Analysis of traditional feeding practices and stunting among children aged 6 to 59 months in Karanganyar District, Central Java Province, Indonesia.

BACKGROUND: Traditional feeding practices are widespread in Indonesia. Therefore, using traditional feeding practices commonly used among mothers, this study examined the association between these practices and stunting along with other relevant factors (i.e., sociodemographic factors, feeding practices, vaccination status, and place of residence). METHODS: This cross-sectional study was conducted in Karanganyar District, Central Java Province. Data from a total of 706 children aged 6 to 59 months (352 children with stunting and 354 children without stunting) were obtained from the medical records of 10 primary health care units (PHCUs) in 9 subdistricts. Descriptive analysis and binary logistic regression (BLR) were performed to explore the association between the dependent (stunting) and independent variables. RESULTS: The BLR results from children 6 to 59 months indicated that children of mothers with food restrictions during pregnancy (AOR = 5.87, 95% CI: 3.03, 11.38), children with prelacteal feeding (AOR = 4.27, 95% CI: 2.16, 8.41) and children with food restrictions (AOR = 7.74, 95% CI: 1.22, 49.16) were more likely to experience stunting. Those from children 6 to 23 months revealed that food restrictions during pregnancy (AOR = 17.55, 95% CI: 2.86, 107.80) and prelacteal feeding (AOR = 10.58, 95% CI: 2.06, 54.41) were related to stunting. The reasons for traditional feeding practices were related to cultural beliefs. For example, mothers believed that red meat could cause high blood pressure; thus, the consumption of red meat could trigger miscarriage or bleeding during delivery. In addition, this study showed that low sociodemographic status, inappropriate feeding practices, incomplete vaccination, and residence in rural areas were related to stunting. CONCLUSIONS: The findings reflect the importance of education for mothers to correct misconceptions of traditional feeding practices. The government should strengthen counseling services in PHCUs to improve mothers' knowledge of and attitudes toward appropriate feeding practices. Additionally, public relations practices through the mass media should continue for family members, especially senior members, as they influence mothers' autonomy in decision-making regarding feeding practices in Indonesia.

Associations Between Spousal Relationship, Husband Involvement, and Postpartum Depression Among Postpartum Mothers in West Java, Indonesia.

INTRODUCTION: Indonesia is actively promoting husband involvement in maternal health care, since it has been claimed to impact the wellbeing of mothers. This study aims to investigate the extent to which spousal relationship, husband involvement, and maternal health behavior affect postpartum depression among Indonesian mothers. METHOD: A survey was carried out among 336 postpartum mothers who received maternal care in 27 independent midwifery clinics in 7 regions of West Java Province, Indonesia. The measurement model of husband involvement comprising 4 dimensions, namely maternity care engagement, instrumental support, emotional support, and informational support were developed and validated using confirmatory factor analysis. The Quality of Marriage Index (QMI) and the Edinburgh Postnatal Depression Scale (EPDS) were also validated and used to measure spousal relationship and postpartum depressive symptoms. A structural equation model was specified to examine the association between spousal relationship, husband involvement, maternal healthy behavior, and postpartum depression. RESULTS: The study confirms the assumption that the quality of the spousal relationship could determine husband's involvement during pregnancy, childbirth, and postpartum (γ = .60, P < .001), eventually leading to better maternal healthy behavior (γ = .015, P < .001) and a decrease in postpartum depressive symptoms among mothers (γ = -.21, P < .001). CONCLUSIONS: The study results suggest the needs to promote comprehensive husband involvement to enhance the wellbeing of mothers. This can be achieved through couple interventions at the community level and the inclusion of a supportive role for husbands in the maternal and childcare guidebook offered during ANC visits.

Transnational Mobility and Utilization of Health Services in Northern Thailand: Implications and Challenges for Border Public Health Facilities.

INTRODUCTION/OBJECTIVE: Transnational populations from the Association of Southeast Asian Nations are crossing borders regardless of whether their status is legal or undocumented, to receive health services in the border regions of Thailand. The implications and challenges of transnational mobility and the utilization of public health facilities in Thailand's border regions are therefore investigated in this study. METHODS: Four public health facilities were selected, located in 2 economically-active border areas in Northern Thailand: Mae Sai-Tachileik at the Thailand-Myanmar border and Chiang Saen-Ton Phueng at the Thailand-Lao PDR border. Qualitative data were obtained from in-depth interviews with 8 medical and non-medical hospital staff responsible for implementing facility-level policies and providing health services for the transnational population. RESULTS: Five themes were identified through analysis of the implications and challenges for transnational mobility and the utilization of public health facilities under study: contextual determinants of illness in specific border areas; uncompensated care as opposed to financial management in serving the transnational population; health service opportunities for the transnational population; cross-border collaboration on public health; and the remaining challenges of transnational mobility in border regions. CONCLUSION: Conventional content analysis with interpretative induction of in-depth interview data offers recommendations for improving the capacity of border health facilities to reduce the burden placed upon them to provide services to the transnational population.

Ownership and utilization of bed nets and reasons for use or non-use of bed nets among community members at risk of malaria along the Thai-Myanmar border.

BACKGROUND: With the goal for malaria elimination in Thailand set for 2024, increased coverage and utilization of bed net, especially insecticide-treated net (ITN) or long-lasting insecticidal net (LLIN) is a key strategy. This study aims to provide the necessary information about bed net ownership and utilization among the population at risk of malaria living along the Thai-Myanmar border in Tak province. METHODS: A cross-sectional study was conducted using a mixed-method approach in 331 households from 5 hamlets in the villages of the Thai-Myanmar border. The research tools included a questionnaire, bed net inspection, and semi-structured interviews. Logistic regression was used to explore the sociodemographic factors associated with bed net utilization. The qualitative analysis employed a thematic analysis approach. RESULTS: This survey found that 98.5% of households had at least one bed net per household, and 74.3% had at least one ITN/LLIN. However, only 30.8% of households reached the standard policy set by the Minister of Public Health of one ITN/LLINs per two persons. Most residents used bed net (92.1% used in the previous night and 80.9% used every day). For those using bed nets, however, 61.9% used ITNs or LLINs the night before and 53.1% used them every day. Nonetheless, the usage rates of bed nets (any type) in the previous night among children and pregnant women were high, reaching 95.3% and 90.0%, respectively. Seven explanatory variables showed statistically significant associations with bed net use every day, including: "not staying overnight in the forest or the field", "sleeping pattern based on gender", "sufficient numbers of bed nets to cover all sleeping spaces", "preference for free bed nets", "age", "gender", and "SES score" showed statistically significant association with bed net use every day. The major reasons for the regular use of bed nets in both household and the forest were to prevent mosquito biting. The reasons for not using bednets in the household were discomfort feelings from heat, perception of unnecessity due to low mosquito density, whereas the reason for not using bed nets in the forest was inconvenience. CONCLUSION: Despite that overall coverage and usage of bed nets was high, only one third reached the standard level specified by the policy. Overnight in the forest, the dissatisfaction with the quality of free bed nets, insufficient number of bed nets, sleeping alone, male gender, age more than 10 years, low socioeconomic status, discomfort from heat, perception of no benefits of bed nets due to low mosquito density, and inconvenience were factors influencing bed net use. Maintaining high coverage and utility rate of bed nets should be a priority for the malaria high-risk population.

Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand.

BACKGROUND: The demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals. METHODS: A cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian's framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand. RESULTS: The study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient's needs, effective communication, and respect for the patient's dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient's needs and effective communication, while the allocation of physical areas was associated with effective communication. CONCLUSION: This model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.

Thailand's universal coverage scheme and its impact on health-seeking behavior.

BACKGROUND: Thailand's Universal Coverage Scheme (UCS) has improved healthcare access and utilization since its initial introduction in 2002. However, a substantial proportion of beneficiaries has utilized care outside the UCS boundaries. Because low utilization may be an indication of a policy gap between people's health needs and the services available to them, we investigated the patterns of health-seeking behavior and their social/contextual determinants among UCS beneficiaries in the year 2013. RESULTS: The study findings from the outpatient analysis showed that the use of designated facilities for care was significantly higher in low-income, unemployed, and chronic status groups. The findings from the inpatient analysis showed that the use of designated facilities for care was significantly higher in the low-income, older, and female groups. Particularly, for the low-income group, we found that they (1) had greater health care needs, (2) received a larger number of services from designated facilities, and (3) paid the least for both inpatient and outpatient services. CONCLUSIONS: This pro-poor impact indicated that the UCS could adequately respond to beneficiaries' needs in terms of vertical equity. However, we also found that a considerable proportion of beneficiaries utilized out-of-network services, which implied a lack of universal access to policy services from a horizontal equity point of view. Thus, the policy should continue expanding and diversifying its service benefits to strengthen horizontal equity. Particularly, private sector involvement for those who are employed as well as the increased unmet health needs of those in rural areas may be important policy priorities for that. Lastly, methodological issues such as severity adjustment and a detailed categorization of health-seeking behaviors need to be further considered for a better understanding of the policy impact.

The reliability and factor structure of Thai Young Schema Questionnaire-Short Form 3.

Previous research which documented the psychometric properties of Young Schema Questionnaire (YSQ) was conducted in Western countries. The current research examined the reliability and factor structure of the Thai version of the Young Schema-Short From-3 (YSQ-S3). The participants were 622 undergraduates (62% females) recruited from three universities in Chiang Mai, Thailand. Results suggested acceptable internal consistency of 18 early maladaptive schemas (EMSs) (Cronbach's α range from 0.619 to 0.846). Confirmatory factor analysis confirmed the factor structures of 18 EMSs. The results failed to support Young's theoretical schema domain. The authors indicated a four-factor solution as the best alternative second-order model for this population. In conclusion, the Thai version of YSQ-S3 is psychometrically sound questionnaire that can be utilized for assessing EMS, both for research and practice purposes. The current study further provides evidence supporting the existence of 18 EMSs in the non-Western context.

Application of the WHOQOL-HIV-BREF Questionnaire in HIV-Infected Thai Patients: Reliability and Validity of the Instrument.

Given the prolonged survival of HIV-infected individuals as a result of widespread availability of treatment, health-related quality of life (HRQOL) becomes a relevant endpoint for assessing the impacts of HIV interventions. We examined the reliability and validity of the World Health Organization Quality of Life in HIV-infected Persons instrument (WHOQOL-HIV-BREF) using data from 329 HIV-infected Thai patients who received outpatient care at seven public hospitals. Our findings revealed acceptable reliability, construct validity, and convergent validity of the WHOQOL-HIV-BREF. No significant difference in HRQOL was found between groups with different CD4+ T cell counts. Conversely, the subgroup with a history of opportunistic infection appeared to have a higher HRQOL compared to those in the latency stage. Challenges to the interpretation of the questions related to culture are discussed. In conclusion, the WHOQOL-HIV-BREF can be added to the limited list of instruments for comprehensive outcome evaluation of HIV interventions in Thailand.

The Impact of State Nursing Home Staffing Standards on Nurse Staffing Levels.

This study investigated the impact of state nursing home staffing standards on nurse staffing levels for the year 2011. Specifically, the study attempted to measure state staffing standards at facility level (i.e., nurse staffing levels that each individual nursing home must retain by its state staffing standards) and analyzed the policy impact. The study findings indicated that state staffing standards for the categories of registered nurse, licensed nurse, or total nurse are positively related to registered nurse, licensed nurse, or total nurse staffing levels, respectively. Nursing homes more actively responded to licensed staffing requirements than total staffing requirements. However, nursing homes did not increase their staffing levels as much as those required by state staffing standards. It is possibly because the quality-oriented inspection allows flexibility in nursing homes' control of nurse staffing levels.

Trends in rural health Clinics and needs during U.S. health care reform.

AIM: Rural Health Clinics (RHCs) are primary care clinics certified through Medicare and Medicaid to provide health care to the medically underserved in rural areas of the United States. The purpose of this paper is to describe how the characteristics of RHCs have either changed or remained stable over a 10-year period in the past: from the late 1990s to 2007. In addition, it is also to describe some of the outstanding needs of RHCs as they navigate the transitions of U.S. health care reform. METHODS: Using a panel of RHCs continuously in existence from 2006 through 2007, we calculated and compared statistics with corresponding statistics from the literature. We described the geographic distribution of RHCs, demographics of their counties of location, and characteristics of RHC structure and staffing. We also explored the implications of the recently enacted health reform law (the Patient Protection and Affordable Care Act or ACA) for RHCs, and the improvements that RHCs need as it is implemented. FINDINGS: By the end of the study period, the highest percentages of RHCs were in the South and Midwest, the percentage of RHCs in the West had grown, and that in the South had declined. RHCs served counties with increasing proportions of individuals below poverty and Hispanics/Latinos. The percentage of independent clinics had grown, as had the percentage of for profit clinics. Finally, the percentage of nurse practitioner full-time equivalents had grown as a proportion of the total for three providers. CONCLUSIONS: In investigating the performance of RHCs, many managerial and operational factors are not well understood. It is imperative that RHCs gather the information that could help them maximize the elements of their performance that would keep them financially stable. In addition, a broader awareness of the unique challenges that RHCs face in this era of health care reform is needed.

Three-dimensional imaging of normal skin and nonmelanoma skin cancer with cellular resolution using Gabor domain optical coherence microscopy.

We investigate morphological differences in three-dimensional (3-D) images with cellular resolution between nonmelanoma skin cancer and normal skin using Gabor domain optical coherence microscopy. As a result, we show for the first time cellular optical coherence images of 3-D features differentiating cancerous skin from normal skin. In addition, in vivo volumetric images of normal skin from different anatomic locations are shown and compared.

Rural Health Clinic efficiency and effectiveness: insight from a nationwide survey.

This study reports the results of a nationwide survey of Rural Health Clinics (RHCs). The purpose was to identify factors that contribute to efficiency and effectiveness in RHCs. Factors related to cost efficiency were analyzed using multiple regression; factors related to the likelihood of providing preventive diabetic care, an effectiveness indicator, were analyzed using logistic regression. The study found: (1) technical efficiency to be positively related to cost efficiency; (2) non-profit control to be inversely related to cost efficiency in independent RHCs; and (3) provider-based RHCs and technology use to be related to the likelihood of providing preventive diabetic care. Implications for RHCs are: (1) improvement in technical efficiency could enhance cost efficiency; (2) visits to PAs and NPs, an indicator of process efficiency, may not guarantee the provision of preventive diabetic care; and (3) strategies for improving RHC efficiency and effectiveness may be different for provider-based and independent clinics.