Conception of public health was firstly put forward by American professor Winslow. Ensuring and promoting the health of general population is the key connotation for the definition of public health. Oral disease has become a public health problem. Caries which preventable and curable is the most common oral disease and the etiology is also clear. Oral health comprehensive intervention program for children in central and western regions was set up in 2008 by Chinese government. The program included sealing on the first permanent molar and oral health education towards primary school children covering mid-west area. This was the first oral health program invested by government and managed by Chinese Stomatological Association. Six years later, the program was popularized to the whole nation, and renamed as national oral health comprehensive intervention program for children in China. The program had made deep impact on development of oral health service in China. The study tries to analyze the challenges of oral health service through reviewing the background, content, organization and effectiveness of the program, aiming to provide suggestions on policy, financing, system, ability and technology for the future development.
Child ; Humans ; China ; Dental Caries/epidemiology* ; Oral Health ; Public Health ; Dental Health Services

As a global public health problem, adverse childhood experiences (ACEs) is an important factor leading to serious psychological and behavioral problems in children and adolescents. Mental health service plan based on mental health service needs is the key to effectively improve the psychological problems of children and adolescents with ACEs. Emotional support, life skills training, mental health education, and individualized psychological intervention can effectively improve the mental health of children and adolescents with ACEs. Among them, emotional support is an important way to help individual reduce psychological and behavioral problems; secondly, life skills training can significantly improve the individual's psychosocial ability; and mental health education is a necessary way to promote the development of individual mental health. Individualized psychological intervention can promote individual to obtain more professional mental health service and improve their psychological symptoms, which is crucial for preventing the occurrence of mental health problems. Future research can develop targeted mental health interventions based on the specific mental health service needs.
Adolescent ; Adverse Childhood Experiences ; Child ; Humans ; Mental Health ; Mental Health Services

INTRODUCTION: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. METHODS: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). RESULTS: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020. CONCLUSION Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.
Adolescent ; COVID-19/prevention & control* ; Child ; Child, Preschool ; Disease Outbreaks ; Emergency Service, Hospital/trends* ; Facilities and Services Utilization/trends* ; Female ; Health Policy ; Humans ; Infant ; Infant, Newborn ; Male ; Patient Acceptance of Health Care/statistics & numerical data* ; Patient Admission/trends* ; Pediatrics ; Retrospective Studies ; Severe Acute Respiratory Syndrome/epidemiology* ; Singapore/epidemiology*

Adolescent ; COVID-19/prevention & control* ; Child ; Child, Preschool ; Emergency Service, Hospital/trends* ; Facilities and Services Utilization/trends* ; Female ; Health Policy ; Humans ; Infant ; Infant, Newborn ; Male ; Pandemics ; Patient Acceptance of Health Care/statistics & numerical data* ; Retrospective Studies ; Singapore/epidemiology*

COVID-19/psychology* ; Child ; Child Health ; Health Care Rationing ; Health Policy ; Health Services Accessibility ; Humans ; Pandemics ; Parents/psychology* ; Patient Acceptance of Health Care ; Singapore/epidemiology*

early intervention. This study aimed to develop a prediction model for transfusion of ≥5 units of packed red blood cells (PRBCs) during cesarean section in women with placenta previa.MATERIALS AND METHODS: We conducted a cohort study including 287 women with placenta previa who delivered between September 2011 and April 2018. Univariate and multivariate logistic regression analyses were used to test the association between clinical factors, ultrasound factors, and massive transfusion. For the external validation set, we obtained data (n=50) from another hospital.RESULTS: We formulated a scoring model for predicting transfusion of ≥5 units of PRBCs, including maternal age, degree of previa, grade of lacunae, presence of a hypoechoic layer, and anterior placentation. For example, total score of 223/260 had a probability of 0.7 for massive transfusion. Hosmer-Lemeshow goodness-of-fit test indicated that the model was suitable (p>0.05). The area under the receiver operating characteristics curve (AUC) was 0.922 [95% confidence interval (CI) 0.89–0.95]. In external validation, the discrimination was good, with an AUC value of 0.833 (95% CI 0.70–0.92) for this model. Nomogram calibration plots indicated good agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observed probability.CONCLUSION: We constructed a scoring model for predicting massive transfusion during cesarean section in women with placenta previa. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timing of blood transfusion.]]>
Area Under Curve ; Blood Transfusion ; Calibration ; Cesarean Section ; Cohort Studies ; Discrimination (Psychology) ; Early Intervention (Education) ; Erythrocytes ; Female ; Humans ; Logistic Models ; Maternal Age ; Nomograms ; Placenta Previa ; Placenta ; Placentation ; Postpartum Hemorrhage ; Pregnancy ; ROC Curve ; Ultrasonography

This article reviewed the current knowledge on time-course manifestation of diabetic urethral dysfunction (DUD), and explored an early intervention target to prevent the contribution of DUD to the progression of diabetes-induced impairment of the lower urinary tract (LUT). In the literature search through PubMed, key words used included “diabetes mellitus,” “diabetic urethral dysfunction,” and “diabetic urethropathy.” Polyuria and hyperglycemia induced by diabetes mellitus (DM) can cause the time-dependent changes in functional and morphological manifestations of DUD. In the early stage, it promotes urethral dysfunction characterized by increased urethral pressure during micturition. However, the detrusor muscle of the bladder tries to compensate for inducing complete voiding by increasing the duration and amplitude of bladder contractions. As the disease progresses, it can induce an impairment of coordinated micturition due to dyssynergic activity of external urethra sphincter, leading to detrusor-sphincter dyssynergia. The impairment of relaxation mechanisms of urethral smooth muscles (USMs) may additionally be attributable to decreased responsiveness to nitric oxide, as well as increased USM responsiveness to α1-adrenergic receptor stimulation. In the late stage, diabetic neuropathy may play an important role in inducing LUT dysfunction, showing that the decompensation of the bladder and urethra, which can cause the decrease of voiding efficiency and the reduced thickness of the urothelium and the atrophy of striated muscle bundles, possibly leading to the vicious cycle of the LUT dysfunction. Further studies to increase our understandings of the functional and molecular mechanisms of DUD are warranted to explore potential targets for therapeutic intervention of DM-induced LUT dysfunction.
Ataxia ; Atrophy ; Diabetes Mellitus ; Diabetic Neuropathies ; Early Intervention (Education) ; Hyperglycemia ; Lower Urinary Tract Symptoms ; Muscle, Smooth ; Muscle, Striated ; Nitric Oxide ; Polyuria ; Relaxation ; Urethra ; Urinary Bladder ; Urinary Tract ; Urination ; Urothelium

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a maternally inherited mitochondrial disorder of which m.3243A>G is the most commonly associated mutation, resulting in an inability to meet the energy requirements of various organs. MELAS poses a diagnostic challenge owing to its multiple organ involvement and great clinical variability due to its heteroplasmic nature. We report three cases from a family who were initially misdiagnosed with myasthenia gravis or undiagnosed. Although there is no optimal consensus treatment approach for patients with MELAS because of the disease's heterogeneity, our 21-year-long therapy regimen of l-arginine, l-carnitine, and coenzyme Q10 supplementation combined with dietary management appeared to provide noticeable protection from the symptoms and complications. Prompt early diagnosis is important, as optimal multidisciplinary management and early intervention may improve outcomes.
Acidosis, Lactic ; Arginine ; Carnitine ; Consensus ; DNA, Mitochondrial ; Early Diagnosis ; Early Intervention (Education) ; Follow-Up Studies ; Humans ; MELAS Syndrome ; Mitochondrial Diseases ; Myasthenia Gravis ; Population Characteristics

OBJECTIVES: This study aimed to estimate the financial budget of light-curing composite resin fillings based on the expanded coverage of the National Health Insurance Service (NHIS), called “Moon Care.” METHODS: The estimated population with dental caries and the amount of light-curing composite resins used were determined. The fees for the resin fillings per tooth were considered for the calculations. The expected budget for the next five years for children and adolescents aged 5–12 and 5–19 years were calculated. RESULTS: During the first year of the coverage, the budget for children and adolescents aged <19 years was estimated to be 201.8 billion South Korean won (5–9 years, 17.9 billion South Korean won; 10–14 years, 76.6 billion South Korean won; and 15–19 years, 107.3 billion South Korean won). The total budget for the next five years for children and adolescents aged <19 years was estimated at 946.4 billion South Korean won. Likewise, the budget for children aged <12 years during the first year of the coverage was estimated at 63.9 billion South Korean won (5–9 years, 17.9 billion South Korean won and 10–12 years, 46 billion South Korean won), and the total budget for the next five years was estimated at 315.9 billion South Korean won. CONCLUSIONS: Government healthcare plans should be established based on treatment needs and financial estimations. All the items in the NHIS, including the light-curing composite resin filling, should be considered based on their contribution to oral health promotion. Furthermore, in the long term, the coverage for preventive health services should be included in the health insurance.
Adolescent ; Budgets ; Child ; Composite Resins ; Delivery of Health Care ; Dental Caries ; Fees and Charges ; Humans ; Insurance, Health ; National Health Programs ; Oral Health ; Preventive Health Services ; Tooth

Several studies have reported adequate patient transfer to higher level hospitals according to the risk for improving perinatal outcomes. According to these reports, countries across the world divide the levels of maternal care on the basis of the assessment of hospital facilities and medical services as well as the assessment of high-risk pregnancies while evaluating the cases of and risks associated with maternal care that can be addressed by these hospitals at each level. Because the level of and policies on maternal care vary across countries, we aimed to evaluate risk assessments and introduction of treatment facility classifications in different countries. In Korea, birth rate is declining and the number of elderly pregnant women is increasing, whereas the number of hospitals that can deliver a baby and care for mothers at high risk is decreasing. We, therefore, need to establish an infrastructure for medically vulnerable areas, a localization center, and a medical personnel supplement. Moreover, establishing detailed guidelines and criteria for different levels of maternal care is necessary. The new guidelines will also need to supplement the policies on the requirement of well-trained obstetricians and of low medical insurance fee.
Aged ; Birth Rate ; Classification ; Fees and Charges ; Female ; Humans ; Insurance ; Korea ; Maternal-Child Health Services ; Mothers ; Patient Transfer ; Pregnancy, High-Risk ; Pregnant Women ; Prenatal Care ; Risk Assessment