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.

The effect of high-fidelity simulation in medical nursing based on the healthcare simulation standards of best practice

Background:High-fidelity simulation has been demonstrated to make great progress in learning.However,there is still ongoing exploration on how to fully harness the advantages of this teaching method and enhance its effectiveness.This study conducted high-fidelity simulation in medical nursing based on the Healthcare Simulation Standards of Best Practice and evaluated its effect.Methods:The study was conducted from September 2019 to June 2020.A total of 82 undergraduate nursing students from a university in Shanghai participated in the high-fidelity simulation in medical nursing.The simulation design scale,educational practices in simulation scale,and students’satisfaction and self-confidence were used to evaluate the effect.Results:The mean score of simulation design scale was 4.06±0.63 with the mean scores of all dimensions being over 3.0.The mean score of educational practices in simulation scale was 4.14±0.56 with the mean scores of all dimensions being over 4.0.The mean scores of students’satisfaction and self-confidence were 4.07±0.72 and 3.89±0.58,respectively.Conclusion:Students reported high levels of simulation design and educational practices in simulation.They were also satisfied with learning and reported high levels of self-confidence.Some key points need to be considered so that the learning effects might be optimized.

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.

Ozone Sterilizer for Treatment and Health Care

Ozone is a green broad-spectrum bactericidal disinfectant, and a trace amount of ozone in the atmosphere makes many viruses and bacteria lose their biochemical activity and infectivity. Nature produces trace amounts of ozone in the air through lightning to purify the ecological environment. The product of ozone decomposition is oxygen, without secondary pollution. Ozone sterilizer is widely used in the epidemic prevention and control of intensive breeding farms and achieved remarkable results. If the concentration and action time of ozone can be accurately controlled, then ozone can quickly eliminate pathogens, without harming the normal cells in the human body. How to use medical ozone for epidemic prevention, treatment and health care is a subject worthy of serious study, which should arouse the attention of the experts in the field.

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.

Does higher tax rate affect tobacco usage?Unravelling the nexus between tobacco regulatory control and public health concern

Objectives:Bangladesh stands as a prominent global consumer of tobacco,with alarming consequences on public health.The Global Adult Tobacco Survey reported that tobacco consumption claimed over 126000 lives in 2018,contributing to 13.5%of all deaths in the country.This study aims to explore the effectiveness of higher tax rates and tobacco use regulation as control mechanisms in mitigating tobacco consumption and health care cost burden,with a particular emphasis on its implications for public health.Methods:This study is based on the annual time series data over the period 2000-2020.The study employs the ordinary least square method to analyze the quantitative confirming the stationarity of data at level.This research uses different models to investigate individual effects and combined effects on both tobacco consumption and tobacco health care cost burden.Results:The study finds a negative relationship between tobacco tax rate and tobacco consumption.More specifically,the higher tax rate of tobacco(low(β=-0.3495),medium(β=-0.2319),high(β=-0.9033),premium(β=-0.7322),filtered(β=-0.2114),and non-filtered(β=-0.3452)categories)is significant to reduce tobacco use at 1%level of significance.The study finds similar results when it applied tobacco retail price instead of tobacco tax rate as the independent variable.Finally,the study investigates the impact on health care cost through tobacco consumption,tobacco control law,growth rate,export-import,and tobacco production.The results indicate that tobacco consumption,export-import,and tobacco production increases health care cost burden while tobacco use regulatory decreases it.By reducing tobacco consumption,higher taxes and tobacco use regulation contribute to alleviating the burden on the healthcare system,promoting healthier lifestyles,and aligning with global health objectives.Conclusions:Higher tax rate on tobacco products is necessary to increase the retail price so that tobacco users cannot consume tobacco.Specific tax and uniform tax base are needed so that tobacco users cannot switch to lower priced brands.Tobacco control laws need to revised and proper implementation should be ensured as well,to achieve the goal of tobacco free Bangladesh by 2040.Tobacco-related diseases,responsible for a significant proportion of deaths in the country,could witness a considerable decline with the successful implementation of higher tax rates and tobacco use regulation.This study provides insights that not only contribute to the economic discourse but also accentuate the broader public health benefits arising from effective tobacco taxation policies.

Current Situation and Prospect of the Application of Real-World Evidence in Health Care

Objective To summarize the application of real-world evidence(RWE)in the medical and healthcare field of various countries,including relevant policies,application scenarios and application methods.Methods Relevant policies and application scenarios were obtained by consulting the official websites and public documents of various countries’healthcare institutions.Systematic literature retrieval was adopted to search PubMed,EMBASE,Cochrane Library,CNKI,CBM and Wanfang databases,and all papers related to real-world study and application were included.Then,these papers were classified and analyzed by country and application method.Results and Conclusion The RWE was mainly applied to supporting the preliminary approval of a new drug,expanding drug indications,accelerating approval or supporting conditional marketing authorizations and drug safety evaluation,etc.The United Kingdom,the United States,Germany,the Netherlands,Italy,Sweden,and France admitted RWE,but they treated the data obtained from RWE with caution.After systematic literature retrieval,a total of 701 articles were obtained,including relevant studies from 36 countries,among which the United States published 264 in total.The most common study was about using real-world data(RWD)to calculate treatment-related costs,which had a total of 259 studies.Secondly,158 articles were used for epidemiological analysis.Then,138 articles were about establishing risk models to analyze disease risk factors.A total of 70 articles were real-world efficacy evaluation of the drug treatment schemes,54 articles were about pharmacoeconomic evaluation with RWD as parameters.A total of 29 articles used RWD to build predictive models,and 15 articles used RWD to evaluate the health-related quality of life in patients.The application of RWE has been used widely in the medical and healthcare field of various countries.The application scenarios are gradually diversified,the application methods of RWD become mature,and the evidence quality of RWE is also improved greatly.

Impact of Tobacco Smoking on Health Care Utilization and Medical Costs in Chronic Obstructive Pulmonary Disease,Coronary Heart Disease and Diabetes

Objective To determine the impact of smoking on disease-specific health care utilization and medical costs in patients with chronic non-communicable diseases(NCDs).Methods Participants were middle-aged and elderly adults with chronic NCDs from a prospective cohort in China.Logistic regressions and linear models were used to assess the relationship between tobacco smoking,health care utilization and medical costs.Results Totally,1020 patients with chronic obstructive pulmonary disease(COPD),3144 patients with coronary heart disease(CHD),and 1405 patients with diabetes were included in the analysis.Among patients with COPD,current smokers(β:0.030,95%CI:−0.032-0.092)and former smokers(β:0.072,95%CI:0.014-0.131)had 3.0%and 7.2%higher total medical costs than never smokers.Medical costs of patients who had smoked for 21-40 years(β:0.028,95%CI:−0.038-0.094)and≥41 years(β:0.053,95%CI:−0.004β0.110)were higher than those of never smokers.Patients who smoked≥21 cigarettes(β:0.145,95%CI:0.051-0.239)per day had more inpatient visits than never smokers.The association between smoking and health care utilization and medical costs in people with CHD group was similar to that in people with COPD;however,there were no significant associations in people with diabetes.Conclusion This study reveals that the impact of smoking on health care utilization and medical costs varies among patients with COPD,CHD,and diabetes.Tobacco control might be more effective at reducing the burden of disease for patients with COPD and CHD than for patients with diabetes.

The Role of Library and Information Science Education in the Development of Community Health Information Services for People Living with HIV/AIDS: Perspectives of Directors and Managers of Public Libraries

This article identifies the role of library and information science (LIS) education in the development of community health information services for people living with HIV/AIDS (PLWHA). Preliminary findings are presented from semi- structured qualitative interviews that were conducted with eleven directors and managers of local branches in the Knox County Public Library (KCPL) System that is located in the East Tennessee region in the United States. Select feedback reported by research participants is summarized in the article about strategies in LIS education that can help local public librarians and others in their efforts to become more responsive information providers to PLWHA. Research findings help better understand the issues and concerns regarding the development of digital and non-digital health information services for PLWHA in local public library institutions.

Operationalizing Adolescent Health Services at Primary Health Care Level in India: Processes, Challenges and Outputs

Background: Ministry of Health, Government of India developed the Adolescent Reproductive and Sexual Health (ARSH) strategy and operationalized adolescent health services up to district and sub-district hospital level. Objectives: To operationalize adolescent health services at primary health care level in a block of Maharashtra;assess impact of need based interventions on quality of services;and understand potential for scalability in the state. Methods: Adolescent and Youth friendly centers were established at primary health care settings and interventions such as health system strengthening, sensitizing gatekeepers, involving Accredited Social Health Activist (ASHAs), developing inter and intra-sectoral linkages, improving monitoring and evaluation were tested. Results: Over a period of 2009-2014, there was a steady increase in the number of clients attending the Adolescent and Youth Friendly Health Centers (A&YFHCs). Attitude of providers to address adolescents’ needs improved significantly. Successful interventions were networking with schools, colleges and Non Government Organization (NGOs), linkages with HIV program and Integrated Child Development Services (ICDS), and involvement of ASHAs. Conclusions: The study demonstrates that although health system has the primary responsibility of addressing health issues among adolescents;it has limitations in terms of its reach to adolescents and generating demand for services. There is a need to network with education sector, ICDS, NGOs working for adolescent health and development to work as a team and address the multifaceted needs of the adolescents. Such a strategy will be crucial while implementing the recently launched Rashtriya Kishor Swasthya Karyakram— the new national adolescent health programme in India.

Access to Child Health Care, Medical Treatment of Sick Children and Childhood Mortality Relationships in Kenya

Child health care factors such as medical treatment of sick children have direct and indirect effect on childhood mortality. Through international cooperation, a number of countries including Kenya have gathered information on provision of child health services at facility level from periodic Service Provision Assessment (SPA) surveys. Kenya has also gathered information on medical treatment of sick children at household level from periodic Demographic and Health Surveys (DHS). However, establishing how health care information in the SPA surveys relates to childhood mortality and also how these factors relate to medical treatment of sick children in the DHS has been constrained by differences in sample designs of the surveys. This study deployed a fstrategy of constructing community level variables derived from the SPA survey data and incorporated them into DHS data which served as the main data source. The SPA and DHS sampling designs for Kenya allow computation of stable estimates of regional demographic and health service indicators at provincial level. This study analyzed information gathered from 690 health facilities in 2010 SPA and 6079 births born less than 60 months from 2008/09 DHS. The study found that access to child health services, waiting time before service in facility and time to the nearest referral facility were significant facilitating factors for medical treatment of sick children. The study also established that waiting time before service in facility was the only access to health care factor which had a significant effect on childhood mortality when HIV prevalence was excluded in the analysis. However, the significance of waiting time before service diminished with inclusion of HIV prevalence. Further research is required to refine definition and measurement for child health care variable on female autonomy.

Accessibility and availability of health care services to internally displaced persons, in Kitgum and Pader districts, northern Uganda

Introduction: During 1986-2009, an estimated 1.6 million persons were internally displaced from northern and eastern regions of Uganda due to civil war. We investigated accessibility to and availability of health care services for the internally displaced persons in Kitgum and Pader districts, northern Uganda. Methods: This was a cross-sectional study conducted in Kitgum and Pader districts, northern Uganda. We interviewed a total of 1383 respondents comprising 968 (70%) adults and 415 (30%) adolescents;60% were females and 40% males, randomly selected from 35 of 67 (52.2%) internally displaced persons (IDP) camps. We held 27 key informant interviews and 52 focus group discussions. Data were entered in EPI data version 3.02 and analysed using SPSS version 12.00 statistical packages. Findings: Two thirds of the respondents 67.5% lived within 5 km distance of a health facility. The majority 62.9% of respondents mentioned that health related information was readily provided. 43.5% of health providers were always available in a health facility. A quarter 25.1% of health facilities always had drugs available, while 56.9% of the drugs prescribed were always available. Two thirds of the respondents 65.9% were satisfied with the health care services provided. The main reasons for the choice of a health facility were proximity 29.6%, provision of free treatment 24.7% and availability of drugs 17.2%. Main barriers to health care access were due to the lack of financial resources, trained personnel, and inadequate drugs and supplies in the health facilities. Conclusions and Recommendations: The majority of IDPs lived in close proximity to health facilities and obtained health care services from public health facilities. Access to health care was determined mainly by proximity and availability of free services and drugs. Although geographic accessibility to health services was high, lack of finances, information and decision power hindered access to health care services.

Users’ Perception and Satisfaction of Current Situation of Home Health Care Services in Jordan

Background: The healthcare system in Jordan is evolving and has to continuously respond to the changing risk profile of the population. The purpose of this study was to examine perception of users and providers of the quality of home health care services. Methods: A descriptive design was used to collect data from a convenience sample of 82 users of home health care services. Results: Users had low to fair satisfaction (30.5% - 69.5%) about the quality of care provided, had moderate satisfaction (72.0% to 81.7%) about the information received, and had low to fair satisfaction about education related to goal of treatment and medication (46.4% - 53.3%). Users had high level of agreement (>70%) that health agencies provided interpersonal care. Conclusion: The ability of the frail people to choose from a variety of cost-effective long-term care services is limited.

Depressed Older Patients’ Need for and Expectations of Improved Health Services—An Evaluative Approach to the Chronic Care Model

Depression in later life is an underrepresented yet important research area. The aim of the study was to explore depressed older persons’ need for and expectations of improved health services one year after implementation of the Chronic Care Model (CCM). A qualitative evaluative design was used. Data were collected through individual interviews with older persons living in Norway. The qualitative content analysis revealed two themes: The need to be safeguarded and Expectation of being considered valuable and capable. Evaluation of the improvement in care with focus on the CCM components showed that the most important components for improving the depressed older person’s daily life were: delivery system re-design, self-management support, productive interaction and a well-informed active patient. The findings highlight the need for a health services designed for persons suffering from chronic ill-health, where the CCM could serve as a framework for policy change and support the redesign of the existing healthcare system. We conclude that older persons with depression need attention, especially those who have been suffering for many years. The identified components may have implications for health professionals in the promotion of mental healthcare.

Health and Medical Care for the Elderly

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Maternal complications and the utilisation of maternal health care services with special reference to West Bengal, India

The study aims to examine maternal complications in the eastern states of India. Further, an attempt is also made to understand the socioeconomic factors that determine the utilization of health care services during maternity in the state of West Bengal. The data used for the study are District Level Household Survey (DLHS) 2007-08, which reveals wide regional variations in maternal complications in India. But the state of West Bengal depicts a unique picture. It has the dubious distinction of achieving low fertility and mortality with high maternal complications. The utilisation of health care services in West Bengal was never near completion. Full utilisation of ANC which is essential for safe motherhood is just above national average. A large number of deliveries still take place out of the institution and are unsafe. Analysis reveals that higher age at motherhood increases the probability of utilising maternal health care services. Social groups, years of schooling, wealth index and place of residence also show significant relationship. The findings of the study provide an insight that efforts should be made to create awareness among socially and economically disadvantaged groups of the society about the benefits of utilisation of health care services. Further it also addresses the issue of creating awareness about MDG’s.

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.

On Rural Medical Care and Health Undertaking Development during New Medical Reform

Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

The impact of the COVID-19 outbreak on Australia’s public health and medical industry in 2020

In 2020,the sudden new crown(COVID-19)virus swept the world.Countries have adopted different epidemic prevention measures.The COVID-19 has brought an extraordinary impact on the economic and social health of all countries.Australia,located in the southern hemisphere,promptly adopted the closure and other epidemic prevention policies in late January.The whole people mobilized to actively fight against the epidemic.Compared with the passive immunization of developed countries such as the United Kingdom and the United States,it has experienced several twists and turns and achieved relatively successful results.However,the epidemic has profoundly affected public health and medical care.They are mainly manifested in mental and psychological,hand hygiene,respiratory diseases,surgical spectrum,cancer screening,and changes in national leadership’s response methods and medical insurance policies.Australia’s early physical distancing measures,relatively high per capita testing rates,political stability,national wealth and geographic isolation are among the explanatory factors.The country’s response to the COVID-19 pandemic has,thus far,been among the most successful in the world.

Research on the Construction of Pharmacy Organization and the Development of Pharmaceutical Services in China’s Primary Medical and Health Institutions—Based on the Survey of 5 Provinces

Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies.Methods Multi-stage stratified random sampling was used to collect questionnaires from primary medical and health institutions in 5 provinces,and 102 questionnaires were distributed.Then Excel 2016 and IBM SPSS 21.0 software were applied for descriptive statistical analysis,chi-square test and multiple response analysis.Results and Conclusion A total of 92 primary medical and health institutions participated in the survey,and 92 valid questionnaires were recovered.The survey shows that 54.1%of the institutions have established more than 8 pharmaceutical administration regulations.63.5%and 31.8%of the institutions have formulated pharmaceutical administration and pharmacotherapy team charters(or management systems).29.7%of institutions have pharmacy personnel in accordance with relevant regulations.The higher proportion of pharmacy services are prescription review and adjustment,medication guidance,collecting and reporting adverse reactions,medication errors and medication hazard information.Primary medical and health institutions still need to further improve their pharmaceutical administration system,organizational structure,pharmacy professional training and clinical pharmacy service.