significant decrease in their mean plaque score, from 0.89 to 0.15. The prevalence of gingival inflammation in the intervention group decreased from 58.2% to 12.7%, with a significant decrease in the mean gingival score, from 0.66 to 0.11. No significant change in degree of oral hygiene and gingival inflammation was observed among the non-intervention group. There was a strong association between the change in the mean gingival score and the change in the mean plaque score between baseline and at six months for the intervention group. The regression analysis yielded a coefficient of determination (r2) of 0.76; therefore, 76% of the variation in change in gingival score was explained by the variables in the equation. Only the change in mean plaque score was a significant predictor of the change in gingival score.

The Level of Satisfaction of the Health Services Offered by the Comprehensive Health Care Center

Problem statement: Health care in Jordan and planning for health policies especially in sector of comprehensive health centers. Approach: This study aimed to explore the level of satisfaction of those who beneficiaries from services which offered by health care center at Suweileh region, west Amman. The study was implemented on four controlled variables: Transportation means to medical center, distance from home to center, number of visits the center and waiting time at center. A system random sample estimated 25% of services recipients, author analyzed the data used: frequencies, percentages, means, standard deviation, and T test for one sample. Results: The results revealed that 50% of beneficiaries used public transportation buses, average of distance from home to center was between 4_6 kilometers, more than 62% of people included in sample visited the center 2_3 times, 80% of them waited in center not more than half an hour. Conclusion/ Recommendations: The study revealed that an excellent of health care services offered by the center, there was a strong relationship between center and recipients of health services. Specialists in this area of study must conduct more studies on such centers which give decision makers headlines to improve planning towards enhancement and development comprehensive health care centers.

Managing Mental Health Conditions in Primary Care Settings

Depression is one of the most commonly encountered conditions in women's health, but many providers lack the knowledge and skills needed to identify and manage depression in primary care settings. This article discusses strategies that can improve the identification and treatment of depression. In addition, it describes how these strategies were incorporated into an urban inner-city health center. These strategies used in this setting can be adapted for use in either comprehensive health care centers or in practices providing primarily obstetric and gynecologic services.

Awareness, attitude and practice of evidence‐based medicine among primary health care doctors in Jordan

To assess the awareness, attitude and knowledge towards evidence-based medicine (EBM) among primary health care doctors in Jordan and to identify the perceived barriers for practising EBM. A simple random sample of 34 comprehensive primary health care centres was selected from a list of 64 centres in Jordan using random number table. A family doctor visited all selected centres and invited the available doctors to participate in the study. Participants were asked to fill the self-administrated questionnaire that was designed to assess beliefs and attitude of doctors towards EBM. Of the total 220 clinicians approached, 202 (91.8%) completed the questionnaire. About 80.7% welcomed promotion of EBM and 91.1% agreed on that research findings are helpful in daily management of patients. About 85.1% stated that practising EBM improves patient care, 68.3% stated that EBM reduces health care costs, 74.8% stated that EBM improves quick knowledge update, 93.6% reported that the doctor-patient relationship is affected positively by practising EBM. About 60.9% reported that they know the concept of EBM and 56.1% reported that they ever used the EBM. Patient overload, limited resources and facilities, and the absence of an effective computer system were the most commonly reported barriers to the implementation of EBM. In spite of the positive attitude towards EBM, this study demonstrated numerous personal, interpersonal and institutional barriers towards implementing EBM which necessitate prompt action to formulate a national plan to overcome such barriers.

Bigger is not always better: what the National Health and Hospitals Reform Commission report means for general practice

The National Health and Hospitals Reform Commission report has a focus on building on "the vital role of general practice", to strengthen primary health care as the "cornerstone of our future health system". The report proposes Comprehensive Primary Health Care Centres and Services that will deliver "one-stop" primary health care; but in health care, bigger is not always better. The biggest challenge for the reform process may well be bringing together the different cultures of the largely private primary health care services, funded by the federal government, and the public, primary and community health services, funded by the states and territories. The report pays little real attention to the reforms needed to address the social determinants of health. There is a clear need for action now on the report's most urgent recommendations for Aboriginal and Torres Strait Islander health, mental health, dental health and services for rural and remote communities. Diversity is a great strength of Australian general practice, and we must not lose it in the rush to reform.

Interorganisational and interprofessional partnership approaches to achieve more coordinated and integrated primary and community health services: the Australian experience

Improving collaboration and coordination in primary and community health is a national priority. Two major approaches have been taken: strengthening interorganisational and interprofessional collaboration. This paper reviews current and emerging models of partnerships: divisions of general practice and primary care partnerships (organisational models); and collaboration between general practitioners with practice nurses and with allied health professionals (interprofessional models). The models are reviewed in terms of the governance and formalisation of the partnership arrangements and the level of collaboration they achieve. The organisational models have had different purposes and taken different forms, the ‘hub and spoke’ model of divisions and decentralised ‘network’ relationships of primary care partnerships, both of which have broadly achieved their aims. Interprofessional collaboration involves a complex mix of allegiances and interests that influences the level of collaboration that is achieved. A combination of approaches is needed to achieve more coordinated and integrated primary health care. The implications for several current policy debates are discussed: the establishment of local integrated and comprehensive primary health care centres, regional level primary care organisations and alternative payment mechanisms.

Atendimento integral às mulheres vítimas de violência sexual: Centro de Assistência Integral à Saúde da Mulher, Universidade Estadual de Campinas

The Women's Comprehensive Healthcare Center (CAISM) has provided care for women who have suffered sexual violence since 1986. Since 1998, a special multidisciplinary team has been in charge of emergency and long-term care for victims of sexual violence. From August 1998 to May 2006, 1,174 women were treated, with an average of 150 per year in the last five years. During the same period, 71/109 women who became pregnant after rape had their pregnancies terminated, 23/109 continued the pregnancy to term, and 15/109 did not undergo abortion due to gestational age greater than 20 weeks. In Brazil, there are not enough public services to treat female victims of sexual violence who require legal abortion. Nationwide implementation of new services should be encouraged, in addition to all measures known to reduce the problem such as sex education in schools and widespread information and easy access to effective contraception.

A comprehensive women's health care center: Are gynecologists offering primary care?

The purpose of this study was to compare patient characteristics and diagnoses in a comprehensive Women's Health Care Clinic between gynecologists and internal medicine physicians. This retrospective cohort study evaluated International Classification of Diseases, 9th Revision, codes that were recorded between January 1, 2001, and January 4, 2004, at the Women's Health Care Clinic. We compared demographics and prevalence of diagnosis codes for patients who were seen by obstetricians/gynecologists and internal medicine physicians and compared these data with national survey statistics. A sampling of charts was reviewed for coding verification. We analyzed 13,462 visits at the Women's Health Care Clinic. Patients who were seen by internists were older, had greater racial diversity, and had more gender-nonspecific medical disorders (hypertension, depression). Gynecologists saw more specific women's health problems (P < .05). The diagnoses of menstrual disorders, menopause, pelvic pain, and abnormal cytologic findings within the Women's Health Care Clinic follow closely with the national ambulatory survey data. Within this multispecialty Women's Health Care Clinic, internal medicine physicians are practicing primary care and obstetricians/gynecologists are providing specialty care.

DSM-IV diagnosed posttraumatic stress disorder in women veterans with and without military sexual trauma

This study compares rates of posttraumatic stress disorder (PTSD) in female veterans who had military sexual trauma (MST) with rates of PTSD in women veterans with all other types of trauma. Subjects were recruited at the Women's Comprehensive Healthcare Center when attending medical or psychiatric appointments or through a mailing; 230 women agreed and 196 completed the study. They completed questionnaires on health and military history, along with the Stressful Life Events Questionnaire (SLEQ). Those who met DSM-IV PTSD Criterion A completed the PTSD Symptom Scale-Interview (PSS-I) on which PTSD diagnoses were based. Ninety-two percent reported at least 1 trauma. Forty-one percent had MST, alone or with other trauma, and 90% had other trauma, with or without MST. Overall, 43% of subjects with trauma had PTSD. Those with MST had higher rates of PTSD than those with other trauma. Sixty percent of those with MST had PTSD; 43% of subjects with other traumas (with or without MST) had PTSD. Military sexual trauma and other trauma both significantly predicted PTSD in regression analyses (P=.0001 and .02, respectively) but MST predicted it more strongly. Prior trauma did not contribute to the relationship between MST and PTSD. Findings suggest that MST is common and that it is a trauma especially associated with PTSD.

Screening of periodontitis with salivary enzyme tests

The purpose of this study was to determine the usefulness of salivary biochemical markers for the screening of periodontal disease and examine the agreement between the results of saliva enzyme tests and those of probing depth. The present study included a total of 187 subjects who underwent annual medical check-ups at the Comprehensive Health Care Center, Honjo, Saitama Prefecture, Japan. Periodontal pocket probing was performed with a WHO probe, and various enzymes and biochemical parameters in saliva were measured. For lactate dehydrogenase (LDH), the proportions of the five isoenzymes were calculated. To decide the cut-off point for each enzymatic activity, receiver operating characteristic curves (ROC curves) were constructed and the points of minimum difference between sensitivity and specificity were decided. Among the biochemical markers tested, salivary LDH level had the highest sensitivity and specificity (sensitivity 0.66, specificity 0.67), while salivary levels of aspartate aminotransferase (AST) and blood urea nitrogen (BUN) also had sensitivity and specificity above 0.60. Among the LDH isoenzymes, LDH4 and LDH5 dominated in whole saliva samples. Salivary LDH may be a feasible and useful parameter for the screening of periodontal disease, while salivary AST and BUN also appear to be potentially useful for this purpose.

Spotlight on Rural Nurses: Implications for a New Nursing Discipline in Jordan

This ethnographic study sought to provide a snapshot of rural nurses’ practice in comprehensive primary health care centres (CPHCCs) in Jordan. These nurses provide a vital service to local populations although it is recognised that the nursing workforce is predominantly secondary level (e.g. practical nurses and aide nurses). The findings indicate that educational preparation, skill-mix, access to professional development, the lack of collegiate support, nursing practice standards, ineffective management, poor distribution of health resources and geographic isolation are important factors impacting on the CPHCC nurses’ practice. The study highlights the need for improved resourcing of the CPHCCs and advocates immediate action by the Ministry of Health (MoH) and senior nursing administration to support the development of rural nursing. In addition, it is recommended that effective recruitment and retention strategies to address the nursing shortage and improve the nursing skill-mix be developed.

The effects of yellow fever immunization (17DD) inadvertently used in early pregnancy during a mass campaign in Brazil

Background This study describes the consequences of the inadvertent immunization of pregnant women during a mass vaccination campaign in the Campinas region of the state of São Paulo, Brazil, in February and March 2000. The study was carried out by the Women's Comprehensive Healthcare Center (CAISM), at the State University of Campinas (UNICAMP). The objective of the study was to evaluate the possible effects of the vaccine on pregnancy and conceptus, and to assess congenital infection resulting from immunization. Methods Pregnant women who received the YF vaccine were identified at primary health clinics and referred to the study site, a public reference, high-risk clinic, serving 42 towns in a region with a population of 3,000,000. A 12-month serological follow-up for newborns (PRNT), and an examination to detect congenital abnormalities was offered to pregnant women, who signed a consent form. In a sub-sample of women who were delivered at the study site, additional exams were proposed: neonatal fontanel ultrasound, funduscopy, audiometry, neuro-pediatric follow-up until 12 months of age, and IgM detection at birth. Fifteen blood samples from placentas and umbilical cords were tested for PCR. Findings A total of 480 pregnant, immunized women were identified, who had received the vaccine at a mean of 5.7 weeks (95% CI 5.2–6.2) of gestation. The great majority of women were unaware of their pregnancy at the time they were vaccinated, and only 46.7% were counseled to avoid immunization if pregnant. After a minimum 6-week interval, 98.2% pregnant women were IgG positive. A total of 19.6% of women reported mild adverse events (headache, fever or myalgia). No IgM antibodies were detected at birth and no placental or umbilical cord blood was positive according to PCR. The frequency of malformations (2.3% or 7/304 babies), miscarriages (2.5% or 11/441 pregnancies), stillbirths (0.7%) and premature delivery (7.8%) was similar to that found in the general population. At 12 months follow-up, 7% of samples were reactive to PRNT. However, after 12 months, only one child was seropositive. Interpretation Contrary to a previous study, maternal seroconversion was very high when immunization was carried out in early pregnancy. Vaccine applied during the first trimester does not appear to cause malformations, complications to the central nervous system, nor adverse perinatal results as represented by premature deliveries or perinatal deaths. The 12-month serological follow-up is inconclusive and should be extended to 24 months. Evaluation of the risk of miscarriage was hindered by late presentation at the study clinic.

Jordan’s vulnerability: A population at risk of HIV/AIDS

This paper describes the findings of an ethnographic study that sought to explore the influence of HIV/AIDS on the practice of primary care nurses in Jordan. The study was undertaken in three (3) rural and three (3) urban comprehensive primary health care centres. Data collection included participant observation, key informant interviews, field notation and document analysis. These data informed the development of descriptive ethnographic accounts that allowed for the subsequent identification of common and divergent themes reflective of factors recognized as influencing the practice of nurses.The findings indicate that the ability of the nurses to raise awareness and therefore reduce the spread of HIV/AIDS is unrealistic. Data shows that the population is at risk because the nurses’ knowledge and skill base is inadequate and the health care facilities are crippled by limited human and physical resources. Poor management and the lack of localised leadership are also factors identified as contributing to the vulnerability of Jordanians.Enhanced commitment from the Ministry of Health and the senior nursing administration in Jordan is required if the comprehensive primary health care centres are to meet expectations and improve health outcomes of the population. Funding must be directed to improve the infrastructure of the comprehensive primary health care centres and adequate concurrent funds provided for the purchase of non-capital items. It is crucial that support be made available to up-skill the nursing staff and superior recruitment and retention initiatives implemented to address the current nursing shortages.

The Union Health Center: A working model of clinical care linked to preventive occupational health services

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having field a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings.

The Union Health Center: A working model of clinical care linked to preventive occupational health services

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having filed a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings. Am. J. Ind. Med. 31:263–273, 1997. © 1997 Wiley-Liss, Inc.

Communicative disorders at a health-care center

The purpose of this study was to identify the prevalence of communicative disorders in a Children and Youth Program during the 5-yr period 1973–1977. It appears that the numerous speech and hearing surveys recorded fail to do the following: (a) identify speech, language, and hearing pathologies from a comprehensive health-care center and/or hospital; (b) study types of clientele longitudinally; (c) study prevalence and needs of minority groups specifically; and (d) study prevalence of communicative disorders in preschool children. For the Black community under study, it appears that the prevalence of communicative disorders is greater than reported in other surveys. In addition, the current study identifies a community not receiving services. In reviewing the facilities available to this socioeconomic community, one finds inadequacies. These inadequacies may be reflected in manpower and equipment rather than programs and resources. The data indicate a tremendous need to expand available services.

LETTERS TO THE EDITOR

Journal of Public Health DentistryVolume 39, Issue 2 p. 96-96 LETTERS TO THE EDITOR Norman J. Schuman DDS, MPH, Norman J. Schuman DDS, MPH Montefiore-Morrisania Comprehensive Health Care Center 230 East 162nd Street Bronx. NY 10451Search for more papers by this author Norman J. Schuman DDS, MPH, Norman J. Schuman DDS, MPH Montefiore-Morrisania Comprehensive Health Care Center 230 East 162nd Street Bronx. NY 10451Search for more papers by this author First published: June 1979 https://doi.org/10.1111/j.1752-7325.1979.tb02926.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume39, Issue2June 1979Pages 96-96 RelatedInformation

A comprehensive health care center for children.

A comprehensive health care center for children.

Family nutritionist on the primary health care team

For decades nutrition counseling was limited to crisis-oriented hospital clinics and public health stations and seemed destined to remain at that limited level of outpatient availability. Mid-twentieth century social changes motivated health planners to develop “innovative” ambulatory preventive health delivery systems for the general public. Some of these “innovations” included nutrition counseling as a preventive health service. In Chicago nutrition counseling is now integrated into primary, multidisciplinary ambulatory health teams in an organization of private, comprehensive health care centers. The nutritionists use attractive surroundings, interesting materials and supportive counseling techniques to encourage health consumers to improve food selection and eating behavior in areas of normal, modified and therapeutic diets. The Illinois Family Health Centers Nutrition Division is a model that can be used as an example or as a point of departure by nutritionists and health planners interested in integrating nutrition counseling services into ambulatory health care organizations.

Nursing service and education in a comprehensive health care center.

Mrs. Bernice F. Morton, R.N., B.S., M.S.N. is Assistant Professor of Public Health Nursing at the College of Nursing, Wayne State University, Detroit, Michigan. At the time this article was written, she was also Director of Nursing Services for the Model Neighborhood Comprehensive Health Center