OBJECTIVES: The purpose of this study is to compare the perceptions of the rural healthcare service improvement project' performance and reorganization of public health centers between project staffs and local residents. METHODS: Data collection from this study was performed in 141 project areas using structured questionnaires. Data analysis was used in SPSS 22.0 version. RESULTS: The public health center staffs were more positive about the items for improving health facilities than the local residents. Residents in the Si area generally perceived performance as more positive than residents in the Gun area, while public health center staffs in the Gun area perceived performance as more positive than public health center staffs in the Si area. Local residents expressed negative opinions about the reduction in the number of branches of public health clinics and health medical clinics. CONCLUSIONS: In conclusion, careful improvement projects for rural health care and the establishment of health care systems will be necessary, reflecting the opinions of local residents, along with a variety of regional characteristics.
Data Collection ; Delivery of Health Care ; Health Facilities ; Public Health* ; Rural Health ; Statistics as Topic

The purposes of the study were to develop an instrument for family value and to identify the relationships of family value, family hardiness, and family adaptation by appling the family value scale to family with cancer children. The study was conducted in three phases. 1) A survey was conducted from July 20 to August 20, 1999 and 18 items of general family value scale was modified from the data of 153 fathers and 164 mothers. 2) In-depth interviews were made with 29 parents of cancer children from April 20, 1998 to May 20, 1999 to develop family value scale with cancer children, and 12 statements were developed. 3) The final survey was conducted from July 18, 2000 to August 30, 2000 and the data from 309 parents of children who are diagnosed as cancer, 18 or less years of age, and treated either hospitalized or at the outpatient clinics were analyzed to identify the relationships of the concepts. The data analysis utilized SAS 6.12 and LISREL 8 for descriptive statistics, correlation, and Regression for path analysis. The study findings are as follows. The psychometric testing of general family value scale was Cronbach's alpha = 0.78. The reliability of the family value scale with cancer children showed the reliability as Cronbach's alpha = 0.73. Demographic characteristics showing significant correlations were cancer children's age, period of illness, period after completing treatment, mother's age, mother's education level, monthly income, payment type, confidence with health professional, and severity of children's illness. The correlation coefficients among major variables showed that family stressor was positively related with family strains(r=0.33, p < .001), and negatively related with family hardiness(r=-0.21, p < .001). Family strains was negatively related with family hardiness(r= -0.41, p < .001) and family adaptation(r=-0.46, p < .001). Correlations of family hardiness was positive with family value with cancer children(r=-0.31, p < .001), and negative with general family value(r=-0.16, p < .01). Family hardiness was positively related with family adaptation(r=0.35, p < .001). The causal relationship between study variables showed that family strains predicts general family value( gamma =0.12, t=2.02), family value with cancer children predicts family hardiness( gamma =0.31, t=6.30), family strains predicts family hardiness( gamma =-0.40, t=-7.70), family value with cancer children predicts family adaptation( gamma =-0.23, t=-4.11), and family hardiness predicts family adaptation( gamma =0.43, t=7.78).
Ambulatory Care Facilities ; Child* ; Education ; Fathers ; Health Occupations ; Humans ; Mothers ; Parents ; Psychometrics ; Statistics as Topic ; Child Health

China ; Health Facilities ; statistics & numerical data ; Humans ; Occupational Health Services ; manpower

The purpose of the study was to develop and test the model for the quality of life in mothers of children with nephrotic syndrome. A hypothetical model was constructed on the basis of previous studies and a review of literature. The conceptual framework was built around ten constructs. Exogenous variables included in this model were mother's health, father's health, marital intimacy, mother's attitude on children, economic state, side effect of steroid, severity of illness and social support. Endogenous variables were mother's burden and quality of life. Empirical data for testing the hypothetical model were collected by using a self-report questionnaire from 152 mothers of children with nephrotic syndrom at the outpatient clinics and in the hospital. The data was collected from May, 1999 to August, 1999. Reliability of the seven instruments was tested with Cronbach's alpha which ranged from 0.71 - 0.92. For the data analysis, SPSS 8.0 WIN program and LISREL 8.20 WIN program were used for descriptive statistics and covariance structural analysis. The results of covariance structural analysis were as follow : 1.The hypothetical model showed a good fit with the empirical data.[x2 = .56, df = 3, p = .90(p > .05 ), GFI = .99, AGFI = .99, RMSR = .005.] 2. For the parsimony of model, a modified model was constructed by deleting 1 variable and excluding 2 paths according to the criteria of statistical significance and meaning. 3.The modified model also showed a good fit with the data[x2 = 2.83, df = 7, p = .90( p > .05 ), GFI = 1.00, AGFI = .97, RMSR = .011]. The result of the testing of the hypothesis were as follows : 1.Mother's health( gamma 21 = .26, t = 4.16), father's health( gamma 22 = .19, t = 2.92), marital intimacy( gamma 23 = .26, t = 4.13) and social support( gamma 28 = .12, t = 2.03) had a significant direct effect on the quality of life. 2. Mother's burden( beta 21 = -.20, t = -3.10) had a significant negative direct effect on the quality of life. 3. Mother's attitude on children( gamma 14 = -.34, t = .-4.57), mother's health( gamma 11 = -.22, t = -2.96) and side effect of steroid ( gamma 16 = -.23, t = .-2.69) had a significant direct negative effect on the burden. The result of this study showed that mother's health, marital intimacy, mother's burden, father's health, and social support had a significant direct effect on the quality of life. Mother's attitude on children, mother's health, and side effect of steroid had a significant direct effect on mother's burden. These six variables, mother's health, marital intimacy, father's health, social support, mother's attitude on children and side effect of steroid were identified as relatively important variables. The results of this study suggest, it needed to determine the nursing intervention will alleviate mother's burden and promote a greater quality of life in mothers of children with nephrotic syndrom.
Ambulatory Care Facilities ; Child* ; Humans ; Mothers* ; Nephrotic Syndrome ; Nursing ; Quality of Life* ; Statistics as Topic ; Child Health

China ; Health Facilities ; statistics & numerical data ; Humans ; Occupational Diseases ; prevention & control

We explored village maternal deaths in an area of the East Sepik Province of Papua New Guinea where most women delivered at home. Postpartum haemorrhage, retained placenta and puerperal sepsis were common causes of death. Follow-up of a group of pregnant women showed that abnormal labour was frequent. 24% of multigravidae (95% CI 17-33) reported a labour that lasted longer than 24 hours. In 9% of all births (95% CI 5-15) the third stage lasted longer than one hour, or products were retained. Despite a high proportion of obstetric complications in apparently low-risk villages births, few women attend a health facility for delivery. Health centre attenders were a relatively privileged group. Some hospital users complained about staff attitudes. A poor reputation means that women are less likely to use health services for delivery. Providers need to improve the acceptability of the care provided, and communities should be encouraged to help with transport for their women to go to a health facility when they are in labour.
Community Health Services - statistics & ; numerical data ; Female ; Health Facilities - statistics & ; numerical data ; Health Services Accessibility ; Maternal Mortality ; Papua New Guinea

As a family respond to any stressful situation as a whole system, cancer diagnosis of a child, as a serious life event, could be emotional shock to destroy homeostasis of the family system. A family has a resilient capacity to adjust and adapt to stressful events. Previous studies have been focused on family stress and adaptation, but little attention has been given to family value as one of resilient factors. The data for model testing were collected from July 18, 2000 to August 30, 2000 and the analysis included 309 parents of children who are diagnosed as cancer, 18 or less years of age, and treated either hospitalized or at the outpatient clinics. The data analysis utilized SAS 6.12 and LISREL 8 for descriptive statistics, correlation, cluster analysis, factor analysis, and LISREL. The study findings are as follows. 1) Monthly income ( gamma =-0.28, t=-5.81) was the most important factor to explain family strain along with family support ( gamma =-0.11, t=-2.43), severity of children's illness ( gamma =0.26, t=5.22), and family stressor ( gamma =0.22, t=4.62). All of these factors together explained 40% of variance in family strain. 2) Among general family value, the relationship with the parents ( gamma =0.28, t=4.89) and relationship with the children ( gamma =0.20, t=3.60) showed positive effects to family value for cancer children, while relationship with the spouse ( gamma =-0.19, t=-3.22) and the age of the cancer children ( gamma =-0.11, t=-2.21) showed negative effects. These predictors together explained 22% of variance in family value for cancer children. 3)Family hardiness was explained mostly by family strain ( gamma =-0.53, t=-8.65) along with direct negative effects of family persistency and indirect negative effects of severity of children's illness, family stressor, relationship with the spouse, and the children's age. Family value for cancer children was the most important predictor with positive effect ( gamma =0.44, t=6.76) along with indirect effects of monthly income, relationship with the parents, relationship with the children, support from family and significant others, and confidence with the health professionals. 51% of variance in family hardiness was explained by all of these predictors. 4)The most important predictor for family adaptation was family stressor ( gamma =-0.50, t=-6.85) with direct and indirect negative effects along with the severity of children's illness ( gamma =-0.27, t=-5.21). However, family value for cancer children showed compromised total effect ( gamma =-0.13, t=-1.99) with negative direct effects ( gamma =-0.28, t=-3.43) and positive indirect effects ( gamma =0.14, t=3.01). Similarly, confidence with the health professionals also showed compromised total effect ( gamma =0.09, t=1.99) with positive direct effects and negative indirect effects. Family hardiness showed the biggest positive direct effects while other factors such as monthly income, family stressor, family persistence, support of family and significant others, relationship with the parents, relationship with the children, and relationship with the spouse, and children's age showed indirect effects only. 39% of variance in family adaptation was explained by all of these predictors.
Ambulatory Care Facilities ; Child* ; Diagnosis ; Health Occupations ; Homeostasis ; Humans ; Life Change Events ; Parents ; Shock ; Spouses ; Statistics as Topic ; Child Health

As a family respond to any stressful situation as a whole system, cancer diagnosis of a child, as a serious life event, could be emotional shock to destroy homeostasis of the family system. A family has a resilient capacity to adjust and adapt to stressful events. Previous studies have been focused on family stress and adaptation, but little attention has been given to family value as one of resilient factors. The data for model testing were collected from July 18, 2000 to August 30, 2000 and the analysis included 309 parents of children who are diagnosed as cancer, 18 or less years of age, and treated either hospitalized or at the outpatient clinics. The data analysis utilized SAS 6.12 and LISREL 8 for descriptive statistics, correlation, cluster analysis, factor analysis, and LISREL. The study findings are as follows. 1) Monthly income ( gamma =-0.28, t=-5.81) was the most important factor to explain family strain along with family support ( gamma =-0.11, t=-2.43), severity of children's illness ( gamma =0.26, t=5.22), and family stressor ( gamma =0.22, t=4.62). All of these factors together explained 40% of variance in family strain. 2) Among general family value, the relationship with the parents ( gamma =0.28, t=4.89) and relationship with the children ( gamma =0.20, t=3.60) showed positive effects to family value for cancer children, while relationship with the spouse ( gamma =-0.19, t=-3.22) and the age of the cancer children ( gamma =-0.11, t=-2.21) showed negative effects. These predictors together explained 22% of variance in family value for cancer children. 3)Family hardiness was explained mostly by family strain ( gamma =-0.53, t=-8.65) along with direct negative effects of family persistency and indirect negative effects of severity of children's illness, family stressor, relationship with the spouse, and the children's age. Family value for cancer children was the most important predictor with positive effect ( gamma =0.44, t=6.76) along with indirect effects of monthly income, relationship with the parents, relationship with the children, support from family and significant others, and confidence with the health professionals. 51% of variance in family hardiness was explained by all of these predictors. 4)The most important predictor for family adaptation was family stressor ( gamma =-0.50, t=-6.85) with direct and indirect negative effects along with the severity of children's illness ( gamma =-0.27, t=-5.21). However, family value for cancer children showed compromised total effect ( gamma =-0.13, t=-1.99) with negative direct effects ( gamma =-0.28, t=-3.43) and positive indirect effects ( gamma =0.14, t=3.01). Similarly, confidence with the health professionals also showed compromised total effect ( gamma =0.09, t=1.99) with positive direct effects and negative indirect effects. Family hardiness showed the biggest positive direct effects while other factors such as monthly income, family stressor, family persistence, support of family and significant others, relationship with the parents, relationship with the children, and relationship with the spouse, and children's age showed indirect effects only. 39% of variance in family adaptation was explained by all of these predictors.
Ambulatory Care Facilities ; Child* ; Diagnosis ; Health Occupations ; Homeostasis ; Humans ; Life Change Events ; Parents ; Shock ; Spouses ; Statistics as Topic ; Child Health

BACKGROUND: The purpose of this study was to investigate longitudinal changes of the utilization of operational and surgical medical care inside and outside a metropolitan area over 10 years, analyzing the residential areas of patients and the locations of medical facilities for major cardiovascular surgery. METHODS: Data analysis was conducted by classifying the addresses of patients and the locations of medical care facilities of metropolitan cities and provinces, using data from the National Health Insurance Corporation from January 2003 to December 2013. RESULTS: There is serious concentration of major heart surgery to medical facilities in Seoul; this problem has not improved over time. There were differences in percentages of surgical procedures performed in the metropolitan areas according to major diseases. In the case of Busan and Daegu provinces, at least 50% of the patients underwent surgery in medical facilities in the city, but there are other regions where the percentage is less than 50%. In the case of provinces, the percentage of surgical procedures performed in medical facilities in Seoul or nearby metropolitan cities is very high. CONCLUSION: Policies to strengthen the regional capabilities of heart surgery and to secure human resources are required to mitigate the concentration of patients in the capital area. Many regional multi-centers must be designated to minimize unnecessary competition among regional university hospitals and activate a win-win partnership model for medical services.
Busan ; Coronary Artery Bypass ; Daegu ; Health Facilities ; Hospitals, University ; Humans ; Korea* ; National Health Programs ; Seoul ; Statistics as Topic ; Thoracic Surgery*

INTRODUCTION: Approximately 1000 children die each year due to preventable water and sanitation-related diarrheal diseases. Six in 10 people lacked access to safely managed sanitation facilities in 2015. Numerous community- and school-based approaches have been implemented to eradicate open defecation practices, promote latrine ownership, improve situation sanitation, and reduce waterborne disease. OBJECTIVE: Given that current evidence for sanitation interventions seem promising, the aim of this study was to systematically summarize existing research on the effectiveness of community- and school-based randomized controlled sanitation intervention in improving (1) free open defecation (safe feces disposal), (2) latrine usage, (3) latrine coverage or access, and (4) improved latrine coverage or access. METHODS: Eight electronic databases were searched: PubMed, Scopus, WHO Global Health Library (GHL), Virtual Health Library (VHL), POPLINE, Web of Science, Cochrane, and Google Scholar up to 26 April 2019. Original randomized clinical trials addressing community-based or school-based intervention that reported feces disposal and latrine coverage were deemed eligible. More than two researchers independently contributed to screening of papers, data extraction, and bias assessment. We conducted a meta-analysis by random-effects model. The risk of bias was assessed by the Cochrane risk of bias tool. RESULTS: Eighteen papers that matched all criteria and 16 studies were included in the final meta-analysis. Compared to the control, the sanitation intervention significantly increased safe feces disposal (OR 2.19, 95% CI 1.51-3.19, p < 0.05, I CONCLUSION Our study showed strong evidence for both community- and school-based sanitation interventions as effective for the safe disposal of human excreta. The finding suggests major implications for health policy and design of future intervention in developing countries.
Community Participation/statistics & numerical data* ; Randomized Controlled Trials as Topic ; Sanitation/instrumentation* ; School Health Services/statistics & numerical data* ; Toilet Facilities/statistics & numerical data*