Community Primary Health Care Research Articles

Risk of falling associated with the use of medicines in the elderly of the community

Falls are multifactor events, where drug use is an important modifiable risk factor. The risk of falling increases with the aging process and is related to a number of consequences such as reduced functionality, injuries, fractures, hospital admissions, morbidity and mortality. The objective of this study was to evaluate the risk of falling associated with the use of medication in the elderly of the community in Campo Grande, Mato Grosso do Sul, Brazil. This was an observational study, of a transversal character, carried out by means of individual interviews. The variables evaluated were: participant profile and social, clinical and drug histories. In addition, the Medication Fall Risk Score scale was applied. The study was approved by the Ethics Committee in Research with Human Beings of the Federal University of Mato Grosso do Sul, through the opinion n° 5.839.799. The study included 50 elderly individuals with an average age of 66 years (±5.41), most of them female (n=36; 72.0%), with a full tertiary education (n=15; 30.0%), physical exercise (n=39; 78.0%), without any physical limitations (n=34; 68.0%), and without caregiver (n=47; 94.0%). In total, 29 drugs (22.3%) associated with the risk of falling were identified in the prescriptions. The most prescribed were losartan potassium (n=x; 23.5%), anlodipine besylate (n=x; 9.8%), valsartan (7.8%), metoprolol succinate (7.8%), and hydrochlorothiazide (7.8%). Considering the total number of prescription-related medicines identified as falling risk, 12 (36.4%), 5 (15.2%) and 15 (48.5%) were high, intermediate and low risk of falling, respectively. Ten elderly people (20.0%) were classified as high risk of falling associated with the use of medicines. The results showed that the use of drugs associated with the risk of falling was common among the elderly participants in this study, since most were in use of at least one drug associated with the risk of falling. The importance of the work of the pharmacist from community pharmacies and Primary Health Care in the evaluation and management, by means of health education, of the risk of falling associated with the use of medicines in the elderly population is suggested.

Family doctors as healthcare coordinators. Matrix of family doctors' competences for unlocking health workforce potential - the case of Poland

The article presents the results of the research on the competences of family doctors in the Polish healthcare system. According to the 2017 bill on primary health care (PHC) introducing integrated care to PHC, family physicians are obliged to coordinate the care delivered to their populations and to manage the PHC teams. First contracts on integrated care with the National Health Fund have been concluded in 2022. 
 The regulation evoked the necessity of redefining the role of family physicians in the healthcare system. Before that they were habitually deprived of chances to manage the care they provide. The author claims that their role should be perceived as managerial. It is crucial for patients and decision makers to understand family physicians' role in the system and properly manage the PHC workforce, especially when new professions and functions are being introduced to PHC. The regulation is not clear enough in regard to the definition of healthcare coordinator and leaves space to terminological inconsistency and, as a consequence, inadequate use of health workforce potential. The observations that led to designing the research were shared and consulted with the PHC community (focus group consisted of family doctors and PHC facilities’ staff members from lubuskie voivodeship). The research has been shared within academia (results of each stage of the research have been published and peer reviewed).
 The author has developed the matrix of family doctors’ competences to show the scope of competences they demonstrate. It is an ordered aggregation of competences classified according to the roles performed by family doctors in the healthcare system. It includes the indication of classified sources of formal requirements of those competences (in brief: sources of competences). One of the six roles presented in the matrix is a healthcare coordinator. Comparative text analyses have been performed to assess the relation between the range of family physicians’ and healthcare coordinators’ competences. 
 The results show that family physicians have a full set of competences, including managerial, to coordinate the care, which means that they are predisposed to play the role of healthcare coordinator. The author proposes a precise competence-based description of the role of family doctor as a healthcare coordinator. The author further suggests introducing a new function of healthcare coordinator’s assistant. 
 Since one of the sources of competences included in the matrix are WHO’s recommendations on competence clusters for coordinated care the results of this research may be found particularly interesting by international audiences. Especially when the shift towards integration of care is common for most of the healthcare systems and many of them are in preliminary stages of introducing the changes when comparing practice is of great value. 
 The research will be followed by qualitative study of family physicians’ experience in playing the role of healthcare coordinator. The aim of this study is to develop a framework for competence training for family physicians delivering coordinated care.

Factors affecting the delivery of community-based salon interventions to prevent cardiovascular disease and breast cancer among ethnically diverse women in South London: a concept-mapping approach

BackgroundIn the UK, women from ethnically diverse and socioeconomically deprived communities are at increased risk of underdiagnosis of cardiovascular disease (CVD) and breast cancer. Promoting CVD prevention and awareness of breast cancer screening via community salons and primary health care partnerships can improve uptake of screening services and early detection. MethodsConcept mapping is a multistage mixed methods participatory approach comprised of six stages: preparation, brainstorming, structuring of statements, representing statements, interpretation and utilisation of maps using Group wisdom software. A target of 20 salons, excluding male-only salons were approached. Salons included Salons included hairdressing or hairdressing and beauty salons. Purposeful and convenience sampling (online and face to face) among UK salons (hair and beauty) was conducted. Participants were given a focus prompt “What would be some factors that can influence the ability of salons to deliver this service?” and required to generate statements, which were sorted into categories based on similarity and rated for importance and feasibility. Concept maps using multidimensional scaling and hierarchical cluster analyses were produced. FindingsOf 35 participants invited, 25 (71%) consented and agreed to take part in concept mapping. Reported ages were 26–35 years (n=5, 20%), 36–45 years (n=12, 48%), 46–55 years (n=3, 12%), 56–65 years (n=5, 20%), and no age reported (n=10, 40%). Around 36% (n=9) of participants were from non-White ethnic groups, with 12% (n=3) being male and 88% (n=22) female. Seven clusters emerged. Salon staff capabilities and capacities and engaging in health conversations in community salons scored average bridging values of 0·09 and 0·2 respectively, indicating good cluster homogeneity (similar meaning statements were closely sorted). Facilitating health-care access with GP practices was rated highly important to effectively promote the intervention. Engaging in health conversations in community salons and salon incentives for participation were examples of factors that were highly feasible to address. The r correlation coefficient was 0·68 between importance and feasibility to address factors affecting community health interventions. InterpretationSalons are well positioned to support health promotion interventions. Actionable priorities were identified for a salon–GP surgery partnership to promote CVD prevention through lifestyle changes and health check uptake, raising breast cancer screening awareness and address issue of equity. FundingNational Institute of Health and Care Research (NIHR), Research for Patient Benefit (RfPB) Programme NIHR202769.

QCARxE: Qatar-based cardiovascular risk assessment using the English/Arabic version of the EPI·RxISK™ mobile application

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for almost one-third of the total global deaths. Early CVD risk assessment and management (RAM) has demonstrated to be effective in decreasing CVD-related burden. However, CVDRAM services face many challenges and barriers in the community. Mobile technology has been advocated to facilitate access to CVDRAM for both healthcare providers and patients to overcome these barriers. Nevertheless, there is limited availability and use of CVDRAM-related mobile technology in the Middle East region.
 Objectives: To develop and implement an English and Arabic version of a mobile and a web application for CVDRAM in both, community pharmacies and selected primary care centres in Qatar.
 Methodology: This study was conducted in two phases. In Phase 1, translation of the EPI·RxISK™ CV risk calculator (ERC) into the Arabic language was conducted based on guidelines developed by the International Society for Pharmacoeconomics and Outcomes Research. The English/Arabic version of the ERC was pilot tested by potential end users, consisting of a sample of community pharmacists (CRxs) and members of the public (MOP) accessing community pharmacy services. Semi-structured interviews were conducted based on the constructs of the Mobile Application Rating Scale (MARS) and data were analyzed using deductive content analysis. In Phase 2, a prospective observational study (QCARxE) is underway to explore the feasibility of using the ERC in patients accessing primary health care services for CVDRAM, including community pharmacies and primary health care centers (PHCC).
 Results: In Phase 1, a total of 10 CRxs and 5 MOP were interviewed. The data derived from the interviews indicate that the ERC web and mobile application were overall, positively perceived as having quality engagement, functionality, aesthetics, information and subjective quality attributes. To date, a total of 36 patients have enrolled in the QCARxE study (20 from PHCC and 16 from community pharmacies). At their initial CVD risk assessment visit, the mean CVD risk score for these patients was 28.3%, and the most prevalent risk factor was obesity (mean BMI = 30.2 kg/m²).
 Conclusion: The themes derived from the interviews indicate that the ERC was overall, positively perceived. Preliminary data derived from the QCARxE study indicated a significant proportion of patients accessing primary health care services are at high CVD risk. It is speculated that the use of the ERC will enable patients to become better aware of their CVD risk and improve access to risk factor interventions.

Perceptions and experiences of primary healthcare providers toward interprofessional collaboration in chronic disease management in Hue, Vietnam

ABSTRACT In Vietnam, each primary care community health center (CHC) consists of a multi-professional team with six disciplines, including a physician, assistant physician, nurse, pharmacist, midwife, and Vietnamese traditional physician, who are able to meet the majority of patient’s needs at the primary care level. How they collaborate, especially in chronic disease management (CDM), is still limited described in the literature. This study aims to gain insight into the perceptions and the experiences of primary health care providers (PHCPs) toward interprofessional collaboration (IPC) in CDM in CHCs in (Hue) Vietnam. A qualitative study of descriptive phenomenology was performed using two focus groups and 15 semi-structured interviews with PHCPs from six professions relevant to CDM in CHCs. The data were analyzed using NVivo 12.0 with a thematic analysis method by a multiprofessional research team. From the analysis, the data were classified into three main themes: “lack of collaborative practice,” “knowledge,” and “facilitators and barriers to IPC.” This study provided evidence of the awareness that actual collaboration in daily care is fragmentarily organized and that PHCPs try to finish their tasks within their profession. PHCPs work multiprofessionally and lack shared decision-making in patient-centered care. There is a need to develop an interprofessional education program and training to address these deficiencies in the Vietnamese context to improve interprofessional collaboration in health care.

Exploring the interface between community health systems and primary health care in Ethiopia, Kenya, Nigeria, Rwanda, and Senegal

Exploring the interface between community health systems and primary health care in Ethiopia, Kenya, Nigeria, Rwanda, and Senegal

Knowledge, Perception and Feasibility of Community Health Influencers, Promoters and Service (CHIPS) Program Among Community Health Workers in Nkanu West and Awgu Local Government Areas, Enugu State, Nigeria

Background: Primary health care (PHC) is the bedrock of our National Health Policy. PHC has two components: Community level and Primary health care facility level. Universal Health Cover cannot be achieved without significant investment in the community level component. Hitherto, the community component of PHC remains a neglected area of PHC program. CHIPS, a community-based programme was designed to allow traditional institution to select individuals who will administer basic medical needs and referring people in their communities to designated medical facilities when necessary. Method: This is a cross-sectional descriptive community-based study that was conducted among community health workers in Nkanu West and Awgu Local Government Areas of Enugu State Nigeria using self-administered questionnaire. Convenience sampling technique was used to select community health workers in the two local government areas. Results: 77.4% of the study population were not aware of the program. 26.9% are of the opinion that the families in the communities will welcome the idea of home visits. 23.3% perceived the implementation process to be slow, there was poor community awareness (22.0%), poor community participation (19.3%) and no community mobilization (19.3%) yet. Conclusion: From our study, the response rate on how best to organize CHIPS and the challenges it may face, is low. The striking thing is that the challenges of the past community health workers are still that of the present. So it is of utmost importance to constructively look at the content of the planning, implementation and its evaluation, and then draw strength from the weaknesses of the already existing community health programs.

Equity in primary health care provision: more than 50 years of the inverse care law.

The Australian Journal of Primary Health is published by CSIRO PUBLISHING on behalf of the Australian Institute for Primary Care and School of Public Health, La Trobe University in association with the Primary and Community Health Network. The Journal is a refereed, international journal designed to publish articles on a range of issues influencing community health services and primary health care. The focus of the Australian Journal of Primary Health is on the integration of theory and practice in primary health utilising perspectives from a range of disciplines. The Journal publishes research articles, policy reports and analyses, book reviews, case reports, the views of practitioners, consumers, carers, students, and special interest groups, and descriptions of professional practice initiatives in the field of primary health care

A Qualitative Exploration on Knowledge of Community-Integrated Management of Childhood Illnesses among Community Resource Persons and Primary Health Care Workers in Oyo State, Nigeria

Community-Integrated Management of Childhood Illnesses (C-IMCI) is a multipronged strategy developed by the World Health Organization aimed at reducing childhood mortality and morbidity through the integration of enhanced health care services, improved case management skills and healthier community practices. Community resource persons (CORPs) play an important role in the knowledge transfer of this strategy to mothers of U-5 children within their communities. This study explored the knowledge of C-IMCI among CORPs and other primary healthcare workers, as well as accessibility to training, and recommendations for the promotion of C-IMCI. Qualitative data were obtained from a larger cross-sectional study conducted in Ibadan North East and Akinyele Local Government Areas of Oyo State, Nigeria. Data were collected through Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) among community resource persons, community health workers and selected key health officers in two local government areas (LGAs) in Oyo State, Nigeria. Data were transcribed and analyzed thematically. There was poor knowledge of C-IMCI among the participants, the majority of respondents received C-IMCI-related information from nurses and LGA staff. Regarding training, a few respondents who received the initial training on C-IMCI had been transferred from their LGAs, monitoring was infrequent and implementation of C-IMCI was not effective in the sampled areas. Community Resource Persons and Primary Health Care workers in this study did not receive regular trainings on C-IMCI; hence their knowledge was limited in this regard. Increased access to trainings on community practices would help in bridging the existing knowledge gaps in this field.

Community pharmacy and primary health care - Types of integration and their applicability: A narrative review.

There is an urgent need for health care systems to be more efficient and efficacious. An approach to integrate public and private provider organizations such as community pharmacies and public primary health care (PHC) merits consideration. The objective of this review was to identify the types of integration in health care settings and discuss their applicability to the potential integration of community pharmacy and PHC. A narrative review using Medline, Scopus and SciELO databases was performed in which terms related to health were combined with terms related to integration. Levels and Types of integration: 14 types of integration were identified (two in breadth, seven as enablers and five in system levels). A model was created which classifies and assigns the types of integration to the different levels of the health system and to the breadth, intensity, and enablers of the integration process. Due to the nature of community pharmacy and PHC system, a horizontal integration at the micro level, supported by meso and macro levels policy, is suggested. The different elements of intensity and enablers can significantly influence the process. The application of principles, concepts and types of integration suggest that it might be feasible and practical to integrate community pharmacies and PHC. However, the conflictive historical context would need to be overcome with appropriate policy and incentives.

Patient-Reported Social Risks and Clinician Decision Making: Results of a Clinician Survey in Primary Care Community Health Centers.

To assess the extent that patients' social determinants of health (SDOH) influence safety-net primary care clinicians' decisions at the point of care; examine how that information comes to the clinician's attention; and analyze clinician, patient, and encounter characteristics associated with the use of SDOH data in clinical decision making. Thirty-eight clinicians working in 21 clinics were prompted to complete 2 short card surveys embedded in the electronic health record (EHR) daily for 3 weeks. Survey data were matched with clinician-, encounter-, and patient-level variables from the EHR. Descriptive statistics and generalized estimating equation models were used to assess relationships between the variables and the clinician reported use of SDOH data to inform care. Social determinants of health were reported to influence care in 35% of surveyed encounters. The most common sources of information on patients' SDOH were conversations with patients (76%), prior knowledge (64%), and the EHR (46%). Social determinants of health were significantly more likely to influence care among male and non-English-speaking patients, and those with discrete SDOH screening data documented in the EHR. Electronic health records present an opportunity to support clinicians integrating information about patients' social and economic circumstances into care planning. Study findings suggest that SDOH information from standardized screening documented in the EHR, combined with patient-clinician conversations, may enable social risk-adjusted care. Electronic health record tools and clinic workflows could be used to support both documentation and conversations. Study results also identified factors that may cue clinicians to include SDOH information in point-of-care decision-making. Future research should explore this topic further.

Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Settings for an Underserved Population: A Feasibility Pilot Study.

Acupuncture and yoga have both been shown to be effective in chronic pain. Underrepresented populations have poorer pain outcomes with less access to effective pain care. To assess the feasibility of bundling group acupuncture with yoga therapy for chronic neck, back or osteoarthritis pain in safety net settings. This was a feasibility pilot in Bronx and Harlem primary care community health centers. Participants with chronic neck, back or osteoarthritis pain received acupuncture and yoga therapy over a 10-week period. Participants received 10weekly acupuncture treatments in group setting; with Yoga therapy sessions beginning immediately following the 3rd session. Primary outcome was pain interference and pain intensity on the Brief Pain Inventory (BPI); Outcomes were measured at baseline, 10-week close of intervention, and 24-week follow-up. 93 patients were determined to be eligible and completed the baseline interview. The majority of participants were non-White and Medicaid recipients. 78 (84%) completed the intervention and 10-week survey, and 58 (62%) completed the 24-week post intervention survey. Participants received an average number of 6.5 acupuncture sessions (out of a possible 10), and 4 yoga sessions (out of a possible 8) over the 10-week intervention. Patients showed statistically significant improvements in pain at the close of the intervention and at a somewhat lesser rate, at 24-weeks post intervention. Challenges included telephone outreach and site coordination integrating acupuncture with yoga therapy. The trial also had to be stopped early due to the COVID-19 pandemic. Bundling acupuncture therapy and yoga therapy is feasible for an underrepresented population with chronic pain in urban community health centers with preliminary indications of acceptability and benefit to participants.

Geriatric Health Care During the COVID-19 Pandemic: Managing the Health Crisis.

COVID-19 pandemic significantly threatens the health and well-being of older adults. Aging-related changes, including multimorbidity, weakened immunity and frailty, may make older people more susceptible to severe infection and place them at higher risk of morbidity and mortality from COVID-19. Various quarantine measures have been implemented to control the spread of COVID-19. Nevertheless, such social distancing has disrupted routine health care practices, such as accessibility of medical services and long-term continuous care services. The medical management of older adults with multimorbidity is significantly afflicted by COVID-19. Older persons with frailty or multiple chronic disease may poorly adapt to the altered health care system, having detrimental consequences on their physical and mental health. COVID-19 pandemic has posed great challenges to the health of older adults. We highlighted the difficulties and obstacles of older adults during this unprecedented time. Also, we provided potential strategies and recommendations for actions to mitigate the COVID-19 pandemic threats. Certain strategies like community primary health care, medication delivery and home care support are adopted by many health facilities and caregivers, whereas other services such as internet hospital and virtual medical care are promoted to be accessible in many regions. However, guidelines and policies based on high-quality data are still needed for better health promotion of older groups with increasing resilience during the COVID-19 pandemic.

Abstracts of the Australasian Association for Academic Primary Care (AAAPC) Annual Research Conference, 18–19 August 2022.

The Australian Journal of Primary Health is published by CSIRO PUBLISHING on behalf of the Australian Institute for Primary Care and School of Public Health, La Trobe University in association with the Primary and Community Health Network. The Journal is a refereed, international journal designed to publish articles on a range of issues influencing community health services and primary health care. The focus of the Australian Journal of Primary Health is on the integration of theory and practice in primary health utilising perspectives from a range of disciplines. The Journal publishes research articles, policy reports and analyses, book reviews, case reports, the views of practitioners, consumers, carers, students, and special interest groups, and descriptions of professional practice initiatives in the field of primary health care

Prevention of Cardiovascular Diseases in Community Settings and Primary Health Care: A Pre-Implementation Contextual Analysis Using the Consolidated Framework for Implementation Research.

Cardiovascular diseases are the world’s leading cause of mortality, with a high burden especially among vulnerable populations. Interventions for primary prevention need to be further implemented in community and primary health care settings. Context is critically important to understand potential implementation determinants. Therefore, we explored stakeholders’ views on the evidence-based SPICES program (EBSP); a multicomponent intervention for the primary prevention of cardiovascular disease, to inform its implementation. In this qualitative study, we conducted interviews and focus groups with 24 key stakeholders, 10 general practitioners, 9 practice nurses, and 13 lay community partners. We used adaptive framework analysis. The Consolidated Framework for Implementation Research guided our data collection, analysis, and reporting. The EBSP was valued as an opportunity to improve risk awareness and health behavior, especially in vulnerable populations. Its relative advantage, evidence-based design, adaptability to the needs and resources of target communities, and the alignment with policy evolutions and local mission and vision, were seen as important facilitators for its implementation. Concerns remain around legal and structural characteristics and intervention complexity. Our results highlight context dimensions that need to be considered and tailored to primary care and community needs and capacities when planning EBSP implementation in real life settings.

Affordable Care Act Medicaid expansion and access to primary-care based smoking cessation assistance among cancer survivors: an observational cohort study

BackgroundSmoking among cancer survivors can increase the risk of cancer reoccurrence, reduce treatment effectiveness and decrease quality of life. Cancer survivors without health insurance have higher rates of smoking and decreased probability of quitting smoking than cancer survivors with health insurance. This study examines the associations of the Affordable Care Act (ACA) Medicaid insurance expansion with smoking cessation assistance and quitting smoking among cancer survivors seen in community health centers (CHCs).MethodsUsing electronic health record data from 337 primary care community health centers in 12 states that expanded Medicaid eligibility and 273 CHCs in 8 states that did not expand, we identified adult cancer survivors with a smoking status indicating current smoking within 6 months prior to ACA expansion in 2014 and ≥ 1 visit with smoking status assessed within 24-months post-expansion. Using an observational cohort propensity score weighted approach and logistic generalized estimating equation regression, we compared odds of quitting smoking, having a cessation medication ordered, and having ≥6 visits within the post-expansion period among cancer survivors in Medicaid expansion versus non-expansion states.ResultsCancer survivors in expansion states had higher odds of having a smoking cessation medication order (adjusted odds ratio [aOR] = 2.54, 95%CI = 1.61-4.03) and higher odds of having ≥6 office visits than those in non-expansion states (aOR = 1.82, 95%CI = 1.22-2.73). Odds of quitting smoking did not differ significantly between patients in Medicaid expansion versus non-expansion states.ConclusionsThe increased odds of having a smoking cessation medication order among cancer survivors seen in Medicaid expansion states compared with those seen in non-expansion states provides evidence of the importance of health insurance coverage in accessing evidence-based tobacco treatment within CHCs. Continued research is needed to understand why, despite increased odds of having a cessation medication prescribed, odds of quitting smoking were not significantly higher among cancer survivors in Medicaid expansion states compared to non-expansion states.

Racial and Ethnic Disparities in Acute Care Use for Pediatric Asthma.

Previous work has shown that asthma-related emergency department (ED) use is greatest among Black and Latine populations, but it is unknown whether health care use for exacerbations differs across settings (outpatient, ED, inpatient) and correlates with use of routine outpatient services. We aimed to measure disparities by race, ethnicity, and language in pediatric acute asthma care using data from US primary care community health centers. In an observational study using electronic health records from community health centers in 18 states, we compared non-Hispanic Black, English-preferring Latine, Spanish-preferring Latine, and non-Hispanic White children aged 3 to 17 years on visits for clinic-coded asthma exacerbations (2012-2018). We further evaluated asthma-related ED use and inpatient admissions in a subsample of Oregon-Medicaid recipients. Covariate-adjusted odds ratios (ORs) and rate ratios (RRs) were derived using logistic or negative binomial regression analysis with generalized estimating equations. Among 41,276 children with asthma, Spanish-preferring Latine children had higher odds of clinic visits for asthma exacerbation than non-Hispanic White peers (OR = 1.10; 95% CI, 1.02-1.18). Among the subsample of 6,555 children insured under Oregon-Medicaid, non-Hispanic Black children had higher odds and rates of asthma-related ED use than non-Hispanic White peers (OR = 1.40; 95% CI, 1.04-1.89 and RR = 1.49; 95% CI, 1.09-2.04, respectively). We observed no differences between groups in asthma-related inpatient admissions. This study is the first to show that patterns of clinic and ED acute-care use differ for non-Hispanic Black and Spanish-preferring Latine children when compared with non-Hispanic White peers. Non-Hispanic Black children had lower use of clinics, whereas Spanish-preferring Latine children had higher use, including for acute exacerbations. These patterns of clinic use were accompanied by higher ED use among Black children. Ensuring adequate care in clinics may be important in mitigating disparities in asthma outcomes.VISUAL ABSTRACT.

CIVIL SOCIETY ORGANIZATION AND COMMUNITY DEVELOPMENT, A STUDY OF ENUGU NORTH SENATORIAL DISTRICT OF ENUGU STATE. NIGERIA (2007-2019)

Civil society organization and community development A study of Enugu north senatorial district of Enugu State (2007-2019). This study adopted three specific objectives: to ascertain the contributions of civil society organization to community road infrastructural development, to establish the linkage between civil society interventions and availability of potable water supply, and to examine the effect of civil society organizations activities in the improvement of community primary healthcare in Enugu North Senatorial District, Diffusion of innovation theory is the theoretical framework of analysis. Survey design utilized with population of 1,660,000 and sample size of 400. Data generated from primary and secondary sources. Descriptive statistics were used for data analysis and hypotheses were tested with chi-square with the aid of SPSS. The major findings are; civil society organization does contribute positively to community road infrastructural development, there is linkage between civil society organization and availability of potable water supply in Enugu north senatorial district and civil society organization’s activities in Enugu north senatorial district did improve community primary healthcare significantly in Enugu north senatorial district. This study concludes that the citizens and other stakeholders are enjoined to advance the course of CSO’s activities towards community development for the betterment of the communities, states and the society at large. It was recommended that public sector should make enabling laws that will guarantee further engagement of various CSOs as development driver of the state and government should sensitize the populace to be actively involved in most CSO’s programmes.

Expert consensus on antiviral therapy for HBV/HCV-related hepatocellular carcinoma: a 2021 update

With the development of anti-HBV and HCV therapy, experts in related fields organized by the Liver Cancer Study Group, Chinese Society of Hepatology, Chinese Medical Association updated "Experts Consensus on Antiviral Therapy for HBV/ HCV-related Hepatocellular Carcinoma" . On the basis of previous expert recommendations/consensus and the new evidence in recent years, this new consensus was developed, and the relevant recommendations are provided to hepatologists, epidemiologists, medical doctors and specialists working in community service centers and primary health care institutions for guidance of hepatocellular carcinoma antiviral treatment.

Efektifitas Pemanfaatan Rumah Tunggu Kelahiran (RTK) Bahari di Sinjai sebagai Wujud Inovasi Pelayanan Publik

This paper aims to analyze how effective the use of the Waiting House is Birth (RTK) in accommodating the residents of Pulau Sembilan. Using descriptive analysis qualitatively through indicators of the mechanism and effectiveness of its use along with community response on the existence of the RTK. The results show that RTK as one of the 99 The Government's Public Service Innovations have had a positive impact on services in the field of public health, Sinjai Regency in general and Pulau Sembilan in particular. The utilization of the Marine RTK in Sinjai Regency is categorized as a means of services that are very effective in accommodating the community's primary health care rights Pulau Sembilan is especially for pregnant women, and the delivery process and pre-care guarantees and post-delivery, in addition to the responsiveness of managers and medical personnel in providing service to patients and their families is an added value in proving that the concepts of assurance, responsiveness, tangiables, reliability and empathy can be realized maximally.