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Background As the most basic unit of infectious disease prevention and control，community health service institutions are the frontline and important gateway for the prevention and control of infectious disease. Primary care physicians are responsible for epidemic surveillance，vaccination，health promotion and assistance to centers for disease control in investigating and disposing outbreaks and public health emergencies in their districts，and play an active role in disease prevention and control by groups，susceptible population protection，infectious source control and health education，as well as the effective prevention and control of infectious diseases. Objective To understand the ability of primary care physicians to diagnose and treat infectious diseases in the community，analyse their existing problems and shortcomings，design and conduct a series of intensive training related to infectious diseases for improving the capacity of infectious disease prevention and control at the primary level；To evaluate the effectiveness of online continuing medical education，so as to provide a reference for better continuing medical education on infectious diseases in the community. Methods All participants of the National Community Infectious Diseases Continuing Education Conference held by the Department of Family Medicine of the University of Hong Kong-Shenzhen Hospital in November 2021 were selected as research subjects from November 2021 to March 2022. The questionnaires were distributed to all registered attendees before and after the conference through the QR code of the questionnaire star，and the content of pre-conference questionnaire included demographic characteristics of the participants，participation in infectious disease training in the community since started working，diagnosis and treatment of infectious diseases in the community，subjective attitudes towards the prevention and control of infectious diseases in the community（willingness to manage infectious diseases in the community，satisfaction with their own infectious disease management skills），expertise in infectious disease prevention and control and knowledge related to conference content，attitude towards hepatitis B. The content of the post-conference questionnaire mainly included knowledge about the content of conference，attitude towards hepatitis B and satisfaction survey of this online conference. A total of 301 primary care physicians completed the questionnaire before and after the conference，and a total of 194 completed the questionnaire before and after the conference. Results Among all participants，166 （55.1%） had attended infectious disease training in the community，of whom 49（29.5%） were satisfied with their infectious disease diagnosis and treatment ability；135（44.8%） had not attended the training，of whom 22（16.3%） were satisfied with their infectious disease diagnosis and treatment ability. 143（86.1 %） of 166 participants who had attended infectious disease training in the community indicated their willingness to manage community infectious diseases，99（73.3%） of 135 participants who had not attended infectious disease training in the community indicated their willingness to manage community infectious diseases. 66（27.3%） of participants who were satisfied with their infectious disease diagnosis and treatment ability indicated their willingness to manage community infectious diseases. The top three infectious disease tests conducted by the institutions were hepatitis B，AIDS，and hepatitis C；the top three infectious diseases treated in the past six months were hepatitis B，influenza，hand，foot and mouth disease. Different self-evaluation and willingness to train may affect the willingness to manage community infectious diseases（P<0.05）. Among the participants who completed the questionnaire both before and after the conference，the highest correct answer rate for compulsory management of statutory infectious diseases before the conference was 89.7%，the owest accuracy rate for the type of disinfection of the COVID-19 infection was only 17.0%，the correct rates of other questions ranged from 34.0% to 40.7%. The correct rates of the questions after the conference were higher than those before the conference，and the correct rates ranged from 48.9% to 52.6%. The score of attitude towards hepatitis B after the conference was higher than that before the conference （P<0.05）. In terms of feedback after conference，254（98.1%） expressed satisfaction in the total of 259 questionnaires. In terms of suggestions for online conference，179（69.1%） and 174（67.2%） participants believed that online fluency and online interaction need to be improved. Conclusion The primary care physicians receive relatively less infectious diseases training in the community，inadequate infectious diseases training in the community can improve the confidence of self-competence，attitude of active management of infectious diseases and diagnosis and treatment ability in the primary care physicians. The future direction of continuing medical education should focus on the training of emerging infectious diseases and novel medical concepts，relevant experts should be invited to comment on the necessity and effectiveness of training in the community. © 2023 Chinese General Practice. All rights reserved.
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This special issue contains 11 s that discuss recent learnings and developments in healthcare financing from a global perspective. The s cover a range of topics such as the impact of mental illness on poverty and catastrophic health expenditure in India, financing challenges in the American healthcare industry, comparative analysis of health system financing in India and Saudi Arabia, and the contribution of the Ghana National Health Insurance Scheme to inequality in healthcare utilisation. Other s explore the influence of socio-economic status on health financing choices in Jambi Province, households' willingness to pay for community-based health insurance in Bangladesh, and changes in household expenditures during the first wave of COVID-19 in India. The issue also includes discussions on managing the provider-purchaser split in India and reconsidering patient value to create better healthcare.
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Background: Children who are neurodiverse have traditionally been segregated from their peers in community-based programs, despite evidence of health benefits of inclusive education. Objectives: This community-initiated project aims to explore barriers and facilitators to inclusive aquatics programming for children with developmental and/or mental health challenges. Methods: Using a participatory-action research methodology, semi-structured interviews and focus groups were conducted with 14 participants from various stakeholder groups, including parents of children who are neurodiverse, helping professionals, and community programmers. Results: Participants described unique definitions of inclusion, from integration with neurotypical peers, to individualized goal-setting and achievement. Major facilitators include adequate resources, flexibility around accommodations, and motivated staff. Major barriers include social stigma, financial limitations, and lack of communication between caregivers and service providers. Conclusions: Participants felt strongly about the need to improve inclusion practices within aquatics—and other community-based—programs. Increased collaboration between families, community programmers, and helping professionals can foster better inclusion and outcomes for children who are neurodiverse. By incorporating various perspectives into the design of future programs, program administrators can ensure more equitable access such that all children are able to participate.
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BACKGROUND: SARS-CoV-2 infection was an unprecedented pandemic with unprecedented global health and socio-economic impact. More than 13 million cases had been confirmed in Spain by August 2022, and diagnostic testing to detect cases of infection in the country has helped to partially mitigate the spread of the virus. In 2021, the first self-testing antigen tests were marketed for dispensing in community pharmacies, and over-the-counter dispensing was allowed from July of that year. The network of community pharmacies played a key role, not only in the informed dispensing of these tests, but also in actively participating in the performance, supervision and reporting of results to the health authorities, and even in the issuing of digital certificates. A compilation has been made of all the available data on the subject, with a deadline of 13 February 2022, which is considered to be the end of the sixth wave of the epidemic in Spain. The results of the action taken by community pharmacies in twelve Autonomous Communities, which somehow participated in these initiatives by carrying out or supervising a total of 1,043,800 tests, from which 109,570 positive cases (10.5% of the total) were detected and reported to the National Health System, are presented in this article. Although the results are provisional, because many of the programmes are still ongoing, they are a clear demonstration of the potential that community pharmacies can play in Public Health work.
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Background During the promotion of category-based management for community healthcare institutions （class 1 institutions obtain the financial security，and class 2 institutions implement a performance management system），how to appropriately determine the security level and scientifically evaluate the performance is a difficulty to tackle for health administrative departments. Objective To assess the operational efficiency of community healthcare institutions with the data envelopment analysis（DEA） using the information of costs of these institutions calculated using the equivalent method，then attempt to develop an input and management model of integrating cost accounting and performance management for these institutions，providing a theoretical basis for accurate and scientific input of various resources into the community through cost measurement with equivalent method，and a data basis for performance assessment in communities with different characteristics through efficiency evaluation. Methods The real data（financial status and staffing） of 14 community healthcare institutions during 2019 to 2020 were collected from their financial reports，hospital information system，maternal and child healthcare information system，chronic disease management information system，as well as focus group interviews. The equivalent method was used to calculate the total costs of medical services and public health services. The super-efficiency DEA was used to evaluate and analyze the operational efficiency of the 14 sample institutions. Results （1）The average cost of one equivalent service（a general medical outpatient service lasting for 15 minutes was defined as one standard service equivalent unit） was 67.64 yuan in 2019 and 69.80 yuan in 2020 for the 14 institutions. The average cost of one equivalent essential medical service was higher than that of one equivalent public health service in both 2019（167.14 yuan vs 18.86 yuan） and 2020（215.43 yuan vs 19.78 yuan）. The institutions demonstrated significant differences in the average cost of one equivalent essential medical service and the average cost of one equivalent public health service. （2）Each institution had its own peculiar characteristics. For example，S1 institution mainly provided essential medical services，and had higher total equivalent essential medical services and efficiency than other institutions，while S9 institution focused on providing public health services，and had the highest efficiency in delivering public health services. （3）In 2020，the 14 institutions provided 134 800 equivalent COVID-19-related services，with a cost of 1.037 8 million yuan. （4）In 2019 and 2020，only two institutions were relatively overall efficient，and ≥ 50.0% institutions were pure technically efficient. The institutions with overall operational inefficiency were mainly caused by scale inefficiency primarily due to increasing returns to scale. Conclusion The equivalent method provides a relatively unified "scale" to standardize the service efficiency of different types of community healthcare institutions，provides support for health administrative departments implementing category-based compensation for the institutions，benefiting the featured and high-level development of community healthcare institutions. Either institutions delivering essential medical services or those delivering public health services，mainly present increasing returns to scale，suggesting that the efficiency of these institutions can be improved by increasing the human/financial/material input into the institutions and providing precise compensation for them. © 2023 Chinese General Practice. All rights reserved.
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Increasing body immunity is very necessary after the Covid-19 pandemic. One of the efforts that can be made to increase the body's immunity is to consume functional foods with immunostimulant activity, such as processed snakehead fish products in the form of nuggets, and "parkusel" juice made from a mixture of bitter melon, dates and celery. The purpose of community service is to provide knowledge and skills to housewives and the community at the Veteran ABRI Housing Complex in Medan Estate, Deli Serdang Regency, in making functional food products in the form of snakehead fish nuggets and Perkusel juice. The community service method used is the counseling method with leafet aids and training in making snakehead fish nuggets and perkusel juice. The results of the activity showed that there was an increase in the knowledge of the community participants in community service activities about nutritious snack products that can increase body immunity by 71% in the good value category.
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Background: Maternal and child health (MCH) services have been affected by the Coronavirus disease (COVID-19) pandemic in all countries, including Indonesia. Information regarding the impact of COVID-19 on MCH service access and provision is limited, particularly in the context of rural Indonesian communities. This study aimed to explore the experiences of Indonesian mothers and midwives from a rural regency regarding MCH services delivery during the pandemic. Methods: This study was a sub-study of a pre-existing cohort study conducted in four sub-districts in Banggai, Indonesia, as the qualitative research. This study was conducted from November 2020 to April 2021, involving 21 mothers and six midwives. We selected the participants using snowball sampling. In-depth interviews were conducted in Bahasa. The study used both deductive and inductive approaches for analysis. Data analysis was performed using NVivo v.12. Results: The study identified three themes and eight sub-themes from the analysis incorporating the midwives' and mothers' data. The themes included health service change, perceived barriers to service delivery, and family impact. This study highlights health service changes due to the pandemic, such as relocating the MCH services. Mothers perceived barriers to accessing health services, including distance reasons and fear of COVID-19. Only the shortages of staff affected the midwives in providing optimal services. Conclusion: The pandemic triggered health service changes and caused some barriers to service delivery. This study recommends that the local government and stakeholders should pay more attention to the health service changes according to the mothers' experiences and address barriers to optimize access to MCH services during the pandemic.
Subject(s)
COVID-19 , Child Health Services , Midwifery , Pregnancy , Female , Child , Humans , Mothers , Indonesia/epidemiology , Pandemics , Cohort Studies , COVID-19/epidemiology , Qualitative ResearchABSTRACT
BACKGROUND: Hospital clinical staff have reported poor psychosocial wellbeing during the COVID-19 pandemic. Little is known about community health service staff who undertake various roles including education, advocacy and clinical services, and work with a range of clients. Few studies have collected longitudinal data. The aim of this study was to assess the psychological wellbeing of community health service staff in Australia during the COVID-19 pandemic at two time points in 2021. METHODS: A prospective cohort design with an anonymous cross-sectional online survey administered at two time points (March/April 2021; n = 681 and September/October 2021; n = 479). Staff (clinical and non-clinical roles) were recruited from eight community health services in Victoria, Australia. Psychological wellbeing was assessed using the Depression, Anxiety and Stress Scale (DASS-21) and resilience using the Brief Resilience Scale (BRS). General linear models were used to measure the effects of survey time point, professional role and geographic location on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics. RESULTS: There were no significant differences in respondent sociodemographic characteristics between the two surveys. Staff's mental health declined as the pandemic continued. Adjusting for dependent children, professional role, general health status, geographic location, COVID-19 contact status and country of birth; depression, anxiety and stress scores were significantly higher for respondents in the second survey than the first (all p < 0.001). Professional role and geographic location were not statistically significantly associated with scores on any of the DASS-21 subscales. Higher levels of depression, anxiety and stress were reported among respondents who were younger, and had less resilience or poorer general health. CONCLUSIONS: The psychological wellbeing of community health staff was significantly worse at the time of the second survey than the first. The findings indicate that the COVID-19 pandemic has had an ongoing and cumulative negative impact on staff wellbeing. Staff would benefit from continued wellbeing support.
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The British Journal of Healthcare Management's editor discusses the potential benefits of community diagnostic centres for patients and the wider NHS, along with key considerations to drive this model forward.
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Health professionals are increasingly using digital technology as a strategy to maximize community engagement and effectively implement health interventions, a phenomenon evidenced by the COVID-19 pandemic. While technology has improved health information dissemination, communication, and data management, it cannot replace the human-based interactions offered by traditional grassroots outreach that can influence long-term health behavior change, particularly for underserved communities. Digital community engagement can be part of the digital divide, often widening disparities by excluding those without access or limited access to technology. It may hinder the accurate collection of contextual and comprehensive data needed to analyze social determinants of health, thereby widening the equity gap. This commentary explores the challenges of using digital technology and justifies leveraging it to complement traditional community engagement rather than as a replacement.
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Background During the promotion of category-based management for community healthcare institutions （class 1 institutions obtain the financial security，and class 2 institutions implement a performance management system），how to appropriately determine the security level and scientifically evaluate the performance is a difficulty to tackle for health administrative departments. Objective To assess the operational efficiency of community healthcare institutions with the data envelopment analysis（DEA） using the information of costs of these institutions calculated using the equivalent method，then attempt to develop an input and management model of integrating cost accounting and performance management for these institutions，providing a theoretical basis for accurate and scientific input of various resources into the community through cost measurement with equivalent method，and a data basis for performance assessment in communities with different characteristics through efficiency evaluation. Methods The real data（financial status and staffing） of 14 community healthcare institutions during 2019 to 2020 were collected from their financial reports，hospital information system，maternal and child healthcare information system，chronic disease management information system，as well as focus group interviews. The equivalent method was used to calculate the total costs of medical services and public health services. The super-efficiency DEA was used to evaluate and analyze the operational efficiency of the 14 sample institutions. Results （1）The average cost of one equivalent service（a general medical outpatient service lasting for 15 minutes was defined as one standard service equivalent unit） was 67.64 yuan in 2019 and 69.80 yuan in 2020 for the 14 institutions. The average cost of one equivalent essential medical service was higher than that of one equivalent public health service in both 2019（167.14 yuan vs 18.86 yuan） and 2020（215.43 yuan vs 19.78 yuan）. The institutions demonstrated significant differences in the average cost of one equivalent essential medical service and the average cost of one equivalent public health service. （2）Each institution had its own peculiar characteristics. For example，S1 institution mainly provided essential medical services，and had higher total equivalent essential medical services and efficiency than other institutions，while S9 institution focused on providing public health services，and had the highest efficiency in delivering public health services. （3）In 2020，the 14 institutions provided 134 800 equivalent COVID-19-related services，with a cost of 1.037 8 million yuan. （4）In 2019 and 2020，only two institutions were relatively overall efficient，and ≥ 50.0% institutions were pure technically efficient. The institutions with overall operational inefficiency were mainly caused by scale inefficiency primarily due to increasing returns to scale. Conclusion The equivalent method provides a relatively unified "scale" to standardize the service efficiency of different types of community healthcare institutions，provides support for health administrative departments implementing category-based compensation for the institutions，benefiting the featured and high-level development of community healthcare institutions. Either institutions delivering essential medical services or those delivering public health services，mainly present increasing returns to scale，suggesting that the efficiency of these institutions can be improved by increasing the human/financial/material input into the institutions and providing precise compensation for them. © 2023 Chinese General Practice. All rights reserved.
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Purpose: This study aimed to identify the factors affecting the self-care of older adults living alone in a community during the COVID-19 pandemic. Methods: Data were collected through a questionnaire survey of 160 older adults living alone in Seoul, Gyeong-gi, and Chung-cheong province using self-care, health conservation, psychological well-being, and self-esteem scales. Data were analyzed using the Pearson cor-relation coefficients, t-test, analysis of variance ANOVA, and Hierarchial stepwise multiple regression with the SPSS/Windows version 25.0 program. Results: The greatest variables affecting the self-care for older adults living alone were compliance with COVID-19 quarantine rules (β=-.04, p=.054), interactions with the neighborhood (β=-.06, p=.029), economic status (β=.10, p=.008), health conservation (β=.29, p<.001), psychological well-being (β=.18, p=.008), and self-esteem (β=.35, p<.001). The explanatory power of these variables was 70.0% (F=18.45, p<.001). Conclusion: Regarding the COVID-19 pandemic, these factors were highly mutually related to older adults living alone, so it is necessary for older adults living alone to actively participate in self-care programs using direct and indirect community resources. © 2023 Korean Gerontological Nursing Society.
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Purpose: The aim of our study is to present the results of the mobile sampling of the National Public Health Center during the Covid-19 pandemic, the implementation process of the screening buses of the program "We bring the screening tests in place” as static points, as well as the spatial and temporal frequency of use. Methods: Our retrospective analysis was performed in Pest County between 12th of November, 2020 and 18th of April 2022 by evaluating the Covid-19 sampling results from screening buses (N=164,576). Descriptive statistical methods were used to process the data. Results: In most cases, the screening was carried out in the patient's car, which reduced the risk of infection and ensured the safety and smoothness of the work by moving quickly through the screening point. Sampling was performed using AbottTM, Clintest® and VivaDiagTM rapid tests, and in case of a negative result, another nasopharyngeal sampling was performed for RT-PCR. An average of 504 samples were taken per day, of which on average almost 1⁄3(31.41%) were positive. Conclusion: The advantage of the screening buses was the ability to perform a significant number of tests, their mobility, the fact that they can be placed in easily accessible locations and the reduced risk of infection. Mass testing at static points has proven to be an efficient process that can be used in the future if the need arises. Célkitűzés: Tanulmányunk célja a Covid-19-járvány során a Nemzeti Népegészségügyi Központ mobil mintavételezésének, a „Helybe visszük a szűrővizsgálatokat” program szűrőbuszainak statikus pontként történő megvalósítási folyamatának, illetve területi és időbeni igénybevételi gyakoriságának, eredményeinek bemutatása. Vizsgálat módszere: Retrospektív elemzésünk Budapesten és Pest megyében 2020. november 12. és 2022. április 18. között a szűrőbuszokon végzett Covid-19-mintavételi leleteinek értékelésével valósult meg (N=164 576). A kapott adatok feldolgozásához leíró statisztikai módszereket alkalmaztunk. Eredmények: A teszteléseket legtöbb esetben a páciens személygépjárműjében végeztük el, ami csökkentette az infektálódás kockázatát, illetve a szűrőponton való gyors áthaladás szavatolta a munka biztonságát és gördülékenységét is. A mintavételezések során az AbottTM, a Clintest®, valamint a VivaDiagTM rapid tesztjeit használtuk, negatív eredmény esetén újabb nasopharingealis mintavétel történt RT-PCR elvégzése céljából. Naponta átlagosan 504 mintavétel valósult meg, amelynek átlagosan közel egyharmada (31,41%) mutatott pozitivitást. Következtetések: A szűrőbuszok előnye a nagyszámú tesztek elvégzésének lehetőségében, a mozgathatóságban, a mindenki számára könnyen megközelíthető pontokra való kihelyezésben, valamint a fertőződés kockázatának csökkentésében mutatkozott meg. A tömeges tesztelések statikus pontokon való lebonyolítása hatékonynak bizonyult, amely folyamatot a jövőben is alkalmazhatunk, ha arra szükség lesz.
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In Hong Kong, professional social workers made their presence felt when they delivered a variety of services at the height of the pandemic. Social workers who were working in community development projects or who had adopted community work approaches have become the major service providers when the availability and accessibility of other types of social services have been seriously impeded. This article reports on a qualitative research study conducted to examine (1) how community social workers have planned and implemented services, (2) their use of information and communication technologies (ICTs), and (3) ideas for addressing injustices in disaster management work.
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The COVID-19 pandemic led to increases in family violence in Australia and elsewhere. In response, organisations in the domestic and family violence (DFV) sector, had to adapt to the emerging public health measures and worked collaboratively to protect the most vulnerable in the community. These services, including courts, rapidly transformed their methods of service delivery that are likely to continue for some time. But what have been the implications/impacts of these rapid changes on the DFV service sector in Australia? How have these impacts informed the future needs of the DFV sector? And what is needed to strengthen this community sector of the future? This article reports on the findings of a national research project examining the impacts of COVID-19 on the DFV service sector and the adaptations and innovations that emerged in response. The study highlights that the surge in demand for services put pressure on an already overwhelmed workforce/service sector and provided an opportunity for front line workers to contribute to building a robust sector to respond to future crisis events. These findings have significant implications for future DFV sector service delivery, and for the social work profession as a whole.
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Aim: To analyze suspected adverse events (AEs) caused by SARS-CoV-2 vaccines administered to community pharmacists (CP) and auxiliary personnel. Methods. Design: Cross-sectional observational study, in February-April 2021. Subjects: Pharmacists, technicians and auxiliaries who work in contact with the public, of legal age, vaccinated against SARS-CoV-2. Variables: Number, type and frequency of AEs, demographic characteristics. Procedure: A formulary was enabled on the website of the Association of Pharmacists of Pontevedra. It was announced to all the associates CP of the province its existence and the convenience of completing it. Outcomes: 167 participants, of whom 153 manifested symptoms related with reactivity to the vaccine, 122 (93.1%) women and 31 (86.1%) men. 146 (95.4%) who received VaxzevriaR, 116 (79.4%) women and 30 (20.6%) men and 7 (4.6%) who received ComirnatyR, 6 (85.7%) women and 1 (14.3%) man. 823 AEs were reported, 811 (5,3 SD=2,8 AEs, 0-12 per patient) with VaxzevriaR and 12 (0,9 SD=1,0 AEs, 0-3 per patient) with ComirnatyR. Most frequent AEs: pain at the injection site, 128 (87.7%), chills, 107 (73.3%) and muscle pain, 106 (72.6%). In all three, we found a higher proportion of women than men (p<0.01). The maximum number of AEs manifested by a participant was 12. 132 (86.3%) vaccinated who reported AEs, 106 (86.9%) women and 26 (83.9%) men, needed medication to relieve symptoms. 77 (46.1%) could not carry out their daily activities and 47 (28.1%) could not work the next day. Conclusions: The number of AEs reported by vaccinated pharmacists and auxiliary personnel was high. Although they were not serious, they considerably affected their daily and work activity.
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Background: The COVID-19 public health crisis has caused disruptions in the continuum of Human Immunodeficiency Virus (HIV) services. Hence, HIV advocates and care providers must innovate to ensure the health and welfare of people living with HIV (PLHIVs) and other at-risk populations. There is a lack of empirical research that explores the experiences and perspectives of HIV volunteers in adapting to pandemic-related challenges. Purpose: This qualitative study aimed to describe the use of information and communications technology (ICT) in the provision of HIV services of Filipino volunteers during the pandemic. Methods: Qualitative descriptive study design was used, focusing on ICT use for HIV care. Sixteen (16) purposively selected volunteers from three community-based organizations (CBO) were interviewed using a semi-structured guide via videoconference. Inductive qualitative content analysis was used to draw insights from the data. Results: Findings revealed that volunteers used various ICTs such as social media, videoconferencing, dating sites, and online-based courier services to ensure continuity of HIV services. However, volunteers noted challenges in using ICT for HIV services, such as limited access to digital resources, increased work demands, and lack of human connection. Conclusion: Various tools and implementations of ICTs have been used by volunteers to ensure the continuity of services of PLHIVs. This study provides insights to nurses and informaticists in implementing digital technologies in caring for vulnerable clients during outbreaks like COVID-19. Copyright © 2022 NMJN.