Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in Myanmar.Methods:A total of 30 CHNs from t...Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in Myanmar.Methods:A total of 30 CHNs from township health centers in the northeastern,southern,and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews.Quantitative data were processed using Microsoft Excel software,and qualitative data were analyzed using thematic analysis.This study is registered with researchregistry6201.Results:Around the country,30 CHNs uncovered their hardships in implementing primary health care to achieve UHC.Over 90%of the participants agreed to the problem of inadequate health infrastructure,while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion.Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services.Complications are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidencebased practices.Insecure work and living conditions,unsupportive community relationships,and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC.Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs.Conclusion:Myanmar’s CHNs face many challenges in achieving UHC.These challenges are not confined to the health sector.Some situations,such as geographical barriers and transportation problems,remain persistent challenges for healthcare providers.This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure.Meanwhile,public empowerment plays a critical role in promoting health development.展开更多
In China, with the restructuring of health care system moving forward, private community health facilities have been playing a complementary but increasingly important role in providing public health and basic medical...In China, with the restructuring of health care system moving forward, private community health facilities have been playing a complementary but increasingly important role in providing public health and basic medical care services in urban areas. However, only limited evidence is available con-cerning the service functions of private community health facilities in China. The aim of this study was to explore the functions of private community health stations (PCHSs) to provide evidence-based rec-ommendations for policy-making and practice in the development of urban community health services systems. A total of 818 PCHSs and 4320 government-sponsored community health stations (GCHSs) located in 28 cities of China were investigated in 2008. The percentages of stations that provided health services and the annual workload per community health worker (CHW) were compared between the two types of institutions. The results showed that the percentages of PCHSs providing public health services were significantly higher than those of GCHSs (P<0.05); but no significant differences were found in the percentages of basic medical services providing between PCHSs and GCHSs (P>0.05). The annual workloads of all the public health services and basic medical services per CHW in PCHSs were lighter than those in GCHSs (P<0.05), except for resident health records establishment and health education materials distribution (P>0.05). At present, the GCHSs are still the mainstream in urban China, which will last for a long period in future. However, our findings showed that the annual workloads of CHWs in PCHSs were no heavier than those in GCHSs, and the PCHSs were willing to provide public health services. In view of current inadequacy of health resources in China, it is feasible to further develop PCHSs under the guidance of the government, given that PCHSs can perform the basic functions of community health services, which is useful for the formation of public-private partnerships (PPP) and the improvement of community health services.展开更多
This is a review paper that brings to focus, concepts of Community Health Practice that connect Community Health Practitioners’ Roles to National development in view of its composite index improvement measure of soci...This is a review paper that brings to focus, concepts of Community Health Practice that connect Community Health Practitioners’ Roles to National development in view of its composite index improvement measure of social welfare services provision among others for the citizens of a country over time, with particular emphasis on medical care component of such index aimed at reduction in diseases and poverty in the population. The objective of the review work is to determine the extent to which Community Health Practice, particularly by Community Health Practitioners is capable of ensuring National Development in democratic governance or otherwise, in the context of our country, Nigeria. The methodology applied was traditional review of published literatures concerning the subject and findings of operational research of programme implemented by Community Health Practitioners at the Primary Health Care facilities and household level in the communities. This paper emphasizes on Primary Health Care services delivery contribution to National Development, since it is the level where Community Health Practitioners are mainly commissioned to render their services. Home-Based Care Strategy for Integrated Maternal, Newborn and Child Health piloted in three (3) local government areas (Ahoada West, Etche and Oyigbo) in Rivers State, Nigeria, in 2012 and implemented by Community Health Practitioners, aimed at reducing maternal, newborn and child morbidity and mortality by 20% by 2015 in line with the United Nations (UN) Millennium Development Goals 4 and 5, had been shown to achieve an average of 26% improvement in utilization of maternal and newborn health services, an average of 27% overall reduction in maternal malnutrition status, an average of 14% overall improvement in under 5 years malnutrition status among others in 2013 on comparing with baseline indicators. Nigeria also attained 80% coverage in routine immunization in most vaccine preventable diseases except Tetanus Toxiod (TT) 2 (54%) in 2013 to achieve herd immunity of the community to prevent transmission of disease pathogen to cause a disease. Community Health Practitioners are the frontline Primary Health Care Professionals charged with the responsibility of implementation of immunization programmes in Nigeria and therefore contributing significantly to the prevention and control of targeted vaccine preventable diseases in Nigeria Health System. Our findings on factors militating against Community Health Practitioners’ Roles in National Development as elicited in this paper may form basis for empirical studies to determine the level of significance of each of these factors. In conclusion, it is when the Community Health parameters are adequately addressed that we can ensure sustainable National Development and we can say we have succeeded in our various strategic agenda of government at whatever level that makes up the complex whole. This brings to fore, the importance of the roles of Community Health Practitioners in health care delivery to National Development in the context of our country, Nigeria.展开更多
The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of Natio...The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.展开更多
As dehydration is related to negative health outcomes in the elderly,including an increased risk of disability and death,prevention may help improve health,functional status,and quality of life.Dehydration diagnosis c...As dehydration is related to negative health outcomes in the elderly,including an increased risk of disability and death,prevention may help improve health,functional status,and quality of life.Dehydration diagnosis can be challenging in the elderly as the traditional physical indications of dehydration may be absent or ambiguous.Numerous etiologies place the elderly at an increased risk.The role of the community health nurse(CHN)derives from the responsibilities attached to her,and the Betty Neuman’s Systems Model of health care with three levels of protection is usually applied to the CHN.In this mini-review,we try to integrate the Betty Neuman’s Systems Model with the results of identified articles.This study includes a literature search of reputable international databases such as SpringerLink,PubMed,Embase,and Wanfang,particularly for the period 2005 to the present.Ten articles that met the qualifying criteria were included in this study.The findings of this study draw a picture of the role of CHN in preventing dehydration across the three levels of prevention as mentioned by Betty Neuman.展开更多
Objective:To explore the therapeutic effects of community health management and nursing strategies for elderly hypertensive patients.Methods:A total of 64 elderly hypertensive patients who were treated in our hospital...Objective:To explore the therapeutic effects of community health management and nursing strategies for elderly hypertensive patients.Methods:A total of 64 elderly hypertensive patients who were treated in our hospital from March 2020 to March 2021 were selected.The control group took conventional care and guidance.The research group carried out community health management and nursing strategy guidance on the basis of the control group.Then compare the blood pressure levels of the two groups of patients before and after nursing and the patients’satisfaction with nursing.Results:Through comparison,it can be seen that the diastolic and systolic blood pressure levels of the study group and the control group are not significantly different before nursing.After nursing,the diastolic blood pressure of the patients in the study group was 81.22.1 mmHg and the systolic blood pressure was 126.58.7 mmHg.The diastolic blood pressure of the control group was 90.55.4 mmHg and the systolic blood pressure was 136.412.9 mmHg.There are obvious differences in the comparison of the two sets of data.By comparing the two groups of patients’satisfactions with nursing care,it can be seen that among the 32 patients in the study group:31 were very satisfied and basically satisfied,with a satisfaction rate of 96.87%.Among the 32 patients in the control group,28 were very satisfied and basically satisfied,with a satisfaction rate of 87.5%.The data of the two groups of patients are clearly comparable.Conclusion:Through community health management and nursing strategies,the satisfaction and treatment effect of elderly hypertensive patients can be improved,thereby contributing to the recovery of patients.展开更多
Background Many studies have demonstrated the effectiveness of Screening,Brief Intervention and Referral to Treatment(SBIRT)in addressing substance use problem.However,owing to the shortage of counsellors,it has not b...Background Many studies have demonstrated the effectiveness of Screening,Brief Intervention and Referral to Treatment(SBIRT)in addressing substance use problem.However,owing to the shortage of counsellors,it has not been widely used in China.With the development of smart medicine,we developed a web-based electronic SBIRT(E-SBIRT)program and explored the effectiveness of E-SBIRT in reducing substance use in China.Methods A randomised controlled trial will be conducted in primary healthcare institutions.Four primary healthcare institutions will be selected and randomly divided into an intervention group and a control group(each institution will recruit 60 participants,and in total,240 participants will be recruited).The control group will get a pamphlet of drug abuse prevention,and the intervention group will get the E-SBIRT intervention and the pamphlet.Both groups will receive baseline and follow-up assessment at 1 and 3 months after the intervention.The primary outcome is the change in scores on the Alcohol,Smoking and Substance Use Involvement Screening Test,and the secondary outcomes include changes in motivation,depression,anxiety,positive/negative emotion,self-esteem,addiction knowledge and addiction severity index.Conclusions If the‘E-SBIRT’program is found to be effective,it will be an accessible,affordable and widely implementable intervention to help participants at moderate risk of substance use to reduce their consumption.The potential benefit is to provide early intervention to high-risk patients in time and reduce the harmful consequences to individuals and society.展开更多
Objective: Relaxation technique is a nonpharmacological treatment applied to increase sleep efficiency and the quality of sleep.Hydrotherapy is one of the relaxation techniques and uses warm water to decrease stress a...Objective: Relaxation technique is a nonpharmacological treatment applied to increase sleep efficiency and the quality of sleep.Hydrotherapy is one of the relaxation techniques and uses warm water to decrease stress and muscle stiffness, as well as to warm the body. The incidence of sleep deficiency among older people in Integrated Community Health Services, Pandak I Bantul, has slightly increased year by year. This research aims to evaluate the effect of hydrotherapy on sleep deprivation among older people.Methods: The research was a quasi-experimental study with a pre-post test design. Purposive sampling was used to enroll 66 older people from the Integrated Community Health Services, Pandak I Bantul, Yogyakarta, Indonesia, as a sample, and we divided them into two groups: 33 people formed the intervention group, and 33 people comprised the control group. The intervention group did hydrotherapy once a day for a total of 7 days. First, they soaked their feet in warm water for 10 minutes. The water temperature was adjusted according to the body temperature, to approximately 40.0℃-43.0℃. Then, the intervention group took a bath using warm water. The level of sleep quality was measured using the Pittsburgh Sleep Quality Index(PSQI) questionnaire. Data analysis was done using the Wilcoxon test.Results: The mean score for sleep quality in the pretest in the intervention group was 9.04(standard deviation [SD]: 2.57) and the score on the posttest was 42(SD: 1.43). The mean score for sleep quality in the intervention group was 4.67, with P=0.05.Meanwhile, the research found that the difference between the pretest and posttest scores for quality of sleep in the control group was 0.42, with P=0.059. Wilcoxon analysis found that in the intervention group, there was a significant difference after intervention using hydrotherapy, with P<0.05. In the control group, there was no significance difference between the pretest and posttest scores,with P> 0.05.Conclusions: According to the results of the present study, it appears that the practice of hydrotherapy is effective in reducing sleep deficiency and hence can be considered an effective method of intervention.展开更多
The promotion of physical activity and healthy eating to prevent obesity among youth is a pressing challenge. The current study examined the feasibility of community health workers (CHWs) conducting a physical activit...The promotion of physical activity and healthy eating to prevent obesity among youth is a pressing challenge. The current study examined the feasibility of community health workers (CHWs) conducting a physical activity (PA) and healthy eating intervention strategy with links to community supports and programs. Youth aged 10 - 18 years were recruited from three clinical sites serving inner-city families. Trained CHWs conducted assessment and counseling for PA and healthy eating among youth and their families and provided customized plans and navigation to neighborhood PA and nutrition programs. Measures of daily PA by self-report, weekday and weekend day sedentary behaviors, fruit and vegetable intake, avoidance of fatty foods, and avoidance of sugary drinks were assessed at baseline and follow-up. Twenty-five patients (mean age = 12.9 years) were exposed to ~9 months of intervention from baseline. Pre- and post-assessments revealed significant changes in reported PA, sedentary behaviors on weekdays, sedentary behaviors on weekend days, fruit and vegetable intake, avoidance of fatty foods, and avoidance of sugary drinks. Results demonstrated the feasibility of having CHWs effectively influenced the PA and eating behaviors of inner-city youth. Greater success was evident when assessment and counseling for PA and healthy eating were accompanied by navigation to neighborhood resources. The use of CHWs may be a cost-effective approach impacting the PA, sedentary, and dietary behaviors of youth.展开更多
The emergence of the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) pneumonia, also referred to as COVID-19 in New York City in March 2020, has put an overwhelming strain on the healthcare system in the city. Man...The emergence of the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) pneumonia, also referred to as COVID-19 in New York City in March 2020, has put an overwhelming strain on the healthcare system in the city. Many local hospitals have reported a surge of cases, with most cases presenting with severe respiratory complications. We aim to present a comprehensive surge filter protocol for outpatient programs to mitigate the surge of cases admitted in the emergency rooms and intensive care units (ICUs) of local hospitals in our community. Our surge filter protocol was developed based on a detailed review of how South Korea and Spain mounted their outpatient surge responses. Our preliminary findings revealed that our Four-Ts approach (<em>i.e.</em>, Test, Treat, Track, and Teach) has resulted in none of our patients reaching a clinical requirement for inpatient care.展开更多
This article will investigate on the current needs of community service for residents in Tianjin city by providing nursing services at a targeted community.The demands for community nursing services in Tianjin city we...This article will investigate on the current needs of community service for residents in Tianjin city by providing nursing services at a targeted community.The demands for community nursing services in Tianjin city were investigated by sending questionnaire to targeted general residents and communities.As collected from the questionnaire,the most common diseases that were mentioned are hypertension(33.2%),coronary heart disease(27.8%),and diabetes(15.7%).63.0%of the residents have health records and 79.7%of the residents have seen a doctor in community hospitals.As results,the highest demands on general nursing services in the community are a regular physical examination,health consultations,and regular home visits.Moreover,the control and management service demands specifically for chronic diseases are a regular heart rate examination,blood pressure examination,blood sugar examination,drug administration,and a diet management.In conclusion,as the age structure of community is higher,a higher demand is needed in providing health services such as caring for chronic disease patients and geriatric,which is conducive in improving the quality and the satisfactory needs of health services for residents in Tianjin,China.展开更多
BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T...BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T2DM).Based on conven-tional nursing methods,community home care has important clinical significance in controlling blood sugar and disease progression.AIM To explore the impact of community public health nursing on treatment effect,health cognition,and self-management in patients with T2DM.METHODS One hundred patients with T2DM were selected as the research subjects.The patients were divided into either a conventional nursing group or community nursing(CN)group using the random number table method.The conventional nursing group(50 cases)received routine care,while the CN group(50 cases)received community public health care in addition to routine care as that for the conventional nursing group.The rate of excellent and good blood glucose control,fasting blood glucose before and after care,2-h postprandial blood glucose,health cognition,and self-management ability,and patient satisfaction were compared between the two groups.RESULTS The CN group had a higher rate of excellent blood sugar control than the conventional nursing group(88%vs 70%,P<0.05).Before care,there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients(P>0.05).After nursing,fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups,and both blood glucose levels in the CN group were lower than those of the conventional nursing group(P<0.05).Compared with the scores before care,the cognitive level score for diabetes and self-management ability score improved after care in both groups.The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group(P<0.05).The overall satisfaction of the CN group was better than that of the conventional nursing group(98%vs 86%,P<0.05).CONCLUSION Community public health care based on conventional care of T2DM can achieve better blood sugar control,and improve patients’health cognitive level and self-management ability.展开更多
Objective: To explore the application effect of optimizing the nursing model in community health centers for elderly health examinations, providing a reference for enhancing the management level of elderly health at t...Objective: To explore the application effect of optimizing the nursing model in community health centers for elderly health examinations, providing a reference for enhancing the management level of elderly health at the grassroots level. Methods: A total of 300 elderly individuals who underwent health examinations at our center from January 2024 to December 2024 were selected as the study subjects. They were randomly divided into a control group and an observation group, with 150 cases in each group. The control group underwent the conventional health examination nursing process, while the observation group adopted an optimized community nursing model, which included stratified education and appointment scheduling before the examination, full-time accompaniment and safety care during the examination, and the establishment of electronic medical records and continuous follow-up after the examination. Differences in health management awareness rates and satisfaction with health examination services between the two groups of elderly individuals were compared. Results: The health management awareness rate in the observation group was 94.67%, significantly higher than that in the control group (78.00%;p < 0.001). The satisfaction rate with health examination services in the observation group was 96.00%, also significantly higher than that in the control group (82.00%;p < 0.001). Conclusion: The optimized community nursing model can effectively enhance the health awareness level and service satisfaction of elderly individuals during health examinations, demonstrating strong practicality and promotion value. It contributes to achieving continuity and precision in grassroots elderly health management.展开更多
Diabetes is highly prevalent among the elderly worldwide,with the highest number of diabetes cases in China.Yet,the management of diabetes remains unsatisfactory.Recent advances in digital health technologies have fac...Diabetes is highly prevalent among the elderly worldwide,with the highest number of diabetes cases in China.Yet,the management of diabetes remains unsatisfactory.Recent advances in digital health technologies have facilitated the establishment of smart wards for diabetes patients.There is a lack of smart wards tailored specifically for older diabetes patients who encounter unique challenges in glycemic control and diabetes management,including an increased vulnerability to hypoglycemia,the presence of multiple chronic diseases,and cognitive decline.In this review,studies on digital health technologies for diabetes in China and beyond were summarized to elucidate how the adoption of digital health technologies,such as real-time continuous glucose monitoring,sensor-augmented pump technology,and their integration with 5th generation networks,big data cloud storage,and hospital information systems,can address issues specifically related to elderly diabetes patients in hospital wards.Furthermore,the challenges and future directions for establishing and implementing smart wards for elderly diabetes patients are discussed,and these challenges may also be applicable to other countries worldwide,not just in China.Taken together,the smart wards may enhance clinical outcomes,address specific issues,and eventually improve patient-centered hospital care for elderly patients with diabetes.展开更多
Introduction: Postpartum mental disorders are psychopathological states that affect women after childbirth. These disorders often negatively impact a child’s mental health and the mother-child bond. The objective of ...Introduction: Postpartum mental disorders are psychopathological states that affect women after childbirth. These disorders often negatively impact a child’s mental health and the mother-child bond. The objective of this work was to determine the frequency of mental disorders during the postpartum period at the University Community Health Center of Konobougou in Mali. Methods: This descriptive cross-sectional study took place from March 1 to July 31, 2022, for four months. Results: The study involved 201 immediate postpartum women at the Konobougou Community and University Health Center. The 20-35 age group accounted for 70.00% of the population;the average age was 24 years ± 5.95 years, with a range of 15 to 45 years. Married women made up 96.00% of the sample. The overall frequency of mental disorders was 15.92%. The mental disorders recorded were postpartum depression (5.47%), anxiety disorders (3.98%), postpartum blues (5.47%), and posttraumatic stress disorder (0.50%). Puerperal psychosis was found in 0.50% of the participants. Conclusion: This study revealed a high prevalence of mental disorders among postpartum women in Konobougou, Mali. During postnatal consultations, health workers should prioritize screening for mental health disorders.展开更多
This article examines the progress in the prevention and treatment of Alzheimer’s disease among elderly individuals in communities from the perspective of traditional Chinese medicine(TCM).Through a systematic review...This article examines the progress in the prevention and treatment of Alzheimer’s disease among elderly individuals in communities from the perspective of traditional Chinese medicine(TCM).Through a systematic review of recent related studies,it analyzes new insights into the etiology and pathogenesis of Alzheimer’s disease within TCM and summarizes novel methods and achievements in the prevention and treatment of the disease using TCM.Based on the TCM principles of“preventive treatment”and holistic health,innovative intervention models with Chinese characteristics,such as the“brain-heart-kidney axis”and“brain-gut connection,”have shown new breakthroughs in improving cognitive function and slowing disease progression.The article also explores the benefits of shifting preventive and therapeutic measures to earlier stages,contributing to the establishment of an integrated community prevention model of“prevention-intervention-rehabilitation.”展开更多
BACKGROUND Diabetic ketoacidosis(DKA)remains a serious and potentially preventable complication among children with type 1 diabetes mellitus(T1DM),particularly in Saudi Arabia.Psychological constructs such as perceive...BACKGROUND Diabetic ketoacidosis(DKA)remains a serious and potentially preventable complication among children with type 1 diabetes mellitus(T1DM),particularly in Saudi Arabia.Psychological constructs such as perceived severity and susceptibility influence health behaviour,yet their role in pediatric diabetes management remains underexplored.AIM To examine psychological predictors of DKA in children with T1DM using the health belief model,and to assess the role of caregiver-perceived understanding in influencing adherence and DKA occurrence.METHODS A case-control study was conducted at Prince Sultan Military Medical City in Riyadh,Saudi Arabia,involving 191 caregivers of children with T1DM(96 cases with a history of DKA and 95 controls without).Validated questionnaires measured perceived severity,susceptibility,understanding,and adherence.Statistical analyses included independent t-tests,Pearson and Spearman correlations,and multiple regression.RESULTS Perceived understanding was the strongest predictor of adherence(β=1.03,P<0.001)and was inversely associated with DKA occurrence(P<0.001).Children without a DKA history had significantly higher levels of perceived understanding and adherence.Perceived severity had a moderate positive association with adherence,while perceived susceptibility showed a weak negative correlation.CONCLUSION Caregiver-perceived understanding plays a critical role in adherence and DKA prevention.These findings support expanding the health belief model to include perceived understanding as a distinct construct and highlight the importance of integrating comprehension-focused strategies into pediatric diabetes education.展开更多
According to the data from the 7th national population census,the population aged 65 and above in China has reached 13.50%,indicating that the country has entered a deeply aging society.The health issues of the elderl...According to the data from the 7th national population census,the population aged 65 and above in China has reached 13.50%,indicating that the country has entered a deeply aging society.The health issues of the elderly have become a significant concern for society.Common brain diseases among the elderly,including cerebrovascular diseases,genetic factors,or long-term solitary living,can all lead to dementia,with Alzheimer’s disease(AD)being the most common.Early symptoms of AD mainly include memory loss and difficulty concentrating,which are often mistaken for normal aging or stress-related issues and thus overlooked.AD lacks specific biomarkers and effective auxiliary diagnostic methods,making it difficult to accurately diagnose with existing imaging and neuroprotein indicators.Therefore,early detection of AD is very challenging.This article explores community-based early detection and intervention strategies from the perspectives of existing mechanism research,clinical manifestations,modern drug treatments,innovative explorations in traditional medicine,and community-appropriate technologies,aiming to construct an ecological management strategy.展开更多
Introduction:Having a primary care usual source of care(USC)is associated with better population health outcomes.However,the percent of adults in the United States(US)with a usual primary care provider is declining.We...Introduction:Having a primary care usual source of care(USC)is associated with better population health outcomes.However,the percent of adults in the United States(US)with a usual primary care provider is declining.We sought to identify factors associated with establishing a USC at an urgent care clinic or emergency department as opposed to primary care.Methods:We analyzed data from 57,152 participants in the All of Us study who reported having a USC.We used the Andersen Behavioral Model of Health Services Use framework and multivariable logistic regression to examine associations among predisposing,enabling,and need factors,according to the source of usual care.Results:An urgent care clinic,minute clinic,or emergency department was the source of usual care for 6.3%of our sample.The odds of seeking care at this type of facility increased with younger age,lower educational attainment,and better health status.Black and Hispanic individuals,as well as those who reported experiencing discrimination in medical settings or that their provider was of a different race and ethnicity,were also less likely to have a primary care USC.Financial concerns,being anxious about seeing a provider,and the inability to take time off from work also increased the likelihood of having a non‐primary care USC.Conclusions:Improving the rates of having a primary care USC among younger and healthy adults may be achievable through policies that can improve access to convenient,affordable primary care.Efforts to improve diversity among primary care providers and reduce discrimination experienced by patients may also improve the USC rates for racial and ethnic minority groups.展开更多
基金This work was supported by the Ministry of Health and Sports,Republic of the Union of Myanmar(MOHS IR Grant 2019,Research ID No.501).
文摘Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in Myanmar.Methods:A total of 30 CHNs from township health centers in the northeastern,southern,and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews.Quantitative data were processed using Microsoft Excel software,and qualitative data were analyzed using thematic analysis.This study is registered with researchregistry6201.Results:Around the country,30 CHNs uncovered their hardships in implementing primary health care to achieve UHC.Over 90%of the participants agreed to the problem of inadequate health infrastructure,while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion.Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services.Complications are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidencebased practices.Insecure work and living conditions,unsupportive community relationships,and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC.Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs.Conclusion:Myanmar’s CHNs face many challenges in achieving UHC.These challenges are not confined to the health sector.Some situations,such as geographical barriers and transportation problems,remain persistent challenges for healthcare providers.This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure.Meanwhile,public empowerment plays a critical role in promoting health development.
基金supported by agrant from"The National Urban Community Health Service System Building Project"of the Ministry of Health of China(No.)
文摘In China, with the restructuring of health care system moving forward, private community health facilities have been playing a complementary but increasingly important role in providing public health and basic medical care services in urban areas. However, only limited evidence is available con-cerning the service functions of private community health facilities in China. The aim of this study was to explore the functions of private community health stations (PCHSs) to provide evidence-based rec-ommendations for policy-making and practice in the development of urban community health services systems. A total of 818 PCHSs and 4320 government-sponsored community health stations (GCHSs) located in 28 cities of China were investigated in 2008. The percentages of stations that provided health services and the annual workload per community health worker (CHW) were compared between the two types of institutions. The results showed that the percentages of PCHSs providing public health services were significantly higher than those of GCHSs (P<0.05); but no significant differences were found in the percentages of basic medical services providing between PCHSs and GCHSs (P>0.05). The annual workloads of all the public health services and basic medical services per CHW in PCHSs were lighter than those in GCHSs (P<0.05), except for resident health records establishment and health education materials distribution (P>0.05). At present, the GCHSs are still the mainstream in urban China, which will last for a long period in future. However, our findings showed that the annual workloads of CHWs in PCHSs were no heavier than those in GCHSs, and the PCHSs were willing to provide public health services. In view of current inadequacy of health resources in China, it is feasible to further develop PCHSs under the guidance of the government, given that PCHSs can perform the basic functions of community health services, which is useful for the formation of public-private partnerships (PPP) and the improvement of community health services.
文摘This is a review paper that brings to focus, concepts of Community Health Practice that connect Community Health Practitioners’ Roles to National development in view of its composite index improvement measure of social welfare services provision among others for the citizens of a country over time, with particular emphasis on medical care component of such index aimed at reduction in diseases and poverty in the population. The objective of the review work is to determine the extent to which Community Health Practice, particularly by Community Health Practitioners is capable of ensuring National Development in democratic governance or otherwise, in the context of our country, Nigeria. The methodology applied was traditional review of published literatures concerning the subject and findings of operational research of programme implemented by Community Health Practitioners at the Primary Health Care facilities and household level in the communities. This paper emphasizes on Primary Health Care services delivery contribution to National Development, since it is the level where Community Health Practitioners are mainly commissioned to render their services. Home-Based Care Strategy for Integrated Maternal, Newborn and Child Health piloted in three (3) local government areas (Ahoada West, Etche and Oyigbo) in Rivers State, Nigeria, in 2012 and implemented by Community Health Practitioners, aimed at reducing maternal, newborn and child morbidity and mortality by 20% by 2015 in line with the United Nations (UN) Millennium Development Goals 4 and 5, had been shown to achieve an average of 26% improvement in utilization of maternal and newborn health services, an average of 27% overall reduction in maternal malnutrition status, an average of 14% overall improvement in under 5 years malnutrition status among others in 2013 on comparing with baseline indicators. Nigeria also attained 80% coverage in routine immunization in most vaccine preventable diseases except Tetanus Toxiod (TT) 2 (54%) in 2013 to achieve herd immunity of the community to prevent transmission of disease pathogen to cause a disease. Community Health Practitioners are the frontline Primary Health Care Professionals charged with the responsibility of implementation of immunization programmes in Nigeria and therefore contributing significantly to the prevention and control of targeted vaccine preventable diseases in Nigeria Health System. Our findings on factors militating against Community Health Practitioners’ Roles in National Development as elicited in this paper may form basis for empirical studies to determine the level of significance of each of these factors. In conclusion, it is when the Community Health parameters are adequately addressed that we can ensure sustainable National Development and we can say we have succeeded in our various strategic agenda of government at whatever level that makes up the complex whole. This brings to fore, the importance of the roles of Community Health Practitioners in health care delivery to National Development in the context of our country, Nigeria.
基金The Baseline Survey of "The National Urban Community Health Service System Building Project" was funded by Ministry Of Health of China
文摘The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.
文摘As dehydration is related to negative health outcomes in the elderly,including an increased risk of disability and death,prevention may help improve health,functional status,and quality of life.Dehydration diagnosis can be challenging in the elderly as the traditional physical indications of dehydration may be absent or ambiguous.Numerous etiologies place the elderly at an increased risk.The role of the community health nurse(CHN)derives from the responsibilities attached to her,and the Betty Neuman’s Systems Model of health care with three levels of protection is usually applied to the CHN.In this mini-review,we try to integrate the Betty Neuman’s Systems Model with the results of identified articles.This study includes a literature search of reputable international databases such as SpringerLink,PubMed,Embase,and Wanfang,particularly for the period 2005 to the present.Ten articles that met the qualifying criteria were included in this study.The findings of this study draw a picture of the role of CHN in preventing dehydration across the three levels of prevention as mentioned by Betty Neuman.
文摘Objective:To explore the therapeutic effects of community health management and nursing strategies for elderly hypertensive patients.Methods:A total of 64 elderly hypertensive patients who were treated in our hospital from March 2020 to March 2021 were selected.The control group took conventional care and guidance.The research group carried out community health management and nursing strategy guidance on the basis of the control group.Then compare the blood pressure levels of the two groups of patients before and after nursing and the patients’satisfaction with nursing.Results:Through comparison,it can be seen that the diastolic and systolic blood pressure levels of the study group and the control group are not significantly different before nursing.After nursing,the diastolic blood pressure of the patients in the study group was 81.22.1 mmHg and the systolic blood pressure was 126.58.7 mmHg.The diastolic blood pressure of the control group was 90.55.4 mmHg and the systolic blood pressure was 136.412.9 mmHg.There are obvious differences in the comparison of the two sets of data.By comparing the two groups of patients’satisfactions with nursing care,it can be seen that among the 32 patients in the study group:31 were very satisfied and basically satisfied,with a satisfaction rate of 96.87%.Among the 32 patients in the control group,28 were very satisfied and basically satisfied,with a satisfaction rate of 87.5%.The data of the two groups of patients are clearly comparable.Conclusion:Through community health management and nursing strategies,the satisfaction and treatment effect of elderly hypertensive patients can be improved,thereby contributing to the recovery of patients.
基金This work was supported by the Shanghai Mental Health Center(SMHC)Clinical Research Center Project(CRC2017YB04).
文摘Background Many studies have demonstrated the effectiveness of Screening,Brief Intervention and Referral to Treatment(SBIRT)in addressing substance use problem.However,owing to the shortage of counsellors,it has not been widely used in China.With the development of smart medicine,we developed a web-based electronic SBIRT(E-SBIRT)program and explored the effectiveness of E-SBIRT in reducing substance use in China.Methods A randomised controlled trial will be conducted in primary healthcare institutions.Four primary healthcare institutions will be selected and randomly divided into an intervention group and a control group(each institution will recruit 60 participants,and in total,240 participants will be recruited).The control group will get a pamphlet of drug abuse prevention,and the intervention group will get the E-SBIRT intervention and the pamphlet.Both groups will receive baseline and follow-up assessment at 1 and 3 months after the intervention.The primary outcome is the change in scores on the Alcohol,Smoking and Substance Use Involvement Screening Test,and the secondary outcomes include changes in motivation,depression,anxiety,positive/negative emotion,self-esteem,addiction knowledge and addiction severity index.Conclusions If the‘E-SBIRT’program is found to be effective,it will be an accessible,affordable and widely implementable intervention to help participants at moderate risk of substance use to reduce their consumption.The potential benefit is to provide early intervention to high-risk patients in time and reduce the harmful consequences to individuals and society.
基金supported by the Center of Research and Community Services(PPPM),Stikes Jenderal Achmad Yani,Yogyakarta(No.SPK/039/STIKES/VI/2016)
文摘Objective: Relaxation technique is a nonpharmacological treatment applied to increase sleep efficiency and the quality of sleep.Hydrotherapy is one of the relaxation techniques and uses warm water to decrease stress and muscle stiffness, as well as to warm the body. The incidence of sleep deficiency among older people in Integrated Community Health Services, Pandak I Bantul, has slightly increased year by year. This research aims to evaluate the effect of hydrotherapy on sleep deprivation among older people.Methods: The research was a quasi-experimental study with a pre-post test design. Purposive sampling was used to enroll 66 older people from the Integrated Community Health Services, Pandak I Bantul, Yogyakarta, Indonesia, as a sample, and we divided them into two groups: 33 people formed the intervention group, and 33 people comprised the control group. The intervention group did hydrotherapy once a day for a total of 7 days. First, they soaked their feet in warm water for 10 minutes. The water temperature was adjusted according to the body temperature, to approximately 40.0℃-43.0℃. Then, the intervention group took a bath using warm water. The level of sleep quality was measured using the Pittsburgh Sleep Quality Index(PSQI) questionnaire. Data analysis was done using the Wilcoxon test.Results: The mean score for sleep quality in the pretest in the intervention group was 9.04(standard deviation [SD]: 2.57) and the score on the posttest was 42(SD: 1.43). The mean score for sleep quality in the intervention group was 4.67, with P=0.05.Meanwhile, the research found that the difference between the pretest and posttest scores for quality of sleep in the control group was 0.42, with P=0.059. Wilcoxon analysis found that in the intervention group, there was a significant difference after intervention using hydrotherapy, with P<0.05. In the control group, there was no significance difference between the pretest and posttest scores,with P> 0.05.Conclusions: According to the results of the present study, it appears that the practice of hydrotherapy is effective in reducing sleep deficiency and hence can be considered an effective method of intervention.
文摘The promotion of physical activity and healthy eating to prevent obesity among youth is a pressing challenge. The current study examined the feasibility of community health workers (CHWs) conducting a physical activity (PA) and healthy eating intervention strategy with links to community supports and programs. Youth aged 10 - 18 years were recruited from three clinical sites serving inner-city families. Trained CHWs conducted assessment and counseling for PA and healthy eating among youth and their families and provided customized plans and navigation to neighborhood PA and nutrition programs. Measures of daily PA by self-report, weekday and weekend day sedentary behaviors, fruit and vegetable intake, avoidance of fatty foods, and avoidance of sugary drinks were assessed at baseline and follow-up. Twenty-five patients (mean age = 12.9 years) were exposed to ~9 months of intervention from baseline. Pre- and post-assessments revealed significant changes in reported PA, sedentary behaviors on weekdays, sedentary behaviors on weekend days, fruit and vegetable intake, avoidance of fatty foods, and avoidance of sugary drinks. Results demonstrated the feasibility of having CHWs effectively influenced the PA and eating behaviors of inner-city youth. Greater success was evident when assessment and counseling for PA and healthy eating were accompanied by navigation to neighborhood resources. The use of CHWs may be a cost-effective approach impacting the PA, sedentary, and dietary behaviors of youth.
文摘The emergence of the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) pneumonia, also referred to as COVID-19 in New York City in March 2020, has put an overwhelming strain on the healthcare system in the city. Many local hospitals have reported a surge of cases, with most cases presenting with severe respiratory complications. We aim to present a comprehensive surge filter protocol for outpatient programs to mitigate the surge of cases admitted in the emergency rooms and intensive care units (ICUs) of local hospitals in our community. Our surge filter protocol was developed based on a detailed review of how South Korea and Spain mounted their outpatient surge responses. Our preliminary findings revealed that our Four-Ts approach (<em>i.e.</em>, Test, Treat, Track, and Teach) has resulted in none of our patients reaching a clinical requirement for inpatient care.
基金Tianjin 2018 Philosophy and Social Science Planning Project(No.TJGL18-044)1The Natural Science Foundation of Tianjin(No.18JCQNJC11500)。
文摘This article will investigate on the current needs of community service for residents in Tianjin city by providing nursing services at a targeted community.The demands for community nursing services in Tianjin city were investigated by sending questionnaire to targeted general residents and communities.As collected from the questionnaire,the most common diseases that were mentioned are hypertension(33.2%),coronary heart disease(27.8%),and diabetes(15.7%).63.0%of the residents have health records and 79.7%of the residents have seen a doctor in community hospitals.As results,the highest demands on general nursing services in the community are a regular physical examination,health consultations,and regular home visits.Moreover,the control and management service demands specifically for chronic diseases are a regular heart rate examination,blood pressure examination,blood sugar examination,drug administration,and a diet management.In conclusion,as the age structure of community is higher,a higher demand is needed in providing health services such as caring for chronic disease patients and geriatric,which is conducive in improving the quality and the satisfactory needs of health services for residents in Tianjin,China.
文摘BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T2DM).Based on conven-tional nursing methods,community home care has important clinical significance in controlling blood sugar and disease progression.AIM To explore the impact of community public health nursing on treatment effect,health cognition,and self-management in patients with T2DM.METHODS One hundred patients with T2DM were selected as the research subjects.The patients were divided into either a conventional nursing group or community nursing(CN)group using the random number table method.The conventional nursing group(50 cases)received routine care,while the CN group(50 cases)received community public health care in addition to routine care as that for the conventional nursing group.The rate of excellent and good blood glucose control,fasting blood glucose before and after care,2-h postprandial blood glucose,health cognition,and self-management ability,and patient satisfaction were compared between the two groups.RESULTS The CN group had a higher rate of excellent blood sugar control than the conventional nursing group(88%vs 70%,P<0.05).Before care,there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients(P>0.05).After nursing,fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups,and both blood glucose levels in the CN group were lower than those of the conventional nursing group(P<0.05).Compared with the scores before care,the cognitive level score for diabetes and self-management ability score improved after care in both groups.The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group(P<0.05).The overall satisfaction of the CN group was better than that of the conventional nursing group(98%vs 86%,P<0.05).CONCLUSION Community public health care based on conventional care of T2DM can achieve better blood sugar control,and improve patients’health cognitive level and self-management ability.
文摘Objective: To explore the application effect of optimizing the nursing model in community health centers for elderly health examinations, providing a reference for enhancing the management level of elderly health at the grassroots level. Methods: A total of 300 elderly individuals who underwent health examinations at our center from January 2024 to December 2024 were selected as the study subjects. They were randomly divided into a control group and an observation group, with 150 cases in each group. The control group underwent the conventional health examination nursing process, while the observation group adopted an optimized community nursing model, which included stratified education and appointment scheduling before the examination, full-time accompaniment and safety care during the examination, and the establishment of electronic medical records and continuous follow-up after the examination. Differences in health management awareness rates and satisfaction with health examination services between the two groups of elderly individuals were compared. Results: The health management awareness rate in the observation group was 94.67%, significantly higher than that in the control group (78.00%;p < 0.001). The satisfaction rate with health examination services in the observation group was 96.00%, also significantly higher than that in the control group (82.00%;p < 0.001). Conclusion: The optimized community nursing model can effectively enhance the health awareness level and service satisfaction of elderly individuals during health examinations, demonstrating strong practicality and promotion value. It contributes to achieving continuity and precision in grassroots elderly health management.
基金Supported by Post-Subsidy Funds from the National Clinical Research Center,Ministry of Science and Technology of China,No.303-01-001-0272-08Beijing Municipal Administration of Hospitals Incubating Program,No.PX2022032Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes(PWD&RPP-MRI),No.JYY2023-13.
文摘Diabetes is highly prevalent among the elderly worldwide,with the highest number of diabetes cases in China.Yet,the management of diabetes remains unsatisfactory.Recent advances in digital health technologies have facilitated the establishment of smart wards for diabetes patients.There is a lack of smart wards tailored specifically for older diabetes patients who encounter unique challenges in glycemic control and diabetes management,including an increased vulnerability to hypoglycemia,the presence of multiple chronic diseases,and cognitive decline.In this review,studies on digital health technologies for diabetes in China and beyond were summarized to elucidate how the adoption of digital health technologies,such as real-time continuous glucose monitoring,sensor-augmented pump technology,and their integration with 5th generation networks,big data cloud storage,and hospital information systems,can address issues specifically related to elderly diabetes patients in hospital wards.Furthermore,the challenges and future directions for establishing and implementing smart wards for elderly diabetes patients are discussed,and these challenges may also be applicable to other countries worldwide,not just in China.Taken together,the smart wards may enhance clinical outcomes,address specific issues,and eventually improve patient-centered hospital care for elderly patients with diabetes.
文摘Introduction: Postpartum mental disorders are psychopathological states that affect women after childbirth. These disorders often negatively impact a child’s mental health and the mother-child bond. The objective of this work was to determine the frequency of mental disorders during the postpartum period at the University Community Health Center of Konobougou in Mali. Methods: This descriptive cross-sectional study took place from March 1 to July 31, 2022, for four months. Results: The study involved 201 immediate postpartum women at the Konobougou Community and University Health Center. The 20-35 age group accounted for 70.00% of the population;the average age was 24 years ± 5.95 years, with a range of 15 to 45 years. Married women made up 96.00% of the sample. The overall frequency of mental disorders was 15.92%. The mental disorders recorded were postpartum depression (5.47%), anxiety disorders (3.98%), postpartum blues (5.47%), and posttraumatic stress disorder (0.50%). Puerperal psychosis was found in 0.50% of the participants. Conclusion: This study revealed a high prevalence of mental disorders among postpartum women in Konobougou, Mali. During postnatal consultations, health workers should prioritize screening for mental health disorders.
基金Shanghai Pudong New District“National Traditional Chinese Medicine Development Comprehensive Reform Experimental Zone”Construction Project(Project No.:PDZY-2024-1003)Shanghai Pudong New District“National Traditional Chinese Medicine Heritage and Innovation Experimental Zone”Project(Project No.:PDZY-2025-0804)。
文摘This article examines the progress in the prevention and treatment of Alzheimer’s disease among elderly individuals in communities from the perspective of traditional Chinese medicine(TCM).Through a systematic review of recent related studies,it analyzes new insights into the etiology and pathogenesis of Alzheimer’s disease within TCM and summarizes novel methods and achievements in the prevention and treatment of the disease using TCM.Based on the TCM principles of“preventive treatment”and holistic health,innovative intervention models with Chinese characteristics,such as the“brain-heart-kidney axis”and“brain-gut connection,”have shown new breakthroughs in improving cognitive function and slowing disease progression.The article also explores the benefits of shifting preventive and therapeutic measures to earlier stages,contributing to the establishment of an integrated community prevention model of“prevention-intervention-rehabilitation.”
基金Supported by the Ongoing Research Funding Program at King Saud University,Riyadh,Saudi Arabia,No.ORF-2025-1315.
文摘BACKGROUND Diabetic ketoacidosis(DKA)remains a serious and potentially preventable complication among children with type 1 diabetes mellitus(T1DM),particularly in Saudi Arabia.Psychological constructs such as perceived severity and susceptibility influence health behaviour,yet their role in pediatric diabetes management remains underexplored.AIM To examine psychological predictors of DKA in children with T1DM using the health belief model,and to assess the role of caregiver-perceived understanding in influencing adherence and DKA occurrence.METHODS A case-control study was conducted at Prince Sultan Military Medical City in Riyadh,Saudi Arabia,involving 191 caregivers of children with T1DM(96 cases with a history of DKA and 95 controls without).Validated questionnaires measured perceived severity,susceptibility,understanding,and adherence.Statistical analyses included independent t-tests,Pearson and Spearman correlations,and multiple regression.RESULTS Perceived understanding was the strongest predictor of adherence(β=1.03,P<0.001)and was inversely associated with DKA occurrence(P<0.001).Children without a DKA history had significantly higher levels of perceived understanding and adherence.Perceived severity had a moderate positive association with adherence,while perceived susceptibility showed a weak negative correlation.CONCLUSION Caregiver-perceived understanding plays a critical role in adherence and DKA prevention.These findings support expanding the health belief model to include perceived understanding as a distinct construct and highlight the importance of integrating comprehension-focused strategies into pediatric diabetes education.
基金Pudong New District“National Comprehensive Reform Experimental Zone for Traditional Chinese Medicine Development”Construction Project(Project No.:PDZY-2024-1003)。
文摘According to the data from the 7th national population census,the population aged 65 and above in China has reached 13.50%,indicating that the country has entered a deeply aging society.The health issues of the elderly have become a significant concern for society.Common brain diseases among the elderly,including cerebrovascular diseases,genetic factors,or long-term solitary living,can all lead to dementia,with Alzheimer’s disease(AD)being the most common.Early symptoms of AD mainly include memory loss and difficulty concentrating,which are often mistaken for normal aging or stress-related issues and thus overlooked.AD lacks specific biomarkers and effective auxiliary diagnostic methods,making it difficult to accurately diagnose with existing imaging and neuroprotein indicators.Therefore,early detection of AD is very challenging.This article explores community-based early detection and intervention strategies from the perspectives of existing mechanism research,clinical manifestations,modern drug treatments,innovative explorations in traditional medicine,and community-appropriate technologies,aiming to construct an ecological management strategy.
文摘Introduction:Having a primary care usual source of care(USC)is associated with better population health outcomes.However,the percent of adults in the United States(US)with a usual primary care provider is declining.We sought to identify factors associated with establishing a USC at an urgent care clinic or emergency department as opposed to primary care.Methods:We analyzed data from 57,152 participants in the All of Us study who reported having a USC.We used the Andersen Behavioral Model of Health Services Use framework and multivariable logistic regression to examine associations among predisposing,enabling,and need factors,according to the source of usual care.Results:An urgent care clinic,minute clinic,or emergency department was the source of usual care for 6.3%of our sample.The odds of seeking care at this type of facility increased with younger age,lower educational attainment,and better health status.Black and Hispanic individuals,as well as those who reported experiencing discrimination in medical settings or that their provider was of a different race and ethnicity,were also less likely to have a primary care USC.Financial concerns,being anxious about seeing a provider,and the inability to take time off from work also increased the likelihood of having a non‐primary care USC.Conclusions:Improving the rates of having a primary care USC among younger and healthy adults may be achievable through policies that can improve access to convenient,affordable primary care.Efforts to improve diversity among primary care providers and reduce discrimination experienced by patients may also improve the USC rates for racial and ethnic minority groups.
