Health Care Centers Research Articles

Prescriptions of generic antiretroviral drugs in three healthcare centers in the Paris area, France.

In a retrospective study conducted in three hospitals in Paris, generic antiretroviral accounted for 30.2% of all prescriptions. Tenofovir disoproxil/emtricitabine (TDF/FTC) was the most prescribed generic ART (82.3% of generic prescriptions). Generic ART (gART) was more likely to be prescribed to women, to patients less than 50 years, and with recent HIV diagnosis less than 3 years. Physicians prescribed more gART if they were men, older than 55 years or worked at a university teaching hospital.

Expression of Survivin and Ki67 in Biopsy Proven Prostatic Carcinoma and Benign Prostatic Hyperplasia and its Correlation with Gleason's Score in Patients from A Tertiary Health Care Center in South Kerala

Expression of Survivin and Ki67 in Biopsy Proven Prostatic Carcinoma and Benign Prostatic Hyperplasia and its Correlation with Gleason's Score in Patients from A Tertiary Health Care Center in South Kerala

Evaluation of Outcomes Following Endovenous Laser Therapy (EVLT) for Chronic Venous Insufficiency (CVI) on a Daycare Basis in a Tertiary Healthcare Centre of Northern India: A Prospective Cohort Study

Evaluation of Outcomes Following Endovenous Laser Therapy (EVLT) for Chronic Venous Insufficiency (CVI) on a Daycare Basis in a Tertiary Healthcare Centre of Northern India: A Prospective Cohort Study

ELISA with recombinant antigen Lb6H validated for the diagnosis of American tegumentary leishmaniasis.

American tegumentary leishmaniasis (ATL) diagnosis is an open question, and the search for a solution is urgent. The available tests that detect the etiological agent of the infection are specific for ATL diagnosis. However, they present disadvantages, such as low sensitivity and the need for invasive procedures to obtain the samples. Immunological methods (leishmanin skin test and search for anti-Leishmania antibodies) are good alternatives to the etiological diagnosis of ATL. Presently, we face problems with disease confirmation due to the discontinuity in the production of leishmanin skin test antigen, particularly in resource-poor settings. Aiming to diagnose ATL, we validated rLb6H-ELISA for IgG antibodies using 1,091 samples from leishmaniasis patients and healthy controls, divided into four panels, living in 19 Brazilian endemic and non-endemic states. The rLb6H-ELISA showed a sensitivity of 98.6% and a specificity of 100.0%, with the reference panel comprising 70 ATL patient samples and 70 healthy controls. The reproducibility evaluation showed a coefficient of variation of positive samples ≤ 8.20% for repeatability, ≤ 17,97% for reproducibility, and ≤ 8.12% for homogeneity. The plates sensitized with rLb6H were stable at 4°C and -20°C for 180 days and 37°C for seven days, indicating 12 months of validity. In samples of ATL patients from five research and healthcare centers in endemic and non-endemic areas, rLb6H-ELISA showed a sensitivity of 84.0%; no significant statistical difference was observed among the five centers (chi-square test, p = 0.13). In samples of healthy controls from four areas with different endemicity, a specificity of 92.4% was obtained; lower specificity was obtained in a visceral leishmaniasis high endemicity locality (chi-square test, p<0.001). Cross-reactivity was assessed in 166 other disease samples with a positivity of 13.9%. Based on the good diagnostic performance and the reproducibility and stability of the antigen, we suggest using ELISA-rLb6H to diagnose ATL.

Process evaluation of the HIV+D intervention for integrating the management of depression in routine HIV care in Uganda

HIV/AIDS continues to be one of the leading global health challenges, having claimed over 40 million lives so far. People infected with HIV are more likely to develop depression, leading to several negative behavioural and clinical outcomes. Studies have reported exceptionally high prevalence of depressive symptoms among people living with HIV/AIDS (PLWHA), making a case for integrating mental healthcare in routine HIV care. The HIV+D program was implemented in Uganda as an intervention model for integrating the management of depression in HIV care. Process evaluation was carried out to understand the contextual factors and explain the outcomes of the intervention. This was a qualitative study, conducted in 28 out of the 40 public health facilities in 3 districts, where the intervention was undertaken. A total of 82 participants, including the implementers and beneficiaries of the intervention were purposively selected for key informant interviews and focus group discussions. Conventional content analysis was done focusing on 6 aspects including reach, effectiveness, acceptability, implementation fidelity, maintenance (sustainability) and contextual factors that affected the intervention. The intervention was well received and believed to address a real need of the intended beneficiaries; many of whom described it as a program for helping the depressed PLWHA to deal with their depression. The implementers were said to have adhered to the intervention protocol, without major program adaptations, suggesting strong implementation fidelity. The respondents cited several positive health outcomes that resulted from the intervention, for both the beneficiaries and the implementers. Several contextual factors affected the implementation. Although it met the beneficiaries’ approval, and was considered relevant and acceptable, they expressed uncertainty over sustainability of the intervention in a health system characterized by understaffing, resource constraints and several other challenges. The intervention was generally implemented as intended, resulting in several positive health outcomes.

Adherence to medication, dietary and physical activity recommendations: Findings from a multicenter cross-sectional study among adults with diabetes in rural South Africa.

Diabetes is a complex health condition requiring medical therapy and lifestyle modifications to attain treatment targets. Previous studies have not fully explored factors associated with adherence to medication, diets and physical activity recommendations among individuals living with diabetes in rural South Africa. We examined the association between knowledge, health belief and adherence to medication, dietary, and physical activity recommendations and explored self-reported reasons for non-adherence. This cross-sectional study was conducted among 399 individuals living with diabetes recruited over 12 weeks from six randomly selected primary healthcare centres in rural South Africa. Sociodemographic and clinical data were obtained by self-report. Health beliefs, knowledge, and adherence were assessed using validated measures. Descriptive and inferential statistics were carried out. The majority (81.7%) of the participants were females, with a mean age of 62 ± 11 years. Only 39% reported adhering to their prescribed medication regimen, 25% reported adhering to dietary recommendations, and 32% reported adhering to physical activity recommendations. The most cited reasons for non-adherence were lack of access to (n = 64) and cost of drugs (n = 50), perceived high costs of healthy diets (n = 243), and lack of time (n = 181) for physical activity. Level of education was an independent predictor of medication adherence [odds ratio, OR = 2.02 (95% confidence interval, CI: 1.20-3.40)] while diabetes knowledge was independently associated with both medications [OR = 3.04 (95% CI: 1.78-45.12)]; and physical activity adherence [OR = 2.92 (95% CI: 1.04-2.96). Positive health belief was independently associated with adherence to medications [OR = 1.72 (95% CI: 1.15-2.57) and dietary recommendations [OR = 1.75 (95% CI: 1.04-2.96)]. Adherence to three important self-care practices, medication, diet, and physical activity, was suboptimal in this study setting. Socioeconomic reasons and access barriers were significant drivers of non-adherence, while increased knowledge and positive health beliefs were potential facilitators. Efforts to improve medication adherence and foster engagement in healthy lifestyle behaviours must consider patients' knowledge and health beliefs. Primary healthcare providers should create awareness on the importance of adherence on health outcomes for people with diabetes. Likewise, efforts to increase the availability and affordability of medications for socioeconomically disadvantaged populations should be prioritised by the key health stakeholders.

Collaborations and Networks Within Communities for Improved Utilization of Primary Healthcare Centers: On the Road to Universal Health Coverage.

Community involvement depends on the level of linked and targeted activities for health by community members. This study examines the collaborations employed within communities to ensure sustainable access and improved use of healthcare in the community. This study was conducted in rural and urban local government areas in Anambra, Kano, and Akwa-Ibom, Nigeria. About 90 in-depth interviews and 12 focus group discussions were conducted with community stakeholders and service users. The findings were transcribed and coded via thematic analysis, guided by the Expanded Health Systems framework. Various horizontal collaborations in communities foster increased use of PHC services; promoting community health. Major horizontal collaborations in these communities were community-led, primary health facility-led, and Individual-led collaborations. Their actions revolved around advocacy, building and renovating PHC centers, equipping facilities, and sensitization to educate community members on the need to utilize services at PHC centers. Strategic involvements and collaborations of local actors within communities give rise to improvements in the utilization of primary healthcare centres, reportedly resulting in improved access to PHC healthcare services for community members.

Evaluation of Language Dysfunction among Untreated Patients with Psychosis Attending the Psychiatry Inpatient Services of a Tertiary Healthcare Centre from North India: A Cross-sectional Study

Background: Psychosis, encompassing conditions such as schizophrenia and bipolar affective disorder with psychotic features, presents a perplexing landscape where language dysfunction emerges as a notable hallmark. Compared to classical psychotic symptoms (such as delusions and hallucinations), language disorganization can be directly observed, and it is not dependent upon subjective reports of abnormal experiences on part of the patient. Consequently, it has been regarded by researchers as a more objective and informative clinical marker of brain dysfunction in psychosis. There is a dearth of Indian studies in this domain and when compared to international studies, a strong need for revival of research has been felt. Aim: To evaluate language dysfunction among first-admission untreated patients of psychosis using the clinical language disorder rating scale (CLANG). Methodology: In this cross-sectional study, language dysfunction among 60 untreated psychotic patients who attended the psychiatry inpatient services of a tertiary care center from North India in the period from January 2022 to October 2023 were evaluated for the presence of language dysfunction using a valid tool called CLANG after taking approval from the Institutional Ethical Committee and with the informed consent of the patients and/or their caregivers. Data set for 60 patients regarding the sociodemographic-clinical profile and language dysfunction was obtained. The data was analyzed using descriptive and inferential statistics as appropriate. Results: Diagnosis-wise, most of our patients belonged to schizophrenia (n = 26) (43.33%). Rest of them psychotic disorders like bipolar affective disorder with psychotic symptoms (15%) and schizoaffective disorder (11.67%) to name a few. The most commonly affected language domains in our patients were referential failures (65%), discourse failures (46.67%) and lack of semantic association (16.67%). Schizophrenics were differentiated from non-schizophrenic psychosis patients based on lack of semantic association (exclusively seen in schizophrenics). Referential failures and discourse failures were commonly noted in both schizophrenia and non-schizophrenic psychotic disorders. Poverty of speech was rather predominant in mood disorders with psychotic symptoms. Conclusion: The findings of our study put emphasis on the fact that language dysfunction is a core component of the phenomenon of psychosis and perhaps revalidates the neural basis of psychosis. The domain ‘lack of semantic association’ was typically present in patients with a diagnosis of schizophrenia, while other language abnormalities like referential failures and abnormal prosody were generally present in patients of untreated psychosis.

A new framework to enhance healthcare monitoring using patient-centric predictive analysis

In the contemporary healthcare landscape, various intelligent automated approaches are revolutionizing healthcare tasks. Learning concepts are pivotal for activities like comprehending acquired data and monitoring patient behavior. Among patient-centric concerns, addressing data heterogeneity, extraction, and prediction challenges is crucial. To enhance patient monitoring using care indicators like cost and length of stay at healthcare centers, many researchers found a model for automated tools, but do not have the artificial intelligence (AI) based models as of now. Therefore, this research study will propose an AI and internet of things (IoT) integrated automated approach with smart sensors called the “PatientE” framework with heterogeneity and patient data. Employing certain rules for data extraction to form a distinct representation, our model integrates pre-treatment information and employs a modified combined random forest, long-short term memory (LSTM), and bidirectional long-short term memory (BiLSTM) algorithm for predictive post-treatment monitoring. This framework, synergizing AI, IoT, and advanced neural networks, facilitates real-time health monitoring, especially focusing on breast cancer patients. Embracing pre-treatment, in-treatment, and post-treatment phases, our model aims for accurate diagnosis, improved cost-efficiency, and extended stays. The evaluation underscores scalability, reliability enhancement, and validates the framework's efficacy in transforming healthcare practices.

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.

Outcomes of a program to improve breast cancer early detection in Cote d’Ivoire.

10553 Background: In Côte d'Ivoire &gt;70% of women with breast cancer are diagnosed with Stage III/IV disease. Patients pay for all diagnosis and treatment costs. We evaluated the effect of provider education, patient navigation and financial support on time from presentation to diagnosis and treatment uptake. Methods: Setting. Five participating primary healthcare centers in Bouaké. Intervention: (1) Breast health training curricula for primary care providers (PCPs), community health workers (CHWs), and patient advocates/cancer survivors (PAs), based on findings from a qualitative assessment. Content included benign breast disease, cancer diagnosis and treatment (PCPs); raising awareness about breast cancer (CHWs); and patient navigation and treatment adherence support (PAs). 36 PCPs, 5 CHWs, and 2 cancer survivors were trained. (2) For indigent patients (almost all patients), the program paid for imaging and pathology diagnosis; for those diagnosed with cancer, costs of bloodwork, imaging, and chemotherapy. Participants: Women with breast symptoms presenting to health centers from December 2022-September 2023. Primary outcome: mean time from presentation to diagnostic resolution. Results: 223 women enrolled in the study. Mean age was 33.7 (st. dev 13.2). 195 (87.3%) were pre-menopausal. 16 (7.1%) had a family history of cancer. 96 (43%) had no formal education, 42 (18.8%) completed primary school or high school, while 85 (38.1%) completed college or university. Time from noticing symptoms to presenting to healthcare center was &lt; 1 month for 96 (43%), 1-3 months for 33 (15%), 3-12 months for 28 (13%), and &gt; 12 months for 62 (28%). The most common symptoms were breast pain in 150 (67.3%) and painless mass in 119 (53.3%). 175 (78.5%) were referred to the gynecology service at the University Teaching Hospital Bouaké for evaluation. 71 (31.8%) were treated with plan for follow-up as needed; 37 (16.6%) continued with surveillance; 90 (43.4%) were referred for breast ultrasound; 26 (11.7%) for mammography; 42 (18.8%) for breast biopsy; 2 receive antibiotics. Among 106 (91.4%) who had imaging, mean time from presentation to the healthcare center to imaging was 14.5 days (st. dev 15.6 days). Among 42 who had a breast biopsy, mean time from presentation to biopsy was 34.5 days (st. dev 27.4). Mean time from presentation to biopsy result was 64.7 days (st. dev 33.0 days). Seventeen (7.6%) patients were diagnosed with breast cancer. Five (29.4%) are undergoing treatment, one was lost to follow-up, and one died. Nine (52.9%) patients declined treatment despite many discussions with patient advocates, mainly citing fear of side-effects. Conclusions: Our program achieved the mean time of &lt; 60 days from presenting to a healthcare center to diagnostic resolution either by imaging or biopsy recommended by the World Health Organization. Despite improving access to early diagnosis, program impact was limited due to suboptimal acceptance of treatment.

Evaluating the impact of translational research enrollment on the patient care experience of Veterans with prostate cancer who receive care through the Veterans Affairs (VA) healthcare system.

e23210 Background: Veterans with cancer represent a unique subset of patients with distinct exposure histories and cancer epidemiology. Translational research studies that incorporate Veteran-derived biospecimens are therefore critical to advance our understanding of Veteran cancer biology and improve treatment options for Veterans with cancer. Biospecimen-based translational studies also offer an opportunity to enhance the Veteran care experience by enabling Veterans to directly contribute to cancer research efforts. While the biologic benefits of biospecimen research have been well established, the benefit of translational research on the Veteran care experience has yet to be defined. In this study, we evaluated: 1. Whether Veteran enrollment in a biospecimen-based prostate cancer research study improved their VA patient care experience and satisfaction and 2. Whether a VA-based data analyst tool could be used to optimize patient enrollment in translational research studies. Methods: Beginning in January, 2022, Veterans with a diagnosis of prostate cancer receiving care at the William S. Middleton VA were enrolled in a translational research study that collected blood and tissue biospecimens for subsequent investigation and analysis. After at least 30 days of enrollment, subjects were sent an anonymous survey inquiring about how participation in the translational research study impacted their VA care experience and healthcare satisfaction. To optimize enrollment in the study, an ICD-9 code search function was employed within the medical record database to readily identify eligible VA clinic patients based on an active prostate cancer diagnosis. Descriptive analyses were performed using Prism statistical software. Results: Nearly all Veterans who responded to the questionnaire agreed that participation in translational research was a meaningful experience that increased their satisfaction with their VA medical care. In addition, a vast majority of Veterans surveyed felt that their research participation could help improve care for other Veterans, and most expressed willingness to participate in future VA research opportunities. In a secondary analysis, our ICD-9 search function accurately identified eligible VA clinic patients with a prostate cancer diagnosis, and implementation of this tool has saved approximately 30 minutes of weekly physician and research coordinator work compared to manual chart review. Conclusions: Veteran enrollment in translational research studies provides a meaningful experience for Veterans that can lead to increased satisfaction with the VA healthcare system. Future VA initiatives to improve the Veteran care experience should focus on expanding translational research opportunities for Veterans as well as addressing potential barriers to enrollment.

A techno-economic assessment of the viability of a photovoltaic-wind-battery storage-hydrogen energy system for electrifying primary healthcare centre in Sub-Saharan Africa

Healthcare facilities in isolated rural areas of sub-Saharan Africa face challenges in providing essential health services due to unreliable energy access. This study examines the use of hybrid renewable energy systems consisting of solar PV, wind turbines, batteries, and hydrogen storage for the electrification of rural healthcare facilities in Nigeria and South Africa. The study deployed the efficacy of Hybrid Optimization of Multiple Energy Resources software for techno-economic analysis and the Evaluation based on the Distance from Average Solution method for multi-criteria decision-making for sizing, optimizing, and selecting the optimal energy system. Results show that the optimal configurations achieve cost-effective levelized energy costs ranging from $0.336 to $0.410/kWh for both countries. For the Nigeria case study, the optimal energy system includes 5 kW PV, 10 kW fuel cell, 10 kW inverter, 10 kW electrolyzer, and 16 kg hydrogen tank. South Africa’s optimal configuration has 5 kW PV, 10 kW battery, 10 kW inverter, and 7.5 kW rectifier. Solar PV provides more than 90 % of energy, with dual axis tracking yielding the highest output: 8,889kWh/yr for Nigeria and 10,470kWh/yr for South Africa. The multi-criteria decision-making analysis reveals that Nigeria’s preferred option is the hybrid system without tracking. In contrast, the horizontal axis, weekly adjustment tracking configuration is optimal for South Africa, considering technical, economic, and environmental criteria. The findings highlight the importance of context-specific optimization for hybrid renewable energy systems in rural healthcare facilities to accelerate Sustainable Development Goals 3 and 7.

Hepatitis E virus in children and adolescents living in an urban environment in central Argentina: An explorative study

In Argentina, circulation of hepatitis E virus (HEV) genotype 3 has been described, producing sporadic cases of acute and chronic hepatitis. Limited information is available regarding HEV infection in children, so we aimed to investigate this virus in a pediatric population from the country. Serum samples from Argentine children (0–18 years old) (n = 213) were studied for IgG anti-HEV, IgM anti-HEV and RNA-HEV: 202 samples belonged to individuals attending health-care centers for routine check-ups, and 11 samples from patients with acute hepatitis of unknown etiology. Seropositivity for IgG anti-HEV was 1.49 % (3/202). One sample from an 18-years-old female patient with acute hepatitis tested positive for IgM anti-HEV detection, negative for IgG anti-HEV and RNA-HEV, but also positive for IgM anti-EBV. The HEV prevalence was low and showed circulation among children in central Argentina.

Effect of Passive Energy Efficiency Measures in Designing Sustainable Primary Healthcare Facilities in Nigeria

This study aims to develop a design for a sustainable healthcare centre through passive energy efficiency measures to improve the thermal comfort, cooling, lighting and ventilation requirements for primary healthcare centres in Nigeria. The methodology adopted for the study included both primary and secondary data collection. Primary data were collected from the administered questionnaire (5-point Likert scale closed-ended), a total of 350 sets of questionnaires administered and 87% were valid. A case study research strategy was adopted to ascertain the effectiveness and efficiency of building design with an emphasis on sustainable architectural design principles. A significant regression equation was revealed (F (2,257) = 33.619, p &lt;.000, with an R2 of 0.294, which revealed that implementing passive measures for energy optimization has a significant and positive effect on designing sustainable healthcare centres. It further recommends the integration of passive design, design for deconstruction, adaptive reuse, and design for human comfort as part of architectural design principles that would result in sustainable energy optimization should be adopted in every design of primary healthcare centres by architects.

Suicidal thoughts and behavior of adolescents with depression in Reunion Island – evolution before and after the initial Covid-19 lockdown

BackgroundThe number of patients consulting with suicidal thoughts and behavior in the health care centers have increased since the Covid-19 pandemic. This increase has been particularly important among adolescents. Most often these patients are diagnosed with anxiety or depressive symptoms. We only have a limited amount of information on depression and STB in adolescents since epidemiological monitoring in health care institutions is based on computerized coding derived from ICD-10. This coding system is very specific for the different forms of depression yet fails to provide accurate coding for suicidal thoughts and behavior. The objectives of this study were to compare the numbers of adolescents with depression who were admitted with suicidal thoughts and behavior before and after the initial Covid-19 lockdown and to highlight possible gender disparities. MethodsPatients’ medical charts for this retrospective research were obtained from the Department of Adolescent Psychiatry at the University Hospital Centre of Reunion Island, manually screened, and then analyzed. We included all adolescents diagnosed with depression who had had their first consultation between January 1, 2019 and July 31, 2021. The number of patients presenting suicidal thoughts, self-harm and suicide attempts were compared before and after the initial Covid-19 lockdown. ResultsThree hundred and sixty-one adolescents diagnosed with depression participated in the study (33.5% males, 66.5% females). Their average age was 16 (SD=1.7). The number of admitted patients increased from 9 to 16 new adolescents with depression and STB each month between the period before and after the first lockdown, with a large proportion of female patients (increase of 74.1%). ConclusionThis study showed an increase in the number of adolescents consulting for suicidal thoughts or behavior in an adolescent psychiatry department in Reunion Island after the initial Covid-19 lockdown. They were mainly female. This increase has strained an already overburdened mental health system by doubling the number of adolescents that each health care provider has had to help which increases the risk of inadequate care by rapidly increasing the workload but with constant resources.

Primary care for cancer survivors: a review of national institutes of health-funded grants 2017-2022.

To describe the characteristics of National Institutes of Health (NIH) grants on primary care cancer research in cancer survivorship funded over the past 5years. Research project grants (RPG) funded during Fiscal Year (FY) 2017 to 2022 focused on cancer survivorship were identified using a text mining algorithm of words from the NIH Research, Condition, and Disease Categorization (RCDC) thesaurus with survivorship-relevant terms. Grants were then reviewed and double-coded to identify those that were carried out in a primary care setting, targeted primary care providers, or had primary care providers in the study team. A total of 24 grants were identified; 23 were funded by the National Cancer Institute and one was funded by the National Institute on Minority Health and Health Disparities. The majority were funded under the R01 mechanism (70.8%) and led by established investigators. Most were interventional design (91.7%), including both survivors and providers (79.2%), and focused care coordination or healthcare utilization (91.7%). Grants focused on primary care cancer survivorship are uncommon in the NIH portfolio. For the over 18 million cancer survivors in the USA, being cared for in a primary care setting is common. Yet, NIH-funded research on primary care cancer survivorship is sparse.

Integrating Syrian refugees into Lebanon’s healthcare system 2011–2022: a mixed-method study

IntroductionThe Lebanese government estimates the number of Syrian refugees to be 1.5 million, representing 25% of the population. Refugee healthcare services have been integrated into the existing Lebanese health system. This study aims to describe the integration of Syrian refugee health services into the Lebanese national health system from 2011 to 2022, amid an ongoing economic crisis since 2019 and the COVID-19 pandemic.MethodsThis paper employs a mixed-methods approach drawing upon different data sources including: 1- document review (policies, legislation, laws, etc.); 2- semi-structured interviews with policymakers, stakeholders, and health workers; 3- focus group discussions with patients from both host and refugee populations; and 4- health systems and care seeking indicators.ResultsAlthough the demand for primary health care increased due to the Syrian refugee crisis, the provision of primary health care services was maintained. The infusion of international funding over time allowed primary health care centers to expand their resources to accommodate increased demand. The oversupply of physicians in Lebanon allowed the system to maintain a relatively high density of physicians even after the massive influx of refugees. The highly privatized, fragmented and expensive healthcare system has impeded Syrian refugees’ access to secondary and tertiary healthcare services. The economic crisis further exacerbated limits on access for both the host and refugee populations and caused tension between the two populations. Our findings showed that the funds are not channeled through the government, fragmentation across multiple financing sources and reliance on international funding. Common medications and vaccines were available in the public system for both refugee and host communities and were reported to be affordable. The economic crisis hindered both communities’ access to medications due to shortages and dramatic price increases.ConclusionIntegrating refugees in national health systems is essential to achieve sustainable development goals, in particular universal health coverage. Although it can strengthen the capacity of national health systems, the integration of refugees in low-resource settings can be challenging due to existing health system arrangements (e.g., heavily privatized care, curative-oriented, high out-of-pocket, fragmentation across multiple financing sources, and system vulnerability to economic shocks).

Our experience with cardiac MRI in a tertiary health care center in Nepal

Our experience with cardiac MRI in a tertiary health care center in Nepal

Knowledge, Attitude, and Barriers of Seasonal Influenza Vaccination among Pregnant Women Visiting Primary Healthcare Centers in Qassim, Saudi Arabia

Knowledge, Attitude, and Barriers of Seasonal Influenza Vaccination among Pregnant Women Visiting Primary Healthcare Centers in Qassim, Saudi Arabia