Cardiovascular Risk in Adults and its Association with Health Services Utilization. ENSANUT 2018-2019

Background The use of health services by the adult population is related to cardiovascular risk and its stratification. Cardiovascular risk (CVR) stratification should be a tool for the assessment of the patients and the appropriate control during the process of medical care and utilization of health services for the adults. Objective Evaluate the association between cardiovascular risk (CVR) in adults and the utilization of health services. Material and Methods A secondary analysis was performed of the data from the National Health and Nutrition Survey (ENSANUT) 2018-2019. The CVR classification (risk score) was obtained in 43,070 adults with a previous diagnosis (self-report) and 1,237 adults newly diagnosed. Independent, risk factors and the association between groups of CVR and utilization of preventive, outpatient and hospital services were analyzed. Results More than 85% of adults interviewed have some degree of CVR. Almost half of them have low CVR (48.2%). Older adults with social security predominate in the group with high and very high CVR. Seventy-five percent of adults recently diagnosed have low CVR. In both, there is very little utilization of health services. For adults previously diagnosed CVR, the higher the CVR, the greater the likelihood of utilization of outpatient, preventive and hospital services, in contrast to adults without CVR independent of the marital status, sex, health institution and socioeconomic level. Conclusion The results give evidence of areas of opportunity for improvement in the quality of health services. The evaluation of CVR in primary care and promotion and prevention of CVR should be strengthened.

Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective:This study aimed to understand the affordability,accessibility,and quality of maternal and child health services for postpartum mothers,and their impact on satisfaction.Methods:The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire.A survey was conducted among 289 mothers aged 20–49 in Feicheng City.Results:Regarding accessibility,most respondents(133)reported that travel time to healthcare services exceeded 60 minutes,while 99 respondents indicated a travel time of 16–30 minutes.The issue of affordability was highlighted,with 86.85%of participants perceiving maternal healthcare services as costly,indicating a significant financial burden.More than 50%of respondents were satisfied with two specific dimensions(P<0.05)regarding the quality of maternal healthcare services.Conclusion:The study found that accessibility,affordability,and quality significantly affect mothers’satisfaction with maternal health services.Future research should focus on developing more suitable service pathways for rural mothers.

Assessment of reproductive health service utilization in urban slums: Evidence from Western Rajasthan

Objective:To assess the utilization of reproductive health services in urban slum of Jodhpur city,India.Methods:A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021.Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care(ANC)services,delivery and post-partum services.Results:The majority of females were aged less than 25 years(n=195;65.0%),married after 18 years(n=240;80%),living in extended families(n=265;88.3%)and with monthly family income less than 10000 rupees(n=182;60.7%).Statistically significant associations were found between≥4 ANC visits and educational level of secondary and above(OR 2.47,95%CI 1.03–6.28;P=0.04),older age(OR 15.70,95%CI 14.87–16.54 for women aged 26-35 years,OR 16.14,95%CI 12.12–20.01 for women aged≥36 years;P<0.01),and backward and general castes(OR 15.91,95%CI 13.57–17.85 for backward caste and OR 8.11,95%CI 8.07–8.26 for general category of caste;P<0.01).Seven percent of females had undergone parturition.Older age was associated with higher risks of postpartum complications(OR 1.06,95%CI 1.01–1.57 for women aged 26-35 years,OR 3.56,95%CI 1.29–4.69 for women aged≥36 years;P<0.01).In addition,risks of postpartum complications were associated with backward and general castes(OR 1.69,95%CI 1.34–2.13 for backward classes and OR 5.01,95%CI 4.29–5.31 for general category castes;P<0.01),and more than 4 ANC visits(OR 0.20,95%CI 0.09–0.34;P<0.01).Conclusions:More frequent ANC visits are associated with a lower risk of postpartum complications.Furthermore,a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

Public satisfaction with the quality of First Health Facility Services in Indonesia: Does sociodemographic matter?

Objective:To investigate individual characteristics related to satisfaction with the quality of First Health Facility Services(FHFS)in Indonesia.Methods:This cross-sectional study analyzes national representation data.Meanwhile,the study involved 9846 representative respondents in 2019.Respondent’s satisfaction with FHFS based on the five dimensions of service quality(SERVQUAL)is a dependent variable.Independent variables consist of sex,marital status,age,education,employment,insurance ownership,and economics.The study used multivariate logistic regression to explain the relationship between individual characteristics and FSHS quality.Results:77.3%Respondents were satisfied with FHFS,with the highest order of satisfaction dimensions being assurance(59.4%),empathy(57.3%),reliability(53.6%),responsiveness(52.7%),and then tangibility(49.1%).Multivariate logistic analysis showed that divorce was 1.48 more likely than never-married to be satisfied(95%CI 1.17-1.87).Employees were 0.77 less likely than the unemployed to get satisfied(95%CI 0.70-0.86).Respondents with higher education was 0.82 less likely than those with primary education to be satisfied(95%CI 0.67-0.99).Meanwhile,respondents who had government-run insurance were 1.61 more likely than uninsured to be satisfied(95%CI 1.42-1.80).Moreover,the rich were 0.82 less likely than the poor to get satisfied(95%CI 0.73-0.92).Conclusions:Community satisfaction with FHFS is generally high,though some areas could be improved.Demographic factors are still strongly related to satisfaction ratings.The government can assess the quality of services in accordance with standards and disseminate information about service standards for primary facilities to all levels of society,ensuring that service satisfaction is rated as good by all groups.

Ontological Model for Cohesive Smart Health Services Management

Health care has become an essential social-economic concern for all stakeholders(e.g.,patients,doctors,hospitals etc.),health needs,private care and the elderly class of society.The massive increase in the usage of health care Internet of things(IoT)applications has great technological evolvement in human life.There are various smart health care services like remote patient monitoring,diagnostic,disease-specific remote treatments and telemedicine.These applications are available in a split fashion and provide solutions for variant diseases,medical resources and remote service management.The main objective of this research is to provide a management platform where all these services work as a single unit to facilitate the users.The ontological model of integrated healthcare services is proposed by getting requirements from various existing healthcare services.There were 26 smart health care services and 26 smart health care services to classify the knowledge-based ontological model.The proposed ontological model is derived from different classes,relationships,and constraints to integrate health care services.This model is developed using Protégébased on each interrelated/correlated health care service having different values.Semantic querying SPARQL protocol and RDF query language(SPARQL)were used for knowledge acquisition.The Pellet Reasoner is used to check the validity and relations coherency of the proposed ontology model.Comparative to other smart health care services integration systems,the proposed ontological model provides more cohesiveness.

Predictors of antenatal health service utilization among left-behind wives of male outmigrants:Evidence from Patna District,India

Objective:To analyze the sociological support system available for left-behind wives of male outmigrants and develop a model that predicts the antenatal care(ANC)services utilization.Methods:A cross-sectional survey was conducted in rural regions of the Patna district,India.The sample size(n=328)was estimated using Cochran’s formula.Five parameters of the social support system were identified(autonomy,spousal support,family support,social circle support,and government support).The score for each was calculated as a composite score using multiple variables;these served as independent variables.The respondents were categorized as efficient and non-efficient users of ANC service based on established criteria.Results:The regression results showed that four out of five social parameters had a significant effect on ANC behavior.Spousal support was the strongest predictor(standardized regression coefficient β=0.57,OR 1.16,95%CI 1.08-1.79,P=0.007).Government support was found to be the second strongest predictor(β=0.40,OR 1.49,95%CI 1.04-2.14,P=0.027),followed by family support(β=0.31,OR 1.36,95%CI 1.23-2.57,P=0.034)and autonomy(β=0.11,OR 1.32,95%CI 1.11-2.26,P=0.030).The social circle support was found to be non-significant in predicting ANC behavior(P>0.05).Conclusions:The policymakers could focus on the identified predictors to strengthen and modify the existing policies for leftbehind wives of male outmigrants.The need of the hour is a strategic intervention for behavioral modification of not only the left-behind wives but also their family members along with reinforcement of the existing social-security net.One strategy we suggest is to launch an awareness campaign focusing on husbands(male outmigrants)and family members.

Availability, Range and Utilization of Sexual and Reproductive Health (SRH) Services for Adolescents at Kinondoni Municipality, Dar es Salaam—Tanzania

Background: It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years;80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and reproductive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with in-charges of Reproductive and Child Health (RCH) clinics to explore barriers for provision of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underutilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents.

Exploring the association of paid sick leave with healthcare utilization and health outcomes in the United States:a rapid evidence review

Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and health outcomes and to summarize the types of utilization and outcomes which have been reported to be associated with PSL.Methods:We conducted a rapid evidence review.Our search of seven databases,including Medline,Embase,PsycINFO,Cochrane Library,CINAHL,Scopus,and JSTOR,on September 21,2020,identified 757 studies,30 of which were retained.Results:Previous evidence is mostly provided by cross-sectional studies with survey data.In this study,evidence suggests that PSL is significantly associated with some types of healthcare utilization and health outcomes.In terms of healthcare utilization,findings indicate PSL is associated with an increase in the use of some preventive sendees and a decrease in the use of emergency care;while findings are mixed regarding associations of PSL with health provider visits and the use of mammograms and pap smears.As for health outcomes,findings suggest PSL is associated with improved mental and self-rated health,decreased incidence of influenza-like illness,and lower occupational injuries and mortality rates.Conclusion:PSL may be an effective tool in improving some healthcare utilization and health outcomes.Future research could help identify mechanisms through which PSL access works and identify what policy components lead to better outcomes.

Health Services Utilization and Health Status of Insured versus Uninsured Nigerian Children with Sickle Cell Disease

Introduction: Nigeria accounts for 150,000 infants born with the Sickle Cell Disease (SCD) every year. Children with SCD are affected by the deleterious effect of user fees which reduces affordability and utilization of health services. Evidences supported that institutionalized health insurance increases intensity of utilization. Methodology: The study was conducted at AKTH, Kano, and north-western, Nigeria. The study was retrospective comparative cross-sectional study. 100 patients were enrolled, 50 for each arm. Paediatric SCD clinic outpatients’ records and a specialty designed form containing the variables of interest were used. Data were analysed using Minitab 16. Proportions, percentages, tables, charts and chi squared test were used to compare the two groups. Result: The study found no association between the two groups in the likelihood of being insured based on age (χ2 = 1.478), gender (χ2 = 0.224) and dwellings (χ2 = 0.062). On health services utilization and insurance status, the study revealed that follow up clinic visits, unscheduled clinic visits and emergency room visits were more likely among the insured group compared to the uninsured group. While the health status and insurance status of the two groups over 12 months period showed a significant association with the insured more likely to have improved health status compared to uninsured (χ2 = 28.019, p = 0.0001). Similarly, health status and health services utilization were significantly associated with insurance status (χ2 = 12.191, p = 0.002). Conclusion: The insurance status of children with SCD is associated with their health services utilization and health status. However, age, gender and dwellings were not associated with insurance status of children with SCD. Therefore, when expanding insurance coverage (NHIS) among children with SCD considerations have to be given to increase health services utilization and resultant improvement in health status as these have the potential of reducing morbidity and mortality among children with SCD.

Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Enhancing pediatric asthma management through multifaceted health education

BACKGROUND Pediatric asthma is a significant public health issue that impacts the quality of life of children globally.Traditional management approaches focus on symptom control and medication adherence but often overlook the comprehensive educational needs of patients and their families.A multifaceted health education approach may offer a more holistic strategy in managing pediatric asthma,especially in outpatient settings.AIM To evaluate the efficacy of a comprehensive health education strategy in improving disease management,medication adherence,and quality of life among children with asthma in outpatient settings.METHODS In total,100 pediatric patients with severe asthma were enrolled from January 2021 to November 2022 and randomly allocated to a control group(n=50)or an observation group(n=50).The control group received standard nursing care,including basic nursing interventions and health education upon admission.In contrast,the observation group was exposed to a broad spectrum of health education methodologies,including internet-based hospital systems,social media channels,one-on-one verbal education,informational brochures,slide present ations,telephone check-ins,animated videos,and illustrated health education manuals.Data on asthma management knowledge,symptom control,quality of life[St.George’s Respiratory Questionnaire(SGRQ)],treatment adherence,and nursing satisfaction were collected and analyzed.RESULTS The scores of the observation group in knowledge areas,such as medication,home care,disease understanding,symptom management,prevention strategies,and nutritional guidance,were significantly higher than those of the control group(P<0.05).In addition,the observation group exhibited greater symptom control,improved quality of life based on their SGRQ scores,and higher treatment adherence post-intervention(P<0.05).Nursing satisfaction was also rated higher in the observation group across all evaluated areas(P<0.05).CONCLUSION Implementing a diversified health education approach in pediatric asthma management significantly enhances disease understanding,symptom management,and treatment adherence,leading to improved quality of life for affected children.These findings underscore the importance of multifaceted clinical health education in augmenting disease awareness and facilitating continuous improvements in asthma control rates,highlighting the potential benefits of incorporating comprehensive educational strategies into pediatric asthma care protocols.

Socio-Cultural Barriers Influencing Utilization of Sexual and Reproductive Health (SRH) Information and Services among Adolescents and Youth 10 - 24 Years in Pastoral Communities in Kenya

Background: As in other developing countries, sexual and reproductive ill-health continues to mostly affect adolescents and youths. Samburu and Turkana counties in Kenya have some of the highest levels of total fertility rates (TFR) at 6.3 and 6.9 respectively placing them well above the national TFR of 3.9. Establishing factors that influence utilization of SRH services among adolescent and youth aged 10 - 24 years is critical in developing an effective program. Method: We used primary data from qualitative and purposeful study design. Data collection used Focus group discussions (FGD), In-depth interviews (IDIs) and Key informant interviews (IDIs). The target groups were adolescents and youth aged 10 - 24 years, health care providers, community health volunteers (CHVs), chemist assistants, parents of adolescents and youth, teachers, spiritual leaders and traditional activists. Findings and Conclusion: Socio-cultural factors were found to influence utilization of SRH services and information. Early marriage, being youth, male only decisions on sexuality matters and fear of family contribute to unprotected sex while myths and misconceptions on contraceptives affected utilization. The findings revealed that youth needs to know sources, how contraceptives work and how to use them. The findings suggest capacity building of health care providers, CHVs, teachers, parents and community leaders on adolescence, sexuality needs of adolescents and disadvantages of female genital mutilation (FGM) including early marriage.

Utilization and Felt Need of Oral Health Care Services among Women in Chennai-Descriptive Cross-Sectional Study

Introduction： Oral health is window to overall health. There is a greatest burden of oral diseases on the underprivileged group. In developing countries like India the affordability to oral health care services is very limited thereby leading to poor oral wellness ＆ millions suffer intractable toothache and poor quality of living and end up with few dentition. Objective： To assess the utilization level of oral health services among women in Chennai. Material and methods： A cross-sectional questionnaire survey was conducted among 200 women in Teynampet Zone in Chennai District, Tamil Nadu. The women were chosen by simple random sampling and were interviewed using the semi-stzuctured questionnaire to assess their utilization level during the period of June to July 2016. The data were analyzed by SPSS Version 22. Result： Descriptive statistics and multivariate analysis--MANOVA were used to analyze the utilization level. Majority of the respondents were in the age group of 30-35years, most of the respondents had oral problem and almost everyone had visited dentist at least once within 3 years. Multivariate analysis--MANOVA also showed that the utilization levels were directly influenced by accessibility, availability and affordability and showed statistical significance （p value 〈 0.05） and also from MANOVA analysis it showed that the respondents who had poor oral hygiene did not utilize oral health care services as the affordability was a problem although accessibility and availability was adequate. Conclusion： Our fmdings suggest that people who had oral problem had visited dentist in previous 3 years and most of the people who visited dentist had a good oral hygiene. Cost of the treatment affected the dental visits. They believed that visiting the dentist is necessary only for pain relief.

Utilization of Youth Reproductive Health Services and Associated Factors among High School Students in Bahir Dar, Amhara Regional State, Ethiopia

Introduction: Young people in Ethiopia face greater reproductive health risks than adults. Despite efforts that were made on youth to utilize reproductive health service, studies show that there is little information about the extent to which youth utilize available health services. For the proper planning of appropriate health services for youth, it is crucial to have knowledge on the pattern of their use and its associated factors. So this study was conducted from June to September 2013 to assess utilization of youth reproductive health and its associated factors among high school students in Bahir Dar town, Amhara region, Ethiopia, 2013. Methods: Institutional based cross-sectional study was conducted among High school student from June to September 2013. Multistage sampling technique was used to select the total of 818 study participants. Data were collected by means of a pretested standardized questionnaire;analysis was carried out using SPSS version 16. Crude and adjusted odds ratio with 95% confidence interval was calculated using binary logistic regression;p-value less than 0.05 was considered as statistically significant. Results: The study indicated that among 818 students, 480(58.7%) were females. The data indicates that, 32% of youth utilized youth reproductive health service. Barriers in utilizing reproductive health services, for 31% of the students were due to inconvenience hours and 28.5% were due to fear of being seen by parents or people whom they know. Among socio-demographic predictors, age and reproductive health problems showed a significant association with utilization of youth reproductive health services. Students with age 20-24 were 2.31 times more likely to utilize reproductive health service than age15-19 (AOR = 2.31, CI 95% (1.01, 5.28)). Similarly, students who had reproductive health problems were 1.54 times more likely to utilize reproductive health services than students who had no reproductive illness. Conclusions: The majority of youth were not utilizing reproductive health services. Age and reproductive health problems showed a significant association with utilization of youth reproductive health services.

Collegiate athletes'mental health services utilization:A systematic review of conceptualizations,operationalizations,facilitators,and barriers

Background: While mental health among collegiate athletes is receiving increased attention, research on factors surrounding collegiate athletes' decision to seek mental health services is limited. The goal of the present review was to analyze and synthesize the current literature concerning collegiate athletes' utilization of mental health services, including the facilitators of and barriers to use of these services.Methods: The analysis was guided and organized using a socio-ecological framework, which considered the unique context in which collegiate athletes study and perform. A total of 21 articles, published between 2005 and 2016, which concern U.S. collegiate athletes' mental health services utilization(MHSU) were selected and included for the final analysis. Conceptualizations and operationalizations of MHSU were compared and contrasted. Facilitators of and barriers to athletes MHSU were examined and summarized while appropriately considering the proximity of each factor(facilitator or barrier) to the athletes.Results: Results showed variations in conceptualizations and operationalizations of MHSU in the articles analyzed, which made interpretation and cross comparison difficult. Collegiate athletes are willing to utilize mental health services, but gender, perceived stigma, peer norms—for athletes and coaches—plus service availability impact their MHSU.Conclusion: Key stakeholders, administrators, and public health officials should partner to eliminate MHSU barriers, support facilitators, and generally empower collegiate athletes to actively manage their mental health.

Health awareness and lifestyle toward healthcare-seeking behavior among students in Universitas Advent Indonesia

Objective:Healthcare-seeking behavior(HSB)would affect the prevalence of morbidity and mortality.There are various factors that affect one's HSB.This study aimed to determine if health awareness and lifestyle might relate to HSB.Methods:A cross-sectional study was applied by using three questionnaires to determine par ticipants'health awareness,lifestyle,and HSB.This study took place in Universitas Advent Indonesia and the students were recruited to be par ticipants.Results:There were 39 par ticipants joined in this study.Most of the par ticipants were females,third-year students,and from Accounting major.Almost all participants were aware of their low risk of health issues,had a fine lifestyle,and had moderate HSB.Conclusions:One's urge to seek health care facilities was not related to their health awareness and lifestyle.There was no fur ther study to contradict with this finding at this moment.

How the Reproductive Health Needs of Unmarried Youth Be Concerned in Quality Services in Family Planning/Reproductive Health?

Objective To understand the reproductive health needs of unmarried youth so as to provide them better quality services. Method Data were drawn from a baseline questionnaire survey of provision of reproductive health information and services for unmarried youth aged 16-20 years in rural areas of Chengdu, Southwest China in 2001-2002. Results The study comprised of 1 895 valid subjects. More than 70% subjects felt that the knowledge, information and services in relation to sexual and reproductive health provided by the society were rather insufficient. Near 95% thought that unmarried young people seeking sexual and reproductive health counseling and services were quite normal, although some of them had different misgivings. Their preferred services in reproductive health included： counseling in relation to sexual and reproductive health, how to cope with unexpected sex and unwanted pregnancy, how to select the appropriate contraceptives for unmarried youth, etc. About 2/3 subjects agreed to provide contraceptive services to unmarried youth actively, by the society. A. nd they thought the difficulties and obstacles in provision of contraceptive services for un- married youth were in the following order.＂ restriction of the traditional conceptions, shyness of unmarried youth in accept of such services, disapproval of parents/school teachers, and so forth. Conclusion To improve reproductive health status of unmarried youth and meet their needs is a challenge to quality service of family planning/reproductive health program in China, The related departments and service providers should pay attention to this matter and take the strategies and measures to provide appropriate, specific, friendly and accessibly services for unmarried young people.

Client views,perception and satisfaction with immunisation services at Primary Health Care Facilities in Calabar,South-South Nigeria

Objective:To determine the degree of client satisfaction with immunisation services at Primary Health facilities in Calabar,Cross River State,Nigeria.Method:A semi-structured questionnaire was administered on 402 caregivers who were selected using systematic random sampling from four primary health centres.The four centres were randomly selected from the 19 health centres using the table of random numbers.Data obtained were analysed using Epi-Info s of tware version 2002.Results:The majority of clients were dissatisfied with most aspects of care given at the Health Care Centres including long waiting time,accessibility of immunisation services,poor respect for clients’ rights,especially to their dignity,health information and counseling on their medical needs.Conclusions:The study concludes that client satisfaction with immunization service in Calabar was low due to poor attitude of health care providers,long waiting time and lack of respect for clients’ rights.

Assessment and regulation of ocean health based on ecosystem services: Case study in the Laizhou Bay, China

The ecosystem-based management of nearshore waters requires integrated assessment of ocean health and scientific guidance on artificial regulations to promote sustainable development. Quantitative approaches were developed in this paper to assess present and near-term ocean health based on ecosystem services. Results of the case study in the Laizhou Bay of China showed that the index score of ocean health was 0.785 6 out of 1.0 at present and was expected to range from 0.555 1 to 0.804 1 in the near-term future depending on different intensities of artificial regulation of negative pressures. Specifically, the results of ocean health at present mainly indicated that cultural services and provisioning services performed essentially perfectly while supporting services and regulating services functioned less well. It can be concluded that this nearshore ecosystem would partially lose supporting and regulating services in the near-term future if the increasing pressures were not wellregulated but that all of these categories of ecosystem services could be slightly improved if the negative pressures were fully controlled. Additionally, it is recommended that publicity and education on ecosystem services especially on cultural services and regulating services should be further strengthened. The analytical process and resulting quantification provide flexible tools to guide future development of regulations so as to facilitate ecosystem-based management in the coastal zone.