Health Center Research Articles

Maintenance of Dental and Oral Health of High Class Students Using Virtual Reality Box Media (Study at SDN Rejosopinggir Tembelang Jombang)

Dental caries is one of the problems related to oral health that can affect overall health. The state of oral and dental health can be ascertained using the initial dental and oral examination data from the Jatiwates Tembelang Jombang Health Center. Specifically, the number of dental caries among high school students at SDN Rejosopinggir Tembelang Jombang, which shows an average DMF-T index of 5.9, can be used to inform this determination. A high DMF-T index falls between 4.5 and 6.5, according to the WHO. The problem in this study is the high school students in SDN Rejosopinggir Tembelang, Jombang Regency, had a high rate of dental cavities in 2023. The purpose of this study is to find out the difference in oral and dental health maintenance between high school students at SDN Rejosopinggir before and after using Virtual Reality Box material. The type of research is called a quasi-experiment, and it aims to enroll 43 students. The data collection method used is a questionnaire. Data findings are summarized and presented in tabular form as part of the data analysis technique. The results of the study is analysis of the Wilcoxon test showed that the ρ value was 0.000<0.05 with a pretest value of Mean±SD 57.67±12.216, and a posttest value of Mean±SD 77.91±11.032, then H1 was accepted and H0 was rejected, meaning that Students' understanding of maintaining their oral and dental health can be improved by the Virtual Reality Box media.

Assessing the role of the for-profit private healthcare sector in malaria elimination efforts in Bangladesh: a cross-sectional study of challenges and opportunities

BackgroundAmong 13 endemic districts, the Chittagong Hill Tracts bear more than 90% of Bangladesh’s malaria burden. Despite the private sector’s prominence in rural healthcare, its role in malaria management remains underutilized. This study aimed to strategize leveraging the for-profit private sector, such as diagnostic and treatment centers, to bolster national malaria surveillance and control, advancing Bangladesh toward malaria elimination by 2030.MethodsThis mixed-method study commenced with a questionnaire-based cross-sectional survey followed by selected focused group discussions (FGDs) among the participants. Three FGDs were held with the for-profit service providers so that further insights and qualitative viewpoints of them can be utilized in situation analysis. Based on the endemicity and strategic priorities, a comprehensive mapping of private for-profit facilities from the regions comprising 15 sub-districts across 8 chosen districts (7 malaria endemic districts and the rest non-endemic districts) was created. For the non-endemic zone, the sub-districts were selected based on their proximity to an area with high malaria transmission.ResultsAmong the 104 representative participants, majority were male (n = 92, 88.5%), had a diploma in their respective fields (n = 53, 51%) and were involved either in laboratory work (n = 49, 47.1%) or as owners/managers of health centers (n = 41, 39.4%). The selected health facilities were close to the corresponding Upazila Health Complexes (mean distance 2.8 km), but were distantly located from the designated district hospitals (mean distance 48.9 km). The main sources of RDT kits (62.3%) and anti-malarial drugs (63.2%) were local wholesale markets. A large share of the corresponding facilities neither provided malaria treatment services (81.7%) nor worked with the NMEP (93.3%).ConclusionsThis study highlights challenges and recommendations for engaging private for-profit health facilities in Bangladesh’s malaria elimination efforts. The identified challenges include low-quality RDTs, staff shortages, and inadequate capacity building. Recommendations emphasize effective training, stakeholder interaction, and enhanced oversight for successful malaria control efforts.

The effect of nutrition education based on the Health Belief Model (HBM) on food intake in pregnant Afghan immigrant women: a semi-experimental study

BackgroundAccording to the World Health Organization report, immigrants are at increased risk of malnutrition. Nutritional deficiencies in pregnancy are a public health concern and around 20 to 30 percent of pregnant women suffer from it worldwide. There has not been any investigation about the effect of any intervention on improving nutritional intake in pregnant Afghan immigrant women. Therefore, the present study was conducted to determine the effect of nutrition education based on the Health Belief Model (HBM) on food intake in pregnant Afghan immigrant women.MethodsA semi-experimental study study was conducted on 116 Afghan immigrant pregnant women who have the inclusion criteria, were referred to health center No. 2 in Mashhad, Iran in June 2022 until February 2023, and were randomly assigned to the intervention (56) and control (56) groups. The demographic, HBM questionnaire and the standard 24-h food reminder questionnaire were the research tools. The intervention consisted of four sessions of 45–60 min of nutrition education based on the Health Belief Model in groups of 8–10 people. The questionnaires were completed before, immediately, and one month after the intervention by the research units. Data were analyzed with SPSS version 21 software.ResultsThe intake of energy, protein, carbohydrates, and micronutrients such as iron, calcium, zinc, and vitamin D increased in the intervention group immediately and one month after the intervention significantly compared to before the intervention (P < 0.05). Although all these nutrients intake had a significant decrease in control group women (P < 0.05).ConclusionsNutrition education based on the health belief model is effective in the nutritional intake of Afghan immigrant pregnant women. According to the importance of getting enough nutrients in pregnancy and its effects on the mother and fetus’s health, nutrition education based on the Health Belief Model model is suggested for these mothers.Trial registrationIt is registered in the Iranian clinical trials database under the code: IRCT20220629055312N1, Date of first registration: 25/07/2022.

Overview of Ventilation and Lighting of Tuberculosis Patients' Homes in Sumenep, Indonesia

Tuberculosis is an infectious disease caused by the mycobacterium tuberculosis germ by causing respiratory disorders and is known as MOTT (Mycobacterium Other Than Tubercoluss). In Indonesia, tuberculosis is one of the public health problems that still has a high incidence rate. Tuberculosis can be affected by unqualified lighting, ventilation of the house. The purpose of this study is to find out the Overview of Ventilation and Lighting of Houses of Tuberculosis Patients in the Working Area of the Arjasa Health Center, Sumenep Regency. This study is an analytical research, with a cross sectional approach. The population of Tuberculosis patients in the Working Area of the Arjasa Health Center, Sumenep Regency is 65 people, with a sample of 56 people. The sampling technique uses Simple Random Sampling. Data collection will be carried out from May to June 2024. Data were collected by observation and interviews. The results of the study showed that the condition of the houses of Tuberculosis patients in the Working Area of the Arjasa Health Center, Sumenep Regency who did not meet the requirements was mostly influenced by house lighting (62.5%) and ventilation (67.9%). To reduce the transmission of Tuberculosis, it is sought to open windows when residents are in the house so that sunlight can kill tuberculosis germs, in addition to modifying the design of the house so that the air circulation system in the house remains fresh and comparing the floor area of the house with the number of residents in accordance with health requirements so as to minimize the transmission of Tuberculosis.

Assessment of magnitude of medicines wastage and the contributing factors in selected public health facilities of Hadiya Zone, Central Ethiopia Regional State

BackgroundMedicine wastage occurs when medicines are damaged, obsolete, or expired and become unsafe for use. In Ethiopia, although there are reports that reveal the presence of wasted medicines in the country, there is limited objective evidence on the type and extent of medicine wastage as well as its contributing factors.ObjectiveThe study aimed to assess the medicine wastage rate and identify its contributing factors in the sampled public health facilities (HFs) in Hadiya Zone, Central Ethiopia Regional State.MethodA facility-based cross-sectional study complemented by a qualitative study was conducted in selected public HFs in Hadiya Zone, Central Ethiopia Regional State, from November 1 to 31, 2022. All the hospitals were selected intentionally, and health centers were selected using simple random sampling techniques. For the qualitative study, the chief clinical officers and pharmacy department heads of HFs were purposefully selected as key informants because they were supposed to be more information-rich than other health professionals. The quantitative data were entered and analyzed using the Statistical Package for Social Sciences version 20.ResultThe total monetary value of wasted medicines in the assessed HFs in the Ethiopian Fiscal Year (EFY) 2011–2013 was 652,479.45 ETB (5.24%). The three-year trend showed that, in the 2011–2012–2013 EFY, medicine wastage was 7.57%, 6.44%, and 3.1%, respectively. Expiration solely accounted for 97.3% of this total value. The alleged explanations for the waste of such medicines were a lack of accurate data available for medicine quantifications, the presence of overstocked medicines due to improper forecasting, a lack of electronic stock management, an abrupt change in the treatment regimen, and improper use of stock management. Whether the perceived causes had an impact on the medicine wastage was assessed, and the results confirmed that a significant association between medicine wastage and overstock (p-value = 0.006, AOR = 8.57, 95% CI = 1.87–39.26), accurate data (p-value = 0.013, AOR = 5.43, 95% CI = 1.42–20.76), and electronic stock management (p-value = 0.05, AOR = 0.311, 95% CI = 0.094–1.03) was observed.ConclusionThe identified medicine wastage rate is significant for a nation that struggles to allocate limited resources fairly. It may negatively affect the initiatives taken by the government to increase public engagement in the healthcare system through insurance contributions. It is a glance for HFs to take immediate corrective action.

The Role of Nursing Guidelines on Successful License Renewal for Nurses and Midwives in Ubungo District Public Hospitals in Tanzania

In the recent years, nurses and mid wives are struggling to keep their knowledge current knowledge and skills current and relevant through to changing requirements and situations. Through engaging in continuing professional development (CPD), care givers become updated knowledge and practice to provide quality care to patients. This study sought to unveil the role of CPD on license renewal of midwives and nurses with a special focus on Ubungo district as Ubungo has more health Centres as compared to other districts in Dar es Salaam. Specifically, the study sought to determine the role of nursing guidelines on successful license renewal for Nurses and Midwives in Ubungo District Public Hospitals, The study was guided by the Kirkpatrick Model as the theoretical framework. The study used descriptive research design while simple random and purposive sampling techniques were used to select members of sample size who were 99 respondents. The target population of the study included all public hospitals, dispensaries and health centres located in the Ubungo district. The data was collected using documents review, in-depth interview, and structured interviews, and then analyzed using content analysis, narrative analysis, and descriptive analysis. Findings revealed that the CPD acquisition and license renewal guidelines are available at the Tanzania nursing and midwifery council(TNMC) website, however, they require registration and login to access them. The license acquisition process was through paper document submission at the TNMC office and later on changed to online in 2022. Apart from insufficient computers and limited internet access, some challenges result from nurses and midwives negative attitude towards license renewal as they tend to not renew them until there is a tactical advantage such as a promotion. Management staff at the hospitals also does not focus on license renewal as they focus more on accomplishment of daily tasks, and only care when a malpractice occurs. CPD points determine the eligibility of the license renewal applicant. The study concludes that the online availability of CPD guidelines is a good way of reaching all stakeholders. The study recommends awareness raising activities regarding access to the guidelines, raise more awareness regarding the online license renewal system, and design more effective and efficient means of stakeholder outreach.

Assessment of Compliance Status and Its Determinants Among Hypertensive Patients From County Areas in Zhejiang, China: A Cross-Sectional Study.

Compliance is crucial for patients to control and manage their high blood pressure. This study assesses the compliance levels of hypertensive patients in China and explores the factors influencing compliance. A descriptive, cross-sectional design was conducted. A total of 371 hypertensive patients were recruited from six County hospitals and 12 township health centers in Zhejiang Province, China. Patient compliance was measured using the Hypertensive Patient Scale (CHPS). Independent-sample T-test or variance analysis was applied to analyze CHPS scores by sociodemographic factors, and linear regression was used to explore the significant correlates of the total CHPS score. The total score of CHPS was 50.18 ± 6.12. Among the seven domains, drug treatment and lifestyle had the highest and lowest average scores, 3.59 ± 0.87 and 2.74 ± 0.73, respectively. The total score of CHPS positively associated with age (β = 0.075, p = 0.028), > 7 years of hypertension (β = 1.896, p = 0.022; Ref: < 3 years), and negatively associated with males (β = -2.224, p = 0.001; Ref: female) and rural area (β = -2.008, p = 0.007; Ref: urban area). These findings highlight the importance of related measurements of thelocal "health-oriented" healthcare system. Primary health professionals should strengthen their health behavior intervention capacity and improve hypertension management among their patients.

Knowledge, attitudes, and practice of primary care professionals regarding community activities: a descriptive study.

Promoting health via a community approach is one of the most effective strategies for reducing the current incidence of chronic diseases. Primary care (PC), through the implementation of community activities (CA), has the potential to achieve this goal. Yet the implementation of CA at health centers is not standardized and is often thanks only to the voluntariness of health professionals. To ascertain the knowledge, attitudes, and practices of PC professionals regarding the implementation of CA. We carried out a cross-sectional study by circulating a self-administered online questionnaire on CA, across the period December 2022 through June 2023 in Galicia (Spain). All health professionals working in the Galician Health Service PC setting were invited to participate. A total of 521 health professionals participated in the study. They included all types of PC health professionals (physicians, general and specialist nurses -midwives, pediatrics, family and community, mental health- and social workers), including residents in training. Only 14.8% and 12.5% of professionals correctly identified CAs and social prescription (SPr) interventions, respectively. Furthermore, 93.9% recognized that the development of CA in health centers was deficient. Despite this, 76.5% showed a good attitude toward participation in CA. PC professionals find it difficult to identify CA and SPr interventions. Therefore, it is necessary to improve the training of these professionals in the implementation of CA with a view to enhancing population health, reducing the incidence of chronic diseases, and helping lessen the healthcare burden of the health system.

51 Feasibility of paediatric postoperative telemedicine in Nunavik

Abstract Background To access surgical care, Inuit children from Nunavik are relocated by plane to an urban tertiary hospital. Current processes that require an in-person follow-up appointment extend their stay away from home despite an overall low rate of postoperative complications. Telemedicine presents the opportunity to reduce this delay, but little is known about its feasibility for paediatric postoperative care in Nunavik. Objectives To determine the feasibility of paediatric postoperative telemedicine in Nunavik. Design/Methods In this mixed methods study using a convergent parallel design (August 2022 – May 2023), we recruited eleven healthcare providers who regularly interact with Inuit families of Nunavik. We conducted individual semi-structured in-depth interviews about postoperative care in this setting and analyzed the data thematically. In parallel, we conducted a narrative synthesis of the literature and gathered input from collaborators to assess the potential resources needed to enable postoperative telemedicine in the region. We then determined the capability for telemedicine in each of the fourteen villages of Nunavik using data provided by the regional health board. A meeting with specialists responsible for telemedicine in the region was held to discuss findings and future steps. We analyzed and compared qualitative and quantitative results to determine the degree of postoperative telemedicine readiness in the region. Results The main themes influencing the feasibility of telemedicine were general considerations for telemedicine use as a follow-up modality, patient characteristics most suitable for postoperative telemedicine, resources needed for telemedicine use as a follow-up modality, and the feasibility of postoperative telemedicine as determined by healthcare providers. All interviewees deemed paediatric postoperative telemedicine in this region feasible but highlighted conditions for its success. The narrative review uncovered limited literature on telemedicine use in Nunavik. As of January 2023, the two regional hospitals and three health centers had full capabilities for postoperative telemedicine. The nine other health centers had partial capabilities, mainly due to limited access to stable high-speed Internet and Internet bandwidth. Only regional hospitals had access to hospitalization, imaging, readaptation, and laboratory departments. The participating specialists deemed telemedicine feasible if patient load and burden of administrative work are manageable. Conclusion Postoperative paediatric telemedicine in Nunavik is feasible from a resource, healthcare providers and specialists standpoint. Leveraging centers with appropriate capacity would allow the increase in telemedicine usage in Nunavik. Next steps in this research program include interviews with families to evaluate their needs, preferences and attitudes toward postoperative paediatric telemedicine.

Applying a Theory of Change for Human Resources Development in Public Health Supply Chains in Rwanda.

The health supply chain (SC) system in Rwanda experienced a number of workforce-related challenges, including insufficient skilled supply chain management (SCM) professionals with the necessary competencies. The Human Resources for Supply Chain Management (HR4SCM) Theory of Change (TOC) provides a methodology to assess human resources (HR) management systems by explaining the preconditions required to achieve optimized workforce performance. We applied this model to design interventions to strengthen the Rwanda health SC workforce. We compared conditions in the health SC HR system in Rwanda with the 60 outcomes described as necessary for optimized workforce performance in the HR4SCM TOC model. We used a survey and participatory workshop at the central level, followed by structured interviews (N=35) with SC professionals in health centers, hospitals, and regional warehouses (N=20) in Southern Province and Kigali City to identify which outcomes already existed in the Rwandan HR system and which outcomes required strengthening through targeted interventions. We used focus groups (N=2) to refine interventions. We identified that 31 of the 60 outcomes were not sufficiently in place in the Rwandan health SC HR system. SCM workers had gaps in the technical and managerial competencies and did not have access to adequate training and professional development opportunities for certain required competencies. An SCM career path did not exist, and education was not available for all required SCM qualifications. Fourteen of these outcomes were prioritized for strengthening. We designed 20 workforce interventions with the Ministry of Health to address these deficiencies and selected indicators to monitor the interventions. Applying this HR TOC model enabled a systematic process to identify gaps, develop and prioritize interventions, and select indicators. Practitioners designing and evaluating SC workforce interventions should consider applying this methodology to design more effective, theory-driven interventions to improve SC workforce performance.

Socio-Cultural Relationship to Self-Efficacy of Breastfeeding in Pregnant Women in the 3rd Trimester in the Working Area of Imogiri Ist Health Center and Kretek Community Health Center, Bantul Regency

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;Socio-cultural factors, especially in Javanese society very influence the success and failure of exclusive breastfeeding. Social culture can be in customs, traditions, taboos, etc. Breastfeeding mothers who have low &lt;em&gt;breastfeeding self-efficacy &lt;/em&gt;when they later face problems while breastfeeding will tend to make it easier to decide to use alternative techniques for breastfeeding their babies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objective: &lt;/em&gt;&lt;/strong&gt;To determine the socio-cultural relationship towards &lt;em&gt;breastfeeding self-efficacy &lt;/em&gt;in third-trimester pregnant women&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Method: &lt;/em&gt;&lt;/strong&gt;The type of research is a quantitative analytical descriptive. Data collection methods use surveys, observations, or interviews with a &lt;em&gt;cross-sectional approach method&lt;/em&gt;&lt;em&gt;. &lt;/em&gt;The sampling technique used &lt;em&gt;purposive sampling of &lt;/em&gt;as many as 126 respondents with a gestational age of &amp;gt;30 weeks and according to the inclusion criteria. There are 2 instruments used, namely Sociocultural and &lt;em&gt;Breastfeeding Self-efficacy Scale-Short Form &lt;/em&gt;&lt;em&gt;(BSES-SF)&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results: &lt;/em&gt;&lt;/strong&gt;Based on research conducted on 126 respondents, Social Culture Supports ( &lt;em&gt;0.000 &amp;lt; 0.05) &lt;/em&gt;and Social Culture Does Not Support &lt;em&gt;(0.009 &amp;lt; 0.05) &lt;/em&gt;from the &lt;em&gt;Chi-Square test &lt;/em&gt;with value 0,000 &lt;em&gt;(p &lt;/em&gt;&lt;em&gt;&amp;gt; &lt;/em&gt;&lt;em&gt;0.05) &lt;/em&gt;H a rejected means it shows that there is a significant relationship between social culture and &lt;em&gt;breastfeeding self-efficacy.&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;The Breastfeeding Self-Efficacy Score &lt;/em&gt;showed that most respondents had high self-confidence ( 82.5 % ).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusion: &lt;/em&gt;&lt;/strong&gt;There is a significant relationship between social culture and &lt;em&gt;breastfeeding self-efficacy.&lt;/em&gt;&lt;em&gt; &lt;/em&gt;In this study, it can be said that respondents in the research area do not have traditions, culture, and taboos that do not support breastfeeding. The majority of respondents with supportive social culture (95%) have high &lt;em&gt;breastfeeding self-efficacy &lt;/em&gt;(73%) with quite a large difference from moderate and very low &lt;em&gt;breastfeeding self-efficacy (27%)&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

Construction and practice of a novel pharmaceutical health literacy intervention model in psychiatric hospital.

Pharmaceutical health literacy intervention (PHLI) plays a crucial role in influencing patients' medical decision-making, particularly concerning medication use. However, PHLI has not been widely implemented in China. This study aims to develop a novel PHLI model within a psychiatric hospital setting and evaluate its effectiveness. A PHLI model encompassing four modes-covering inpatients, outpatients, Internet+ and community-was established at The Affiliated Mental Health Center of Jiangnan University. The model's operation was detailed, and its performance data from 2022 and 2023 were evaluated. In 2022 and 2023, a total of 636 PHLI cases were reported. Of these, 386 cases (60.69%) were identified through the inpatient mode. The proportion of PHLI delivered via inpatient and Internet information subscription modes gradually increased, while interventions through other methods decreased. The age group of 18-30 accounted for 21.97% of cases, with 116 instances reported. Various types of PHLI were provided, including adverse reactions (18.87%), dosage and administration (11.64%), and therapeutic drug monitoring (9.43%). In addition, intervention strategies primarily focused on adverse reaction identification (10.22%), interpretation of pharmaceutical reports (7.23%), and routine examination reminders (6.45%). The PHLI model developed at our hospital offers an effective approach to health literacy intervention and represents an innovation advancement in pharmaceutical health literacy management. It can also serve as a reference framework for other hospitals.

Automated Breast Ultrasound With Remote Reading for Primary Breast Cancer Screening: A Prospective Study Involving 46 Community Health Centers in China.

Background: China has faced barriers to implementation of a population-based mammographic screening program. Breast ultrasound provides an alternative screening modality to mammography in low-resource settings. Objective: To evaluate the performance of ABUS with remote reading as the primary screening modality for breast cancer. Methods: This prospective study enrolled asymptomatic women 35-69 years old from 46 community health centers across 18 provinces representing all six regions of China from January 2021 to December 2021. Participants underwent screening ABUS as the sole breast cancer screening modality, with images acquired by a technologist at the community health center. The 3D volumetric data were transferred via cloud-based software to a single remote reading center, where examinations were interpreted independently in batches by two subspecialized breast radiologists using BI-RADS; a third radiologist at the remote reader center resolved discrepancies. Diagnostic reports were returned to the community centers, and patients sought follow-up care at local hospitals. The reference standard incorporated a combination of histopathology and 24-month follow-up. Outcomes measures included cancer detection rate, abnormal interpretation rate (AIR), sensitivity, specificity, biopsy rate, and PPV. Results: The final analysis included 5978 enrolled participants (median age, 46 years [IQR 40-52 years]) who underwent screening ABUS at the community health centers with subsequent remote reading. A total of 24 ABUS-detected cancers and two interval cancers were diagnosed. The cancer detection rate was 4.0 per 1000 women (95% CI: 2.7-5.9), and the AIR was 11.9% (95% CI: 11.1-12.7). A total of 95.8% (23/24) of ABUS-detected cancers were invasive. The 23 invasive cancers had a median diameter of 10.0 mm; 73.9% (17/23) were node-negative. Sensitivity was 92.3% (95% CI: 75.9-97.9), and specificity was 88.4% (95% CI: 87.6-89.2). The biopsy rate was 1.7% (95% CI: 1.4-2.0), and the PPV of biopsy was 24.0% (95% CI: 16.7-33.2). Conclusion: ABUS screening with remote reading met benchmark performance for cancer detection in comparison to mammography, with infrequent interval cancers. Clinical Impact: ABUS with remote reading holds promise in enhancing access to breast cancer screening and early detection in low-resource settings or underserved regions where mammographic screening is not established.

Exploring the relationship between self-stigma and resilience among people living with HIV: a cross-sectional study

HIV is a disease that not only affects physical health but also carries a heavy psychological burden, primarily through self-stigma. Self-stigma can lead to low self-esteem, helplessness, and social isolation, weakening resilience or an individual's ability to survive and adapt to life's challenges. However, there is a gap in knowledge regarding the specific mechanisms by which resilience can mitigate the impact of self-stigma on PLHIV. Whether resilience can completely neutralize the effects of self-stigma or only partially is a question that still requires further answers. This study aims to find out the relationship between self-stigma and resilience among people living with HIV. This research used an observational research design using a cross-sectional approach. 150 HIV patients at Six Public Health Centre of Semarang City were involved in using purposive sampling techniques. The data was gathered using the Indonesian version of CD-RISC and the Indonesian version of the Self-Stigma Questionnaire. Spearman rank correlations were used to analyze the data. The health research ethics committee of the faculty of nursing at Universitas Islam Sultan Agung has approved this study as ethically appropriate. The results found a relationship between self-stigma and resilience where a p-value of 0.006 &lt; α (0.05) with a contingency coefficient value of 0.222. The self-stigma and resilience have a weak correlation. Self-stigma can weaken the ability to create resilience in PLHIV, although the impact may vary depending on other factors. Nurses or health workers need to pay attention to PLHIV, who experience self-stigma, to rise and be resilient while being HIV positive.

Monitoring patients on ART within the CCMDD programme and those attending an urban healthcare facility in KwaZulu-Natal.

South Africa has high number of patients on antiretroviral treatment, necessitating innovative approaches to decongest healthcare facilities. The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme is a national initiative that identifies stable chronic patients for collection at pick-up points away from the health facility. This study aimed to compare patient satisfaction and virological suppression among those who collected medication through the CCMDD programme and routine care. This descriptive retrospective analytical study was conducted at a community health centre in Pietermaritzburg from 01 January 2018 to 31 December 2018 and included a questionnaire and access to their medical records on the national medicines database. The 117 patients in the routine care and CCMDD programme groups were assessed at baseline and evaluated at 6 months and 12 months, which were the time points for viral load (VL) testing. Of the 234 participants, 34 out of 117 (31.6%) remained in routine care at the 6-month review, and all but 7 patients had transferred to the CCMDD after 12 months. At the end of the study, 7 patients had VLs above 50 copies/mL and continued in routine care, while 97% (n= 27/234) remained virologically suppressed. None of the CCMDD programme patients moved out of the programme. Satisfaction with the CCMDD programme is indicated by the patients' continued VL suppression, highlighting its potential to decongest healthcare facilities and reduce the strain associated with medication collection.Contribution:The findings in this study validate patients being registered onto the CCMDD programme.

Karakteristik Pasien Dermatitis Kontak (Iritan dan Alergi) di Puskesmas Tarowang Kabupaten Jeneponto Provinsi Sulawesi Selatan Tahun 2022-2023

Contact dermatitis is a general term for an acute or chronic inflammatory reaction to a substance that stimulates the skin. This disease can cause work discomfort and reduce worker productivity. Women, babies, the elderly, and those with atopic tendencies are more susceptible to irritant contact dermatitis, while allergic contact dermatitis has risks including age, occupation, and a history of atopic dermatitis. The aim of this study was to determine the characteristics of contact dermatitis patients (irritants and allergies) at the Tarowang Community Health Center, Jeneponto Regency in 2022-2023. This research is a quantitative descriptive study with a research sample of all patients diagnosed with contact dermatitis (irritant and allergic) at the Tarowang Community Health Center and 455 samples were obtained from medical record data. The results of this study show that the incidence of DKA is greater than DKI at the Tarowang Community Health Center in 2022-2023 with the general occupational characteristics of DKI patients being housewives while DKA are fishermen in the 26-45 year age category with the highest number of lesion locations on the hands of this type. The most common gender is female and the therapy used in DKI patients is an antihistamine type cetrizine while in DKA it is an antihistamine type mebihydroline napadisylate.

02 Youth perspectives on virtual healthcare appointments in Nova Scotia – a qualitative study

Abstract Background With the onset of the COVID-19 pandemic, public safety measures required healthcare providers to look for alternative ways of delivering care in a safe and timely fashion. This led to an escalated use of virtual appointments to continue to provide patient care. For future decision-making regarding virtual care in our community, we must consider the youth perspective to ensure our healthcare delivery meets the needs of this patient population. Objectives Our study aims to determine the perspectives of local youth patients on their experience with virtual and in-person paediatric clinic appointments. Design/Methods Participants were recruited from general and subspecialty paediatrics clinics at the IWK Health Centre, in Nova Scotia, Canada. Eligibility criteria included attending both a virtual and in-person appointment from 2019-2022. Participants completed a semi-structured interview and provided their perspective on comfort level, accessibility, participation, and general preferences between virtual and in-person clinics. Transcribed data was analyzed using thematic analysis with both inductive and deductive approaches to identify themes. Results 12 participants aged 14-18 provided interviews. Participants represented clinical areas of general paediatrics, rheumatology, diabetes clinic and gender clinic. Virtual appointments were preferred for convenience, flexibility, and efficiency during shorter conversations. In-person appointments were preferred for physical concerns, communication and relationship building. Some youth appreciated talking face-to-face for the ease of communication, feeling able to “get the point across” in this setting. The value of the in-person connection with their healthcare team was expressed by some youth, and building this relationship held importance. When appointments provided education, youth preferred for that information to be delivered in-person. Participants overall felt more comfortable during virtual appointments, and participation levels varied based on the individual and not based on an appointment being virtual versus in-person. Accessibility issues were predominantly associated with in-person appointments, with barriers including access to transportation, time spent attending appointment, and the cost of travelling to a tertiary care centre. Conclusion Youth patients have unique and individual preferences for virtual versus in-person appointments. This study provided insight into situations when each appointment type should be considered and emphasizes the importance of including the youth in the decision-making process around appointment scheduling when possible.

28 Vaccination experiences for children with special needs - An examination of the impact of behaviours on vaccine uptake

Abstract Background While vaccines have been one of the most effective medical interventions to reduce the morbidity and mortality of many communicable illnesses, many factors have led to suboptimal immunization rates amongst paediatric patients. One of which that has not been explored widely in research literature is the impact of maladaptive behaviours on annual immunization rates. Behaviours such as aggression, agitation and flight are common amongst children with a neurodevelopmental diagnosis such as autism spectrum disorder, global developmental delay, and intellectual delay. When children are young, physical restraints by parents are often the method used to aid in the administration of the vaccine. However, as they age physical restraints is often regarded as inappropriate. Objectives The purpose of this study is to determine the extent in which disruptive behaviours (aggression, agitation and flight) affect annual vaccination rates for children with a neurodevelopmental diagnosis above the age of 6 years where physical restraining for vaccinations is no longer deemed appropriate or safe. Design/Methods Families with children diagnosed with Autism Spectrum Disorder (ASD), Intellectual Disorder (ID), and/or Global Developmental Delay (GDD) aged 6-17 years, seen through outpatient clinics at the Ron Joyce Children’s Health Centre of McMaster Children’s hospital in Hamilton between November 2022 – April 2023 were invited to participate in this cross sectional survey. The study aimed to capture both quantitative data on vaccine uptake and qualitative data on how vaccination experiences could be improved for children with neurodiversity. Results A total of 109 participants completed the survey. Among them, forty-three (39%) participants had a diagnosis of ASD and sixty-six (51.2%) had a diagnosis of global developmental delay or intellectual disability. Forty-six (45.6%) and 82 (76%) did not receive the Covid-19 and the influenza vaccination respectively. Of the children that did not receive the CoVid-19 vaccine, fourteen (30%) of the families had brought their child to be vaccinated, but the health care team could not administer the vaccine due to their child’s behaviours and twenty-one (37%) of the families anticipated that the vaccination would be a difficult experience because of their child’s behaviours and did not bring their child to get vaccinated. Of the children that did not receive the influenza vaccine, fifteen (18%) families had brought their child to be vaccinated, but the health care team could not administer the vaccine due to the child’s behaviours and 42 (50%) families anticipated that the vaccination would be a difficult experience because of their child’s behaviours and did not bring their child to get vaccinated. The main themes that emerged from the studies on ways to improve the vaccination experience for families include administering the vaccine in a low sensory environment, decreasing wait time, and ensuring clinic staff have experience in caring for children with special needs. Conclusion Children with special needs are a vulnerable population warranting concerted effort to ensure equitable access to immunizations. Interventions such as clinics specifically designed for children with neurodiversity should be implemented with the hope to further improve immunization rates within this population.

The Association between Emotional Responses to Climate Change, Antenatal Anxiety and Maternal-Fetal Attachment in Primigravida Women.

To investigate the association between emotional responses to climate change, antenatal anxiety, and maternal-fetal attachment in primigravida women. A multi-site cross-sectional research design study. This study was conducted at four primary health care (PHC) facilities in Damanhur district, El-Behera, from February 2024 to April 2024. Two hundred eighty-five women completed a comprehensive questionnaire that included a Woman's Social and Reproductive Form, The inventory of climate emotions (ICE) scale, The Stirling Antenatal Anxiety Scale (SAAS) and the Maternal-Fetal Attachment Scale (MFAS-HU-20). The study revealed that emotional responses to climate change show strong positive correlations with each other, ranging from 0.689 to 0.840, all significant at p < 0.001 level. Additionally, antenatal anxiety demonstrates substantial positive correlations with emotional responses to climate change, albeit with associations ranging from 0.239 to 0.287, all significant at p < 0.001 level. Moreover, maternal-fetal attachment displays substantial negative correlations with emotional responses to climate change, indicating that as emotional responses to climate change increase, maternal-fetal attachment tends to decrease. The correlations range from -0.263 to -0.426, all significant at p < 0.001. The emotional impact of climate change can adversely affect the bonding process between mother and fetus. Healthcare professionals, including obstetricians, midwives, and mental health counsellors, should integrate climate-related emotional distress into their assessments and interventions. Providing targeted psychological support for expectant mothers. The study's findings highlight the need for nursing to integrate climate-related emotional distress screening into prenatal care and for research to explore long-term effects and intervention effectiveness. In practice, healthcare providers should adopt holistic approaches that combine environmental and psychological support, developing comprehensive guidelines and community-based programs to support pregnant women. The research adhered to that is STROBE. Public contributions by women in community health centers.

Clinician Staffing and Quality of Care in US Health Centers

Health centers are vital primary care safety nets for underserved populations, but optimal clinician staffing associated with quality care is unclear. Understanding the association of clinician staffing patterns with quality of care may inform care delivery, scope-of-practice policy, and resource allocation. To describe the association of clinician staffing models and ratios with quality-of-care metrics in health centers. This cross-sectional study of US health centers used data from the 2022 Health Resources and Services Administration Uniform Data System (UDS). Clinician staffing ratios, expressed as the fraction of full-time equivalents (FTEs) per 1000 visits of physicians, advanced practice registered nurses (APRNs), and physician associates (PAs) to total clinician FTEs at each health center. Percentage of eligible patients receiving the corresponding service or outcome for 14 individual clinical quality metrics collected by the UDS, including infant immunizations; screening for cancer, depression, tobacco use, hypertension, HIV, and glycated hemoglobin levels; weight and body mass index (BMI) assessment; and appropriate statin, aspirin, and/or antiplatelet therapy. This analysis of 791 health centers serving 16 114 842 patients (56.6% female) identified 5 clinician staffing models: balanced (similar FTEs of physicians, APRNs, and PAs; 152 [19.2%] of health centers), higher FTEs of APRNs than physicians (174 [22.0%]), higher FTEs of physicians than APRNs (160 [20.2%]), approximately equal FTEs of physicians and APRNs (263 [33.2%]), and large scale (42 [5.3%]). Adjusted linear models showed positive associations between physician FTEs per 1000 visits and cervical (β, 14.9; 95% CI, 3.1-26.7), breast (β, 15.7; 95% CI, 3.2-28.1), and colorectal (β, 18.3; 95% CI, 6.0-30.6) cancer screening. Generalized additive models showed nonlinear positive associations beginning at a physician FTE ratio of 0.45 (95% CI, 0.02-6.22) for infant vaccinations, 0.39 (95% CI, 0.05-2.21) for cervical cancer screening, 0.39 (95% CI, 0.02-1.67) for breast cancer screening, 0.47 (95% CI, 0.00-5.76) for HIV testing, and 0.70 (95% CI, 0.18-19.96) for depression in remission; APRN FTE ratio of 0.45 (95% CI, 0.17-7.46) for adult BMI assessment; and PA FTE ratio of 0.16 (95% CI, 0.11-3.88) for infant vaccinations. Staffing models were not associated with 7 of the 14 metrics analyzed. In this cross-sectional study of health centers, physician FTE ratio was associated with higher performance in cancer screening, infant vaccinations, and HIV testing; APRN FTE ratio was associated with higher performance in preventative health assessments; and PA FTE ratio was associated with higher performance in infant vaccination. These findings suggest that targeted staffing strategies may be associated with quality of care in certain domains and that tailored approaches to health center staffing based on community-specific needs are warranted.