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Background. Every life aspect and group of the community have changed during the COVID-19 pandemic, including the group of pregnant, childbirth, and postpartum woman. COVID-19 Pandemic occurred in 2020-2021. Maternal mortality in East Java Province was the highest in Indonesia during the pandemic. Objective. This study analyzed the effect of spatial determinants that consist of antenatal, childbirth, and post-partum care on maternal mortality in East Java Province during the Pandemic. Methods. This study used a crossectional method with the unit of analysis in this study was all pregnant, childbirth and postpartum women in 38 districts of East Java Province from 2020 until 2021. Data were analyzed with spatial regression by using Geographically Weighted Regression Software. Results. Maternal mortality in East Java had a spreading pat-tern and negative value of the diff criterion, so we concluded that there was a spatial influence. The variables of antenatal care, accessibility of healthcare service, third postpartum visit, and complication service had significant effects on maternal mortality in all regions (P<0,05). There were four groups of districts that showed a similarity of significant factors. This result showed that each region's diversity of the accessibility of health services affects maternal mortality during the COVID-19 era. Antenatal services, access to health facilities and complication services affected maternal mortality in regions with high maternal mortality rate. Conclusion. Every region has its spatial determinants of maternal mortality. The top government should give authority to local government to have programs to reduce maternal mortality according to the condition in their region. r.Copyright © the Author(s), 2023.
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Background. The Maternal Mortality Rate (MMR) in Indonesia is still a health problem that must be solved. In 2018 and 2019, the postpartum period still dominates maternal mortality in Surabaya. The postpartum visit method is one of the essential things that can affect postpartum services, so it is necessary to evaluate the implementation of the postpartum visit method and recommend visiting methods to improve maternal health. Objective.The study explores the implementation and recommendation of postpartum visit methods during the COVID-19 Pandemic. Materials and Methods. It used a qualitative research type by assessing the interview and observation dept. The instruments used are questionnaires and observation sheets. Researchers conducted interviews with 14 mothers who had completed the postpartum period, five midwives, a stakeholder in the health office and two experts in the field of maternal health. The data is processed using organizing, reduction, coding, description, linking between themes, and data interpretation. Results. Offline visits to health facilities still dominate the implementation of the postpartum visit method. The recommended postpartum visit method combines visits to health facilities, home visits, and telehealth. Besides that, it is necessary to consider maternal postpartum services up to 3 months after delivery, especially for postpartum mothers who have problems. Conclusion. The postpartum visit method during the COVID-19 pandemic, has not run optimally because there are restrictions on offline visits. However, it has not been supported by online monitoring or home visits.Copyright © the Author(s), 2023.
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Introduction: Federally Qualified Health Centers (FQHCs) are funded by the Health Resources and Services Administration (HRSA) to provide primary care services to low-income and underinsured individuals. Los Angeles County (LAC) is a large, diverse county with greater than 10.2 million residents and 8 distinct Service Planning Areas (SPAs) that represent specific geographic regions with variable resources. We aimed to describe colorectal cancer (CRC) screening rates (CRCSR) and the screening rate change (SRCs) in LAC overall and for each SPA between 2019 and 2020 to determine where resources are most needed for CRCSR recovery following the COVID-19 pandemic. Method(s): Our data source was the Uniform Data System (UDS), which includes quality data for the FQHCs funded by HRSA. We determined 2019 and 2020 CRCSR for LAC FQHCs overall and for each FQHC, including average-risk patients age 50-74. We then separated FQHCs into quartiles based on SRC and performed mixed-effects logistic regression to determine FQHC-level characteristics associated with the largest decline in CRCSR from 2019 to 2020 (i.e., predictors of category SRC Q1). Lastly, we determined SRC for each SPA in LAC. Result(s): In 2019, there were 58 FQHCs in LAC with 326,473 patients eligible for CRC screening. In 2020, there were 59 FQHCs with 350,405 eligible patients. The median 2020 CRCSR in LAC FQHCs was 37.3%, down from 48.0% in 2019 (2020 median SRC= -9.6%) (Table). In the regression model among all LAC FQHCs, those with higher proportions of patients preferring a non-English language had significantly higher odds of having the largest decline in CRCSR from 2019 to 2020 (SRC Q1) (aOR=3.25, 95% CI=1.22-8.65;data not shown). CRCSR decreased from 2019 to 2020 in all SPAs with SRC ranging from -17.0% (South Bay) to -1.4% (West LA) (Figure). Conclusion(s): In Los Angeles County FQHCs, CRC screening rates were higher than the national FQHC average in 2019 however declined considerably between 2019 and 2020. The decline in CRC screening rates was highest in FQHCs serving a higher proportion of patients with a preference for a non-English language and varied by county region. Our findings highlight the need for targeted measures, including language-appropriate resources, to improve CRC screening uptake in FQHCs that provide care to some of the most historically marginalized individuals.
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With the acceleration of globalization, the sustained increase of mobility, the intensification of global warming and environmental changes, the transmission of diseases has become more diverse. In recent years, the corona virus disease 2019(COVID-19) has caused huge economic losses and social unrest around the world. A single-discipline has been unable to solve such complex public health problems effectively. The proposal and development of the One Health approach is closely related to the issues on veterinary medicine and zoonoses. One Health focuses on intradisciplinary, multi-sectoral, and cross-fields collaboration at three levels, including local, regional and global levels, to explore the humans-animals-environment interface complexity. In this review, the development process of One Health approach was introduced. The relationship between the One Health and zoonoses, the role of the One Health in the prevention and control of zoonoses, and how to effectively implement the One Health approach in the real world were explored, providing references for research on zoonoses prevention and control, anti-microbial resistance, food safety, and the impact of climate change on health.Copyright © 2022, National Institute of Parasitic Diseases. All rights reserved.
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With the outbreak and rapid spread of the COVID-19 worldwide, a large amount of relevant research evidence has quickly emerged. However, due to the uneven quality of evidence, poor quality and slow speed of evidence translation, it is a big challenge for health decision-makers, clinicians, and patients to make evidence-based decisions. Based on rapid systematic review of evidence, the rapid advice-guidelines can promptly and effectively transform the latest current evidence into recommendations guiding clinical practice. In the face of global public health emergencies, by building a new type of evidence ecosystem, a completely closed loop of evidence from production and evaluation to application and transformation is formed to improve the level of medical practice and reduce the waste of health resources.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.
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Aim. To evaluate the effectiveness of a novel approach to followup monitoring of patients with lower extremity peripheral artery disease (PAD) using telemedicine technologies. Material and methods. The study included 175 patients (mean age, 68, 1+/-7, 7 years). Two following groups of patients were formed: the main group (n=86), which used an optimized monitoring program using telemedicine techniques, and the control group (n=89), which assumed traditional monitoring by a cardiologist and a vascular surgeon. The mean followup period was 11, 77+/-1, 5 months. The optimized monitoring program included the implementation of audio communication with patients by an employee with a secondary medical education with an assessment of the current health status according to original unified questionnaire, with the definition of personalized management tactics. At the primary and final stages, the patient underwent an assessment of clinical and anamnestic data, mental and cognitive status, and compliance. Results. At the final stage, uncompensated hypertension was revealed in 36, 0% and 49, 4% (p=0, 0001), smoking - in 30, 6% and 42, 9% (p=0, 05) in the main and control group, respectively. In the main group, a greater painfree walking distance was revealed - 625, 8+/-395, 3 m (control group - 443+/-417 m (p=0, 013)). The average systolic blood pressure was 125, 2+/-10, 2 mm Hg and 138, 8+/-15, 8 mm Hg (p=0, 0001) in the main and control group, respectively. In the control group, a greater number of patients with a high level of personal and situational anxiety were revealed (p=0, 05). In the main group, a higher level of adherence to therapy was established at the final study stage (p=0, 001). Conclusion. The optimized monitoring program for patients with limited mobility is effective and can be implemented in practical healthcare for patients with lower extremity PAD.Copyright © 2023 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.
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Aim: This study aimed to examine the utilization of health resources during the first year of the COVID-19 pandemic in Israel through the analysis of Meuhedet Health Services' real-world database. Background(s): The history of COVID-19 in Israel comprises three waves: from February to May 2020, from May to November 2020, and from November 2020 to April 2021. Restrictions imposed on the Israeli population included travel limitations and even lockdowns. Meuhedet Health Services, the third largest health management organization in Israel, manages all its medical data through computerized electronic files and has collected various types of health services data from 2018 to 2020. This paper compared the consumption of Meuhedet Health Services over two consecutive years of the pandemic using a real-world database. Method(s): Electronic medical records from primary care physicians, laboratory tests, hospitalization medical histories, treatments in hospitals and institutes, visits to and treatments by community physicians, and prescriptions and medical equipment consumption were collected from 2018 to 2020. This research used aggregated, non-personalized, and decoded data from a cohort of insured individuals, and the research was approved by all the relevant institutional Helsinki Committees. The data analysis compared the corresponding data in a chosen month of the year with the data in the same month of the previous year. The differences were then scaled by the data corresponding to the month of the previous year, and the result was multiplied by 100 and plotted. To analyze drug consumption, we used the fixed price of every drug in a year multiplied by the difference in consumption of the drug in question between the month of the current year and the same month of the previous year, multiplied by 100. Result(s): A significant decrease was noted in hospitalization days, general hospital outpatient clinic visits, general hospital emergency room visits, and total numbers of visits to community physicians during the first lockdown in the first wave of the pandemic in comparison to 2019. At the end of the lockdown, however, a compensatory increase was noted in all services. In terms of drug consumption, the data showed no differences in the effects of the different waves. Our findings revealed that the first wave of COVID-19 was a shock, with a significant reduction in the consumption of health services, but this decrease attenuated with the second wave due to immediate management interventions and safety rules implemented in hospitals and clinics. Conclusion(s): People shun medical services during a fast-spreading epidemic that causes significant mortality. Since new variants of COVID-19 could be part of our lives for the next few years, we should learn how to continue living with the pandemic and develop alternative medical services to maintain healthy states. Digitization, remote services, telemedicine, and home care, including home hospitalization, should be part of the health services to cope with pandemic situations.Copyright © 2023 Klang et al.
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India's response to meet the mental health needs of 252 million young people between 15 and 24 years is guided by the Mental Healthcare Act 2017 (MHCA), which advocates a rights-based approach to receiving mental healthcare, the National Mental Health Policy 2014, and the National Mental Health Program operational since 1982. We undertook a comprehensive narrative review of policies, programs, and legislations across five ministries of the Government of India-Health and Family Welfare, Education, Women and Child Development, Youth Affairs and Sports, and Social Justice and Empowerment-over the last ten years to map their approach and identify enablers and barriers for promoting youth mental health in India. Our work builds on the previous reviews on children and adolescents' mental health in India and captures the rapidly advancing policy landscape amidst the new challenges and opportunities presented by the COVID-19 pandemic, especially the increasing acceptability of digital health interventions including tele-consultations. We note that all the five ministries recognized mental health as an important aspect of overall development and well-being of young people. However, their approach is fragmented and a comprehensive approach to youth mental health is missing in the Indian context. Having said that, many enablers for integration of preventive, promotive, and curative mental health interventions exist especially as mental health is increasingly being recognized as an integral part of the comprehensive primary healthcare. However, much needs to be done in terms of strategic planning for screening, early detection and treatment, and developing strong referral systems between community, schools and mental healthcare services. Effective implementation of MHCA, sustainable intersectoral integration of mental health across youth-oriented services, empowerment of young people, and judicious use of digital technology hold the key to reimagining the approach to advance young people's mental health in India.Copyright © 2022 The Authors
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Aim of the study was to assess the current state of implementating key aspects of infection prevention and control (IPC) in Armenian hospitals, defined by the main WHO components, using the survey tool IPCAF (Infection Prevention and Control Assessment Framework). Materials and methods. 113 hospitals were involved in the study. All participants filled out the IPCAF questionnaire, consisting of 8 sections (each rated up to 100 points) devoted to various IPC aspects. Depending on the total final score, IPC programs were divided into the following categories: advanced (601-800 points), intermediate (401-600 points), basic (201-400 points) and inadequate (0-200 points). The study conducted a descriptive analysis of the overall IPCAF score as well as score evaluation of the relevant core components and some selected questions of particular interest. Results. The 2021 total average score for all IPCAF components for all hospitals in Armenia is 578.0+/-7.9 points, which is currently regarded as an "intermediate" level. At the same time, 47 (41.6%) hospitals were assigned to the advanced category, 63 (55.7%) - to the average category and 3 (2.7%) - to the basic category. Analysis of the main IPC components (CC, Core component) revealed that the maximum average scores were obtained for the components CC2 (IPC Guidelines) - 80.8 points, CC8 (Creating a safe environment in medical premises, as well as materials and equipment for IPC) - 75.5 points and CC7 (Workload, staffing and number of beds) - 75.2 points. The lowest average scores were obtained for the key components: CC4 (Surveillance for healthcare-associated infections) with 54.7 points and CC3 (IPC education and training) with 59.5 points. Conclusion. Legislative and practical changes implemented in the real world during the novel coronavirus infection (COVID-19) pandemic have significantly contributed to improved scores for many key components of IPC programs. The study found that the IPCAF is a useful tool for assessing IPC standards and identifying gaps, regardless of a country economic development level. In our opinion, the re-use of IPCAF in all medical institutions should be encouraged, which is important for monitoring changes and trends in IPC, as well as proposing individual strategies in the development and improvement of IPC.Copyright © 2022 Saint Petersburg Pasteur Institute. All rights reserved.
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Background During the COVID pandemic, we designed and implemented a program, called BQualD, to maintain high quality care for patients with HR+, HER2 negative MBC who were taking oral anti-cancer therapy and needed to shelter at home. This program augmented available clinical resources with (1) trained nurse coaches to manage side effects, improve adherence, monitor for cancer progression and screen for psychological distress via telehealth, and (2) a care coordinator to arrange blood testing at local labs to facilitate timely medication dose adjustments. BQual-D served patients from August 2020 through April 2021. Here, we describe survey results assessing patient (pt) satisfaction with BQual-D. Methods Pt's satisfaction surveys included questions rated on a Likert scale (1 "strongly disagree" to 5 "strongly agree") with questions regarding the following: satisfaction with the quality of the nurse coaching calls;perception that the nurse coach listened to what they were trying to convey;whether or not their needs were met by the nurse coaching calls;whether they felt that they received adequate explanation regarding the nurse coaching calls;whether they would recommend the nurse coaching calls to a friend;perception of whether or not the nurse coach was negative or critical towards them;whether or not they would do it over (i.e., if they would return to the nurse coaching calls);whether or not they felt that the nurse coach was friendly or warm toward them;they were able to more effectively deal with care and symptoms;they felt free to express themselves;they were able to focus on what was of real concern to them;the nurse seemed to understand what they were thinking and feeling. Patients were also asked how much the calls helped with their care and symptoms. Descriptive statistics are reported (i.e., frequencies and means). Results 84 pts were screened and contacted for the BQual-D program. Of the 64 pts who responded, 52 (81.3%) were interested and enrolled in BQual-D;12 (18.8%) declined. Among those who enrolled, 1 voluntarily withdrew, and 7 withdrew due to change in treatment. Participants had a mean age of 65 (range 36 - 88 yrs) and the following racial distribution -Caucasian/White (38, 73.1%), Black or African American (12, 23.1%), American Indian (1, 1.9%) and American Indian or Alaskan Native (1, 1.9%). Satisfaction surveys were received from 32 (50%) pts. Results of surveys regarding patient satisfaction with the nurse coach were generally positive. Pts agreed or strongly agreed that they were satisfied with the quality of the nurse coaching calls (94%), the nurse coach listened to what they were trying to convey (94%), their needs were met by the nurse coaching calls (91%), they understood the purpose of the call (90%), and they would recommend the nurse coaching calls to a friend (88%). The majority (74%) agreed or strongly agreed that they were able to more effectively deal with their care and symptoms after the nurse coach calls. When asked how much the calls helped their care and symptoms, 61% indicated that they made things a lot better, 19% indicated that they made things somewhat better, 16% indicated that they made no difference. One patient indicated that the calls made things somewhat worse. Conclusions During the COVID pandemic, when sheltering at home was encouraged, patient satisfaction with BQual-D, which provided additional health resources (nurse coaches, care coordinator) to support pts on oral therapy for HR+ MBC, was high. Resources needed to implement BQual-D should be explored as a way of providing additional support for pts to minimize the requirement for in-person visits. Funding(s): Supported by a grant from Pfizer.
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The coronavirus Covid-19 has sent reverberations in all aspects of healthcare, where its spread in 2019 has impacted multiple National Health Services, including the head and neck cancer clinics. Early diagnosis combined with the appropriate treatment plays an unquestionable significant role in the survival rates and prognosis for head and neck cancer patients. King's College Hospital sits in the heart of south-east London, serving a population of 700,000;however also acts as a tertiary care centre receiving referrals for a multitude of specialties from across the South of England. A retrospective review was conducted of 365 cases referred for suspected head and neck cancer to the Oral and Maxillofacial Surgery and Oral Medicine two-week-wait clinic at King's College Hospital during the first coronavirus wave (1st of March 2020 to 31st of September 2020) and the same time period in 2019. A total of 233 suspected head and neck cancer referrals were made via the Pan London referral pathway during the first wave in 2020, compared to 132 referrals made in 2019. A total of 3.4% (n = 8) of the patients referred during the first wave were diagnosed with a subtype of head and neck cancer, compared with 9.8%(n = 13) in 2019. Of these referrals, the proportion of patients not seen within the required 14-day period only slightly increased from 3.03% (n = 4) in 2019 to 3.86% (n = 9) in 2020. There was a significant impact from the government-enforced lockdown where reduced face-to-face examinations impacted the quantity of referrals and their diagnosis via the two-week-wait pathway. This study allows reflection of the impact of the first coronavirus wave on the two-week-wait head and neck cancer referrals and gives valuable insight for service implementation and staff reallocation in the event of future periods of waves to prevent overburdening of services.Copyright © 2021
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Background: This qualitative exploratory research was the first study to explore Leg Club volunteering through focusing specifically on volunteers' narratives. Aim(s): The aim was to understand volunteers' motivations and experiences and to outline the crucial steps for maintaining volunteers' positive trajectory towards providing social support. Method(s): A qualitative study based on semi-structured interviews with volunteers from UK Leg Clubs was undertaken. Interview transcripts were analysed using a constructivist reflexive thematic analysis. Result(s): I recruited 16 volunteers from three UK Leg Clubs. The study explained the motivations for volunteering (started as members or companions;retired individuals with a strong sense of purpose;emotional, social and mental health reasons), experiences of volunteering (satisfaction from helping;meaningful social connections;personal growth) and volunteers' objectives (desire to recruit more volunteers;concerns about long-term capacity to return to pre-pandemic activities). Conclusion(s): The study outlines the conditions necessary for Leg Club volunteers' continued success in the social dimension of leg care. Declaration of Interest: Dr Anna Galazka is a volunteer project consultant for the Lindsay Leg Club Foundation. The research was funded by Cardiff Business School Research and Scholarship Seedcorn Funding Scheme.Copyright © 2023, OmniaMed Communications Ltd. All rights reserved.
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Introduction: The current corona virus disease 2019 (COVID-19) outbreak set new challenges to nearly all health plans and large health organizations worldwide, including movement restrictions, strict limitations in healthcare services, especially in the dental profession, and patient fears regarding potential infection. Telehealth can serve as an effective platform for remote connection between dental healthcare providers and patients, and can help reduce the risk of infection when social distancing is required. Objective(s): The current study aimed to evaluate the quality of treatment provided via teledentistry, as perceived by patients using the service, as well as their willingness to use online distant medical consultation in the future. Method(s): Since March 2020, a new online service was implemented in the Oral Medicine Unit and Oral and Maxillofacial Surgery Department in the Galilee Medical Center, to expand the range of services beyond merely emergency treatments. Result(s): The current study examined the quality of teledentistry services as perceived by 89 patients participating in at least one teleconsultation, and their acceptance of remote healthcare. Satisfaction rates were high in patients who received both full and partial solution to their chief complaint. Moreover, acceptance of the teledentistry platform was high, even in the older age groups. Conclusion(s): We propose to implement teledentistry services in current and future pandemics, as well as during routine times, to strengthen our health care system with digital technologies.Copyright © 2021 The Authors