Adults In Primary Health Care Research Articles

Association between sleep problems and functional disability in community-dwelling older adults

BackgroundSleep problems are frequently observed in older adults. They can lead to changes in the individual’s physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults.MethodsThis was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest.ResultsOlder adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems.ConclusionsOlder adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.

Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care

PurposeThis study aims to identify PIM prevalence in older adults according to the 2019 Beers criteria, Screening Tool of Older Person’s Prescriptions version 2 (STOPP v2) criteria, and the Portuguese EU(7)-PIM list and also to analyze the concordance between these criteria.MethodsA retrospective study was conducted among 1200 Portuguese older adults (≥ 65 years old), users of primary health care. Demographic, clinical, and pharmacological data were collected concerning the period between April 2021 and August 2022. A comparative analysis was performed between the three PIM identification criteria, and the concordance was determined according to the Lin concordance correlation coefficient.ResultsThe mean age was 76.3 (SD 7.7) years old and 57.6% of the older adults were females. Our findings indicate varying prevalence rates among these criteria with 63.8% (95% CI 61.0–66.6%), 66.8% (95% CI 64.1–69.5%), and 50.1% (95% CI 47.2–53.0%) of the older adults take at least one PIM according to the EU(7)-PIM list, Beers 2019, and STOPP v2 criteria, respectively. The highest prevalence observed was for proton pump inhibitors according to EU(7)-PIM list (30.1%, 95% CI 27.6–32.9) and Beers criteria (30.1%, 95% CI 27.6–32.9) and alprazolam according to STOPP v2 criteria (10.1%, 95% CI 8.4–11.9%). A poor concordance between criteria was observed (< 0.834). The highest concordance coefficient was found between the EU(7)-PIM list and the Beers criteria (0.833), and the lowest between the EU(7)-PIM list and STOPP criteria (0.735).ConclusionThis study reveals varying prevalence rates of PIM in older adults, as assessed by different criteria, and highlights the need for targeted interventions and improved prescribing practices. In the future, studies should focus on the occurrence of negative outcomes in older adults associated with PIM consumption.

Motivation and responsibility of employees of primary health care facilities: results of a social survey on current motivation measures

Aim. To study the relevance of motivation measures based on the survey of medical staff.Material and methods. Medical staff of adult primary health care facilities was surveyed using an original questionnaire regarding the organization of work, the importance of financial and non-financial incentives. The survey was strictly voluntary and anonymous, and conducted electronically and on paper. In total, 35191 questionnaires were accepted for processing. Processing was carried out using the method of descriptive statistics.Results. The organization of work environment is of the greatest importance to respondents (&gt;80%), while in second place is the presence of clear criteria for work efficiency assessment, and in third place — a clear incentive and penal scheme. Respondents rated the opportunity for contact with the administration more highly than "communicating work assessment criteria to employees". The undisputed top in financial incentives is payments for high performance criteria in all categories of personnel. Of the non-financial measures, the most popular were a letter of gratitude from the manager and permission to independently plan working hours (maximum among medical specialists (51%)).Conclusion. The results obtained make it possible to highlight the main directions for motivation system of medical staff as follows: clear evaluation criteria for all personnel categories, provision of conditions for fulfilling the developed criteria, active outreach on evaluation criteria, incentive payments and other measures of material incentives, development of targeted incentive technologies, feedback with employees on issues related to their performance, working conditions, etc., developing a system of non-financial incentives and corporate culture.

Lists of potentially inappropriate medications for older people in primary care: a systematic review of health outcomes.

This study is a systematic literature review of the association between lists of potentially inappropriate medications (PIM) in clinical practice and health outcomes of older adults followed up in primary health care. For this purpose, the PRISMA protocol was used to systematize the search for articles in the PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO and LILACS databases, in addition to the gray literature. Studies with randomized clinical trials were selected, using explicit criteria (lists) for the identification and management of PIM in prescriptions of older patients in primary care. Of the 2,400 articles found, six were used for data extraction. The interventions resulted in significant reductions in the number of PIM and adverse drug events and, consequently, in potentially inappropriate prescriptions (PIP) in polymedicated older adults. However, there were no significant effects of the interventions on negative clinical outcomes, such as emergency room visits, hospitalizations and death, or on improving the health status of the older adults. The use of PIM lists promotes adequate medication prescriptions for older adults in primary health care, but further studies are needed to determine the impact of reducing PIM on primary clinical outcomes.

Gap Analysis of Providing Primary Health Care in Comprehensive Rural Health Centers of Iran

Background: The lack of primary health care (PHC) assessment will lead to the lack of knowledge of the final client's needs and to deviation from the mission of the health system. This study was conducted to compare the understanding and experience of PHC providers and recipients regarding the principles of PHC in Iran.&#x0D; Methods: This cross-sectional descriptive-analytical study was conducted on Comprehensive Rural Health Centers (CRHCs) in 2022. The research population consisted of health service providers and recipients in rural areas. A Primary Care Assessment Tool (PCAT) was used. 410 child/ adolescent and 402 adult PCAT were completed by stratified cluster sampling method and 413 service providers were randomly selected. This questionnaire had 6 core domains and 3 ancillary domains. After collection and entering the Excel; data were analyzed by inferential statistics tests including Independent T-test and one-way ANOVA, by SPSS26 and STATA16 at the significant level of P&gt;0.05.&#x0D; Results: Except for the Cultural Competence and Services Available domains, in the rest of the domains, there was not the same understanding between the service provider and recipient regarding PHC services. Also. child/adolescent PHC recipients had the same understanding as adult PHC recipients in the domains of Cultural Competence, Family Centeredness, Information System, Ongoing Care, and Access. But a significant difference was between the two groups in other domains, Primary Care Score, and Primary Care Expanded scores (P &gt;0.05).&#x0D; Conclusions: For the common understanding between all three compared groups, cultural competence was the strongest component, and coordination-referral system, services provided, and community orientation were the weakest components. To fill this gap, increasing the health literacy of service recipients, real needs assessment, and providing services based on the needs of the community, reforming the processes of the referral system, and the commitment of the government to implement the processes seem necessary.

Magnitude and Determinants of Long-term Use of Proton Pump Inhibitors Among Portuguese Older Adults in Primary Health Care

PurposeProton Pump Inhibitors (PPIs) have been associated with several adverse effects of particular concern in older populations. Their use for a period longer than 8 weeks is not recommended for older adults. Strategies to discontinue PPIs have been offered; however, their use remains high. This study aims to characterize PPI use in Portuguese older people and to identify the factors associated with potentially inappropriate use. MethodsA cross-sectional study was conducted on 1200 randomly selected older adults (≥65 years of age), users of primary health care facilities in the Regional Health Administration (Administração Regional de Saúde of Centro [ARSC]) of Portugal between April 2021 and August 2022. Data concerning their characteristics and PPI use were provided by the Shared Services of the Health Ministry (Serviços Partilhados do Ministério da Saúde) and collected retrospectively. Associations between independent variables and PPI use were investigated by logistic regression analysis. FindingsOf the older adults, 37.92% were receiving PPIs and 78.68% of them were taking them for a longer period than recommended; 49.79% were taking PPIs without having any digestive system–related disease. Multivariate analysis showed that the prolonged use of PPIs was not associated with any specific pattern, although inappropriate PPI use is high among Portuguese older adults. ImplicationsLong-term PPI use in older adults is widespread and does not fit any particular patient profile; therefore, cross-cutting educational interventions should be designed independently of the patient's pathologic condition or treatment.

Medication use problems and factors affecting older adults in primary healthcare

BackgroundAs the largest demographic group utilizing primary healthcare facilities, older adults often face the challenge of managing multiple chronic illnesses, leading to numerous medications. ObjectiveThe present study aims to assess medication use problems among older adults and explore the factors affecting them in primary healthcare settings. MethodsA mixed-method study was conducted to establish a baseline understanding of the perspectives and challenges faced by older adults, with regards to medication use. Translated Medication Use Questionnaire (MedUseQ), a patient-centered tool, was distributed to older adults above 60 in primary healthcare settings to assess their frequency of problems related to medication use. Fifteen semi-structured interviews were conducted to explore this topic in depth. Descriptive and inferential analyses were conducted with quantitative data. Interviews were transcribed verbatim, and thematic analysis was conducted. Quantitative and qualitative findings data were triangulated. ResultsThe study involved 393 participants. The most common problems with regards to medication use were polypharmacy (55.4%), administration difficulties (48.4%), limited awareness about adverse drug events (47.3%), issues with adherence (46.5%), and accessibility to primary healthcare (42.7%). Approximately 55% were satisfied with the older adult-centered medication use services by pharmacist and doctors. The qualitative findings showed that major factors affecting medication use were forgetfulness, language barriers, lack of awareness, transportation problems, long waiting times, and multiple visits to healthcare facilities. ConclusionThe findings of this study reveal that a significant proportion, around 50%, of the older adult population face challenges with medication use in Penang. These difficulties mainly stem from medication administration, adherence, accessibility, polypharmacy, and inadequate medication knowledge. The qualitative analysis further highlighted several factors that contribute to such medication-related problems. Given the rapidly aging Association of Southeast Asian Nations (ASEAN) population, it is essential to devise effective solutions and strategies to tackle medication use-related issues among older adults.

Muscle strength: development of predictive equation for handgrip strength in older adults on the primary health care

Introduction: Monitoring the functional capacity of older adults is fundamental, and Handgrip Strength (HGS) is a consolidated marker of functional status in this age group. This study aimed to develop equations for predicting HGS in community-dwelling older adults in Primary Health Care (PHC). Methods: It is a cross-sectional study conducted with 316 older adults, in which a Multiple Linear Regression (MLR) was performed for the right hand (R-HGS) and left hand (L-HGS). The variables sex, age, weight, knee height (KH), arm circumference (AC), triceps skinfold (TSF), and calf circumference (CC) were considered predictors because they were easily obtained in PHC and significantly related to HGS. Results: In the final models, the variables sex, age, and KH together explained more than 50 % of the HGS variation. There was agreement between the estimated and measured HGS measurements, both for right and left side. Conclusions: It is concluded that the variability of HGS can be explained by age, sex, and KH, which are parameters simple and routinely used to evaluate older adults.

Management of Depression in Chronic Care Patients Using a Task-Sharing Approach in a Real-World Primary Health Care Setting in South Africa: Outcomes of a Cohort Study.

Depressive symptoms are common in South African primary care patients with chronic medical conditions, but are usually unrecognised and untreated. This study evaluated an integrated, task-sharing collaborative approach to management of depression comorbid with chronic diseases in primary health care (PHC) patients in a real-world setting. Existing HIV clinic counsellors provided a manualised depression counselling intervention with stepped-up referral pathways to PHC doctors for initiation of anti-depressant medication and/ or referral to specialist mental health services. Using a comparative group cohort design, adult PHC patients in 10 PHC facilities were screened with the Patient Health Questionnaire-9 with those scoring above the validated cut-off enrolled. PHC nurses independently assessed, diagnosed and referred patients. Referral for treatment was independently associated with substantial improvements in depression symptoms three months later. The study confirms the viability of task-shared stepped-up collaborative care for depression treatment using co-located counselling in underserved real-world PHC settings.

Vaccination Coverage and Associated Factors of COVID-19 Uptake in Adult Primary Health Care Users in Greece.

In our study, attitudes and perceptions of adult primary health care users regarding COVID-19 vaccination were evaluated. A single-center, cross-sectional study was conducted during a 1-year period (March 2021-March 2022) in a rural area in Crete, Greece. A sample of 626 self-reported questionnaires was collected at the end of the study period. Overall, 78% of respondents stated that they had received the COVID-19 vaccine. The reasons behind vaccine uptake were mainly personal beliefs and the desire to avoid professional constraints. The presence of diabetes type 2, fear of infection, and high perceived efficacy of vaccine previous flu vaccination, living with vulnerable persons, and the influence of scientific information were all significant predictors of COVID-19 vaccine uptake. On the contrary, unwillingness and/or uncertainty to be vaccinated was associated with fear of vaccine side effects, information insufficiency, media/internet information, older age, the presence of inflammatory arthritis, previous COVID-19 infection, the belief that infection confers much greater immunity than the vaccine, and attitudes against vaccinations in general were predictors against COVID-19 vaccination. In conclusion, taking into account all of the above predictors and particularly those regarding safety and vaccine effectiveness may guide future strategies appropriately tailored to specific characteristics and needs of different geographic populations.

Level of satisfaction and socio-demographic correlates among users of primary health care services in Kosovo

Aim: The aim of this study was to assess the level and socio-demographic correlates of satisfaction with services among adult primary health care users in Kosovo.&#x0D; Methods: A cross-sectional study was conducted in Kosovo during the period May-June 2022 including a representative sample of 510 adult users (238 men and 272 women) of primary health care services in Kosovo (mean age: 44.6±19.2 years). In addition to socio-demographic data, a structured 23-item questionnaire aiming at assessing the level of satisfaction with primary health care services was administered to all participants (each item ranging from 1 [high] to 5 [low]). A summary score was calculated for all 23 items related to satisfaction level ranging from 23 (the highest satisfaction level) to 115 (the lowest satisfaction level). General linear model was used to assess the association between the summary score of satisfaction level with primary health care services and socio-demographic factors of study participants. &#x0D; Results: Mean summary score of the 23 items related to the satisfaction level with primary health care services was 49.8±13.0; median score was 49 (interquartile range: 41-57). In multivariable-adjusted models, the level of satisfaction with primary health care services was significantly higher among participants with a lower educational attainment, individuals with e lower income level, and ethnic Albanian participants.&#x0D; Conclusion: This study identified important socio-demographic correlates of the level of satisfaction with primary health care services in the adult population of Kosovo. Findings from this study should raise the awareness of policymakers and decision-makers in Kosovo and elsewhere in order to improve the quality of primary health care services. &#x0D;

Use of potentially inappropriate medications by older adults in Primary Health Care: cross-sectional study

Resumo Objetivo Verificar a prevalência e fatores associados ao uso de medicamentos potencialmente inapropriados (MPI) pela população idosa e a concordância entre duas metodologias de avaliação no contexto da Atenção Primária à Saúde (APS). Método Estudo observacional transversal. Foi estimada a prevalência de pessoas idosas que utilizam MPI e fatores associados. Inicialmente foi calculada a frequência de medicamentos, entre os utilizados, considerados MPI. A classificação como MPI foi pelos Critérios de Beers 2019 e Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para idosos (CBMPI) 2016. Também avaliou-se a concordância entre as duas classificações. Foram construídos modelos de regressão logística multivariada para avaliação da associação pelo Odds Ratio (OR), e calculado Kappa para concordância entre os dois critérios de classificações. Resultados A prevalência de pessoas idosas que usavam MPI foi 32,9% pelos Critérios de Beers e 27,6% pelo CBMPI. Associações estatisticamente significativas (p&lt;0,001) ao uso de medicamentos inapropriados, pelos Critérios de Beers foram: relato de diabetes (OR=1,96), depressão (OR=2,25) e polifarmácia (OR=4,11). Pessoas idosas satisfeitas com a própria saúde tiveram menor chance de usarem MP, em ambas classificações, Critérios Beers (OR=0,02) e CBMPI (OR=0,09). A concordância entre as classificações foi muito boa (k=0,75, p&lt;0,001). Conclusão Foram associados ao uso de MPI relato de diabetes e depressão, polifarmácia e satisfação negativa com a saúde. As associações foram semelhantes entre as duas classificações, indicando que ambas são pertinentes na identificação do uso de MPI em pessoas idosas usuárias da APS.

Gender Differences in Health Self-Perception in Older Adults in Primary Health Care in Brazil

Abstract The men-to-women ratio shows that women outnumber men, and aging-related aspects signal differences between older men and older women, confirming gender-based differences in aging. Our study aimed to foster discussion on gender and its consequences for health, considering the perceived and self-reported health of older people attending primary health care facilities. We carried out a quantitative descriptive cross-sectional study in the city of Fortaleza, Ceará, Northeastern Brazil, with people aged 60 or older who were individually interviewed using a questionnaire addressing sociodemographic data (age, gender, marital status, income, education), systemic health (self-reported diseases), oral health and perceived general health (ipresent and past year health status). Participants were 821 older people whose age ranged from 60 to 100 years, with a mean of 69.7 years. There was a predominance of women (n=580; 70.6%). Participants presented low levels of education and income. Women were 1.3 times more likely to present systemic diseases and 1.5 times more likely to use medications compared with men. Women were more edentulous and presented more soft tissue problems than men. There were no differences in self-perceived general health and past year health status among the participants. The participants’ self-reported health status revealed women are at an increased risk of getting sick, thus demonstrating gender-based inequalities in health among older adults. Public health policies need to improve people's access to primary care, especially in disadvantaged socioeconomic classes. Strategies should include financial support for health, retirement and social security policies to diminish gender-based inequalities in health.

Sedentary Behavior Counseling Received from Healthcare Professionals: An Exploratory Analysis in Adults at Primary Health Care in Brazil.

Counseling by health professionals has promising results in behavior change and is recommended as part of integrated community interventions. However, the knowledge about sedentary behavior (SB) counseling is incipient. The study aimed to identify the prevalence and explore the associated factors with SB counseling received from healthcare professionals by adults in primary health care (PHC) in Brazil. A cross-sectional study was conducted in 2019 that included a representative sample of 779 users in all 15 basic health units (BHU) in São José dos Pinhais, Paraná. We identified those who reported having received SB counseling during a consultation. The association between the sociodemographic factors, chronic diseases, access to health services, physical activity, SB, and counseling were analyzed using Poisson regression in a hierarchical model. The prevalence of counseling was 12.2% (95% CI: 10.1–14.7%); it was higher in women (PR: 1.77; 95% CI: 1.10–2.83), those aged ≥60 yrs (PR: 1.84; 95% CI: 1.14–2.98), BMI ≥ 30 kg/m2 (PR: 2.60; 95% CI: 1.31–5.17), who consume ≥3 medications (PR: 2.21; 95% CI: 1.06–4.59), and those who spend a prolonged period of the day engaged in SB (4th quartile PR: 3.44; 95% CI: 1.88–6.31). The results highlight that SB counseling is underutilized and incipient in PHC. Understanding these results can help managers and healthcare professionals in BHU teams to implement and direct specific actions to reduce SB in adults through counseling.

Exposure to Public Open Spaces and Leisure-Time Physical Activity: An Analysis of Adults in Primary Health Care in Brazil.

Public open spaces (POS) enable many leisure activities. However, few studies have evaluated how different exposures to POS with structured physical activities (PA) could affect the leisure-time PA (LTPA) of adults with chronic diseases. This study aimed to analyze the associations between different exposures to POS and LTPA in adults in primary health care in Brazil. In 2019, a cross-sectional study was conducted with a representative sample of 615 users of 15 Basic Health Units in São José dos Pinhais. The POS exposure was measured by the presence and distance (GIS), and the usage and frequency of usage were self-reported. The IPAQ identified walking and moderate-to-vigorous PA (MVPA). Data were analyzed with multilevel Poisson regression adjusted for the possible confounders (sex, age, economic level, chronic diseases). The prevalence of walking and MVPA ≥150 min/week was 12% and 14%, respectively. The usage of POS increased by 52% the likelihood of walking ≥10 min/week (PR: 1.52; 95%CI: 1.02–2.21), while usage ≥2 times/week increased by 2 times the likelihood of this outcome (PR: 2.01; 95%CI: 1.28–3.05). The usage of POS increased by 2.7 times the likelihood of MVPA ≥10 min/week (PR: 2.73; 95%CI: 1.86–3.97), and usage ≥2 times/week increased by 3.5 times the likelihood of this outcome (PR: 3.45; 95%CI: 2.14–5.42). Finally, the usage of POS increased by 3 times the likelihood of MVPA ≥150 min/week (PR: 3.03; 95%CI: 1.92–4.74), while usage ≥2 times/week increased by 3.8 times the likelihood of this outcome (PR: 3.81; 95%CI: 2.19–6.38). In conclusion, only the usage of POS is positively associated with walking and MVPA in the leisure time of adult primary health care users.

Atherosclerosis in the primary health care setting: A real-word data study

Introduction and ObjectivesTo characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. MethodsA cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. ResultsA total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001). ConclusionsAbout one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.

Factors associated with the identification of drug therapy problems among older patients in Primary Health Care.

To determine the frequency of drug therapy problems among older adults in Primary Health Care, and to analyze the factors associated with their identification in the initial patient assessment, carried out by pharmacists offering medication therapy management services. A cross-sectional study conducted with data from 758 older adults followed up in medication therapy management services in Primary Health Care in the cities of Belo Horizonte, Betim, and Lagoa Santa (MG, Brazil). Univariate and multivariate analyses were performed to evaluate the factors associated with identification of four or more drug therapy problems in the initial clinical assessment. A total of 1,683 drug therapy problems were identified, 73.6% of older patients had at least one problem. The most frequent problems were nonadherence (23.0%) and the need for additional drug therapy (18.0%). Polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and aged 75 years or older remained positively and statistically associated with identification of four or more drug therapy problems (p<0.05). There is a high frequency of problems related to medication use among older users of Primary Health Care, and the medication therapy management services should be prioritized to the older patients, who present with polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and age ≥ 75 years, since they are more likely to have more drug therapy problems.

Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool.

Health complexity includes biological, psychological, social, and health systems. Having complex health needs is associated with poorer clinical outcomes and higher healthcare costs. Care management for people with health complexity is increasingly recommended in primary health care (PHC). The INTERMED complexity assessment grid showed adequate psychometric properties in specialized settings. This study aimed to evaluate INTERMED's validity and feasibility to assess health complexity in an adult PHC population. The biopsychosocial health care needs of 230 consecutive adult patients from three Brazilian PHC services were assessed using the INTERMED interview. Participants with a total score >20 were classified as "complex". Quality of life was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF); symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); social support using the Medical Outcomes Study-Social Support Survey (MOS-SSS); comorbidity levels using the Charlson Comorbidity Index (CCI). We developed two questionnaires to evaluate health services use, and patient perceived feasibility of INTERMED. 42 participants (18.3%) were classified as "complex". A moderate correlation was found between the total INTERMED score and the total scores of WHOQOL-BREF (rho = - 0.59) and HADS (rho = 0.56), and between the social domains of INTERMED and MOS-SSS (rho = -0.44). After adjustment, the use of PHC (β = 2.12, t = 2.10, p < 0.05), any other health care services (β = 3.05, t = 3.97, p < 0.01), and any medication (β = 3.64, t = 4.16, p < 0.01) were associated with higher INTERMED scores. The INTERMED internal consistency was good (ω = 0.83), and the median application time was 7 min. Patients reported satisfaction with the questions, answers, and application time. INTERMED displayed good psychometric values in a PHC population and proved promising for practical use in PHC.

Association between falls in older adults and prevention group.

to assess the effectiveness of guidelines on fall prevention in a group of older adults in Primary Health Care. a cross-sectional study, carried out with older adults selected by a simple random sample (274; N=1,234). Data covered sociodemographic and socioeconomic variables, marital status, health conditions, factors associated with falls and participation in the prevention group. Student's t test was used, and dichotomous variables were used by the chi-square test. The project met ethical requirements. sample with female profile (61.7%), married, with low education, mean age of 71.69 years. The factors associated with falls identified were female sex, medicalization and participation in the prevention group. There was no protective association between participation in a fall prevention group in older adults and a decrease in the number of falls. based on evidence, a personalized intervention during the nursing visit is suggested as a strategy to prevent falls.

Prevalence and socio-demographic factors associated with physical inactivity among primary health care users in Tirana, Albania: A cross-sectional study

Introduction: The World Health Organization (WHO) defines physical activity (PA) as any movement of the body produced by skeletal muscle that requires expenditure of energy. The aim of research is to assess the prevalence of and socio-demographic characteristics associated with physical inactivity (PI) among adult primary healthcare (PHC) users in Tirana, the capital of Albania.Methods: This was a cross-sectional study carried out in Tirana from November 2020 to January 2021. During this period 500 consecutively approached individuals aged ≥18 years exiting PHC centers were interviewed face-to-face about the presence of some of the risk factors for non-communicable disease. A structured WHO STEPS questionnaire, an integrated part of which is the instrument required for this study, “Global PA Questionnaire,” was used. In addition to demographic and socioeconomic data, we obtained data on the performance of PA in terms of domains, duration, and intensity. Logistic regression was used to assess socio-demographic factors associated with PI.Results: Prevalence of PI in the study population was 31.6%. Following multivariable adjustment for all covariates, significant positive correlates of PI were female gender, rural residence, retiree status, and unemployment. Conversely, there was an inverse association with moderate level of education.Conclusions: Similar to that of other European populations, the population of Tirana has a high rate of PI showing an upward tendency. The population groups at the highest risk of PI who may be targeted for intervention programs to address this risk factor are women, rural residents, unemployed persons, and retirees.