A community-based friendly health clinic:An initiative adolescent reproductive health project in the rural and urban areas of Indonesia

Objective:This study aims to examine the effects of a community-based friendly health clinic(CFHC)program that adopts manual participatory learning(MPL)intervention on the adolescents living in the rural and urban areas of Indonesia to gain further insights into their knowledge,attitudes,and skills related to adolescent reproductive health(ARH).Methods:A quasi-experimental design was used to obtain information on the ARH knowledge,attitudes,and skills of adolescents.Two intervention studies that used similar protocols and measures were conducted.A total of 192 adolescents(96 adolescents from urban and rural areas)participated in the project,and the participants from each area were divided into eight groups.A questionairre was adopted to measure the ARH knowledge,attitudes,and skills of these participants.A content analysis of the logbook entries of these respondents was conducted to identify their ARH-related problems.The questionnairre and self-reported ARH data were collected before and after the eight-week program.Results:The CFHC program significantly increased the ARH attitudes(p=0.045)and skills(p=0.009)of adolescents in the rural area,but only improved the ARH knowledge(p<0.001)of adolescents in both rural and urban areas.Fourteen themes were identified in three dominant categories,namely,schools,families,and communities.Conclusions:The CFHC with MPL intervention can improve the ARH knowledge,attitudes,and skills of adolescents in the rural area,but can only improve the ARH knowledge of adolescents in the urban area.The ARH program must be designed based on the characterictics of these adolescents to improve their life skills during puberty.

Implementing and Popularizing Health Clinics and Educational Programs in NJ School Areas for Supporting NJ Pregnant Teenagers

This proposal focuses on the prevalence of teenage pregnancy issue in NJ and illustrates the benefits of school-based health clinics and educational programs which should be implemented for teenage pregnancy and childbearing.Without the early intervention of educational programs and preventive medical services which should be implemented in school areas,teen pregnancy and childbearing can have physical and emotional health influences on teen mothers,their babies and other family members,and the worst consequence should be abortion.What’s more,teenage pregnancy and childbearing have substantial economic consequence for state.The annual estimated cost associated with teen childbearing (teens 19 and younger) in NJ to taxpayers is at least $167 million in 2004 (24% federal costs and 76% state and local costs).Studies demonstrated that a much larger amount of money is spent on the consequences of teenage pregnancy than on prevention.NJ has an opportunity to invest in prevention and reduce not only the monetary but also the societal costs to our youth burdened by the often overwhelming responsibilities of teenage pregnancy and parenting.According to the 15 years follow-up research and data analyzing,two models of success which specifically implemented in South Carolina high schools and Chicago public schools have been proved to effectively reduce incidence of repeat pregnancy and emergency room visits,reduce incidence of teen mothers smoking during pregnancy,improve emotional outcomes among teen mothers,decrease incidence of teen mothers drug impairment,arrest,conviction,or jail time and reduce use of food stamps and other public assistances,which can consequently increase the state public health costs.In order to support teen mothers’ academic,physical,emotional and social needs in a stable and consistent school environment,the plan which titled "Physical and Mental Health Promotion for NJ Teen Mothers" is effective and practical enough to arouse the attention of some relevant departments.It’s worth patron to fund the plan because supporting teenage pregnancy at early stage can subsequently benefit the national and state economy and teen mothers.

Optimizing Vaccine Access: A Web-Based Scheduling System with Geo-Tagging Integration and Decision Support for Local Health Centers

The system created aims to produce an online vaccination appointment scheduling system with geo-tagging integration and a decision-support mechanism for neighborhood health clinics. With a decision support mechanism that suggests the essential vaccines based on their account details, it is made to meet the unique vaccination needs of each patient. The system includes immunizations that are accessible locally, and patients and midwives can manage their own corresponding information through personal accounts. Viewers of websites can visualize the distribution of vaccines by purok thanks to geotagging. The Agile Scrum Methodology was modified by the researchers for early delivery, change flexibility, and continual system improvement in order to accomplish the study’s main goal. In order to assess the system’s acceptability in terms of functional adequacy, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability, it was designed in accordance with the ISO 25010 Product Software Quality Standards. Following the assessment, the system was given an average total weighted mean score of 4.62, which represents a verbal interpretation of “strongly agree”. This score demonstrates that the evaluators were in agreement that the system met the requirements of ISO 25010 for Product Software Quality Standards.

Constructing Large Scale Cohort for Clinical Study on Heart Failure with Electronic Health Record in Regional Healthcare Platform:Challenges and Strategies in Data Reuse

Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.

The Effects of a Single Bout of Exercise on Mood and Self-Esteem in Clinically Diagnosed Mental Health Patients

Objectives: Research has highlighted the importance of regular exercise within the general population and mental health groups in regard to mood and self-esteem, as well as single bout exercise within the general population. However, research into single bout exercise in mental health population is lacking. This study investigated the impact of a single bout of exercise, on mood and self-esteem, in patients with a wider clinical mental health diagnosis. Design: A quantitative questionnaire was completed immediately pre and post a single, 45 minute bout of moderate intensity exercise, consisting of the Brunel Universal Mood States (BRUMS) questionnaire and the Rosenberg Self Esteem Scale (RSE). Methods: Participants attending a mental health hospital with a clinical mental health diagnosis (N = 54) completed the questionnaire. Information regarding physical activity levels, mental health diagnosis and length of hospital stay were collated. Results: A significant improvement was identified on the RSE as well as the BRUMS (depression, anger, confusion, anxious tension and vigour) over time. Conclusion: The significant findings highlight the importance of exercise promotion within this population group, and the potentially beneficial role that a single bout of exercise can have on mood and self-esteem in patients experiencing mental health problems.

Conducting clinical research in community mental health settings: Opportunities and challenges

Tremendous progress has been made in the past decade surrounding the underlying mechanisms and treatment of neuropsychiatric disease. Technological advancements and a broadened research paradigm have contributed to the understanding of the neurochemistry, brain function and brain circuitry involved in neuropsychiatric disorders. The predominant area of unmet medical need in the United States is major psychiatric disorders, and major depressive disorder is the leading cause of disability for ages 15-44. Total spending on research and development by the pharmaceutical industry has grown exponentially during the past decade, but fewer new molecular entities(NME) for the treatment of major psychiatric disorders have received regulatory approvals compared to other therapeutic areas. Though significant expansion has occurred during the "decade of the brain", the translation of clinical trials outcomes into the community mental health setting is deficient. Randomized controlled trials(RCTs) have been the standard approach to clinical evaluation of the safety and efficacy of NMEs for the past 60 years; however, there are significant barriers and skepticism in the implementation of evidence-based outcomes into clinical practice. Recruitment of patients, shortages of experiencedclinical researchers, regulatory requirements and later translation of outcomes into clinical practice are ever growing problems faced by investigators. The community mental health setting presents particular barriers in the replication of therapeutic outcomes from RCTs. The diagnostic complexity of major psychiatric diseases and the highly selective patient populations involved in clinical trials lend to the gap in translation from the "bench to the bedside". The community mental health setting lends to a diverse patient population with numerous co-morbidities and environmental factors that are unaccounted in the average RCT. While we acknowledge the enormous complexity in developing novel and innovative treatments for major psychiatric disorders, we must continue to improve the translatability of clinical trials to real world settings. Progress has been rather slow but as the gap in treatment effectiveness is reduced, so will costs and barriers in community mental health.

Pediatric Clinical Pharmacology and Child Health:A Canadian Perspective

Introduction Canadian academic centres and children’s hospitals have had a longstanding interest in the improvement of drug therapy for children through research conducted across the four pillars of activity identified as being of

中医适宜技术治疗脑卒中后偏瘫的循证临床实践指南

脑卒中是成年人死亡和残疾的主要原因之一。中医适宜技术在脑卒中后偏瘫的康复治疗中广泛应用,然而尚缺乏系统的、高质量的循证指南来指导这些实践。本指南根据《世界卫生组织指南制订手册》和《中西医结合诊疗指南制订手册》制定,遵循卫生保健实践指南的报告要求,并参照推荐分级的评估、制定与评价系统对证据质量及推荐强度进行分级。本指南组建了包括5个小组在内的跨学科工作团队,通过问卷、面对面专家会议和问题解构方法来选择指南中需要回答的关键临床问题。从25个关键问题中筛选出10个进行研究。基于系统评价的结果,考虑到证据的优缺点、干预成本、证据质量、患者偏好及价值观、多学科专家的反馈和共识,本指南提出了20条关于中医适宜技术在脑卒中后偏瘫康复治疗中应用的推荐意见。本指南主要面向中国各级医院和康复机构的医务工作者,专注于中医适宜技术在脑卒中后偏瘫康复治疗中的临床应用。

SACI Protocol: Preliminary Guidelines for the Development of Digital Health Technologies for Clinical Trials in Brazil

In the last decade, evidence-based medical practice has been supported on a large scale by computerized decision support tools, aiming to reduce diagnostic and therapeutic uncertainty, complementing the actions of the health professional. With technological developments, it is now possible to consider these systems as part of clinical intervention, both for the diagnosis and treatment of diseases. The literature has described the implementation of e-health tools, that is, technological innovations in the health area such as software, applications, serious games, among others, as a strategy to improve the process and adherence to treatment. However, there is still no standardized instrument in Brazil that can be used to guide the development, from the research phase, and the implementation of these tools as a health intervention, also impacting patient outcomes. With the objective of investigating a new therapeutic and preventive form, based on intervention with a computerized system, this work proposes the creation of guidelines for the registration and implementation of e-health tools as a clinical intervention. The proposal aims to be able to assist in the reporting standardization from the development stage to the application of the e-health tool helping in the treatment of diseases, registering all the experience lived in the research and applying it in different contexts of health.

新时期我国结核病防治服务体系建设及展望

中国结核病防治服务体系是随着疫情水平的变化和经济社会的发展不断调整变化的。自2011年,中国逐步推行新型结核病防治服务体系。进入新时代,如何更好地健全和完善结核病防治服务体系,是结核病防治工作面临的重大问题。作者系统总结了中国结核病防治服务体系的演变沿革,阐述了结核病防治服务体系运行现状,分析了其中存在的问题和挑战,对结核病防治服务体系建设提出了工作意见和建议,并展示了未来发展前景。

国内亚健康状态中医临床试验的文献计量学研究

[目的]探讨国内亚健康状态中医临床试验方法、干预措施及目前研究热点分布领域,为日后临床研究及干预提供参考。[方法]采用循证医学定性系统综述研究方法,检索中国知网(CNKI)、维普(VIP)及万方数据库(WANFANG DATA)文献,应用Note Express 3.2.0软件结合人工阅读文章的方式对检索的文献进行筛选,分别从文献研究方法、干预措施、有效率、受试人群、发表时间、核心作者、期刊分布、基金分布等方面进行定性系统综述分析。[结果]纳入141篇文献,近5年发文量明显降低,可见近几年国内对亚健康状态中医临床试验的关注度呈下降趋势;临床试验研究方法以随机对照试验居多,占总文献的78.72%,但阐明随机化方法的仅占32.43%,且样本含量普遍较低,以致文章可信度低;共有38种结局指标,累计频次279次,说明中医临床试验已有较成熟体系;涉及作者389位,根据普赖斯定律尚未形成核心作者群;涉及期刊67种,尚未形成核心期刊;省级基金项目最多,国家级次之;高频关键词分析,亚健康仍为热点词,其次为亚健康状态,临床疗效;受试人群有25种,较为广泛。干预措施以中药治疗者居多,其次为中医综合疗法、中医推拿法,由此可见,中药在本研究所提及的众多干预措施中是认可度最高的。[结论]研究表明,亚健康状态中医临床试验研究热度有所降低,但受试人群比较广,相对具有代表性,现亚健康人群较多,应重视亚健康状态临床试验的研究及研究的严谨性。

Patient Satisfaction Related to Their Eye Health Examination at Lúrio University Clinic in Nampula, Mozambique during COVID-19

Introduction: Patient satisfaction is defined as the extent of agreement between what a patient expects to receive from his or her health experience and the perception of the level of care he or she actually receive. With the COVID-19 pandemic, many practices have to adapt to provide health ensuring patients’ safety in first instance. Eye care procedures may be delayed during the pandemic, so eye safety is more important than ever, and it doesn’t only focus on the examination room, all the clinic compartments must be adjusted to ensure that no patient is infected by COVID-19 within the clinic. The aim of this study was to assess the satisfaction of patients who attended the Lúrio University Clinic for eye care during COVID-19. Material and Methods: This is a quantitative, descriptive and cross-sectional study conducted from December 30th, 2020 to April 30th, 2021. A systematic random sampling method was used to enrol 173 participants. Data were collected using an identification form and the patient satisfaction survey. Ethical clearance was obtained from the Lúrio University Bioethical Committee review board, and informed consent term was also received from the participants before data collection. Results: 173 participants (84 women, 48.6% and 89 men, 51.4%) completed the survey with the mean age of 31.14 and standard deviation of ±14.6 years. We found that 98.3% of the participants were satisfied (63.6% satisfied and 34.7% extremely satisfied) with the eye care provided in Lúrio University Clinic. Conclusion: Most of the patients were satisfied with the eye health examination provided in Lúrio University clinic, thus the directions for future research of the study are now opened.

Investigation on Psychological Health and Resilience of Clinical Nursing Students in “Post-Pandemic Era”

The study aims to learn about the psychological health and counseling situation of nursing students in the post-pandemic era through investigation on the psychological health, resilience and counseling demand of nursing students by randomly selecting clinical nursing students interned in a Grade III Level A hospital in Guangzhou from June 2020 to January 2021 as the objects of study. The internship can be divided into three stages: initial (1st - 3rd month), middle (4th - 7th month) and final (8th - 12th month). The investigator educated the nursing students about psychological health in the initial stage to improve their adaptability to clinical practice. Then they were given questionnaires including Symptom Checklist 90 (SCL-90), Connor-Davidson Resilience Scale (CD-RISC) and general questionnaires. And this study further completed difference analysis on psychological health and resilience in gender, educational background, internship stages and non-only/only children. It turned out that all factors scored above the national norm except anxiety in nine symptom clusters and three dimensions of CD-RISC. As for the scores of four factors of somatization, interpersonal relationship, hostility and bigotry and three dimensions of tenacity, optimism and strength in the CD-RISC, the difference was considered to indicate statistical significance (P < 0.001). Among factors affecting the psychological health of clinical nursing students, score differences involving somatization and compulsion (P < 0.001, P < 0.05) under different educational backgrounds showed statistically significant. With regard to different clinical stages, there were significant differences in somatization, compulsion, tenacity and strength (P < 0.001, P < 0.05). Finally, the conclusion is drawn that, during the period of pandemic prevention and control, the overall psychological status of clinical nursing students was good, but there remain part of cases with mild psychological problems that cannot be ignored. In the post-pandemic era, it is necessary to strengthen the awareness of teaching groups of clinical hospitals to psychological counseling for nursing students.

古代肺系疫病的记载价值和意义剖析

从人类发展史看,疫病一直伴随着人类的生息繁衍,对人类的身体健康及生命安全造成了严重威胁。疫病起病急、传染性强,一旦发病,能够迅速传染给周围的人,会使许多人在很短时间内被感染。肺系疫病是疫病中发病率、流行性及传染性最高的一类疾病,其对经济社会发展乃至历史进程也会产生影响。概览中国古代文献,古代医家智慧对今天或者未来可能的相关工作具有一定的借鉴价值。从梳理中医古籍中记载的经典理论出发,深入挖掘,重新认识,以期为临床诊治和公共卫生事业发展提供借鉴。

福建省运动健康指导门诊建设的实践样态与治理路径研究

运动健康指导门诊是体医融合工作的重要突破口和具体抓手。采用问卷调查法、专家访谈法等,对福建省运动健康指导门诊的建设样态和治理路径进行系统分析。研究认为,目前福建省运动健康指导门诊尚处于探索阶段,存在的问题包括缺乏独立门诊部门、体适能评估用房不足、运动处方师队伍规模有限等。研究认为,应通过加强政策引导支持、推动门诊环境建设;扩大专业人才队伍,优化医生进修体系;明确分级诊疗职责,完善双向转诊机制;扩大医保支付范围,提升运动处方应用等路径推动福建省运动健康指导门诊的建设。

医学生临床实习结合健康管理实践教学的方法探索

目的:探索医学生临床实习结合健康管理实践教学的方法和效果。方法:选取实习生100人,分为试验组与对照组,每组50人。对照组采取传统实习教学模式和健康管理理论授课,试验组在对照组的基础上增加健康管理实践教学,对两组教学效果进行评价。结果:试验组和对照组理论成绩差异无统计学意义(P>0.05),但试验组操作成绩优于对照组(P<0.05);试验组病健康管理能力均优于对照组(P<0.05)。结论:临床实习结合健康管理实践的创新教学方法能显著提高临床医学生的临床实习成绩和健康管理实践能力。

临床医学专业学生对公共卫生课程认知与态度的调查研究

目的:明确临床医学专业学生对公共卫生课程教学评价现况与存在问题,优化公共卫生课程体系建设方案。方法:采用定量与定性研究相结合的方法,分析临床医学专业学生对公共卫生课程的认知、满意度与学习效果。结果:临床医学专业学生对公共卫生课程的认知情况整体较好,但仍有7%的学生对公共卫生课程不感兴趣,约10%的学生对教学方法不满意;10.6%的学生觉得公共卫生课程学习效果差。结论:应加强临床医学专业学生公共卫生思想教育,采用先进教学模式,合理增减、整合、序化教学内容,增加考核方法多样性,加大形成性评价力度。

临床护理路径联合健康教育在NTM肺病合并支气管扩张患者中的效果评价

目的探讨临床护理路径联合健康教育在非结核分枝杆菌(NTM)肺病合并支气管扩张患者中的护理效果。方法选取2022年1月至12月入住广州市胸科医院的206例NTM肺病合并支气管扩张患者,按照组间基本特征均衡可比的原则分为试验组(105例)与对照组(101例)。试验组男32例,女73例,年龄(60.20±9.06)岁。对照组男38例,女63例,年龄(63.18±10.96)岁。对照组实施常规护理,试验组在常规护理基础上实施NTM肺病临床护理路径联合健康教育,持续至患者出院。以问卷形式调查试验组、对照组患者关于NTM肺病合并支气管扩张相关知识的知晓情况,包括疾病知识、用药知识、饮食、排痰。对比两组疾病知识、用药知识、饮食、排痰的知晓情况,住院时间,健康教育满意度。采用χ^(2)检验、独立样本t检验。结果试验组疾病知识、用药知识、饮食、排痰知晓率分别为(93.29±7.72)%、(86.27±5.26)%、(86.56±8.09)%、(83.82±6.23)%,高于对照组的(85.59±9.91)%、(81.34±5.19)%、(82.87±8.10)%、(80.59±7.12)%;试验组住院时间为(15.97±5.45)d,短于对照组(17.95±5.98)d,满意度评分为(4.39±0.83)分,高于对照组(4.10±0.17)分,两组差异均有统计学意义(均P<0.05)。结论对NTM肺病合并支气管扩张患者使用NTM肺病临床护理路径联合健康教育,可有效加强患者对健康知识的掌握,提高护理满意度,从而促进病情康复,缩短住院时间。

远程采集数字健康技术赋能临床研究的伦理探讨

近年来,随着可实现远程采集的数字健康技术逐步成熟,越来越多的临床研究应用这一技术提高了数据收集的质量并减轻研究参与者负担。但是,其脱离诊疗环境以及实时传输敏感信息的技术特点,也对受试者权益保障以及数据规范管理造成相应的风险,其中个人信息保护和数据控制权限是较为突出的问题。在风险分析和法规梳理的基础上,探讨申办方、研究者、临床试验机构及伦理委员会多方职责,并提出五项伦理审查特殊关注要素,以期为推动临床研究中数字健康技术部分的规范开展提供参考。

基于医疗失效模式与效应分析框架的社区2型糖尿病临床惰性形成原因及对策研究

背景自2009年起,社区2型糖尿病(T2DM)健康管理作为国家基本公共卫生服务项目在全国得到推广实施,但由于临床惰性(即发现问题未能及时采取干预措施)的影响,造成患者血糖长期控制效果不佳,因此如何克服临床惰性以提高血糖控制率是优化糖尿病健康管理所面临的一项重要而紧迫的任务。目的识别社区T2DM健康管理过程中临床惰性发生的关键失效模式,系统分析关键失效模式的发生原因,并提出相应的干预对策措施。方法立足社区实情,以医疗失效模式与效应分析(HFMEA)框架为指导,通过实地调研、访谈及文献归纳分析法初步明确社区T2DM健康管理流程、临床惰性发生的原因及干预措施。文献检索时间为2020-01-01—2023-06-30。在此基础上,应用德尔菲法,选择16名专家于2022-01-10—02-25期间进行两轮专家咨询,最终确定社区T2DM健康管理过程中临床惰性发生的关键失效模式、发生原因和干预措施。结果第一轮和第二轮专家权威系数分别为0.791和0.729。最终通过计算风险优先指数(RPN)量化确定了社区T2DM健康管理过程中临床惰性发生的10个关键失效模式,按RPN从大到小,依次为未(及时)胰岛素治疗、未(及时)戒酒、未(及时)常规转诊、未(及时)戒烟、未(及时)紧急转诊、未(及时)三联治疗、未(及时)控制体质量、未(及时)调整膳食结构、未(及时)二联治疗和未(及时)发现低血糖,并从患者、医生及卫生系统层面阐明了关键失效模式形成的根本原因,制定了针对性的干预措施。结论制定的临床惰性干预措施具有较高的科学性和权威性,为优化社区T2DM健康管理模式奠定了基础。