Social Health Centers Research Articles

Exploring Decisional Conflict Experienced by Individuals Considering Metoidioplasty and Phalloplasty Gender-affirming Surgery.

Metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is increasingly performed and requires patients to make complex decisions that may lead to decisional uncertainty. This study aimed to evaluate decisional conflict in individuals considering MaPGAS. We administered a cross-sectional survey to adult participants assigned female sex at birth and considering MaPGAS, recruited via social media platforms and community health centers. We collected data on demographics, medical and surgical history, MaPGAS type considered, and the Decisional Conflict Scale (DCS). DCS scores range from 0 to 100 (>37.5 indicates greater decisional conflict). Demographic characteristics and DCS scores were compared between subgroups, using descriptive and chi-square statistics. Participants commented on MaPGAS uncertainty, and their comments were evaluated and thematically analyzed. Responses from 264 participants were analyzed: mean age 29 years; 64% (n = 168) trans men, 80% (n = 210) White, 78% (n = 206) nonrural, 45% (n = 120) privately insured, 56% (n = 148) had 4 or more years of college, 23% (n = 84) considering metoidioplasty, 24% (n = 87) considering phalloplasty, and 26% (n = 93) considering metoidioplasty and phalloplasty. DCS total scores were significantly higher (39.8; P < 0.001) among those considering both MaPGAS options, as were mean ratings on the Uncertainty subscale [64.1 (SD 25.5; P < 0.001)]. Concerns surrounding complications were the top factor contributing to uncertainty and decisional conflict. In a cross-sectional national sample of individuals seeking MaPGAS, decisional uncertainty was the highest for those considering both MaPGAS options compared with metoidioplasty or phalloplasty alone. This suggests this cohort would benefit from focused decision support.

Specialized pharmaceutical care in social health centers in COVID-19 times

The COVID-19 pandemic is having a devastating effect on the nursing homes for dependent older people. The difficulty of management of this crisis is aggravated by the frailty of the people served and by the specific characteristics of the care area, mainly the fact of not being integrated into the health system.The objective of this work is to describe the pharmaceutical care developed by a hospital pharmacy service established in a nursing home and, from a more global perspective, analyze the strengths and weaknesses found from the various experiences of hospital pharmacy in all spanish autonomous communities to deal with this pandemic.Specialized pharmaceutical care has provided rigor in the validation and treatments review processes from a comprehensive perspective, maximizing safety and collaborating in the establishment of the therapeutic intensity degree most appropriate to the individual situation, has ensured the availability of all necessary medications, has collaborated in the acquisition and management of personal protective equipment, has been able to adapt the dispensation processes to the internal nursing homes sectorization and has facilitated the coordination between the nursing home and the health system.It is clear that the crisis casued by COVID-19 has put relevance of the need to integrate the social-health level into the health system. And also, the contribution of specialized pharmaceutical care in improving healthcare coverage and coordination with health services has highlighted the urgency of developing the current legislation, prioritizing the establishment of pharmacy services able to provid specialized and specific care for this area, so that it meets healthcare needs and is integrated into the health system.

What is the uptake rate of breast self-examination in Iranian women? Estimation based on systematic review and meta-analysis

BackgroundBreast self-examination is a simple, painless, confidential and inexpensive screening method for early diagnosis that does not require specialized tools and equipment. In this study, we have estimated the pooled percentage of breast self-examination (BSE) in Iranian women.MethodsAll the published literatures between 2012 and 2022 have been reviewed. Searches were performed in PubMed, Web of Science, ProQuest, Science Direct, Google Scholar, Scientific Information and Magiran databases. The effect size was the pooled percentage of breast self-examination (BSE). In order to check the heterogeneity, the estimation of the I2 index and extraction of the Galbraith plot were used, and the drivers of heterogeneity have been identified through meta-regression and estimates were made based on subgroups. All the analysis was done in STATA 15.ResultsFrom the initial 294 records, 38 were included in the final analysis in which 9960 women have been studied. The heterogeneity of the studies was high based on the variation in OR (I2 = 98.4%, heterogeneity X2 = 2278.21 (d.f. = 37), p < 0.01). The pooled rate of BSE based on fixed and random methods was obtained as 15.46 (95% CI: 14.83 to 16.09) and 24.74 (95% CI: 19.62 to 29.86) percent, respectively. The highest pooled percentage BSE (39.41%, 95% CI: 30.98 to 47.83) was obtained from studies that investigated the action phase in the Trans theoretical model. The pooled percentage obtained from the studies conducted in the central regions of Iran was higher than other cities (27.47%, 95% CI: 17.38 to 37.55).ConclusionThe result from our analysis determined that performing breast self-examination in Iranian women is low. Health policy makers can increase the rate of breast self-examination in Iran by implementing basic educational programs in schools and encouraging and justifying women in social health centers.

Paritas Dengan Usia Menopause Pada Wanita Usia 45-59 Tahun

Menopause is a period of cessation of the menstrual cycle forever for women who previously experienced menstruation every month, which is caused by the number of follicles that experience atresia continues to increase, until there are no more follicles available, and in the last 12 months experience amenorrhea (Fitri, 2017). The factors that influence the occurrence of menopause among women were the age at first menstruation (menarche), number of children, age at delivery, use of contraception, smoking and socioeconomic status (Kumlasari, 2012). The purpose of this study was to determine the relationship between the parity and the age of menopause in women aged 45-59 years at the Palembang Social Health Center. A cross sectional approach was the method used in this study and it was analytic. The population of this study was all women aged 45-59 years at the Palembang Social Health Center. The sample was 100 people chosen by using an accidental sampling technique. The data were collected by using the direct measurements, interviews, filling out questionnaires and the data were analyzed by using the Chi-Square statistical test. The results of the study showed that there was a significant relationship between parity and the age of menopause in women aged 45-59 years at the Palembang Social Health Center in 2019, with a p value of parity = 0.000 &lt; α (0.05).

The Urgency of Establishing a Social Welfare Center (Puskesos) in Cirebon City

This research discusses the urgency of establishing a Social Welfare Center (Puskesos) in Cirebon City as a response to the ineffectiveness of the social welfare service system faced by the community, even though a Community Social Worker (PSM) unit has been formed which functions as a partner of the Cirebon City Social Service (Dinsos). The research method uses a qualitative approach, namely collecting data through observation, Focus Group Discussion (FGD), and literature review. The informants in this research were PSM and Social Service officers in the field of social protection and security services. The research results show that in Cirebon City, there has not been a Social Health Center that functions as a center for information and data, providing services and an integrated referral system to the community. So PSM, whose function is to help implement social welfare services, cannot play their role effectively. This shows the urgency of establishing a Community Health Center as a forum for social welfare services at the sub-district level. Implementation of services in the Social Health Center uses an Integrated Service and Referral System, namely providing social welfare services collaboratively with the community in dealing with problems and developing existing social welfare potential. So that shared responsibility is created, not only involving the government but the private sector and society.

COVID 19 comprehensive management in a regional hospital of Northwestern Spain

Introduction: The COVID-19 pandemic has brought about a paradigm shift in healthcare. Objective: To evaluate the utility of a strategy to comprehensively address the pandemic in a health area that covers 42,000 people. Method: Between March 10 and May 15, 2020, the COVID Unit was created in the corresponding regional hospital, and an independent circuit was established for the diagnosis and management of patients with suspected or confirmed COVID-19; social health centers were monitored with PCR testing. Results: Eighteen COVID-19-positive patients (age 72.9 ± 13.2 years) were admitted, out of which 66% were males. All these patients had pneumonia and 67% had respiratory distress syndrome; no one required mechanical ventilation. Mean hospital stay was 9.4 ± 5.3 days, and mortality, 11%. PCR tests were applied to all hospital residents (n = 827) and workers (n = 519), 1,044 phone calls were made and 36 hospital admissions were avoided. Only 50 patients required close follow-up, out of which four (0.48%) were positive for COVID-19. Conclusion: Clinical monitoring at the hospital and social health centers showed that patient profile was like that documented in the literature and that the incidence of COVID-19 was low in social health centers.

Pressure ulcers in older adults in a permanent geriatric stay

We call human aging a gradual and adaptive process of a biological, psychological and social type, produced as a consequence of genetically programmed changes, history, lifestyles, environment and social conditions to which the person was exposed. On the other hand, old age is a stage of life whose beginning is established by society, which is why the United Nations Organization agreed that, in developing countries, people aged 60 and over are classified as older adults. In institutionalized older adults, the prevalence of pressure ulcers is a worrying issue in the development of nursing care plans. Prolonged bedridden, reduced mobility, malnutrition, physiological alterations, incontinence, among others, are causes that can cause pressure ulcers, as well as aspects related to current strategies and practices for their prevention in patients at a social health center. This is considered important because during aging structural and functional changes occur in different organs and systems. For this reason, as health professionals, we must know the normal morphological and functional changes of physiological aging, and thus guide the elderly to adapt and improve their lifestyle.

About a case: affective psychosis and hyperthyroidism

IntroductionHyperthyroidism due to Graves-Basedow disease is a common cause of neuropsychiatric manifestations, such as anxiety, psychomotor restlessness, mood disturbances, insomnia and psychosis. Hashimoto’s encephalopathy rarely occurs in so-called autoimmune thyroiditis, which can present with hyperthyroidism and neuropsychiatric symptoms similar to Graves’ disease. We add that the mystical-religious beliefs, present in all human cultures, and decisive in the case at hand, make us propose an evolutionary origin of them.ObjectivesClinical case descriptionMethodsA clinical case based on medical reports is describedResultsWe present the case of a 72-year-old woman, a member of the Seventh-day Adventist Church, well adapted to the Community. Known history of elevated antithyroid antibodies since 2019, brought to the emergency room involuntarily due to a mystical-religious delusional condition associated with behavioral disturbance. On examination, cachectic appearance, distal tremor, emotional exaltation and megalomanic speech were highlighted. Laboratory tests revealed primary hyperthyroidism with elevated antibodies. During admission, the differential diagnosis between Graves-Basedow disease and Hashimoto’s encephalopathy was considered. Thyroid scintigraphy oriented the diagnosis to Graves-Basedow disease, not requiring lumbar puncture or corticosteroid treatment. Treatment was based on high-dose antithyroid and antipsychotic drugs, with clinical and analytical remission at 3 weeks. The patient was referred to a Social Health Center for functional recovery. The family refers to a similar episode in 2014, of less intensity and self-limited, which is proposed to be a hashitoxicosis.ConclusionsDifferential diagnosis between Graves-Basedow and Hashimoto disease is essential as they differ in treatment and prognosis. The continuity that the delusion presents with the previous beliefs of the patient, differing mainly in the affective-behavioral implication, makes us consider a predisposition to psychosis in our patient. Religiosity can be adaptive in certain environments, since mystical beliefs have existed throughout the history of the human species and seem to be part of our nature.Disclosure of InterestNone Declared

CHANGE OF BEHAVIOR AND IMPROVEMENT OF COMMUNITY SKILLS IN PREVENTING AND CONTROLLING BLOOD LIPID LEVELS DURING THE COVID 19 PANDEMIC AREA OF PALEMBANG SOCIAL HEALTH CENTER

Manifestations of lifestyle changes are physical activity, and changes in unhealthy eating patterns including a diet high in fat, carbohydrates, and low fiber intake one of the reasons for degenerative diseases, namely dyslipidemia. The cause of changes in blood lipid profiles is a diet that can be influenced by nutritional knowledge and a person's attitude. The older the age, the lower the body's metabolic function. For this reason, the target of this community service activity is the elderly. The purpose of this study was to determine the knowledge and skills of the community through education about healthy lifestyles in an effort to prevent dyslipidemia and control blood lipid levels in members and cadres of the Teratai Elderly Integrated Healthcare Center in the Work Area of the Palembang Social Health Center. The activity was carried out at the Integrated Healthcare Center which has elderly members under the guidance of the Palembang Social Health Center. Community service activities were carried out 2 times in Nutrition Education in the form of espionage and counseling for Integrated Healthcare Center members and 1 training for Posyandu cadres. From the results of measuring cholesterol levels, 10 people (32.25%) with cholesterol levels above normal. In addition, this community service activity is expected to increase the knowledge of nutrition and health for elderly Integrated Healthcare Center members and Teratai Integrated Healthcare Center cadres about balanced nutrition and how to make fruit and vegetable smoothies in preventing dyslipidemia.

HEPA filters of portable air cleaners as a tool for the surveillance of SARS-CoV-2.

Studies about the identification of SARS‐CoV‐2 in indoor aerosols have been conducted in hospital patient rooms and to a lesser extent in nonhealthcare environments. In these studies, people were already infected with SARS‐CoV‐2. However, in the present study, we investigated the presence of SARS‐CoV‐2 in HEPA filters housed in portable air cleaners (PACs) located in places with apparently healthy people to prevent possible outbreaks. A method for detecting the presence of SARS‐CoV‐2 RNA in HEPA filters was developed and validated. The study was conducted for 13 weeks in three indoor environments: school, nursery, and a household of a social health center, all in Ciudad Real, Spain. The environmental monitoring of the presence of SARS‐CoV‐2 was conducted in HEPA filters and other surfaces of these indoor spaces for a selective screening in asymptomatic population groups. The objective was to limit outbreaks at an early stage. One HEPA filter tested positive in the social health center. After analysis by RT‐PCR of SARS‐CoV‐2 in residents and healthcare workers, one worker tested positive. Therefore, this study provides direct evidence of virus‐containing aerosols trapped in HEPA filters and the possibility of using these PACs for environmental monitoring of SARS‐CoV‐2 while they remove airborne aerosols and trap the virus.

Giving Dragon Fruit, Apple, and Papaya Juice on Blood Glucose Levels to Diabetes Mellitus Type 2

Diabetes Mellitus (DM) was a chronic metabolic disorder that occurs when the pancreas fails to produce enough insulin or when the body fails to effectively use the insulin that is produces. One of the non-medical therapies that can be given to patients with diabetes mellitus is giving dragon fruit, apples and papayas. This purpose of this study to see how giving dragon fruit, apple and papaya juice affects blood glucose levels in type 2 diabetes patients. This study is a quasi-experimental design with a pretest and posttest with a control group. This study was carried out at the Palembang Social Health Center from March to October 2022.The sample in this study was selected by accidental sampling with a total sample of 30 subjekts in the treatment and control groups. The paired sample t-test was used to analyze the data, and there was a difference in the average difference of blood glucose levels in the treatment group of 68,44 mg/dl (p-value = 0,000) and the control group of 1,2 mg/dl (p-value = 0,770). Analysis of the multiple linear regression multivariate test showed that there is an effect of energy, fat, carbohydrate and fiber intake on blood glucose levels with a p value &lt;0,005. The conclution that there is an effect of giving dragon fruit, apple and papaya juice on blood glucose levels in diabetes mellitus type 2 patients the differences in average blood glucose levels of the treatment group were greater than those of the control group.

Validation of the Spanish Versions of FACIT-PAL and FACIT-PAL-14 in Palliative Patients.

Palliative patients require several types of care to improve their quality of life as much as possible, and valid and reliable assessment instruments are essential. The objective of this study is the Spanish validation of the Functional Assessment Chronic Illness Therapy-Palliative Care (FACIT-PAL) and its abbreviated version, FACIT-PAL-14, in palliative care patients. FACIT-PAL and FACIT-PAL-14 were translated into Spanish and administered to 131 terminal oncology patients in home palliative care units, hospital palliative care units, health center teams, and social health centers. The European Organization for Research and Treatment of Cancer questionnaire, EORTC-QLQ-C15-PAL version, was used to evaluate the criterion validity. The EORTC-QLQ-C15-PAL was employed as a “gold standard”, and it obtained significant results with FACIT scales. FACIT-PAL-14, FACIT-PAL, and its subscales reported high internal consistency, from 0.640 to 0.816. The exploratory factor analysis for FACIT-PAL-14 found a structure in three factors that explained the 70.10% variance, and the FACIT-PAL scale found a structure of five factors. Physical wellbeing from FACIT-PAL highly correlated to the EORTC-QLQ-C15-PAL (r = 0.700), but social and family wellbeing was correlated to a lesser extent (r = −0.323). FACIT-PAL and the TOI (Toi Outcome Index) were also highly correlated with the EORTC-QLQ-C15-PAL, with values of r = −0.708 and r = −0.709, respectively. The Spanish versions of FACIT-PAL and FACIT-PAL-14 were demonstrated to be valid and reliable scales in palliative care patients.

Stroke in Djibouti

• Sub-Saharan Africa is experiencing an increasing burden of stroke, with current prevalence as high as 1.46 per 1000 population. • Limited cohort studies exist to profile the epidemiological, clinical and paraclinical characteristics of stroke in this setting. • Identifying the most at-risk population for ischemic and haemorrhagic stroke can improve approaches for prevention in this setting. Stroke is a neurological emergency affecting both developed and developing countries. In Djibouti, stroke is the fourth leading cause of death. Our objective was to describe the demographic, clinical, paraclinical profile of stroke in Djibouti and identify the possible underlying risk factors. We conducted a cross-sectional multicentre study carried out over a period of 6 months in the medical services of the Soudano-Djibouti military hospital, the General Peltier hospital and the emergency department of the National fund for social security health centre. A total of seventy patients were included. The mean age was 59.61 years with a male predominance (sex ratio: 2.5) and a statistically significant female-related difference beyond the age of 60 years (p <10 −3 ). Cardiovascular risk factors were mainly hypertension (73%), khat chewing (64%) and tobacco use (50%). Khat chewing and tobacco use were associated with a younger age of occurrence of stroke (p=0.020 and p=0.004, respectively). Diabetes mellitus and hypercholesterolemia were found respectively in 30% and 19% of cases, and were more associated with ischemic stroke. Coronary disease (11%), heart failure (3%) and obesity (4%) (significantly associated with the female gender; p= 0,021) were less common. Motor deficits (94%) were the most common clinical manifestations, followed by sensory deficits (51%) and alteration of consciousness (37%). Stroke was ischemic in 61.5% of patients. The most affected territory in ischemic stroke was the territory of the middle cerebral artery, and capsulo-thalamic involvement in haemorrhagic stroke which was significantly associated with the alteration of consciousness(p=0,003). Stroke had primarily modifiable risk factors in Djiboutian patients dominated by high blood pressure, tobacco use and khat chewing especially in the male population under the age of 60 years. These findings could have implications on future preventive measures and a better approach to public health policy.

Pengaruh Pelayanan Informasi Obat (PIO) Terhadap Kepatuhan Pasien Tuberkulosis Paru Di Puskesmas Sosial Palembang

Drug Information Service (PIO) is an activity of providing and providing information, drug recommendations that are independent, accurate, unbiased, current, and comprehensive carried out by pharmacists to doctors, pharmacists, nurses, other health professionals as well as patients and other parties. To improve patient compliance, it can be done by providing drug information services (PIO). This study aims to determine the effect of PIO on the level of compliance of tuberculosis patients at the Palembang Social Health Center. This study used a Nonrandomized Control Group Pretest Posttest design which consisted of two groups, namely before PIO and after PIO. Data was obtained from the MMAS-8 questionnaire, sampling was carried out prospectively based on inclusion and exclusion criteria during February – March 2020 and analyzed using the Wilcoxon test. The samples obtained were 36 patients. The results showed that as many as 72.9% of tuberculosis patients were male and 27.0% female. A total of 40.5% were aged 25-44 years, aged 60 years were 21.6%. The percentage of patients complying before PIO high adherence 27.7%, moderate adherence 27.7%, and low adherence 44.4%. The percentage of patients who comply after PIO is high adherence 52.7%, moderate adherence 44.4% and low adherence 8.3%. Based on the Wilcoxon test, the value of p = 0.046 (&lt;0.05) so that the provision of drug information services has a significant effect on the level of compliance of tuberculosis patients at the Palembang Social Health Center.

Predictive validity of the functional capacity of the CUPAX questionnaire in older adults with hip fracture

Background and objectivesOsteoporotic hip fracture is a relevant pathology due to its prevalence and social and health impact. The aim of this study is to explore the predictive validity of the CUPAX questionnaire on mortality, place of residence and post-fracture functionality. Materials and methodsProspective observational study. Two hundred and six patients older than 65 years were included, admitted after a hip fracture. The CUPAX questionnaire score was collected before fracture and one year later, and the place of residence and survival at hospital discharge, and after 6 and 12 months. The statistical analysis was carried out with the SAS®9.4 and Stata®13.1 programmes. ResultsThe median age of the sample was 87.0 years (80.1% women). The in-hospital and one-year mortality rate were 5.8% and 19.1%, respectively. Most of the patients were admitted from home (71.4%), and the most frequent discharge destination was a social health centre (48.2%). The percentage of retention of previous functional level in the total sample was 50%, being higher in the younger patients. The area under the curve ROC for mortality one year later was .697 (95% CI .626–.760) and 0.659 (95%CI .576–.741) for the discharge destination of patients admitted from home. Evaluation of functional retention one year after the fracture, identified three groups of patients based on the pre-fracture CUPAX value. ConclusionsThese findings support the clinical utility of the CUPAX questionnaire as a predictive functional tool in elderly patients with hip fracture.

Social Media Use and Its Link to Physical Health Indicators.

Social media use has become an integral part of many young adults' daily lives. Although much research has examined how social media use relates to psychological well-being, little is known about how it relates to physical health. To address this knowledge gap, the present research investigated how the amount of social media people use relates to various indices of physical health. Young adults provided a blood sample that was analyzed for C-reactive protein (CRP), a marker of chronic inflammation. They also completed self-report measures of social media use, somatic symptoms, illness-related physician or health center visits, and whether they sought medical care for infection-related illnesses in the last 3 months. Social media use was positively correlated with higher levels of CRP, more somatic symptoms, and more visits to the doctor or health centers for an illness. Although directionally consistent, the correlation with likelihood of seeking medical care for infection-related illnesses was nonsignificant (p = 0.061). All of these results held after controlling for factors such as sociodemographic information and depressive symptoms. Given the prevalence of social media use in daily life, these findings underscore the need for more research examining how social media use relates to physical health.

PENGARUH PEMBERIAN COOKIES TEPUNG LABU KUNING DAN KEDELAI TERHADAP PENURUNAN KADAR GLUKOSA DARAH PADA PASIEN DIABETES MELLITUS TIPE II

Introduction Diabetes Mellitus is a chronic disease caused by reduced insulin production from the pancreas and insulin produced is not effective in reducing blood sugar levels. This situation will increase blood glucose levels. Alternative therapy management to control blood glucose by utilizing food ingredients that can help reduce blood sugar levels, one of which is pumpkin flour and soybeans. The purpose of this study was to determine the effect of giving pumpkin flour cookies to a decrease in blood sugar levels in Type 2 DM patients in Palembang Social Health Center. Method is a quasi-experimental research design with a pretest-posttest with control group using a comparison group. The subjects of this study were 76 people with Type 2 Diabetes Mellitus in the Social Health Center who were willing and fulfilled the inclusion and exclusion criteria. Data analysis uses t-dependent and t-independent tests. Results showed that there was an average difference in the determination of blood sugar levels in the treatment group at 59.89 mg / dl and in the comparison group at 17.89 mg / dl. The t-independent statistical test results obtained p-value &lt;0.05 (0,000), that there was an Effect of Provision of Yellow Pumpkin Flour Cookies and Soybeans on Decreasing Blood Sugar Levels in Type 2 Diabetes Mellitus Patients in Palembang Social Health Center. Conclusion There Is An Effect Of Provision Of Pumpkin Flour Cookies And Soy To Lower Blood Sugar Levels In Type 2 Diabetes Mellitus Patients in Palembang Social Health Center.

Social causes of violence against the elderly in Bosnia and Herzegovina

The paper discussed a complex and insufficiently researched social phenomenon, namely violence against the elderly. The aim of the research was to describe, investigate and explain the social causes of violence against the elderly, and to offer proposals for solving the phenomenon of violence against the elderly in Bosnia and Hercegovina. The following methods were used in the research process: a descriptive method, a content analysis method, general scientific methods (statistical, comparative) and a survey research method. In terms of research instruments, a survey questionnaire for the elderly population, a survey questionnaire for professionals, a structured and unstructured interview were used. The sample of respondents consisted of 500 elderly people and 50 professionals employed in the judiciary, prosecutor's office, ministry, police, social work centers, nursing homes, health centers and NGOs, from Bosnia and Herzegovina. The research results show that there are risk causes that contribute to violence against the elderly, visible in the increased cultural differences between generations in one family, and if they live in families with a history of violent behavior and a history of intragenerational and intergenerational conflicts. The social status of families, in which the elderly live, is extremely bad and does not give the possibility of a quality life to the elderly in the third age. The research results indicate that we should work on the adoption of normative legal solutions in the field of protection from violence against the elderly and their application. In order to make this happen, comprehensive education of professionals through multisectoral cooperation is necessary. Keywords: abuse, the elderly, social causes.

POLICY IMPLEMENTATION ON INTEGRATED REFERRAL SERVICE SYSTEM PROGRAM OF POVERTY ALLEVIATIONIN BANDUNG CITY, WEST JAVA, INDONESIA

&#x0D; &#x0D; &#x0D; &#x0D; Integrated Referral Service System (IRSS) program is a service system to assist the poor in their needs through poverty reduction and social protection programs. One of them is the government makes a program or policy to be able to serve various social services in reducing poverty. It was found that the implementation of the Integrated Referral Service System program policy in its implementation involved legal rules and other regional regulations.&#x0D; This study aims to determine and describe the extent of policy implementation in the Integrated Referral Service System program at the Bandung City Social Service. This research report discusses the implementation of policies regarding the Integrated Referral Service System program, the obstacles faced and the efforts made by the Bandung City Social Service through the Puskesos assistant for Integrated Referral Service System implementation or facilitators in the Maleber village.&#x0D; The research method used in this method is a qualitative research method. Data collection techniques used are observation, interviews, and documentation. This research is a comparison in policy implementation is the theory of David L. Weimer and Aidan R. Vining (2014) namely Policy Logic, Environment in which Policy is Operated, and Implementor Capability. There were four informants in this study, namely the Head of Protection and Social Security, Head of the Service and Referral Section, Integrated Referral Service System of Implementing Facilitators and people who use Integrated Referral Service System.&#x0D; The conclusions drawn in this study are based on indicators that the Policy Implementation regarding the Integrated Referral Service System program in Bandung City through the Social Health Center in Maleber Village from 2019 to 2020 experienced a fairly high increase. Due to the large number of poor and underprivileged people who need assistance in the form of complaints about social problems, especially the impact of the covid 19. Poverty Reduction at the Bandung City Social Service is quite optimal, it's just that there are some obstacles regarding infrastructure and understanding in carrying out various complaints and services to the public. Integrated Referral Service System Health Center Scores.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Validez predictiva de la capacidad funcional del cuestionario CUPAX en pacientes ancianos afectos de fractura de cadera

Background and objectivesOsteoporotic hip fracture is a relevant pathology due to its prevalence and social and health impact. The aim of this study is to explore the predictive validity of the CUPAX questionnaire on mortality, place of residence and post-fracture functionality. Materials and methodsProspective observational study. Two hundred and six patients older than 65 years were included, admitted after a hip fracture. The CUPAX questionnaire score was collected before fracture and one year later, and the place of residence and survival at hospital discharge, and after 6 and 12 months. The statistical analysis was carried out with the SAS® 9.4 and Stata® 13.1 programmes. ResultsThe median age of the sample was 87.0 years (80.1% women). The in-hospital and one-year mortality rate were 5.8% and 19.1%, respectively. Most of the patients were admitted from home (71.4%), and the most frequent discharge destination was a social health centre (48.2%). The percentage of retention of previous functional level in the total sample was 50%, being higher in the younger patients. The area under the curve ROC for mortality one year later was .697 (95% CI .626-.760) and .659 (95% CI .576-.741) for the discharge destination of patients admitted from home. Evaluation of functional retention one year after the fracture, identified three groups of patients based on the pre-fracture CUPAX value. ConclusionsThese findings support the clinical utility of the CUPAX questionnaire as a predictive functional tool in elderly patients with hip fracture.