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O bjective To survey the availability of dental services in Shanghai community health service centers and the differences between urban and suburban areas. Methods:A questionnaire survey on dental service in Shanghai community health service centers were conducted from March 10 to 17, 2023. The availability of dental services and the differences among health service centers in central urban area, urban area and suburban area were analyzed.Results:A total of 249 community health service center participated in the survey and 249 effective questionnaires were returned with a response rate of 100.0%. Among 249 centers, 220 (88.4%) had set up dental clinics. The proportion of community health service centers with dental clinics in the urban areas, central urban areas and suburban areas is 95.0% (76/80), 98.2% (107/109) and 61.7% (37/60), respectively ( H=35.44, P<0.05). Among the 220 centers with dental clinics, the floor space of dental clinic was 40.00 (28.50, 73.24), 31.70 (24.40, 49.35) and 20.00 (16.75, 34.00) square meters in suburban areas, central urban areas, and suburban areas, respectively. There were significant differences in the inspection equipment including comprehensive dental chairs, X-ray panoramic machine, X-ray dental machine, dental implants, ultrasonic dental cleaning machine, portable dental chairs, light curing lamps, and enzyme cleaning machine among community health service centers in three types of city areas ( H=35.44, 8.32, 25.53, 7.46 20.95, 43.00, 23.22, 13.35, all P<0.05). Among 220 centers with dental services, all provided dental caries filling, 175 (79.55%) provided root canal treatment, 161 (73.18%) provided extraction of various impacted teeth, 104 (47.27%) provided minor maxillofacial surgery, 132 (60.00%) provided fixed denture restoration, and 139 (63.18%) provided removable local denture restoration. Only a few centers provided orthodontics and dental implant services, including 20 provided removable orthodontics (9.09%), 11 provided fixed orthodontics (5.00%), and 9 provided dental implants (4.09%). There were significant differences in provision of services for root canal treatment, gingival scaling, subgingival scraping, various types of impacted tooth extraction, maxillofacial surgery minor surgery, fixed denture restoration, removable local denture restoration, mobile correction, and oral implant restoration among centers in three types of city areas ( H=29.19, 51.73, 25.32, 31.93, 8.23, 25.98, 28.26, 10.46, 7.84, all P<0.05). There were total 511 dentists in 220 community health service centers, including 24(4.70%) with master degree, 53(10.37%) with associate senior professional titles. There were significant differences in number of dentists, those with undergraduate and below education, those with master degree, those with intermediate and below professional titles among centers in three types of city areas ( H=66.35, 50.33, 11.19, 42.17, all P<0.05). Conclusion:Community health service centers in Shanghai generally have basic capacity of dental service, but there are significant differences among the central urban areas, suburban areas, and suburban areas, indicating that it need to be further strengthened in terms of facilities, equipment, and talent team development in different city areas accordingly.
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RESUMEN Las mujeres consumidoras de drogas se enfrentan a grandes desafíos en el acceso y la adherencia al tratamiento ambulatorio. Sin embargo, esta cuestión ha sido poco estudiada. El objetivo del estudio es comprender las experiencias de un grupo de mujeres en tratamiento por consumo de drogas. Entre marzo y diciembre de 2021, se realizó un estudio cualitativo fenomenológico interpretativo mediante entrevistas semiestructuradas a 16 mujeres usuarias de un centro de atención a las drogodependencias de Cataluña (España). Los datos se procesaron mediante el análisis de contenido. Los resultados indican que las mujeres, pese a percibir un impacto positivo del tratamiento, viven realidades de vulnerabilidad relacionadas con la estigmatización, la falta de apoyo social y una baja cobertura de necesidades específicas con implicaciones en el seguimiento terapéutico. Los hallazgos enfatizan la necesidad de mejorar los recursos para una atención especializada y promover una red de apoyo social donde participen activamente las mujeres consumidoras de drogas.
ABSTRACT Women drug-users face significant challenges in accessing and adhering to outpatient treatment. However, this issue has been underexplored. The study aims to understand the experiences of a group of women undergoing drug use treatment. Between March and December 2021, a qualitative phenomenological interpretative study was carried out through semi-structured interviews with 16 women attending a drug-dependence care center in Catalonia, Spain. Data were processed through content analysis. The results indicate that, despite perceiving a positive impact of the treatment, women experience vulnerabilities related to stigmatization, lack of social support, and insufficient coverage of specific needs, impacting therapeutic follow-up. The findings emphasize the need to enhance resources for specialized care and promote a social support network where women drug-users actively participate.
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Fundamento: El panorama económico y epidemiológico ha repercutido en la salud bucal de las comunidades rurales. Objetivo: Describir el estado de salud bucal, así como identificar factores de riesgo en 16 campesinos de la comunidad rural La Picadora. Metodología: En 2022 se realizó un estudio transversal descriptivo en 16 campesinos de la comunidad rural La Picadora, Yaguajay, Sancti Spíritus. Se hicieron entrevistas y examen bucal. Se calcularon indicadores epidemiológicos estomatológicos en el SPSS 16 y se resumieron los factores de riesgo mediante estadística descriptiva. Resultados: El índice de COP-D fue de 10.7 con predominio de dientes perdidos, el índice gingival fue de 1.4 y el de placa bacteriana de 1.0. Fue frecuente el desgaste de incipiente a moderado en menores de 60 años y de moderado a severo en mayores de 60 años. El 75 % de la muestra presentó oclusión normal o maloclusión mínima y el 94 % necesitó rehabilitación protésica. El 81.2 % consumió bebidas alcohólicas en los últimos 30 días, el 62.5 % ha fumado o fuma actualmente, el 87.5 % refirió el cepillado diario menor de 3 veces y el 43.8 % no asistió al estomatólogo en los últimos 10 años. Conclusiones: Se identificó la necesidad de atención estomatológica, así como la urgencia de acciones de prevención y promoción en esta comunidad.
Background: The economic and epidemiological panorama has impacted on oral health in rural communities. Objective: To describe the oral health status, as well as to identify risk factors in 16 farmers from the La Picadora rural community. Methodology: In 2022, a descriptive cross-sectional study was conducted in 16 farmers in the La Picadora rural community, Yaguajay, Sancti Spíritus. Interviews and oral examination were performed. Stomatological epidemiological indicators in SPSS 16 were calculated and risk factors were summarized using descriptive statistics. Results: The COP-D index was 10.7 with a predominance of missing teeth, The COP-D index was 10.7 with a predominance of missing teeth, the gingival index was 1.4 and the bacterial plaque index was 1.0. Incipient to moderate wear was frequent in people under 60 years of age and moderate to severe in over 60 years of age. 75% of the sample presented normal occlusion or minimal malocclusion and 94% required prosthetic rehabilitation. 81.2% consumed alcoholic beverages in the last 30 days, 62.5% have smoked or currently smokes, 87.5% referred the daily brushing less than 3 times a day and 43.8% did not attend a stomatologist in the last 10 years. Conclusions: The need for stomatological attention, was identified, as well as the urgency for prevention and promotion actions in this community.
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INTRODUCCIÓN: El estudio presenta perfiles integrales para usuarios de los Centros de Salud primaria de la comuna de Alto Hospicio. OBJETIVO: Conocer los perfiles de usuarios inscritos en los Centros de Salud de la comuna de Alto Hospicio desde una perspectiva integral e incorporando indicadores de satisfacción y conocimiento acerca del Modelo de Atención Integral de Salud Familiar y Comunitaria (MAIS). MATERIAL Y MÉTODO: Se elaboró un instrumento conformado por ocho dimensiones y 73 ítems, el cual se aplicó en cuatro centros de Atención de Salud Primaria de la comuna. Se realizó un muestreo aleatorio simple por cada Centro. En total se encuestaron a 1.124 personas, se obtuvo una representatividad de entre 95% y 93% de confianza, con niveles de significación que van de 5% a 7%. RESULTADOS: La caracterización usuaria pone en relevancia la diversidad de perfiles atendidos en cada Centro de Salud y revela problemáticas generales como la escasa información recibida respecto del modelo de atención familiar, el desconocimiento de los servicios prestados por los Centros de Salud y la dificultad de enfrentar situaciones de salud mental en el contexto de la pandemia COVID-19. CONCLUSIONES: Aquellos Centros de Salud que transmiten mayor información del MAIS presentan mejores indicadores respecto al conocimiento de los servicios de salud y de satisfacción usuaria. En el marco de la implementación del Modelo de Salud Familiar, es relevante conocer los perfiles de usuarios según las características de cada Centro de Salud, su población y territorio, y compartir buenas prácticas entre los Centros.
BACKGROUND: The study presents comprehensive profiles of Primary Health Care Centers of the Alto Hospicio Commune users. OBJECTIVE: To characterize users registered in the Health Centers of Alto Hospicio Commune from a comprehensive perspective, including satisfaction indicators and knowledge about the Comprehensive Family and Community Health Care Model (MAIS). METHODS: A questionnaire of 8 dimensions and 73 items was designed and applied in 4 Primary Health Care Centers in the commune. Four simple random samplings were applied. In total, 1,124 users were surveyed. The confidence and significance levels were between 95%-93% and 5%-7%, respectively. RESULTS: The user profile highlights the diversity in each Health Care Center and reveals general problems such as the lack of information regarding the family care model and services provided by the Health Care Centers and the difficulty of facing mental health situations in the context of the COVID-19 pandemic. CONCLUSIONS: Those Health Centers that provide more information about MAIS show better indicators regarding knowledge of health services and user satisfaction. The changes in public health policies and the implementation of the Comprehensive Family and Community Health Care Model require clarifying user profiles according to the characteristics of each health center, its population, and the territory, as well as sharing best practices between health centers.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Primary Health Care/statistics & numerical data , Community Health Services/organization & administration , Community Health Services/statistics & numerical data , COVID-19/epidemiology , Chile , Family Health , Cross-Sectional Studies , Surveys and Questionnaires , Delivery of Health Care, Integrated/organization & administration , SARS-CoV-2ABSTRACT
Background: Mental health is important at every stage of life, from childhood and adolescence through adulthood. Worldwide interest in geriatric depression has increased but studies to assess the depression among the elderly population in urban slums has hardly been done. So this study would shed light on the risk factors of depression among geriatrics in urban slums. Aim & Objective: To study the epidemiological determinants such as age, marital status, education, financial dependency, economic status and chronic illness in relation to of depression among the geriatric population (60–80 years). Settings and Design: Community-based, cross-sectional study for 24 months with a samplesize of 209. Methods & Material: Urban slum area represented by one health post was selectedas the study area which caters to around 96,630 slum residents. Pre-tested semi-structuredinterviews were conducted after selecting households by systematic random sampling. Statistical analysis: Data was analyzed using SPSS version 21. A chi-square test was applied. Result: The present study shows overall prevalence of depression among the elderly above 60 years of age to be 48.6%. Depression is found to been significantly associated with an increase in age, living alone (72.7%), lower class economic status (100%), financial dependency (54%), history of chronic family illness (54.7%) and with no formal education (62.1%) among elderly dwelling in slums. Conclusions: There is a high prevalence of depression in the community and hence, a need to sensitize Primary level Health Care Services to institute screening tests considering the association of these determinants with depression and link them to specialized services for further management.
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Objective:To explore the demand and actual supply of community-based care services for the elderly residents and the factors that affecting care mode for them in the context of rapid urbanization and population aging in China.Methods:Based on the cross-sectional data of the seventh China Longitudinal Survey on Health and Longevity(CLHLS)(2018), 15 854 elderly residents aged 60 and above were selected as the research population.Logistic regression method was used to analyze the patterns of community-based care services and their influencing factors.Results:Among 15 854 elderly residents, 6 912(43.60%)were male and 8 942(56.40%)were female.The results of activities of daily living(ADL)evaluation showed that 11 109 elderly residents could take care of themselves completely, and 3 889 elderly residents were disabled.The disability rate was 25.93%.The proportion of social services that elderly town dwellers expect the community to provide is higher than those living in cities and rural areas in terms of daily care, spiritual care, providing health care knowledge, and dealing with neighborhood disputes.From the perspective of social services actually provided by the community, in addition to providing home-based care, the proportion of community services available to the elderly living in towns and rural areas are similar, but significantly lower than the proportion of social services provided for elderly city dwellers.Age, marital status, residence, cultural differences, health status, source of life and living preference had significant impacts on the choice of care demand patterns.Those of older age( OR=2.29, 95% CI: 1.04-5.03 for 70-79 years old; OR=2.94, 95% CI: 1.38-6.25 for elderly 80 years old or above), having no spouse( OR=3.50, 95% CI: 2.49-4.92), and with higher levels of disability( OR=4.24, 95% CI: 3.12-5.77 for mild disability; OR=7.54, 95% CI: 5.19-10.95 for moderate disability; OR=10.50, 95% CI: 7.59-14.53 for severe disability)are more inclined to choose socialized care. Conclusions:In the process of rapid urbanization in China, the demands for care services of elderly living in towns has increased, but the actual care services provided for them by the communities are yet to be improved.Moreover, elderly town dwellers are still inclined to family care, the same as those of elderly rural dwellers.
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Objective:To investigate the knowledge, attitude and practice of general practitioners (GPs) in Shenzhen towards managing patients with common mental health problems.Methods:It was a cross-sectional study, from September 19 to October 31, 2020, 500 GPs from 100 community health centers (CHC) in 10 districts of Shenzhen municipality were randomly selected as the research subjects by stratified random sampling; the survey was conducted by self-filled questionnaire, which included general conditions, knowledge tests of common psychological problems (generalized anxiety disorder, depressive disorder, panic attacks, sleep disorders), GPs′ attitudes to take care of common psychological problems, and GPs′ practice of caring for common psychological problems.Results:A total of 500 questionnaires were distributed and 329 valid ones were collected. In terms of knowledge, GPs had the highest accuracy of answering the characteristics of depressive disorder (97.3%, 320/329), and the lowest accuracy of case analysis of panic attacks (50.2%, 165/329). In terms of attitude, 71.1%(234/329)of GPs agreed that "common psychological problems should be taken care of",there was a statistically significant difference in attitude scores among GPs with different years of working in CHC ( Z=14.60, P=0.006). In terms of practice, the most encountered mental health problem was insomnia (91.2%, 300/329), 46.5% (153/329) of GPs would use psychological assessment scales, 52.9% (174/329) of GPs would choose direct referral, and there were statistically significant differences in attitude scores among GPs with different years of working ( Z=10.70, P=0.030) and years of working in CHC ( Z=22.14, P<0.001). Conclusions:GPs have a positive attitude in taking care of common psychological problems, but lack of knowledge and confidence. As working in CHC for more years, GPs are more inclined to care for patients with common psychological problems in practice.
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From November 2020 to November 2021, the TEST(Task-Experience- Supervise-Thinking) teaching model was adopted for general practice residency training in teaching clinic of Changfeng Health Service Center of Shanghai Putuo district. The satisfaction of mentors, residents and patients was surveyed with self-assessment questionnaire. The satisfaction scores of mentors, residents and patients were (79.89±0.40), (79.96±0.19) and (49.92±0.40). The adaption of model TEST in teaching clinic is more effective in training of clinical competency, communication ability, management ability and narrative ability for general practice residents. It is also beneficial for mentors to upgrade their teaching ability, as well as for patients to improve their experience and satisfaction for seeking medical service. It is worth popularizing in the community practice base of general resident training.
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Objective:To explore the influencing factors and effectiveness of community follow-up in patients with cardiac implantable electronic device (CIED) implantation.Method:A total of 132 patients who received CIED implantation in the Department of Cardiology of Tongren Hospital, Shanghai Jiao Tong University School of Medicine from February 2021 to February 2022 were enrolled in this prospective cohort study. Among them 33 patients were followed up in community health service centers associated with Tongren Hospital (community follow-up group) and 99 matched patients were followed up in the CIED outpatient clinic of the hospital (outpatient follow-up group) with a ratio of 1∶3. The clinical data of the selected patients were collected through a questionnaire survey; the follow-up data were extracted through the CarelinkExpress electronic follow-up platform and the CIED outpatient information system of Tongren Hospital. Adjustment of the treatment protocol or CIED parameters at follow-up, and the referral from the community health service centers were defined as visit with-an-action (VWA). The endpoint of follow-up was the occurrence of major adverse events. The multivariate logistic regression model was used to analyze the factors influencing patient selection for community follow-up.Results:The univariate analysis showed that the frequency of visits to community health service centers and the service contracting rate in community follow-up group were higher than those of outpatient follow-up group ( P<0.05). The multivariate logistic regression analysis showed that the contracted community physician service was an independent influencing factor of patient choosing community follow-up ( OR=2.143, 95% CI: 1.103-4.166, P=0.025). A total of 469 visits of followed up occurred in 132 patients, including 45 community visits and 424 outpatient visits. VWA accounted for 22.2% (10/45) in the community follow-up group, and 17.2% (73/424) in the outpatient follow-up group ( P>0.05). There was no significant difference in the safety and effectiveness indicators (VWA, major adverse events, and unplanned follow-up) between the two groups ( P>0.05). More patients in the community follow-up group walked to the hospital than the outpatient follow-up group ( P<0.05);and the main transportation for the later was by bus or taxi(42(42.4%)or 41(41.4%)). The average waiting time in the community follow-up group was significantly shorter than that in outpatient follow-up group ( P<0.05). The total time required for a single follow-up in the community follow-up group was 50.0 (45.0, 59.5) minutes, which was significantly shorter than that in the routine outpatient follow-up group (107.0 (90.0, 135.0) minutes, P<0.05). Conclusions:The contracting with community physicians is an independent influencing factor for CIED implanted patients to choose community follow-up. The safety and effectiveness of community follow-up are comparable to routine outpatient follow-up, and community follow-up is more convenient.
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Objective:To analyze the demands of contracted family doctor service among uncontracted young and middle-aged people in Shanghai Baoshan.Methods:An online questionnaire survey on demands of contracted family doctor service was conducted in June 2021 among 702 uncontracted residents aged 18-60 years from Shanghai Baoshan district selected by stratified random sampling method. The demands of contracted family doctor service, including digital health file, routine laboratory tests and imaging investigation;health promotion;service convenience; home service were surveyed, and the factors related the demands were analyzed with regression analysis.Results:The survey showed that the demands of service convenience (3.8(3.0, 5.0)) and home service (4.0(3.0, 5.0)) were higher, while those of digital health file (3.0(2.0, 5.0)) and health promotion (3.0(2.0, 5.0)) were relatively lower. There were significant differences in the demands of all five contracted services among residents with different gender, age, education level, household register and family income (all P<0.05); while for young residents with different types of medical insurance there was significant difference in demands of all contracted services except digital health file (all P<0.05). Logistic regression analysis indicated that female( OR=1.83, P<0.001), high educational level( OR=4.81, P=0.019), household registered in Shanghai( OR=1.80, P=0.004)had higher demand for service convenience; female gender( OR=1.68, P=0.001), high educational level( OR=4.56, P=0.023)had higher demand for home service demands. Conclusion:The demands for contracted family doctor services are different among the uncontracted young and middle-aged people in Baoshan district, while the service convenience is generally most demanded. The study indicates that the contracted family doctor service should be provided accordingly.