Health Center Research Articles

Extent and causes of unused medications among patients in rural Ethiopia: a prospective multicenter cohort study

BackgroundMedication waste poses health, economic, and environmental challenges. However, the extent among patients living in rural areas is underexplored. This study assessed the proportion of prescribed medications remaining unused by patients living in rural areas of Ethiopia, and identify the causes thereof and disposal practices.MethodsA prospective multicenter cohort study was conducted in 5 rural health centers in Ethiopia. Patients (≥ 18 years), who received a prescription for acute or chronic medication for pick up from the outpatient pharmacy were included. After 3 months, participants received a house visit by a health employee during which a questionnaire was verbally administered to assess the quantity of unused medication, reason thereof, and disposal practices used. Data were analyzed using descriptive statistics and multivariate logistic regression to identify factors associated with presence of unused medications.ResultsIn total, 178 patients participated. Up to 136 out of 601 (22.6%) dispensed medications ended up unused, mainly antibiotics and analgesics, with an average economic value of $0.37. Of 178 patients, 72 (40.4%) ended up with unused medication, and 15 (8.4%) did not use 80% or more of the prescribed quantity. Early discontinuation of therapy was the main reason (61.8%) for patients’ ending with unused medication. Patients reported to primarily dispose of unused medication either through the toilet (43.6%), household garbage (22.7%), burning (13.6%), or returning it to the pharmacy (2.7%). Medications dispensed to be administered with two or more-unit doses at a time were more likely to remain unused (adjusted OR 1.6 [1.0–3.4]) compared to medications dispensed to be administered one-unit dose.ConclusionA substantial amount of prescribed medications remains unused by patients in rural areas, frequently not properly disposed. Interventions are needed to ensure medications are not wasted and reduce the unwanted consequences.

Level of institutional delivery service utilization and associated factors among women who gave birth in the past 12 months, Ga’an libah district, Marodijeh region, Somaliland: a community-based cross-sectional study

BackgroundInstitutional delivery has been considered one of the important strategies to improve maternal and child health and significantly reduce birth-related complications. However, it is still low in developing countries though there are some improvements. even among the community who has access to the health institutions weather health center and hospital including Somaliland. Hence, the aim of this study was to assess the level of institutional delivery service utilization and associated factors among women who gave birth in the last 12 months in Ga’an libah district, Marodijeh region, Somaliland.MethodsThe community-based cross-sectional study was conducted among women who gave birth in the last 12 months from September to December 2022. A simple random sampling technique was employed to select study participants from a total of sample population. Data was collected using semi-structural administered questionnaire through interviewing women. Data was collected with online mobile data collection (Kobo collect). SPSS version 25.0 was used for data management, entering and analysis. Bivariate and multivariable logistic regression models were fitted to determine the presence of a statistically significant association between independent variables and the outcome variable with p-value < 0.05.ResultLevel of Institutional delivery services utilization in Ga’an libah district was 53.9% [95% Cl 48.2–59.6] gave birth at health institutions. Women who can read and write local were (AOR 2.18, 95% CI 1.08–4.56, p<0.01), Women with their husband can be capable to read and write are [(AOR = 6.95, 95% Cl 2.82–21.58, p<0.002]). Additionally, ability to cost transportation for referral [AOR 5.21, 95% Cl 2.44–11.13, p<0.001]. not good services available [AOR 0.07, 95%Cl 0.01–0.10, p<0.02]. lack of maternal health and child knowledge [AOR 0.034, 95% Cl 0.02–0.57, p<0.01]. were observed associated with level of institutional deliver services utilization.ConclusionThe institutional delivery service utilization was relatively high compared to national demographic health services in the study area. A large proportion of women gave both at home without a skilled attendant. Therefore, this finding has important policy implications since changes in the cost of the health service and perceived quality would mean changes in client satisfaction as well as their choice, as well emphasize to expectant women can receive medical advice and ambulance for referrals.

Feasibility, acceptability and preliminary evaluation of a user co-facilitated psychoeducational programme: a feasibility proof-of-concept randomised control trial

BackgroundMental health settings are increasingly using co-facilitation of educational group interventions in collaboration with patient partners and service users. However, despite promising results, limited information is available regarding the feasibility and satisfaction levels of these programmes among adults newly diagnosed with attention-deficit hyperactivity/impulsivity disorder (ADHD). Hence, this study aimed to determine the feasibility, acceptability, and preliminary effects of a user co-facilitated psychoeducational group programme for adults diagnosed with ADHD.MethodsThis feasibility proof-of-concept randomised controlled trial recruited outpatients from a Norwegian community mental health centre. Outpatients randomised to the intervention group (IG) received a psychoeducational programme supplementing Treatment As Usual (TAU), while the control group received TAU. Feasibility was determined by the acceptance rate, adherence rate, and dropout rate. Acceptability was measured with the Client Satisfaction Questionnaire and a 3-item scale measuring satisfaction with the received information. To test the preliminary effects, self-efficacy, symptom severity, and quality of life were measured at baseline and pre- and post-intervention.ResultsFeasibility was demonstrated; most of the patients were willing to enrol, participants attended 82% of the psychoeducational programme, and only 13% dropped out of the study. The between-group analyses revealed that the IG reported significantly greater mean satisfaction than the CG. Moreover, the intervention group was more satisfied with the information they received during the psychoeducational programme. Concerning the preliminary effects, the linear mixed model showed improvement in quality of life (the subscale relationship); however, other patient-reported outcomes did not show improvements.ConclusionsThis proof-of-concept randomised controlled trial supports the feasibility and acceptability of the user co-facilitated psychoeducational programme for patients newly diagnosed with ADHD in an outpatient setting. While preliminary findings indicate promise in enhancing patient-reported outcomes, a larger study is warranted to assess the intervention’s effectiveness rigorously.Trial registrationNCT03425, 09/11/2017.

Transcultural adaptation and validation of Persian Version of Patient Assessment of Chronic Illness Care (PACIC-5As) Questionnaire in Iranian older patients with type 2 diabetes

BackgroundThe Patient Assessment of Chronic Illness Care (PACIC-5As) questionnaire has been designed to evaluate the healthcare experiences of individuals with chronic diseases such as diabetes. Older adults are at higher risk for diabetes and its associated complications. The aim of this study was transcultural adaptation and evaluation of the validity and reliability of the PACIC-5As questionnaire in older patients with diabetes residing in Qazvin City, Iran.MethodIn this validation study, we recruited 306 older patients with diabetes from Comprehensive Health Centers in Qazvin, Iran. The multi-stage cluster sampling technique was used to choose a representative sample. The PACIC-5As questionnaire was translated into Persian using the World Health Organization (WHO) standardized method. The validity (face, content, and construct) and reliability (Cronbach’s alpha) of the PACIC-5As were assessed. Data analysis was conducted using R software and the Lavaan package.ResultsThe mean age of the older patients was 69.99 ± 6.94 years old. Most older participants were female (n = 180, 58.82%) and married (n = 216, 70.59%). Regarding face validity, all items of PACIC-5As had impact scores greater than 1.5. In terms of content validity, all items had a content validity ratio > 0.49 and a content validity index > 0.79. The results of confirmatory factor analysis demonstrated that the model exhibited satisfactory fit across the expected five factors, including assess, advise, agree, assist, and arrange, for the 25 items of the PACIC-5As questionnaire. The Cronbach’s alpha coefficient for the PACIC-5As questionnaire was 0.805.ConclusionThis study indicates that the Persian version of the PACIC-5As questionnaire is valid and reliable for assessing healthcare experiences in older patients with diabetes. This means that the questionnaire can be effectively used in this population.

Recommendations to Address Barriers to Patient Portal Use Among Persons With Diabetes Seeking Care at Community Health Centers: Interview Study With Patients and Health Care Providers.

Community health centers (CHCs) are safety-net health care facilities in the United States that provide care for a substantial number of low-income, non-English speaking adults with type 2 diabetes (T2D). Whereas patient portals have been shown to be associated with significant improvements in diabetes self-management and outcomes, they remain underused in CHCs. In addition, little is known about the specific barriers to and facilitators of patient portal use in CHCs and strategies to address the barriers. The objectives of this qualitative study were to explore the barriers to and facilitators of the use of patient portals for managing diabetes in 2 CHCs from the perspective of adults with T2D and clinicians (community health workers, nurses, nurse practitioners, and physicians) and to make recommendations on strategies to enhance use. A qualitative description design was used. A total of 21 participants (n=13, 62% clinicians and n=8, 38% adults with T2D) were purposively and conveniently selected from 2 CHCs. Adults with T2D were included if they were an established patient of one of the partner CHCs, aged ≥18 years, diagnosed with T2D ≥6 months, and able to read English or Spanish. Clinicians at our partner CHCs who provided care or services for adults with T2D were eligible for this study. Semistructured interviews were conducted in either Spanish or English based on participant preference. Interviews were audio-recorded and transcribed. Spanish interviews were translated into English by a bilingual research assistant. Data were collected between October 5, 2022, and March 16, 2023. Data were analyzed using a rapid content analysis method. Standards of rigor were implemented. Themes generated from interviews included perceived usefulness and challenges of the patient portal, strategies to improve patient portal use, and challenges in diabetes self-management. Participants were enthusiastic about the potential of the portal to improve access to health information and patient-clinician communication. However, challenges of health and technology literacy, maintaining engagement, and clinician burden were identified. Standardized implementation strategies were recommended to raise awareness of patient portal benefits, provide simplified training and technology support, change clinic workflow to triage messages, customize portal notification messages, minimize clinician burden, and enhance the ease with which blood glucose data can be uploaded into the portal. Adults with T2D and clinicians at CHCs continue to report pervasive challenges to patient portal use in CHCs. Providing training and technical support on patient portal use for patients with low health literacy at CHCs is a critical next step. Implementing standardized patient portal strategies to address the unique needs of patients receiving care at CHCs also has the potential to improve health equity and health outcomes associated with patient portal use.

Organizational resilience and primary care nurses' work conditions and wellbeing: a multilevel empirical study in China.

Resilience is crucial for the health system better preventing and responding to public health threats and providing high-quality services. Despite the growing interest in the concept of resilience in health care, however, there is little empirical evidence of the impact of organizational resilience, especially in primary care settings. As the largest professional group in primary care, primary care nurses are taking more and more responsibilities during their daily practice, which influences both their work conditions and wellbeing. This study aims to examine the association between organizational resilience and primary care nurses' working conditions and wellbeing. Using a convenience sampling approach, we recruited 175 primary care nurses from 38 community health centers (CHCs) in four cities in China. Organizational resilience was operationalized as comprising two domains: adaptive capacity and planning capacity, and measured using a 16-item scale. The primary care nurses' working condition indicators comprised variables of psychological safety, organizational commitment, professional commitment, and self-directed learning; wellbeing indicators included depression and burnout. Hierarchical linear regression models were built for analysis. We found that the sampled CHCs have a relatively high level of organizational resilience. The organizational resilience was positively associated with the four indicators of working conditions: psychological safety (β=0.04, p<0.01), organizational commitment (β=0.38,p<0.01), professional commitment (β=0.39, p<0.01), and self-directed learning (β=0.28, p<0.01). However, organizational resilience was not significantly associated with the two wellbeing indicators. Furthermore, we found the adaptive capacity has stronger association compared with planning capacity. Therefore, primary care manager should build resilient organizations, especially the adaptive capacity, in order to enhance primary care nurses' psychological safety, commitment and learning behaviors. Further studies should also be conducted to understand the link between organizational resilience and primary care nurses' wellbeing.

The effect of an educational intervention on healthy lifestyle knowledge and behaviour among middle-aged women

Objectives: This study aimed to assess the impact of an educational intervention on middle-aged women’s knowledge and behaviour regarding various aspects of a healthy lifestyle. Design: Quasi-experimental study involving 150 middle-aged women (divided into experimental and control groups). Setting: Participants were selected from health centres of Tehran, Iran. Method: Data collection included demographic information, knowledge of a healthy lifestyle and healthy lifestyle behaviour. Participants in both the intervention and control groups completed the questionnaires before and 2 months after the educational intervention. The intervention involved 10 minutes of face-to-face training followed by distribution of training booklets provided by the Ministry of Health in Iran. Statistical analyses were conducted using SPSS. Results: Within the intervention group, significant differences were observed in total healthy lifestyle knowledge and subscales for physical activity knowledge, anthropometry knowledge, healthy diet knowledge, and smoking knowledge, between the pre- and post-intervention periods. Other than for smoking behaviour, there was no significant difference in healthy behaviours pre- and post-intervention for the experimental and also the control group. Conclusion: While there was an increase in knowledge about healthy lifestyles following the intervention, this knowledge increase was not associated with a change in healthy lifestyle behaviours. Attention should therefore be given to other influences including socio-economic factors, mental health status, environmental factors, cultural influences, duration of the intervention and psychological factors if changes in healthy behaviour are to be achieved.

TUBERCULOSIS PREVENTION BEHAVIOR AND RELATED FACTORS (STUDY AT NAIBONAT PRIMARY HEALTH CENTER, KUPANG REGENCY, 2023)

Background: Tuberculosis (TB) Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, which attacks the lungs and other organs. Purpose: To determine the relationship between the level of knowledge, attitudes, and preventive actions of Tuberculosis disease and TB incidence in the Naibonat Health Center working area 2023. Methods: The research design used was case-control by conducting analytical observations. Using a simple random sampling technique, the sample consisted of 41 cases and 41 controls. Data analysis used the chi-square test at a significance level of 95%. (α = 0.05). Results: Based on the research shows that there is a significant relationship between knowledge (p=0.00; OR=5.98), attitude (p=0.00; OR=4.66), TB prevention actions (p=0.01; OR=5.20) on the incidence of TB at the Naibonat Primary Health Center. Conclusion: The knowledge, attitudes, and preventive measures are significantly related to the incidence of pulmonary TB in the Naibonat Health Center working area. The community is expected to be able to pay attention to the environment where they live, have clean living behavior, and be able to participate in educational activities/socialization (counseling) related to Pulmonary TB conducted by health centers, NGOs, or health workers which help increase public knowledge.

Assessment of Helicobacter pylori Infection and Associated Risk Factors in Asymptomatic Patients Attending Muhoza Health Center

Background: H. pylori, is a bacterial pathogen that colonizes the gastric mucous lining and the epithelial tissue of the stomach. Helicobacter pylori strains infections can lead to several diseases such as duodenal ulcers, gastric ulcers, adenocarcinoma of the distal stomach, mucosa-associated lymphoid tissue (MALT) lymphoma, diabetes mellitus, cardiovascular disease and autoimmune diseases. The objectives of this study were to assess the prevalence of H. pylori infection and risk factors associated with H. pylori in asymptomatic participants attending Muhoza health center Methodology: A cross-sectional study was conducted from 13th September to 13th October. Stool samples from 60 eligible participants were collected in sterile containers and they were immunoserologicaly analysed. Rapid tests were used to detect H. pylori antigens. A liquid in the testing kit was mixed with a small portion of the stool. The mixture was poured to the sample hole on the rapid test which displayed results. Data regarding risk factors were collected using questionnaires and were analyzed statistically using SPSS 20. Results: The prevalence of H. pylori infection was 37%. Females were more affected than males, with 25% and 12% respectively. Age, education, source of water and household population were significantly associated with Helicobacter pylori with p-values &lt; 0.05. The study was limited since it was one health center based, hence not having large representative population. Conclusion: Education of the population about prevention of the infection, supply clean, treated water for home usage and drinking, are recommended to the local government authorities in Musanze. Screening for H. pylori infection, good adherence on antibiotics against H. pylori, hand washing, and proper household settings to reduce crowding issue are recommended. Further researches are recommended for more conclusive results. Keywords: H. pylori infection, risk factors, stomach, asymptomatic.

HbA1c Point-of-Care Testing and its Role in the Management of Diabetes

The San Joaquin Central Valley, known for its thriving agricultural industry, faces challenges related to low socioeconomic status, limited access to healthy food, and healthcare disparities. To enhance compliance among patients with diabetes, United Health Centers (UHC) implemented in-clinic HbA1c Point-of-Care Testing (POCT) to provide instant data for managing diabetes. The total number of patients with diabetes screened was 2,020 across three sites, with the total number of those in poor control totaling 825. Despite theorizing that these HbA1c machines would improve patient management, statistical analysis revealed no significant impact on diabetes control within the population. However, a closer examination of percentage data demonstrated clinical relevance across UHC sites. Initially, only one out of three UHC sites met the organization’s goal of keeping uncontrolled diabetic patient populations below 30%. After one year of POCT utilization, two out of three sites nearly achieved this goal, resulting in a 27% reduction in poorly managed diabetic patients. While the study’s duration may have limited statistical significance, further analysis and a longer study period could confirm the positive impact of HbA1c POCT on patient compliance.

RELATIONSHIP BETWEEN FAMILY SUPPORT WITH LOW-SALT COMPLIANCE IN ELDERLY HYPERTENSION AT SEI MENCIRIM HEALTH CENTER

Background: Hypertension is a chronic health condition that cannot be cured. It is caused by high sodium consumption, obesity, stress, smoking, and alcohol consumption. Purpose: Determine the relationship between family support and adherence to a low-salt diet in the working area of ​​the Sei Mencirim Health Center, Deli Serdang District, for the elderly with hypertension. Methods: The population in this study was older adults with hypertension, totaling 110 respondents. The sample in this study was 52 respondents using a purposive sampling technique, using univariate and bivariate data analysis with the chi-square test. Results: The results of the chi-square statistical test obtained a p-value of 0.00 compared to the value of α = 0.05, so the p-value &lt; 0.05 (0.00&lt; 0.05). This means that there is a significant relationship between family support and adherence to a low-salt diet in the elderly with hypertension in the Sei Mencirim Health Center, Deli Serdang District. Conclusion: This study found that there is a significant relationship between family support and adherence to a low-salt diet in the elderly with hypertension. It is hoped that health workers will provide more information about adherence to a low-salt diet in hypertensive patients through health education.

Policy Analysis for Anemia and Pregnant Women Care Eleviation Program Through Prospective Bride’s Preparation

Background: The percentage of pregnant women experiencing anemia in Indonesia has increased 37.1% compared to 2018 Riskesdas. The incidence of stunting is also influenced by the anemia and nutritional status of the mother during pregnancy. The implementation of 1000HPK has been widely implemented in all districts and cities throughout Indonesia but there are still obstacles in policy integration and cross-sector coordination caused by a lack of understanding of the program so that priority placement is not determined. Aim: to obtain policy recommendations for improving programs to prevent and alleviate anemia and Chronic Energy Deficiency (CED) for pregnant women through the process of prospective bride’s preparation. Research method: The method used Action research with 3 stages. The sample are key persons of 1000 HPK program which are Public Health Office, BKKBN, Midwifery and Nursing Health Providers, and Regional Ministry of Religion (Kemenag and KUA). 24 people participate in FGD and 5 people for the In-depth Interview which was carried out at a place agreed upon by the respondents. Results: of the research provide recommendations for the need for collaboration between schools and universities for health education, schools and community health centers in providing blood supplement tablets, the need for an SOP for administration flow and procurement flow for Fe tablets as well as evaluation and monitoring. Modifying Fe tablets to make them popular with teenagers, creating health check formats for use, utilizing research and community service results and utilizing digital-based communications. Conclusion: achieving the goals of the anemia policy program requires cooperation and collaboration between various stakeholders. Keywords: Policy, Anemia, CED, Pregnant Women, Prospective Brides

CARING OF INPATIENT NURSES WITH THE FAMILY'S READINESS TO RECEIVE MEDICAL INFORMATION ABOUT ADVANCED THERAPY

Background. Caring is the basis for nurses to be able to analyze nursing actions carried out well and appropriately for clients which becomes a reference in further care. In other words, caring is the moral ideal of the nursing profession which refers to the willingness to provide sincere care with seriousness in carrying out actions to care for clients' health. Research Method. A literature search in this research was carried out by identifying all types of national and international articles regarding caring for community nurses and the readiness of families to receive further therapy information The electronic databases used were PubMed, Springer, and Google Scholar with 30 articles then filtered into 3 articles with a search strategy using the PICO method (patient, intervention, comparison and outcome). Findings. Participants expressed that caring is an attitude of empathy, caring about patient needs, providing nursing care not only when patients come to the health center but also when nurses provide home care. Participants expressed caring behavior such as empathy, being friendly to patients who came to the treatment center, caring about patient needs, making home visits to patients, paying attention to the patient's health needs. Conclusion. Caring for inpatient nurses is an effort to improve the performance of nurses in providing nursing services to patients so as to create integrated and comprehensive care for patients. By increasing professional patient-nurse relationships, participants said they were helped by getting to know the many patients who came for treatment at the health center.

Dental Anxiety Amongst Pregnant Women: Relationship with Dental Attendance and Sociodemographic Factors

Purpose: The purposes of this study were to investigate the relationship between dental anxiety amongst pregnant women and their dental attendance patterns, considering various sociodemographic factors, at health centers in the Kingdom of Saudi Arabia. Materials and Methods: Participants in this cross-sectional descriptive study were 386 pregnant women seeking care at Saudi Ministry of Health centers. A validated version of the Modified Dental Anxiety Scale (MDAS) was used to measure dental anxiety. Questionnaires including background data and dental anxiety were used and clinical data were collected. The association between oral health literacy and dental anxiety was evaluated with Spearman’s correlation coefficient. A multiple linear regression model with dental anxiety (MDAS score) as the dependent variable was developed to investigate further the relationship dental anxiety amongst pregnant women and their dental attendance patterns. Results: The prevalence of dental anxiety was very anxious (3.595). According to a multiple binary logistic regression model, previous experiences with dentists, household income, educational level, number of times and months of pregnancy, and the perception that oral care should be avoided during pregnancy were independently associated with dental anxiety. Conclusions: Dental anxiety in pregnant women is linked to social and psychological factors, in addition to oral health. Specifically, prior experiences with dentists, attitudes toward dental care, and general fear appear to have the strongest influence on dental anxiety. The prevalence of dental anxiety was high among this sample of pregnant women. The study shows that dental care providers need to pay attention to providing a supportive dental care situation, where patients should not experience pain. There is a need to understand the psychological factors associated with dental care procedures.

Disparity in healthcare seeking behaviors between impoverished and non-impoverished populations with implications for healthcare resource optimization

Globally, poverty and illness are linked, attracting widespread attention. In China, illness contributes to about 40% of rural poverty. This study sought to investigate how healthcare-seeking behavior differs between impoverished and non-impoverished populations within the same Chinese healthcare delivery system. It also sought to understand how differences should be considered when assessing spatial accessibility to provide more accurate recommendations for healthcare resource optimization and promote village revitalization and health equity in China. Methodologically, a survey conducted in May 2019 in Enshi Prefecture (a national impoverished region in Hubei Province, China) collected data on healthcare resource utilization regarding the inpatient and outpatient needs of both impoverished and non-impoverished populations. A Chi-square test compared their respective healthcare-seeking behaviors in three respects (e.g., preference for healthcare institution type, transportation mode, and travel time). Baidu Map data with healthcare institution locations and real-life travel times were then incorporated to assess spatial access to different types of healthcare institutions. Results showed that in Enshi, the most widespread village clinics (low-level) were generally the most utilized healthcare institutions for outpatient visits, with patients usually walking for about 30 min. The middle-level Township Health Centers (THCs) and high-level public hospitals were the most used for inpatient visits, with patients willing to drive up to 30 min to THCs and 60 min to hospitals. Comparatively, the impoverished have more frequent service demands but tend to choose lower-level healthcare institutions, with longer travel times and limited transportation modes. Although 75% of Enshi’s area was covered within 30 min by village clinics and 51% of the villages were within 60 min’ drive to hospitals, considerable areas remain under-served compared with the shortest travel time targets in China. In conclusion, spatial access to healthcare resources in Enshi must be further improved, especially by strengthening the service capacity of primary healthcare institutions to address the healthcare needs of Enshi’s impoverished population. The disparity in healthcare-seeking behavior between different population groups should be fully considered to effectively allocate limited healthcare resources to promote health equity for vulnerable populations as proposed in international and domestic policies.

Clinico-pathological association of BCL2 in invasive breast carcinoma: A study from tertiary care health centre in Northern India.

B-cell lymphoma 2 (Bcl-2) is an antiapoptotic protein and an important clinical breast cancer prognostic marker. The aim of this study was to evaluate the relationship between the BCL2 expression and clinico-pathological parameters in breast cancer. Present study is observational cross-sectional study of 100 biopsy proven cases of breast cancer, and cases with resection specimens were included. IHC analyses for ER, PR, Her2neu, Ki67 and Bcl2 were performed in each case. Bcl2 expression was seen in 52% cases. BCL2-positive expression was associated with lower histological grade (0.026), low Ki-67 level (<14%, P < 0.001), hormone receptor positivity (P < 0.001) and luminal breast cancer (P < 0.001) but no association with tumour size, lymphovascular invasion, perineural invasion and TNM stage. Expression of Bcl-2, an antiapoptotic protein, is associated with low-grade, slowly proliferating, luminal A-type BC. IHC analysis of Bcl-2 is simple, inexpensive, readily available test to stratify early-stage hormone-positive patients who can be included in clinical trials for Bcl-2 inhibitors.

Effectiveness of Acupressure Therapy in Reducing Blood Pressure Hypertension sufferers

Hypertension is a disease that causes complications in sufferers, thereby reducing the sufferer's quality of life. Increased blood pressure in hypertension sufferers can be controlled with pharmacological and non-pharmacological therapy, one of which is using acupressure therapy. This study aims to determine the effectiveness of providing acupressure therapy in reducing blood pressure for hypertension sufferers in the Bukit Raya Village Sub-district Health Center Work Area, East Lampung. This research design is quantitative analytical with a Quasi-Experimental approach using a one group pretest and posttest design. The results of the research conducted showed that the average systolic blood pressure before acupuncture therapy was 168 with a standard deviation of 26.943. After therapy the average blood pressure value decreased to 122 with a standard deviation of 3.535. Meanwhile, the average diastolic blood pressure before acupressure therapy was 103 with a standard deviation of 11.18. After therapy the average blood pressure value decreased to 71 with a standard deviation of 2.204. Seeing the effectiveness of acupressure therapy in lowering blood pressure in hypertensive patients, this therapy can be applied as a non-pharmacological treatment for patients who experience high blood pressure. Keywords: Acupressure, blood pressure, hypertension

PREVALENCE OF PAROTID TUMORS AMONG YEMENI PATIENTS IN SANA'A CITY, YEMEN

Background and aims: Parotid gland tumors (PGT) are a moderately scarce group of tumors with a broad range of histopathological manifestations and clinical characteristics. To date, most epidemiological studies on salivary gland tumors including PGT are limited in Yemen and this is one of the first studies, so the aim of the study was to determine the prevalence of different tumors affecting the parotid glands and the effect of age and sex on their distribution. Methods: Epidemiological information as well as demographic data, anatomical site, and histological analysis of PGT were analyzed. The data analyzed included age, sex, site, and histological diagnosis. Data were collected from all histopathological centers covering the majority of Sana'a city between 2019 and 2023. Results: A total of 284 cases- 69% benign and 31% malignant tumors were examined. Both benign and malignant tumors showed a little male inclination (52.5%) and a peak occurrence between the third and fifth decade. Malignant tumors make up 31% of patients, while benign tumors make up 69%. Mucoepidermoid carcinoma (36.4%) and adenoid cystic carcinoma (11.4%) are two common malignant tumor types. Benign parotid tumors include pleomorphic adenoma (71.4%) and Warthin tumors (11.2%) of benigns. Other malignants and benigns are less frequent. Conclusions: This study presents the first prospective study to date to analyze PGT data from health centers spread across Sana'a city. These results should serve the same as the basis for prospect studies assessing the epidemiological geography of these tumors in Sana'a in particular and Yemen in general. Peer Review History: Received 18 May 2024; Reviewed 12 July 2024; Accepted 23 August; Available online 15 September 2024 Academic Editor: Dr. Nuray Arı, Ankara University, Turkiye, ari@ankara.edu.tr Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Asmaa Ahmed Mohamed Ahmed Khalifa, Pharos University, Alexandria, Egypt, asmaa.khalifa@pua.edu.eg Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

Post-Caesarean Surgical Site Infections at the Reference Health Center of Commune V (Mali)

During this study period, we recorded 10187 deliveries, including 2763 caesarean sections. Surgical site infections were found in 102 caesarean sections, i.e. 3.69%. We found that age over 35 years, history of diabetes, asthma, sickle cell anemia, obesity (BMI &gt; 30 kg/m2) and history of caesarean section were risk factors for the occurrence of an infection at the surgical site. The bacteriological profile was dominated by Staphylococcus Aureus (21%) followed by Klebsiella Pneumoniae (20%) and Escherichia Coli (16%). Superficial infection was the most common at 65%. Most of the germs were sensitive to imipenems; to the ertapenems; amikacin; gentamycin; colistin and ciprofloxacin. Klebsiella was the germ most resistant to common antibiotics.

Centering the role of community health workers in social risk screening, referral, and follow-up within the primary care setting

BackgroundCommunity health workers (CHWs) remain an underutilized resource in social risk diagnostics in the primary care setting. This process evaluation study seeks to assess the role of CHWs in social risk screening, referral, and follow-up through process mapping to identify barriers to the process for future quality improvement efforts.MethodsResearchers at the Arizona Prevention Research Center (AzPRC) engaged with two Federally Qualified Health Centers (FQHCs) in two of Arizona’s major urban areas to evaluate their internal processes for social risk screening and intervention. The Consolidated Framework for Implementation Research (CFIR) was used to direct a process mapping exercise to visually describe the workflow, gaps, and barriers to identifying and addressing social risk.ResultsThe process unveiled key areas for health system improvements in the community setting, the organizational setting, and in the implementation of social risk screening, referral, and follow-up. Further, process maps highlight the potential resources needed for effective CHW integration to address social risk in the primary care setting.ConclusionsOur findings demonstrate the importance of organizational tools, such as process mapping, to assist primary care settings in evaluating internal processes for quality improvement in addressing social risk and in effectively integrating the CHW workforce. Subsequent research will evaluate rates of social risk screening, referral, and follow-up within all of Arizona’s FQHCs and propose models for CHW integration to address social risk in primary care and strengthen social risk screening reach and effectiveness.