Improvements In Health Indicators Research Articles

Exploring the shift in newborn care practices among mothers and grandmothers in rural Odisha, India — a qualitative study

BackgroundThis study delves into newborn care and infant-feeding practices in rural Odisha, specifically focusing on the rural KBK + region of Odisha (Kalahandi-Bolangir-Koraput region), inhabited predominantly by Schedule Tribes and Schedule Castes individuals. There has been an improvement in the health indicators in these areas in recent times. In the background of improved health indicators in these areas, this research explores the current and changing newborn care practices and attempts to gain insight into people’s perceptions of the factors that brought about the changes.MethodsThis qualitative study was conducted between February and July 2023 at Christian Hospital, Bissamcuttack in Odisha. The methodology involved focused group discussions with mothers and grandmothers.ResultsAnalysis revealed healthy practices like exclusive breastfeeding till six months of age, appropriate timing of the first bath, and prompt healthcare-seeking behavior for minor illnesses among the mothers. The use of cow ghee or breast milk in a baby’s eyes, the application of ash on the umbilical cord, and the use of herbal medicines for minor illnesses were practiced more by the grandmothers in the past and were not as popular among the mothers. It is noteworthy that the cultural practices to ward off the ‘evil eye’ were practiced by both mothers and grandmothers alike. Despite the influence of traditional cultural practices on the beliefs and norms of the community, the study identified a shift in health-seeking behavior, with increased reliance on healthcare providers and safe healthcare practices. The study identifies the pivotal role of Accredited Social Health Activists (ASHAs) as a bridge between the rural communities and the healthcare system.ConclusionsThis research provides valuable insights for healthcare providers aiming to enhance community-centric safe newborn care practices in rural settings. The emphasis is on the importance of understanding the current and changing local practices. This would help the healthcare providers to encourage healthy practices while eliminating the harmful practices related to newborn care through community workers like ASHA and Anganwadi workers.

Engaging communities as partners in health crisis response: a realist-informed scoping review for research and policy

BackgroundHealth is increasingly affected by multiple types of crises. Community engagement is recognised as being a critical element in successful crisis response, and a number of conceptual frameworks and global guideline documents have been produced. However, little is known about the usefulness of such documents and whether they contain sufficient information to guide effective community engagement in crisis response. We undertake a scoping review to examine the usefulness of conceptual literature and official guidelines on community engagement in crisis response using a realist-informed analysis [exploring contexts, mechanisms, and outcomes(CMOs)]. Specifically, we assess the extent to which sufficient detail is provided on specific health crisis contexts, the range of mechanisms (actions) that are developed and employed to engage communities in crisis response and the outcomes achieved. We also consider the extent of analysis of interactions between the mechanisms and contexts which can explain whether successful outcomes are achieved or not.Scope and findingsWe retained 30 documents from a total of 10,780 initially identified. Our analysis found that available evidence on context, mechanism and outcomes on community engagement in crisis response, or some of their elements, was promising, but few documents provided details on all three and even fewer were able to show evidence of the interactions between these categories, thus leaving gaps in understanding how to successfully engage communities in crisis response to secure impactful outcomes. There is evidence that involving community members in all the steps of response increases community resilience and helps to build trust. Consistent communication with the communities in time of crisis is the key for effective responses and helps to improve health indicators by avoiding preventable deaths.ConclusionsOur analysis confirms the complexity of successful community engagement and the need for strategies that help to deal with this complexity to achieve good health outcomes. Further primary research is needed to answer questions of how and why specific mechanisms, in particular contexts, can lead to positive outcomes, including what works and what does not work and how to measure these processes.

A Comparative Analysis of Healthcare Facilities: With and Without 24/7 Interventions.

Background: Maternal and neonatal mortality remains disproportionately high in low and middle-income countries, particularly in remote areas with limited healthcare accessibility. The Tharparkar district of Sindh, Pakistan, exemplifies such challenges, with basic utilities and healthcare services notably lacking. Objective: This study aimed to assess the impact of 24/7 availability of Maternal, Newborn, and Child Health (MNCH) services on healthcare delivery and patient outcomes in government healthcare facilities in the Tharparkar district. Methods: This action research followed a cross-sectional study design. Data collection commenced after receiving ethical approval and written consent from the Government District Health Officer of Tharparkar. Longitudinal data were collected using District Health Information tools from six healthcare facilities, three of which operated 24/7 and the remaining three for six hours daily. Data included indicators such as general outpatient department (OPD) visits, non-vaginal deliveries (NVD), antenatal, postnatal care, family planning, immunization, neonatal deaths, stillbirths, and live births. Statistical analysis was conducted using SPSS version 25, and results were visualized using Tableau 2024. Results: Facilities operating 24/7 reported a significant increase in healthcare utilization: general OPD attendance increased by 118.5% at THQ Kheeme Jo Par, 168.2% at GD Jese Jo Par, and 150.5% at GD Mehrna Vero. There were also notable improvements in NVD, antenatal, postnatal care, and family planning services. Immunization rates improved, stillbirths decreased, and there were zero neonatal deaths reported in these facilities following the intervention. Conclusion: The implementation of 24/7 MNCH services in Tharparkar significantly enhanced healthcare service delivery and improved maternal and child health outcomes. Continuous healthcare availability is crucial for improving health indicators and achieving global health targets in underserved populations.

IJCM_249A: Assessment of availability of drugs & logistics on Village Health Sanitation and Nutrition Day (VHSND) sessions of Raipur district, CG- A cross-sectional observational study

Background: Maternal and Child health remains one highly pervasive and damaging condition in low-middle-income countries. To improve the situation Govt. of India in 2007 initiated VHSND, as an effective platform for delivering healthcare services at the doorsteps of the unserved and underserved village population, improving awareness and access of the community for health services thereby leading to improvement in the health indicators.,(VHSND) are community-based health initiatives designed to bring essential healthcare services to the doorsteps of rural populations. These sessions serve as a crucial platform for promoting health, hygiene, and nutrition awareness within villages. Organized regularly, VHSNDs aim to address a spectrum of health issues, ranging from maternal and child health to sanitation and nutrition. The success of VHSNDs relies heavily on community participation. These sessions not only offer immediate health services but also empower communities by fostering a sense of ownership over their well-being. By engaging with local residents, VHSNDs contribute to the overall improvement of health indicators and the quality of life in rural areas. In summary, VHSNDs play a vital role in bridging the healthcare gap in rural communities, emphasizing preventive healthcare, and promoting a holistic approach to well-being. They embody the collaborative efforts of health professionals, community leaders, and residents to create healthier and more resilient villages. Objective: 1. To assess the status of logistic availability on VHSND sessions of Raipur District Methodology: A cross-sectional study was conducted to assess the status of logistic availability on 30 VHSND sessions of Raipur district during March- July 2023 in Chhattisgarh by observation and pre-tested pre-designed semi- structured questionnaires. Results: It was observed that out of 30 VHSND sessions site, 77 % were held as per the micro plan and from those 90% ANM, 97% ASHA, 84% Anganwadi workers, 57% Anganwadi helpers, and only 10% PRI members were present at the site of the session. Only 56% of session sites were supervised by supervisors, 28 (93.33%) session sites had drinking water facilities, 21 (70%) sites had toilet facilities, and only 25(83.33%) sites had electricity connectivity. BP Instrument, Stethoscope, Weighing scale, Hemoglobinometer, Glucometer, Disposable syringe 5ml, Disposable syringe 0.5 ml, Disposable syringe 0.1, MCP card, Examination table, were above (90%) present in most of the VHSND sessions. Out of 30 Sessions Stadiometer (19) Fetal Doppler (15), Curtains (21), Stepping stool for climbing on the examination table (17), and Referral slip (5) are present in the VHSND sessions. Nischaya kit, VDRL, HIV, and RDK for malaria kit were present in 74%,43%,97%, and 93% respectively. Iodized salt testing is not available in any sessions. All vaccines were available 100% except BCG, DPT, and Td, which were present in 87%,93%, and 90% sessions. AEFI Kit was available in 80% of sessions. Condom, OCPs, and Centchroman were present most of the site of the sessions but Inj. MPA, IUCD, and emergency contraceptive pills were available only in 14%,37%, and 14% of sessions respectively, 7.23 (77%) of the session sites have Information displayed about the day, time, and site of the VHSND session, Conclusion: Most of the session sites were held as per the micro plan, there is some lacuna in the availability of logistics although a majority of essential items were found at session sites special focus needs to be given to fetal doppler, HIV kit cold-chain maintenance, Iodized salt kit, Cotrimoxazole, Anti-malaria drugs, Td, and BCG vaccine. Satisfactory maternal and child health services were provided in many sessions.

INFLUENCE OF THE ENVIRONMENT ON HUMAN HEALTH AND QUALITY OF LIFE (ON THE EXAMPLE OF THE GREATER CAUCASUS OF THE REPUBLIC OF AZERBAIJAN)

Health occupies an important place in the system of indicators determining the quality of life. Issues of improving health indicators are especially relevant for the Greater Caucasus province, which plays an important role in the socio-economic development of the Azerbaijan Republic and has a high standard of living, demographic and labor potential. The territorial organization of health care in the Greater Caucasus province, environmental peculiarities and their impact on the quality of life have been studied. On the basis of statistical materials the indicators of disease spread among the population living in the region are studied. Atmospheric air pollution is mainly responsible for the spread of infectious diseases, so the relationship between them has been studied. The relationship between the human development index and the environment and its impact on the quality of life has been studied. It is found that the amount of waste from stationary sources in the region has decreased. Air pollution directly affects the health of the population. Thus, the low amount of waste emitted into the atmosphere corresponds to high values of the Human Development Index. More precisely, the correlation between them is negative, and the coefficient of determination is equal to 0.857, i.e. the dependence is determined at the level of 85%.

Colon and rectal cancer: An emergent public health problem.

Colorectal cancer ranks third globally, with a high mortality rate. In the United States, and different countries in Europe, organized population screenings exist and include people between 50 and 74 years of age. These screenings have allowed an early diagnosis and consequently an improvement in health indicators. Colon and rectal cancer (CRC) is a disease of particular interest due to the high global burden associated with it and the role attributed to prevention and early diagnosis in reducing morbidity and mortality. This study is a review of CRC pathology and includes the most recent scientific evidence regarding this pathology, as well as a diagnosis of the epidemiological situation of CRC. Finally, the recommendation from a public health perspective will be discussed in detail taking into account the context and the most current recommendations.

Nursing in one health, extension and research

Nursing plays a vital role in promoting One Health, integrating care for humans, animals and the environment. Here we focus on nursing's contribution to the One Health approach through outreach and research. Introduction: One Health recognizes the interconnection between human, animal and environmental health. Nursing plays a central role in this approach, as nursing professionals are positioned to understand and promote holistic well-being. Objectives: The objective of single health nursing is to improve overall health through collaborative interventions that address the needs of humans, animals, and the environment. This involves raising awareness about zoonotic diseases, the impact of environmental degradation on health, and promoting healthy practices in all areas. Methodology: Extension activity, through educational programs for communities, highlighting the importance of vaccination for both humans and animals, promoting environmental hygiene and providing information on healthy eating. In addition, blood samples were collected in the communities studied to evaluate zoonoses in order to induce treatment and prevention and for research, investigating the relationships between environmental exposure and human diseases, as well as the transmission of pathogens between humans and animals. Results: The results of the One Health Nursing approach are evident in the decreased spread of zoonotic diseases, improved health indicators in participating communities, and increased awareness of sustainable health practices. Research contributes to the knowledge base, informing public health policy and clinical practice.

Critical Success Factors for Deployment of Primary Health Care Networks and their Impact in Kenya

The Government of Kenya through the Bottom-up Economic Transformational Agenda (BETA) acknowledges Primary Health Care (PHC) as a cost-effective and efficient means to achieve Universal Health Coverage (UHC). The aim is to enhance equitable access to high-quality and affordable healthcare for all Kenyan citizens. Primary Health Care Networks (PCNs) are gaining traction as the main mode of achieving PHC in Low- and Middle-Income Countries, and Kenya is no exception. In Kenya, PCNs approach seeks to empower local communities at subcounty level through mobilizing resources and strengthening their decision-making authority to address context specific healthcare needs. The investment in PCNs is geared towards advancing equitable access to quality healthcare at the community level, mitigating fragmentation of health care services, strengthening preventive and promotive healthcare hence creating a more resilient and efficient healthcare system. The Ministry of Health in Kenya, in collaboration with County Governments and Development partners, initiated a Rapid Results Initiative (RRI) to deploy PCNs across the country in August, 2023. The goal was to establish 315 Primary Health Care Networks (PCN) across the 47 counties in Kenya. This was preceded by a Pilot phase in 3 Counties (Kisumu, Garissa, and Kwale) which was conducted in 2021. The pilot phase informed cost-effective approaches for the deployment and critical success factors for scale-up of PCNs countrywide. The nationwide deployment of PCNs followed a 10-step process of establishing PCNs as stipulated in Kenya PHC Guidelines. Data on experiences, progress in implementation and lessons learnt was abstracted from grey literature including reports from PCN establishment at County level, Stakeholder meetings through Accelerator and Sustainability taskforce and data from PCN observatory. The average time taken to establish a PCN was 3 weeks and costed approximately USD 34,000 for its full establishment. As at 20th December, 2023 (within 4 months of initiating the RRI), of the target of 315 PCNs, 93(30%) PCNs were fully established, 27(9%) PCNs were in progress and 195(62%) yet to start. Out of the 47 counties, 37(79%) counties have at least a fully established PCN, 4 Counties are in the process of establishing the first PCN and 6 are awaiting partner readiness. The eight main critical success factors for successful establishment included: County ownership and commitment, availability of Key Policy guidelines and strategies for reference, funding from development partners and donors, leveraging on existing National and County governance structures, multisectoral collaborations and partnerships, tracking of PCN establishment through National PCN observatory and Community engagement. Key process enablers to successful role out included: Meaningful engagement of development and implementing partners, Execution through County trained TOTs, Community engagement through Community Health Workforce and support from National Government. Over time, the Established PCNs in 3 pilot counties have demonstrated significant reduction in facility based maternal mortality, increased access to NCD screening services, coordinated health care workers through MDTs and improved forward and backward referrals. Additionally, incorporated innovation models within PCNs have improved access to medical supplies and specialized healthcare services at level 2 and 3 facilities. To achieve successful scale up of PCNs and sustainability for impact it is critical to contextualize PCNs to the County needs, establish sustainable primary health care financing mechanism for PCN activities, Strengthen PCN governance structures and utilise PCN observatory to continuously track PCN performance measurements and decision making. Adoption of a unified focus on PCN performance improvement including one PCN strategy, one action plan on how to optimally implement PCNs and one monitoring framework is critical. If implemented successfully, PCNs will contribute to long term social return on investments and improved health indicators for the Country

Improvement trend for individual health guidance intervention according to Japan clinical guidelines by public health nurses for type 2 diabetes mellitus who visited for medical checkups regularly: a case-control preliminary report.

We conducted a retrospective case-control study to assess the efficacy of personalized health guidance interventions on individuals with type 2 diabetes mellitus and obesity. A selection was made of individuals in regular visits to the Takagi Hospital for medical checkups between January 2017, and October 2021. Totally, 108 subjects (cases) with health guidance were divided into 2 groups: one group without pharmacotherapy for diabetes mellitus in medical institutions (n = 92) and another group with pharmacotherapy (n = 116). Cases were provided with personalized health guidance interventions by public health nurses for 30 min, in accordance with the Japanese clinical guidelines for the prevention of lifestyle-related diseases. Sex- and age-matched controls were chosen from individuals with diabetes mellitus without health guidance. The intervention without pharmacotherapy resulted in improvements in health indicators, including body weight, waist circumference, diastolic blood pressure, triglyceride levels, and γ-glutamyl trans-peptidase. These positive effects were not observed in the control group without health guidance. The therapeutic effects of health guidance were observed in cases where pharmacotherapy was administered. In conclusion, the implementation of individual health guidance interventions may prove to be effective for individuals with type 2 diabetes mellitus and obesity who regularly attend medical checkups.

Improving health indicators of mothers and newborns by empowering communities in urban slums of Mumbai, Maharashtra, India

Abstract Background: Newborns represent the most vulnerable segment of our society, constituting nearly 30% of all under-5 mortality cases. Despite well-established healthcare systems in metropolitan areas, urban slum dwellers, comprising approximately 50%–60% of the population, often lack access to these services. The Society for Nutrition, Education, and Health Action (SNEHA) operates within urban slums, aiming to enhance health outcomes for mothers and children. At SNEHA, we firmly believe that a healthy society starts with the well-being of mothers and infants. Our organization is dedicated to empowering communities to improve the health status of newborns in urban slums. Material and Methods: As part of the intervention, 7819 households with a population of 35,000 were targeted. SNEHA’s field workers conducted regular visits to these households, providing counseling on breastfeeding immunization and identifying potential health risks. Married women of reproductive age were specifically identified and consistently educated about the significance of early pregnancy registration. Pregnant women received support for registering their pregnancies, attending regular antenatal care (ANC) check-ups, adhering to ANC visit schedules, and maintaining adequate iron, calcium, and nutrition intake. Additionally, they were informed about the advantages of institutional delivery and encouraged to prepare for childbirth. Mothers of children under 2 years were urged to bring them to primary health centers for routine immunizations. Furthermore, they were advised on contraception methods to ensure proper spacing between children. Results: Our endeavors have resulted in a 34% rise in early pregnancy registration, a 22% increase in the number of women attending four antenatal check-ups, an 11% uptick in institutional deliveries, a 24% improvement in exclusive breastfeeding rates, and a notable 67% surge in the prevalence of contraception. Conclusion: Our intervention has proven that it is possible to improve the health indicators of women and children through behavior change communication, regular home visits, and community awareness.

Synergistic effects of Sargassum vulgare extract and lipid levels on growth performance, blood biochemical indices, immunological competence, and antioxidant capacity in juvenile common carp (Cyprinus carpio)

The aim of this study was to investigate the potential synergistic effects of Sargassum vulgare extract (SVe) and lipid (L) on growth, feed conversion, blood biochemistry, antioxidant protection, and immunity of juvenile carp (Cyprinus carp). Test diets were formulated with three levels of SVe (0, 7.5, and 15 g/kg) and two levels of lipids (50 and 100 g/kg): the control diets without additional SVe (SVe0L50; SVe0L100), 7.5 g SVe/kg (SVe7.5L50; SVe7.5L100), and 15 g SVe/kg (SVe15L50; SVe15L100). Three replicate fish tanks were randomly assigned to six experimental groups, each receiving one of the diets for a duration of eight weeks. The results showed that 7.5–15 g SVe/kg significantly improved growth performance and feed utilization. The SVe15L100 group showed improved health indicators, including higher concentrations of hematocrit, hemoglobin, high-density lipoprotein, total protein, globulin, lysozyme, and complement. Additionally, the SVe15L100 group displayed the most robust antioxidant capacity, as evidenced by higher serum levels of superoxide dismutase, glutathione peroxidase, catalase, and lower levels of malondialdehyde. Based on results, it is recommended to enrich the diet with 15 g SVe and 100 g lipid/kg for simultaneous enhancement of antioxidant capacity and immune of juvenile common carp.

Association between greenery and health indicators in urban patients with symptomatic heart failure: a retrospective cohort study in Lithuania

ABSTRACT Urban green spaces benefit physical, mental health, and reduses the risk of cardiovascular disease. A study in Kaunas, Lithuania collected health data from 100 patients with symptomatic heart failure (HF) during 2006–2009. Residential greenness was measured by the normalized difference vegetation index (NDVI). We assessed the impact of greenness on health indicators and on changes in health markers after 6 months. Higher greenness levels based on the NDVI 1-km radius were related to higher mean values of heart rate (HR) and ejection fraction and lower left ventricular (LV) end-diastolic diameter index (LV EDDI), LV end-systolic volume (ESV), left atrium size (LAS), and right atrium size (RAS) at baseline. After 6 months, a decrease in DBP and HR and an improvement in spiroergometric parameters were associated with exposure to high levels of greenness. The long-term rehabilitation group experienced significant changes in spiroergometric indicators. The results confirm that the greenness of the residential environment can improve health indicators in patients with HF.

Assessing Causality Between Second-Hand Smoking and Potentially Associated Diseases in Multiple Systems: A Two-Sample Mendelian Randomization Study.

The global disease burden may be exacerbated by exposure to passive smoking (SHS), with the workplace being a primary location for such exposure. Numerous epidemiological studies have identified SHS as a risk factor for diseases affecting various systems, including cardiovascular, respiratory, immune, endocrine, and nervous systems. The conventional observational study has certain methodological constraints that can be circumvented through a Mendelian randomization (MR) study. Our MR study intends to investigate the causal link between workplace exposure to SHS and the potential associated diseases. Summary statistics data involving European participants were sourced from three databases: the UK Biobank, the FinnGen study, and the European Bioinformatics Institute. Genetic variants linked with exposure to SHS in the workplace were identified as instrumental variables. The MR was carried out using inverse variance weighted (IVW), MR-Egger, and weighted median methods. Sensitivity tests were also undertaken within the MR to evaluate the validity of the causality. According to the IVW model, genetically determined atrial fibrillation (AF) and stroke (p = 6.64E-04 and 5.68E-07, odds ratio = 2.030 and 2.494, 95% confidence interval = 1.350 to 3.051 and 1.743 to 3.569) were robustly associated with exposure to SHS in the workplace. Suggestive associations were found between workplace SHS and myocardial infarction (MI), asthma, and depression. The MR study demonstrates that exposure to SHS in the workplace is a significant risk factor for AF and stroke in European individuals. Whether workplace exposure to SHS influences other diseases and the causality between them requires further exploration. This study explored the causality between exposure to SHS in the workplace and potential associated diseases in multiple systems, including MI, AF, stroke, lung cancer, asthma, allergic disease, type 2 diabetes, and depression, using an MR study. The MR study can circumvent the methodological constraints of observational studies and establish a causal relationship. The two-sample MR analysis provides evidence supporting the causal association of frequent workplace SHS with AF and stroke. Individuals exposed to SHS in the workplace may also have a heightened risk of MI, asthma, and depression. However, whether SHS affects other diseases and the causality between them requires further investigation. To our knowledge, this is the first two-sample MR study to determine the causal relationship between SHS and potential diseases. Exposure to SHS in the workplace is a prevalent issue and may contribute to a global disease burden. The reduction of exposure following the introduction of smoke-free laws has led to a decrease in the admission rate for cardiac events and an improvement in health indicators. It is crucial to further advance smoke-free policies and their implementation.

Результаты медицинского обеспечения подготовки граждан к военной службе в субъекте Российской Федерации.

The armed forces of the Russian Federation are the guarantor of ensuring the national security of our state. The importance of strengthening the health of citizens of military age is increasing, which are viewed from the perspective of a human resource responsible for the country’s defense capability. Purpose of the study is to analyze the results of medical support for the preparation of citizens for military service in the Orenburg region for the period from 2000 to 2022. M a t e r i a l s a n d m e t h o d s . Statistical and analytical methods were used in the study. The data of statistical collections of the Territorial Body of the Federal State Statistics Service for the Orenburg region, accounting and reporting documents of the Center for military medical expertise of the Federal State Institution «Military Commissariat of the Orenburg Region» were used. R e s u l t s . Over the years of the study, there has been a gradual decrease in the conscription resource (the number of young men put on military registration) by 49,2% – from 19,504 in 2000 to 9598 young men in 2022. In 2000, the fitness for military service for health reasons was 60,2%. The current situation required the adoption of managerial decisions aimed at compensating the conscription resource needed to recruit the Armed Forces of the Russian Federation in sufficient quantity by increasing the fitness of conscripts for military service. The promotion of a healthy lifestyle by young people, regular physical education and sports has become widespread. The result of the work done is a gradual increase in the fitness for military service, which in 2022 amounted to 76,3%. F i n d i n g s . The organization of medical support required interdepartmental interaction in the work of state and public organizations for timely management decisions on problematic issues. The improvement of health indicators and, as a result, an increase in the number of citizens fit for military service, contributed to the stable fulfillment of the state task of conscription of citizens for military service.

The Impact of Continuity of Care on Health Indicators in Patients With Type 2 Diabetes Mellitus in Family Medicine Clinics in Riyadh.

Diabetes Mellitus Type 2 (DM2) is highly prevalent in Saudi Arabia, with many experiencing complications due to the disease.Family medicine physicians are usually the primary care providers responsible for the medical management of type 2 diabetes mellitus patients.Microvascular and macrovascular complications can occur if type 2 diabetes mellitusis poorly managed.Effective management of health indicators in patients with DM2 relating to glycated hemoglobin (HbA1c), low density lipoprotein cholesterol, blood pressure, and tobacco use is an essential part ofmedical care to prevent complications. Due to the projected increase in the number of patients with DM2, there is huge concern surrounding the management of this chronic illness that requires review.This study aims to evaluate the impact of continuity of care on health indicators among family medicine patients diagnosed with diabetes mellitus type 2 and to analyze the effect of continuity of care regarding the completion of age-appropriate preventive health screenings. This is a retrospective cohort study. Data collected from electronic medical records ofpatients 40-75 years of age that received care at the Family Medicine clinics that werediagnosed with type 2 diabetes mellitus with ≥4 clinic visits from January 1, 2017, to June 30, 2020, at King Faisal Specialist Hospital & Research Centre in Riyadh, Saudi Arabia. Datacollected included demographic data, body mass index, smoking status, blood pressure, past medical history, preventive health screening completed, and laboratory results, including HbA1c and lipid profile.The continuity of care index and usual provider continuity score indices were calculated for the analysis to measure continuity of care. Three hundred and fifty-two patients were included in thestudy.Most of the patients were Saudi (74.15%), female (51.99%), and married (82.67%).In addition, 90.34% accounted for a high usual provider continuity of care score (UPCS), and 64.20% of the patients had a high continuity of care index (COCi). Younger age groups were significantly more prevalent in the high UPCS group (p=0.037). Additionally, patients of non-Saudi nationalities constituted a significantly larger proportion of the high UPCS group. Single patients showed high UPCS.Comorbidities were not different between the groups, except inflammatory joint disease, which was more common in the low COCi group.Preventative screening measures were also not different between the groups; however, the type of colon cancer screening differed, where patients with high COCi more frequently underwent colonoscopies (13.3% vs. 4.4%, p=0.015) instead of fecal occult blood tests. For the first time, we report the implications of the continuity of care for DM2 patients in Saudi Arabia and the Middle East. Continuity of care did not result in the improvement of health indicators or in the completion of preventive health screenings in diabetic patients. Further studies are needed in the region to confirm our findings and assess the association between continuity of care and patient health indicators impact.

The Effectiveness of a Physical Literacy-Based Intervention for Increasing Physical Activity Levels and Improving Health Indicators in Overweight and Obese Adolescents (CAPACITES 64).

Recently, the concept of Physical Literacy (PL) has emerged as a key concept for promoting active behavior and improving health indicators in adolescents. Overweight and obese adolescents have a low level of Physical Activity (PA), low cardiorespiratory capacity, and high Body Fat percentage (%BF). However, the development of PL in the interest of health improvement has never been studied in overweight and obese adolescents. The objective of this study was to evaluate the impact of an intervention developing PL in overweight and obese adolescents in order to increase their (PA) and improve their health. The study was a prospective, single-arm, non-randomized interventional study. The intervention brings together different actions in PA and dietary education in different adolescent living environments. The study took place over a 9-month period with two data collection times (0; +9 months) and measured Body Mass Index (BMI) and BMI z score, %BF and Skeletal Muscle Mass (%SMM), Moderate-to-Vigorous intensity Physical Activity (MVPA) by accelerometry, CRF, as well as PL by the CAPL-2 tool. Thirteen adolescents (age 11.7 (±1.09) years old) improved their PL scores (+8.3 (±9.3) pts; p ≤ 0.01). BMI z score (-0.3 (±0.3), p ≤ 0.01), their %BF (-3.8 (±4.9); p ≤ 0.01), their CRF (+1.5 (±1.7) mL·min·kg-1; p ≤ 0.01), and their MVPA (+4.6 (±13.7) min/day; p = 0.36). Initiating multidimensional interventions to develop PL in overweight and obese adolescents may be a promising prospect to enable an increase in their MVPA and improve their long-term health. Longer-term randomized controlled interventional studies are needed to confirm these findings.

Enhancing family medicine training to build capacity in Pakistan: a call for action

ABSTRACT A high-performing, integrated, primary healthcare system is essential to achieve universal health coverage (UHC) goals and improve health indicators. There is enough evidence that healthcare is cost-effective with significantly better outcomes in countries where primary care is delivered through trained family physicians. The concept of “Family Practice approach” is relatively new in developing countries like Pakistan, where majority of basic healthcare is provided by doctors without a formal postgraduate training. The intention to adopt this approach in primary care has increased in recent years in an effort to attain UHC, yet implementation requires a paradigm shift with intervention at multiple levels. There is an opportunity to learn from better developed primary care models for example in UK and Australia to develop a pragmatic and collaborative approach to develop the specialty of family medicine in primary care. This calls for academic interventions at multiple levels, such as mandating family medicine inclusion in undergraduate medical curricula, and ensuring quality of postgraduate training by investment in developing primary care sites for training, curricula, assessment, and quality assurance structures. Encouraging medical students and general practitioners to pursue a post graduate qualification in family medicine would also require promoting family medicine as a worthwhile career and developing a higher esteem for qualified family physicians than the conventional GPs in public and private sector healthcare institutions. These interventions would help evolution of locally grounded solutions to improve the quality of primary care, hence the health outcomes of the larger population of Pakistan.

Adherence to 24-h movement guidelines among Chinese children and adolescents with intellectual disabilities.

Meeting 24-h movement guidelines for children and adolescents has been associated with improved health indicators. However, the literature examining adherence to 24-h movement guidelines among Chinese children and adolescents with intellectual disability (ID) remains lacking. This study aims to investigate the prevalence of meeting the 24-h movement guidelines and its socio-demographic correlates for this population. The sample includes 319 Chinese students with ID. Accelerometers are used to measure moderate-to-vigorous physical activity time and sleep duration. Questionnaires are adopted to measure screen time (ST) and demographic factors. Associations among socio-demographic factors, body mass index and 24-h movement are analysed by using multivariable logistic regressions. The proportions of participants who meet none, moderate-to-vigorous physical activity, ST, sleep duration and all three recommendations are 8.15%, 33.54%, 54.23%, 75.55% and 17.55%, respectively. In general, multivariable logistic regression analysis indicates that older participants are less likely to meet the ST guidelines [odds ratio (OR): 0.931; 95% confidence interval (CI): 0.869-0.998] and more likely to meet the sleep guidelines (OR: 1.106; 95% CI: 1.016-1.204) than younger individuals. Participants with moderate ID are less likely to meet the sleep guidelines (OR: 0.345; 95% CI: 0.140-0.850) than those with profound ID. Individuals from families with middle-income (OR: 0.434; 95% CI: 0.226-0.836) and high-income (OR: 0.219; 95% CI: 0.080-0.605) levels were less likely to meet the physical activity guidelines than those from low-income families. Furthermore, participants from high-income families were less likely to meet ST (OR: 0.426; 95% CI: 0.187-0.969) and all three movement guidelines (OR: 0.083; 95% CI: 0.010-0.659) than those in the low household income groups. Interventions that improve the health-related behaviours of children and adolescents with ID are needed, particularly those that target their increased engagement in physical activity.

Nursing leadership and influence in practice domains at a Veterans Affairs Health Care System

BackgroundStudies in Veteran populations have examined disparities in health service use, care quality, outcomes and increased demands for behavioral health. PurposeThe purpose is to describe the development of nursing leadership roles that influenced practice improvements and demonstrated outcomes related to health disparities in a Veterans Affairs (VA) population over a 12-year period. MethodsThe Sundean and colleagues' concept analysis of nurse leadership influence was applied to frame the initiative process and impacts. DiscussionAntecedents and processes that facilitated leadership development included mentorship, disparities expertise, partnerships, consultation, scholarship, dissemination, advocacy, education, and strong coauthor collaboration. Improvements and outcomes included access to services, improved health indicators, tools, workforce, funding, innovations, and nurse investigator studies, consistent with VA priorities and policy related to disparities and equity. Limitations and barriers were addressed. ConclusionThis initiative models’ strategies to increase nurse leadership in health equity and care transformation in health systems and community practices.

Problem-oriented coping and resilience among Fibromyalgia patients who live under security threats and have undergone a Fibrotherapy intervention program

ABSTRACT Our study examined the association between problem-focused coping and resilience among fibromyalgia (FM) patients who live under constant security threats. Resilience is a coping resource and detrimentally affects FM female patients (FMPs) to get up and cope with life. A cohort of 96 FMPs ages 19–75 was subjected to a Fibrotherapy intervention program in the Rehabilitation Help Center in Sderot (Ezra Le’Marpeh), Israel. We examined levels of problem-oriented coping and levels of resilience among the sample. In addition, we assessed whether there is a correlation between their resilience level and their medical metrics. The research included medical metrics and physical metrics. A cohort of 16 FMPs who participated in the quantitative phase composed the qualitative sample. Data from the t-test showed improved mental resilience among all the sample, with a significantly higher level among problem-oriented FMPs. We conclude that resilience is acquired through problem-oriented coping strategies. Furthermore, the association between resilience and problem-oriented coping helped to improve health indicators since coping with the disease included entering a regime of physicals activity and maintaining a healthy lifestyle.