Community Health Care System Research Articles

Gender-Affirming Clinics Subject to Onslaught of Threats, Harassment

Gender-Affirming Clinics Subject to Onslaught of Threats, Harassment

Parents' experiences of paediatric palliative care in the community healthcare system: a qualitative study.

Having a child with a life-limiting illness is a situation that is relatively rare and represents a multidimensional burden on the family. Paediatric palliative care (PPC) aims to maintain the quality of life for the ill child and the family. Traditionally, most PPC has been provided at a specialist healthcare level, but research indicates that most families wish to spend as much time at home as possible. However, we have limited knowledge of PPC in community healthcare, especially from the parent's perspective. This knowledge is important to provide optimal home-based PPC. To explore parents' experiences of PPC within the community healthcare system. Qualitative study with an interpretive descriptive design. In all, 11 parents of children with different life-limiting illnesses were interviewed after the child's death using a semi-structured interview guideline. Data were analysed using systematic text condensation. Consolidated criteria for reporting qualitative research (QOREQ) was followed. The parents' experiences were captured in five main themes: (i) 'Interaction with hospital and community services', (ii) 'Parents did not always get the help they needed', (iii) 'The child's needs became increasingly complex', (iv) 'When the end came' and (v) 'The parents asked for an ordinary life in an unordinary situation'. Each main theme was further elaborated by two subthemes. Overall, the parents experienced PPC in the community as limited and fragile, and as lacking flexibility, coordination and professional competence related to the children's complex needs. There appears to be potential for improvement in PPC through improved care coordination between the hospital and the community healthcare services, involving the community healthcare system at an early timepoint in the illness trajectory, including a family focus, and providing accessibility, flexibility and care coordination of community services. The study is registered in the institutional system for research project (RETTE; ID number F2082).

Impact of smart health systems on the behavior of older adults under community healthcare.

With the trend of world population aging, a good community health care system will determine whether the elderly can get good medical conditions. How to improve the community health care system can study how the behavior of the elderly affects it. This paper is based on the analysis of the current situation of population aging at home and abroad. On the premise of analyzing the demand and behavior of elderly people seeking medical treatment and the function of community health service institutions. Literature research was conducted to analyze the influencing factors of community health care needs and elderly people's medical seeking behavior at home and abroad. Then the elderly in Tianjin were investigated by issuing questionnaires, and the law of medical treatment behavior of the elderly in Tianjin was calculated. Combined with the results of relevant investigations abroad, the common phenomenon is summarized. Finally, the analysis method of intelligent medical system is proposed, and the design process of system acquisition module and user usage mode are given. The smart medical system can bring great convenience to the elderly and community healthcare. It emphasizes the powerful functions of smart health systems and their future importance for the health care of the elderly.

Factors contributing to parental stress among Chinese families of children with autism: A qualitative study

AbstractAutism spectrum disorder (ASD) is a pervasive developmental disorder that has grown in prevalence over the past few decades and has a tremendous impact on families that struggle with adjustment to this disorder. Initial exposure to such a disorder may be a significant source of stress and tribulation for Chinese families who are not familiar with mental health discourse and how to navigate community healthcare systems. More extensive research with this population is vital to understand how cultural values and perceptions of parenting self‐efficacy contribute to parenting stress and coping in Asian families. This qualitative study sought to gain understanding of the ways that Asian families coped with stress when they had a child diagnosed with ASD. Seven Chinese families living in New York, with children between the ages of two and five, who were diagnosed with ASD, participated in semi‐structured interviews. Thematic analyses generated primary themes that explored factors contributing to Chinese parental stress: Chinese parents’ perceived parenting self‐efficacy, parents’ adherence to traditional Asian values, parental patterns of coping, and overall satisfaction with the early intervention services which their children were receiving. Results can guide specialized assessment and intervention for professionals who work with Chinese families within clinical, school, and community settings. Implications for practices of psychology in schools, limitations of this current study, and future directions are also discussed.

미얀마 보건의료체계: 분권화(Decentralization)를 통한 회복탄력성(Resilience) 향상

Purpose: To assess the resilience and decentralization of the healthcare system in Myanmar, especially under the recent Covid-19 and civil disobedience movement contexts. Methods: Literature published in between 2015 to 2022 available in PubMed and GoogleScholar, reports of government and organizations, and news and social media were screened and reviewed. The WHO Six Building Blocks were adapted as a framework. Results: Though the healthcare system of Myanmar has shown the fundamental ingredients needed for resilience, the current system failed to implement its resilience capacity under recent events. The system is highly centralized and the public healthcare system apart from the civil community healthcare system officially dominates healthcare functions both domestically and globally, while the later system plays an important role in healthcare service delivery. Unfortunately, these two systems are currently parallel and have shown little efficiency in terms of collaboration. Nursing is significantly influenced and faces difficulties in developing itself under such a healthcare system. Conclusion: Decentralization of the healthcare system can be the main priority towards strengthening the healthcare system in Myanmar, and nursing leadership can play a part in both the conflict and collaboration of public and civil healthcare systems.

Assessing the Rate of Compliance with the Revised Sapporo/Sydney Criteria in Diagnosing Antiphospholipid Syndrome: A Multicenter Retrospective Analysis

Background: Antiphospholipid syndrome (APS) is a systemic autoimmune disease defined by thrombotic or obstetrical events in patients with persistent elevation of antiphospholipid antibodies (aPL) (Lim, 2013). The revised Sapporo/Sydney criteria has been adopted by most professional societies as a guidance to APS diagnosis. To be diagnosed with APS, a patient has to meet at least one clinical criteria and one laboratory criteria. Clinical criteria includes either vascular thrombosis or an adverse outcome during pregnancy. The lab criteria consist of the presence of one or more specified aPL, identified on two or more occasions, at least 12 weeks apart (Miyakis et al., 2006). Antibody testing in patients with suspected APS involves immunoassays for IgG and IgM antibodies to cardiolipin (aCL), and beta2-glycoprotein I (anti-β2GPI), as well as a functional assay for the lupus anticoagulant (LA) phenomenon (Miyakis et al., 2006). Testing asymptomatic individuals is not recommended and carries a significant rate of false positivity, given that up to 10% of healthy individuals may have transient aPL elevation (Vila et al., 1994). Furthermore, certain medications, infections, malignancies, autoimmune diseases, and rheumatologic diseases can also induce transient elevation of aPL antibodies without associated thrombotic complications, emphasizing the importance of repeated aPL measurements in the diagnosis (Lim, 2013; Rand & Wolgast, 2012). Weakly positive levels of aCL and anti-β2GPI antibodies should not be considered significant. Most authorities require Ab levels to be at or above the 99th percentile to be considered clinically significant (Rand & Wolgast, 2012). We aim to assess the compliance with revised Sapporo/Sydney criteria in diagnosing APS in our community hospital system. Methods: We conducted a multi-center, retrospective study among adult patients who were diagnosed with APS in a community healthcare system in southeast Michigan. Demographic and clinical characteristics were collected along with history of venous thrombosis, arterial thrombosis, pregnancy complications, aPL testing results and use of anticoagulants. We used SAS for exploratory data analysis and descriptive statistics. Results: A total of 781 patients were diagnosed with APS between August 2016 to December 2021 (table 1). The median age at diagnosis was 51.3 years (interquartile range 18-93 years). 639 (81.8%) patients were females and 142 (18.2%) were males. Majority of patients were white (n=563, 72.1%). 570 (73.0%) patients had history of venous or arterial thrombosis, 309 (49.9%) had pregnancy complications included in the revised Sapporo/Sydney criteria, and 211 (27.0%) had neither history of thrombosis nor pregnancy complications, not meeting the clinical criteria for APS diagnosis. 528 (67.6%) patients did not meet the laboratory criteria for the diagnosis (figure 1). Of these patients, 439 (83.1%) did not have a repeated testing of aPL antibodies.88 (16.7%) had weakly positive levels of aCL and anti-β2GPI antibodies, below the 99th percentile, and 1 (0.2%) had repeated antibodies testing in less than12 weeks. Out of 528 patients who did not meet the laboratory criteria, 321 (60.8%) were started on anticoagulants. Of these 321 patients, 135 (42%) did not have any history of thrombosis or other appropriate indication of anticoagulation, such as atrial fibrillation. Of 321 patients who were treated with anticoagulation, warfarin was the most prescribed accounting in 120 patients (37.4%). The remainder of patients (62%) were treated with apixaban, rivaroxaban or enoxaparin. Conclusion: Our results showed poor compliance with the current guidelines in both selecting the appropriate candidate for testing, and interpreting aPL testing results, leading to an alarmingly high rate of false diagnosis of APS. Obtaining a positive aPL test result in an otherwise disease-free individual can contribute to unnecessary anticoagulation and side effects including bleeding and increased cost burden to patients and families. Therefore, caution must be exercised while ordering aPL tests and adherence to current guidelines should be encouraged in the routine clinical settings. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The Impact of Surgeon Volume on Hysterectomy Risk: A Concentration Curve Analysis

<h3>Study Objective</h3> To evaluate the relationship between surgeon volume and the outcomes of hospital readmission and return to the operating room in women who underwent hysterectomy. <h3>Design</h3> Retrospective cohort study <h3>Setting</h3> Multicenter community healthcare system <h3>Patients or Participants</h3> 2,730 women who underwent hysterectomy from July 1, 2015, to June 30, 2019. Patients of the resident practice and hysterectomies for obstetric indications were excluded. <h3>Interventions</h3> Surgeon volume greater than 25 hysterectomies per year. <h3>Measurements and Main Results</h3> A concentration curve was used to evaluate the impact of annual surgeon hysterectomy volume on 30-day all-cause readmission or return to the operating room. The concentration curve suggested a disproportionate number of complications attributed to lower volume surgeons. The peak difference between the curve and the line of equality was used to identify a surgeon volume of 25 hysterectomies per year as the cutoff between low- and high-volume surgeons. Demographics and outcomes were compared using Chi-squared and Mann-Whitney U tests where appropriate. Logistic regression was used to correct for confounders. Low-volume surgeons had a higher rate of reoperation or readmission within 30 days compared to those who underwent surgery by high-volume surgeons (4.9% vs 2.9%, <i>P</i>=0.02). After adjusting for confounders, the adjusted odds ratio was 1.67 (95% CI: 1.03 - 2.81). High-volume surgeons performed a greater percentage of laparoscopic hysterectomies (75% vs 45%), had a shorter length of stay (0.4 days vs 1.2 days, <i>P<</i>0.00001), and a greater total operating room cost ($9,827 vs $9,551, <i>P</i>=0.005). <h3>Conclusion</h3> High-volume surgeons performing more than 25 hysterectomies per year had lower rates of reoperation or readmission within 30 days compared to low-volume surgeons. Concentration curve analysis can be useful in determining if outcome differences can be seen based on volume, and helpful in selecting potential cutoffs to analyze surgeon groups by volume. Surgeon grouping is likely not bimodal, and differences are likely to be detectable at many different volume levels.

Improving lung cancer screening in a community healthcare system by electronic health record (EHR) optimization.

437 Background: In March 2021, the United States Preventative Services Taskforce updated its lung cancer screening guidelines to improve overall survival rates, decrease disparities and provide a net cost savings to the healthcare system. With many patients having advanced lung cancer at the time of their diagnosis, it is imperative that screening is performed as soon as applicable. The objective of this study was to improve documentation in EPIC to help prompt low-dose CT (LDCT) scan reminders for providers on the EHR. Methods: This was a prospective study that utilized patient data from EPIC from the Baylor Scott &amp; White Healthcare primary care clinic in Round Rock, Texas. Our version of EPIC used the guidelines prior to the 2021 change. To prompt a reminder on EPIC, there needs to be sufficient numerical data in the smoking history entry form to calculate the pack-years for a patient. EPIC will then automatically generate a notification for providers to order screening LDCT scans for patients that fulfill the screening criteria. We utilized “SlicerDicer” on EPIC to create a custom report of patients that qualified for the study in terms of the inclusion and exclusion criteria. From October 2021 to January 2022, we collected a pre-intervention representative sample to assess how well smoking had been documented during this period. We manually reviewed each medical record number (MRN) listed in the report to verify if proper documentation was used. Our intervention was to contact the clinic manager multiple times with specific instructions on proper smoking history charting. This was then distributed to all ancillary clinic staff via team meetings and flyers. We planned an intervention period from February 2022 to May 2022 that involved data totaling 1178 patients with similar abstraction methods as the pre-intervention data set. Results: We were able to increase lung cancer screening reminders on EPIC for this higher risk patient population. Specifically, 37% of patients pre-intervention had complete data compared to 49% of patients post-intervention. Therefore, an absolute difference of 12% (31.80% increase) of proper documentation was achieved to increase LDCT reminders. The most common mistake by staff was documenting smoking history into the free-text portion of the entry-data forms, which EPIC is not able to calculate pack-years from. Conclusions: Following the intervention at the outpatient clinic, we were able to boost LDCT reminders via an already established process. Increased reminders will eventually lead to more screening orders placed, which we plan to assess for in the next phase of our study. This study can be easily replicated at other centers by instilling similar clinical staff information sessions about documentation. Proper documentation by all healthcare providers is a shared responsibility that has both immediate and longer-lasting impacts on an individual and population level.

원격의료의 쟁점과 지역사회보건의료를 위한 활용 방안

The paradigm of the medical care delivery system must be shifted from the existing hospital visit and hospitalization to community. This is the establishment of the community health care system, and for this, the role of the local clinic must be changed. Primary care clinics should provide visiting medical services to patients with impaired mobility. In addition, it is necessary to continuously treat and manage registered chronically ill patients in the community. In this process, it is necessary to systematically introduce and utilize telemedicine. In this paper, we present specific plans and logic for local clinics to introduce and utilize telemedicine for the development of community health care. In addition, it is argued that telemedicine used in the institutionalization of community health care and primary care clinics has nothing to do with the medical privatization that civil society was concerned about, but rather corresponds to measures to strengthen the publicness of health care.

The Need to Prioritize Prevention of Viral Spillover in the Anthropopandemicene: A Message to Global Health Researchers and Policymakers

Increased anthropogenic activities including changes in land use and unrelenting ecosystem services related to animal husbandry, wildlife trade, and deforestation are driving the emergence of viral zoonosis. This is primarily due to human–animal interaction which is facilitating the spillover of viral zoonotic pathogens from animals (domestic and wildlife) to humans that could result in epidemics or pandemics. Scientific reports so far have revealed that viral epidemics and pandemics in recent years such as H1N1 Swine Influenza, H5N1 Avian Influenza, Ebola, Zika, Severe Acute Respiratory Syndrome (SARS), and the ongoing SARS-CoV-2 were all zoonotic, and their emergence has been linked with spillover events arising from human–animal interaction. This increased interaction and the increased spillover event could facilitate future pandemic risk, and the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, “IPBES”, has declared this “the era of pandemics”. Furthermore, since future pandemics would be triggered by anthropogenic activities, we have called this “anthropopandemicene”, i.e., an era of pandemics driven by anthropogenic activities. To minimize the risk of future pandemics, it is important to prioritize the prevention of viral spillover events. Here, we outline five priority areas for global health researchers and policymakers. These areas include improvement of biosecurity at livestock farms, imposing a moratorium or strictly banning wildlife trade that poses a public health risk, conservation of biodiversity by halting deforestation, investing in community-based research for infectious disease control, and strengthening community healthcare systems in precarious ecosystems and infectious diseases hotspots. Finally, we acknowledge the efforts of other renowned global and legally binding frameworks such as IHR, the Paris Agreement, and CITES with regard to addressing the public health risk of infectious diseases, and we provide recommendations for their improvement.

Using the Soft Systems Methodology to Link Healthcare and Long-Term Care Delivery Systems: A Case Study of Community Policy Coordinator Activities in Japan.

Due to the rapidly aging population in Japan, the government has been attempting to link the healthcare delivery system with the long-term care delivery system. However, there are complex challenges that must be overcome to link the two systems. A new methodology should be used to organize complex community challenges and propose solutions. This study aimed to visualize the unique challenges and worldviews of interested parties in each community, using the soft systems methodology (SSM). We aimed to visualize issues and clarify challenges associated with linking the healthcare and long-term care delivery systems; in turn, clarifying the thought process behind solution proposals. We gathered information regarding those who are actively linking these systems in communities in a Japanese municipality (community care coordinators) and organized the information according to the SSM procedure. By organizing information using the SSM, we were able to summarize the present situations of the community healthcare and long-term care delivery systems, visualize issues, clarify challenges associated with linking these two systems, and propose solutions. The SSM may be useful in organizing complex community information and deriving solutions.

Effect of a Perinatal Clinical Decision Support System on the Incidence and Management of Uterine Tachysystole

A multihospital community health care system installed and implemented a new perinatal clinical decision support software program in October 2020. This system included artificial intelligence to assess uterine contractions and to display an alert if uterine tachysystole (UT; more than five contractions in a 10-minute period averaged over 30 minutes) was detected. Only one study was identified in the literature that demonstrated that the rate of UT decreased after implementation of this perinatal system.

Abandoned places, complexes and parts of cities. Regeneration and enhancement of monumental hospitals in the historic centre of Naples

Even before Covid-19 although in the very center of the old town and historic center of Naples there were abandoned buildings and complexes, uninhabited and unused for decades. The cause is attributed to multiple reasons such as functional obsolescence, failure to adapt to intervening European standards in terms of hospital construction, technological facilities to standards, etc. The health crisis which strongly affected European societies revealed the fragilities of our healthcare systems. In Italy, a large number of COVID-19 patients congested hospitals while the continuity of essential services was interrupted at the expense of other needs. At the same time, the process of abandonment of historic buildings affects different monumental hospitals, such as the “San Giacomo degli Incurabili” and the “Carlo Forlanini” in Rome, or the “Gesù e Maria” Hospital, “San Gennaro dei Poveri” and the “Santa Maria del Popolo degli Incurabili” in Naples. This paper reports three case studies of Neapolitan historical hospitals regeneration proposals with the goal of strengthening the existing community healthcare system and developing energy efficiency and seismic improvement strategies in the spirit of sustainable development. Leveraging the flexibility of monumental hospitals, the proposed light retrofit interventions restore the historial healthcare functional destination ensuring also the reuse of such an heritage. The current research delineates an approach to the recovery and enhancement for social and cultural purposes of unused and abandoned historical hospitals. This approach can positively affect the quality of life of citizens and the use of health services, while recovering historical cultural heritage buildings.

Abandoned places, complexes and parts of cities. Regeneration and enhancement of monumental hospitals in the historic centre of Naples

Even before Covid-19 although in the very center of the old town and historic center of Naples there were abandoned buildings and complexes, uninhabited and unused for decades. The cause is attributed to multiple reasons such as functional obsolescence, failure to adapt to intervening European standards in terms of hospital construction, technological facilities to standards, etc. The health crisis which strongly affected European societies revealed the fragilities of our healthcare systems. In Italy, a large number of COVID-19 patients congested hospitals while the continuity of essential services was interrupted at the expense of other needs. At the same time, the process of abandonment of historic buildings affects different monumental hospitals, such as the “San Giacomo degli Incurabili” and the “Carlo Forlanini” in Rome, or the “Gesù e Maria” Hospital, “San Gennaro dei Poveri” and the “Santa Maria del Popolo degli Incurabili” in Naples. This paper reports three case studies of Neapolitan historical hospitals regeneration proposals with the goal of strengthening the existing community healthcare system and developing energy efficiency and seismic improvement strategies in the spirit of sustainable development. Leveraging the flexibility of monumental hospitals, the proposed light retrofit interventions restore the historial healthcare functional destination ensuring also the reuse of such an heritage. The current research delineates an approach to the recovery and enhancement for social and cultural purposes of unused and abandoned historical hospitals. This approach can positively affect the quality of life of citizens and the use of health services, while recovering historical cultural heritage buildings.

Lung cancer risk in persons enrolled in low-dose CT screening (LDCT) versus incidental lung nodule programs (ILNP).

8553 Background: LDCT screening saves lives, but &lt;10% of eligible persons participate; eligibility criteria are imperfect; geographic, racial and socio-economic disparities have emerged. ILNP may expand access to early detection. We compared rates of lung cancer diagnosis in LDCT and ILNP population subsets. Methods: Prospective observational cohort study of enrollees in LDCT and ILNP in a community healthcare system in AR, MS and TN. We compared LDCT vs 4 ILNP cohorts (C) based on USPSTF 2021 LDCT eligibility criteria: &lt;50 years (C1, too young); &gt;80 years (C2, too old); 50 – 80 years (C3, ineligible smoking history); 50 – 80 years (C4, eligible). For certain analyses, we stratified the LDCT cohort by baseline (T0) Lung-RADS score (0-2 v 3-4). We used a Cox model to calculate crude and adjusted hazard ratios (aHR) for lung cancer diagnosis within 24 months of enrollment. Results: From 2015-2021, 7050 persons were in LDCT- 6073 (86%) Lung-RADS 0-2 (no/benign lesions), 977 (14%) Lung-RADS 3 or 4 (possibly malignant lesion) on T0 scan; 17,579 were in ILNP, 16%, 10%, 57% and 16% respectively in C1-4. Demographics and tobacco use history of the ILNP cohorts differed strikingly; C4 was very similar to LDCT (Table). Black persons were significantly more in C1 (too young) and C3 (insufficient tobacco use). Diagnosis of lung cancer at 36 months ranged from 1% in C1 to 15% in C4, compared to 3% in LDCT; aHR for lung cancer diagnosis within 2 years ranged from 0.23 to 5.12 (all LDCT ref), but ranged from 0.04 to 1.02 with reference to LDCT Lung-RADS 3-4. Most patients in LDCT and ILNP C2-4 had early stage. There were proportionately more Black lung cancer patients in C1-4, and 3 times more Black patients in C3 and 4 than in LDCT. Conclusions: ILNP provides early-detection access to a larger, more diverse population than LDCT, potentially alleviating race and socio-economics-based outcomes disparities. [Table: see text]

The experiences and needs of nurses providing home-based palliative care: A qualitative meta-synthesis.

Objective(s): We conducted a qualitative meta-synthesis of qualitative studies on nurses' experiences when caring for palliative patients to (1) identify the needs of nurses and (2) describe their experiences to provide more in-depth information. Methods: Qualitative articles published in English from 2000 to 2022 were identified from several databases through a searching strategy. Authors screened through the title, abstract, and full text of relevant studies. Articles were read repeatedly and discussed. The thematic analysis methodology was adopted to analyze the data. Results: Of 967 articles, 22 were included in our review. Notions reflecting community nurses providing palliative home care were clustered into four themes: (1) nature of community-based palliative nursing, (2) teamwork, (3) relationship with patient and family, and (4) resources. Findings also suggest establishing a sound support system, strengthening palliative education, and creating more decisive referral criteria and systems. Conclusions: The growing need for palliative home care has become challenging for community health care systems. Our study summarized various aspects of nurses providing home-based palliative care. The findings provide information for health care and education settings to improve home care systems and recruit more staff to meet the needs.

COVID-19 in Africa: An Explorative Cross-Sectional Analysis of Twenty-One African Countries From January to June 2020.

Introduction: Africa has surprisingly recorded better gains in containing the coronavirus spread than countries with the better health indices, such as the USA and UK. The low rate of coronavirus disease 2019 (COVID-19) cases and death in Africa represents a puzzle with different biological and social theories such as low COVID-19 testing capacity, substantial young population, few old people, favourable climate, genetic admixture, infectious disease antibodies, and sound community health care systems proposed. We aimed to understand the COVID-19 preventive measures in a group of twenty-one systematically selected African countries that may explain the low burden of COVID-19 in Africa.Methods: Data (COVID-19, health, socioeconomic, and demographics indices) of twenty-one systemically selected African countries were retrieved from the various official country and multilateral organization sources such as Worldbank, and the United nations development Programme (UNDP). The extracted data were analyzed in three large groups: international travel restrictions, physical and social distancing, and movement restrictions (lockdown measures; curfews, partial or/and national lockdowns). Data cleaning, analysis (including Pearson correlation), and visualization were done with Microsoft Excel and Graph Pad Prism version 9 (https://www.graphpad.com/).Result: Southern Africa had the greatest number of cases and deaths within the period studied compared to East Africa, which was the least COVID-19 affected sub-region (in terms of COVID-19 cases and deaths). We observed that coronary artery disease death rate was highly correlated with COVID-19 death density (number of COVID-19 deaths/total population) and similarly observed a correlation between the number of cases and deaths and number of in-country arrivals, pandemic preparedness (health security index), COVID-19 containment, and health index (not correlated with deaths). Finally, we noted that the most effective preventive strategy was the 'use of a face mask'.Conclusion: Africa had fewer COVID-19 cases and COVID-19 related deaths. Our data shows that the rapidity and stringency of COVID-19 preventive measures and government policies, and the low level of tourism in Africa compared to other countries (i.e., low COVID-19 seeding rate) may have been contributory to these favorable statistics. We hope these findings impact how the preparedness for pandemics can be enhanced to decrease the burden of preventable deaths and morbidity.

Strengths and Challenges to the Integration of Mental Health Services into the Primary Health Care System in Developing Countries: A Systematic Review

The existence of a treatment gap for persons with mental disorders has led the WHO to implore leaders around the world to integrate mental health services into the community or primary health care system. Whilst there are strengths, there are great challenges to the integration process that are hindering the implementation of this initiative in developing countries. The aim of this paper is to synthesize evidence from various researchers regarding the strengths and challenges to the integration of mental health services into the primary or community health care system in developing countries. The sources of information included Pubmed, Medline, Google Scholar, Ebsco Host, and the WHO website. Seventeen (17) studies met the inclusion criteria out of the search results of 2,200. The challenges most reported were inadequate support and supervision structures; lack of key resources, limited Knowledge, inadequate training, and lack of experience of healthcare providers in mental health; time constraints for the primary healthcare workers; lack of regulatory measures to encourage the integration. The strengths most reported were health care workers’ acceptance of responsibility to provide mental health services in the community setting. This paper has proven a number of strengths and challenges regarding the integration of mental health services into the primary or community health care system. It is hoped that this paper will assist stakeholders and policymakers in overcoming the majority of the challenges identified in the integration of mental health services in the primary health care system.

General Vaccination and Active Prevention of COVID-19 Epidemic at the Primary Health Care Level: The Fifth Step of the National Mobilization Program against COVID-19

Background. One of the most effective ways to prevent coronavirus disease 2019 (COVID-19) is to perform general vaccination and actively prevent the outbreak at the primary health care level. The present study aimed to review the measures against COVID-19 in Iran from April to September 2021. Methods. A cross-sectional and descriptive study was conducted at the national level from April to September 2021. Data related to COVID-19 vaccination, prevention, care, and outpatient services was collected from databases, including first level electronic health record systems, the portal of Network Management Center, the portal of Infectious Diseases Management Center, and the portal of Health Observatory. The target population of the study included medical universities and schools in Iran. Using a census sampling method, all 63 medical universities and schools in the country were included in the study. The Statistical Package for the Social Sciences (SPSS) version 16 was utilized to analyze the collected data. Results. In the fifth step of the national mobilization program against COVID-19 epidemic, a total of 1,228 vaccination centers with 6,490 stations were established across the country from April to September 2021. In these centers, more than 47 million doses of the COVID-19 vaccines were injected. At this step, over 15 million people exposed to close contact with infected people were intercepted. A home care team was deployed at each selected health center for COVID-19, providing 532,551 home care services. At the fifth step, the monitoring teams issued 1,015,831 warnings to trading, industrial, or administrative units, which led to the sealing of 73,443 units. Also, more than six million rapid tests were performed in homes and health units. During the same period, 30,843 vulnerable households received support packages. Conclusion. The national mobilization program to combat COVID-19 in Iran focused on the community and primary health care system. The program was successful in strengthening the health system to expand vaccination and actively prevent COVID-19 epidemic.

Reflections on the Prospective Professional Competency of Taiwan Public Health Nurses

Societal ageing, the rising prevalence of chronic diseases, and the COVID-19 pandemic have changed the global healthcare environment dramatically. These challenges have significantly burdened community medical and healthcare systems and complicated the work of public health nursing. As an important care provider on the frontlines of primary care, public health nurses (PHNs) must keep up with the current state of the medical environment and statistical data interpretation, scientific data translation, community resource sharing, and telehealth applications. These demands have greatly impacted the traditional routines and existing professional core competencies of PHNs. Discussions among 12 Taiwanese public healthcare experts and the definition of public health nursing capacity from World Health Organization were considered in this review. In addition to reflecting on social changes and the professional development of public health nursing, eight prospective recommendations were provided in this review to enhance the professional competence of PHNs and better prepare them for future changes in the health environment and primary healthcare. The suggestions provide a reference for updating the position statement of PHNs.