Newborn Care Practices in Urban Slums of Lucknow City, UP

Objectives:

To study the knowledge and practices related to newborn care in urban slums of Lucknow city, UP, and to identify critical behaviors, practices, and barriers that influence the survival of newborns.

Materials and Methods:

A cross-sectional study in urban slums of Lucknow city, UP, included 524 women who had a live birth during last 1 year preceding data collection. Data were analyzed using statistical software SPSS 10.0 for windows.

Results:

Study findings showed that about half of the deliveries took place at home. Majority (77.1%) of the mothers believed that baby should be bathed with warm water and dried with clean cloth and 79.7% mothers practiced it. Only 36.6% mothers initiated breast-feeding within 1 h of birth and 30.2% initiated after 1 day. The mothers who have not given colostrum to their baby, in majority the reason was customs.

Conclusion:

In majority of cases, correct knowledge and correct practices regarding newborn care were lacking among mothers and this should be promoted through improved coverage with existing health services.     

Community Supported Agriculture Programs: A Novel Venue for Theory-Based Health Behavior Change Interventions

Local foods programs such as community supported agriculture programs (CSAs) and farmers’ markets have increased greatly in popularity. However, little research has been conducted regarding the effect of involvement in local foods programs on diet-related attitudes and behaviors. A series of focus groups was conducted to identify the motives that propel individuals to join a CSA, the experiences of belonging to a CSA, and the diet-related outcomes of CSA membership. Using the Theory of Planned Behavior (TPB) as a framework to categorize findings, data suggest the potential of CSAs as a viable intervention strategy for promoting healthful diets and behaviors.     

The Use of Behavior Change Theories in Dietetics Practice in Primary Health Care: A Systematic Review of Randomized Controlled Trials

BackgroundBehavior change theories frameworks provide the theoretical underpinning for effective health care. The extent to which they are applied in contemporary dietetics interventions has not been explored.ObjectiveTo systematically review the evidence of behavior change theory-based interventions delivered by credentialed nutrition and dietetics practitioners in primary health care settings.MethodsMedline, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, and Cochrane databases were searched for English language, randomized controlled trials before August 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Eligible interventions included adults (aged ≥18 years) receiving face-to-face dietetics care underpinned by behavior change theories in primary health care settings with outcome measures targeting changes in health behaviors or health outcomes. Screening was conducted independently in duplicate and data were extracted using predefined categories. The quality of each study was assessed using the Cochrane Risk of Bias tool. The body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual Conclusion Grading Table.ResultsThirty articles reporting on 19 randomized controlled trials met the eligibility criteria, representing 5,172 adults. Thirteen studies (68%) showed significant improvements for the primary outcome measured. Social cognitive theory was the behavior change theory most commonly applied in interventions (n=15) with 11 finding significant intervention effects. Goal setting, problem solving, social support, and self-monitoring were the most commonly reported techniques (n=15, n=14, n=11, and n=11, respectively). Most studies had a high (n=11) or unclear (n=8) risk of bias. There was fair evidence (Grade II) supporting the use of behavior change theories to inform development of dietetics interventions.ConclusionsInterventions delivered by credentialed nutrition and dietetics practitioners that were underpinned by behavior change theories and utilizing various behavior change techniques were found to have potential to be more effective at improving patient health outcomes than dietary interventions without theoretical underpinnings. Findings from this review should inform future primary health care research in the area of dietary behavior change. In addition, findings from this review highlight the need for stronger documentation of use of behavior change theory and techniques that map on to the theory within dietetics practice.     

Quality of Hospital Communication and Patient Preparation for Home Health Care: Results From a Statewide Survey of Home Health Care Nurses and Staff

Objectives

To evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff.

The Dynamics of Community Health Care Consolidation: Acquisition of Physician Practices

Context

Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems.

Methods

We used key informant interviews, supplemented by document analysis.

Findings

The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future.

Conclusions

In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices.     

The Effects of Prenatal Care Utilization on Maternal Health and Health Behaviors

While many economic studies have explored the role of prenatal care in infant health production, the literature is sporadic on the effects of prenatal care on the mother. This research contributes to this understudied but important area using a unique large dataset of sibling newborns delivered by 0.17 million mothers. We apply within‐mother estimators to find robust evidence that poor prenatal care utilization due to late onset of care, low frequency of care visits, or combinations of the two significantly increases the risks of maternal insufficient gestational weight gain, prenatal smoking, premature rupture of membranes, precipitous labor, no breastfeeding, postnatal underweight, and postpartum smoking. The magnitude of the estimates relative to the respective sample means of the outcome variables ranges from 3% to 33%. The results highlight the importance of receiving timely and sufficient prenatal care in improving maternal health and health behaviors during pregnancy as well as after childbirth. Copyright © 2016 John Wiley & Sons, Ltd.     

北京市密云县农村已婚育龄妇女生殖道感染现状和求医行为分析

目的:了解农村已婚育龄妇女生殖感染现状和求医行为,为制定有效的干预措施提供依据。方法:采用分层-整群抽样的方法抽取样本人群,采用统一的方法进行问卷调查、临床检查和实验室检查。结果:①RTI总患病率为49％,其中常见RTI的患病率为21.4％,性病为2.71％,HIV阳性率为0.04％(确证了1例HIV阳性患者);②RTI患者中无症状的比例为34.76％,有症状且就诊的比例为57.49％,就诊者中遵医嘱治疗的比例为10.90％。结论:农村已婚育龄妇女RTI的患病率高,求医意识淡漠,遵医嘱治病率低。在防治工作中应因地制宜,综合干预。     

Equity in Health Care from a Communitarian Standpoint

Equity in health and health care is animportant issue. It has been proposed that thepursuit of equity in health care is beinghampered by the dominance of individualism inhealth care practices. This paper explores theway in which communitarian ideals and practicesmight lend themselves to the pursuit of equity.Communitarians acknowledge, respect and fosterthe bonds that unite and identify communities.The paper argues that, to achieve equity inhealth care, these bonds need to be recognisedand harnessed rather than ignored. The notionof individual autonomy in the context of thecommunity is examined. Alternative concepts ofautonomy – social autonomy and communityautonomy – are seen to be more respectful andnurturing of both the individual and thecommunity. Moreover, these concepts appeardesirable for the pursuit of health care equitygoals. The paper concludes with some thoughtsabout how equity in Australia's health caresystem can reasonably progress within acommunitarian vision. Disadvantaged communitiesare discussed throughout, in particular,Australian Aboriginal communities.     

社区产妇产后保健的市场开发策略分析

从市场分析的角度探讨了开展社区产妇产后保健的潜在市场并作了市场细分,探讨了产妇产后保健市场形成的障碍,并提出了相应的市场开发策略,为社区卫生服务脆弱人群保健功能的切实落实探索一条在技术和经济上可行的途径。     

现阶段城市社区预防保健服务评价指标研究

目的建立社区预防保健等公共卫生服务评价指标体系,提高社区卫生服务管理的科学化水平,确保社区公共卫生服务目标的实现。方法采用文献研究法和专家深入访谈法相结合的研究方法。结果建立的评价体系由一级指标、二级指标和权重、分值等构成。结论本评价体系较适用于现阶段城市社区公共卫生卫生服务的评价,评价指标体系应随着社区卫生服务的发展不断调整和完善。     

Study of Prevalence and Response to Needle Stick Injuries among Health Care Workers in a Tertiary Care Hospital in Delhi, India

Background:

Because of the environment in which they work, many health care workers are at an increased risk of accidental needle stick injuries (NSI).

Objective:

To study prevalence and response to needle stick injuries among health care workers.

Materials and Methods:

Study Design: Cross-sectional study. Setting: A tertiary care hospital in Delhi. Participants: 322 resident doctors, interns, nursing staff, nursing students, and technicians. Statistical Analysis: Proportions and Chi-square test.

Results:

A large percentage (79.5%) of HCWs reported having had one or more NSIs in their career. The average number of NSIs ever was found to be 3.85 per HCW (range 0-20). 72 (22.4%) reported having received a NSI within the last month. More than half (50.4%) ascribed fatigue as a cause in their injury. Most of the injuries (34.0%) occurred during recapping. In response to their most recent NSI, 60.9% washed the site of injury with water and soap while 38 (14.8%) did nothing. Only 20 (7.8%) of the HCWs took post-exposure prophylaxis (PEP) against HIV/AIDS after their injury.

Conclusions:

The occurrence of NSI was found to be quite common. Avoidable practices like recapping of needles were contributing to the injuries. Prevention of NSI is an integral part of prevention programs in the work place, and training of HCWs regarding safety practices indispensably needs to be an ongoing activity at a hospital.     

广州市某区2007年社区预防保健服务评价探索与实践

目的通过对社区卫生服务机构提供的社区预防保健等公共卫生服务项目进行评价,核拨社区预防保健等公共卫生服务补助经费,引导社区卫生服务机构健康发展。方法组织专家成立社区公共卫生服务评价小组,对9家社区卫生中心(站)进行了社区预防保健等公共卫生服务评价。结果各社区卫生服务机构社区预防保健等公共卫生服务评价分数相差悬殊(32.5～84.5分),其中社区卫生服务中心评价分数(56分)比社区卫生服务站(48分)高。结论本评价体系较适用于现阶段城市社区公共卫生服务的评价,有助于保证政府"购买服务"政策的实施。     

Observation of Hand Hygiene Practices in Home Health Care

ObjectiveTo describe nurse hand hygiene practices in the home health care (HHC) setting, nurse adherence to hand hygiene guidelines, and factors associated with hand hygiene opportunities during home care visits.DesignObservational study of nurse hand hygiene practices.Settingand Participants: Licensed practical/vocational and registered nurses were observed in the homes of patients being served by a large nonprofit HHC agency.MethodsTwo researchers observed 400 home care visits conducted by 50 nurses. The World Health Organization's “5 Moments for Hand Hygiene” validated observation tool was used to record opportunities and actual practices of hand hygiene, with 3 additional opportunities specific to the HHC setting. Patient assessment data available in the agency electronic health record and a nurse demographic questionnaire were also collected to describe patients and nurse participants.ResultsA total of 2014 opportunities were observed. On arrival in the home was the most frequent opportunity (n = 384), the least frequent was after touching a patient's surroundings (n = 43). The average hand hygiene adherence rate was 45.6% after adjusting for clustering at the nurse level. Adherence was highest after contact with body fluid (65.1%) and lowest after touching a patient (29.5%). The number of hand hygiene opportunities was higher when patients being served were at increased risk of an infection-related emergency department visit or hospitalization and when the home environment was observed to be “dirty.” No nurse or patient demographic characteristics were associated with the rate of nurse hand hygiene adherence.Conclusions and ImplicationsHand hygiene adherence in HHC is suboptimal, with rates mirroring those reported in hospital and outpatient settings. The connection between poor hand hygiene and infection transmission has been well studied, and it has received widespread attention with the outbreak of SARS-CoV-2. Agencies can use results found in this study to better inform quality improvement initiatives.     

新医改背景下杭州市社区卫生服务满意度及需求的调查分析

目的 了解新医改背景下杭州市居民对社区卫生服务的满意度水平及服务需求.方法 分层随机抽取了杭州市下城区、拱墅区、余杭区三个地区,并分别于三个区中随机抽取1个社区卫生服务中心进行拦截式满意度问卷调查,每个社区分别调查70例当天的就诊居民,共210例.结果 了解和熟悉新医改的居民为0.5％,社区卫生服务总体满意度为33.3％,最需要的社区卫生服务是常见病诊治和配药服务.结论 杭州市社区卫生服务的总体满意度和社区医师的主动服务意识有待提高,“强基层”重在“强人才”,落实基本药物制度和新医改需要舆论助推.     

Sun Protection Policies and Practices at Child Care Centers in Massachusetts

We assessed the relationship between sun protection policies and practices at child care centers in Massachusetts. We hypothesized that centers with sun protection policies were more likely to have regular sun protection practices in place compared to centers without these policies. We conducted a telephone survey with directors or assistant directors at 327 child care centers during the summer of 2002. The main outcome measure was sun protection practices, which included time spent outside during mid-day and the use of sunscreen, hats, and protective clothing by the majority of children assessed over the last 5 program days. The 36-item survey also inquired about the center’s sun protection policy and included demographic questions. Most centers (73%) reported having a written sun protection policy. Sun protection policies were positively associated with reported sunscreen (χ²=14.63, p = 0.0001) and hat use (χ²=30.98, p < 0.0001) and inversely associated with time outside (χ²=10.76, p = 0.001). Seventy-seven percent of centers followed recommended sunscreen practices. However, centers were far less likely to have recommended hat use (36%) and protective clothing (1.5%) practices. A formal sun protection policy may be an effective way to increase sun protection practices in the child care setting. Further research should assess this relationship in other states. Improving and expanding existing state regulations may be a reasonable strategy to increase sun protection at child care centers. Stacey A. Kenfield is a doctoral candidate in the Epidemiology Department, Harvard School of Public Health, Boston, MA; Alan C. Geller is Research Associate Professor in the Department of Dermatology at the Boston University School of Medicine, Boston, MA; Elizabeth M. Richter is Cancer Prevention and Control Director, Bureau of Family and Community Health, Massachusetts Department of Public Health, Boston, MA; Steve Shuman is Health Specialist for ACF Region 1 Head Start Quality Initiative, Boston, MA; David O’Riordan is Assistant Professor at the Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI; Howard K. Koh is Harvey V. Fineberg Professor of the Practice of Public Health, Division of Public Health Practice, Harvard School of Public Health, Boston, MA; Graham A. Colditz is Professor of Medicine at Harvard Medical School, Boston, MA.     

新疆克拉玛依区社区卫生服务中心的服务状况分析

对新疆克拉玛拉市克拉玛依区的社区卫生服务状况进行了调查。结果显示,近年来克拉玛依区的社区卫生服务已有较大的发展,基本得到了社区居民和病人的认可。但是,社区卫生服务中心的人才引入与培养、功能的完善、药品的合理使用、学科发展和就诊设施与环境的改善仍需关注。我国各级政府应对边疆地区社区卫生的发展,给予更多的技术支持和特殊的人事政策。对新疆克拉玛拉市克拉玛依区的社区卫生服务状况进行了调查。结果显示,近年来克拉玛依区的社区卫生服务已有较大的发展,基本得到了社区居民和病人的认可。但是,社区卫生服务中心的人才引入与培养、功能的完善、药品的合理使用、学科发展和就诊设施与环境的改善仍需关注。我国各级政府应对边疆地区社区卫生的发展,给予更多的技术支持和特殊的人事政策。     

社区卫生服务机构在产前筛查网络管理中的实践体会

青岛市李沧区建立并完善以基层社区卫生服务机构为网底,以区级妇幼保健机构为枢纽,以市级产前诊断中心为技术支撑的三级产前筛查管理网络。不断加强社区网底建设,充分发挥基层社区在出生缺陷防治中的优势,依托基本公共卫生服务,从建立《母子健康手册》开始,以健康教育与健康促进为有力抓手,落实好产前筛查的宣传告知、高风险人群初筛、孕期督促筛查及产后妊娠结局随访等工作,将社区基本公共卫生服务与出生缺陷产前筛查服务紧密结合,可有效提高孕妇产前筛查知晓率、参与率和产前诊断率,有效减少先天缺陷儿出生。     

陕西部分农村社区围产保健质量对母亲喂养行为的影响

为了解围产保健质量对母亲喂养行为的影响,分别对陕西省富平,澄城两县农村社区的围产保健质量和母亲喂养行为进行对比研究,结果显示澄城县围产保健质量较好,母乳喂养及辅食添加情况也优于富平县,经统计学处理,两者有显著性差异（P＜0．005）,故认为围产保健质量高可改进母亲喂养行为,应重视农村社区围产保健工作,特别应加强母乳喂养及辅食添加新知识的宣传教育工作。