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*

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service (CHS) under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor-patient relationships, information and support, organization of care, and accessibility (P < 0.001). One or more factors such as gender and self-perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients' satisfaction with CHS by strengthening their awareness of the gatekeeper policy.
Adolescent ; Adult ; China ; Community Health Services ; organization & administration ; Data Collection ; Female ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; statistics & numerical data ; Young Adult

PURPOSE: The purpose of this study was to examine the association between utilization of home care services under the national long-term care insurance system and family caregiver distress. METHODS: A secondary data analysis was conducted in this study using data collected in 2011 and 2012 from the Korean version of International Resident Assessment Instrument (interRAI) Home Care assessment system. The study sample included 228 clients receiving community based home care and their family caregivers in Korea. Descriptive statistics, χ² test, t-test, and Heckman selection model analysis were conducted using SAS 9.3. RESULTS: Presence of family caregiver distress was significantly associated with days of nurse visits (β=-.89, p=<.001) and home helper visits (β=-.53, p=.014). Level of caregiver distress was also significantly associated with days of nurse visits (β=-.66, p=.028). Other factors which were significantly associated with caregiver distress were depression, cognitive function, inadequate pain control, social support for older adult, and caregiver relationship to the older adult. CONCLUSION: The results of this study show that visiting nurse service and appropriate support programs for Older Adults and family caregivers experiencing caregiver distress should be developed and provided to families based on the health care needs of older adults and their family caregivers for effective and sustainable home care.
Adult* ; Caregivers* ; Cognition ; Delivery of Health Care ; Depression ; Home Care Services* ; Humans ; Insurance, Long-Term Care ; Korea ; Long-Term Care ; Nurses, Community Health ; Social Control, Formal ; Statistics as Topic

PURPOSE: The purpose of this study was to explore ethical problems that cause moral distress in nurses and affects the quality of care provided by community mental health nurses working in community mental health settings. METHODS: Three focus group interviews were held with 14 nurses working in 3 community mental health centers in Korea. Qualitative descriptive methods and qualitative content analysis were used. RESULTS: Data analysis found 5 domains (decision making, communication, resources, safety, advocacy), 9 categories (personal information sharing issues, ethical insensibility, collisions between principles and practice, institutions unprepared in ethical problems, ethical dilemma in interactions with clients, problems with the evaluation system, problems with the budget structure, problems with the lack of safety measure, and problems with role limitation as a professional) and 11 subcategories. CONCLUSION: Results of this study suggest a) a need for further research on identifying ethical conflicts arising in community mental health fields, and b) on what nurses actually do when they deal with ethical conflicts, c) efforts to develop ethics support programs such as ethics education, training and reflection meetings to enhance nurses' ethical sensitivity, d) consideration of a supportive environment and culture that prioritizes ethical concerns in practitioners as well as administrators.
Administrative Personnel ; Budgets ; Community Mental Health Centers ; Education ; Ethics ; Focus Groups ; Humans ; Information Dissemination ; Korea* ; Mental Health Services ; Mental Health* ; Nursing ; Qualitative Research ; Statistics as Topic

PURPOSE: This study was attempted to provide quality improvement and revitalization of visiting nurse services by Importance-Performance Analysis of persons being provided with the services. METHODS: The subjects were 350 people being provided with visiting nurse services from a long term home care institution in the kangwon Province during the period of data collection between Aug. 16 and Sep. 15, 2011. Data analysis was conducted through t-test, ANOVA, and IPA by using the SPSS/WIN 12.0 program. RESULTS: As a result of the Importance-Performance Analysis of visiting nurse services, it turned out that the strength on reliability, assurance, and empathy should be maintained with good work and the aspects of responsiveness appeared to be intensively improved, and the tangibility proved to be subject to improvement. CONCLUSION: For the activation of visiting nurse services, methods for improving the performance in the intensive care area and management strategy establishment which highlights the advantages of strength maintenance area are needed.
Community Health Nursing* ; Data Collection ; Empathy ; Home Care Services ; Humans ; Insurance, Long-Term Care* ; Critical Care ; Long-Term Care* ; Quality Improvement ; Statistics as Topic

OBJECTIVES: The purpose of the study was to examine the relationships among the psychological, social, and environmental factors influencing the utilization of senior centers among older adults in Korea. METHODS: A questionnaire survey was administered to two types of older adults who lived in Seoul, Korea: 262 older adults who used senior centers (3 places) and 156 older adults who did not use senior centers. RESULTS: Our results showed clearly that the utilization of the senior centers in Korea is affected by higher self-efficacy (odds ratio [OR], 6.08; 95% confidence interval [CI], 3.31 to 12.32), higher perceived benefits (OR, 1.71; 95% CI, 1.16 to 4.36), lower perceived barriers (OR, 6.43; 95% CI, 3.07 to 11.45), higher family support (OR, 4.21; 95% CI, 2.02 to 8.77), and higher support from friends (OR, 4.08; 95% CI, 2.38 to 7.81). The results also showed that participants whose total travel time was 15 to 29 minutes (OR, 2.84; 95% CI, 1.21 to 3.64) or less than 14 minutes (OR, 4.68; 95% CI, 3.41 to 8.41) were more likely to use a senior center than those who had to travel more than 30 minutes. CONCLUSIONS: This study showed that the utilization of senior centers in Korea is affected by psychological, social, and environmental factors, specifically by self-efficacy, perceived benefits, perceived barriers, social support, convenience of transportation, and total travel time to the senior centers. The effects of longer-term utilization of the senior centers by non-users on health-related outcomes in a large population warrant attention.
Aged ; Aging/*psychology ; Community Health Centers/statistics & numerical data/*utilization ; Cross-Sectional Studies ; *Environment ; Female ; Health Services for the Aged/statistics & numerical data/*utilization ; Health Surveys ; Humans ; Korea ; Male ; Questionnaires ; Self Efficacy ; *Social Behavior ; Social Support ; Time Factors ; Travel

OBJECTIVE: To determine the prevalence and incidence of illness of two-week duration, and the factors influencing these, among residents 15 years and older in four counties of Hunan Province. METHODS: Data were sampled from four counties of Hunan Province for the Fourth National Health Service Survey. Incidence and two-week prevalence of disease were used to assess the health service needs of residents. A non-conditional, stepwise logistic regression was employed to explore the influencing factors. RESULTS: The two-week prevalence and incidence were 11.5% and 3.9%, respectively, in four counties of Hunan. The three leading diseases of two-week prevalence were: respiratory diseases, digestive diseases, and musculoskeletal diseases. Non-conditional stepwise logistic regression showed that urban residents had 0.64 times the risk of two-week illness compared with the rural residents (P< 0.05); residents in the 45-59 year age group and the 60+ year age group had 1.69 and 2.62 times the risk of two-week illness compared with residents in the 15-44 year age group, respectively (P<0.05). The widowed had 1.91 times the risk of prevalence of two-week illness contrasted to singles (P<0.05); the students had 0.29 times the risk of two-week illness contrasted to the workers (P<0.05); urban residents had 0.63 times the risk of two-week illness compared with the rural (P<0.05); the widowed had 2.37 times the risk of incidence of two-week illness compared with singles (P<0.05). CONCLUSION The majority of health service needs of residents of four counties is generated by three diseases: respiratory diseases, digestive diseases, and musculoskeletal diseases. Relatively, rural residents, the elderly, employed persons and the widowed have higher health service needs than others and deserve specific attention.
Adolescent ; Adult ; Aged ; China ; epidemiology ; Community Health Services ; statistics & numerical data ; Digestive System Diseases ; epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Musculoskeletal Diseases ; epidemiology ; Respiratory Tract Diseases ; epidemiology ; Sampling Studies ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo investigate the current situation of drug cost, hospitalization cost and direct medical expense in community health management of hypertensive patients, in order to lay foundation for evaluating whether the community health management in basic public health service has cost-effect in Health Economics.

METHODSA total of 8326 hypertensive patients from 10 survey pilots in 5 provinces were selected by cluster sampling methods, including 3967 patients who took part in community health management for over 1 year as management group and 4359 cases who have never taken part in community health management as control group. The essential information of research objects were collected by questionnaire; and the medical cost information in the last year (from November 2009 to November 2010) were collected retrospectively. The different annual medical treatment cost, hospitalization cost and direct medical expense in the two groups were compared and analyzed.

RESULTSThe average annual drug cost in hypertension was (621.50 ± 1337.78) yuan per patient; while the cost was (616.13 ± 1248.40) yuan in management group and (626.44 ± 1414.30) yuan in control group respectively. The average annual drug cost of hypertensive patients who took medicine therapy was (702.05 ± 1401.79) yuan per person, while the cost in the management group ((688.50 ± 1300.70) yuan) was much lower than it in control group ((714.64 ± 1489.60) yuan). The annual average drug cost in urban was (731.88 ± 1403.31) yuan per person, which was higher than it in rural as (407.44 ± 1171.44) yuan per person. The average hospitalized rate was 12.2% (1014/8326), and the average annual cost among the hospitalized patients was (9264.47 ± 18 088.49) yuan per person; while the cost was (7583.70 ± 13 267.00) yuan in management group, which was lower than it in control group as (11 028.00 ± 21 919.00) yuan. The average annual hospitalized cost in hypertension was (1064.87 ± 6804.83) yuan per person; while the cost was (936.73 ± 5284.90) yuan in management group, which was lower than it in control group as (1181.50 ± 7937.90) yuan. The average annual direct medical expense in hypertension was (2275.08 ± 8225.66) yuan per person; while the expense was (2165.10 ± 6564.60) yuan in management group and (2375.20 ± 9487.60) yuan in control group. The average annual direct medical expense in urban ((2801.06 ± 9428.54) yuan per person) was higher than it in rural ((1254.70 ± 4990.27) yuan per person).

CONCLUSIONThe community health or standardized management of hypertensive patients can reduce the average annual drug cost and hospitalization cost (around 26 yuan and 245 yuan separately); and thereby save the annual direct medical expense per capita in hypertension (around 210 yuan). In the reform and development of national medical health system, we should enhance and promote the standardized community health management of hypertensive patients.

Aged ; Community Health Services ; economics ; Cost-Benefit Analysis ; Drug Costs ; Female ; Health Care Costs ; statistics & numerical data ; Humans ; Hypertension ; drug therapy ; economics ; Male ; Middle Aged ; Public Health ; economics

PURPOSE: This descriptive survey was done to assess how rural women with osteoarthritis perceive their symptoms, what are their treatment preferences, and how they manage their illness. METHOD: Individual interviews were carried out with 205 women with osteoarthritis living in rural areas. Structured questionnaires were used and the interviewers were 7 trained research assistants. Descriptive statistics were used for data analysis with SPSS win 11.5 program. RESULTS: Of the respondents, 68.8% were overweight and 15.1% were obese, 86.9% reported pain in the knees, low back, and shoulders and the average pain score was 66.06. Those knowing the exact diagnosis accounted for 73.7% of the respondents but only 49.7% reported receiving medical treatments, and 40.2% who received treatment adhered to their prescription. Folk medicines were used by 14.1% of the respondents, but 65.2% among them reported that folk medicines were not effective. Exercise 2.03 times per week was reported by 17.1% of the respondents and 48.6% reported preferring to walk. CONCLUSION: Women with osteoarthritis in rural areas need a rehabilitative care program focused on exercise. The community health care system in the rural area should deliver optimal health care for this population. The results of this study can be used as a basis for planning intervention programs for women with osteoarthritis in the rural area.
Community Health Services ; Surveys and Questionnaires ; Delivery of Health Care ; Diagnosis ; Female ; Humans ; Knee ; Osteoarthritis* ; Overweight ; Prescriptions ; Shoulder ; Statistics as Topic

There have been many epidemiological and clinical researches on chronic fatigue (CF) and chronic fatigue syndrome (CFS) since the 1990s, but such studies have been quite limited in Korea. The aim of this study was to investigate the point prevalence of CF and CFS in patients who visited community-based eight primary care clinics in Korea. The study subjects were 1,648 patients aged 18 yr and over who visited one of eight primary care clinics in Korea between the 7th and 17th of May 2001. The physicians determined the status of the subjects through fatigue-related questionnaires, medical history, physical examination, and laboratory tests. The subjects were categorized into no fatigue, prolonged fatigue, CF and then CF were further classified to medically explained CF (Physical CF and Psychological CF) and medically unexplained CF (CFS and idiopathic chronic fatigue). The point prevalence of CF and CFS were 8.4% (95% CI 7.1-9.7%) and 0.6% (95% CI 0.2-1.0%). Medically explained CF was 80.5% of CF, of which 57.1% had psychological causes. The clinical characteristics of CFS were distinguished from explained CF. CF was common but CFS was rare in community-based primary care settings in Korea.
Adolescent ; Adult ; Age Distribution ; Chronic Disease ; Community Health Services/statistics & numerical data ; Comparative Study ; Fatigue/*epidemiology ; Fatigue Syndrome, Chronic/*epidemiology ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; Sex Distribution