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.

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.

Analysis of home care-based multi-level old-age service system

With the deepening of China＇s aging, China＇s social pension problem more obvious each day, and gradually become the focus of attention of the whole society. On the one hand, China entered the aging society, old-age needs to grow exponentially. The sixth national census shows that in our country, the population aged 60 and 13.26% of the total population over the total number of 179 million, 65 years and older the proportion of 8.87% of the total population, the absolute number of nearly 120 million. Hundreds of millions of older age groups will produce a growing demand for care services, which is the original old-age service system and the whole economic and social development is a huge pressure. On the other hand, with the economic and social transformation, the traditional model of family pension has been unable to adapt to the profound changes in modem employment, family structure, the concept of retirement, since most parts of China, ＂old before getting ricE＂ the situation, how to solve the elderly the pension problem is related to the overall situation of China＇s economic and social development, related to the overall situation of building a harmonious society in China. Under current national conditions, the emphasis on the development of a single individual body to meet the growing demand for pension service is not realistic, we must mobilize the enthusiasm of all aspects of the element, multi-service integration of resources subject to their commitment to a different responsibilities and tasks provide a full range of care services according to different types, different levels of the actual needs of the older age groups. On the aging problem is that the whole community to face, you need to multi-government body, families, communities, institutions combine effectively starting from the actual needs of the elderly population, according to the financial assistance, life care, spiritual consolation three set the specific needs of services, through a government-led, home-based care services, community care services for the core and supplementary services for institutions focused on pension and other means to provide a full range of pension services.

Aging Characteristics and Layout Planning of Old-age Care Facilities in the Downtown Area of Nanchang City

Compared to the situation of population aging and the elderly aging, the development of oldage undertaking in Nanchang is still undeveloped in that the old-age care industry lags behind the urban renewal speed and the objective needs of aging. Apart from discussions on the composition of elderly population and the status quo of aging, this paper took the institutional old-age care in the downtown area of Nanchang for example, explored problems in the current institutional old-age care facilities through field investigation, and proposed suggestions for the layout planning of old-age care facilities in the study area.

Construction of Xi'an ecological old-age care community in the new urbanization

The new urbanization is an important carrier of ecological civilization construction, and ecological old-age care is the concrete manifestation of the perfect combination of the two, the proper meaning of the new urbanization connotation and an inevitable trend of its development. Based on the analysis of the connotation and relationship between the new urbanization and ecological old-age care, together with the current situation and existing problems of the current nursing institutions and ecological old-age care in Xi'an area, this paper discusses the major issues that should be noticed when constructing the ecological old-age care community in Xi'an and three main construction modes.

The Experience and Enlightenment of the Development of Old-age Care Services in Russia

Through the analysis of the history and current situation of Russia＇s old-age care services system, this paper analyzes and studies the old-age care services system in Russia. By means of law and social policy, Russia can promote the active participation of the elderly in politics, economy, culture and other activities to promote the positive image of the elderly. The active aging policy in Russia and the development trend of the old-age care service to promote the social adaptation and re-employment of the elderly are of positive significance to the development of our country＇s old-age care service.

Nurse-staffing level and quality of acute care services:Evidence from cross-national panel data analysis in OECD countries

Background:Most of previous studies aimed to estimate the effect of nurse staffing on quality of acute hospital care have used stochastic methods and their results are mixed.Objective:To measure the magnitude of effect of nurse-staffing level on increasing quality of acute care services in long-run.Data:The number of practicing nurses'density per 1000 population as the proxy of nurse-staffing level and three Health Care Quality Indicators(HCQI)included 30-day mortality per 100 patients based on acute myocardial infarction(MORTAMIO),hemorrhagic stroke(MORTHSTO)and ischemic stroke(MORTISTO)were collected as a part of ongoing project by OECD.org in panels of 26 OECD countries over 2005-2015 period.Method:Panel data analysis.Results:There were committed relationships from nurse-staffing level to the enhancement of HCQI i.e.1%increase in nurse-staffing level would reduce the rates of patient mortality based on MORTAMIO,MORTHSTO and MORTISTO by 0.65%,0.60%and 0.80%,respectively.Furthermore,the role of nursestaffing level in increasing overall HCQI were simulated at the highest level in Sweden(-3.53),Denmark(-3.31),Canada(-2.59),Netherlands(-2.33),Finland(-2.09),Switzerland(-1.72),Australia(-1.64)and United States(-1.53).Conclusion:A higher proportion of nurses-staffing level is associated with higher quality of acute care services in OECD countries.Also,the nursing characteristics of Sweden,Denmark,Canada,Netherlands,Finland,Switzerland,Australia and United States would be good patterns for other countries to maximize nursing outcomes in the care of patients with acute and life-threatening conditions by reducing the risk of complication,mortality and adverse clinical outcomes.

Practical Experience of Establishing German Standard Level 1 Perinatal Center in Chongqing Health Care for Women and Children

Germany,as a western developed country,has an advanced medical level,especially in the health care of very immature premature infants.We trace the medical history of perinatology to understand the development of perinatal centers in Germany.After analyzing the classification and function,hierarchical management and quality control systems of German perinatal centers,we established a German standard level 1 perinatal center in the Chongqing Health Center for Women and Children(CHCWC).During more than two years of practice,we changed concepts,continuously updated clinical knowledge and skills,developed a series o f high-quality work processes and supervision systems and introduced advanced medical equipment.We believe that the experience of establishing a German standard level 1 perinatal center and perinatal center network in Chongqing is worthy of being promoted to the Chinese maternal and child health care system.

Improvement of the Legal System for Addressing the Issue of Elderly Care in China in the Context of Population Aging

Rapid population aging is a social reality facing China at present,and the issue of elderly care has become a hot topic of social concern.Legislation to address the issue of elderly care in the context of population aging should follow systematic concepts to achieve“vertical and horizontal integration.”In terms of content,it is necessary to formulate specific legal approaches around“the elderly and children,”with a focus on guaranteeing the livelihood and protection of the rights of the elderly while taking into account childbirth,employment and other issues.the laws should not only safeguard the social participation and labor rights of the elderly,but also effectively respond to the social challenges brought about by the aging of the population.It is also necessary to optimize the family planning policy to ease the burden of child-raising,improve the population structure and promote the long-term balanced development of the population,thus fundamentally solving the problem of population aging.the effort to improve the legal system to deal with the issue of elderly care in the context of population aging will better advance Chinese modernization.

基于全流程仿真创伤救治模拟演练下的县域医院创伤救治现状分析

目的通过仿真创伤全流程早期救治模拟演练分析我国县域医院创伤救治能力现状。方法2018年7月—2022年7月在全国40家县域医院举办了中国创伤救治培训基层版(China trauma training basic,CTCT?-B),培训包括仿真的创伤早期全流程救治模拟演练。本研究对演练中创伤院前急救、院前院内信息联动、院内早期评估与处置、院内救治模式和流程、影响救治结局因素等进行归纳统计分析。结果40家县域医院,其中二级医院29家,三级医院11家;院前急救模式:依托型32家,指挥型6家,独立型2家;院前急救能力方面:院前规范处置31家,不规范处置7家,不处置2家;院前院内信息联动方面:电话/微信24家,院前急救系统8家,中国创伤联盟紫云系统6家,无信息交互2家;院内交接和早期评估:能够按照创伤救治规范化培训要求进行评估和处置23家,不规范17家;创伤救治模式方面:以急诊科为主导的多学科会诊模式34家,创伤科主导的创伤救治模式4家,专科主导多学科会诊模式2家;实体创伤病房6家,急诊病房23家,无病房11家;40名模拟创伤患者16人死亡,其余存活,死亡原因为早期评估和处置不规范,输血流程不合理、创伤相关核心技术缺乏,有效运行的创伤多学科团队缺乏。结论县域创伤救治过程中存在创伤早期评估和核心技术不足、缺乏院内高效的多学科救治团队、创伤集中收治模式尚未普及等问题,亟须重视解决。

基于诉求溯源定制护理方案对糖尿病患者血糖水平与并发症的影响

目的探讨基于诉求溯源定制护理方案对糖尿病患者血糖水平、自我管理能力水平、并发症发生率以及生活质量的影响。方法选择2020年10月—2022年9月就治于医院的2型糖尿病患者100例为研究对象,按照组间基本特征匹配的原则分为观察组和对照组,每组50例。对照组患者遵循2型糖尿病常规护理方法实施干预,观察组患者采用基于诉求溯源定制护理方案实施干预,比较两组患者干预前后空腹血糖、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)水平、自我管理能力评分、并发症发生率、糖尿病特异性生存质量量表(DSQL)评分。结果两组患者护理干预前血糖水平的比较,差异均无统计学意义(P>0.05);观察组患者实施基于诉求溯源定制的护理方案后,各项血糖水平低于对照组,差异均有统计学意义(P<0.05)。两组患者护理干预前自我管理能力评分比较,差异无统计学意义(P>0.05);观察组患者实施基于诉求溯源定制的护理方案后自我管理能力评分高于对照组,经比较差异具有统计学意义(P<0.05)。观察组患者实施基于诉求溯源定制的护理方案后糖尿病视网膜病变、糖尿病足、糖尿病高渗昏迷等并发症总发生率低于对照组,经比较有统计学意义(P<0.05)。两组患者护理干预前糖尿病特异性生存质量量表中生理功能、心理健康、社会关系、治疗情况比较,差异无统计学意义(P>0.05);观察组患者实施基于诉求溯源定制的护理方案后糖尿病特异性生存质量量表中各维度评分均低于对照组,经比较差异具有统计学意义(P<0.05)。结论诉求溯源定制护理方案应用于糖尿病患者,有利于患者控制其血糖水平,提高其自我管理能力和生活质量,降低并发症的发生率。

县域医共体医防融合实现机制与典型路径

目的:构建县域医共体医防融合实现机制,总结医防融合的典型路径,为其他地区开展基层医防融合提供借鉴和参考。方法:基于扎根理论并借助Nvivo软件进行数据编码及定性分析。结果:确定县域医共体开展医防融合的7个核心维度为体系融、管理融、服务融、人员融、信息融、绩效融和资金融,在实践中仅有少数县域医共体实现了较多维度的融合。结论:将服务融、管理融、信息融放在开展医防融合的首要位置,注重体系融和资金融的均衡设置,参考县域医共体医防融合实践的典型路径,进一步推动医防融合的发展。

社区慢性病共病患者自我同情现状及影响因素分析

目的了解社区慢性病共病患者自我同情现状及其影响因素,为护理人员采取针对性措施促进社区慢性病共病患者的身心健康发展提供科学依据。方法采用一般资料调查问卷、自我同情量表、Herth希望量表和领悟社会支持量表对社区402例慢性病共病患者进行调查。结果社区慢性病共病患者的自我同情得分(79.04±7.82)分。多元线性逐步回归分析显示,希望水平和领悟社会支持水平是社区慢性病共病患者自我同情的影响因素(均P<0.05)。结论社区慢性病共病患者自我同情处于中等水平,护理人员应加强患者自我同情的识别与干预,制订针对性护理方案,充分调动患者及其家庭对慢性病共病相关身心健康管理的积极性,以提升社区慢性病共病患者的自我同情水平。

智慧健康养老产业的现实需求与发展进路

智慧健康养老产业高质量发展是深入实施健康中国战略和积极应对人口老龄化国家战略的重要内容。基于智慧健康养老产业的供需分析框架,分析智慧健康养老产业的现实需求、供给现状,发现智慧健康养老产业供给不平衡、不充分,产业链环节衔接不当,智慧健康养老产品的数字鸿沟难以跨越,智慧健康养老服务的专业人才匮乏,政府和市场的协同合作机制不健全等。据此提出以需定供,提升产业供给质量;整合优势,构建稳定高效产业链;智享养老,推进数字无障碍建设;人才为本,夯实高素质专业队伍;协同发力,推动有效市场和有为政府更好结合等。

分阶段护理在达芬奇机器人辅助肺癌根治术患者中的应用

目的分析基于德尔菲法的分阶段护理在达芬奇机器人辅助肺癌根治术患者中的应用效果。方法选取医院2021年5月至2022年10月收治的87例肺癌患者,均在全麻下接受达芬奇机器人辅助肺癌根治术治疗,依照随机数字表法分为两组,对照组(43例)接受常规护理干预,观察组(44例)在对照组基础上接受基于德尔菲法指导的分阶段护理,比较两组干预前后心理应激反应、生理应激反应、癌因性疲乏程度、生活质量。结果术前30 min,两组14项汉密尔顿焦虑量表(HAMA)、17项汉密尔顿抑郁量表(HAMD)评分均降低,且观察组低于对照组(P<0.05);术前30 min,两组心率、收缩压、舒张压水平均升高,但观察组较对照组低(P<0.05);干预后,观察组Piper疲乏量表(PFS)评分低于对照组,肺癌患者生存质量测定量表(FACT-L)评分高于对照组(P<0.05)。结论基于德尔菲法指导的分阶段护理应用于全麻下达芬奇机器人辅助肺癌根治术患者,能有效减少心理、生理应激,缓解癌因性疲乏程度,提高生活质量。

基于SERVQUAL模型的基层医疗卫生服务质量评价研究

目的:在县域医共体的建设背景下,评价社区卫生服务中心服务质量及影响因素,提出基层医疗卫生服务质量改善对策。方法:运用SERVQUAL模型,从社区卫生服务中心服务质量的有形性、可靠性、响应性、信任性、移情性方面,形成问卷条目;通过多因素二分类logistic回归探索筛查服务质量差距的影响因素;借助IPA象限图呈现居民对社区卫生服务中心的SERVQUAL模型各维度服务质量重要性的分布情况。结果:问卷各项条目的服务质量差距均为负值,服务保证性和移情性维度的服务质量差距得分最高,分别为-0.47±0.59分和-0.47±0.65分;服务有形性维度的服务质量差距得分最低,为-0.40±0.55分。年龄、收入情况和慢病年限是服务质量差距的影响因素。结论:当前基层医疗卫生服务质量与居民的期望之间存在一定差距,基层医疗卫生服务机构应重视对低年龄、高收入和慢病病程较长的居民的服务需求。

阶段性术前心理护理联合肠内营养支持在食道癌患者中的应用

目的:探究阶段性术前心理护理联合肠内营养支持在食道癌患者中的应用效果。方法:选取2022年3月—2023年6月南通大学附属医院收治的97例食道癌患者作为研究对象,按照干预方案不同分为对照组(n=48例)和研究组(n=49例)。对照组给予常规肠内营养支持方案,研究组在对照组基础上联合使用阶段性术前心理护理干预。比较两组干预前后心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、希望水平(Herth希望量表)、生活质量[生活质量综合评定问卷(GQOLI-74)]。结果:干预后,研究组SAS和SDS评分均低于对照组,差异有统计学意义(P<0.05);干预后,研究组Herth希望量表各维度评分均高于对照组,差异有统计学意义(P<0.05);干预后,研究组GQOLI-74量表各维度评分均高于对照组,差异有统计学意义(P<0.05)。结论:在给予肠内营养支持的基础上联合使用阶段性术前心理护理,不仅可以改善食道癌患者的心理状态,还可以提高患者的希望水平和生活质量。

口腔专科医院非计划二次手术的回顾性分析

目的探讨口腔专科医院非计划二次手术发生的特点及影响因素。方法选取北京大学口腔医院2016—2021年所有二次手术患者信息,对非计划二次手术的病种、发生原因等进行统计分析,通过logistic回归进一步分析舌恶性肿瘤非计划二次手术的相关性因素。结果2016—2021年共发生非计划二次手术468例(1.17%),与第一次手术的间隔时间为0~20 d。构成比排在前3位的病种为颌面部恶性肿瘤、颌面部良性肿瘤、颌面部感染,导致非计划二次手术的主要原因为皮瓣血管危象、手术后血肿出血,占比为90.17%(422/468)。非计划二次手术组男性319例,女性149例,男女之比为2.14∶1,年龄53.00(36.00,62.00)岁,住院时间14.00(12.00,18.00)d,总费用为68694.91(51773.01,89850.04)元;对照组男性19932例,女性19495例,年龄31.00(18.00,53.00)岁,住院时间7.00(4.00,10.00)d,总费用为12338.96(8869.90,28650.17)元,比较差异有统计学意义(P<0.05)。非计划二次手术术式以有皮瓣为主,占比为76.07%。2016—2021年三四级手术中非计划二次手术发生率为3.62%(397/10966),高于一二级手术的0.25%(71/28929)。年龄、饮酒史、高血压、皮瓣手术是影响舌恶性肿瘤非计划二次手术的主要危险因素(P<0.05)。结论应针对口腔颌面外科专业非计划二次手术危险因素,加强围手术期和手术分级管理,以提升医疗质量。

乙肝肝硬化患者心理危机感水平及其相关影响因素分析

目的:探讨乙肝肝硬化(HBC)患者心理危机感水平的影响因素,以指导临床拟定干预措施。方法:选取2021年1月—2022年12月莆田学院附属医院收治的78例HBC患者作为研究对象。评估所有患者的心理危机感水平[危机干预分类评估表(TAF)],设计基线资料调查表,详细统计所有患者的基线资料,比较不同资料特征HBC患者的TAF评分,重点分析HBC患者心理危机感水平的影响因素。结果:78例HBC患者的平均TAF评分为(44.65±5.82)分。不同病程、家庭关怀度、心理弹性及文化水平HBC患者的TAF评分比较,差异有统计学意义(P<0.05)。不同家庭月人均收入、工作、居住地、年龄、婚姻状况及性别HBC患者的TAF评分比较,差异无统计学意义(P>0.05)。经多元线性回归分析发现,HBC患者心理危机感水平的影响因素为文化水平低、家庭关怀度低、心理弹性低下及病程短(P<0.05)。结论:HBC患者心理危机感处于中等水平,HBC患者心理危机感水平的影响因素为文化水平低、家庭关怀度低、心理弹性低下及病程短。

风险等级防控护理对重症肺炎俯卧位通气治疗患者安全性与疗效的影响

目的 探究风险等级防控护理在重症肺炎俯卧位通气治疗患者中的临床应用效果。方法 抽选南通三院在2018年8月—2023年3月期间收治的81例重症肺炎俯卧位通气治疗患者作为观察对象,随机分为对照组和观察组,对照组40例实施常规重症监护室护理措施,观察组41例实施风险等级防控护理措施,于干预前、干预14 d后,对两组患者动脉血气、呼吸力学、临床指标及并发症发生情况进行分析对比。结果 干预前,两组患者动脉血气、呼吸力学等指标相比,差异不具有统计学意义(P>0.05);干预14 d后,两组动脉血气、呼吸力学指标高于干预前,且观察组在动脉血氧分压(PaO2)、肺总量(TLC)、动态顺应性(Cdyn)等指标高于对照组,气道峰值(PIP)低于对照组(P<0.05);观察组在机械通气时间、咳嗽、ICU治疗时间、平均住院时间均低于对照组(P<0.05);观察组在营养不良、呼吸机相关肺炎、呼吸衰竭、压力性损伤等并发症发生率低于对照组(P<0.05)。结论风险等级防控护理有助于改善重症肺炎俯卧位通气治疗患者动脉血气、呼吸力学等指标,缩短机械通气、ICU治疗、平均住院时间,降低机体各器官衰竭评分,减少并发症发生。