Physical examination performed by general practitioners in 5 community health service institutions in Beijing: an observational study

Background Physical examination is a core component of consultation. Little is known about the status quo of physical examinations performed by general practitioners in community health service institutions in China. The aim of this study was to investigate general practitioners’ performance of physical examinations in consultations. Methods An observational study was conducted in 5 community health service institutions in Beijing between November 2019 and January 2020. Eleven general practitioners were observed for one workday. Information of consecutive consultations was recorded including patient characteristics, reasons for encounter, physical examinations performed by general practitioners, length of consultation time and time spent on specific activities in consultations. Results A total of 682 consultations of 11 general practitioners were recorded. Physical examinations were performed in 126 consultations (15.8%). Physical examination was more likely to be performed in patients visiting with symptoms (P < 0.001). Majority of the 126 physical examinations were distributed in “Head, face, and neck examination” (n = 54, 42.9%) and “Cardiovascular examination” (n = 55, 43.7%). No physical examination was performed on skin, male genitalia, female breasts and genitalia, and neurological systems. Total 2823 min of activities were observed and recorded. General practitioners only spent 3.1% of the recorded time on physical examination, which was less than the time spent on taking history (18.2%), test (4.9%), diagnosis (22.7%), therapy (38.4%), and health education (8.6%). The average time spent on physical examinations was 0.8±0.4 min per consultation. Conclusion Physical examination was insufficiently performed by general practitioners in community health service institutions in Beijing. More time and commitment should be advocated for improving the quality of physical examinations in primary care.

Pelatihan Keterampilan Kompres Tepid Water Sponge Sebagai Upaya Pencegahan Kejang Demam Anak Dimasa Pandemi Covid - 19

ABSTRAKPenyakit infeksi pada anak selalu ditandai dengan demam yang akan berlanjut terjadi kejang demam pada anak apabila tidak segera ditangani. Metode kompres dengan water tepid sponge efektif dalam menurunkan demam pada anak sehingga mampu mencegah terjadinya kejang demam. Kondisi pandemi COVID – 19 membuat masyarakat takut untuk memeriksakan anak ke Palayanan Kesehatan masyarakat. Ibu sering mengalami kepanikan saat anak kejang demam sehingga pengetahuan dan keterampilan penanganan demam dirumah sangat dibutuhakn masyarakat di masa pandemic COVID-19. Kader Posyandu sebagai penggerak kesehatan di masyarakat diharapkan mempunyai pengetahuan dan pemahaman yang lebih untuk bisa meningkatkan derajad kesehatan mayarakat. Tujuan setelah pelatihan singkat melalui whatsapp group discussion diharapkan dapat meningkatkan pengetahuan dan keterampilan dalam penanganan kejang demam dirumah. Adapun kegiatan yang dilakukan berupa pelatihan singkat menggunakan media whatsapp, video pembelajaran keterampilan kompres WTS serta booklet penaganan kejang demam. Hasil evaluasi kegiatan terdapat peningkatan pengetahuan dan keterampilan kompres pada kader Posyandu Wilayah Kerja Puskesmas Sangkrah Surakarta. Kata Kunci: water tepid sponge, kader posyandu, pademi COVID – 19. ABSTRACTFever marks an infectious disease in children. it can progress to febrile seizures if not treated immediately. The compressing method with the tepid water sponge effectively reduces fever in children to prevent febrile seizures. The COVID-19 pandemic has made people afraid to check their children at the community health service. Mothers often experience panic when their child has a febrile seizure, so the community very much needs that knowledge and skills in handling fever at home during the COVID-19 pandemic. Posyandu cadres, as health drivers in the community, are expected to have more knowledge and understanding to be able to improve the level of public health. After short training through WhatsApp group discussion, the goal is to increase knowledge and skills in handling febrile seizures at home. The activities carried out were short training using WhatsApp media, video learning of WTS compress skills, and booklets for handling febrile seizures. The activity evaluation results showed an increase in knowledge and skills in compressing the Posyandu cadres in the Sangkrah Surakarta Health Center Work Area. Keywords: Water Tepid Sponge, Posyandu cadres, COVID-19 pandemic

Retrospective observational study of ethnicity-gender pay gaps among hospital and community health service doctors in England

ObjectivesTo identify differences in average basic pay between groups of National Health Service (NHS) doctors cross-classified by ethnicity and gender. Analyse the extent to which characteristics (grade, specialty, age, hours, etc.) can explain these differences.DesignRetrospective observational study using repeated cross-section design.SettingHospital and Community Health Service (HCHS) in England.ParticipantsAll HCHS doctors in England employed by the NHS between 2016 and 2020 appearing in the Digital Electronic Staff Record dataset (average N=99 953 per year).Main outcome measuresHours-adjusted full-time equivalent pay gaps; given as raw data and further adjusted for demographic, job, and workplace characteristics (such as grade, specialty, age, whether British nationality, region) using multivariable regression and statistical decomposition techniques.ResultsPay gaps relative to white men vary with the ethnicity-gender combination. Indian men slightly out-earn white men and Bangladeshi women have a 40% pay gap. In most cases, pay gaps can largely be explained by characteristics that can be measured, especially grade, with the extent varying by specific ethnicity-gender group. However, a portion of pay gaps cannot be explained by characteristics that can be measured.ConclusionsThis study presents new evidence on ethnicity-gender pay gaps among NHS doctors in England using high quality administrative and payroll data. The findings indicate all ethnicity-gender groups earn less than white men on average, except for Indian men. In some cases, these differences cannot be explained giving rise to discussions about the role of discrimination.

Risk factors for the frequent attendance of older patients at community health service centers in China: a cross-sectional study based on stratified sampling

Background This study aimed to investigate the characteristics of frequent attenders (FAs) among older patients in Shanghai, China, and explore the associated factors. Methods This cross-sectional study was conducted in six community health service centers in Shanghai, China, from August to December 2018 based on stratified sampling. On the basis of our preliminary study, FAs were defined as those attending at least four consultations in a month. A self-administered questionnaire was used to collect the clinicodemographic data of the participants. Social support, pain severity, depression, and anxiety were evaluated using the Social Support Revalued Scale, six-point Behavioral Rating Scale, Patient Health Questionnaire–9, and Generalized Anxiety Disorder Scale, respectively. Results This study included 619 patients aged > 60 years. Among these patients, 155 (25%) were FAs to a community health service center, 366 (59.1%) had 1 or 2 chronic diseases, 179 (28.9%) had ≥3 chronic diseases, 313 (50.4%) opted for a family doctor service, and 537 (86.8%) chose a community health service center for the first consultation. The following were identified as independent risk factors for frequent attendance: widowed status, unmarried status, the presence of > 3 chronic diseases, first consultation at a community health service center, high medical expenses, frequent attendance of the spouses, long-term medication, the use of both traditional Chinese and Western medicine services, and depression. Conclusions This study summarizes the characteristics of older FAs to community health service centers in China and identifies 10 risk factors significantly associated with frequent attendance.

Agent-Based Simulation of Virus Testing in Certain-Exposure Time through Community Health Service Centers’ Evaluation—A Case Study of Wuhan

Short-term and large-scale full-population virus testing is crucial in containing the spread of the COVID-19 pandemic in China. However, the uneven distribution of health service facilities in terms of space and size may lead to prolonged crowding during testing, thus increasing the chance of virus cross-infection. Therefore, appropriate control of crowd exposure time in large-scale virus testing should be an important goal in the layout of urban community health facilities. This paper uses the Quanta concept and Wells-Riley model to define the “certain-exposure time” under low cross-infection rate. Then, an agent-based simulation model was used to simulate the reasonable screening efficiency of community health service facilities during certain-exposure time at different stages of the COVID-19 pandemic and under different screening processes. Eventually, the screening efficiency was evaluated for all community health service centers in Wuhan. During the early period of the pandemic, 23.13% of communities failed to complete virus testing of community residents within 2 h of certain-exposure time, leaving approximately 56.07% of the population unscreened; during the later period of the COVID-19 pandemic, approximately 53% of communities and 75% of residents could not be screened. The results can pinpoint the distribution of community health service centers with inadequate screening capacity, facilitate targeted policymaking and planning, and effectively curb COVID-19 cross-infection during screening.

Public awareness of acute myocardial infarction symptoms and emergency response in community residents

Background Patient delay in seeking help has been reported to be a major factor that related to delay in care of acute myocardial infarction (AMI). Lack the knowledge of symptoms may translate to behavioral deficiencies which lead up to failing to seek medical assistant at early stage of AMI. Purpose The aim of present study is to investigate the awareness of AMI symptoms and the emergency responses among community residents over 35 years old. Methods The sample was proportionally distributed by age according to the national census data. The sex ratio was 1:1. The sample size is calculated according to the significance level of 0.05, the allowable error of 0.1, and the estimated Excellent awareness level of 10%. The final sample size is adjusted to 4200, considering non-response rate of 20%. Multi-stage stratified random sampling was used. On the first stage, two districts each in urban and rural regions were randomly selected. On the second stage, 3–10 community health service centers were randomly selected in each district. On the third stage, residents over 35 managed by the community health service center were proportionally sampled to be interviewed. A structured questionnaire was used and the survey was conducted in a face-to-face interview by clinical physicians. Logistic regression was applied to analyze factors related to Good knowledge. Results The top three symptom recognized by public is “pain or discomfort in the chest” (71.3%), followed by “difficulty breathing” (65.1%) and “pain or discomfort in the jaw, neck, or back” (60.9%). 85.0% chose to call an ambulance as first response when witness others having an AMI. Those who lives alone (OR=1.408; 95% CI, 1.005–1.972) and whose immediate family had been diagnosed with AMI (OR=1.510; 95% CI, 1.040–2.192) has better knowledge. A significant positive correlation was observed for those with hypertension (OR=1.199; 95% CI, 1.007–1.429), while a negative correlation was observed for those with diabetes (OR=0.788; 95% CI, 0.626–0.992). Public education could improve Good knowledge (OR=1.662; 95% CI, 1.388–1.990), while doctoral advise has been shown negative impact (OR=0.824; 95% CI, 0.691–0.984). Conclusions Our data provide first population-based estimates of public awareness in our country. Further promotional strategies to increase overall awareness in general public are seriously needed. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Major Science and Technology Projects of Tianjin Science and Technology Commission Multivariable logistic regression

FAKTOR-FAKTOR YANG MEMPENGARUHI KUNJUNGAN IBU BALITA KE POSYANDU: LITERATUR REVIEW

AbstrakPosyandu merupakan suatu kegiatan pelayanan kesehatan masyarakat yang dikelola bersama sebagai upaya dalam peningkatan kesehatan. Kegiatan posyandu salah satunya yakni untuk memantau pertumbuhan dan perkembangan balita. Posyandu balita dilakukan secara rutin sesuai dengan yang jadwalkan dan perlunya peran aktif ibu yang memiliki anak balita untuk melakukan kunjungan guna mendapat penyuluhan terkait kesehatan, pemantauan tumbuh kembang anak, pemberian vitamin, dan imunisasi. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kunjungan balita ke Posyandu. Hasil penelitian menunjukan factor kunjungan posyandu antara lain pengetahuan, pekerjaan ibu, peran kader dan petugas kesehatan, dukungan keluarga, jarak posyandu, pendidikan ibu, sikap, motivasi, kepemilikan KMS. Penelitian ini dilakukan dengan menggunakan literature riview yaitu sebanyak 10 artikel dan dipublikasikan 5 tahun terakhir yaitu tahun 2017-2021. Pencarian artikel dengan menggunakan google scolar dan science direct. Kata Kunci: Kunjungan Posyandu, Ibu, Balita Abstract Posyandu is a community health service activity that is jointly managed as an effort to improve health. One of the posyandu activities is for the growth and development of children under five. Posyandu for toddlers are carried out regularly as scheduled and the need for an active role for mothers with children under five to make visits to get health-related education, warnings on child development, offer vitamins, and immunization. This study aims to determine the factors associated with under-five visits to Posyandu. The results showed that the posyandu visit factors included knowledge, maternal occupation, the role of cadres and health workers, family support, distance of posyandu, mother's education, attitudes, motivation, ownership of KMS. This research was conducted using a literature review of 10 articles and published in the last 5 years, namely 2017-2021. Search for articles using google scolar and science direct. Keywords: Posyandu visits, mothers, toddlers