Comprehensive Health Care Program Research Articles

보육시설 아동의 감염성 질환 예방 관리를 위한 한의사 주치의 프로그램 개발 및 평가

Objectives: The present study was carried out to develop and evaluate comprehensive health care program to prevent infectious disease and promote health in child-care centers by Doctor of Korean medicine. Methods: A nonequivalent control group pretest-posttest design study was conducted on 568 children and 85 child care teacher at 12 child care facilities for 12 weeks from July to October 2012. The program was consist of management, education, screening under concepts of traditional preventive medicine, Yangsaeng and Chimibyeong. Children's medical utilization due to infectious disease and attendance means functional status were measured by reports from parents. The Difference in difference(DID) estimator was applied data analysis, and added Zero-inflated negative binomial regression model. Also, attitudes on the infection of teacher was measured and analyzed through t-test. Results: After the intervention, the total medical utilization due to infectious disease decreased, but not significantly. Total absence, early leave and lateness decreased significantly. But, Attitude on the infection of child care teacher was not changed. The parent's satisfaction showed positive overall. Conclusions: The intervention program may be effective in preventing infectious disease and managing health in child-care center partially. To measure long-term effect, long-term study improved is requested.

Prevention of invasive cervical cancer in the United States: past, present, and future.

Over the past several decades, invasive cervical cancer (ICC) incidence in the United States has declined dramatically. Much of this decline has been attributed to widespread use of cytology screening followed by treatment of precancerous lesions. Despite available technologies to prevent ICC and screening programs targeting high-risk women, certain populations in the United States experience disproportionately high rates of ICC (e.g., racial/ethnic minorities and rural women). Limited access to and use of screening/follow-up services underlie this disparity. The licensure of the human papillomavirus (HPV) vaccine in 2006 introduced an additional method of ICC prevention. Unfortunately, dissemination of the vaccine to age-eligible females has been lower than expected (32% have received all 3 recommended doses). Decreasing the burden of HPV infection and HPV-related diseases in the United States will require greater dissemination of the HPV vaccine to adolescents and young adults, along with successful implementation of revised ICC screening guidelines that incorporate HPV and cytology cotesting. While a future without ICC is possible, we will need a comprehensive national health care program and innovative approaches to reduce ICC burden and disparities.

Association between anaemia, iron deficiency anaemia, neglected parasitic infections and socioeconomic factors in rural children of West Malaysia.

BackgroundGiven that micronutrient deficiency, neglected intestinal parasitic infections (IPIs) and poor socioeconomic status are closely linked, we conducted a cross-sectional study to assess the relationship between IPIs and nutritional status of children living in remote and rural areas in West Malaysia.Methods/FindingsA total of 550 children participated, comprising 520 (94.5%) school children aged 7 to 12 years old, 30 (5.5%) young children aged 1 to 6 years old, 254 (46.2%) boys and 296 (53.8%) girls. Of the 550 children, 26.2% were anaemic, 54.9% iron deficient and 16.9% had iron deficiency anaemia (IDA). The overall prevalence of helminths was 76.5% comprising Trichuris trichiura (71.5%), Ascaris lumbricoides (41.6%) and hookworm infection (13.5%). It was observed that iron deficiency was significantly higher in girls (p = 0.032) compared to boys. Univariate analysis demonstrated that low level of mother's education (OR = 2.52; 95% CI = 1.38–4.60; p = 0.002), non working parents (OR = 2.18; 95% CI = 2.06–2.31; p = 0.013), low household income (OR = 2.02; 95% CI = 1.14–3.59; p = 0.015), T. trichiura (OR = 2.15; 95% CI = 1.21–3.81; p = 0.008) and A. lumbricoides infections (OR = 1.63; 95% CI = 1.04–2.55; p = 0.032) were significantly associated with the high prevalence of IDA. Multivariate analysis confirmed that low level of mother's education (OR = 1.48; 95 CI% = 1.33–2.58; p<0.001) was a significant predictor for IDA in these children.ConclusionIt is crucial that a comprehensive primary health care programme for these communities that includes periodic de-worming, nutrition supplement, improved household economy, education, sanitation status and personal hygiene are taken into consideration to improve the nutritional status of these children.

Comprehensive dental health care program at an orphanage in Nellore district of Andhra Pradesh

Provision of oral health care in India, especially for the underprivileged is limited due to inadequate finances and manpower. Resources of dental colleges in such a scenario can be utilized to provide prevention oriented oral health care. To improve the oral health status of children at an institute in Nellore district of Andhra Pradesh, India, through prevention based comprehensive dental health care program (CDHP). A longitudinal institution based interventional study conducted among the primary grade children (n=162). Baseline data collection included (i) basic demographic data (ii) body mass index (BMI) (iii) assessment of the dentition status and treatment needs according to WHO 1997 criteria. The CDHP included group based dental health education, professional oral prophylaxis, weekly (0.2%) sodium fluoride mouth rinse program, biannual application of topical fluoride (1.23% APF), pit and fissure sealants for all first permanent molars and provision of all necessary curative services. Mean treatment requirements per child decreased at 18 months. New caries lesions developed among four children. BMI of children with decay was seen to improve significantly after instituting the CDHP. CDHP is effective in overall improvement of general and oral health. In resource limited countries like India, such programs organized by dental schools can improve oral health.

Sri Lanka's Health Unit Program: A Model of "Selective" Primary Health Care

hirty years ago vigorous debates on primary health care articulated at least two main approaches to health promotion in developing countries. The Alma-Ata Declaration of the World Health Organization (WHO) kicked off the debate in 1978 by urging all nations to promote health through primary health care. Reaffirming the 1946 WHO charter that recognized health as a “state of complete physical, mental and social well-being,” the Declaration recommended a comprehensive primary health care program, which included at least the following key sectors: “education to inform prevailing health problems and measures to control them, food security and improved nutrition, supply of clean water and sanitary services, maternal and child care services including family planning, immunization against communicable diseases, the control of locally endemic disease, and the supply of essential drugs for critical health problems.” In allocating resources to these key sectors of the primary health care, the Declaration recommended, countries must ensure “equality,” “affordability” and “community participation.” An alternative to this approach was promoted mainly by the representatives of the United States Agency for International Development, the Rockefeller Foundation and the World Bank who argued that comprehensive primary health care would be prohibitively costly to implement for most nations. One of the

Psychiatric morbidity among elderly in Chandigarh

To find out the prevalence of Psychiatric Morbidity Among Elderly in the age-group of 65 years and above. This community based study was conducted by house to house visit after selecting a sample by stratified random technique from the 47 sectors in urban areas and 27 villages in Chandigarh. A total of 250 households in urban and 50 households in rural areas were covered which consisted of 362 elderly (313 urban and 49 rural) who were enrolled and psychiatric morbidity was assessed by using R Kellner & B F Shaffield (1979) scale. All study subjects had at least one symptom related to psychiatric morbidity. Over two-third elderly were having somatic (72.1%) and depression (68.2%) related symptoms of anger - hostility, cognition and anxiety. Paranoid and psychotic symptoms were noticed among 6.9% and 6.6% of elderly, respectively. Anxiety, depression, somatic, cognitive symptoms were more prevalent in females while anger hostility was more common in males. Some of the common symptom from each of the 7 groups were : Anxiety : Nervousness (37.3%), Depression : Feeling tired lack of energy (57.2%), Somatic : Irritable (48.3%), Anger Hostility: Angry (55.8%), Cognitive : Poor memory (45.6%), Paranoid : Feeling that people do not like you (7.5%) and Psychotic : Strange experiences which other people do not have (4.4%). Prevalence of high morbidity related to psychiatric symptoms among elderly in Chandigarh, India highlights the significance and need to develop comprehensive mental health care program for elderly.

The health system of Uruguay

This paper describes the Uruguayan health system, including its structure and coverage, its financial sources, the level and distribution of its health expenditure, the physical, material and human resources available, its stewardship functions, the institutions in charge of information and research, and the level and type of citizen's participation in the operation and evaluation of the system. The most recent policy innovations are also discussed, including the creation of the National Comprehensive Health System, the National Health Insurance, the National Health Fund and the Comprehensive Health Care Program. Finally, the impact of these innovations in health expenditure, fairness of health financing, coverage levels and main health indicators is analyzed.

Persistence of Mental Health Needs among Children Affected by Hurricane Katrina in New Orleans

Hurricane Katrina made landfall in August 2005 and destroyed the infrastructure ofNew Orleans. Mass evacuation ensued. The immediate and long-lasting impact of these events on the mental health of children have been reported in survey research. This study was done to describe the nature of mental health need of children during the four years after Hurricane Katrina using clinical data from a comprehensive healthcare program. Medical and mental health services were delivered on mobile clinics that traveled to medically underserved communities on a regular schedule beginning immediately after the hurricane. Patients were self-selected residents of New Orleans. Most had incomes below the federal poverty level and were severely affected by the hurricane. Paper charts of pediatric mental health patients were reviewed for visits beginning with the establishment of the mental health program from 01 July 2007 through 30 June 2009 (n = 296). Demographics, referral sources, presenting problems, diagnoses, and qualitative data describing Katrina-related traumatic exposures were abstracted. Psychosocial data were abstracted from medical charts. Data were coded and processed for demographic, referral, and diagnostic trends. Mental health service needs continued unabated throughout this period (two to nearly four years post-event). In 2008, 29% of pediatric primary care patients presented with mental health or developmental/learning problems, including the need for intensive case management. The typical presentation of pediatric mental health patients was a disruptive behavior disorder with an underlying mood or anxiety disorder. Qualitative descriptive data are presented to illustrate the traumatic post-disaster experience of many children. School referrals for mental health evaluation and services were overwhelmingly made for disruptive behavior disorders. Pediatric referrals were more nuanced, reflecting underlying mood and anxiety disorders. Histories indicated that many missed opportunities for earlier identification and intervention. Mental health and case management needs persisted four years after Hurricane Katrina and showed no signs of abating. Many children who received mental health services had shown signs of psychological distress prior to the hurricane, and no causal inferences are drawn between disaster experience and psychiatric disorders. Post-disaster mental health and case management services should remain available for years post-event. To ensure timely identification and intervention of child mental health needs, pediatricians and school officials may need additional training.

Transforming A Traditional Safety Net Into A Coordinated Care System: Lessons From Healthy San Francisco

Since 2007, San Francisco, California, has transformed its traditional safety-net health care "system"-in reality, an amalgam of a public hospital, private nonprofit hospitals, public and private clinics, and community health centers-into a comprehensive health care program called Healthy San Francisco. The experience offers lessons in how other local safety-net systems can prepare for profound changes under health reform. By July 2010, 53,546 adults had enrolled (70-89 percent of uninsured adults in San Francisco), and satisfaction is high (94 percent). Unnecessary emergency department visits were less common among enrollees (7.9 percent) than among Medicaid managed care recipients (15 percent). These findings indicate that other safety-net systems would do well to invest in information technology, establish primary care homes, increase coordination of care, and improve customer service as provisions of the national health care reform law phase in.

Reducing Childhood Mortality From Diarrhea and Lower Respiratory Tract Infections in Brazil

To evaluate the effects of the Family Health Program (FHP), a strategy for reorganization of primary health care in Brazil, on mortality of children younger than 5 years, particularly from diarrheal diseases and lower respiratory tract infections. Mortality rates and the extent of FHP coverage from 2000 to 2005 was evaluated from the 2601 (of 5507) Brazilian municipalities with an adequate quality of vital information. A multivariable regression analysis for panel data was conducted by using a negative binomial model with fixed effects, adjusted for relevant demographic and socioeconomic covariates. A statistically significant negative association was observed between FHP coverage levels, classified as none (the reference category), low (<30%), intermediate (>or=30% and <70%), or high (>or=70%), and all analyzed mortality rates, with a reduction of 4% (95% confidence interval [CI]: 2%-6%), 9% (95% CI: 7%-12%), and 13% (95% CI: 10%-15%), respectively, on mortality rates or children younger than 5. The greatest effect was on postneonatal mortality. Reductions of 31% (95% CI: 20%-40%) and 19% (95% CI: 8%-28%) in mortality rates from diarrheal diseases and lower respiratory infections, respectively, were found in the group of municipalities with the highest FHP coverage. The FHP, one of the largest comprehensive primary health care programs in the world, was effective in reducing overall mortality of children younger than 5, and particularly deaths related to diarrheal diseases and lower respiratory tract infections.

Advanced Practice Nursing in Performing Arts Health Care

Performing arts medicine is a growing health care profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique health care needs requiring a more collaborative and holistic health care program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts health care. APNs, with focus on collaborative and holistic health care, are ideally suited to join other health care professionals in developing and implementing comprehensive health care programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts health care.

The Office on Women's Health Initiative to Improve Women's Heart Health: Program Description, Site Characteristics, and Lessons Learned

Improving, Enhancing and Evaluating Outcomes of Comprehensive Heart Health Care Programs for High Risk Women has funded six diverse centers to provide chronic disease risk factor screening and lifestyle interventions for women and focuses specifically on low-income, minority women. This article describes the rationale for these diverse programs across the country, all focusing on improving outcomes for women with or at risk for cardiovascular disease (CVD). The six programs include College of Physicians and Surgeons at Columbia University, Christ Community Health Services in Memphis, Women's Heart Center of Fox Valley Cardiovascular Consultants, University of Minnesota, University of California Davis Women's Cardiovascular Medicine Program, and Yale-New Haven Hospital's Women's Heart Advantage. We present six differing approaches to women's heart programs. Based on this experience, promoting CVD prevention in women is a feasible healthcare delivery strategy for health promotion and for delivering preventive strategies for high-risk women. It is possible to deliver heart-healthy programs through existing healthcare infrastructures. These programs provide important models for public health, voluntary, and other health organizations to develop networks for population-based, targeted, relatively low cost programs that support Healthy People 2010 objectives for lifestyle changes and cardiovascular health. Ongoing longitudinal analysis of the programs will provide information about clinical outcomes and sustainability of such programs beyond the funding period.

Computer Vision Syndrome (CVS): Recognition and Control in Software Professionals

Musculoskeletal Disorders among video display terminal (VDT) users have become a worldwide problem. Computer Vision Syndrome holds the distinction of being called the number one occupational hazard of the 21st century. Prevention of injury and illness is, obviously, the best approach, but comprehensive health care and safety programs can help to reduce corporate sector's workplace injuries, absenteeism or presenteeism and related expenses. A fitness program was designed to reduce the symptoms of CVS in software professionals. A pre and post-test study was conducted to evaluate the effect of the fitness program. The study revealed that the fitness program helped to reduce the symptoms of CVS in software professionals.

Factors associated with the risk of progression to precursor lesions or cervical cancer in women with negative cytologic findings

Objective To evaluate factors associated with progression to cervical cancer or moderate to severe precursor lesions (cervical intraepithelial neoplasia grade 2 [CIN 2] or higher) in women with negative cervical screening results. Method A cohort of 1236 women from the state of Rio de Janeiro, Brazil, was followed up for 36 months. Hazards ratios (HR) and related 95% confidence intervals (CIs) were calculated, and the Cox proportional hazards model was used to evaluate factors associated with the development of lesions grade CIN 2 or higher. Results After adjusting for age, education level, number of sexual partners, and parity, the presence of CIN 2 or more advanced lesions was associated with HPV infection (HR, 39.0; 95% CI, 9.8–156.0), smoking (HR, 7.7; 95% CI, 2.0–29.6), and early age at first sexual intercourse (HR, 4.1; 95% CI, 1.1–15.1). Conclusion These findings suggest that women at increased risk for cervical cancer be screened for HPV at the time of cervical screening, particularly in areas where access to health services is difficult. Antismoking strategies especially targeting young women should be a priority in a comprehensive women's health care program.

Adherence to Antiretroviral Therapy among Older Children and Adolescents with HIV: A Qualitative Study of Psychosocial Contexts

Abstract Survival among perinatally infected children and youth with HIV has been greatly extended since the advent of highly active antiretroviral therapies. Yet, adherence to HIV medication regimens is suboptimal and decreases as children reach adolescence. This paper reports on a qualitative study examining psychosocial factors associated with adherence among perinatally infected youth ages 10-16 years. The study was based on in-depth interviews with a sample of 30 caregivers participating in a comprehensive health care program in New York City serving families with HIV. A subsample comprising 14 caregivers of children ages 10 and above is the focus of this paper. The analysis identified a number of themes associated with the psychosocial context of managing adherence among older children. Maintaining adherence was an ongoing challenge and strategies evolved as children matured. Regimen fatigue and resistance to taking the medications were major challenges to maintaining adherence among the oldest children. In other cases, caregivers developed a kind of partnership with their child for administering the medications. Disclosure to the child of his or her HIV status was used as a strategy to promote adherence but seemed to be effective only under certain circumstances. Social support appeared to have an indirect influence on adherence, primarily by providing caregivers with temporary help when needed. Health care professionals were an important source of disclosure and adherence support for parents. The study illustrates the interplay of maturational issues with other contextual psychosocial factors as influences on adherence among older children and adolescents.

Programa Embu Enxergando Melhor: uma proposta de atenção integral à saúde ocular em pré-escolares

OBJETIVO: A visão desempenha um papel preponderante no desenvolvimento global da criança. A detecção e o tratamento precoce de problemas visuais são fundamentais para impedir a instalação de seqüelas sensório-motoras irreversíveis. Este estudo visou descrever um programa de atenção integral à saúde ocular de crianças, constituído por ações educativas, de prevenção, de assistência e de reabilitação. MÉTODOS: Estudo descritivo transversal, no qual se utilizaram dados do treinamento dos professores, da triagem visual realizada na escola e do exame oftalmológico e ortóptico de 23.374 crianças, de cinco a sete anos de idade, matriculadas na rede municipal de educação infantil do município do Embu, no período de 1994 a 2002. RESULTADOS: Foram capacitados 600 professores e testados 22.118 (95%) pré-escolares. Destes, 4.553 (21%) precisavam de exame oftalmológico e, deles, 3.016 (66%) compareceram à consulta. Dos examinados, 1.389 (46%) receberam prescrição óptica, 477 (16%), foram encaminhadas para tratamento ortóptico e 1.601 (53%) receberam alta. CONCLUSÕES: A triagem visual é uma prática eficiente para promover a saúde ocular de pré-escolares, na qual o professor é o elemento chave. Para o êxito destas ações, é fundamental estruturar práticas educativas e de promoção da saúde ocular destinadas às crianças, às famílias e à sociedade.

States Try Several Strategies to Expand Health Coverage

States Try Several Strategies to Expand Health Coverage

District health programmes in Lao PDR

The Lao People's Democratic Republic (Lao PDR) is classified by the World Bank as a low-income country under stress. Development partners have sought to utilize effective aid instruments to help countries classified in this way achieve the Millennium Development Goals; these aid instruments include sector-wide approaches (SWAps) that support decentralized district health systems and seek to avoid fragmentation and duplication. In Asia and the Pacific, only Bangladesh, Papua New Guinea and the Solomon Islands have adopted SWAps. Since 1991, a comprehensive primary health care programme in the remote Sayaboury Province of Lao PDR has focused on strengthening district health management, improving access to health facilities and responding to the most common causes of mortality and morbidity among women and children. Between 1996 and 2003, health-facility utilization tripled, and the proportion of households that have access to a facility increased to 92% compared with only 61% nationally. By 2003, infant and child mortality rates were less than one-third of the national rates. The maternal mortality ratio decreased by 50% despite comprehensive emergency obstetric care not being available in most district hospitals. These trends were achieved with an investment of approximately 4 million US dollars over 12 years (equivalent to US 1.00 US dollars per person per year). However, this project did not overcome weaknesses in some national disease-control programmes, especially the expanded programme on immunization, that require strong central management. In Lao PDR, which is not yet committed to using SWAps, tools developed in Sayaboury could help other district health offices assume greater planning responsibilities in the recently decentralized system. Development partners should balance their support for centrally managed disease-specific programmes with assistance to horizontally integrated primary health care at the district level.

Health Status of Incarcerated Adolescents: Implications for Juvenile Justice Decision Making

ABSTRACTAdolescents arriving in detention often bring with them significant medical, dental, and psychological problems. These issues have important implications for courts that must decide the best disposition for offending youths. Appropriate treatment benefits the individual by enhancing his/her well‐being and improving his/her chances of successful rehabilitation. Society also benefits by avoiding the higher cost of caring for neglected conditions later in life. A comprehensive health care program for detention facilities involves establishing standardized procedures that address both common adolescent problems plus those more peculiar to detainees. Health care professionals working in a correctional setting have unique duties such as clearing youths for boot camp, monitoring injuries, dealing with resistant patients, monitoring for safe activities, and planning aftercare for youths who may face impediments to accessing care such as poor motivation and poverty. Research concerning issues specific to the needs of incarcerated youths remains infrequent and should be undertaken by health care providers. This article provides an overview of medical issues confronting juvenile offenders that should be considered when a juvenile becomes involved in the juvenile justice system.

Social and functional status of older persons in a north Indian community.

With increase in life expectancy, the geriatric population is growing in developing countries. The Union Territory of Chandigarh has a population of about 0.9 million with nearly 90% in urban and 10% in rural areas. This cross-sectional, descriptive study was conducted in Chandigarh over a period of one year; 1998-99 among 362 subjects 65 years or more of age covering a population of 7937 family members in 1882 houses. The sampling was done by random sampling technique covering urban and rural population. The proportion of older persons in Chandigarh comprised 5.47% of the population. Most of the respondents were living with their spouses. More than one-fifth of urban and two third of rural older persons were illiterate. About 86% were living with their families and only 3.6% were living alone. Major modes of recreation were visiting religious places by two-thirds followed by going to parks and gardens by nearly one-fourth. Among 203 older persons having living partners in the study, one in every fifth older persons had indulged in sexual intercourse in the past six months. Nearly 2% of older persons needed assistance (partial or full) in activities of daily living like bathing, dressing, toileting, feeding, continence etc. The study also observed rural and urban variation in the use of aids and appliances by older persons. On the basis of very few having functional limitations, there is a need to include components of recreational facilities, activities of daily living, and not just assistance and aids and appliances, while developing a comprehensive geriatric health care programme in developing countries.