Provision Of Comprehensive Health Services Research Articles

Perinatal Mood and Anxiety Disorder and Reproductive Justice: Examining Unmet Needs for Mental Health and Social Services in a National Cohort.

Perinatal Mood and Anxiety Disorders (PMADs) are the most common complications during the perinatal period. There is limited understanding of the gaps between need and provision of comprehensive health services for childbearing people, especially among racialized populations. The Giving Voice to Mothers Study (GVtM; n=2700), led by a multistakeholder, Steering Council, captured experiences of engaging with perinatal services, including access, respectful care, and health systems' responsiveness across the United States. A patient-designed survey included variables to assess relationships between race, care provider type (midwife or doctor), and needs for psychosocial health services. We calculated summary statistics and tested for significant differences across racialized groups, subsequently reporting odds ratios (ORs) for each group. Among all respondents, 11% (n=274) reported unmet needs for social and mental health services. Indigenous women were three times as likely to have unmet needs for treatment for depression (OR [95% confidence interval, CI]: 3.1 [1.5-6.5]) or mental health counseling (OR [95% CI]: 2.8 [1.5-5.4]), followed by Black women (OR [95% CI]: 1.8 [1.2-2.8] and 2.4 [1.7-3.4]). Odds of postpartum screening for PMAD were significantly lower for Latina women (OR [95% CI]=0.6 [0.4-0.8]). Those with midwife providers were significantly more likely to report screening for anxiety or depression (OR [95% CI]=1.81 [1.45-2.23]) than those with physician providers. We found significant unmet need for mental health screening and treatment in the United States. Our results confirm racial disparities in referrals to social services and highlight differences across provider types. We discuss barriers to the integration of assessments and interventions for PMAD into routine perinatal services. We propose incentivizing reimbursement schema for screening and treatment programs; for community-based organizations that provide mental health and social services; and for culture-centered midwife-led perinatal and birth centers. Addressing these gaps is essential to reproductive justice.

Improving digital health services strategy using evidence to support community health care

Efforts to improve health evaluation strategies with the help of technology or so-called software applications to improve public services are an exciting issue to be reviewed. This study tries to obtain scientific evidence from various fires and viewpoints from various publication sources. We examine it with a phenomenological approach, and finally, we find very valid results to answer the problem. Based on the study and discussion results, we have obtained results, including efforts to increase digital health evaluation and the provision of comprehensive health services, which are believed to increase the effectiveness of accessibility, convenience, efficiency, and personalized services for every community. Experts say these strategies are technological innovations in health services that involve a digital-based service system. People who seek treatment can benefit from the cost-effectiveness of spending and other dangers that often occur before digital-based health innovations occur.

Oral Hygiene Practices and Knowledge on Periodontal Diseases and Therapy: A Cross-Sectional Questionnaire Study on Gypsy Narikuravars in Puducherry.

Background:Gypsy “Narikuravars” constituted separate sociocultural groups having distinct cultures, customs, traditions, and lifestyles. Oral health-seeking behavior of this group remains to be an ignored part. This study aims to assess the oral hygiene practices and knowledge on periodontal diseases and therapy among Gypsy Narikuravars in Puducherry.Materials and Methods:The total study population consisted of 100 subjects, and a performed validated pro forma about oral hygiene practices and knowledge on periodontal diseases was used.Results:There is no significant association between sociodemographic factors and knowledge on periodontal disease and therapy. Majority (90%) of the participants have poor knowledge of periodontal disease and therapy. 56% of the participants used their fingers to clean the teeth, and very few subjects (13%) used toothbrush to clean their teeth, and most of the participants (92%) brushes once daily using manual method.Conclusion:The practice of poor oral hygiene and lack of knowledge on periodontal disease and therapy was observed. Hence, the implementation of oral health programs and provision of comprehensive health services for these Gypsy population should be a high priority.

Clinical Presentation to Nursing Office in a Selected International School

Nurses in Schools play an important role in the provision of comprehensive health services to school students. Increased number of students entering nurse office with chronic health conditions requiring nursing attention during school day. The aim of this study is to investigate related physical illness or injury that effects the student’s studies and performance. Students in International School in Malaysia physical ailments are the main factor that affects their educational achievements. A total of 2,764 nursing office visit logs were reviewed retrospectively from January 2012 to December 2018. The students’ age group ranging from 4 to 17 years old. Most of the respondents were boys (50.1%), and the mean age of 9.7 years with Standard Deviation (SD)=3.7. During the nursing office visit, the school children were mostly diagnosed with injury (n=1432, 51.8%). Followed by stomach-ache (n=476, 17.2%) and headache (n=383, 13.9%). Independent t test showed that there was no significant difference of age (p=0.419) and the duration of treatment (p=0.453), between boys and girl who went for treatment in the nursing office. Pearson Chi Square test indicated that there were no significant difference of nationality and the diagnosis given during the clinic visit when compared to the gender, with p=0.227 and p=0.478, respectively. School nurse role in health education is primarily to advise and support student’s education success rather than to directly deliver education.

Identifying Possible Gaps and Gray Areas in the Draft Universal Health Care Act Implementing Rules and Regulations: a Thematic Analysis of a Roundtable Event on Local Health Systems

Background. The Universal Health Care (UHC) Act is a landmark legislation that seeks to improve provision ofcomprehensive health services through the integration of local health systems. The Department of Health (DOH)conducted a series of roundtable discussions to gather stakeholders' inputs and concerns to refine the initial draftof the Implementing Rules and Regulations (IRR) of UHC.
 Methods. On April 4, 2019, the Department of Health led a roundtable discussion on the Local Health Systemssections of the UHC IRR in collaboration with University of the Philippines Manila. A total of 65 stakeholders fromdifferent sectors participated in a semi-structured roundtable event. The proceedings were audio recorded andtranscribed. A thematic analysis was done using NVivo 12 software to document gaps and gray areas identifiedby the participants.
 Results. Concerns of the participants revolved around the following: role of the private sector in local health systems;the integration of different municipal and other component health systems into a province-wide health system;organizational design of the health systems; pooling and utilization of the Special Health Fund (SHF). Gaps andgray areas were concentrated on the transfer of personnel and other health resources to the province-wide system,the composition of the Provincial Health Board, and the utilization and management of the SHF.
 Conclusion. The roundtable event acquired various perspectives from stakeholders that could help the DOH identifypriority action points that could be resolved at the agency level. The identified themes from the study analysis couldbe of value to decision makers to clarify issues, address policy gaps, and to prioritize future research directions.

Haitian health system

The Haitian health system includes a public and a private sector. The public sector comprises the Ministry of Health and Population (MSPP) and a social security institution (Ofatma). The private sector includes private insurance agencies and providers. MSPP provides health services to the non-salaried population, while Ofatma provides services to the salaried population. Health expenditure in Haiti in 2016 was 5.4% of gross domestic product. Expenditure per capita in health was 38 American dollars. There is a great dependency on foreign resources. The MSPP is in charge of most stewardship functions. The main challenge faced by the Haitian health system is the provision of comprehensive health services with financial protection to all the population. This goal will not be met without additional financial resources, mostly public, and an effort to strengthen health institutions.

Quality of Work Life of Public School Nurses in the Philippines

Background: School nurses play a crucial role in the provision of comprehensive health services to the school population. A balanced quality of work life (QWL) with favorable conditions that support and uphold employee satisfaction is imperative for school nurses to maximize their provision of care for their clientele. Among the many nursing specialties, research among school nurses is not given much attention.Purpose: This study aimed to determine the QWL of public school nurses in the Philippines.Methods: This study utilized a descriptive correlational research design with 57 public school nurses as study participants. Self-reported data were gathered utilizing Walton’s QWL scale. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman–rank correlation coefficient. Results: Results indicated that public school nurses had high QWL (M=4.16). Among the eight subscales, opportunities at work (M=4.04) and social integration at work (M=4.03) had the lowest mean scores. There were no significant differences in the QWL according to sex (p=0.929), marital status (p=0.326), educational attainment (p=0.391) and length of work experience (p=0.059), while there was a significant relationship between age (p=0.005) and QWL of public school nurses.Conclusion: Public school nurses generally have a high QWL. Nevertheless, to further improve their QWL, it is recommended that public school nurses must be provided with more chances for continuous professional growth and opportunities for better social integration.

9. Photovoice: Empowering Transgender And Gender-Expansive Youth

Transgender and gender-expansive youth have unique healthcare needs; however, they often eschew visiting health centers given a history of misinformation and discrimination. Photovoice, a community-based participatory research method, is an apt technique to engage this population. This study sought to learn from the unique perspectives of transgender and gender-expansive youth on what may challenge or facilitate gender identity affirmation to improve healthcare usability for those receiving care at a gender affirming clinic. We recruited 16 transgender and gender-expansive youth from a gender clinic at a children’s hospital. Eleven transmen and five transwomen (ages 16-21) participated in an initial session that discussed photography techniques, safety, and ethics. Participants were prompted to take photographs for one month to explore how their gender identity affects their social relationships including their clinical care. After one month, all participants engaged in critical reflection of their photos and an in-depth interview with a study member. Of the 16 participants, 6 also participated in a focus group. Interviews and the focus group were audio recorded, transcribed, and analyzed using Grounded Theory. Three key themes emerged: positive effects of care, gender representation, and advocacy. Participants described many ways that transition and gender affirming care had positively affected their physical, emotional, and social health: “Transitioning has been my process of finding safety and of finding affection, both within and without myself.” Participants also emphasized the importance of representations of gender and trans identity. They confronted how idealized masculine or feminine gender expression should not be an expectation: “I see it so much with the celebrities that are trans and open about it. They present so femininely and it’s a hyper-femininity that not everyone can attain or even wants to obtain.” Other participants mentioned being disregarded by peers, family, and health providers by not presenting convincingly enough or by experimenting with makeup, clothing, or other gendered activities. Some emphasized that being trans is only one part of their identity and they rebuked social relationships or healthcare services that exoticized them as trans above all else: “A really important part of my transition and my journey is [that] another person wouldn’t see me as an object or an oddity.” Lastly, participants expressed the importance of advocacy on behalf of others and recognized that they receive gender affirming care others are not able to access: “If you are in a place of privilege, it is your responsibility as someone who has power in society to stand up for the people who don’t.” Transgender youth identified many opportunities to improve the quality and accessibility of gender affirming care. Their narratives revealed that youth experience and express gender in complex ways, and experimentation should not impact a person’s ability to affirm their gender identity. To further improve gender affirming care, providers need to take this complexity into account in their provision of comprehensive health services.

The evolving role of CSR in international development: Evidence from Canadian extractive companies’ involvement in community health initiatives in low-income countries

Overseas development agencies and international finance organisations view the exploitation of minerals as a strategy for alleviating poverty in low-income countries. However, for local communities that are directly affected by extractive industry projects, economic and social benefits often fail to materialise. By engaging in Corporate Social Responsibility (CSR), transnational companies operating in the extractive industries ‘space’ verbally commit to preventing environmental impacts and providing health services in low-income countries. However, the actual impacts of CSR initiatives can be difficult to assess.We help to bridge this gap by analysing the reach of health-related CSR activities financed by Canadian mining companies in the low-income countries where they operate. We found that in 2015, only 27 of 102 Canadian companies disclosed information on their websites concerning health-related CSR activities for impacted communities. Furthermore, for these 27 companies, there is very little evidence that alleged CSR activities may substantially contribute to the provision of comprehensive health services or more broadly to the sustainable development of the health sector.

Primary health care research in Bolivia: systematic review and analysis.

Bolivia is currently undergoing a series of healthcare reforms centred around the Unified Family, Community and Intercultural Health System (SAFCI), established in 2008 and Law 475 for Provision of Comprehensive Health Services enacted in 2014 as a first step towards universal health coverage. The SAFCI model aims to establish an intercultural, intersectoral and integrated primary health care (PHC) system, but there has not been a comprehensive analysis of effective strategies towards such an end. In this systematic review, we analyse research into developing PHC in Bolivia utilizing MEDLINE, the Virtual Health Library and grey literature from Pan American Health Organization/World Health Organization's internal database. We find that although progress has been made towards implementation of a healthcare system incorporating principles of PHC, further refining the system and targeting improvements effectively will require increased research and evaluation. Particularly in the 7 years since establishment of SAFCI, there has been a dearth of PHC research that makes evaluation of such key national policies impossible. The quantity and quality of PHC research must be improved, especially quasi-experimental studies with adequate control groups. The infrastructure for such studies must be strengthened through improved financing mechanisms, expanded institutional capacity and setting national research priorities. Important for future progress are improved tracking of health indicators, which in Bolivia are often out-of-date or incomplete, and prioritization of focused national research priorities on relevant policy issues. This study aims to serve as an aid towards PHC development efforts at the national level, as well as provide lessons for countries globally attempting to build effective health systems accommodating of a multi-national population in the midst of development.

Creating the health care team of the future: the toronto model for interprofessional education and practice.

Creating the health care team of the future: the toronto model for interprofessional education and practice.

Perceptions of school nurses and principals towards nurse role in providing school health services in Qatar

The school nurse plays a crucial role in the provision of comprehensive health services to students. This role encompasses both health and educational goals. The perception of the school nurse's role and its relation to health promotion is fundamental to the development of school nursing. This study aimed to determine the perception of school nurses and principals toward the role of school nurses in providing school health services in Qatar. A cross-sectional study was carried out among all school nurses (n=159) and principals (n=159) of governmental schools in Qatar. The participants were assessed for their perception toward the role of the school nurse in the school using 19-Likert-type scaled items Questionnaire. The response rates were 100% for nurses and 94% for principals. The most commonly perceived roles of the school nurse by both nurses and principals were 'following up of chronically ill students', 'providing first aid', and 'referral of students with health problems', whereas most of the roles that were not perceived as school nurse roles were related to student academic achievements. School nurses and principals agreed on the clinical/medical aspects of nurses' role within schools, but disagreed on nurses' involvement in issues related to the school performance of students. The study recommends raising awareness of school principals on the school nursing role, especially in issues related to the school performance of students.

“Research participants want to feel they are better off than they were before research was introduced to them”: engaging cameroonian rural plantation populations in HIV research

BackgroundDuring a period of evolving international consensus on how to engage communities in research, facilitators and barriers to participation in HIV prevention research were explored in a rural plantation community in the coastal region of Cameroon.MethodsA formative rapid assessment using structured observations, focus group discussions (FGD), and key informant interviews (KIIs) was conducted with a purposive non-probabilistic sample of plantation workers and their household members. Eligibility criteria included living or working >1 year within the plantation community and age >18 years. Both rapid and in-depth techniques were used to complete thematic analysis.ResultsSixty-five persons participated in the study (6 FGDs and 12 KIIs). Participants viewed malaria and gastrointestinal conditions as more common health concerns than HIV. They identified three factors as contributing to HIV risk: concurrent sexual relationships, sex work, and infrequent condom use. Interviewees perceived that the community would participate in HIV research if it is designed to: (1) improve community welfare, (2) provide comprehensive health services and treatment for illnesses, (3) protect the personal information of participants, especially those who test positive for HIV, (4) provide participant incentives, (5) incorporate community input, and (6) minimize disruptions to “everyday life”. Barriers to participation included: (1) fear of HIV testing, (2) mistrust of researchers given possible disrespect or intolerance of plantation community life and lack of concern for communication, (3) time commitment demands, (3) medical care and treatment that would be difficult or costly to access, and (4) life disruptions along with potential requirements for changes in behaviour (i.e., engage in or abstain from alcohol use and sex activities).ConclusionsConsistent with UNAIDS guidelines for good participatory practice in HIV prevention research, study participants placed a high premium on researchers’ politeness, trust, respect, communication, tolerance and empathy towards their community. Plantation community members viewed provision of comprehensive health services as an important community benefit likely to enhance HIV research participation.

The Role of the School Nurse in Providing School Health Services

The school nurse has a crucial role in the seamless provision of comprehensive health services to children and youth. Increasing numbers of students enter schools with chronic health conditions that require management during the school day. This policy statement describes for pediatricians the role of the school nurse in serving as a team member in providing preventive services, early identification of problems, interventions, and referrals to foster health and educational success. To optimally care for children, preparation, ongoing education, and appropriate staffing levels of school nurses are important factors for success. Recommendations are offered to facilitate the working relationship between the school nurse and the child's medical home. This statement has been endorsed by the National Association of School Nurses.

Role of the School Nurse in Providing School Health Services

The school nurse has a crucial role in the seamless provision of comprehensive health services to children and youth. Increasing numbers of students enter schools with chronic health conditions that require management during the school day. This policy statement describes for pediatricians the role of the school nurse in serving as a team member in providing preventive services, early identification of problems, interventions, and referrals to foster health and educational success. To optimally care for children, preparation, ongoing education, and appropriate staffing levels of school nurses are important factors for success. Recommendations are offered to facilitate the working relationship between the school nurse and the child's medical home. This statement has been endorsed by the National Association of School Nurses.

Providers of primary care to homeless women in Los Angeles County.

Little is known about the access barriers homeless women face at the sites where they are most likely to receive primary health care. To investigate this issue, we administered a mail survey to administrators and clinicians at clinic sites that were actual or potential providers of primary health care to homeless women in Los Angeles County in 1997. The response rate was 65%. Ninety percent of the homeless women seen by responding sites were seen at only 34% of those sites (designated as "major providers"). Deficiencies were identified in several structural and process characteristics that enhance access to and quality of care for homeless women, including clinician training in care for homeless persons; formal screening for homeless status and associated risk factors; and on-site provision of comprehensive health services, including mental health, substance abuse, reproductive health, and ancillary services. Some, but not all, deficiencies were less severe at major providers. Our results suggest that, although providers of care to homeless women share challenges faced by many safety net providers, there are several policy interventions that could improve access to and quality of care for homeless women.

The road to Cairo.

The final statement made by DAWN to the 3rd final preparatory meeting for the United Nations Conference on Population and Development scheduled for September, 1994, in Cairo was given in full. DAWN's recommendations were briefly stated in 10 points. The women's group suggested that 1) structural adjustment assurances be made that investments in social programs would not be reduced; 2) equity and poverty adjustment and job creation be included in the development model; 3) population policy promote the well-being of people and reproductive rights of women; 4) comprehensive, high quality health services for women be provided responsibly by governments; 5) women's rights be recognized as human rights; 6) health services be reorganized to incorporate a wide range of services, including safe abortion; 7) safe, legal abortion be recognized as a necessary right; 8) gender and empowerment programs receive financial support; 9) accountability be required and women's groups' representation be included; and 10) resources be restructured to incorporate the aforementioned recommendations. The closing statement stressed the need to use a broad context and not to separate population issues from other issues of development. Women's issues are inseparably linked with women's rights, women's empowerment, and provision of comprehensive health services. Equity is a central development issue. The impact of development models on women must be considered. Development models and women's rights are both topics that need to be addressed concurrently at the conference. The Vatican's attempt to separate the issues and focus exclusively on women's rights only in religiously defined terms is blatantly political and an exercise of power domination of women. Many women's groups from a broad base of support have lobbied this forthcoming proceeding for a broader framework of women's rights within the document. Respect for women's issues will come from greater involvement of women in monitoring policies and implementation of programs.

An Experiment in Education for Family Practice

An experiment in the education of family physicians and in the provision of comprehensive health services to indigent patients is in its third year at St. Joseph's Hospital, a community hospital of 350 beds with a major affiliation with the State University of New York, Upstate Medical Center. The plan, independently designed by interested personnel from the hospital, the local Department of Social Welfare, and the Upstate Medical Center, coincidentally embodies many of the principles recently set forth by Carmichael. 1 It is primarily an attempt to train family physicians in a setting similar to one in which they will ultimately practice, and has been approved by the Council on Medical Education of the American Medical Association as a pilot program in family practice. At the same time, the Family Practice Project (FPP), as it is being called, represents an experimental approach to community health needs by (1) providing an