Community Health Care Centers Research Articles

Community collaboration to advance racial/ethnic equity in colorectal Cancer screening: Protocol for a multilevel intervention to improve screening and follow-up in community Health centers

IntroductionColorectal cancer (CRC) screening utilization is low among low-income, uninsured, and minority populations that receive care in community health centers (CHCs). There is a need for evidence-based interventions to increase screening and follow-up care in these settings. MethodsA multilevel, multi-component pragmatic cluster randomized controlled trial is being conducted at 8 CHCs in two metropolitan areas (Boston and Los Angeles), with two arms: (1) Mailed FIT outreach with text reminders, and (2) Mailed FIT-DNA with patient support. We also include an additional CHC in Rapid City (South Dakota) that follows a parallel protocol for FIT-DNA but is not randomized due to lack of a comparison group. Eligible individuals in participating clinics are primary care patients ages 45–75, at average-risk for CRC, and overdue for CRC screening. Participants with abnormal screening results are offered navigation for follow-up colonoscopy and CRC risk assessment. ResultsThe primary outcome is the completion rate of CRC screening at 90 days. Secondary outcomes include the screening completion rate at 180 days and the rate of colonoscopy completion within 6 months among participants with an abnormal result. Additional goals are to enhance our understanding of facilitators and barriers to CRC risk assessment in CHC settings. ConclusionsThis study assesses the effectiveness of two multilevel interventions to increase screening participation and follow-up after abnormal screening in under-resourced clinical settings, informing future efforts to address CRC disparities. Trial RegistrationNCT05714644

First-aid training for primary Healthcare providers on a remote Island: a mixed-methods study

BackgroundEnsuring ongoing first-aid training for primary healthcare providers (PHPs) is one of the critical strategies for providing quality health services and contributing to achieving universal health coverage. However, PHPs have received insufficient attention in terms of training and capacity building, especially in the remote areas of low-to-middle-income countries. This study evaluated the effectiveness of a first-aid training program for PHPs on a Vietnamese island and explored their perspectives and experiences regarding first-aid implementation.MethodsA mixed-methods study was conducted among 39 PHPs working in community healthcare centers. The quantitative method utilized a quasi-experimental design to evaluate participants’ first-aid knowledge at three time points: pre-training, immediately post-training, and three months post-training. Sixteen of the PHPs participated in subsequent semi-structured focus group interviews using the qualitative method. Quantitative data were analyzed using repeated measures analysis of variance (ANOVA), while qualitative data were subjected to thematic analysis.ResultsThe quantitative results showed a significant improvement in both the overall mean first-aid knowledge scores and the subdimensions of the first-aid knowledge scores among healthcare providers post-training. There was a statistically significant difference between the baseline and immediate posttest and follow-up knowledge scores (p < 0.001). However, the difference in knowledge scores between the immediate posttest and three-month follow-up was not significant (p > 0.05). Three main themes emerged from the focus group discussions: perception of first-aid in remote areas, facilitators and barriers. Participants identified barriers, including infrastructure limitations, shortage of the primary healthcare workforce, inadequate competencies, and insufficient resources. Conversely, receiving considerable support from colleagues and the benefits of communication technologies in implementing first aid were mentioned as facilitators. The training bolstered the participants’ confidence in their first-aid responses, and there was a desire for continued education.ConclusionsImplementing periodic first-aid refresher training for PHPs in a nationwide resource-limited setting can contribute significantly to achieving universal health coverage goals. This approach potentially enhances the preparedness of healthcare providers in these areas to deliver timely and effective first aid during emergencies, which may lead to more consistent primary healthcare services despite various challenges.

Frailty trajectories and determinants in Chinese older adults: A longitudinal study

ObjectivesThis study aimed to enrich the research on frailty trajectories by using FRAIL scale and frailty index (FI), and analyze the determinants of the different trajectories in older Chinese. Methods2268 older adults from the Chinese Longitudinal Healthy Longevity Survey were included. The FRAIL scale was constructed from 5 items and FI was constructed from 39 deficits. Latent Class Trajectory Model was used to depict frailty trajectories. Lasso - logistic model was applied to exploration of influencing factors. ResultsFour FRAIL trajectories and three FI trajectories were identified. Women, smoking, illiteracy, more than two chronic diseases, and poor instrumental activities of daily living (all p < 0.05) were associated with frailty trajectories, regardless of the frailty instrument employed. ConclusionsFrailty trajectories of older Chinese adults are diverse and they are influenced by different frailty measurement tools. Long-term assessment and management of frailty are recommended as routine care in community healthcare centers.

Navigating disparities: Insights from a colorectal cancer screening program in federally qualified community healthcare centers.

1537 Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in Georgia. Despite evidence for the effectiveness of CRC screening, disparities in access are prevalent in underserved populations. Georgia’s Federally Qualified Health Centers (FQHCs) struggle with low screening rates (42.8%), partly due to Georgia’s lack of Medicaid expansion, poor access to health services in rural areas, and deficiencies in coordinated strategies. The Georgia Colorectal Cancer Control Program (GCRCCP) was funded by the Centers for Disease Control and Prevention to implement evidence-based interventions (EBIs) in qualifying FQHCs across South Georgia. Here, we assess the program's impact on clinic-level screening rates (SR). Methods: Fourteen clinics with 12,159 CRC-eligible patients (ages 50-75) were enrolled from East Georgia Healthcare Center (EGHC) and Albany Area Primary Health Center (AAPHC). FQHC clinics had to have a SR below 60% to participate in the program. In addition to the EBIs (provider assessment and feedback, provider reminders, patient reminders, reducing structural barriers), the GCRCCP integrated provider education using the ECHO Model and navigation through a nationally recognized, evidence-based patient navigation program. We compared baseline (2020 and 2021) and follow-up data (2022) to determine the average change in SR over time, overall, and by demographic sub-groups. Results: The overall change in SR for the 14 clinics was +6.7%, from a baseline average of 45.3% to 52% in 2022. The average change in SR for EGHC clinics (n=9) was +11.5% (from 32.2 to 43.7%). Women had a higher SR (44.9%) than men (41.8%), but both realized an increase in SR, +10.5% and +9.1%. Non-Hispanic Black Americans (NHBA) experienced a higher increase in SR, +13.7% (from 37.2 to 50.9%) than their Non-Hispanic White (NHW) counterparts (+7.5% (from 29.8 to 37.3%)). The uninsured vs. insured followed a similar pattern (+15.3% (from 17.8 to 33.1%)) vs. +2.1 (from 45.9 to 48%). The average change in SR for AAPHC clinics (n=5) was +1.8% (from 58.4 to 60.2%). There was a decline in SR for men, -8.6% (from 64 to 55.4%), and an increase for women, +3.8% (from 58.2 to 62%). NHBA had a decrease in SR, -0.8% (from 61.2 to 61%), while NHW Americans had an increase in SR, +0.2% (from 53.8 to 54.2%). The uninsured and insured groups realized minimal increases of +0.6% (from 46 to 46.6%) and +0.8% (from 62 to 62.8%), respectively. Conclusions: The implementation of EBIs and patient navigation show varied potential to reduce disparities in accessing CRC screening in underserved populations. FQHC clinics that sustain implementation activities and workflow processes can benefit communities long-term and improve health equity.

Enhancing Neonatal Care: The Vital Role of Pulse Oximetry in the Early Screening of Critical Congenital Heart Diseases and Respiratory Diseases in Rural Areas.

Background Pulse oximetry screening (POS) is acknowledged globally as a noninvasive method to detect critical congenital heart diseases (CCHDs) and respiratory illnesses. However, its value for early diagnosis and treatment remains unrecognized in many hospitals with limited resources around the world. This study aimed to evaluate POS's application in CCHDs, persistent pulmonary hypertension (PPHN), and respiratory distress syndrome (RDS) for early diagnosis and its influence on clinical procedures in rural areas. Methods This prospective observational study included all eligible newborn infants in the regional neonatal unit of a community healthcare center. Their peripheral oxygen saturation was assessed at <24 hours and >24 hours after birth, in the right upper limb and either lower limb. An oxygen saturation of <95% or >3% difference between pre-ductal and post-ductal circulations was considered abnormal. All neonates with abnormal oxygen saturations at >24 hours after birth were subjected to another POS test within two hours of the last test. If the oxygen saturation was still abnormal, it was considered a positive POS test. The POS results were classified as oxygen saturation abnormal (<90%), abnormal (90-94%), and normal (≥95%). All neonates with a positive POS test were referred for echocardiography. Results Overall, 440 infants had documented POS results. A total of 65 (14.77%) infants had a positive POS test result, out of which 39 (8.86%) cases were diagnosed on further evaluation. Four neonates had CCHD (positive predictive value (PPV) = 6.15%), 26 had RDS (PPV = 40%), and nine had PPHN (PPV = 13.85%). Without any further delay, the doctor directed them all to a more advanced facility. Conclusion Our research showed that, in large-scale clinical settings, the addition of pulse oximetry to routine cardiac auscultation could be a reliable and feasible method to screen newborns for CCHD, PPHN, and RDS early on. Our research underscores the importance of implementing routine POS to detect CCHD, RDS, and PPHN in clinical practice.

How dyadic appraisal moderate the association between dyadic coping and diabetes management efficacy.

To explore the moderating role of dyadic appraisal in the association between dyadic coping and diabetes management efficacy. Two hundred seventy six middle-aged and older couple pairs with one spouse who had diabetes were recruited from 14 community healthcare centers across Guangzhou. The moderating role of dyadic appraisal was investigated using the actor-partner interdependence moderation model. When both couples considered diabetes to be a shared condition, statistically-significant associations were found between patients' negative (β = -22.7, p = 0.008) and neutral behaviors (β = 13.6, p = 0.017), plus spouses' positive behaviors (β = 22.8, p = 0.009) on their own diabetes management efficacy, respectively (i.e. actor effects); as well as between spouses' positive (β = 16.8, p = 0.028), negative (β = -28.5, p < 0.001), and neutral behaviors (β = 16.9, p = 0.006) on patient's diabetes management efficacy (i.e. partner effects). Dyadic appraisal moderates the association between dyadic coping and diabetes management efficacy.

Abstract 811: Impact of Medicaid eligibility expansion to adults regardless of immigration status on health insurance access among Latina patients

Abstract Background: Disparities in the receipt of cancer screening and preventive services are strongly associated with health insurance status. Even after federal- and state-wide initiatives to boost access to health insurance such as the Patient Protection and Affordable Care Act (ACA) Medicaid Expansion to all individuals earning ≤138% of the federal poverty level (FPL) and nationwide individual health insurance marketplaces, Latino populations continue to have the highest uninsured rate of any racial or ethnic group in the US, with 17% of Latinos remaining uninsured compared to 5% of non-Hispanic white peers. In 2021, California and Oregon states amended their respective Medicaid program to expand eligibility to adults regardless of immigration status; which could reduce access disparities for patients from Latino communities. This study shows preliminary results of changes in health insurance status among Latina patients (who have multiple cancer prevention services recommended in middle age) receiving care in community health centers. Methods: A retrospective cohort study of Latina, non-Hispanic Black, and non-Hispanic white women ages 50-64 years receiving primary care from 382 community health clinics in California and Oregon. Using 2018, 2019, 2021, and 2022 electronic health record data, we estimated monthly rates of insured-type visits per 100 visits. We compared rates pre- and post-Medicaid eligibility expansion, both within and between race and ethnicity groups. Reported estimates were derived from generalized estimating equations Poisson regression, clustered on clinic, and adjusted for clinic-level demographics. Results: Of 41,960 patients, over half (53%) were Latina, most of whom (83%) preferred Spanish language communication. Latina patients had more uninsured visits pre-Medicaid eligibility expansion than did non-Hispanic Black and white patients (Rate: 27% versus 5% and 4%, respectively). All racial and ethnic groups experienced a decrease in uninsured visit rates, and this change was similar for all groups [Difference-in-difference Latina versus Black patients: 0.77 (95% CI 0.55, 10.7) and versus white patients: 1.02 (95% CI 0.89, 1.17)]. Overall rates of Medicaid-insured visits increased only for Latina patients [pre-to-post Relative Rate=1.06 (95% CI: 1.03-1.10)]. Both non-Hispanic Black and white patients experienced a drop in Medicaid-insured visits. Only Black patients experienced a significant decline in private-insured visits [pre-to-post RR=0.79 (95% CI: 0.70-0.89)]. Conclusion: These early results suggest an uptake of Medicaid-paid visits among Latina patients. This increase in healthcare coverage for Latina patients could significantly reduce disparities in access to primary care and especially in cancer preventive care. Citation Format: Nathalie Huguet, Jorge Kaufmann, Heather Holderness, Margaret Vieira, Gretchen Mertes, Jackilen Shannon, John Heintzman. Impact of Medicaid eligibility expansion to adults regardless of immigration status on health insurance access among Latina patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 811.

Individual stigma in people with severe mental illness: Associations with public stigma, psychological capital, cognitive appraisal and coping orientations

IntroductionThe reason why some people with severe mental illness (SMI) maintain positive self-identity, while some are affected by the stigmatized environment is unclear. AimsTo describe the status of individual stigma and explore the relationship between self-stigma, stigma resistance and related variables in people with SMI. MethodsA cross-sectional study was conducted from April 2021 to March 2022. The Chinese version of Internalized Stigma of Mental Illness Scale and Stigma Resistance Scale were used to assess individual stigma. Perceived public stigma, psychological capital, stigma stress appraisal and coping orientations were also measured by scales. Data was provided by 422 patients with schizophrenia or bipolar disorder, from one psychiatric hospital and four community healthcare centers in China. A structural equation model was applied for analysis. ResultsThe total mean scores of self-stigma and stigma resistance were (2.06 ± 0.65), and (3.95 ± 0.84). Perceived public stigma was the primary condition for constructing individual stigma, which indirectly affected self-stigma (β = 0.268) and stigma resistance (β = −0.145). Stigma stress appraisal mediated the transformation of public stigma into individual, which had direct and indirect effects on self-stigma (β = 0.417, 0.166), and an indirect effect on stigma resistance (β = −0.374). Secrecy positively affected self-stigma (β = 0.117), while positive coping positively affected stigma resistance (β = 0.380). Psychological capital significantly directly impacted individual stigma. ConclusionsFindings highlighted how public stigma determines the degree to which patients with SMI deal with stigma stress appraisal, and how this influences individuals. Anti-stigma programs and interventions to improve individuals' psychological capital and coping capabilities should be emphasized.

Abstract HUP15: An Exploring Qualitative Study of Real Life Experiences and Needs of Psychosocial Recovery Among Chinese Community Dwelling Stroke Survivors

Introduction: Stroke survivors may face challenges in managing their psychosocial functions. However, little is known about psychosocial experiences and needs of community-dwelling stroke survivors, particularly in China. Purpose: This study explored the experiences and needs of psychosocial recovery among Chinese community-dwelling stroke survivors. Methods: Semi-structured and individual interviews were conducted with participants in Macao from community healthcare centers and supported groups using convenience sampling. Participants were asked about their experiences, challenges, and strategies for managing post-stroke psychosocial functions, and desired support for psychosocial recovery. Interview data were transcribed verbatim and analyzed thematically. Results: Twenty-six participants (mean age: 69.96±14.06 years old; mean post-stroke duration: 83.88±66.8 months) were recruited to participate in interviews. Regarding the experiences and challenges, most participants faced obstacles in managing emotions and barriers to rebuilding social lives due to the impacts of physical disabilities. Generally, most participants recognized that they were a minority of people in society, and some experienced further invalidation by society. The majority of participants lost motivation and expectations to face challenges, hesitated to disclose their conditions to others, and had less confidence in social interactions as they felt that they were different from others. Meanwhile, some participants adopted strategies to improve their psychosocial functions, including appreciation for oneself and important persons or events supporting them, adjustments to the disparity between expectations and reality, and reinterpretations of unpleasant experiences. Furthermore, communal creative activities offered by health professionals and peer support were recommended. Conclusion: To promote post-stroke psychosocial recovery in communities, health professionals should consider designing meaningful group activities for stroke survivors to meet their psychosocial needs. These findings will guide the development of interventions for enhancing psychosocial functions among Chinese community-dwelling stroke survivors.

Abstract WP113: An Exploring Qualitative Study of Real Life Experiences and Needs of Psychosocial Recovery Among Chinese Community Dwelling Stroke Survivors

Introduction: Stroke survivors may face challenges in managing their psychosocial functions. However, little is known about psychosocial experiences and needs of community-dwelling stroke survivors, particularly in China. Purpose: This study explored the experiences and needs of psychosocial recovery among Chinese community-dwelling stroke survivors. Methods: Semi-structured and individual interviews were conducted with participants in Macao from community healthcare centers and supported groups using convenience sampling. Participants were asked about their experiences, challenges, and strategies for managing post-stroke psychosocial functions, and desired support for psychosocial recovery. Interview data were transcribed verbatim and analyzed thematically. Results: Twenty-six participants (mean age: 69.96±14.06 years old; mean post-stroke duration: 83.88±66.8 months) were recruited to participate in interviews. Regarding the experiences and challenges, most participants faced obstacles in managing emotions and barriers to rebuilding social lives due to the impacts of physical disabilities. Generally, most participants recognized that they were a minority of people in society, and some experienced further invalidation by society. The majority of participants lost motivation and expectations to face challenges, hesitated to disclose their conditions to others, and had less confidence in social interactions as they felt that they were different from others. Meanwhile, some participants adopted strategies to improve their psychosocial functions, including appreciation for oneself and important persons or events supporting them, adjustments to the disparity between expectations and reality, and reinterpretations of unpleasant experiences. Furthermore, communal creative activities offered by health professionals and peer support were recommended. Conclusion: To promote post-stroke psychosocial recovery in communities, health professionals should consider designing meaningful group activities for stroke survivors to meet their psychosocial needs. These findings will guide the development of interventions for enhancing psychosocial functions among Chinese community-dwelling stroke survivors.

Structure of Health Care System: Vital in Promoting Community Well-Being

It is understood on a comprehensive basis that individuals, belonging to all occupations, communities, and socio-economic backgrounds are overwhelmed by different types of health problems and illnesses. These are experienced in a major or minor form. The research studies have indicated that in rural communities, the individuals are depending on the natural environmental conditions in order to treat various types of health problems and illnesses. But there are formulation of programs, which are putting emphasis on bringing about improvements in health care services within rural communities. On the other hand, within urban communities, the medical and health care services are in a well-developed condition. The individuals employed in these are required to be well-versed in terms of job duties and responsibilities. Furthermore, the different types of methodologies and procedures are required to be put into operation in a satisfactory manner. As a consequence, individuals are rendering an important contribution in promoting good health, physically as well as psychologically. One of the important aspects that needs to be taken into account is, individuals are required to prepare themselves adequately in making sure, individuals are benefitting from the services. Therefore, it is well-understood, structure of health care system is vital in promoting community well-being. The main concepts that are taken into account in this research paper are, the health care system in rural areas, functioning of community health care centres, functioning of primary health care centres, functioning of sub-centres and measures to be implemented in bringing about improvements in structure of health care system.

Utilisation of community healthcare services among older adults with disabilities in Luohu district, Shenzhen: a community-based survey

ObjectiveChina faces the challenge of an ageing population with disabilities. Community healthcare centres (CHCs) serve as frontline community healthcare providers for older adults with and without disabilities. Despite their significance,...

A qualitative study to assess satisfaction with the Manipal model of telepsychiatry among patients and caregivers.

Telepsychiatry in India is nearly two decades old and is witnessing rapid adaptation in clinical services. This warrants studying the satisfaction with this mode from healthcare seekers' point of view. This study aimed to study the treatment satisfaction among persons with psychiatric disorders and their caregivers receiving telepsychiatry services via the Manipal model. This was a qualitative cross-sectional study conducted in three centers, which were part of the Manipal model of telepsychiatry, namely community healthcare centers at Hebri, community healthcare centers at Byndoor, and primary healthcare center (PHC) at Kandlur of Udupi District. Semi-structured interview schedule and focused group discussions were conducted to assess the treatment satisfaction. Descriptive statistics were used to analyze sociodemographic data, and data generated from focused group discussions were qualitatively analyzed. Collected data were coded, and themes were generated from the codes. A total of 45 persons with psychiatric disorders and 28 of the caregivers receiving telepsychiatry services were recruited into this study. Results revealed high satisfaction among patients and caregivers with telepsychiatry services provided to them. Qualitative results of this study revealed high satisfaction among patients and caregivers with telepsychiatry services in different domains such as time, cost of treatment, convenience, doctor-patient communication, and healthcare quality. This study witnessed that patients and caregivers were highly satisfied with telepsychiatry services provided to them. These findings clearly indicate the importance of telepsychiatry services in the country, where the concept of telepsychiatry and its practice is rising.

Integrated institutional care based on comprehensive assessment – a case study of Yanda Long-term Care Centre in China

Introduction: Long-term elderly care institutions in China usually solely provide care for daily living to the residents. In response to the multiple needs of the elderly and the policies of integrating health and care by the government, some elderly care institutions started exploring new care models.Yanda Long-term Care Centre is a private institution with more than 5000 beds participating in the interRAI initiative in China. Partnering with a built-in community health care center, it explored integrated institutional care based on interRAI assessment.&#x0D; Practice change implemented: The Centre has established a service model of ""integrated multidisciplinary care based on comprehensive assessment"" to provide integrated health and social care for the elderly. The main concept of the model is to provide comprehensive and effective care through care management and multi-professional teamwork. This care model started its official operation in 2010 and the development is ongoing.&#x0D; Targeted population and stakeholders:The targeted population is all residents in the center especially those with disability or other chronic conditions. Key stakeholders include the management team of the facility, the case managers, the multi-disciplinary care team, the interRAI company in China and the residents’ families. &#x0D; Highlights&#x0D; &#x0D; Yanda Long-term Care Centre adopted a three-tier assessment model. A basic ADL assessment was conducted as initial screening, with disabled residents entering into the next comprehensive assessment which used Long Term Care Facility Assessment Scale (InterRAI-LTCF) as the tool. Specialist assessment scales measuring functional, cognitive, nutritional, spiritual and other dimensions will be employed for specific conditions, such as mini nutritional assessment (MNA), Braden scale for predicting pressure score risk etc.&#x0D; The case managers are responsible for assessing the needs of the elderly and the quality of long-term care services, developing and guiding the implementation of integrated long-term care plans, integrating care resources.&#x0D; Multi-disciplinary care team supported by the built-in community health center，include physician, nurse, therapist, nutritionist, pharmacist, physical and occupational therapist , social worker and so on. They provide comprehensive services, including medical, nursing and rehabilitation services, health management upon needed.&#x0D; &#x0D; &#x0D; Comments on sustainability and transfer-ability: The service model could be sustainable if the current management team of the facility remains stable. The service procedures, assessment methods, case management and multidisciplinary team formation based on the built-in health care center all provide valuable experiences for other elderly care facilities to learn and practice in China.&#x0D; Discussion: Despite progress made, there are still some barriers, including the lack of training systems for professional assessors, underdevelopment of the insurance system for integrated long-term care services.&#x0D; Conclusion: The model develops individualised service plans based on comprehensive assessment and establishes a case management system, providing integrated interventions and services to high-needs residents. It reduces the incidence of risk, improves residents’ quality of life and acquires high satisfaction from both residents and their families. Attention should be given to a more standardised implementation pathway for comprehensive assessment, cultivation of professional talents and further development of financing and payment systems for integrated long-term care services.&#x0D; &#x0D;

The Effects of Diabetes and Being Overweight on Patients with Post-COVID-19 Syndrome.

In the aftermath of the COVID-19 pandemic, post-COVID-19 syndrome (PCS) remains a challenge and may continue to pose a major health problem in the future. Moreover, the influences of type 2 diabetes and being overweight on PCS remain unclear. This study aimed to assess these influences. We performed an observational study from October 2020 to July 2022, which included 466 patients (269 males and 197 females) with a median age of 65. They were hospitalized due to COVID-19 pneumonia and had persistent symptoms after 1 month of COVID-19 infection. The patients were divided into four groups according to the study objectives: patients with type 2 diabetes, overweight patients, overweight patients with type 2 diabetes, and average-weight patients without type 2 diabetes. The clinical and demographic data collected during hospitalization and regular visits to the Community Healthcare Center dr. Adolf Drolc Maribor were analyzed. Our results showed that type 2 diabetes patients had more difficult courses of treatment and longer hospitalizations. Moreover, more type 2 diabetes patients underwent rehabilitation than the other study groups. The prevailing symptoms of our patients with PCS were dyspnea and fatigue, mostly among female patients with type 2 diabetes. Our study also showed that more women with type 2 diabetes and overweight women with type 2 diabetes suffered from secondary infections. Furthermore, more overweight patients were treated in the intensive care unit than patients from the other groups. However, our study showed an interesting result: patients with type 2 diabetes had the shortest PCS durations. Type 2 diabetes and being overweight are risk factors for PCS onset and prolonged duration. Therefore, our data that revealed a shorter duration of PCS in type 2 diabetes patients than the other investigated groups was unexpected. We believe that answering the questions arising from our unexpected results will improve PCS treatment in general.

Development of a Quality Assessment Tool for Hypertension Management by Public Healthcare Providers: A Cross-Sectional Survey

Purpose: This study aimed to develop and assess the validity of a quality assessment tool for hypertension management (QAT-HTN), to evaluate the quality of hypertension management by public healthcare providers working in community healthcare centers. Methods: The QAT-HTN was distributed to 528 patients with HTN. The construct validity (exploratory and confirmatory factor analyses), internal consistency reliability, and concurrent validity of the QAT-HTN were evaluated. Results: A six-subscale measurement model of the QAT-HTN involving blood pressure (BP) control, regular checkups and medicine education, complication prevention and assessment, BP measurement, and lifestyle management was validated using exploratory and confirmatory factor analyses. Concurrent validity was evaluated based on correlations with HTN self-care behavior. The Cronbach’s ⍺ coefficient for internal consistency was .92. Conclusion: The QAT-HTN was found to be a reliable and valid measure of the quality of HTN management in Korean community healthcare centers.

Fecal carriage of extended-spectrum β-lactamase-producing enterobacterales from hospitals and community settings in Gaza Strip, Palestine

BackgroundThe fecal carriage of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) is a major driver of the global spread of these antibiotic resistance determinants. Here we determined the rate of fecal ESBL-PE carriage in pediatric hospitals and community-serving healthcare centers serving adults and children in the Gaza Strip, Palestine.MethodsA total of 373 fecal and rectal samples were collected from different hospitals and clinics in Gaza. The antibiotic susceptibility was determined using the disk diffusion method and interpreted according to CLSI guidelines. The bacterial isolates were tested for ESBL production using phenotypic methods (double disk synergy test and growth on selective chromogenic media). BlaCTX−M, blaSHV, and blaTEM genes were sought by PCR.ResultsOut of the 373 isolates tested, 138 (37%) were considered ESBL positive as revealed by phenotypic tests. The prevalence of ESBLs among hospitalized patients was 39.1% (hospital setting) whereas, among outpatients attending community healthcare centers, it was 35.1% (community setting). ESBL production among Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Proteus mirabilis, and Klebsiella aerogenes isolates was 52.8%, 39.1%, 26.7%, 2.8%, and 2.1% respectively. Meropenem and amikacin were the most effective antibiotics against ESBL producers (68.9% and 73.6% susceptibility, respectively), while only 15.2%, 22.5%, and 24.6% remained susceptible to ceftazidime, cefotaxime, and ceftriaxone, respectively. Out of 138 phenotypically ESBL-positive isolates, 98 randomly chosen were screened for blaCTX−M, blaTEM, and blaSHV genes. The prevalence rate of blaCTX−M was 45.9%, while blaTEM and blaSHV genes were detected in 16.8% and 5.2% of CTX-M-negative isolates (corresponding mostly for K. pneumoniae isolates in the case of SHV-PCR), respectively.ConclusionsThe study revealed an alarmingly high prevalence of fecal carriage of ESBL-producing Enterobacterales among hospitalized children but also in the community of the Gaza Strip. In addition, 30% of ESBL-producers were already resistant to carbapenems, the treatment of choice of infections with ESBL-producers.

SOURCE, a learned resourcefulness program to reduce caregiver burden and improve quality of life for older family caregivers

AbstractBackgroundFamily members often undertake caregiving responsibilities over long periods of time, which could lead to caregiving burden. A theory‐based and culturally sensitive learned resourcefulness program may help family caregivers mitigate stress by learning and using self‐help strategies.ObjectivesThis study's aim is to use rigorous methods to investigate the effects of a learned resourcefulness program called SOURCE (Chen et al., Geriatric Nursing, 2021, 45, 1129) to reduce caregiver burden and improve quality of life (QOL) for family caregivers. SOURCE is an acronym for the six self‐help behaviors at the core of this theory‐based learned resourcefulness program, developed by the Principal Investigator (PI) in collaboration with other researchers (Chen et al., Geriatric Nursing, 2021, 45, 1129). These behaviors are: seeking problem‐solving strategies, organizing daily actions, using self‐regulation, reframing positive situations, changing negative self‐thinking, and exploring new thinking and skills.MethodsWe used a quasi‐experimental design with repeated measures for this study. The potential subjects were family caregivers whose family member was receiving home care. PI recruited 94 family caregivers (60 years old or older) who were caring for disabled and/or ill family members who also were 60 years old or older and living at home at the time of the study. The PI recruited these caregivers through the home care services department of a hospital and two community healthcare centers in Taiwan. The experimental group (n = 46) received the four‐week in‐person SOURCE while their family member continued to receive home care services, whereas the control group (n = 48) did not receive the SOURCE program while their family member received home care services. We collected data from the participants using the Caregiver Burden Scale, EuroQol‐5 Dimension, and Rosenbaum's Self‐Control Scale at baseline (T0, Week 1), after the intervention (T1, Week 5), and at follow‐up (T2, Week 9). We analyzed the data using paired‐sample t‐tests and used the generalized estimating equation method to compare paired data between the baseline and follow‐up.ResultsOf the 94 recruited family caregivers, 90.4% (n = 85) completed the study. We found no significant differences between the experimental and control groups in terms of demographic, caregiver burden, and QOL variables at baseline. Compared to the control group, the experimental group had significantly improved caregiver burden scores (indicating a reduction in caregiver burden) at the end of the intervention and at follow‐up. The experimental group had significantly improved QOL scores at follow‐up only. The experimental group also showed high levels of adherence to and satisfaction with the intervention. The paired‐sample t‐test results show significantly improved learned resourcefulness between T0 and T1 and between T0 and T2 (t = −5.84, p &lt; 0.001; t = −6.77, p &lt; 0.001) for the experimental group.ConclusionThe SOURCE program helped family caregivers develop and use self‐help behaviors during their daily caregiving tasks. The family caregivers reported satisfaction with the program as well as reduced caregiver burden and improved QOL after the program ended.Implications for practiceThe SOURCE program can be implemented to improve family caregivers' caregiver burden and QOL. Community health nurses can improve self‐help abilities of family caregivers by helping them to acquire abilities and skills that allow them to effectively handle stress and reduce their caregiver burden.

Abstract 14018: Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients

Background: Sex differences in cardiac arrhythmias are well-established and partly attributed to sex hormones. Aim: We aimed to explore the prevalence of arrhythmias in transgender and nonbinary ( TGNB ) adults. Methods: This cross-sectional study utilized patient electronic medical records from a single community healthcare center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups as TGNB (transgender man[TGM], transgender woman[TGW], nonbinary-assigned male at birth, nonbinary-assigned female at birth) and cisgender (cisgender man[CisM] or cisgender woman[CisW]). We categorized arrhythmias as atrial, ventricular, or other. Descriptive statistics characterized the prevalence of arrhythmias by gender group. Age- and race-adjusted Firth-type logistic regression models compared TGNB patients to CisM and CisW. The prevalence of arrhythmias was also descriptively explored in nonbinary people and in TGNB people with a gender-affirming hormone therapy (GAHT) prescription. Results: Among 49,862 adults, 7121 (14%) identified as TGNB persons. Participants were young (median age 28 years-old) and prevalence of arrhythmias was low (0.7-1.4% in nonbinary persons, 1.4-1.5% in transgender persons). Adjusting for age and race, TGM and TGW had a similar risk of arrhythmias compared to CisM (TGW: OR=0.89 (0.63-1.24), p=0.52; TGM: OR=1.17 (0.82-1.62), p=0.37), but statistically significantly higher odds of arrhythmias compared to CisW (TGW: OR=1.65 (1.13-2.34), p=0.01; TGM: OR=2.15 (1.48-3.04), p&lt;0.01). Prevalence of arrhythmias appeared similar among TGNB adults who used GAHT and those who did not (1.5% vs 1.9% in TGM, 1.2% vs 2.1% in TGW). Conclusion: Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.

Prevalence and factors associated with anaemia among pregnant women attending antenatal care in a district hospital and its feeder community healthcare centre of the Limpopo Province, South Africa.

Pregnancy anaemia is a significant public health concern in South Africa (SA), particularly in rural areas, but little is known about its prevalence and risk factors in rural areas. The objective of the study was to determine the prevalence and identify risk factors of pregnancy anaemia in the public health facilities of Limpopo Province (LP), SA. A cross-sectional study was conducted among a consecutive sample of 211 pregnant women attending antenatal care at Seshego Hospital and its feeder health centre (May to June 2019). Anaemia was defined as haemoglobin (Hb) <11 g/dL and classified as mild (10-10.9 g/dL), moderate (7-9.9 g/dL) and severe anaemia (<7 g/dL). A multiple logistic regression analysis was used to identify predictors of anaemia. The mean age of the women was 28.4 ± 5.7 years (range from 18 to 41 years). Over half (52%) had secondary education, 65% were unmarried, 72% were unemployed, 34% were nulliparous, 15% were human immunodeficiency virus (HIV) infected and 67% were in the third trimester. The anaemia prevalence was 18.0% and was significantly associated with parity, HIV status and body mass index (BMI) in a multivariate logistic regression analysis. This study found that less than one-third of pregnant women were affected by anaemia, associated with parity, HIV infected and BMI. It is essential to promote routine screening for anaemia, health education and prompt treatment of infections to reduce this burden. In addition, further studies on risk factors for anaemia during pregnancy in both urban and rural communities should be conducted to strengthen these findings.