Health Center Research Articles

Effects of socio-economic factors on reproductive health among women in south-East Nigeria

Reproductive activity is an activity that involves both male and female and this activity is encouraged by certain factors like social, economic and political. These factors should be favourable for reproductive activity to occur. Reproduction is a seamless process that occur when two opposite partner agree, and desire to have children. The aim of the study is to investigate Effects of Socio-Economic Factors on Reproductive Activity Among Women in South-East, Nigeria. This was a cross-sectional study involving 480 women who were within the age of 18 to 47 years. A well-structured questionnaire was administered to participants. Each participant had one questionnaire to fill appropriately and independently after instructions were given to them by the Research Assistants. The study lasted for a period of 4 months. The results of the study revealed that, the educational qualification of respondents also indicated that 80(16.67%) has primary education, 100(20.83%) secondary education while 300(62.50%) had tertiary education. The marital statuses of the respondents also showed that 300(62.50%) were married, 100(20.83) single, while 80(16.67%) were divorced. 300(72.92%) of the respondents have health centre in their community whereas 350(62.50) said the health centres are not functioning. Also, 300(62.50%) of the participants have not visited the health centre. 380(79.17) of the respondents said no access road to the health centre. The study revealed that 60(12.50%) of participants had money to access hospital while 420(87.50%) did not and 460(95.83%) do not have the desire to get pregnant.

Peningkatan Pengetahuan Dan Praktik Ibu Balita Tentang Komposisi Dan Informasi Nilai Gizi Makanan Kemasanan

Public awareness and ability to read food labels is still very low. A National Consumer Protection Agency survey stated that 6.7% of people in Indonesia pay attention to the completeness of food labels. One of the Messages of Balanced Nutrition is reading food labels. S1 Nutrition Study Program STIK Sint Carolus together with Nutritionists from the Galur Supporting Community Health Center provided counseling to mothers of toddlers on the topic "Let's Check the Coins (Composition and Nutritional Value Information) on Food Packaging" to 20 mothers of toddlers who visited the Posyandu. Counseling participants are given an identity and pretest form to fill out. The first session included material on definitions and food labels, and the second session provided material on how to read composition and nutritional value information. The third session involved practicing reading packaged food and conducting questions and answers and filling in the posttest form. After 3 days of providing material, monitoring and evaluation was carried out via Whatsapp. Based on the results of statistical analysis, 55% of mothers were classified as lacking knowledge during the pretest. However, it increased after nutrition education was carried out to 95% of mothers who were classified as well informed. The results of the Wilcoxon analysis show that there is a difference in knowledge between before and after counseling with p-value = 0.007. The results of monitoring and evaluation from 5 mothers, 100% of mothers had paid attention to food labels on packaging, especially composition and nutritional information. There has been a change in practice in reading food labels. Keywords: food labels; knowledge; nutrition information; nutrition counseling

A Qualitative Study of A Health Center-Based Mobile Produce Market.

Healthcare-based food assistance programs have the potential to improve patients' food security, but are underutilized. We conducted a qualitative study of user and staff perceptions of an on-site mobile market at a federally-qualified health center (FQHC). Five themes were identified: 1) financial need drives the decision to use the market, 2) people attend specifically to receive healthy food, 3) users feel a connection to the FQHC, which increases participation, 4) social networks increase usage of the program, and 5) long lines, inclement weather, inaccessibility, and inconsistent marketing and communication are attendance barriers. Findings should inform implementation of future healthcare-based food assistance programs.

Estimating the Health Care Providers’ Number Needed in Northwest Health Service Centers of Tehran Based on Workload Index

Background: One of the major challenges of primary health care (PHC) in developing countries is supplying the growing needs of the populations with sufficient and skilled health workers. In this context, use of a simple and relevant workforce planning method such as Workload Indicators of Staffing Need (WISN) could help authorities allocate adequate number of professionals to health centers to meet the health needs of target populations. Methods: This was a descriptive-analytical study, and WISN methodology was used at 48 Comprehensive Health Centers (CHC) located in the northwest of Tehran, in 2022. The present study was conducted in 7 steps and included measures such as the available work Stime, initial and final required manpower, extracurricular activities and their coefficients, standard work activity and workload, and scheduling activities. Results: According to the collected data, the total number of health care workers needed for the covered population was calculated to be approximately 1018 people, and the ratio of available manpower to the required manpower was reported as 24%; this indicated a 76% difference in the number of health care providers regarding the implementation of complete service package. Conclusion: The results of the research showed that if all the referrals are made through network, the network would likely have a shortage of human resources. Although the standard workload in most cases is lower than anticipated based on the reviewed performance regarding the health care provided, this can be caused by not going to the center to receive services, going to the private sector, and also not knowing about the services that can be provided.

The Medical Writing Center Model in an Academic Teaching Hospital.

Editing services within academic health centers are uncommon, and few studies have reported on their impact. In this article, we describe our medical writing center's editing service for faculty and trainees at a pediatric teaching hospital and associated outcomes of scholarly products (e.g., manuscripts and grants) over an 8-year period. Data for manuscripts and grant proposals edited by the writing center from 2015 through 2022 were collected electronically from our service request database. Outcome data on publications and grant proposals were regularly collected up to 12 months post-submission. Users were also asked if the writing center edits were helpful, improved readability, and if they planned to use the service in the future. From 2015 through 2022, the writing center received 697 requests, 88.4% to edit a document. Of the documents edited, 81.3% of manuscripts and 44.4% of grant proposals were successfully published or funded. When rating their experience, 97.8% of respondents rated the edits "helpful," 96.7% indicated the edits "improved readability," and 99.3% stated they planned to use the writing center in the future. Our results showed steady use of the writing center and high satisfaction with services. A writing center can be an effective tool to support psychology faculty development.

Nurse’s role as a counselor and adherence to antiretroviral therapy among HIV/AIDS patients: a cross-sectional study in a public health center setting in Indonesia

Nurse’s role as a counselor and adherence to antiretroviral therapy among HIV/AIDS patients: a cross-sectional study in a public health center setting in Indonesia

Effectiveness of two educational interventions based on the theory of planned behavior on oral cancer self-examination in adults: a randomized controlled trial.

The theory of planned behavior (TPB) is recognized as an effective theory for behavior change. The aim of the present study was to investigate the impact of two TPB-based educational interventions on oral self-examination (OSE) behavior and the related TPB constructs among adults in Tehran, Iran, in 2022. This randomized controlled trial involved 400 healthy individuals recruited from 20 urban comprehensive health centers in the southern part of Tehran, Iran. The health centers were randomly assigned to two control (PowerPoint) and intervention (WhatsApp) groups (200 individuals in each group). In the control group (the recipient of the routine care), participants received a 20-minute lecture through a PowerPoint presentation and a pamphlet. In the intervention group (the recipient of an additional intervention alongside the routine care), participants were educated through messages and images on WhatsApp along with having monthly group discussions. Data was collected at baseline, as well as at 1- and 3-month follow-ups using a structured questionnaire. The outcomes assessed included OSE behavior and the related TPB constructs: intention, attitude, subjective norm, and perceived behavioral control. Linear and logistic generalized estimating equations (GEE) regression models were used to evaluate the impact of the interventions with STATA version 17. Of the total participants, 151 (37.75%) were men. The mean ± standard deviation (SD) of ages in the PowerPoint and WhatsApp groups were 39.89 ± 13.72 and 39.45 ± 13.90, respectively. OSE and the related TPB constructs showed significant differences between the groups at the 1-month post-intervention assessment. The effect of PowerPoint was more significant in the short-term (one month), while both methods showed similar effectiveness after three months, specifically in relation to OSE and the TPB constructs. At the 3-month post-intervention assessment, there were significant increases in OSE (OR = 28.63), intention (β = 1.47), attitude (β = 0.66), subjective norm (β = 2.82), and perceived behavioral control (β = 1.19) in both groups (p < 0.001). The present study provides evidence of the effectiveness of both educational interventions in improving OSE and the TPB constructs after three months. Therefore, both TPB-based educational methods can be recommended for designing and implementing interventions aimed at preventing oral cancer. The trial protocol was registered in the Iranian Registry of Clinical Trials (IRCT) on 04/03/2022 (registration number: IRCT20220221054086N1).

Neuroserpin, IL-33 and IL-17A as potential markers of mild symptoms of depressive syndrome in Toxoplasma gondii-infected pregnant women

IntroductionDepressive syndrome (DS) is a common complication during pregnancy and the postpartum period, and is triggered by multiple organic/genetic and environmental factors. Clinical and biochemical follow-up is essential for the early diagnosis and prognosis of DS. The protozoan Toxoplasma gondii causes infectious damage to the fetus during parasite primary-infection. However, in long-term infections, pregnant women develop immune protection to protect the fetus, although they remain susceptible to pathological or inflammatory effects induced by T. gondii. This study aimed to investigate plasma inflammatory biomarkers in pregnant women seropositive and seronegative for T. gondii, with diagnoses of minor and moderate/severe DS. MethodsPregnant women (n=45; age=18–39 years) were recruited during prenatal care at health centers in Ouro Preto, Minas Gerais, Brazil. Participants were asked to complete a socio-demographic questionnaire to be submitted to well-standardized DS scale calculators (Beck Depression Inventory Questionnaire, Edinburgh Postnatal Depression Scale, and Major Depressive Episode Module). Additionally, 4 mL of blood was collected for plasma neuroserpin, CCL2, IL-17A, and IL-33 analysis. ResultsPregnant volunteers with chronic T. gondii contact were all IgG+ (44%; n=21) and exhibited increased plasma IL-33, IL-17A, and neuroserpin levels, but not CCL2, compared to uninfected pregnant women. Using Beck’s depression inventory, we observed an increase in plasma IL-17A and IL-33 in women with T. gondii infeCction diagnosed with mild DS, whereas neuroserpin was associated with minor and moderate/severe DS. DiscussionOur data suggest a close relationship between DS in pregnant women with chronic T. gondii infection and neurological conditions, which may be partially mediated by plasma neuroserpin, IL-33, and IL-17A levels.

Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial.

Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting. Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH's training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140). With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points. The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.

Intersectionality analysis of young people’s experiences and perceptions of discrimination in primary health centers in Ebonyi State, Southeast Nigeria

Background Young people (aged 10 to 24 years) in sub-Saharan Africa bear a huge and disproportionate burden of poor sexual and reproductive health (SRH) outcomes due to inequalities and discrimination in accessing sexual and reproductive health services (SRHS). This study assessed the experiences and perceptions of discrimination among young people seeking SRH services in Primary Health Centers (PHCs) using an intersectionality lens.Methods A cross-sectional mixed-methods study was undertaken in six local government areas (LGAs) in Ebonyi State, southeast Nigeria. The LGAs comprise both urban and rural locations. The study population for the quantitative survey consisted of 1025 randomly selected young boys and girls aged 15–24 years. Eleven focus group discussions (FGDs) were conducted with the young people. Descriptive and inferential analyses were performed for quantitative data, while thematic analysis was performed for the qualitative data, using NVivo.Results A total of 16.68% participants in the survey reported that young girls/women were treated badly/unfairly compared to young boys/men when seeking SRH services in PHCs; 15.22% reported that young clients get treated badly/unfairly from adults; and 12.49% reported that young clients with poor economic status were treated unfairly. Respondents also reported that young clients with disability (12.12%), and those who are poorly educated or uneducated (10.63%) are treated badly by healthcare providers when they access SRH services. Young people in urban areas were about 7 times more likely to believe that girls/young women are treated badly than boys/young men when seeking SRH services in PHCs compared to those who live in rural areas (p < 0.001). Among the young girls/women, residing in urban areas, being poor and in school increased the likelihood of getting treated badly/unfairly when receiving SRH services by 4 times (p < 0.001). The qualitative results revealed that health workers were generally harsh to young people seeking SRH services and the level of harshness or unfriendliness of the health workers varied depending on the young person’s social identity.ConclusionThere are varieties of intersecting factors that contribute to the discrimination of young clients in PHCs. This underscores the urgent need to prioritize intersectional perspectives in the design and implementation of interventions that will improve access and use of SRH services by young people.

Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study

Background Sleep can be defined as a state of reduced attention from where the person can be woken up by any kind of stimuli. Sleep difficulties are a major group of disorders affecting one third of the adult population. The present study was taken up to assess the sleep quality and prevalence of sleep disorders among the adult population in the urban slum area of H Siddaiah Road Urban Primary Health Center (UPHC), which is in the Urban Field Practice Area, BMCRI. Methods Stratified random sampling was used to select 821 adults in the population of 18-60 years of age. Ethical clearance was obtained from the Institutional Ethical Committee. A pretested semi-structured questionnaire was used to interview the adults after obtaining their consent. The data was entered in Microsoft Office Excel and analysed using SPSS ver20.0. Results The study population was 52.81% females and 77.5% in the age group of 18-30 years. Most of the study population were Hindus (78.90%), and only 3.8% of the study population were illiterate. Most of them were employed (86.12%). Substance use was present in 82.9% of the study participants and overcrowding was present in 51.3% of the subjects. Female gender, being unemployed, living with relatives, overcrowding, and substance use such as alcohol and smokeless tobacco were the factors associated with poor sleep quality as measured using the Pittsburgh Sleep Quality Index. Among the study participants having poor sleep quality, most of participants needed further clinical assessment for insomnia (86%) followed by assessment for sleep apnoea (50.5%). Conclusions 200 (24.36%) study participants were determined to have poor sleep quality. Gender, marital status and overcrowding were the factors associated with poor sleep quality. A significant number of study participants need further assessment on insomnia, sleep apnoea and psychiatric disorders.

Key issues in Japan's public health centers to prepare for future pandemics: a text mining study using a topic model.

In Japan, over 450 public health centers played a central role in the operation of the local public health system in response to the COVID-19 pandemic. This study aimed to identify key issues for improving the system for public health centers for future pandemics. We conducted a cross-sectional study using an online questionnaire. The respondents were first line workers in public health centers or local governments during the pandemic. We solicited open-ended responses concerning improvements needed for future pandemics. Issues were identified from these descriptions using morphological analysis and a topic model with KHcoder3.0. The number of topics was estimated using Perplexity as a measure, and Latent Dirichlet Allocation for meaning identification. We received open-ended responses from 784 (48.6%) of the 1,612 survey respondents, which included 111 physicians, 330 nurses, and 172 administrative staff. Morphological analysis processed these descriptions into 36,632 words. The topic model summarized them into eight issues: 1) establishment of a crisis management system, 2) division of functions among public health centers, prefectures, and medical institutions, 3) clear role distribution in public health center staff, 4) training of specialists, 5) information sharing system (information about infectious diseases and government policies), 6) response to excessive workload (support from other local governments, cooperation within public health centers, and outsourcing), 7) streamlining operations, and 8) balance with regular duties. This study identified key issues that need to be addressed to prepare Japan's public health centers for future pandemics. These findings are vital for discussions aimed at strengthening the public health system based on experiences from the COVID-19 pandemic.

Public health nurse perspectives on predicting nonattendance for cervical cancer screening through classification, ensemble, and deep learning models.

Women's attendance to cervical cancer screening (CCS) is a major concern for healthcare providers in community. This study aims to use the various algorithms that can accurately predict the most barriers of women for nonattendance to CS. The real-time data were collected from women presented at OPD of primary health centers (PHCs). About 1046 women's data regarding attendance and nonattendance to CCS were included. In this study, we have used three models, classification, ensemble, and deep learning models, to compare the specific accuracy and AU-ROC for predicting non-attenders for CC. The current model employs 22 predictors, with soft voting in ensemble models showing slightly higher specificity (96%) and sensitivity (93%) than weighted averaging. Bagging excels with the highest accuracy (98.49%), specificity (97.3%), and ideal sensitivity (100%) with an AUC of 0.99. Classification models reveal Naive Bayes with higher specificity (97%) but lower sensitivity (91%) than Logistic Regression. Random Forest and Neural Network achieve the highest accuracy (98.49%), with an AUC of 0.98. In deep learning, LSTM has an accuracy of 95.68%, higher specificity (97.60%), and lower sensitivity (93.42%) compared to other models. MLP and NN showed the highest AUC values of 0.99. Employing ensemble and deep learning models proved most effective in predicting barriers to nonattendance in cervical screening.

Not All Days Were Created Equal-Better Day Orientation Following the Weekend on Mini-Mental State Examination (MMSE).

The aim of this study was to test whether patients are better oriented to the day on the first working day following the weekend (in Israel-Sunday), compared with other weekdays, on the Mini-Mental Score Examination (MMSE). All MMSE scores from November 2016 until December 2022 in our mental health center's computerized system were collected. The proportion of correct answers to orientation to the day was compared between weekdays. The cohort consisted of 2049 MMSEs taken by 1376 patients [average age 80.3 (SD=9.3), 56.4% female]. The difference between the proportion of correct and incorrect answers was statistically significant between the days, of which Sundays showed a larger difference (53.4%) compared with the other days (χ2=20.77, P<0.001, Cramer V=0.104). A statistically significant odds ratio (OR) for providing a correct response was found for Sundays (OR=1.55, P=0.001) and, to a lesser extent, on Thursdays (OR=1.29, P=0.01). The difference between Sundays and other weekdays disappears as the total MMSE decreases. Day orientation on the MMSE may be better on the first day following the weekend, especially in early cognitive decline. The weekday in which the MMSE is performed may influence its results.

Acceptance of virtual patients as a continuous professional development approach among practicing nurses in primary health care settings in a low-income country: a quasi-experimental posttest setup design

BackgroundVirtual patients are an educational technological approach used in healthcare education. Its distinctive features have rendered virtual patient technology appealing for the training of medical and healthcare students, particularly in the enhancement of clinical reasoning. Virtual patients are less often applied for continuous professional development for practicing healthcare providers, and there is a scarcity of studies exploring this possibility. This study aimed to assess the acceptability of nurses for using virtual patients as a continuous professional development approach.MethodThe study used a quasi-experimental posttest setup design. The study was conducted in ten primary healthcare settings in Rwanda. Among 76 nurses who consented to participate in the study, 56 completed the intervention and responded to the study questionnaire. Following a one-week program of continuous professional development on four non-communicable diseases, the study used a self-administered questionnaire based on the Technology Acceptance Model 3 to collect data. Descriptive analysis served as the primary method for analyzing participants’ responses. The study also used a correlation test to assess the relationship of variables.ResultsAcross all items in the questionnaire, the median response tended towards either agree or strongly agree, with only a minority number of participants expressing strong disagreement, disagreement, or neutrality. The results indicated a significant positive correlation between perceived usefulness and behavior intention (p < 0.001).ConclusionThe findings indicate an acceptability and behavioral intention of adopting virtual patients as an alternative continuous professional development approach among nurses working at health centers in Rwanda or other locations with similar contexts.

Investigating the Effect of Liver Regeneration on Tumor Growth: Development of a Mouse Model with Orthotopic Implantation of Patient-derived HCC Organoids

Abstract Background Recurrence after hepatocellular carcinoma (HCC) treatment is a significant problem. It affects more than 70% of patients undergoing liver resection. Recurrence can arise from undetected micro metastasis or de novo cancer. Clinical and experimental studies suggest that liver regeneration ensuing surgical resection may activate occult micro-metastasis leading to regeneration induced tumor recurrence. However, in vivo patient-derived organoid (PDO) HCC models that are translatable to patient tumors are sparse. Aims Here, we aim to establish a new in vivo model to understand the impact of liver regeneration on HCC tumor growth. Methods PDOs were generated from HCC tissue obtained from patients undergoing liver resection at the Clarunis University Digestive Health and Care Center and transduced with firefly luciferase. Implantation was performed via laparotomy and orthotopic injection of the organoids in the right superior liver lobe. Tumor growth is monitored by in vivo bioluminescence imaging until the endpoint of the experiment. As a primary endpoint tumor growth two weeks after liver resection was defined. Experimental groups underwent either minor (30%) or major (65%) hepatectomy of tumor-free liver, whereas the control group received a re-laparotomy with subsequent closure of the abdomen. Normal liver and tumor tissue were characterized using immunohistochemistry. Results Two HCC-PDO lines were successfully implanted. Compared to the control, after minor and major liver resection the mean weight increased significantly to 0.82% (p &amp;lt; 0.0001) respectively 0.99% (p &amp;lt; 0.0001). Preliminary data about the tumor volume have yet to be concluded. Histology and immunohistochemistry staining for HCC confirmed the origin of the PDOs from the original patient tumor. Conclusion The establishment of an orthotopic xenograft mouse model for HCC PDO was successful. Through liver resection, a regenerative environment could be achieved, to investigate the molecular behavior of HCC recurrence after surgery. This offers the basis to study potential new targets and mechanisms to improve HCC-treatment.

Assessment of the knowledge, attitudes, and practices toward human tuberculosis amongst rural communities in Chad

IntroductionTuberculosis (TB) is an infectious zoonotic disease caused by bacteria belonging to the Mycobacterium tuberculosis complex. In sub-Saharan African countries such as Chad, TB is endemic and causes a high burden on humans and animals through morbidity, mortality, and reduced productivity in livestock. To effectively prevent and control the disease, strong coordination between policymakers, health and veterinary services, civil society organizations, and communities is needed. It also requires an understanding of the knowledge the communities have regarding TB. However, such knowledge is under-investigated, especially in rural areas. How knowledge affects people's attitudes and practices is also unclear. The main objective of this study was to investigate the knowledge, attitudes, and practices (KAP) of Chadian rural communities to better involve them in TB surveillance programs.MethodsA survey was conducted in 2021 in five rural health centers. Face-to-face interviews were conducted with persons suspected of having TB, and data on KAP were recorded and analyzed.ResultsIn total, 139 participants were enrolled. Overall, the knowledge and attitude of the participants were found to be good to moderate, with 126 (90.6%) and 97 (69.7%) having good knowledge and attitude, respectively. However, their practices were found to be rather weak, with only 40 (28.7%) participants having good practices. Men were found to have good knowledge about the disease significantly more often than women. Poor attitude was significantly associated with a mobile lifestyle compared to settled lifestyles and with farmers (mainly engaged in agriculture) compared to breeders (livestock keepers). Poor health practices were associated more with men than women and with settled lifestyles compared to a mobile lifestyle. Good practices were found to be in line with good knowledge and good attitudes; however, in the analyses, the association was not significant [OR knowledge = 5.83 (95% C.I. 0.6842.83), p = 0.112; OR attitude = 2.09 (95% C.I. 0.875.04), p = 0.100]. Furthermore, attitude was not associated with knowledge [OR = 1.03 (95% C.I. 0.303.55), p = 0.964].Discussion and conclusionOur study highlights the need for targeted sensitization and awareness campaigns for communities with poor knowledge and attitudes regarding TB. These campaigns should also include practical training to increase the level of good practice rather than simply providing knowledge.

Medical Assistant Health Coaching for Type 2 Diabetes in Primary Care: Results From a Pragmatic Cluster Randomized Controlled Trial.

This cluster (clinic-level) randomized controlled trial (RCT) compared medical assistant (MA) health coaching (MAC) with usual care (UC) among at-risk adults with type 2 diabetes in two diverse real-world primary care environments: a federally qualified health center (FQHC; Neighborhood Healthcare) and a large nonprofit private insurance-based health system (Scripps Health). A total of 600 adults with type 2 diabetes who met one or more of the following criteria in the last 90 days were enrolled: HbA1c ≥8% and/or LDL cholesterol ≥100 mg/dL and/or systolic blood pressure (SBP) ≥140 mmHg. Participants at MAC clinics received in-person and telephone self-management support from a specially trained MA health coach for 12 months. Electronic medical records were used to examine clinical outcomes in the overall sample. Behavioral and psychosocial outcomes were evaluated in a subsample (n = 300). All clinical outcomes improved significantly over 1 year in the overall sample (statistical significance [P] <0.001). The reduction in HbA1c was significantly greater in the MAC versus UC group (unstandardized Binteraction = -0.06; P = 0.002). A significant time by group by site interaction also showed that MAC resulted in greater improvements in LDL cholesterol than UC at Neighborhood Healthcare relative to Scripps Health (Binteraction = -1.78 vs. 1.49; P < 0.05). No other statistically significant effects were observed. This was the first large-scale pragmatic RCT supporting the real-world effectiveness of MAC for type 2 diabetes in U.S. primary care settings. Findings suggest that this team-based approach may be particularly effective in improving diabetes outcomes in FQHC settings.

Risk factors of substance use treatment gaps among a nationally representative sample of black American adults in relation to sexual minority status and health insurance coverage

BackgroundLittle research has investigated predictors of specialty substance use treatment gaps among Black adults. This study examined differential odds of experiencing self-reported, past-year treatment gaps among Black adults with respect to sexual minority status and health insurance coverage, accounting for social cofactors.MethodThis cross-sectional study comprised 36,098 Black Americans aged 18 and older who completed the 2015–2019 National Survey on Drug Use and Health (NSDUH) and provided responses for all selected survey items. Design-based multivariable logistic regression models were used to examine predictors of drug and alcohol treatment gaps.ResultsSexual minority Black adults reported greater odds of experiencing treatment gaps to specialty treatment (i.e., inpatient hospital, inpatient/outpatient rehabilitation facility, or mental health center) compared to Black heterosexuals in adjusted models (Gay or lesbian: AOR = 2.01, 95% CI = 1.39–2.89; Bisexual: AOR = 2.35, 95% CI = 1.77–3.12), with bisexual Black women experiencing the greatest odds (AOR = 3.10, 95% CI = 2.33–4.14). Black adults with no health insurance were significantly more likely to report substance use treatment gaps relative to their peers with health insurance coverage (AOR = 50, 95% CI = 1.26–1.78).ConclusionThe results suggest a critical need for more investigations into patterns of specialty substance use treatment gaps within Black populations and for developing sexual identity-affirming mechanisms for closing the disparity gap, particularly for Black sexual minorities and those who lack health insurance coverage.

Effect of Procurement Planning on Organizational Performance Within the Public Sector: A Case of Ruhengeri Referral Hospital in Musanze District, Rwanda

Public entities in Rwanda spend a significant amount of money on procurement. This is the process of acquiring goods, works, or services from a vendor. The general objective of this study was to assess the effect of procurement planning on organizational performance within the public sector. Specifically, the study assessed the effect of needs assessments in procurement planning on performance of Ruhengeri referral hospital, analyze the effect of quality specification in procurement planning on performance of Ruhengeri referral hospital, examine the effect of cost estimation in procurement planning on performance of Ruhengeri referral hospital and assess the effect of terms of payment in procurement planning on performance of Ruhengeri referral hospital. Research was guided by Resource Based viewpoint theory and Transaction Cost Economics theory. Descriptive research design was adopted in this research. This study has taken 106 populations who have direct works related to procurement planning functions from Ruhengeri referral hospital and reporting health centers (42 working at Ruhengeri referral hospital main location and 64 from 12 health centers under management of Ruhengeri referral hospital). The researcher has determined that due to the small population size, a census inquiry method employed instead of sampling. This study used both primary and secondary data, and each has its specific instruments for collection including questionnaire, documentary and interview. Here the researcher tends to interpret frequency, percentages, mean, and standard deviation, as results of Statistical Package for Social Scientists (SPSS) version 20 while content analysis used to analyze qualitative data. The Model Summary provides valuable observations into the effect of independent variables Terms of payment in procurement planning, Needs identification in procurement planning, Quality specification in procurement planning, Cost estimation in procurement planning on the dependent variable, organization performance. The findings revealed the coefficient of determination (R Square), which is 0.652, demonstrates that 65.2% of the variance in organizational performance of Ruhengeri Referral Hospital explained Terms of payment in procurement planning, Needs identification in procurement planning, Quality specification in procurement planning, Cost estimation in procurement planning. The results indicate the coefficient of needs identification in procurement planning (β: 0.399, p: 0.000), it shows the significant effect of needs assessments in procurement planning on organizational performance of Ruhengeri referral hospital. The results indicate the coefficient of quality specification in procurement planning (β: 0.387, p: 0.001), it shows the significant effect of quality specification in procurement planning on organizational performance of Ruhengeri referral hospital. The results indicate the coefficient of cost estimation in procurement planning (β: 0.152, p: 0.022), it shows the significant effect of cost estimation in procurement planning on organizational performance of Ruhengeri referral hospital. The results indicate the coefficient of terms of payment in procurement planning (β: 0.237, p: 0.021), it shows the significant effect of terms of payment in procurement planning on organizational performance of Ruhengeri referral hospital. It is recommended that Ruhengeri Referral Hospital continues to strengthen its needs assessment process by involving a wider range of stakeholders.