Concepções de jovens educandos sobre sistema e serviços de saúde públicos / Conceptualizaciones de jóvenes educandos sobre sistema y servicios de salud públicos / Conceptions of young students about public health system and services

RESUMO Objetivo: descrever as concepções de jovens educandos sobre o sistema e serviços de saúde públicos, a partir da pesquisa participante. Métodos: pesquisa participante realizada no período de outubro a dezembro de 2017, com 12 educandos de 12 a 16 anos, pertencentes a uma escola pública de Pelotas. A coleta e análise de dados ocorreu por meio do Círculo de Cultura e Photovoice. Resultados: os educandos associam serviços de saúde com doenças e questões biológicas, e sabem que os serviços prestados pelo Sistema Único de saúde são financiados com dinheiro público. A visão dos educandos sobre a Unidade Básica de Saúde foi preocupante pelo desconhecimento sobre o que é este serviço, apesar da proximidade física com a escola e, além disso, referem não frequentar a unidade. Considerações finais: o diálogo permitiu o reconhecimento de concepções dos educandos relativo ao sistema de saúde, porém evidenciou desconhecimento e falta de vivências em serviços públicos. Isto reforça a importância da promoção do diálogo no espaço da escola para que se tenha a formação de cidadãos críticos e atuantes na sociedade, podendo refletir na construção de outros significados e valores e com isso, outras concepções de sociedade, saúde e doença.

RESUMEN Objetivo: describir las conceptualizaciones de jóvenes educandos sobre el sistema y servicios de salud públicos, a partir de la investigación participante. Método: investigación participante realizada en el período de octubre a diciembre de 2017, con 12 educandos de 12 a 16 años, pertenecientes a una escuela pública de Pelotas-RS-Brasil. La recolección y el análisis de datos se llevó a cabo a través del Círculo de Cultura y Photovoice. Resultados: los educandos asocian los servicios de salud con enfermedades y problemas biológicos, y saben que los servicios prestados por el Sistema Único de Salud se financian con dinero público. La visión de los educandos sobre la Unidad Básica de Salud fue preocupante por el desconocimiento sobre qué es este servicio, a pesar de la proximidad física con la escuela y, además, relatan no frecuentar la unidad. Consideraciones finales: el diálogo permitió el reconocimiento de conceptualizaciones de los educandos relativo al sistema de salud, pero evidenció desconocimiento y falta de vivencias en servicios públicos. Esto refuerza la importancia de la promoción del diálogo en el espacio de la escuela para que se tenga la formación de ciudadanos críticos y actuantes en la sociedad, pudiendo reflejar en la construcción de otros significados y valores y con ello, otras conceptualizaciones de sociedad, salud y enfermedad.

ABSTRACT Objective: to describe the conceptions of young students about the public health system and services, based on the participant research. Methods: participant research conducted from October to December 2017, with 12 students aged 12 to 16 years, belonging to a public school in Pelotas. Data collection and analysis occurred through the Circle of Culture and Photovoice. Results: students associate health services with diseases and biological issues, and know that the services provided by the Unified Health System are financed with public money. The students' view of the Basic Health Unit was worrisome because of the lack of knowledge about what this service is, despite the physical proximity to the school and, moreover, they reported not attending the unit. Final considerations: the dialogue allowed the recognition of students' conceptions related to the health system, but showed ignorance and lack of experiences in public services. This reinforces the importance of promoting dialogue in the school space so that critical and active citizens in society are trained, and may reflect on the construction of other meanings and values and thus other conceptions of society, health and disease.

Patients Are Willing to Wait for Rapid Sexually Transmitted Infection Results in a University Student Health Clinic.

We examined the acceptability and feasibility of using a 30-minute chlamydia/gonorrhea test in a student health clinical setting. One hundred eight students were enrolled and 89.4% were willing to wait up to 20 minutes beyond the conclusion of their routine visit. The average amount of time added per clinic visit was less than 11 minutes. Patient and staff satisfaction were high.

Intimate partner and sexual violence screening practices of college health care providers.

BACKGROUND: Female college students experience higher rates of intimate partner violence (IPV) and sexual violence (SV) compared to men of all ages, older women and young women who are not attending college. Experts and medical organizations have issued recommendations that health care providers should routinely screen women for IPV and SV. However, most female college students report they are not being screened for IPV and SV at college health centers. AIM: This exploratory study sought to examine the IPV and SV screening practices of college health care providers and identify individual and organizational influences using a cross-sectional, quantitative survey design. METHODS: Sixty-four health care providers (physicians, nurse practitioners and registered nurses) from five colleges and universities in the northeastern U.S. were invited to participate in an anonymous, web-based survey about their IPV/SV-related screening practices and beliefs, and organizational characteristics of their college health centers. RESULTS: Twenty-six health care providers completed surveys (56% response rate). The median reported IPV/SV screening rate was 15%. More IPV/SV screening was reported by nurse practitioners, providers at state colleges, and by those in health centers that prioritized IPV/SV screening and had greater organizational capacity for change. CONCLUSIONS: College health centers represent unique, yet often missed, opportunities to screen for IPV/SV in a high-risk population. Provider- and organization-level influences should be incorporated into future interventions to improve IPV/SV screening in college health centers. Future studies with larger numbers of colleges and providers are needed to better understand organizational influences and identify mediators and moderators of effects.

The state of sexual health services at U.S. Colleges and Universities.

OBJECTIVE: To describe the array of sexual health care services provided at US colleges and universities. PARTICIPANTS: During 2014-2015, 885 colleges were surveyed about their provision of sexual health services. METHODS: 55% of colleges responded. Data were weighted and stratified by minority-serving institutions (MSIs), 2-year and 4-year institutions. RESULTS: 70.6% of colleges reported having a health center (HC), of which 73.0% offered STI diagnosis/treatment (4 years vs. 2 years; 77.9% vs. 53.1%) and contraceptive services (70.1% vs. 46.4%), all p < .001. HCs less frequently offered LARC (19.7%), express STI testing (24.4%) and self-collection (31.4%). Condoms were available on 66.8% of campuses. HPV vaccination was available at more 4-year colleges (73.7% vs. 48.5%, p < .003) and non-MSIs (74.4% vs. 58.5, p = .019). Regarding MSM-targeted services, 54.6% offered pharyngeal and 51.8% rectal STI testing. CONCLUSIONS: 2-year colleges may require additional support with providing sexual health care. Improvements could entail increasing express testing, extra-genital STI testing, and LARC.

Chlamydia and gonorrhea screening and expedited partner therapy (EPT) practices of college student health centers.

OBJECTIVE: To examine college student health centers' (SHCs) practices related to sexually transmitted disease (STD) screening and treatment over a 5-year period. PARTICIPANTS: College SHCs that completed the ACHA Pap and STI Survey between 2010 and 2014. METHODS: Chi-square tests were conducted with Cramer's V providing a measure of association. RESULTS: Chlamydia screening of women under 25 years of age was a well-established practice. Almost one-third of SHCs did not report screening practices of men who have sex with men (MSM) consistent with current chlamydia and gonorrhea guidelines; however, there was improvement over time. Few college SHCs utilized expedited partner therapy (EPT), though fewer had blanket restrictions prohibiting its use in 2014 compared to 2010. CONCLUSIONS: Over the 5-year period, more SHCs followed current best practices. Improvement in compliance with guidelines related to MSM STD screening as well as increased usage of EPT is needed to best address the needs of the diverse college student population.

Improving STD Screening Rates on a University Campus.

Gonorrhea and chlamydia infections have a high incidence among young adults. To increase screening rates among individuals aged 25 years of age and younger on a university campus, this quality improvement project was implemented to improve providers' knowledge of CDC guidelines through education. Education was provided to providers and staff members at a health clinic on a private residential university campus through informational sessions to increase knowledge of guideline-directed screening for gonorrhea and chlamydia. This education was coupled with a multifaceted approach for provider-reminder interventions: flagging patients in the EHR system that fall within the age group (25 years of age and younger) to generate an alert, patients completing a questionnaire while in the exam room, and identification of a project champion. Screening rates were evaluated during pre- and post-implementation phases to determine if a change in practice occurred among providers. Post-intervention revealed the average number of patients screened for gonorrhea and chlamydia was 65.85% (349/530). This change represented a marked increase from pre-intervention screening of 2% (11/405). The testing rate increased during the post-intervention phase to 17.86% (65/364), up from 7.90% (32/405) pre-implementation. Provider education on guideline-directed screening for gonorrhea and chlamydia increased screening among providers at a university health clinic. This intervention, combined with provider-reminder interventions, increased screening of patients, leading to an increased testing rate for gonorrhea and chlamydia.

Human papillomavirus vaccine and Pap tests on college campuses: How do historically black colleges and universities (HBCUs) measure up?

OBJECTIVE: The availability of cervical cancer prevention services at college health centers was compared between historically black colleges and universities (HBCUs) and non-HBCUs. METHODS: Four-year, non-primarily distant learning colleges, matching HBCUs with randomly selected non-HBCUs within the same states (N = 136) were examined. Data were collected (2014-2015 academic year) on the availability of human papillomavirus (HPV) vaccine and Pap tests at college health centers. HBCUs were compared with non-HBCUs using conditional logistic regression, and correlates of offering these services were identified. RESULTS: Many institutions did not offer HPV vaccine or Pap tests. Fewer HBCUs offered HPV vaccine (18% vs 53%) and Pap tests (50% vs 76%) compared with non-HBCUs. In multivariable analyses, HBCUs remained less likely than non-HBCUs to offer HPV vaccine (odds ratio [OR] = 0.07, 95% confidence interval [CI]: 0.02-0.26) and Pap tests (OR = 0.19, 95% CI: 0.06-0.61). CONCLUSIONS: Greater effort is needed to make cervical cancer prevention services available at colleges, especially at HBCUs.

Income Disparities in the Use of Health Screening Services Among University Students in Korea: A Cross-Sectional Study of 2479 Participants in a University.

Public health insurance coverage for preventive care in young adults is incomplete in Korea. Few studies have focused on young adults' socioeconomic disparities in preventive care utilization. We aimed to explore household income disparities in the use of different types of health screening services among university students in Korea.This cross-sectional study used a web-based self-administered survey of students at a university in Korea from January to February 2013. To examine the associations between household income levels and health screening service use within the past 2 years, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression with adjustment for various covariables.Of 2479 participants, 45.5% reported using health screening services within 2 years (university-provided screening 32.9%, private sector screening 16.7%, and both 4.1%). Household income levels were not significantly associated with overall rates of health screening service use with a multivariable-adjusted OR (95% CI) in the lowest versus highest income group of 1.12 (0.87-1.45, Ptrend = 0.35). However, we found significantly different associations in specific types of utilized screening services by household income levels. The multivariable-adjusted OR (95% CI) of university-provided health screening service use in the lowest versus highest income level was 1.74 (1.30-2.34; Ptrend < 0.001), whereas the multivariable-adjusted OR (95% CI) of private sector service use in the lowest versus highest income level was 0.45 (0.31-0.66; Ptrend < 0.001).This study demonstrated significant disparities in the types of utilized health screening services by income groups among university students in Korea, although overall rates of health screening service use were similar across income levels. Low-income students were more likely to use university-provided health screening services, and less likely to use private sector screening services. To ensure appropriate preventive care delivery for young adults and to address disparities in disadvantaged groups, the expansion of medical insurance coverage for preventive health care, establishment of a usual source of care, focusing on vulnerable groups, and the development of evidence-based standardized health screening guidelines for young adults are needed.

US college and university student health screening requirements for tuberculosis and vaccine-preventable diseases, 2012.

OBJECTIVE: Colleges are at risk for communicable disease outbreaks because of the high degree of person-to-person interactions and relatively crowded dormitory settings. This report describes the US college student health screening requirements among US resident and international students for tuberculosis (TB) and vaccine-preventable diseases (VPDs) as they relate to the American College Health Association (ACHA) guidelines. Methods/Participants: In April 2012, US college health administrators (N = 2,858) were sent online surveys to assess their respective school's TB screening and immunization requirements. RESULTS: Surveys were completed by 308 (11%) schools. Most schools were aware of the ACHA immunization (78%) and TB screening (76%) guidelines. Schools reported having policies related to immunization screening (80.4%), immunization compliance (93%), TB screening (55%), and TB compliance (87%). CONCLUSION: Most colleges were following ACHA guidelines. However, there are opportunities for improvement to fully utilize the recommendations and prevent outbreaks of communicable diseases among students in colleges.

Managing Helicobacter pylori in college health, with special considerations for international students.

OBJECTIVE: Helicobacter pylori infection is the major cause of dyspepsia, peptic ulcer disease, and gastric cancer. This paper will make specific recommendations for a diagnostic and treatment strategy tailored to the international student population. PARTICIPANTS/METHODS: This paper is a case report and narrative review based on recent international epidemiologic studies and consensus conference recommendations identified in MEDLINE. RESULTS: In the nations (mostly Asian) that send the largest number of students to the United States, the prevalence of H. pylori is generally 60% to 80%, whereas the prevalence in the United States is about 25%. The patterns of antibiotic resistance in those countries are also different than that in the general US population. CONCLUSIONS: Health care providers should have a higher index of suspicion for Helicobacter infection among international students with dyspepsia and need to use a different treatment regimen than is standard for the general US population.

Screening and Counseling for Tobacco Use in Student Health Clinics: Reports of Health Care Providers.

PURPOSE: To assess tobacco screening and counseling in student health clinics, including facilitators, barriers, and associations with campus- and state-level variables. DESIGN: We conducted a mixed-methods study with an online survey and qualitative interviews. SETTING: Study setting was student health clinics on college campuses. SUBJECTS: Subjects included 71 clinic directors or designees from 10 Southeastern states (quantitative survey) and 8 directors or designees from 4 Southeastern states (qualitative interviews). MEASURES: Quantitative measures included demographics, screening and counseling practices, clinic-level supports for such practices, perceptions of tobacco on campus, institution size, public/private status, state tobacco farming revenue, and state tobacco control funding. Qualitative measures included barriers and facilitators of tobacco screening and counseling practices. ANALYSIS: Logistic and linear regression models assessed correlates of screening and counseling. Qualitative data were analyzed using multistage interpretive thematic analysis. RESULTS: A total of 55% of online survey respondents reported that their clinics screen for tobacco at every visit, whereas 80% reported their clinics offer counseling and pharmacotherapy. Barriers included lack of the following: time with patients, relevance to chief complaint, student self-identification as a tobacco user, access to pharmacotherapy, and interest in quitting among smokers. In multivariable models, more efforts to reduce tobacco use, student enrollment, and state-level cash receipts for tobacco were positively associated with clinic-level supports. CONCLUSION: This study highlights missed opportunities for screening. Although reports of counseling were higher, providers identified many barriers.

Development of a community pharmacy human papillomavirus vaccine program for underinsured university students along the United States/Mexico border.

OBJECTIVE: To describe the development and implementation of a human papillomavirus (HPV) vaccine patient assistance program (PAP) for university students, and to acquire information on the number who accessed the program and completed the series. SETTING: University of Texas at El Paso University Student Health Clinic Pharmacy, Fall 2011-Spring 2014. PRACTICE DESCRIPTION: A community pharmacy located within the university student health clinic providing services to an underinsured student population. PRACTICE INNOVATION: Existing evidence shows the benefit of using PAP in community pharmacies but is nonspecific regarding the use of PAP for vaccines in an uninsured and underinsured Hispanic student population. The implementation of this unique HPV vaccine program in a community setting aims to increase awareness, access, and rates. MAIN OUTCOME MEASURES: Primary measures included results from a needs-assessment questionnaire that were used to implement the HPV vaccine program. After implementation, utilization data were collected on the number of students who qualified and enrolled in the HPV PAP and the number of students who completed the HPV series. RESULTS: The preliminary data from a needs assessment indicated that a majority (72.1%, n = 80) of students did not understand how HPV is transmitted. A total of 89 students qualified for PAP. The majority were women (81%). A total of 71 students (79.8%) received their second dose and 43 (48.3%) completed the series. CONCLUSIONS: Although pharmacists continue to provide vaccine services, minorities such as the Hispanic population continue to be underimmunized. Students may not be taking the proper precautions to prevent the acquisition of HPV. For these reasons services such as this HPV vaccine program are warranted. Pharmacists need to continue to educate and advocate on the importance of vaccines and how they prevent disease.

Implementation of universal behavioral health screening in a university health setting.

Universal screening at university health centers can facilitate early identification and treatment of behavioral health problems common among college students. This article describes the (a) process of implementing behavioral health screening at a university health center and (b) results of universal screening for depression, suicidal ideation, alcohol misuse, tobacco use, and sleep problems. We discuss the decision points involved in screening, including what to screen for, whom to screen, how to implement the screening measure, and how to deal with patients who screen positive. During the Spring and Fall 2010 academic semesters, 4,126 screening questionnaires were completed by students (62% female) accessing a university health center. Each semester, 9-13% of students screened positive for depression, 2.5-3% for suicidal ideation, and 33-38% for alcohol misuse, while 10% wanted help with smoking cessation and 12-13% with sleep problems. The results suggest that behavioral health screening in a university health center can help identify students with behavioral health concerns to increase access to care.

Web-based screening and brief intervention for student marijuana use in a university health center: pilot study to examine the implementation of eCHECKUP TO GO in different contexts.

This pilot study sought to test the feasibility of procedures to screen students for marijuana use in Student Health Services (SHS) and test the efficacy of a web-based intervention designed to reduce marijuana use and consequences. Students were asked to participate in voluntary screening of health behaviors upon arrival at SHS. One hundred and twenty-three students who used marijuana at least monthly completed assessments and were randomized to one of four intervention conditions in a 2 (intervention: Marijuana eCHECKUP TO GO vs. control)×2 (site of intervention: on-site vs. off-site) between-groups design. Follow-up assessments were conducted online at 3 and 6 months. Latent growth modeling was used to provide effect size estimates for the influence of intervention on outcomes. One thousand and eighty undergraduate students completed screening. The intervention did not influence marijuana use frequency. However, there was evidence of a small overall intervention effect on marijuana-related consequences and a medium effect in stratified analyses in the on-site condition. Analyses of psychological variables showed that the intervention significantly reduced perceived norms regarding peer marijuana use. These findings demonstrate that it is feasible to identify marijuana users in SHS and deliver an automated web-based intervention to these students in different contexts. Effect size estimates suggest that the intervention has some promise as a means of correcting misperceptions of marijuana use norms and reducing marijuana-related consequences. Future work should test the efficacy of this intervention in a full scale randomized controlled trial.

College health as a partner in the care of pediatric cancer survivors.

OBJECTIVE: This study reviews an initiative to educate providers on pediatric cancer survivor care and to establish a cancer survivor registry in a college health center. PARTICIPANTS: PARTICIPANTS were University of Georgia (UGA) college health providers. METHODS: Providers attended lectures on survivor care and were encouraged to register on Cancer SurvivorLink. Changes in provider familiarity and practice were measured using baseline and follow-up surveys. A survivor registry was created using health entrance forms and medical records abstraction. RESULTS: Twenty-four providers registered on SurvivorLink, and 16 completed both surveys. Familiarity with survivor care (p = .003) and a survivor health care plan (p = .016) increased. Likelihood to deliver survivor care increased (p = .01). UGA follows 95 survivors; 71 diagnosed at < 21 years. Among survivors diagnosed at < 21 years, 91% reported their diagnosis on entrance forms. CONCLUSIONS: Through education and optimization of health informatics, college health centers can identify and provide survivor care to this medically vulnerable population.

Participación en un estudio para valorar la Atención Primaria de Salud entre afiliados de una obra social universitaria / Participation in a study to assess primary health care among members of university health insurance in Argentina / Participação em uma pesquisa para avaliar osciudados primários da saúde entre filiados e filiadasde um plano médico universitário na Argentina

Objetivo: Describir la proporción de localización, participación y respuesta en una encuesta para valorar la atención primaria de la salud de afiliados de una obra social universitaria. Métodos: Estudio piloto descriptivo transversal. Muestreo aleatorio simple de 500 personas adultas de la base de datos de afiliaciones. Se calcularon proporciones de localización, participación, respuesta y respuesta total, luego se analizaron por sexo, edad, tipo de afiliación y modo de administración. Resultados: El 61,8% de afiliados fue localizado, el 84,5% de las personas localizadas aceptó participar y el 64,4% de ellas respondió el cuestionario, alcanzando una proporción de respuesta total del 54,4%. Las personas jóvenes fueron relativamente menos localizadas (52,2%; p<0,01) y la mayor proporción de respuesta total se consiguió en las mayores de 65 años (68,2%; p<0,05). Conclusiones: La localización fue dificultosa pero hubo una buena aceptación del estudio. Los medios informatizados de administración fueron preferidos pero tuvieron una baja respuesta

Aim: To describe the location, participation and response to a survey to assess primary health care in members of a University Health Insurance.Materials and methods: Pilot cross-sectional descriptive study. Simple random sample of 500 adults from members’ database. Proportions of location, participation, response and total response were calculated and analyzed according to sex, age, and type of membership and administration. Results: 61.8% of members were found, 84.5% agreed to participate and 64.4% answered the questionnaire, reaching a total response rate of 54.4%. Young people were less likely to be localized (52.2%, P <0.01) and higher total response rate was achieved in people over 65 (68.2%, P <0.05).Conclusions: Finding the members was difficult but there was a good level of study acceptance. The computerized questionnaire showed strong preference but low response

[Chronic tonsillitis in the students of a humanitarian higher school: incidence, diagnostics, and therapeutic strategies].

The objective of the present work was to study peculiar features of the nosological structure of chronic ENT pathology in the applicants and students of a higher education institution and perform a thorough analysis of the prevalence of various forms of chronic pharyngeal diseases. The study was based at the Polyclinic of Moscow State Institute of International Relations, Russian Ministry of Foreign Affairs, and lasted from 1998 to 2011. A total of 42 829 subjects aged between 15-30 years were examined including 32 186 applicants undergoing physical qualification by the medical evaluation board and 10 643 students subjected to routine annual medical examination. The latter group was characterized by the high prevalence of chronic ENT diseases predominated by pharyngeal pathology (39.6-59.8%). Chronic pharyngeal pathology was prevailed by chronic tonsillitis (32.7-50.6%) followed in the descending order by chronic pharyngitis (16.9-25.2%), papillomas affecting the soft palate, palatine arches and tonsils (0.8-1.5%), and adenoid vegetations (0.05-0.4%). It is concluded that regular medical check-up and treatment provide an effective tool for the prevention of CT progression and the development of its complications in the young subjects. 93.81% of the students were removed from dispensary observation due to improvement of health conditions or recovery. It is concluded that the surgical treatment of CT (bilateral tonsillectomy) should be more extensively applied in the absence of the desired effect of its conservative therapy.

Acceptability of sexually transmitted infection testing using self-collected vaginal swabs among college women.

OBJECTIVE: To assess the acceptability of sexually transmitted infection (STI) testing using self-collected vaginal swabs (SCVS) among college women. PARTICIPANTS: First-year female students (N=483). METHODS: Participants were offered free testing for 3 STIs using SCVS in April 2010 and later completed a survey regarding their testing decision and experiences. RESULTS: Sixty-four percent (n=310) accepted testing; of these, 98% found it easy or very easy to understand the SCVS instructions, and 93% found it easy or very easy to collect the specimen. Among the 36% who did not participate in testing, most had scheduling conflicts or did not perceive a risk for STIs; only 26% felt uncomfortable about the SCVS procedure. Among all women, SCVS was preferred over other STI testing methods. CONCLUSIONS: STI testing using SCVS was acceptable to the majority of college women and could increase the uptake of testing among sexually active college women.

Help seeking for mental health on college campuses: review of evidence and next steps for research and practice.

This article reviews what is known about help-seeking behavior for mental health problems in college populations and offers suggestions for the next steps that could be undertaken to improve knowledge and practice in this area. Our review suggests that traditional barriers, such as stigma, can only partially explain the high prevalence of untreated disorders. We discuss the conclusions and limitations of research on campus-based intervention strategies, including anti-stigma campaigns, screening programs, and gatekeeper trainings. In proposing new directions for research and practice, we consider insights from research on other health behaviors (e.g., diet and exercise) as well as innovative ideas from behavioral economics and cognitive psychology regarding behavior change.