Health Center Research Articles

Comorbidities and use of health services in people with diabetes mellitus according to risk levels by adjusted morbidity groups

BackgroundPeople with diabetes mellitus frequently have other comorbidities and involve greater use of primary and hospital care services. The aim of this study was to describe the comorbidities and use of primary and hospital care services of people with diabetes according to their risk level by adjusted morbidity groups (AMG) and to analyse the factors associated with the utilisation of these services.MethodsCross-sectional study. People with diabetes were identified within the population of patients with chronic conditions of an urban health care centre by the AMG stratification tool integrated into the primary health care electronic clinical record of the Community of Madrid. Sociodemographic, functional, clinical characteristics and annual health care services utilisation variables were collected. Univariate, bivariate and Poisson regression analyses were performed.ResultsA total of 1,063 people with diabetes were identified, representing 10.8% of patients with chronic conditions within the health centre. A total of 51.4% were female, the mean age was 70 years, 94.4% had multimorbidity. According to their risk level, 17.8% were high-risk, 40.6% were medium-risk and 41.6% were low-risk. The most prevalent comorbidities were hypertension (70%), dyslipidaemia (67%) and obesity (32.4%). Almost 50% were polymedicated. Regarding health services utilisation, 94% were users of primary care, and 59.3% were users of hospital care. Among the main factors associated with the utilisation of both primary and hospital care services were AMG risk level and complexity index. In primary care, utilisation was also associated with the need for primary caregivers, palliative care and comorbidities such as chronic heart failure and polymedication, while in hospital care, utilisation was also associated with comorbidities such as cancer, chronic obstructive pulmonary disease or depression.ConclusionsPeople with diabetes were older, with important needs for care, many associated comorbidities and polypharmacy that increased in parallel with the patient’s risk level and complexity. The utilisation of primary and hospital care services was very high, being more frequent in primary care. Health services utilization were principally associated with functional factors related to the need of care and with clinical factors such as AMG medium and high-risk level, more complexity index, some serious comorbidities and polymedication.

Sedation reversal trends at outpatient ambulatory endoscopic center vs in-hospital ambulatory procedure center using a triage protocol

BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings. A known risk of performing endoscopy under moderate sedation is the potential for over-sedation, requiring the use of reversal agents. More needs to be reported on rates of reversal across different outpatient settings. Our academic tertiary care center utilizes a triage tool that directs higher-risk patients to the in-hospital ambulatory procedure center (APC) for their procedure. Here, we report data on outpatient sedation reversal rates for endoscopy performed at an in-hospital APC vs at a free-standing ambulatory endoscopy digestive health center (AEC-DHC) following risk stratification with a triage tool. AIM To observe the effect of risk stratification using a triage tool on patient outcomes, primarily sedation reversal events. METHODS We observed all outpatient endoscopy procedures performed at AEC-DHC and APC from April 2013 to September 2019. Procedures were stratified to their respective sites using a triage tool. We evaluated each procedure for which sedation reversal with flumazenil and naloxone was recorded. Demographics and characteristics recorded include patient age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, procedure type, and reason for sedation reversal. RESULTS There were 97366 endoscopic procedures performed at AEC-DHC and 22494 at the APC during the study period. Of these, 17 patients at AEC-DHC and 9 at the APC underwent sedation reversals (0.017% vs 0.04%; P = 0.06). Demographics recorded for those requiring reversal at AEC-DHC vs APC included mean age (53.5 ± 21 vs 60.4 ± 17.42 years; P = 0.23), ASA class (1.66 ± 0.48 vs 2.22 ± 0.83; P = 0.20), BMI (27.7 ± 6.7 kg/m2 vs 23.7 ± 4.03 kg/m2; P = 0.06), and female gender (64.7% vs 22%; P = 0.04). The mean doses of sedative agents and reversal drugs used at AEC-DHC vs APC were midazolam (5.9 ± 1.7 mg vs 8.9 ± 3.5 mg; P = 0.01), fentanyl (147.1 ± 49.9 μg vs 188.9 ± 74.1 μg; P = 0.10), flumazenil (0.3 ± 0.18 μg vs 0.17 ± 0.17 μg; P = 0.13) and naloxone (0.32 ± 0.10 mg vs 0.28 ± 0.12 mg; P = 0.35). Procedures at AEC-DHC requiring sedation reversal included colonoscopies (n = 6), esophagogastroduodenoscopy (EGD) (n = 9) and EGD/colonoscopies (n = 2), whereas APC procedures included EGDs (n = 2), EGD with gastrostomy tube placement (n = 1), endoscopic retrograde cholangiopancreatography (n = 2) and endoscopic ultrasound's (n = 4). The indications for sedation reversal at AEC-DHC included hypoxia (n = 13; 76%), excessive somnolence (n = 3; 18%), and hypotension (n = 1; 6%), whereas, at APC, these included hypoxia (n = 7; 78%) and hypotension (n = 2; 22%). No sedation-related deaths or long-term post-sedation reversal adverse outcomes occurred at either site. CONCLUSION Our study highlights the effectiveness of a triage tool used at our tertiary care hospital for risk stratification in minimizing sedation reversal events during outpatient endoscopy procedures. Using a triage tool for risk stratification, low rates of sedation reversal can be achieved in the ambulatory settings for EGD and colonoscopy.

Confidence as a Buffer Against Covid-19 Stigma: Enhancing Employee Engagement Among Recovered Individuals

Quality of work life (QWL) is important for individual and organizational success. Post-pandemic times have brought the challenge of declined, yet continued Covid-19 cases among the working Pakistani population. Stigma due to Covid-19 and thus deteriorated QWL in such individuals is plausible. Hence, elucidating factors that enhance the possible damaged quality of work life among Covid-19 stigmatized individuals remains an essential question for managers and practitioners. Drawing on the Social Identity theory, we hypothesize that QWL is damaged in Covid-19 recovered, stigmatized working individuals through deterioration in self-esteem as such individuals are prone to influences from the societal groups that they psychologically identify with. We also argue that self-efficacy buffers this negative effect. Albeit several researches have probed into relations of QWL with stigma-related antecedents and moderation and mediation mechanisms that underlie these effect, but this study investigates self-esteem and self-efficacy as mediator and moderator, respectively, of the Covid-19 related stigma and quality of work life relationship through the lens of the Social Identity Theory. Employing a correlational framework using purposive sampling, we obtained data from 133 working individuals who had been tested positive with Covid-19 in public and private hospitals and health centers of Pakistan during November 2022 – November 2023, had completely recovered and joined their professional lives. Results confirmed study hypotheses, suggesting that stigma related to Covid-19 damages QWL, this relationship is mediated by self-esteem, while self-efficacy buffers the relationship between Covid-19 related stigma and self-esteem. Such individuals and their managers need to collaboratively work in order to reduce effects of this stigma, and undo its damaging effects on self-esteem and QWL. In this regard, boosting self-efficacy plays a supporting role as it acts as a coping mechanism in the inter-play between Covid-19 stigma, self-esteem, and QWL.

Performance Analysis of the Regional Public Service Agency (BLUD) of the Tanara Health Center, Serang Regency using the Balance Scorecard Approach

This study aims to analyze the performance of the Regional Public Service Agency (BLUD) at the Tanara Community Health Center in Serang Regency using the Balance Scorecard approach. The Balance Scorecard emphasizes the importance of balancing various aspects such as financial and non-financial, short-term and long-term, as well as internal and external factors. The performance analysis of the BLUD is viewed from four perspectives: growth and learning, internal processes, customer satisfaction, and financial perspectives. This research adopts a quantitative approach. Data collection is conducted through surveys to gather insights into the growth and learning perspective, the internal process perspective, and the customer satisfaction perspective. Secondary data is used to analyze the BLUD's performance from the financial perspective. The results of this study indicate that the health center has not yet met the target scores set by the government. Although some indikators have been achieved, there is still a need for improvement, particularly in internal processes and customer satisfaction. To enhance the performance of the BLUD at this health center, integrated efforts are required, such as improving services and internal processes as well as fostering innovation.

"I Heard of PrEP-I Didn't Think I Needed it." Understanding the Formation of HIV Risk Perception Among People Who Inject Drugs.

Uptake of pre-exposure prophylaxis medication (PrEP) to prevent HIV among people who inject drugs (PWID) remains extremely low in the United States. West Virginia's rising HIV incidence and highest drug overdose rate in the nation makes it an important locus for opioid use and HIV risk interaction. In this pilot study we pioneered the use of Cultural Theory among PWID to understand HIV-related risk perception arising from four contrasting modes of social organization. Carried out during an HIV outbreak, we explored PrEP uptake qualitatively as a window onto risk perception. Of the 26 interviewees, 18 were HIV- and despite the medication's free availability from the health center where recruitment took place, none had taken PrEP, half considering they were not at risk. Intimate couples who showed characteristics of 'enclaves' considered the boundary around themselves protective against HIV, creating a safe space or 'invisible risk group'. Higher HIV risk was perceived among those who were housed compared to those living homeless. Beliefs about the causation of the local HIV outbreak and the validity of scientific research corresponded with characteristics of the contrasting modes of social organization and the approach is promising for informing public health interventions among PWID.

Perceptions of Mothers with Children Aged 0 to 59 Months Regarding Exclusive Breastfeeding (EBF) in the Rural Community of Wogo, Sinder, Tillabery, Niger

The objective of this study was to evaluate perceptions and beliefs regarding exclusive breastfeeding (EBF) according to the sociodemographic and economic characteristics of mothers of children aged 0 to 59 months in the Wogo rural commune of Sinder/Tillabery/ Niger. This is a cross-sectional descriptive study, on a representative sample of mothers of children aged under five years. A questionnaire was completed using a structured interview. The data were collected with ODK software then analyzed with SPSS and Epi Info version 7.2 software. Mothers in the age groups of 15 to 24 and 25 to 34 years mainly perceive that colostrum is bad for the health of the newborn 22.22% and 17.20%. These mothers use pre-lacteal products until the milk matures, which then changes color and becomes white. Mothers aged 35 to 53 years, for their part, perceive more of an insufficiency of milk secretion 26.87%. Among those not in school, 20.93% say that colostrum is bad; 14.53% think they don't have enough milk. 23.4% of those at primary level reject colostrum. Among unemployed mothers, 19.31% perceive colostrum as bad milk, and 16.55% of them perceive insufficient milk. First-time mothers mainly believe that the child is not satisfied with the consumption of milk only 28.67%. Despite their awareness, some mothers 10.24% say that the child will be thirsty, 14.45% perceive insufficient milk and 13.25% consider colostrum bad for health. The majority of mothers who gave birth in health centers and who did not practice EBF perceive insufficient milk secretion and the majority of women who gave birth at home say that colostrum is bad for the child 27, 37% and 22.10% say that the child is not satisfied with the consumption of breast milk alone. The perceptions and beliefs of mothers and their elders in traditional myths dangerously hinder the practice of EBF in this community.

Development of Indian Council of Medical Research (ICMR) Standard Treatment Workflows for Skin Diseases: A Step Toward Universal Health Coverage

Abstract Background: Skin conditions form a major bulk of diseases in the community. With a disproportionately low number of dermatologists in the country, and a greatly unequal distribution between urban versus rural areas, ineffective treatment and mismanagement of skin conditions are, however, commonplace. Objective: To develop standard treatment workflows (STWs) for certain skin diseases for use by clinicians at primary, secondary, and tertiary care centers. Methodology: Seven members, from various academic institutes across the country, were selected for formulation of the STWs. They were provided logistic and technical support by the ICMR, Department of Health Research (DHR), and WHO India office. Multiple rounds of online and physical discussions were performed to identify topics that would be most useful in the management of skin diseases for the health care personnel (HCP) and subsequently to frame the STW content. Results: The selected diseases included acne and rosacea, alopecia, bacterial skin infections, cutaneous adverse drug reactions, dermatophytosis, eczema/dermatitis, immunobullous dermatoses, psoriasis, scabies, varicella and herpes, vitiligo, and urticaria. There was one separate module on rational use of topical corticosteroids. The STWs for these conditions have been finalised and are available as physical posters in health centers and can also be accessed online and through mobile applications. Conclusion: Thirteen STW modules have been prepared with a view to optimize management of skin diseases at various levels of health care system of the country.

Cost-effectiveness of implementing performance-based financing for improving maternal and child health in Ethiopia.

Performance Based Financing (PBF) supports realization of universal health coverage by promoting bargaining between purchasers and health service providers through identifying priority services and monitoring indicators. In PBF, purchasers use health statistics and information to make decisions rather than merely reimbursing invoices. In this respect, PBF shares certain elements of strategic health purchasing. PBF implementation began in Ethiopia in 2015 as a pilot at one hospital and eight health centers. Prior to this the system predominantly followed input-based financing where providers were provided with a predetermined budget for inputs for service provision. The purpose of the study is to determine whether the implementation of PBF is cost-effective in improving maternal and child health in Ethiopia compared to the standard care. The current study used cost-effectiveness analysis to assess the effects of PBF on maternal and child health. Two districts implementing PBF and two following standard care were selected for the study. Both groups of selected districts share common grounds before initiating PBF in the selected group. The provider perspective costing approach was used in the study. Data at the district level were gathered retrospectively for the period of July 2018 to June 2021. Data from health service statistics were transformed to population level coverages and the Lives Saved Tool method used to compute the number of lives saved. Additionally for purpose of comparison, lives saved were translated into discounted quality-adjusted life years. The number of lives saved under PBF was 261, whereas number of lives saved under standard care was 194. The identified incremental cost per capita due to PBF was $1.8 while total costs of delivering service at PBF district was 8,816,370 USD per million population per year while the standard care costs 9,780,920 USD per million population per year. QALYs obtained under PBF and standard care were 6,118 and 4,526 per million population per year, respectively. The conclusion made from this analysis is that, implementing PBF is cost-saving in Ethiopia compared to the standard care. Due to lack of district-level survey-based data, such as prevalence and effects on maternal and child health, national-level estimates were used into the LiST tool.There may be some central-level PBF start-up costs that were not captured, which may have spillover effects on the existing health system performance that this study has not considered.There may be health statistics data accuracy differences between the PBF and non-PBF districts. The researchers considered using data from records as reported by both groups of districts.

Implementation of a remote behavioral intervention for older adults with asthma – a pilot study

ABSTRACT Objective Older adults with asthma (OAA) have elevated asthma morbidity rates. A six-session intervention based on self-regulation theory was shown to improve outcomes. However wide-spread implementation was difficult due to the in-person design. Our objective was to determine the feasibility and acceptability of an updated intervention for OAA that is completely remote, includes a physician component, and utilizes shared decision making (SDM). Methods A pilot study of 12 OAA with uncontrolled asthma and their asthma providers was conducted at three health centers. The remote intervention (titled SOAR) consisted of 4 sessions (2 group and 2 individual). Asthma providers (both specialists and primary care) were sent updates of progress along with information on how to incorporate SDM into the visit. Implementation (feasibility, acceptability, and appropriateness) and clinical (asthma control, asthma quality of life, perceived control, depression, and self-confidence) outcomes were measured. Results SOAR was found to be feasible, acceptable, and appropriate, with values on validated implementation scales similar to those of in-person behavioral interventions. Asthma providers found the program helpful and intended to change care based on the updates. Asthma control scores improved significantly from baseline (14.2 to 16.8, p = 0.04), as did asthma quality of life (4.2 to 4.9, p = 0.03) and self-confidence to manage asthma (7.1 to 8.5, p = 0.02). There was no change in depression nor perceived control scores. Conclusion A remote behavioral intervention appeared feasible and acceptable for OAA and their health care providers, and can improve outcomes. Larger scale implementation trials are warranted.

A protocol for the formative evaluation of the implementation of patient-reported outcome measures in child and adolescent mental health services as part of a learning health system

BackgroundMental health conditions affect one in seven young people and research suggests that current mental health services are not meeting the needs of most children and youth. Learning health systems are an approach to enhancing services through rapid, routinized cycles of continuous learning and improvement. Patient-reported outcome measures provide a key data source for learning health systems. They have also been shown to improve outcomes for patients when integrated into routine clinical care. However, implementing these measures into health systems is a challenging process. This paper describes a protocol for a formative evaluation of the implementation of patient-reported measures in a newly operational child and adolescent mental health centre in Calgary, Canada. The purpose is to optimize the collection and use of patient-reported outcome measures. Our specific objectives are to assess the implementation progress, identify barriers and facilitators to implementation, and explore patient, caregivers and clinician experiences of using these measures in routine clinical care.MethodsThis study is a mixed-methods, formative evaluation using the Consolidated Framework for Implementation Research. Participants include patients and caregivers who have used the centre’s services, as well as leadership, clinical and support staff at the centre. Focus groups and semi-structured interviews will be conducted to assess barriers and facilitators to the implementation and sustainability of the use of patient-reported outcome measures, as well as individuals’ experiences with using these measures within clinical care. The data generated by the patient-reported measures over the first five months of the centre’s operation will be analyzed to understand implementation progress, as well as validity of the chosen measures for the centres’ population.DiscussionThe findings of this evaluation will help to identify and address the factors that are affecting the successful implementation of patient-reported measures at the centre. They will inform the co-design of strategies to improve implementation with key stakeholders, which include patients, clinical staff, and leadership at the centre. To our knowledge, this is the first study of the implementation of patient-reported outcome measures in child and adolescent mental health services and our findings can be used to enhance future implementation efforts in similar settings.

Determinants of birth weight and length: an analysis of the 2020 mothers' cohort register data

A woman's nutritional status significantly impacts the qualities of the baby she delivers, as assessed by the baby's weight and length at birth. This study aimed to identify factors influencing birth weight and length using a retrospective case-control design with secondary data collected from the mothers' cohort register at the Community Health Center in 2020-2021. The study included 100 samples, comprising 25 cases and 75 controls. Several determinants of birth weight and length were examined: the mother's age (OR=4.1, 95% CI 1.41-12.0), weight gain during pregnancy (OR=3.6, 95% CI 1.051-12.553), mid-upper arm circumference (OR=2.9, 95% CI 1.061-8.220), hemoglobin level (OR=4.711, 95% CI 1.57-14.11), and iron supplement intake (OR=1.837, 95% CI 0.600-5.624), with hemoglobin level identified as the most influential factor on birth qualities. Mothers with less than normal hemoglobin levels have a 4.7 times higher risk of delivering babies of lower weight and length than mothers with normal hemoglobin levels. The impact of low hemoglobin in pregnant women includes reduced oxygen supply for both the mother and fetus, resulting in low birth weight, child anemia, premature birth, and child mortality. Given these significant effects, it is crucial to establish standards for health services in Indonesia, ensuring that pregnant women with low hemoglobin receive comprehensive care aligned with Indonesia's Sustainable Development Goals (SDGs) standards.

First-line treatment with ceftriaxone for Neisseria gonorrhoeae infection less likely to be prescribed to patients with a penicillin allergy label: a retrospective audit of medical records.

Background Gonorrhoea notifications have increased substantially in Australia over the past decade. Neisseria gonorrhoeae is already highly resistant to several antibiotics and so, alternatives to first-line treatment are generally strongly discouraged. The penicillin allergy label (AL) on patient medical records has previously been shown to influence prescribing practices, to the detriment of best-practice management and antimicrobial stewardship. This study aimed to understand how the penicillin AL influences antibiotic selection for gonorrhoea treatment at Canberra Sexual Health Centre. Methods A retrospective chart audit of gonorrhoea cases treated at Canberra Sexual Health Centre between January 2020 and October 2023 (n =619 patients, n =728 cases). Antibiotic selection was assessed according to penicillin AL status. Ceftriaxone selection was assessed according to penicillin allergy severity reported in the medical records and as determined using a validated antibiotic allergy assessment tool. Results Cases with a penicillin AL were more likely to receive antibiotics other than ceftriaxone (n =7/41, 17.1%) than cases without the label (n =8/687, 1.2%, P n =28/41, 68.3%) to apply the assessment tool. Those reported as low-severity in the records were more likely to receive ceftriaxone (n =21/22, 95.5%) than those reported as moderate-high (n =7/11, 63.6%) or unreported (n =6/8, 0.75%). Conclusions Treatment of gonorrhoea in outpatient settings requires an understanding of penicillin allergy, and the ability to quickly and accurately identify penicillin-AL patients who can safely tolerate ceftriaxone. Institutionally endorsed penicillin allergy de-labelling protocols and access to easy-to-navigate prescribing advice within national sexually transmitted infection management guidelines would support this.

Support of Characteristics, Physical Environmental and Psychological On Quality Of Life Of Patients With DM Type II

Background: Diabetes mellitus is one of the diseases that ranks high in the list of non-communicable diseases in Indonesia. Factors that can affect quality of life such as physical environment and psychological. Objective: This study aims to examine the relationship between characteristic, physical environment and psychological on quality of life of type II diabetes mellitus patients at the Barombong Public Health Center, Makkasar City. Methodology: This study is a quantitative research with an analytical observational approach using a cross-sectional design. The population size in this study is 578 individuals, sample calculation using the WHO formula yielded a sample size of 385 individuals with predefined exclusion an inclusion criteria. The sampling technique employed is simple random sampling (SRS), and the hypothesis test used is chi-square. Results: Bivariate statistical analysis shows that there is a relationship between quality of life and age (p=0,000), duration of illness (p=0,000), temperature (p=0,000), noise (p=0,000), positive feelings (p=0,000), thinking, learning, and concentration (p=0,000), self-esteem (p=0,000), while variables that are not associated with quality of life are gender (p=0,111), marital status (p=0,228) and social support (p=0,645). Based on logistic regression analysis, it was found that the factors that most influence quality of life are duration of illness (p=0,000) and positive feelings (p=0,000). Conclusion: Length of suffering and positive feelings are the most dominant variables associated with quality of life with a probability level of 99.8%.

PENGARUH PERLAKUAN METODE BIRTHING BALL TERHADAP PENURUNAN INTENSITAS NYERI KALA 1 FASE AKTIF

Childbirth is a natural thing and will definitely be experienced by every woman who has a partner. However, the fact that cannot be denied is that many women feel anxious before giving birth, which can be influenced by various factors. The aim of providing Endorphine Massage with lavender aromatherapy is to reduce the anxiety level of mothers in the first stage of labor at the Sekar Community Health Center, Bojonegoro Regency. The design provides instillation, massage, Endorphine Massage with lavender aromatherapy to reduce the anxiety level of mothers in the first stage of labor at the Sekar Community Health Center, Bojonegoro Regency. The results of the instillation, giving Endorphine Massage pills with lavender aromatherapy which has no side effects in reducing the anxiety level of mothers giving birth at the Sekar Community Health Center, Bojonegoro Regency, so that mothers can apply endorphine massage with lavender aromatherapy to reduce the level of anxiety in labor without causing side effects in reducing Anxiety level

Tingkat Kemandirian Pasien Dengan Gangguan Mobilitas Fisik Dengan Berbagai Macam Penyakit

In Indonesia, 22.5 million people experience disabilities with the highest incidence occurring in those aged 60 years and over (elderly). Meanwhile, the most common impairment or limitation of function experienced by persons with disabilities in Indonesia is impaired walking (immobility). This mobility impairment can affect a person's independence in fulfilling their daily activities.This study aims to determine the level of independence of activity of daily living (ADL) in patients who experience impaired physical mobility. This research is quantitative research with a descriptive survey design. The sampling technique used purposive sampling technique with a total sample of 102 patients who experienced impaired physical mobility aged ≥ 60 years and domiciled in the Sukra Health Center work area. Measurement of ADL independence using the Katz Index questionnaire, which has been back translated and tested for construct validity with a calculated r value of 0.580-0.740 > r table 0.361 which means it is valid. Data were analyzed univariately and cross-tabulated. The results showed that the majority of patients with impaired physical mobility experienced total dependence in performing ADL (23.5%). Total dependence was more experienced by patients aged > 90 years (24.7%), female (26.1%), suffered a stroke (42.6%), lived with family (27.1%), usually assisted by other people (nurses/neighbors/helpers) (50%), and had been hospitalized less than 1 year ago (35%). Patients with impaired physical mobility are expected to be able to fulfill all activities daily living either independently or with the help of others.

Factors affecting the nutritional status of toddlers between the ages of 12-59 months in the workplace of UPTD Puskemas Batu Kambing

Nutritional problems in children at this time are still high. Malnutrition will have an impact on the development and growth of children. The purpose of this study is to find out the Factors Related to the Nutritional Status of Toddlers Aged 12 – 59 Months in the Working Area of the UPTD Batu Kambing Health Center in 2023. The type of research used is quantitative with a crosssectional research design. The population is all mothers who have toddlers aged 12-59 months totaling 610 with a sample of 86 people. The sampling technique is purposive sampling. This research has been carried out in March – April 2023 at the UPTD Batu Kambing Health Center. The data used were primary data and secondary data, namely by conducting interviews with respondents, univariate and bivariate data analysis using the Chi-Square test. The results of the study were less than half, namely 21 respondents (24.4%) who experienced malnutrition, 36 respondents (41.9%) who had a low level of knowledge, 28 respondents (32.6%) with poor parenting and 37 respondents (43.0%) who had a history of infectious diseases. The results of the statistical test showed that the relationship between knowledge and nutritional status was obtained with a value of p = 0.005 (p < 0.05), parenting style with nutritional status was obtained with a value of p = 0.003 (p < 0.05) and the relationship between history of infectious diseases and nutritional status was obtained with a value of p = 0.007 (p < 0.05). It can be concluded that there is a relationship between the level of knowledge, parenting, eating and history of infectious diseases with the nutritional status of toddlers aged 12 – 59 months at the UPTD Batu Kambing Health Center in 2023. It is recommended to health workers to provide counseling on nutrition and the provision of PMT to undernourished children and to mothers to increase maternal knowledge about nutrition and improve maternal parenting by learning how to feed children.

Relationship Between Eating Pattern, Home Sanitation and Parenting Mother with Stunting in Children Under Two Years in The Working Area of Puskesmas Puuwatu Kendari City

Stunting is one of the nutritional problems that adversely affects the quality of life of children in achieving optimal growth and development points according to their genetic potential. Stunting is more dangerous for baduta, because it is more likely to inhibit the growth process. The 2018 of Indonesia resistance increased to 36.4%. This research aims to determine the relationship between eating patterns, house sanitation, maternal parenting patterns and the nutritional status (stunting) of children under two years of age in the Puuwatu Health Center Working Area, Kendari City. This research was an observational analytic study with a cross-sectional approach and was conducted in March at the Posyandu Dian Palupi and Posyandu Membiri in Puuwatu Village. The sample used in this study was 58 baduta. The sampling technique is a random sampling, The data was analyzed using the chi square test. This study showed no significant relationship (p = 0.095) between diet and child nutritional status, no significant relationship (p = 0.265) between parenting and child nutritional status and no significant relationship (p = 0.620) between sanitation home with the nutritional status of children

Risk factors associated with underweight in children aged one to two years: a longitudinal study

BackgroundUnderweight is a prevalent health issue in children. This study aimed to identify factors associated with underweight in children aged 1–2 years in Hamadan city. Unlike the studies conducted in this field, which are cross-sectional and do not provide information on the effect of age changes on underweight, our longitudinal approach provides insights into weight changes over time. On the other hand, this study focuses on the high-risk age group of 1 to 2 years, which has only been addressed in a few studies.MethodsIn this longitudinal study, 414 mothers with 1 to 2 year-old children referred to the health centers of Hamadan city, whose information is in the SIB system, a comprehensive electronic system, were examined to identify factors related to underweight. The response variable was weight-for-age criteria classified into three categories: underweight, normal weight, and overweight. A two-level longitudinal ordinal model was used to determine the factors associated with underweight.ResultsOf the children studied, 201 (48.6%) were girls and 213 (51.4%) were boys. Significant risk factors for underweight included low maternal education (AOR = 3.56, 95% CI: 1.10–11.47), maternal unemployment (AOR = 3.38, 95% CI: 1.05–10.91), maternal height (AOR = 0.85, 95% CI: 0.79–0.92), lack of health insurance (AOR = 2.85, 95% CI: 1.04–7.84), gestational age less than 24 years (AOR = 3.17, 95% CI: 16.28–0.97), child age 12–15 months (AOR = 2.27, 95% CI: 1.37–3.74), and child's birth weight (AOR = 0.63, 95% CI: 0.70–0.58).ConclusionBased on the results of the present study, it seems that the possibility of being underweight among children is more related to the characteristics of mothers; therefore, taking care of mothers can control some of the weight loss of children.

Reducing patients’ rate of frequent attendance through a training intervention for physicians

BackgroundFrequent attendance is a common issue for primary care health centres. The phenomenon affects the quality of care, increases doctors’ workloads and can lead to burnout.This study presents the results of an educational intervention for primary care physicians, aimed at helping them to decrease the prevalence rate of excessive attendance by patients at their centres.MethodsA training programme was carried out for 11 primary care doctors in Barcelona who had patient lists totalling 20,064 patients. The goal of the training was to provide the participating physicians with techniques to curb frequent attendance. Additionally, the programme sought to offer them strategies to prevent professional burnout and tools to better organize their everyday medical practice. The study used a quasi-experimental design for an evaluation of an educational intervention, featuring a pre-test assessment (before the training programme) and a post-test assessment (after the training programme), as well as comparison with a control group that did not undergo the training. The study assessed the effects of the programme on the rates of frequent attendance of patients served by the participating physicians. These rates were compared with those registered by the patients seen by the control group physicians over the same period.ResultsAmong the group of physicians who received the training, the mean prevalence of patients who qualified as frequent attenders decreased from 22% prior to the training programme to 8% after completion of the programme. In other words, 14% of patients (2,809) limited the frequency of their visits to primary care physicians after their physicians had completed the training programme. Meanwhile, the study recorded an average decrease of 3.1 visits per year by the patients of the physicians who had undergone the training. Statistically significant differences between this group and the control group were observed.ConclusionsThe educational intervention proved effective at helping primary care physicians to decrease their patients’ rates of frequent attendance. It also contributes to the impact research of continuing education on doctors and their patients. We need to increase primary care spending from the current 14% to the 25%, to address this problem, among others.

Comparative study of physical activity status and food patterns in adolescents with and without polycystic ovary syndrome: an analytical approach

BackgroundPolycystic ovary syndrome (PCOS) in adolescents causes appearance changes such as hirsutism, alopecia, acne and long-term complications, such as metabolic syndrome and infertility. This study aimed to compare physical activity...