Health Education Of Population Research Articles

Effect of a two-stage intervention package on the cesarean section rate in Guangzhou, China: A before-and-after study.

BackgroundThe cesarean section (CS) rate has risen globally during the last two decades. Effective and feasible strategies are needed to reduce it. The aim of this study was to assess the CS rate change after a two-stage intervention package that was designed to reduce the overall CS rate in Guangzhou, China.Methods and findingsThis intervention package was implemented by the Health Commission of Guangzhou Municipality in 2 stages (October 2010–September 2014 and October 2014–December 2016) and included programs for population health education, skills training for healthcare professionals, equipment and technical support for local healthcare facilities, and capacity building for the maternal near-miss care system. A retrospective repeated cross-sectional study was conducted to evaluate influences of the intervention on CS rates. A pre-intervention period from January 2008 to September 2010 served as the baseline. The primary outcome was the CS rate, and the secondary outcomes included maternal mortality ratio (MMR) and perinatal mortality rate (PMR), all obtained from the Guangzhou Perinatal Health Care and Delivery Surveillance System (GPHCDSS). The Cochran-Armitage test was used to examine the trends of the overall CS rate, MMR, and PMR across different stages. Segmented linear regression analysis was used to assess the change of the CS rate over the intervention period.A total of 1,921,932 records of births and 108 monthly CS rates from 2008 to 2016 were analyzed. The monthly CS rate declined across the intervention stages (Z = 75.067, p < 0.001), with an average rate of 42.4% at baseline, 39.8% at Stage 1, and 35.0% at Stage 2. The CS rate declined substantially among nulliparous women who delivered term singletons, with an accelerating decreasing trend observed across Stage 1 and Stage 2 (the difference in slopes: −0.09 [95% CI −0.16 to −0.02] between Stage 1 and baseline, p = 0.014; −0.11 [95% CI −0.20 to −0.02] between Stage 1 and Stage 2, p = 0.017). The CS rate in the remaining population increased during baseline and Stage 1 and subsequently decreased during Stage 2. The sensitivity analysis suggested no immediate impact of the universal two-child policy on the trend of the CS rate. The MMR (Z = −4.368, p < 0.001) and PMR (Z = −13.142, p < 0.001) declined by stage over the intervention period.One of the main limitations of the study is the lack of a parallel control group. Moreover, the influence of temporal changes in the study population on the CS rate was unknown. Given the observational nature of the present study, causality cannot be confirmed.ConclusionsApparent decline in the overall CS rate was observed in Guangzhou, China, after the implementation of a two-stage intervention package. The decline was most evident among nulliparous women who delivered term singletons. Despite some limitations for causal inference, Guangzhou’s experience in controlling the CS rate by implementing composite interventions with public health education and perinatal healthcare service improvement could have implications for other similar areas with high rates of CS.

THE PREVALENCE RATE OF HEPATITIS C VIRUS IN BASRAH CITY AND THE COMMON CAUSATIVE RISK FACTORS

Background: This prospective descriptive study was carried out in the Basra Public Health Department fromAugust 2017 to August 2018 on all patients registered at the Communicable Disease Control unit. Aim of the study. is to detect the prevalence rate of hepatitis c virus among risky group and to determined the most common risk factors. Patients and method.A total of 162137 (97283 male and 64854 female) people were screened and 355 (205 male and 150 female) people were found to be infected. The laboratory investigation included a blood sample to detect anti-hepatitis C virus antibodies by using an enzyme-linked immunosorbent assay test, which is a confirmatory test for those with positive results found using the HCV RNA genotype. Result. In this study, we found that the prevalence rate of the hepatitis C virus in Basra city among the screening group was 2% in comparison with the global population affected by this diseasebeing a little more than 3%. The most common risk factor for infection with the hepatitis C virus is dentinal interference (83 patients) with 23% affected cases, while the lowest risk factor is in prisoners. Among patients with cancer, the most common age group at the risk of infection with hepatitis C is 15 to less than 45 years and 0.5%. The number of infected people in rural areas is greater than in the center with a prevalence rate of 0.22% in Al-Qurna. The most common risky group exposed to infection are hemodialysis patient( prevalence rate 84.5%). Conclusion. It’s important to apply a screening program of hepatitis C to all population to have a more quorate prevalence rate; population health education about the risk factor of infection with hepatitis C and how to prevent it; a strict follow-up of all dentinal clinics by the health directorate and insure the use of sterilized instrument for every patient; use of disposable instrument in dentinal clinic if possible; early screening for renal disease is necessary to prevent the development of renal failure and its complication. Keywords. HBV, HCV, prevalence of hepatitis virus

Promoting and strengthening public health through undergraduate education.

There are widely divergent views as to what constitutes "public health" and "public health research". But regardless of these views, readers of this journal would likely agree that public health matters; we assert that so does the educational programming that prepares its workforce. Our voiced perspectives as authors are influenced by our respective training, occupations, and academic locales, and we believe that undergraduate public and population health education (UGPPHE) across many disciplines is crucial to strengthening public health in Canada. Existing literature and discourse related to UGPPHE in Canada tends to be concentrated around its ancillary positioning within clinical health disciplines such as medicine, nursing, and dentistry, rather than on the evolution of undergraduate degree programs. While UGPPHE programming has the important function of preparing undergraduates to enter into practice as public health professionals, it has added virtue in its capacity to improve public health literacy and produce a more robust body of informed and engaged citizens. The intent of this commentary is to draw increased attention towards the other disciplines less well known for bringing awareness to UGPPHE in Canada and to commence what will hopefully be a cascade of dialogue from stakeholders across the nation.

Seroepidemiology of Toxoplasma gondii infection in patients with liver disease in eastern China.

The role of the protozoan parasite Toxoplasma gondii in the pathogenesis of liver disease has recently gained much interest. The aim of this study was to determine the prevalence and risk factors associated with T. gondii infection in patients with liver disease from three cities in Shandong and Henan provinces, China. A case-control study was conducted from December 2014 to November 2015 and included 1142 patients with liver disease and 1142 healthy controls. Serum samples were collected from all individuals and were examined with enzyme-linked immunosorbent assay for the presence of anti-T. gondii IgG and IgM antibodies. Information on the demographics, clinical, and lifestyle characteristics of the participants was collected from the medical records and by the use of a questionnaire. The prevalence of anti-T. gondii IgG was 19·7% in patients with liver disease compared with 12·17% in the controls. Only 13 patients had anti-T. gondii IgM antibodies compared with 12 control individuals (1·14% vs. 1·05%, respectively). The highest seroprevalence was detected in patients with liver cancer (22·13%), followed by hepatitis patients (20·86%), liver cirrhosis patients (20·42%), and steatosis patients (20%). Multivariate logistic regression analysis indicated that consumption of raw meat (odds ratio (OR) = 1·32; 95% confidence interval (CI) 1·01-1·71; P = 0·03) and source of drinking water from wells (OR = 1·56; 95% CI 1·08-2·27; P = 0·01) were independent risk factors for T. gondii infection in liver disease patients. These findings indicate that T. gondii infection is more likely to be present in patients with liver disease. Therefore, efforts should be directed toward health education of populations at high risk of T. gondii infection and measures should be taken to protect vulnerable patients with liver disease.

Teaching Population Health: Community-Oriented Primary Care Revisited.

Teaching Population Health: Community-Oriented Primary Care Revisited.

Teaching population health to medical students through the community health assessment

Clinical medicine and population health typically operate independently in the United States but they should be more integrated. Recent calls to integrate include an Institute of Medicine report[1]...

Improvement of cancer control in mainland China: epidemiological profiles during the 2004–10 National Cancer Prevention and Control Program

BackgroundFollowing the appeal of the World Health Assembly for national cancer plans and programmes, the Chinese Ministry of Health issued governmental outlines of the National Cancer Prevention and Control Programme (2004–10). This study aimed to evaluate the efficacy of that programme in mainland China. MethodsThe Chinese Ministry of Health outlines aimed to establish a national cancer registry system, enhance the population health education, and organise prevention, early detection, and early treatment for principal cancers, especially in rural areas for high-incidence cancers. We retrieved the crude incidence and mortality (per 100 000 people) in urban and rural areas from annual reports of the National Central Cancer Registry from 2004 to 2010. We estimated mortality index [MI=mortality/(incidence+mortality)] to represent the overall efficacy of screening and treatment for cancers. Trends of epidemiological profiles were observed over time. Only descriptive results are provided in this abstract, a statistical test was not performed. FindingsThe all-cancer incidence reached the peak at the 2008 and then decreased, whereas the all-cancer mortality changed accordingly. All-cancer incidence was higher in urban areas than in rural areas, but the urban MI was lower. The all-cancer MIs decreased more sharply in the rural population (from 43·2% to 39·8%) than in the urban population (from 38·8% to 37·8%), while rural-to-urban ratios of MI were decreased, especially among women (from 1·19 to 1·05). Lung, colorectal, and breast cancers were predominant among urban populations, whereas oesophageal, gastric, and liver cancers were predominant among the rural population. Particularly, rural-to-urban ratios of oesophageal cancer incidence and mortality were decreased from 3·73 to 1·65 for incidence and from 3·82 to 1·61 for mortality, but MIs never differed between rural and urban populations. The rural-to-urban ratio of MI for breast cancer was decreased from 1·47 to 1·08. InterpretationThe National Cancer Prevention and Control Programme (2004–10) obtained obvious achievement in narrowing the urban-rural gap of the worse cancer incidence or survival in the rural areas, especially for oesophageal and breast cancers respectively. However, the overall health burden from cancers is still heavy in mainland China and requires further governmental support to improve the cancer control. FundingNational Natural Science Foundation of China (81301866) and Outstanding Young Scientific Scholarship Foundation of Sichuan University, from the Fundamental Research Funds for the Central Universities of China (2015SCU04A43).

Population Health: Curriculum Framework for an Emerging Discipline.

"Population health" has come to describe an array of initiatives supporting new care and reimbursement models that reward health outcomes rather than volume of services. However, without a standard definition of population health and a comprehensive inventory of the core competencies and knowledge its practitioners must possess, ongoing efforts to address community health outcomes will be hampered. A literature search of peer-reviewed and gray literature, a curriculum scan of current graduate health programs, and an expert panel of industry stakeholders were conducted to develop a comprehensive curriculum framework that broadly defines population health. The result is a concept map consisting of 6 domains--3 knowledge and 3 skills--based-and subcategories. This article discusses the implications for teaching population health and the need for further scholarship to define the field from the point of view of health system leaders, academics, and others who need to hire health professionals with these skills.

Teaching Population Health Outcomes Research, Advocacy, and the Population Health Perspective in Public Health Law

The goal of this project was to expand an existing public health law curriculum to incorporate lessons on population health outcomes research, extra-legal advocacy, and the population health perspective. The project also created opportunities for students not only to read about and discuss concepts, but also to employ the lessons more practically through exercises and by writing white papers on public health law reform topics relevant to population health in Missouri. To do this, the project expanded an existing didactic course and created a new credit-bearing, experiential “Lab.”

ELABORAÇÃO DE MATERIAL DIDÁTICO PARA EDUCAÇÃO EM SAÚDE DIRECIONADO PARA HIPERTENSÃO ARTERIAL

Health Education (HE) is an important instrument to facilitate the training of the community, contributing to the promotion of health. To present the development of a health educational tool aimed at combating the systemic arterial hypertension (SAH), thus reinforcing the importance of Health Education in combating chronic diseases. This is a proposal to build an educational stuff (Circle of Hypertension) providing guidelines for care SAH. It is believed to have created a way to make this more interactive and for more uninformed or hard to adhere to the change of lifestyle in the prevention and / or complication of SAH population HE. It is considered that the instrumente fulfills its purpose being a tool of easy construction, low cost and pedagogical, and may be relevant in the monitoring of hypertensive patients.

Teaching Population Health in the Digital Age: Community-Oriented Primary Care 2.0

Teaching Population Health in the Digital Age: Community-Oriented Primary Care 2.0

Model for teaching population health and community-based care across diverse clinical experiences.

The pillars constructivist model is designed to offer a unifying clinical paradigm to support consistent learning opportunities across diverse configurations of community and public health clinical sites. Thirty-six students and six faculty members participated in a mixed methods evaluation to assess the model after its inaugural semester of implementation. The evaluation methods included a rating scale that measures the model's ability to provide consistent learning opportunities at both population health and direct care sites, a case study to measure student growth within the five conceptual pillars, and a faculty focus group. Results revealed that the model served as an effective means of clinical education to support the use of multiple, small-scale public health sites. Although measurements of student growth within the pillars are inconclusive, the findings suggest efficacy. The authors recommend the continued use of the pillars constructivist model in baccalaureate programs, with further study of the author-designed evaluation tools.

Teaching Population Health and Community-Based Care Across Diverse Clinical Experiences: Integration of Conceptual Pillars and Constructivist Learning

Nursing programs are challenged to prepare future nurses to provide care and affect determinants of health for individuals and populations. This article advances a pedagogical model for clinical education that builds concepts related to both population-level care and direct care in the community through a contextual learning approach. Because the conceptual pillars and hybrid constructivist approach allow for conceptual learning consistency across experiences, the model expands programmatic capacity to use diverse community clinical sites that accept only small numbers of students. The concept-based and hybrid constructivist learning approach is expected to contribute to the development of broad intellectual skills and lifelong learning. The pillar concepts include determinants of health and nursing care of population aggregates; direct care, based on evidence and best practices; appreciation of lived experience of health and illness; public health nursing roles and relationship to ethical and professional formation; and multidisciplinary collaboration.

Factors associated with positive outcome of avulsion injuries in children

Avulsions are severe dental injuries with high impact on patients' quality of life due to prolonged treatment and possible severe complications. The aim of the study was to analyze the epidemiological factors related to the occurrence, treatment and outcome of avulsions in Serbian children. This research included 2,194 patients aged 1-18 years with traumatic dental injuries. The history, demographic, clinical and radiographic data of the patients were observed from dental medical records. A total of 266 avulsions were observed in 207 patients. The frequency of avulsions was 12% in primary dentition and 5% in permanent dentition. A statistically significant relationship between place, cause of avulsion and outcome was observed. Replantation of permanent teeth was performed in 46.7% with a mean time 6.9 h. Almost a half of permanently avulsed teeth (48.7%) were not retrieved from the accident site and 11.3% of replanted teeth were transported in adequate media. The observed incidence of complications was 31.9%. Replantation was not performed in more than a half of all eligible teeth due to either loss or inadequate/delayed transport, which emphasizes the need for preventive strategies and health education in population.

Health systems innovation: addressing the dynamics of multilayered ‘complex bundles’ of knowledge

Health innovation, Consoli and Mina argue, represents ‘complex bundles’ of new knowledge and services ‘emerging from a highly distributed competence base’ [1]. Complex systems theories have emerged from insights gained encompassing human behaviour, human values, evolutionary biological systems and statistical physics of the early complex systems theorists [2]. The recently published Handbook on Systems and Complexity in Health provides a broad overview and very detailed specific examples of the adoption and implementation of these sciences into the health professions [3]. Taking a broader view of health and care related to human systems than Consoli and Mina, these Forum papers reflect on a range of ‘complex bundles’ of innovation from a widely distributed knowledge base at population, clinical practice and biological levels. They illustrate the importance of using a complex systems lens to make sense of innovation and change in human systems. This is always a pressing challenge as health systems leaders and professionals continue to struggle to adapt to changing internal and external constraints. Inequalities, fairness and justice are important dynamic elements of human health systems, as change invariably causes shifts among intended and unexpected interdependent agencies. Buse [4] and Reynolds [5] have explored case studies of phenomena that impact on the health of individuals and populations. At a macro-population level, Buse [4] examines the contribution of intersectoral action for health equity, as it relates to climate change through the lens of critical heuristics (CSH) – viewed holistically and through multiple lenses, and rejecting reductionist analyses that predefine a system according to its parts. Systems thinking in general seeks to understand an issue as more than the sum of its parts. Accounting for the human dimension of social systems, ‘CSH provides three overarching contributions to the systems literature: a fundamental commitment to emancipation through practical action; critical awareness; and methodological pluralism’ [4]. Reynolds [5], in an entirely different area, explores the nature of fairness and conflicting value systems in hospital charity lotteries, which provide money for selective popular health services but may undermine individuals’ health potentials in the process. This raises the challenges of contradictions and tensions in dynamic health systems. Norman [6] provides a personal analysis of his role as an educator, promoting systems thinking in population health education, and reflects on the work of Buse and Reynolds. He highlights the fact that the challenges in education for systems thinking reach beyond overcoming resistance in social and professional acceptance, to encompass balancing new ideas, seeing existing ideas in new ways and ‘unlearning’ others. Techniques are needed to educate students to be open, responsive and adaptive in their thinking, and to embrace contradictions, tensions and changing dynamics of ‘bundles of knowledge’ in different competency domains. Health professionals need to demonstrate capability as much as competence. New ways of teaching and learning with curricula and learning materials need to be developed. At the level of clinical practice, Persky et al. [7] examine communication between residents and attending doctors on-call after hours in the light of existing local guidelines. Surveys were conducted with residents about their expectations and experiences of interactions with attending doctors. The study found considerable variability among reported experiences in relation to different specialities, individual resident expectations and attending doctor’s reported behaviour. The authors identify that the communication has complex social dynamics. They hypothesized about the contribution of power and deference, as well as variations in resident’s self-confidence and perceived competence to undermining adherence to local guidelines. Interestingly, they propose that the solution to the perceived complexity is the enforcement of greater regulation. This is a typical and bureaucratic response to complex situations identified in the Cynefin framework [8] See Fig. 1. However, there are potentially a range of opportunities for solutions other than regulatory, using creativity and trial and error. Finally, reflecting the need to better understand how to characterize complex systems of biometric properties in health care, bs_bs_banner

Are there too many or too few physicians in Spain? Migration: the eternal resource

At the end of the last century, several Spanish doctors had to migrate overseas looking for a decent job. No decent jobs were offered by then in Spain. Last decade, the lack of doctors was a problem and a great social alarm was born. Mechanisms to attract doctors form overseas and medical training, both uncontrolled, were settled in, to get the numbers right. The result was a surplus of qualified health professionals. Today, overseas doctors who were invited to come and native doctors, both, trained for specific health situations have to leave the country. An extraordinary planning never heard of in neighbouring countries due to its “inefficiency”. It was characteristic its lack of capability to take advantage of health professional's abilities – doctors and nurses – its lack of population's health education, its waste of resources in training and its uncontrolled immigration.

¿Sobran o faltan médicos en España? La migración, el eterno recurso

At the end of the last century, several Spanish doctors had to migrate overseas looking for a decent job. No decent jobs were offered by then in Spain. Last decade, the lack of doctors was a problem and a great social alarm was born. Mechanisms to attract doctors form overseas and medical training, both uncontrolled, were settled in, to get the numbers right. The result was a surplus of qualified health professionals. Today, overseas doctors who were invited to come and native doctors, both, trained for specific health situations have to leave the country. An extraordinary planning never heard of in neighbouring countries due to its “inefficiency”. It was characteristic its lack of capability to take advantage of health professional's abilities – doctors and nurses-, its lack of population's health education, its waste of resources in training and its uncontrolled immigration.

Teaching Population Health

A 2012 Institute of Medicine report is the latest in the growing number of calls to incorporate a population health approach in health professionals' training. Over the last decade, Duke University, particularly its Department of Community and Family Medicine, has been heavily involved with community partners in Durham, North Carolina, to improve the local community's health. On the basis of these initiatives, a group of interprofessional faculty began tackling the need to fill the curriculum gap to train future health professionals in public health practice, community engagement, critical thinking, and team skills to improve population health effectively in Durham and elsewhere. The Department of Community and Family Medicine has spent years in care delivery redesign and curriculum experimentation, design, and evaluation to distinguish the skills trainees and faculty need for population health improvement and to integrate them into educational programs. These clinical and educational experiences have led to a set of competencies that form an organizational framework for curricular planning and training. This framework delineates which learning objectives are appropriate and necessary for each learning level, from novice through expert, across multiple disciplines and domains. The resulting competency map has guided Duke's efforts to develop, implement, and assess training in population health for learners and faculty. In this article, the authors describe the competency map development process as well as examples of its application and evaluation at Duke and limitations to its use with the hope that other institutions will apply it in different settings.

Teaching Population Health: A Competency Map Approach to Education

Teaching Population Health: A Competency Map Approach to Education

Gastric Cancer: Environmental Risk Factors, Treatment and Prevention

Gastric Cancer is a heterogeneous, multifactorial, aggressive disease that has been and still remains one of the most common causes of cancer-related death and a major public health issue worldwide. Currently, gastric cancer shows decreasing trends in its incidence and mortality in some geographic areas; however the disease still shows poor prognosis and remains difficult to cure. The prognosis for patients with gastric cancer depends on the stage at which the gastric cancer is detected, and complete excision of the cancer is the only proven curative option. However, recently the treatment of gastric cancer has been rapidly evolving with the emergence of new cytotoxic drugs and molecular targeted agents that show promising response rate and disease progression-free survival. Cancer prevention intervention such as screening to ensure early detection, population health education, anti-cancer knowledge popularization, identification and correction of unhealthy lifestyles has demonstrated to be effective; and improved treatment modalities can dramatically increase the poor prognosis for patients with gastric cancer. Demographic, ecological, environmental, culture, and genetic variables all contribute to the heterogeneity of gastric cancer; however, environmental risk factors play an important role throughout all the stages of the disease progression, management and surveillance. In this review, we address the role of important environmental risk factors in the onset of gastric cancer, and highlight the current treatments modalities and prevention measures for gastric cancer.