Analisis Situasi Komunikasi dan Jaringan Komunikasi Kesehatan pada Masyarakat Cintaratu

Masyarakat Cintaratu merupakan masyarakat pedesaan yang memiliki permasalahan kesehatan yang cukup kompleks. Permasalahan ini tidak lepas dari pengetahuan tentang infomasi kesehatan yang masih rendah. Dalam diseminasi informasi kesehatan yang efektif diperlukan suatu strategi yang tepat. Analisis situasi komunikasi kesehatan dan pemetaan komunikasi merupakan suatu tindakan yang tepat sebelum melakukan diseminasi infomasi kesehatan.� Metode Analisis situasi komunikasi dan pemetaan jaringan komunikasi ini menggunakan metode survey dan juga dilengkapi dengan data hasil wawancara dan FGD. Responden yang dijadikan objek pada riset dan pengabdian masyarakat ini adalah seluruh warga Desa Cintaratu. Hasil dari analisis diketahui bahwa dalam pemenuhan infomasi kesehatan, masyarakat Desa Cintaratu secara relatif masih rendah. Pemetaan media atau konsumsi media untuk pemenuhan infomasi kesehatan masih sangat rendah hanya sekitar dua persen. Penggunakan internet untuk hal-hal yang terkait kesehatan mencapai angka yang relatif lebih baik. Sementara itu pemenuhan kebutuhan infomasi lebih dominan dengan komunikasi langsung, yaitu dengan tokoh masyarakat atau sesama warga, kolega, keluarga, forum-forum pengajian, arisan, dan lain-lain. Sementara itu jaringan komunikasi kesehatan di Desa Cintaratu berbentuk interlocking personal network. Dengan tipologi jaringan ini, menunjukan ada beberapa individu yang berperan sebagai sumber infomasi kesehatan. Beberapa individu yang berperan sebagai sumber informasi tersebut antara lain: Bidan Ecih, tenaga medis di Puskesmas Selasari, Kader Oom, Kader Imas, dan Dokter Klinik Sandaan.�The Cintaratu community is a rural community that has quite complex health problems. This problem can not be separated from knowledge about health information which is still low. In disseminating effective health information, an appropriate strategy is needed. Health communication situation analysis and communication mapping are appropriate actions before disseminating health information. Methods The analysis of the communication situation and the mapping of the communication network uses the survey method and is also equipped with data from interviews and FGDs. Respondents who were used as objects in this research and community service were all residents of Cintaratu Village. The results of the analysis show that in fulfilling health information, the people of Cintaratu Village are still relatively low. Media mapping or media consumption for the fulfillment of health information is still very low, only around two percent. The use of the internet for health-related matters reaches relatively better numbers. Meanwhile, the fulfillment of information needs is more dominant with direct communication, namely with community leaders or fellow citizens, colleagues, family, recitation forums, social gatherings, and others. Meanwhile, the health communication network in Cintaratu Village is in the form of an interlocking personal network. With this network typology, it shows that there are several individuals who act as sources of health information. Several individuals who act as sources of this information include: Midwife Ecih, medical personnel at the Selasari Health Center, Oom Cadre, Imas Cadre, and Sandaan Clinic Doctor.

The Financial Costs of Registered Nurse-Led Relationship-Centred Care: A Single-Case Australian Feasibility Study

People with intellectual disability are accommodated and cared for in a variety of settings in Australia. Direct care is delivered by a mixture of qualified health professionals (nurses) and unlicenced disability support workers in varying combinations depending on the complexity and chronicity of comorbidities experienced by people with intellectual disability. Although some of these disability services continue to employ registered nurses, the size and specialised education of this workforce is decreasing due to a myriad of policy changes, which has the effect of compromising continuity of care and adverse effects on health outcomes. The objective of this study was to compare the differences on the financial cost of a single case using different models of care with, and without, specialised registered nursing input. The single case had profound intellectual disability and multiple chronic and complex health problems and was cared for by a model that included 24 h registered nurse care and support. Four financial scenarios are presented, and the differences both in terms of actual cost, and potential health outcomes are discussed. This study has set the scene for a large study where health economic data can be compared against multiple cases, across a range of care contexts, in order to advance evidence about which models provide the better health outcomes for people with intellectual disability and associated multiple chronic and complex health problems.

Trends Over Two Decades in Life Expectancy With Complex Health Problems Among Older Swedes: Implications for The Provision of Integrated Medical and Social Care

Background Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years. Methods CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n ≈ 2000), was used to estimate the prevalence of CHP. Age- and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP. Results Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in residential care was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%).

651The voice of Indian women on family planning: A qualitative systematic review and meta-synthesis

Background This systematic review and meta-synthesis was conducted to explore the views and experiences of women on family planning in India. Methods We included qualitative studies conducted in India and published in English. PubMed, SCOPUS, Web of Science, CINHAL and ProQuest were searched from inception till April 2019. Population of interest were women in reproductive age group. Additionally, husband of the woman and mother-in-law were eligible to be included. Studies conducted among HIV positive, commercial sex workers and drug addicts were excluded. Selection of studies (titles, abstracts and full tests screening), data extraction and methodological quality assessment (using CASP checklist) was undertaken independently by four authors in pairs. Any discrepancies were resolved by discussion until consensus. Thematic analysis was used to analyse the data (PROSPERO registration number CRD42018093960). Results We included 39 full texts through database and reference searching. Most of the women were married. Main themes were; ‘family influence’, ‘perceived benefits/harm of son/daughter’, ‘perceived misconception of contraception’, ‘socio-cultural norms’, ‘abortion as a family planning option’, ‘healthcare reach and mistrust’ and ‘demographic dividend’. Conclusion There is a need to include husband and mother-in-law while delivering messages or strategies to women on family planning in India. Traditional norms are deep rooted in the community therefore, family planning strategies should be context and need based. Key message Meta-synthesis is a promising approach to gather evidence of complex health problems that require an understanding of social and cultural determinants of health.

624Integrating human behaviour models with epidemiology to frame complex health problems

Focus of Presentation Health problems are complex due to multiple interactions whose outcomes are not easily predicted with traditional epidemiology methods. The problems themselves require careful evaluation. Predictive models of human behaviour are potentially powerful tools to frame health problems, especially if the models can link the attributes and behaviour of individuals with the dynamics of the social and environmental systems within which they operate. We explore this potential by proposing a framework combining two modelling approaches — social network analysis (SNA) and agent-based modelling (ABM) - with epidemiological methods. We then apply this framework to understand why measles vaccination rates are decreasing across the world. Findings These techniques allowed us to understand the etiologic implications of heterogeneity within the population, social interaction, and environmental influences simultaneously, and to explore mechanistic interactions, feedback loops, and reciprocity between exposures and outcomes. This approach allowed us to frame complex social factors of health and disease in a holistic manner. Conclusions/Implications The proposed framework allows investigators to analyse complex health problems in a holistic manner. However, both SNA and ABM, and other modelling tools, are still too compartmentalised in application, despite the strong methodological and conceptual parallels between their uses in different disciplines. Key messages A fully integrated approach is needed to understanding complex health problems, which combines modelling approaches and the disciplinary insights of epidemiology and public health.

Peningkatan Kesehatan Reproduksi Remaja melalui Posyandu Remaja Pashmina pada Era New Normal Covid -19

Adolescence is a period of storm and stress, because adolescents experience many challenges both from themselves (biopsychosocial factors) and the environment (environmental factors). If adolescents do not have the ability to face these challenges, they can end up with complex health problems as a result of their risky behavior. The establishment of the Youth Posyandu is expected to be a forum to facilitate adolescents in understanding adolescent health problems, find alternative solutions to problems, form youth support groups, expand the reach of the PKPR Health Center, especially for regional youth who have limited access. The purpose of this community service is to provide health education about Adolescent Reproductive Health through the “Pashmina” Youth Posyandu in the New Normal Covid 19 Era. The health education methods carried out are (1) Socialization and Licensing, (2) Affirmation and Pre Test (3) Conducting Health education on Adolescent Reproductive Health. (4) Evaluation of the results of health education activities with Post Test. The results of the activity are expected to increase and understand Adolescent Reproductive Health as indicated by an increase in adolescent reproductive health from the results of the Pre Test (before Health Education) and Post Test Results (after health education).

Exploring the Application of Interpretive Description in Chronic Illness: A Scoping Review

Background and PurposeChronic illness is a complex condition that affects over one billion people. To develop a deeper insight of the needs of this patient population, interpretive description uses disciplinary knowledge as the source of understanding. This methodology is a pragmatic approach to research without focusing on a strict methodological directive. The aims of this scoping review are twofold, (a) to describe the findings of studies that have used Thorne's interpretive description to research chronic illness and (b) to discuss the application of interpretive description in clinical research. Thereby, showing interpretive description as a valuable tool to advance nursing knowledge and patient care.MethodsThe methodological framework for this review was based on the Johanna Briggs Institute guidelines for scoping reviews.ResultsTo develop an understanding of interpretive description, it is essential to examine the results of studies which have applied the methodology. Our scoping review showed that researchers utilizing interpretive description identified four common challenges experienced by individuals living with chronic illness: symptom management, education and knowledge, supportive care, and cultural disadvantages. By demonstrating how interpretive description is applied, it shows how it can be used to understand and interpret clinical phenomena to improve practice.Implication for PracticeThis scoping review demonstrates how interpretive description was used to develop knowledge about chronic illness. The premise of interpretive description is that disciplinary knowledge offers a sufficient foundation to develop meaningful research to support health practices. By approaching research from a disciplinary perspective, new knowledge can be discovered to complex health problems.

Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders

Few studies have examined predictors of recurrent high ED use. This study assessed predictors of recurrent high ED use over two and three consecutive years, compared with high one-year ED use. This five-year longitudinal study is based on a cohort of 3121 patients who visited one of six Quebec (Canada) ED at least three times in 2014–2015. Multinomial logistic regression was performed. Clinical, sociodemographic and service use variables were identified based on data extracted from health administrative databases for 2012–2013 to 2014–2015. Of the 3121 high ED users, 15% (n = 468) were recurrent high ED users for a two-year period and 12% (n = 364) over three years. Patients with three consecutive years of high ED use had more personality disorders, anxiety disorders, alcohol or drug related disorders, chronic physical illnesses, suicidal behaviors and violence or social issues. More resided in areas with high social deprivation, consulted frequently with psychiatrists, had more interventions in local community health service centers, more prior hospitalizations and lower continuity of medical care. Three consecutive years of high ED use may be a benchmark for identifying high users needing better ambulatory care. As most have multiple and complex health problems, higher continuity and adequacy of medical care should be prioritized.

Anti-Obesity Properties of Calocybe Indica in Zebra fishes with Short-Term High-Fat Diet Induction

Obesity, a disease involved with complex health problems, is indicated by increased BMI, triglyceride and cholesterol levels. Obese individuals are found to be highly susceptible to develop non-alcoholic fatty liver disease,cardiovascular diseases, and also type 2 diabetes mellitus. Synthetic drugs used for treating obesity have been found to be associated with side effects such as anxiety,sleeplessness,hypertension, and drug addiction. Research on natural productspossessing therapeutic biological activitieshasdiscoveredtheir potential to minimize or even completely eliminate such side effects. Medicinal properties ofCalocybe indica include antidiabetic, hypertensive, anticancer, anti-inflammatory, antibacterial, and hepatoprotective effects; however, its anti-obesity activity is obscure.In this study, the anti-obesity effects of Calocybe indicawere investigated using a diet-induced obese Zebrafish modeland compared with standard drug Atorvastatin.Results show that 200µg of C. indica was able to effectively bring down triglyceride levels (12.5± 0 mg/ml; normal control 12.7 ± 0.7 mg/ml), cholesterol (210± 15.9 mg; normal control =70.4± 0)and HMG COA Reductase levels (0.9± 0.03; normal = 1.2 ± 0.01). Excessive fat accumulation in the liver (steatohepatitis) reduced after treatment with C. indica to a greater extent than by treatment with standard drug Atorvastatin. 100 µg of C. indica was found to be optimum in decreasing the levels of the liver enzymes, AST (177.1±5.7 IU/L; normal control =177.7±43.02 IU/l), ALT (365.5±2.9 IU/L; normal control= 355.5±34.4 IU/l), and ALP (2.3±1.1μmoles of phenol liberated/mg of protein/min; normal control = 0.7±1.2 μmoles of phenol liberated/mg of protein/min).Whole-body Oil Red O staining of the zebrafishes showed that with increasing concentration of C. indica, the accumulation of triglycerides and lipids decreased.

Tackling health inequity: a commentary on the potential of acupuncture to improve health outcomes of marginalised populations

Background: Health inequities or disparities challenge governments and public health systems, impacting health service delivery worldwide. Inherent disadvantage linked to the social determinants of health is intrinsic to the health outcomes among society’s marginalised and most vulnerable members. It is acknowledged that marginalised individuals present with higher levels of chronic disease, multi-morbidities and adverse health behaviours than their non-disadvantaged peers. Marginalised individuals and communities present with complex health problems and often receive poor quality or inadequate health care that is unable to meet their needs, leading to stigmatisation and perpetuating the cycle of disadvantage. Discussion: Emerging research indicates that there may be a role for acupuncture in managing the health needs of marginalised populations and that when historical barriers to accessing acupuncture treatment (such as awareness, availability and affordability of this therapy) are removed, certain marginalised populations are open to engaging with acupuncture treatment. Acupuncture has been used by low-income, refugee, veteran and ethnic minority groups to manage chronic pain, substance use disorders, stress and the impacts of trauma in conventional health settings such as community clinics and hospitals. There is the suggestion that integrative health settings and group treatment models may improve access and uptake of acupuncture among marginalised groups. Conclusion: Evidence suggests that the sociodemographic profile of acupuncture users is diverse and acupuncture therapy holds potential value in the treatment of marginalised populations. Further research that investigates reframing and expanding the scope of practice for acupuncture is timely and may contribute to tackling health inequity.