Academic literature on the topic 'Health Care for the Homeless Program (U.S.)'

Introduction:Spiritual care is an important component of holistic care in nursing. However, health care workers are not unanimous in who is responsible for the spiritual care of patients. It is likely that nurses are best suited to provide spiritual care because of the nature of their work, which requires constant contact with patients. Yet, meeting spiritual needs is not well defined in the role of nurses and is not always taught comprehensively in formal nursing education programmes. The aim of this study was to explore the extent to which nurses working in social care settings implement interventions related to spiritual care in their daily practise, how they perceive their knowledge of spiritual care, and the extent to which this dimension of care was included in their nursing education programmes.Methods:A non-experimental quantitative descriptive research study was used. In April 2020, 214 nurse assistants and registered nurses from 12 nursing homes in Slovenia participated in the study. The questionnaire used in the study included 12 statements related to 3 main areas: i) knowledge of the concepts of spirituality and religion, ii) implementation of spiritual/religious interventions in daily practice, iii) spirituality in nursing education. The individual statements were rated by the respondents on a 5-point Likert scale (1 - strongly disagree to 5 - strongly agree). The questionnaire had adequate internal consistency (Cronbach alpha = 0.857). Data were described using calculated means, Mann-Whitney U test, and Spearman correlation coefficient. A p-value ≤ 0.05 was considered significant.Results:Regular spiritual assessment of nursing home residents is rarely performed by nurses (x̄=2.73, s=1.03). Female nurses (U=2191.500, p=0.008) and nurses who described themselves as religious (U=3314.000, p=0.001) implement spiritual/religious interventions in daily practice to a greater extent; they also expressed higher knowledge of the concepts of spirituality and religion compared to the others (religious/non-religious: U=2920.000, p=0.000; female/male: U=1885.000, p=0.000). The implementation of spiritual/religious interventions in daily practice correlated positively and statistically significantly mainly with self-perceived knowledge of the concepts of spirituality and religion (r=0.495, p=0.000) and the extent to which the content of spiritual care was represented in their nursing education program (r=0.494, p=0.000). However, nurses emphasized that the concept of spirituality and spiritual care tended to be poorly represented in formal nursing education programs (x̄=2.76, s=0.89).Discussion and conclusions:Individual characteristics, particularly self-reported religiosity and gender, appear to have an important influence on the implementation of spiritual/religious interventions in daily practise. In addition, our study suggests that the level of knowledge about the concepts of spirituality and religion influences nurses' willingness to implement spiritual care with their residents. Therefore, nursing educators need to develop curricula that include strategies to increase trainees' awareness of spiritual care. Current international research efforts on perceptions of spirituality and spiritual care in nursing offer important contributions to understanding the role of nursing in relation to spirituality and to developing educational content and approaches for both undergraduate and lifelong learning in nursing.

Early detection of gastrointestinal cancer is an actual public health problem. The implementation of the modern endoscopic diagnostic methods based on the progressive digital technologies significantly reduce the risks of diagnostic errors and contributes to the effective solution of that problem. P u r p o s e : to clarify the possibilities of the early detection of gastrointestinal cancer by equipping the endoscopy unit of the city district hospital with the modern digital endoscopes, including devices with zoom functions – ZOOM. M a t e r i a l s a n d m e t h o d s . The article analyzes the statistical data of the work of the endoscopy unit of Nizniy Tagil State city hospital № 1 from 2013 to 2022 (except 2020–21, when the hospital was completely redesigned as a COVID-hospital). R e s u l t s . A clear relationship between the increase in the number of detected oncopathologies of the gastrointestinal tract and the modern technical equipment of the endoscopic units under the modernization of primary health care program in the Sverdlovsk region in 2021 is presented. Based on risk-based approaches and evidence-based medicine data, the importance expert-class equipment in the routine endoscopic practice in the primary healthcare district hospital for diagnosing gastrointestinal cancer at an early stage is shown. Modern approaches to optical endoscopic diagnostics are analyzed, as well as the potential risks of diagnostic errors associated with technical equipment and possible measures to reduce these risks for further improvement of primary endoscopic diagnostics aimed at detecting gastrointestinal cancer in the early stages are determined, the expediency of equipping endoscopic units of primary care medical organizations with endoscopes inreached magnification functions – ZOOM, as well as photo and video recording of digital images with the possibility of archiving, color printing and further expert analysis of endoscopic images. C o n s e q u e n c e . From the presented statistical data, it is clearly seen how with the improvement of the equipment quality, the detection of gastrointestinal cancer of various localizations is growing.

Abstract Introduction Holistic care for children with chronic diseases including cancer should include psychological support for children and their families. The impact of pediatric malignancies in regard to quality of life (QOL) of parents is poorly described. Objectives We aim to study the QOL of parents of children diagnosed with cancer in physical, psychosocial, environmental, and social domains. Materials and Methods A prospective, cross-sectional study was conducted with 162 parents of children diagnosed with malignancy for 3 months or more. Assessment was done by World Health Organization quality of life (WHOQOL-BREF) questionnaire that includes four domains with a total of 26 questions. Data analysis was done by using Statistical Package for Social Sciences (SPSS) version 20.0; p-value less than 0.05 was considered significant. Results on continuous measurements were presented as “Mean ± SD” and categorical measurements were presented as percentages (%). Differences in the quantitative variables between groups were assessed by unpaired-t-test; comparison between groups by nonparametric Mann–Whitney U test and chi-squared test was used to analyze categorical variables with p-value of < 0.05 using a two-tailed taken as statistically significant. Results Mean raw scores of QOL in physical health, psychological, social, and environmental domains were 20.10, 15.28, 8.10, and 25.24, respectively, with social relationships being the lowest; inadequate or low QOL was noted in 50% study population and it was maximally affected by increased duration of treatment, multimodality treatment, socioeconomic status, rural population, education and occupation status of the parents, and increased cost of care. Type of family or place of residence, family history of psychiatric illness, or malignancy did not influence the QOL of parents of children with cancer. Conclusion Psychological support from the beginning of the treatment along with financial, social support should be offered through a comprehensive care program to improve the QOL.

Introduction Children with cancer are at an increased risk for various physical and cognitive challenges due to their illness and its treatment. A concerning observation is that young cancer patients often lead sedentary or even lying lifestyles, clearly failing to meet the WHO’s recommendation of 60 minutes of moderate-to-vigorous physical activity (PA) daily. This is alarming considering that PA is essential for physical and mental health, e.g., for the development of motor skills and cognitive functions (Bull et al., 2020). However, PA promotion in acute care in Swiss pediatric oncology units is hardly existent. Therefore, the aim of this project is to develop and conduct a physical activity program in a pediatric oncology unit and investigate its effects on cognitive and motor performance. Methods Part A of this project involved a qualitative study conducted at the Inselspital Bern’s pediatric oncology unit, aiming to design a tailored PA therapy program. This part included patient interviews and staff surveys. Part B, which is ongoing, focuses on a forthcoming two-arm multicenter crossover-controlled trial. This trial will compare the exercise therapy and PA counseling (intervention group in Bern, n = 40) with standard treatment (control group in Basel, n = 40). Participants will be aged 6-18 years, newly diagnosed with cancer and undergoing cytotoxictreatment for at least six weeks. The 12-week program will consist of thrice-weekly, 45-minute sessions of individualized exercise, aligned with the SK2-guidelines, NAOK, and international Pediatric Oncology Exercise Guidelines (Götte et al., 2022; Wurz et al., 2021). The sessions will focus on motor skills and cognitively challenging PA. In addition, children will receive 4 exercise counseling sessions. To evaluate the study, there will be three measurement points (once at admission, after twelve weeks of intervention and one follow-up after six months). The outcome measures include motor and cognitive performance, physiological and psychosocial functioning. Results Initial findings from the qualitative study indicate a strong patient and staff interest in exercise therapy. The study also provided valuable insights for developing and implementing the intervention. Discussion/conclusion The results will reveal important insights relevant to research and practice. Adopting a research perspective, the results will shed light on the effects of PA on cognitive performance in acute cancer care. Adopting a more applied perspective, PA has been neglected in Swiss pediatric oncology units so far. Therefore, this study may contribute to proof the effectiveness of PA for childhood cancer patients and thus help implementing it in standard care in the long term. References Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., Dempsey, P. C., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., Lambert, E., Leitzmann, M., … & Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451-1462. https://doi.org/10.1136/bjsports-2020-102955 Götte, M., Gauß, G., Dirksen, U., Driever, P. H., Basu, O., Baumann, F. T., Wiskemann, J., Boos, J., & Kesting, S. V. (2022). Multidisciplinary Network ActiveOncoKids guidelines for providing movement and exercise in pediatric oncology: Consensus-based recommendations. Pediatric Blood & Cancer, 69(11), Article e29953. https://doi.org/10.1002/pbc.29953 Wurz, A., McLaughlin, E., Lategan, C., Chamorro Viña, C., Grimshaw, S. L., Hamari, L., Götte, M., Kesting, S., Rossi, F., van der Torre, P., Guilcher, G. M. T., McIntyre, K., & Culos-Reed, S. N. (2021). The international Pediatric Oncology Exercise Guidelines (iPOEG). Translational Behavioral Medicine, 11(10), 1915-1922. https://doi.org/10.1093/tbm/ibab028

Eating habits develop during the first years of a child's life, children learn what, when, and how much to eat through direct experience with food and by observing the eating habits of others. The aim of this study is to get a clear picture of the Eating program Healthy, starting from the planning, implementation, supervision, and evaluation as a case study of nutrition education; to get information about the advantages, disadvantages and effects of implementing a healthy eating program for children. This research was conducted through a case study with qualitative data analysed using Miles and Huberman techniques. Sample of children in Ananda Islāmic School Kindergarten. The results showed the Healthy Eating program could be implemented well, the diet was quite varied and could be considered a healthy and nutritious food. The visible impact is the emotion of pleasure experienced by children, children become fond of eating vegetables, and make children disciplined and responsible. Inadequate results were found due to the limitations of an adequate kitchen for cooking healthy food, such as cooking activities still carried out by the cook himself at the Foundation's house which is located not far from the school place; use of melamine and plastic cutlery for food; the spoon and fork used already uses aluminium material but still does not match its size; does not involve nutritionists. Keywords: Early Childhood, Eating Healthy Program References: Bandura, A. (1977). Social learning theory. Englewood Cliffs: Prentice-Hall. Bandura, Albert. (2004). Health promotion by social cognitive means. Health Education and Behavior, 31(2), 143–164. https://doi.org/10.1177/1090198104263660 Battjes-Fries, M. C. E., Haveman-Nies, A., Renes, R. J., Meester, H. J., & Van’T Veer, P. (2015). Effect of the Dutch school-based education programme “Taste Lessons” on behavioural determinants of taste acceptance and healthy eating: A quasi-experimental study. Public Health Nutrition, 18(12), 2231–2241. https://doi.org/10.1017/S1368980014003012 Birch, L., Savage, J. S., & Ventura, A. (2007). Influences on the Development of Children’s Eating Behaviours: From Infancy to Adolescence. Canadian Journal of Dietetic Practice and Research : A Publication of Dietitians of Canada = Revue Canadienne de La Pratique et de La Recherche En Dietetique : Une Publication Des Dietetistes Du Canada, 68(1), s1– s56. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19430591%0Ahttp://www.pubmedcentral.nih.gov/a rticlerender.fcgi?artid=PMC2678872 Coulthard, H., Williamson, I., Palfreyman, Z., & Lyttle, S. (2018). Evaluation of a pilot sensory play intervention to increase fruit acceptance in preschool children. Appetite, 120, 609–615. https://doi.org/10.1016/j.appet.2017.10.011 Coulthard, Helen, & Sealy, A. (2017). Play with your food! Sensory play is associated with tasting of fruits and vegetables in preschool children. Appetite, 113, 84–90. https://doi.org/10.1016/j.appet.2017.02.003 Crain, W. C. (2005). Theories of development: Concepts and applications. Upper Saddle River: Pearson Prentice Hall. Dazeley, P., Houston-Price, C., & Hill, C. (2012). Should healthy eating programmes incorporate interaction with foods in different sensory modalities? A review of the evidence. British Journal of Nutrition, 108(5), 769–777. https://doi.org/10.1017/S0007114511007343 Derscheid, L. E., Umoren, J., Kim, S. Y., Henry, B. W., & Zittel, L. L. (2010). Early childhood teachers’ and staff members’ perceptions of nutrition and physical activity practices for preschoolers. Journal of Research in Childhood Education, 24(3), 248–265. https://doi.org/10.1080/02568543.2010.487405 Eliassen, E. K. (2011). The impact of teachers and families on young children’s eating behaviors. YC Young Children, 66(2), 84–89. Elliott, E., Isaacs, M., & Chugani, C. (2010). Promoting Self-Efficacy in Early Career Teachers: A Principal’s Guide for Differentiated Mentoring and Supervision. Florida Journal of Educational Administration & Policy, 4(1), 131–146. Emm, S., Harris, J., Halterman, J., Chvilicek, S., & Bishop, C. (2019). Increasing Fruit and Vegetable Intake with Reservation and Off-reservation Kindergarten Students in Nevada. Journal of Agriculture, Food Systems, and Community Development, 9, 1–10. https://doi.org/10.5304/jafscd.2019.09b.014 Flynn, M. A. T. (2015). Empowering people to be healthier: Public health nutrition through the Ottawa Charter. Proceedings of the Nutrition Society, 74(3), 303–312. https://doi.org/10.1017/S002966511400161X Franciscato, S. J., Janson, G., Machado, R., Lauris, J. R. P., de Andrade, S. M. J., & Fisberg, M. (2019). Impact of the nutrition education Program Nutriamigos® on levels of awareness on healthy eating habits in school-aged children. Journal of Human Growth and Development, 29(3), 390–402. https://doi.org/10.7322/jhgd.v29.9538 Froehlich Chow, A., & Humbert, M. L. (2014). Perceptions of early childhood educators: Factors influencing the promotion of physical activity opportunities in Canadian rural care centers. Child Indicators Research, 7(1), 57–73. https://doi.org/10.1007/s12187-013-9202-x Graham, H., Feenstra, G., Evans, A. M., & Zidenberg-Cherr, S. (2002). Healthy Eating Habits in Children. California Agriculture, 58(4), 200–205. Gucciardi, E., Nagel, R., Szwiega, S., Chow, B. Y. Y., Barker, C., Nezon, J., ... Butler, A. (2019). Evaluation of a Sensory-Based Food Education Program on Fruit and V egetable Consumption among Kindergarten Children. Journal of Child Nutrition & Management, 43(1). Holley, C. E., Farrow, C., & Haycraft, E. (2017). A Systematic Review of Methods for Increasing Vegetable Consumption in Early Childhood. Current Nutrition Reports, 6(2), 157–170. https://doi.org/10.1007/s13668-017-0202-1 Hoppu, U., Prinz, M., Ojansivu, P., Laaksonen, O., & Sandell, M. A. (2015). Impact of sensory- based food education in kindergarten on willingness to eat vegetables and berries. Food and Nutrition Research, 59, 1–8. https://doi.org/10.3402/fnr.v59.28795 Jarpe-Ratner, E., Folkens, S., Sharma, S., Daro, D., & Edens, N. K. (2016). An Experiential Cooking and Nutrition Education Program Increases Cooking Self-Efficacy and Vegetable Consumption in Children in Grades 3–8. Journal of Nutrition Education and Behavior, 48(10), 697-705.e1. https://doi.org/10.1016/j.jneb.2016.07.021 Jones, A. M., & Zidenberg-Cherr, S. (2015). Exploring Nutrition Education Resources and Barriers, and Nutrition Knowledge in Teachers in California. Journal of Nutrition Education and Behavior, 47(2), 162–169. https://doi.org/10.1016/j.jneb.2014.06.011 Jung, T., Huang, J., Eagan, L., & Oldenburg, D. (2019). Influence of school-based nutrition education program on healthy eating literacy and healthy food choice among primary school children. International Journal of Health Promotion and Education, 57(2), 67–81. https://doi.org/10.1080/14635240.2018.1552177 Lwin, M. O., Malik, S., Ridwan, H., & Sum Au, C. S. (2017). Media exposure and parental mediation on fast-food consumption among children in metropolitan and suburban Indonesian. Asia Pacific Journal of Clinical Nutrition, 26(5), 899–905. https://doi.org/10.6133/apjcn.122016.04 Mc Kenna, & L, M. (2010). Policy Options to Support Healthy Eating in Schools. Canadian Journal of Public Health, 101(2), S14–S18. https://doi.org/10.1007/BF03405619 Menkes, R. PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR 41 TAHUN 2014. , Menteri Kesehatan Republik Indonesia § (2014). Mitsopoulou, A. V., Magriplis, E., Dimakopoulos, I., Karageorgou, D., Bakogianni, I., Micha, R., ... Zampelas, A. (2019). Association of meal and snack patterns with micronutrient intakes among Greek children and adolescents: data from the Hellenic National Nutrition and Health Survey. Journal of Human Nutrition and Dietetics, 32(4), 455–467. https://doi.org/10.1111/jhn.12639 Moffitt, A. (2019). Early Childhood Educators and the Development of Family Literacy Programs: A Qualitative Case Study. ProQuest Dissertations and Theses, 96. Retrieved from http://proxy.mul.missouri.edu/login?url=https://search.proquest.com/docview/2242479347 ?accountid=14576%0Ahttps://library.missouri.edu/findit?genre=dissertations+%26+theses &title=Early+Childhood+Educators+and+the+Development+of+Family+Literacy+Progra ms%3A+ Mustonen, S., & Tuorila, H. (2010). Sensory education decreases food neophobia score and encourages trying unfamiliar foods in 8-12-year-old children. Food Quality and Preference, 21(4), 353–360. https://doi.org/10.1016/j.foodqual.2009.09.001 Myszkowska-Ryciak, J., & Harton, A. (2019). Eating healthy, growing healthy: Outcome evaluation of the nutrition education program optimizing the nutritional value of preschool menus, Poland. Nutrients, 11(10), 1–17. https://doi.org/10.3390/nu11102438 Nekitsing, C., Hetherington, M. M., & Blundell-Birtill, P. (2018). Developing Healthy Food Preferences in Preschool Children Through Taste Exposure, Sensory Learning, and Nutrition Education. Current Obesity Reports, 7(1), 60–67. https://doi.org/10.1007/s13679- 018-0297-8 Noura, M. S. pd. (2018). Child nutrition programs in kindergarten schools implemented by the governmental sector and global nutrition consulting companies: A systematic review. Current Research in Nutrition and Food Science, 6(3), 656–663. https://doi.org/10.12944/CRNFSJ.6.3.07 Oh, S. M., Yu, Y. L., Choi, H. I., & Kim, K. W. (2012). Implementation and Evaluation of Nutrition Education Programs Focusing on Increasing Vegetables, Fruits and Dairy Foods Consumption for Preschool Children. Korean Journal of Community Nutrition, 17(5), 517. https://doi.org/10.5720/kjcn.2012.17.5.517 Osera, T., Tsutie, S., & Kobayashi, M. (2016). Using Soybean Products in School Lunch for Health Education may improve Children’s Attitude and Guardians’ Knowledge in Kindergarten. Journal of Child and Adolescent Behaviour, 04(05). https://doi.org/10.4172/2375-4494.1000310 Park, B. K., & Cho, M. S. (2016). Taste education reduces food neophobia and increases willingness to try novel foods in school children. Nutrition Research and Practice, 10(2), 221–228. https://doi.org/10.4162/nrp.2016.10.2.221 Pendidikan, K., & Kebudayaan, D. A. N. Menteri Pendidikan Dan Kebudayaan Republik Indonesia Nomor 137 Tahun 2013 Tentang Standar Nasional Pendidikan Anak Usia Dini. , (2015). Prima, E., Yuliantina, I., Nurfadillah, Handayani, I., Riana, & Ganesa, R. eni. (2017). Layanan Kesehatan,Gizi dan Perawatan. Jakarta: Direktorat Pembinaan Pendidikan Anak Usia Dini Direktorat Jenderal Pendidikan Anak Usia Dini dan Pendidikan Masyarakat Kementerian Pendidikan dan Kebudayaan. Resor, J., Hegde, A. V., & Stage, V. C. (2020). Pre-service early childhood educators’ perceived barriers and supports to nutrition education. Journal of Early Childhood Teacher Education, 00(00), 1–17. https://doi.org/10.1080/10901027.2020.1740841 Rizqie Aulianaca5804p200-169314. (2011). Gizi Seimbang Dan Makanan Sehat Untuk Anak Usia Dini. Journal of Nutrition and Food Research, 2(1), 1–12. Retrieved from http://staff.uny.ac.id/sites/default/files/pengabdian/rizqie-auliana-dra-mkes/gizi-seimbang- dan-makanan-sehat-untuk-anak-usia-dini.pdf Sandell, M., Mikkelsen, B. E., Lyytikäinen, A., Ojansivu, P., Hoppu, U., Hillgrén, A., & Lagström, H. (2016). Future for food education of children. Futures, 83, 15–23. https://doi.org/10.1016/j.futures.2016.04.006 Schanzenbach, D. W., & Thorn, B. (2019). Food Support Programs and Their Impacts on Young Children. Health Affairs, (march). Retrieved from https://www.healthaffairs.org/briefs Schmitt, S. A., Bryant, L. M., Korucu, I., Kirkham, L., Katare, B., & Benjamin, T. (2019). The effects of a nutrition education curriculum on improving young children’s fruit and vegetable preferences and nutrition and health knowledge. Public Health Nutrition, 22(1), 28–34. https://doi.org/10.1017/S1368980018002586 Sekiyama, M., Roosita, K., & Ohtsuka, R. (2012). Snack foods consumption contributes to poor nutrition of rural children in West Java, Indonesia. Asia Pacific Journal of Clinical Nutrition, 21(4), 558–567. https://doi.org/10.6133/apjcn.2012.21.4.11 Sepp, H., & Ho, K. (2016). Food as a tool for learning in everyday activities at preschool exploratory study from Sweden. Food & Nurtition Research, 1, 1–7. Shor, R., & Friedman, A. (2009). 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Abstract Background Infectious diseases (ID) consultation improves SAB readmission rates, compliance with care bundles and mortality. Small community hospitals (SCHs) (which comprise 70% of US hospitals) often lack access to on-site ID physicians. IDt is one way to overcome this barrier, but it is unknown if IDt provides similar clinical benefits to traditional ID consultation. Our study aims to evaluate the impact of IDt on patient outcomes at 15 SCHs (bed range: 16–146) within the Intermountain Healthcare system in Utah. Methods Baseline demographics, Charlson Comorbidity Index (CCI), hospital length of stay (LOS), and mortality (in-hospital, 30- and 90-day) were collected using an electronic health record database and health department vital records on all patients with a positive S. aureus blood culture from January 1, 2009 through December 31, 2018. Data from January 2014 through Sep 2016 were excluded to avoid potential influence of a concurrent antimicrobial stewardship study. Starting in October 2016 an IDt program (staffed by an ID physician and pharmacist) provided consultation for SCH providers and patients using electronic consultation and encrypted two-way audiovisual communication.Statistical analyses were performed using Fisher’s exact test or χ 2 test for categorical variables and Mann–Whitney U test for nonparametric continuous data. Results In total, 625 patients with SAB were identified: 127 (20%) received IDt and 498 (80%) did not (non-IDt). The two groups (IDt vs. non-IDt) were similar in median age (66 vs. 62 years; P = 0.76), percent male (62% vs. 58%; P = 0.35), and median baseline CCI (4 vs. 4; P = 0.54). There were no statistically significant differences in median LOS (5 vs. 5 days; P = 0.93) or in-hospital mortality (2% in both groups). The IDt group had a lower 30-day (9% vs. 15%; P = 0.049) and 90-day mortality (13% vs. 21%; P = 0.034). Conclusion IDt consultation was associated with a decrease in 30- and 90-day mortality for SCH SAB cases. Early transfer of critically ill patients might have affected LOS and in-hospital mortality. Post-discharge care factors might also contribute to 30- and 90-day mortality. While more work is needed to identify other factors associated with the effect of IDt on SAB, these data support the use of IDt to increase access to care and improve SAB outcomes in SCHs. Disclosures All Authors: No reported Disclosures.

Objective: To assess whether to have a steady loving relationship changes sexual desire, level of depression and subjective need for sexual counselling to those patients who have suffered an Acute Coronary Syndrome (ACS) episode within the last year Design and Method: The sample consisted of males under 76, with a diagnosis of ACS episode, from September 1st 2014 to August 31st 2015, within the area of The University Health Care Hospital Complex of Palencia. They were appointed by a telephone call at the local Health Center to hold a personal interview in which they answered an inquiry ad hoc and the validated Beck´s Depression Questionnaire and Sexual Desire and Aversion to Sex (DESEA) Questionnaire. Data were analyzed using the statistical program SPSS Statistics 20.0. Results: 73% of patients in our sample had a partner. When applied non-parametric U-Mann-Whitney and Kruskal-Wallis as statistical contrast, it shows that loving relationships do not have any influence neither on patients’ sexual desire, nor on their demand for greater sexual counselling. It was also found that there is a direct correlation between the parameters of DESEA Questionnaire and de score reached on Beck’s Depression Questionnaire. And finally, that a decreased sexual desire will not influence their request for sexual advice. Conclusions: Sexual desire is a characteristic part of each person and that is confirmed in the participants of our research. Patients continued keeping interest for their sexuality after having suffer an ACS within the last year, regardless of the stability of their sexual relationships.

Objective: To assess whether patients’ sexual activity has worsened after suffering an Acute Coronary Syndrome (ACS). To know whether to consider sex important and to have an active sexual life has any influence on the demand for sexual counselling after the episode. Design and Method: The sample consisted of men aged <76 with diagnosis of ACS episode, from September 1st 2014 to August 31st 2015, within the area of The University Health Care Hospital Complex of Palencia. They were appointed by a telephone call to hold a personal interview in which they answered an inquiry ad hoc and the validated Beck´s Depression Questionnaire and Sexual Desire and Aversion to Sex (DESEA) Questionnaire. Data were analyzed using the statistical program SPSS Statistics 20.0. Results: Only 30.8% of patients in our sample received sexual counselling after an ACS and 86.5% of those considered it insufficient. After an assessment using non-parametric test for dependent samples and U-Mann-Whitney, we noticed that sexual activity after an ACS has worsened and the fact that those patients consider sex important or have an active sexual life doesn’t significantly influence their request for sexual advice. Conclusions: Very few patients have received sexual counselling after an ACS and most of them require more. In our sample of patients, we may guess that this demand could be due to the fact that a significant number of them no longer have a sexually active life. But, considering sex important or having an active sexual life doesn’t have any influence on that demand.

ABSTRAK Masa nifas dimulai dari placenta lahir dan berakhir ketika alat-alat kandungan kembali seperti keadaan sebelum hamil. Ibu nifas akan mengalami banyak perubahan fisik maupun psikologis. Senam nifas merupakan salah satu cara membantu ibu segera pulih, bertujuan memperlancar proses involusi uteri, bermanfaat dari segi kecantikan, mengembalikan kondisi kesehatan dan memperbaiki keregangan otot-otot setelah kehamilan. Pelaksanaan senam nifas dipengaruhi oleh faktor internal dan eksternal. Rumusan masalah berupa terbatasnya pengetahuan dan keterampilan tentang senam nifas di wilayah kerja Puskesmas Talagasari Kabupaten Karawang, dikarenakan belum adanya sosialisasi dan bimbingan tentang senam nifas. Tujuan pengabdian untuk meningkatkan pengetahuan dan keterampilan tentang senam nifas pada ibu nifas menggunakan media modul dan vidio sehingga membantu dalam melakukan senam nifas secara mandiri dan sebagai program tambahan pada kelas ibu hamil. Metode pengabdian dalam kegiatan sosialisasi dan bimbingan senam nifas menggunakan ceramah tanya jawab, diskusi, simulasi dan praktek senam nifas, disertai pre test dan post test. Kegiatan dilaksanakan selama tiga bulan di rumah responden sebanyak 185 orang. Hasil kegiatan sosialisasi dan bimbingan senam nifas ini memberikan implikasi berupa peningkatan pengetahuan ibu nifas hingga sebesar 9,28. Kegiatan telah memberikan manfaat berupa peningkatan pengetahuan dan keterampilan tentang senam nifas bagi seluruh responden. Kesimpulannya bahwa kegiatan sosialisasi dan bimbingan senam nifas memberikan implikasi berupa peningkatan pengetahuan dan kemampuan dalam melakukan gerakan-gerakan senam nifas secara mandiri menggunakan modul dan vidio senam nifas. Selanjutnya puskesmas dapat melanjutkan kegiatan senam nifas tersebut ke dalam materi perawatan nifas pada program kelas ibu hamil. Kata Kunci: Sosialisasi, Bimbingan, Senam , Nifas ABSTRACT The puerperium begins when the placenta is born and ends when the uterine organs return to their pre-pregnancy state. Postpartum mothers will experience many physical and psychological changes. Postpartum gymnastics is one way to help the mother recover soon, aims to expedite the process of uterine involution, is beneficial in terms of beauty, restores health and improves muscle tension after pregnancy. Implementation of postpartum exercise is influenced by internal and external factors. The formulation of the problem is in the form of limited knowledge and skills about postpartum exercise in the working area of the Talagasari Health Center, Karawang Regency, due to the absence of socialization and guidance regarding postpartum exercise. The purpose of the service is to increase knowledge and skills about postpartum exercise for postpartum mothers using modules and video media so that it helps in carrying out postpartum exercise independently and as an additional program for pregnant women classes. The service method in the socialization and guidance of postpartum gymnastics uses question-and-answer lectures, discussions, simulations and practice of postpartum gymnastics, accompanied by pre-tests and post-tests. The activity was carried out for three months in the homes of 185 respondents. The results of this socialization activity and postpartum exercise guidance have implications in the form of increasing the knowledge of postpartum mothers up to 9.28. Activities have provided benefits in the form of increased knowledge and skills about postpartum exercise for all respondents. The conclusion is that postpartum exercise socialization and guidance activities have implications in the form of increasing knowledge and ability to carry out postpartum exercise movements independently using postpartum exercise modules and videos. Furthermore, the health center can continue the postpartum exercise activities in the postnatal care material in the class program for pregnant women. Keywords: Socialization, Guidance, Gymnastics, PostpartumAnggarini, I. A. (2020). Pengaruh Senam Nifas Dan Pijat Oksitosin Terhadap Involusi Uteri Pada Ibu Postpartum. Midwifery Journal: Jurnal Kebidanan Um. Mataram, 5(2), 65. Https://Doi.Org/10.31764/Mj.V5i2.1277Anggarini, I. A., Hakim, M., & Hidayat, A. (2017). Pengaruh Senam Nifas Terhadap Perubahan Maternal Depressive Symptoms Di Rumah Sakit Ibu Dan Anak (Rsia) Sakina Idaman Kabupaten Sleman. Jurnal Unisa Yogya.Ayundya Prameswary1, F. K. (2019). Hubungan Inisiasi Menyusu Dini (Imd), Mobilisasi Dini Dan Senam Nifas Dengan Involusi Uteri. Jurnal Ilmiah Kebidanan Indonesia. Https://Doi.Org/10.33221/Jiki.V7i04.442Azhari, T., & Triana, A. (2022). Percepatan Involusi Uterus Pasca Persalinan Melalui Senam Nifas. Jurnal Kebidanan Tekini, 01(1), 45–55.Bi’i, G. R. M., Folamauk, C. L. H., & Telussa, A. S. (2021). Efektivitas Media Video Terhadap Peningkatan Pengetahuan Tentang Social Distancing Dalam Pencegahan Covid-19 Pada Mahasiswa Baru Universitas Nusa Cendana. Cendana Medical Journal (Cmj), 9(2), 231–239. Https://Doi.Org/10.35508/Cmj.V9i2.5975Brier, J., & Lia Dwi Jayanti. (2020). Application Of Gymnastics Nifas To Afterpains Level In Mother Post Partum In Ponek Room Salatiga City Hospital Lutfaturrohmah1priharyanti. 21(1), 1–9. Http://Journal.Um-Surabaya.Ac.Id/Index.Php/Jkm/Article/View/2203Hutabarat, V., Sitepu, S. A., Sitepu, M. S., & Situmorang, R. B. (2020). Hubungan Tingkat Pengetahuan Ibu Nifas Tentang. Jurnal Keperawatan Komprehensif, 2(2), 58–65.Ineke, S H, Murti Ani, S. S. (2016). Pengaruh Senam Nifas Terhadap Tinggi Fundus Uteri Dan Jenis Lochea Pada Primipara. Jurnal Ilmiah Bidan.Knowledge, I., Public, O., About, M., Exercise, O., Moncongloe, I., & Regency, M. (N.D.). Peningkatan Pengetahuan Ibu Nifas Tentang Senam Otaria Di Desa Moncongloe Kabupaten Maros. 2181–2185.Mindarsih, T., & Pattypeilohy, A. (2020). Pengaruh Senam Nifas Pada Ibu Postpartum Terhadap Involusi Uterus Di Wilayah Kerja The Influence Of Postpartum Exercise On Postpartum Woman To. Jurnal Kesehatan Madani Medika, 11(02), 235–246. Http://Jurnalmadanimedika.Ac.Id/Index.Php/Jmm/Article/View/129/87Mularsih, S. (2017). Studi Komparatif Tentang Minat Praktek Senam Nifas Sebelum Dan Sesudah Di Berikan Penyuluhan Pada Ibu Nifas Di Bidan Praktek Mandiri Wilayah Kota Semarang. Jurnal Penelitian Dan Pengabdian Kepada Masyarakat Unsiq, 4(3), 287–302. Https://Doi.Org/10.32699/Ppkm.V4i3.433Sari, F. N., & Suhertusi, B. (2022). Senam Nifas Upaya Percepatan Involusi Uterus Pada Ibu Postpartum. Jurnal Abdidas, 1(3), 149–156.Sari, V. K., Khairani, N., Kesehatan, F., Kebidanan, P., Fort, U., Bukittinggi, D. K., Kesehatan, F., Kebidanan, P., Fort, U., & Bukittinggi, D. K. (2022). Pengaruh Senam Nifas Terhadap Kualitas Tidur Ibu Nifas Di Praktik Mandiri Bidan R Bukittinggi. Jurnal Endurance, 7(1), 199–208. Http://Publikasi.Lldikti10.Id/Index.Php/Endurance/Article/View/743Savitri, N. P. H., & . S. (2018). Pengaruh Senam Nifas Dalam Peningkatan Produksi Asi. Jurnal Kebidanan, 9(02), 138. Https://Doi.Org/10.35872/Jurkeb.V9i02.315Sayuti, S., Almuhaimin, Sofiyetti, & Sari, P. (2022). Efektivitas Edukasi Kesehatan Melalui Media Video Terhadap Tingkat Pengetahuan Siswa Dalam Penerapan Protokol Kesehatan Di Smpn 19 Kota Jambi. Jurnal Kesmas Jambi, 6(2), 32–39.Siti Noor Hasanah1), Lisda Handayani2), Ainul Fithrah Syahidina3), Agusta Leni4), Dini Indah Purnamasari5), Hema Malinie6), Ratnawiyah7), Rida Ayu Rizki8), Salma Mariesa9), I. F. (2023). Postpartum Exercise In Digital Era In The Working Area Of Guntung. 2(1), 347–354.Sumarni, S., Lasanuddin, H. V., & Annisa, R. (2021). Pendidikan Kesehatan Dan Pelatihan Senam Nifas Agar Ibu Tetap Sehat Dimasa Pandemi Covid-19 Di Akademi Kebidanan Tahirah Al Baeti Bulukumba. Jcs, 3(1), 15–21. Https://Doi.Org/10.57170/Jcs.V3i1.5Victoria, S. I., & Yanti, J. S. (2021). Asuhan Kebidanan Pada Ibu Nifas Dengan Pelaksanaan Senam Nifas, Jurnal Kebidanan Terkini ( Current Midwifery Journal ). 01, 45–55.Widatiningsih, S., Rofi’ah, S., Yuniyanti, B., & Sukini, T. (2018). Pelatihan Senam Nifas Bagi Kader Posyandu Di Desa Ambartawang Kecamatan Mungkid Kabupaten Magelang. Link. Https://Doi.Org/10.31983/Link.V14i1.2955World Health Organization; London School Of Hygiene And Tropical Medicine. (2017). Efektivitas Antara Senam Nifas Versi A Dan Senam Nifas Versi N Terhadap Kelancaran Involusio Uteri Di Puskesmas Binuang Tahun 2017 (Lina Fitriani,S.St.,M.Keb) Salah. Bmc Public Health, 5(1), 1–8. 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Background:Outpatient non-attendance refers to the phenomenon of patients who have a medical appointment but do not show up at the specified date, time, and location without giving previous notice.1In addition to affecting the efficiency and thereby increasing the healthcare total costs, nonattendance might also delay access to care for users on waiting lists.1Nonattendance at health appointments is costly to services, and can risk patient health.2There is very little data on the nonattendance prevalence and impact in Portugal. This knowledge might be fundamental to improve effectiveness of outpatient care in Portugal.Objectives:1) describe patient’s non-attendance rate; 2) assess and characterize the sociodemographic and clinical characteristics among non-attending patients; 3) estimate the economic burden of non-attendance.Methods:Retrospective, cross-sectional and analytical study. We reviewed a one-month Rheumatology consultation period regarding performed medical consultations and non-attended consultations without previous notification from patients. Direct economic costs of non-attended appointments were calculated based on the “Amending Agreement to the ULSAM, EPE Program Agreement”.Results:982 consultations within January 2018 were included. Appointments episodes for therapeutic prescription, medical reports or programmed admissions were excluded. Fifty-seven (5.8%) of scheduled outpatient appointments were non-attended. Subsequent consultations represented 85.2% of attended appointments and 80.7% of non-attended appointments. Female gender was the most prevalent in both groups – 620 (67.0%) among attended consultations and 37 (65.0%) among non-attended consultations. Mean age was 57±15 years in the first group and 54±16 years in the second one. Among attended appointments, mean education level was 8±5 years versus 9±6 years among non-attended appointments. There were no differences between both groups in gender, age, education level, diagnosis, disease duration and activity or appointment type (first or subsequent consultation). A cost of 2,438 euros was estimated regarding non-attended appointments for this period, what could represent a burden of more than 29,000 euros yearly, in direct costs, only.Conclusion:Non-attendance at scheduled appointments in public hospitals seems to be influenced by other factors besides gender, age and education level. The burden of non-attended appointments is undeniable. In addition to the costs estimated in this study, further indirect costs such as poorer patients outcomes, impaired access to medical care and hospital penalties should be taken into account. Implementation of awareness strategies aiming the optimization and effectiveness of healthcare system are required.References:[1]Blæhr EE, Kristensen T, Væggemose U, Søgaard R. The effect of fines on nonattendance in public hospital outpatient clinics: study protocol for a randomized controlled trial.Trials. 2016;17(1):288. doi:10.1186/s13063-016-1420-3[2]Akter S. A qualitative study of staff perspectives of patient non-attendance in a regional primary healthcare setting.Australas Med J. 2014;7(5):218-226. doi:10.4066/AMJ.2014.2056Disclosure of Interests:None declared

The welfare system in the United States is not simply “small,”“residualist,” or “laggard.” It is true that protection against standard social risks is generally less comprehensive and less generous in the United States than in other rich democracies, but there are other important differences as well: The U. S. welfare state is unusual in its extensive reliance on private markets to produce public social goods; its geographic variability; its insistence on deservingness as an eligibility criterion; and its orientation toward benefits for the elderly rather than children and working-age adults. Nevertheless, the U.S. welfare state is not sui generis. The actors involved in the construction of the U.S. welfare state, the institutions created in response to social problems, and the contemporary pressures confronting the welfare state all have parallels in other countries. The markets that provide so many social goods in the United States are the products of state action and state regulation, and hence should really be thought of as part of the welfare “state.” Even recent expansions to the welfare state in the United States have, with the partial exception of health-care reform, reinforced old patterns of elderly oriented spending and benefits for worthy (working) adults. In order for the U.S. welfare state to adjust successfully to ensure against new social risks, it must focus more on underdeveloped program areas like health care, child care, early childhood education, and vocational training.