Levels Of Health Care Institutions Research Articles

Neuroimaging of intracranial neoplasms: volume segmentation of 3D images

The progressive development of medical bioinformatics, namely computer vision and deep learning technologies, will allow accurate screening of neurooncological diseases and evaluate the effectiveness of the treatment methods performed in dynamics at all levels of healthcare institutions. At present, the Matlab platform is the most functional environment for image processing with the implemented possibility of using semantic segmentation. An algorithm for creating masks of the area of interest of specialists and a listing for training a neural network in the diagnostic screening of neurooncological patients are presented.

DEVELOPING STEPS TO IMPROVE ADHERENCE IN HEALTHCARE PROFESSIONALS DAILY PRACTICE

Adherence is a a term that has been prominently used and emphasized recently, representing the connection between a patient and their treatment. Medical adherence has its hierarchical structure, with roots primarily stemming from legislative bodies to the healthcare system, institutions and ultimately healthcare professionals (doctors, nurses, technicians). However, medical adherence faces a significant obstacle in achieving therapy goals and improving treatment outcomes among many patients, especially those with chronic conditions. Social and sociental conditions, as well as the state organization in Bosnia and Herzegovina (BiH), greatly influence the healthcare system and the purchasing power of healthcare service users. Due to significant barriers and challenges regarding adherence, efforts are being made to maintain a system that supports increasing patient adherence levels. Within this research paper, three questionable theses are presented: internal and external education, improvement of the healthcare system and the implementation of systematic data collection on patient adherence. All three questionable thesis recived positive feedback from respondents (200 participants). From the first thesis, 154 respondents voted in favor, for the second thesis, 142 respondents and for the third thesis, 134 respondents agreed with the proposed suggestions. Unfortunately, in BiH insufficinet attention is given to patient adherence and there is no unified strategy to increase adherence levels. Internal and external education would be essential as healthcare workers are not adequately trained, nor are conditions created for its implementation. Increasing the level of adherence can greatly benefit healthcare workers in their daily practice if they have adequate conditions in place. Unfortunately, a significant number of healthcare employees lack the knowledge, experience and a clearly defined strategy on how to increase patient adherence. The complexity of measuring adherence only adds to the intricacy of an already complex problem and the inefficiency and sluggishness of the healthcare system hinder the creation of appropriate activities that should result in increased patient adherence. The patient’s adhrence is influenced by numerous factors for which there is no unique solution or overcoming suggestions. Also, problems in the process of identifying and measuring adherence further complicate the already complex matter and the process of increasing user adherence. Creating a strategy to improve adhrence at the state level in Bosnia and Herzegovina is almost impossible; therefore, the increase in adhrence can only be achived at the level of the patient, healthcare personnel and ideally, at the level of healthcare institutions. Unfortunately, in most cases, conditions and workload do not allow healthcare workers to spend enough time with patients, establish adequate communication and demonstrate that the patient is genuinely important to them. Providing not only the necessary care but also essential information about the illness and treatment can directly impact the level of patient adhrence. The healthcare system in developed countries, although technologically possible, lacks and adequate mechanism for collecting, processing and analyzing data related to the adherence level of patients with a specific condition or in a particular geographic region. Data is often collected based on indirect methods that do not provide accurate and precise information, posing a significant challenge in proving the role and importance of medical adhrence in the healthcare system and treatment outcomes. Considering that the adhrence level ranges from 43% to 78%, which is too high for certain treatment regimens, legislative reforms are needed. In addition to the law and its govering body, it is necssary to ensure all essential materials, from medications to specific medical supplies are provided to all healthcare institutions, hospitals and healthcare centres. Both internal and external education are crucial for patient treatment and therefore it sholud be implemented and carried out on a monthly basis. In addition to healthcare professionals, the education of patients with medical conditions is essential, considering they can be divided into those who are not familiar with using modern technologies to educate themselves and understand the role and significance of medical adherence. Moreover, there are patients who are adept at using modern tchnology to research their condition and treatment options, but they lack sufficinet knowledge and information to assess the accuracy of the available data.

SVEIKATOS PRIEŽIŪROS SPECIALISTŲ KVALIFIKACIJOS TOBULINIMO POREIKIAI IR YPATUMAI

The professional development of health-care workers is a key prerequisite for professional success, and its effectiveness contributes to the quality of health-care services at any level of health-care institution. Health-care professionals face constant changes, as a challenge to adapt to the competitive environment around them. This makes it important to ensure that health-care workers have effective training to meet their professional development needs. Thus, the aim of this study is to analyse the theoretical assumptions of professional development, and to reveal the attitudes of health-care professionals towards the needs and specifics of professional development. The study has indicated that the professional development for health-care workers is result-oriented, yet of insufficient quality, with organisational, financial and other problems. It has been found that the planning and implementation of professional development for health-care professionals is subject to specific requirements. The combination of these requirements and the way they are evolving imply that the needs and specifics of health-care professionals in the field of professional development need to be addressed beyond doubt.

Birth Preparedness Plans and Status Disclosure Among Pregnant Women Living with HIV Who are Receiving Antiretroviral Therapy in Ibadan, Southwest, Nigeria.

Promoting the maternal health of pregnant women who are living with human immunodeficiency virus (HIV; [PWLH]) is key to reducing maternal mortality and morbidity. Thus, inadequate birth preparedness plans, non-institutional delivery, and status concealment among PWLH contribute to the spread of HIV infection and threaten the prevention of mother-to-child transmission (PMTCT). Therefore, this study aimed to assess the birth preparedness plan and status disclosure among PWLH, as well as the prevalence of HIV infection among pregnant women. The study adopted a descriptive cross-sectional research design; a quantitative approach was used for data collection. Three healthcare facilities that represented the three levels of healthcare institutions and referral centers for the care of PWLH in the Ibadan metropolis were selected for the recruitment process. A validated questionnaire was used to collect data from 77 participants within the targeted population. Ethical approval was obtained prior to the commencement of data collection. The prevalence rate of HIV infection among the participants was 3.7%. Only 37.1% of the participants had a birth preparedness plan. A total of 40% of the participants tested for HIV, because testing was compulsory for antenatal registration. Only 7.1% of the participants had their status disclosed to their partners. Although 90% of the participants proposed delivering their babies in a hospital, only 80% of these participants had their status known in their proposed place of birth. The prevalence of HIV infection among pregnant women is very low, which is an indication of improved maternal health. However, the level of birth preparedness plan and status disclosure to partners are equally low, and these factors can hinder PMTCT. Institutional delivery should be encouraged among all PWLH, and their HIV status must be disclosed at their place of birth.

Epidemiology, Evaluation and Surgical Treatment of undescended Testis in North Macedonia in the Period from 2011 to 2020.

Background; Cryptorchidism or undescended testis (UDT) is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. The main reasons for treatment of cryptorchidism include increased risks of impairment of fertility potential, testicular malignancy, testis torsion, and/or associated inguinal hernia
 Material and Methods; The aim of this study is to show the epidemical distribution of this pathology in the republic of North Macedonia from 2011-2020 and simultaneously show the number of cases in every city of Macedonia. The number of cases (by city) is shown in Table 1.
 All data is provided by the archives of The Institute of Public Health, North Macedonia.
 Discussion: It is very important to find if there is a correlation between the number of undescended testis cases in North Macedonia to the environment, genetics, level of education, level of health care institutions, etc.
 Reduced hormonal levels, reduced fertility and increased risk of testicular cancer are the most common side effects of no treatment or late treatment.
 Conclusion; This condition of the undescended testis is very common, and the possible effects of late treatment or no treatment at all are very risky. So, we have to pay attention to the risks in order to try to provide better treatment at the right point of age.

Perceived policy-related barriers to palliative care implementation: a qualitative descriptive study.

Ethiopia has a national palliative care guideline, and palliative care is explicitly recognised in the country's healthcare policy and health sector transformation plans. However, palliative care is not fully delivered in the regional public hospitals and primary health care units. This study explores perceived policy barriers to deliver palliative care services in rural and regional healthcare settings, which primary healthcare units largely serve. Face-to-face interviews were conducted in a rural region of Ethiopia. Forty-two participants were recruited from a variety of health settings including primary, secondary and tertiary levels across the region. Interviews were conducted with policymakers from the regional health bureau, pharmacists, medical doctors, health officers (clinical officers) and nurses, including chief nursing officers in leadership roles at all levels of healthcare institutions. Data analysed using thematic analysis. Participants described several barriers related to healthcare policy, including lack of government priority and focus on palliative care; lack of health professionals' awareness of the national palliative care plans and guidelines; and lack of palliative care integration into the existing healthcare system and the national budget. Participants remarked that palliative care services in the region were mainly limited to HIV patients, often managed with external support and, hence unsustainable. Policy priority and focus is a fundamental component for the provision of palliative care because lack of focus and support from the government have led to inadequate access to palliative care for all in need. Hence, as participants suggested, palliative care should be integrated into all healthcare levels, particularly into the primary health care units and the health extension programme, to facilitate health extension workers to support millions living in rural areas.

Cost study of three selected laboratory investigations at different levels of healthcare institutions in Western Province, Sri Lanka

<strong>Introduction:</strong> The cost of laboratory services has become a challenge for continuing free healthcare in developing countries like Sri Lanka. <strong> </strong> <strong>Objectives:</strong> To undertake cost estimation and cost comparison of three selected laboratory investigations at different levels of healthcare institutions in the Western Province. <strong> </strong> <strong>Methodology:</strong> A descriptive cross-sectional study was carried out from May 2019 to July 2019. The analysis was based on secondary data collected from Lady Ridgeway Children's Hospital Colombo (LRH), Base Hospital Horana (BHH), and Divisional Hospital Bandaragama (DHB), during the study period. The cost analysis was performed using the step-down method. <strong> </strong> <strong>Results:</strong> Total cost of FBC, CRP, and UFR tests were calculated, and compared among three hospitals. The total cost of FBC in the LRH, BHH, and DHB was Rs.301.16, Rs.255.19, and Rs.380.83 respectively. The total cost of CRP in those hospitals was Rs.264.46, Rs.237.70, and Rs.85.63 while the total cost of UFR was Rs.130.21, Rs.126.42, and Rs.81.83 respectively. <strong> </strong> <strong>Discussion:</strong> The highest cost of FBC as revealed by this study was in DHB. It comprised of a high equipment cost per test. Though the LRH possesses a high-tech hematology analyzer, the higher volume of investigations done makes the equipment cost less per test in the LRH. The cost of testing CRP, in the order of highest to lowest, was in the LRH, BHH, and DHB. The reason for the lowest cost of CRP in DHB can be attributable to the non-usage of reagents and less equipment cost due to manual handling. The cost of UFR was comparatively low in DHB. It can be due to the contribution of low salary cost and low cleaning service cost because of less human resource usage. Conclusion This study reveals that the lower a hospital in the hospital hierarchy the cost of investigations tends to increase. This can be attributable to the fact that the number of investigations done is relatively less in smaller hospitals. At macro economical level, this is a challenge to the efficient utilization of scarce resources. <strong> </strong> <strong>Recommendation:</strong> In keeping with the primary health care reforms, it is proposed to channel investigations from primary medical care units to divisional hospitals. Thereby utilization of investigative equipment could be optimized.

Why Othering should be considered in research on health inequalities: Theoretical perspectives and research needs

Othering broadly refers to various constructed notions of (non-)belonging and difference that engender marginality and structural inequality. Social-psychological approaches that conceive ingroup and outgroup formations as an interaction between cognitive, emotional, and conative processes are not sufficient to conceptualize Othering. It is important to include the social and historical imprint of Othering and the resulting power relations between ingroups and outgroups. In this paper we demonstrate that a postcolonial-intersectional perspective is needed to understand the social and discursive character of Othering and the historically grown formation of Self-Other power relations. Othering can be understood as a (multidimensional) social phenomenon that requires a critical perspective on difference to analyze the processes of making Others through difference construction.Othering is relevant to public health as an analytical lens that helps to understand the link between minority status and health inequalities. Othering can affect health in different ways as it occurs in multiple dimensions and forms that vary according to marginalized groups and institutional as well as social contexts. First, Othering can affect othered persons on an individual level. Second, Othering can manifest itself at the institutional level of health care institutions; and third, it can have far-reaching effects on a contextual level. To benefit from the analytical capacity of this concept, and to understand the complex relationship between Othering and health, a theoretical understanding of Othering is needed.

Aspects of quality control over the organization and examination of temporary disability at the current stage

Purpose of the study. Coverage of the problem and formation of recommendations for quality control over the organization and conduct of examination of temporary disability at the present stage.&#x0D; Materials and methods of research. In order to highlight the problems of legal assessment of the quality of the organization and conduct an interim examination at the current level, we analyzed the regulations adopted at the level of the Cabinet of Ministers, the Ministry of Health of Ukraine, identified gaps and recommendations for adopting orders of the Ministry of Health of Ukraine. quality at the level of health care institutions&#x0D; Conclusions. When implementing quality control measures for the organization and examination of temporary disability at the present stage, special attention should be paid to the development of more detailed and specific legislative documents highlighting the functional responsibilities, rights and responsibilities of health care workers, as well as internal orders governing the examination of temporary disability. disability (ETN) and all components of its activities, including the availability of quarterly and annual reports, analysis of morbidity with temporary disability, indicating specific measures to reduce it, etc. Changes in the regulatory framework of external departmental and interagency control over the implementation of ETN dictate the need to adjust already established organizational forms of control at the level of relevant control structures, as well as strengthening internal departmental control over the organization of ETN in health care facilities. requirements at the present stage.

Practice, Perceptions, and Prospects of Mammography Screening in Nigeria: Insights From a National Survey of Female Health Workers

BackgroundMammography, the most preferred tool for breast cancer screening, has very poor uptake in Nigeria, even among health workers. No nationwide study has been done to ascertain this. This study sought to determine the current perceptions and practices of Nigerian female health care practitioners on mammography screening across different types and levels of health care institutions in the country's 6 geopolitical zones. MethodsThis cross-sectional online survey was conducted using Google Forms distributed among Nigerian female health workers via online professional associations and networks. Descriptive and inferential statistics were done using SPSS version 20. ResultsA total of 562 respondents, with mean age of 41.30 ± 9.8 years, were surveyed. About half (50.3%) were doctors, with majority practicing in southern Nigeria. A mammography screening utilization rate of 15.4% was found, with majority having their first mammography long after attaining the age of eligibility. As of the time of the survey, only 24.8% of tertiary health workers had access to functional mammography machines at their place of work. Majority of female doctors (78%) never refer eligible patients for mammography, although nearly all (98.6%) were willing to do so. About 54% of those who have had a previous mammography screening vs. 17% who have not had 1 would recommend it to others. Majority of respondents recommended annual mammography from the age of forty at a subsidized cost. ConclusionNigerian female health workers have limited access to mammography and consequently do not screen often. Efforts must be made to make ‘charity begin at home’.

Assessing Elderly User Preference for Telehealth Solutions in China: Exploratory Quantitative Study.

BackgroundIn the next 15 to 20 years, the Chinese population will reach a plateau and start to decline. With the changing family structure and rushed urbanization policies, there will be greater demand for high-quality medical resources at urban centers and home-based elderly care driven by telehealth solutions. This paper describes an exploratory study regarding elderly users’ preference for telehealth solutions in the next 5 to 10 years in 4 cities, Shenzhen, Hangzhou, Wuhan, and Yichang.ObjectiveThe goal is to analyze why users choose telehealth solutions over traditional health solutions based on a questionnaire study involving 4 age groups (50-60, 61-70, 71-80, and 80+) in 4 cities (Shenzhen, Hangzhou, Wuhan, and Yichang) in the next 10 to 20 years. The legal retirement age for female workers in China is 50 to 55 years and 60 years for male workers. To simulate reality in terms of elderly care in China, the authors use the Chinese definition of elderly for employees, defined as being 50 to 60 years old rather than 65 years, as defined by the World Health Organization.MethodsThe questionnaires were collected from Shenzhen, Hangzhou, Wuhan, and Yichang randomly with 390 valid data samples. The questionnaire consists of 31 questions distributed offline on tablet devices by local investigators. Subsequently, Stata 16.0 and SPSS 24.0 were used to analyze the data. O-logit ordered regression and principal component analysis (PCA) were the main theoretical models used. The study is currently in the exploratory stage and therefore does not seek generalization of the results.ResultsApproximately 71.09% (280/390) of the respondents reported having at least 1 type of chronic disease. We started with PCA and categorized all Likert scale variables into 3 factors. The influence of demographic variables on Factors 1, 2, and 3 was verified using analysis of variance (ANOVA) and t tests. The ordered logit regression results suggest that health-related motivations are positively related to the willingness to use telehealth solutions, and trust on data collected from telehealth solutions is negatively correlated with the willingness to use telehealth solutions.ConclusionsThe findings suggest that there is a need to address the gap in community health care and ensure health care continuity between different levels of health care institutions in China by providing telehealth solutions. Meanwhile, telehealth solution providers must focus on improving users’ health awareness and lower health risk for chronic diseases by addressing lifestyle changes such as regular exercise and social activity. The interoperability between the electronic health record system and telehealth solutions remains a hurdle for telehealth solutions to add value in health care. The hurdle is that doctors neither adjust health care plans nor diagnose based on data collected by telehealth solutions.

Factors influencing upward referral system of patients in Nairobi County

Background: The referral system forms main health systems coordinating a mechanism ensuring the harmonious movement of patients between different levels of health care institutions for effective and efficient service delivery. The study aimed at establishing the determinants of upward referral system of patients in Nairobi County. Methods: Cross-Sectional data collected from 204 respondents from 2May to 30June, 2021, through a structured questionnaire from level 3-5 public facilities in Nairobi County was used. Data was analyzed using SPSS. Doctors, nurses and clinical officers who have referred patients in the previous three months were included while those who had not were excluded.Results: Bivariate analysis results revealed that knowledge of referral system (r=179*, p=0.011) and complexity of patient disease (r=097, p=0.170) had positive and significant correlation with upward referral system. Multivariate analysis results showed that proximity to the referral health facility had positive and statistical significant (β4=0.640, p&lt;0.002) to upward referral system.Conclusions: The results revealed that although healthcare workers know about the referral strategy, they lack full comprehension of the referral strategy. Patients are mostly referred when higher diagnostic equipment are needed and when the medical conditions are dire. The study recommends professional medical education to equip the human resources for health with the requisite knowledge on the referral system and establishment of effective communication systems between the lower levels health facilities and the higher or specialized facilities to ensure there a smooth referral system in Nairobi County.

The importance of the partnership between the public and private healthcare institutions to improve interhospital patient transfers

Purpose The purpose of this study/paper is to identify the importance of the partnership between the public and private health-care institutions to improve interhospital patient transfers. Scientific research and statistical data show the increased number of interhospital transportation services; therefore, timely and qualified patient transportation between different health-care institutions must be considered, the activity that directly and significantly impacts the patient’s health status and overall quality of the health-care services. The successful patient transportation from the smaller hospitals to the health-care institutions with advanced intensive care or urgent care units can be enhanced through the partnership between private and public health-care institutions. Design/methodology/approach The methodology included quantitative method, statistical data analysis and theoretical data generalization. Both primary and secondary data were collected and analyzed during the research. Expert quantification was performed using the survey research method. The survey was conducted in Lithuania. The respondents were selected to be the general managers of the health-care and urgent care institutions, the chief doctors of the reanimation and intensive care department also the chief doctors of the emergency department. Findings Because of the centralization and regionalization of health-care services, the number of patients transferred between hospitals by the emergency medical services (EMS) and personal health-care institutions has increased. University hospitals are not sufficiently prepared to accept an increasing flow of patients in accordance with the Ministry of Health orders. Not all regional or district hospitals have the right to provide such assistance, which increases transportation time and costs as well as requires additional human resources. The five EMS categories could be used to improve the patient transfer between different levels of health-care institutions. To increase partnership between private and public health-care organizations, incentives should be provided for the development of private health-care organizations, as well as encouraging actions should be taken to increase the demand for private health-care services by Lithuanian patients. Practical implications Five EMS categories identified in this paper could be used to ensure a smooth mechanism for the patient transfer between different levels of the personal health-care institutions. The proposed categories should also be used in the pre-stationary emergency phase (for reducing the interhospital patient transportation amount). Social implications Properly organized secondary and tertiary interhospital patient transfers influence the availability and quality of the EMS and reduce inequalities in the provided services and social exclusion. Originality/value This paper presents the classification of the interhospital transfer issues, determines the main reasons for the patient interhospital transfer, creates the model for the EMS patient process flows and defines five EMS categories for the assessment of patient conditions. Therefore, the research conducted and the results obtained have both theoretical and social-practical value.

A survey on the application of oral propranolol and atenolol for the management of infantile hemangiomas in mainland China: Survey on propranolol atenolol hemangiomas.

Since 2008, oral propranolol has evolved as the first-line therapy for infantile hemangiomas (IHs). Meanwhile, oral atenolol gradually shows comparative effectiveness versus oral propranolol with few side effects. Here, we conducted a mobile internal survey among a group of Chinese clinicians about how they choose the dosage, dose regimen, and dose escalation methods of propranolol and atenolol for the treatment of IH.A mobile-ready internal survey on the application of oral propranolol and oral atenolol for IH in mainland China was performed and distributed to 333 potential clinicians from different levels of healthcare institutions in mainland China. Eighty-one doctors responded to the survey. All the respondents had the experience of treating IH with oral propranolol and 32 had the experience with oral atenolol.Most of the doctors from tertiary hospitals chose 2 mg/kg/d twice daily, while most of those with the experience of propranolol from private hospitals chose 1 mg/kg/d once daily. More doctors from tertiary hospitals had the experience of atenolol than those from private hospitals.Oral atenolol has become another medication intervention option for IH in mainland China. This survey is helpful to standardize and develop a guideline of oral atenolol therapy for IH.

ANALYSIS OF THE EFFECTIVENESS OF THE FUNCTIONAL ORGANIZATIONAL MODEL FOR KNOWN PROPHYLAXIS OF CHRONIC NONINFECTIOUS DISEASES BASED ON THE ASSESSMENT OF THE QUALITY OF LIFE OF PATIENTS AT THE MEDICAL INSTITUTION

The aim: Study of the indicators of quality of life of patients served by a multidisciplinary health care institution with the functionally-organizational model of coded prevention of chronic noninfectious diseases is implemented. Materials and methods: To evaluate the effectiveness of the model's use we used the assessment of the dynamics of QL indices, which was assessed according to the EUROHISQOL 8-item index methodology among 376 patients aged over 18 years. Results: Most of the respondents (61.4%) were dissatisfied to varying degrees with their state of health and, on average, evaluated their QL (56.1%). ЗThe overall assessment of the quality of life of the surveyed population was on a 20-point scale of 13.5 (3.19) points in 2017 before the introduction of the program of managed prevention of СNCDs and 14.6 (3.48) points after its three-year operation, with an increase integrated indicator on average by 1.1 (95% CI 0.59 - 1.60) points (p <0.001). Among the areas of QOL assessment, the assessments in the physical sphere and the environment increased at most (p<0.05). It is determined that the overall level of QOL of patients with NCDs is 40% due to medical and social factors that can be positively influenced by medical care using a model of managed prevention. Conclusions: The analysis of changes in the quality of life of patients of multidisciplinary institutions who have risk factors for СNCDs or suffer from chronic non-communicable diseases, showed that the introduction of a functional-organizational model of managed prevention at the health care institution level can improve integrated assessment of QOL and positively affect the overall complex of medical and social factors, including managed risk factors. This indicates the effectiveness of this model of managed prevention at the level of a multidisciplinary health care institution.

WHO Guidelines on Tuberculosis Infection Prevention and Control

Despite considerable progress in the fight against tuberculosis, it is still the most deadly bacterial infectious disease worldwide. Every year, up to 10 million people worldwide still die of tuberculosis. The World Health Assembly has set itself the goal of reducing the number of tuberculosis deaths by 90% and the number of new infections by 80% by 2030. Prevention and infection control measures in public health facilities and wherever the risk of transmission of the tuberculosis bacterium "Mycobacterium tuberculosis" is high are especially important. The aim of the guideline is to provide updated and evidence-based recommendations for public health measures to prevent the spread of the tuberculosis bacterium in clinical settings and in tuberculosis management. The World Health Organization (WHO) developed these recommendations according to the methods outlined in the WHO handbook for guideline development. This publication is a summary of the most important aspects of this guideline translated into German by members of the WHO Collaborating Centre at the Danube University Krems (Austria). This guideline takes into account the current evidence base and provides recommendations and comments on the implementation of tuberculosis prevention and control measures at the level of health care institutions and at the national level.

Enjoying Breathing Program: A National Prospective Study Protocol to Improve Chronic Obstructive Pulmonary Disease Management in Chinese Primary Health Care.

BackgroundChronic obstructive pulmonary disease (COPD) is prevalent and poses a heavy burden worldwide. However, patients know little about COPD, and primary health care providers have poor therapy capability in China. Enjoying Breathing Program aims to establish a new comprehensive COPD patient management system, including early detection, standardized therapy, and follow-up in China. The goal of the study is to 1) describe the intervention for physicians and patients and 2) to assess the effectiveness of this program.MethodsIt is the first nationwide trial involving all levels of health care institutions from primary health care institutions to tertiary hospitals. It includes a series of structured but individualized intervention for both health care providers and COPD patients. Primary health care providers from pilot hospitals will take both online and face-to-face courses, including the procedure of COPD patients’ management and prevention, diagnosis and treatment. Once the patients are diagnosed with COPD, they will undertake standard therapy and self-management education program, perform rehabilitation exercises, and be followed up by primary health care providers every 3 months. The primary outcome will be exacerbation-related hospital/emergency admission and the change of patients’ awareness and primary health care providers’ knowledge of COPD within 36 months. Secondary outcome will include the change of pulmonary function test, structured COPD patients’ management, two-way referral, and standardized therapy.ConclusionA comprehensive COPD patient management model to promote the standardized therapy will be established; this will improve COPD patients’ awareness and health quality.Trial Registration NumberThis study has been registered at www.ClinicalTrials.gov (registration identifier: NCT04318912).

Influences of rurality on action to diagnose cancer by primary care practitioners – Results from a Europe-wide survey in 20 countries

BackgroundRural-dwellers have poorer cancer outcomes than urban counterparts, for reasons which are unclear. At healthcare institution level, poorer access to investigations and different clinical decision-making by rural primary healthcare practitioners (PCPs) could be important. AimTo compare access to investigations, attitudes to cancer diagnosis and clinical decision-making between rural and urban PCPs. SettingA vignette-based cross-sectional survey of rural and urban PCPs in 20 European countries. MethodsData on PCPs’ decision-making and attitudes to cancer diagnosis were based on clinical scenarios. Comparisons were made using tests of proportion, univariable and multivariable binary logistic regression. ResultsOf the 1779 PCPs completing the survey 541 30.4 %) practiced rurally. Rural PCPs had significantly less direct access to all investigative modalities: ultrasound; endoscopy; x-ray and advanced screening (all p < 0.001). Rural PCPs were as likely as urban PCPs to take diagnostic action (investigation and/or referral) at the index consultation in all four clinical vignettes ((OR, 95 % CI) for lung: 0.90, 0.72–1.12; ovarian: 0.95, 0.75–1.19; breast: 0.87, 0.69–1.09; colorectal: 0.98, 0.75–1.30). Rural PCPs were less likely to refer to a specialist at the index consultation for ovarian cancer (OR 0.71 95 % CI 0.51-0.99). Rural PCPs were significantly more likely to report that their patients faced barriers to accessing specialist care, but practitioners did not report greater difficulties making specialist referral than their urban counterparts ConclusionsEuropean rural PCPs report poorer access to investigations but are at least as likely as urban PCPs to investigate or refer patients that might have cancer at the index consultation.

MODEL OF MEDICAL-SOCIAL MONITORING OF OBESITY IN CHILDREN (STRUCTURE AND FUNCTIONS AT THE LEVEL OF HEALTH CARE INSTITUTION)

The aim: To substantiate conceptual directions and organizational technology of medico-social monitoring of obesity and risk factors of its development in schoolchildren at the level of health care institution. Materials and methods: Modern strategies and recommendations for the prevention of obesity in children, local normative documents for the organization of preventive medical examinations of children where analyzed. The basis for developing a functional-structural model of medical and social monitoring of obesity in children based on the results of own research, its concept and organizational technology are developed on the basis of methodology of systematic approach and systematic analysis using informationanalytical method. Results: In the procecc of monitoring we saw the health of children and the harmony of their physical development, nutrition and lifestyle, hereditary risk factors for overweight, and the dynamics of the child's physical development. The program of medical and social monitoring of obesity in schoolchildren allows to check among the attached for medical care children the risk factors for the development of overweight, predict health disorders that are associated with it, plan preventive programs. Conclusions: The model of organization of medico-social monitoring of obesity in children is developed for the health care institution, the peculiarities of which are: - enhancing the role of primary care physicians in the provision of medical assistance to the pediatric population in monitoring the health of children and implementing of preventive measures; - involveming parents in monitoring of the risk factors for overweight and preventing obesity at the individual level.

Emotional burnout of mothers as socio-psychological phenomenon in the context of modern culture

The article is devoted to the description of various approaches to the study of the phenomenon of motherhood at different stages of the cultural and historical development of society. It is shown that the use of the term “emotional burnout” can be extended to women on maternity leave too. This approach is the basis for the development of a package of measures to prevent maternal burnout and to work with this condition at the level of healthcare institutions.