Local Health Care Centers Research Articles

Asynchronous teledentistry program in two long-term care facilities: Iowa's virtual dental home pilot project.

Older adults living in long-term care facilities (LTCFs) often have poor oral health and difficulty accessing dental services. The aim was to implement a virtual dental home (VDH) program for residents in two LTCFs utilizing asynchronous teledentistry techniques and mobile dental equipment. This pilot project was a 6-month longitudinal cohort study in two LTCFs. Dental hygienists and dentists from a local community health care center utilized asynchronous teledentistry to provide diagnostic and preventive dental services onsite and to establish a dental home for additional comprehensive care services. Data were collected, including resident's demographics, oral health status, and dental services received. Descriptive data analyses, Wilcoxon signed rank, and McNemar tests were conducted. Thirty-four residents completed in-person baseline oral exams and 16 residents completed the recall exams. Ninety-two percent (n=23) of dentate residents (n=25) had untreated caries and 64% (n=16) of dentate residents had at least one sextant of severe gingival inflammation. The median number of teeth with active untreated caries (p=.01) significantly decreased and arrested caries (p=.02) significantly increased from baseline. Iowa's VDH pilot project was successful in establishing a dental home using asynchronous teledentistry for residents in two LTCFs and providing resident access to preventive and disease control dental services.

Mobile Critical Care in Resource-Limited Settings: An Unmet Need.

Care of the critically ill in resource-limited areas, inside or outside the intensive care unit (ICU), is indispensable. Murthy and Adhikari noted that about 70% of patients in low-middle income (LMIC) areas could benefit from good critical care. Many patients in resource-limited settings still die before getting to the hospital. Investing in capacity building by strengthening and expanding ICU capability and training intensivists, critical care nurses, respiratory therapists, and other ICU staff is essential, but this process will take years. Also, having advanced healthcare facilities that are still far from remote areas will not do much to alleviate distance and mode of transportation as barriers to achieving good critical care. This paper discusses the importance of mobile critical care units (MCCUs) in supporting and enhancing existing emergency medical systems. MCCUs will be crucial in addressing critical delays in transportation and time to receive appropriate lifesaving critical care in remote areas. They are incredibly versatile and could be used to transfer severely ill patients to a higher level of care from the field, safely transfer critically ill patients between hospitals, and, sometimes, almost more importantly, provide standalone short-term critical care in regions where ICUs might be absent or immediately inaccessible. MCCUs should not be used as a substitute for primary care or to bypass readily available services at local healthcare centers. It is essential to rethink the traditional paradigm of 'prehospital care' and 'hospital care' and focus on improving the care of critically ill patients from the field to the hospital.

Association Between Bladder Cancer and Environmental Risk Factors in Guilan Province: A Case-Control Study

Background: Occupational settings expose workers to various substances linked to cancer risk, influenced by exposure intensity and duration. Considering the diverse work conditions across Iranian cities and the unexplored link between occupation and bladder cancer (BC) in Guilan Province, identifying high-risk occupations and industries is imperative for implementing preventive measures in the region. Objectives: To investigate the effect of people's occupations on bladder cancer in Guilan Province. Methods: The study encompassed 266 diagnosed BC patients in Guilan Province who received treatment at local healthcare centers, along with 191 control individuals aged 18 and over. Data for the cases were meticulously recorded in medical records at the Guilan Cancer Registry. The same checklists, including demographic characteristics, comorbidities, addiction status, water consumption habits, environmental exposures, current and previous occupation, previous history of cancer, and family history of cancer, were recorded for the controls. Odds ratios and their 95% confidence intervals were estimated using adjusted logistic regression (LR). Results: The study found that the odds ratio of bladder cancer (BC) was 2.80 (95% CI: 1.26 - 6.21) for the age group 60 - 70 years and 18.2 (95% CI: 7.31 - 45.6) for individuals above 70 years. Rural dwelling increased the risk by 5.06-fold, while well water consumption and regular opium use amplified it by 6.12-fold and 2.58-fold, respectively. Exposure to tar and carbon derivatives led to a 3.53-fold increase in risk, and exposure to combustion/greenhouse gases showed a 10.72-fold increase. Chemical-related occupations, tar, carbon derivatives, smoking, and opium consumption were significant risk factors. Conclusions: Occupations involving chemical substances such as greenhouse gases, tar, and carbon derivatives are associated with a higher risk of bladder cancer (BC). Furthermore, smoking, opium use, and well water consumption significantly elevate the risk of this cancer.

Synergistic patient factors are driving recent increased pediatric urgent care demand.

We aimed to use the high fidelity urgent care patient data to model the factors that have led to the increased demand at our local pediatric urgent care centre. The dataset for this retrospective cohort study was obtained from our local healthcare centre's national reporting data for pediatric urgent care visits from 2006 to 2022. Variables analyzed included: basic patient demographics, chief complaint, triage urgency, date and time of registration/discharge, discharge diagnosis, and discharge destination. Statistical analysis of non-linear trends was summarized by locally estimated scatterplot smoothing splines. For machine learning, we used the tidymodels R package. Models were validated in training using k-fold cross validation with k = 5. We used univariate linear regression as a baseline model. After the data was standardized, correlation and homoscedasticity were evaluated between all parameter permutations. This dataset consisted of 164,660 unique visits to our academic centre's pediatric urgent care. Over the study period, there was an overall substantial increase in the number of urgent care visits per day, with a rapid increase beyond previous levels in 2021 and further in 2022. The increased length of stay trend was consistent across presenting complaint categories. The proportion of patients without primary care in 2022 was 2.5 times higher than in 2013. A random forest machine learning model revealed the relative importance of features to predicting a visit in 2022 were: longer stay, later registration in the day, diagnosis of an infectious illness, and younger age. This study identified a combination of declining primary care access, circulating viral infections, and shifting chief complaints as factors driving the recent increase in frequency and duration of visits to our urgent care service.

Patient experiences of interprofessional collaboration and intersectoral communication in rare disease healthcare in Germany – a mixed-methods study

BackgroundRare diseases are often complex, chronic and many of them life-shortening. In Germany, healthcare for rare diseases is organized in expert centers for rare diseases. Most patients additionally have regional general practicioners and specialists for basic medical care. Thus, collaboration and information exchange between sectors is highly relevant. Our study focuses on the patient and caregiver perspective on intersectoral and interdisciplinary care between local healthcare professionals (HCPs) and centers for rare diseases in Germany. The aims were (1) to investigate patients’ and caregivers’ general experience of healthcare, (2) to analyse patients’ and caregivers’ perception of collaboration and cooperation between local healthcare professionals and expert centers for rare diseases and (3) to investigate patients’ and caregivers’ satisfaction with healthcare in the expert centers for rare diseases.ResultsIn total 299 individuals of whom 176 were patients and 123 were caregivers to pediatric patients participated in a survey using a questionnaire comprising several instruments and constructs. Fifty participants were additionally interviewed using a semistructured guideline. Most patients reported to receive written information about their care, have a contact person for medical issues and experienced interdisciplinary exchange within the centers for rare diseases. Patients and caregivers in our sample were mainly satisfied with the healthcare in the centers for rare diseases. The qualitative interviews showed a rather mixed picture including experiences of uncoordinated care, low engagement and communication difficulties between professionals of different sectors. Patients reported several factors that influenced the organization and quality of healthcare e.g. engagement and health literacy in patients or engagement of HCPs.ConclusionsOur findings indicate the high relevance of transferring affected patients to specialized care as fast as possible to provide best medical treatment and increase patient satisfaction. Intersectoral collaboration should exceed written information exchange and should unburden patients of being and feeling responsible for communication between sectors and specialists. Results indicate a lack of inclusion of psychosocial aspects in routine care, which suggests opportunities for necessary improvements.

Expectations of a new eating disorder treatment and its delivery: Perspectives of patients and new therapists.

A significant number of people with bulimia nervosa (BN) or binge-eating disorder (BED) do not seek professional help. Important reasons include limited knowledge of eating disorders (EDs), feelings of shame, treatment costs, and restricted access to specialized healthcare. In this study, we explored if a novel therapy delivered in a primary care setting could overcome these barriers. We investigated factors such as motivation and expectations and included the patients' and newly trained therapists' perspectives. We interviewed 10 women with BN (n = 2) or BED (n = 8), enrolled in the Physical Exercise and Dietary therapy (PED-t) program, in a Healthy Life Center (HLC) located in a primary healthcare facility. Interview topics discussed were motivations for and expectations of therapy, and the treatment location. In addition, 10 therapists from HLC's were interviewed on their experiences with the PED-t training program and expectations of running PED-t within their service. The semi-structured interviews were analyzed using reflexive thematic analysis. Most patients had limited knowledge about EDs and first realized the need for professional help after learning about PED-t. Patients exhibited strong motivations for treatment and a positive perception of both the PED-t, the new treatment setting, and the therapists' competencies. The therapists, following a brief training program, felt confident in their abilities to treat EDs and provide PED-t. With minor operational adjustments, PED-t can seamlessly be integrated into national HLC service locations. PED-t is an accessible therapeutic service that can be delivered in a primary care environment in a stepped-care therapy model. This study investigates the views and experiences of patients and newly trained therapists of PED-t (Physical Exercise and Dietary therapy), a new program-led primary care therapy for binge-eating spectrum eating disorders. The treatment and the locations for the intervention, that is, local health care centers, were found to be highly acceptable to both patients and therapists, thus PED-t could easily be integrated as a first step into a step-care delivery model.

Traditional Atlantic Diet and Its Effect on Health and the Environment

The universal call to action for healthier and more sustainable dietary choices is the framework of the United Nations's Sustainable Development Goals. The Atlantic diet, originating from the northwest of the Iberian Peninsula, represents an example of a traditional diet that aligns with these principles. To explore a 6-month intervention based on the Atlantic diet's effects on metabolic and environmental health, assessing metabolic syndrome (MetS) incidence and the carbon footprint. The Galician Atlantic Diet study was a 6-month randomized clinical trial designed to assess the effects of this regional traditional diet on families' eating habits. The study was conducted from March 3, 2014, to May 29, 2015, at a local primary health care center in the rural town of A Estrada in northwestern Spain and involved a multisectoral collaboration. Families were randomly selected from National Health System records and randomized 1:1 to an intervention or control group. This secondary analysis of the trial findings was performed between March 24, 2021, and November 7, 2023. Over 6 months, families in the intervention group received educational sessions, cooking classes, written supporting material, and foods characteristic of the Atlantic diet, whereas those randomized to the control group continued with their habitual lifestyle. The main outcomes were MetS incidence, defined per National Cholesterol Education Program Adult Treatment Panel III guidelines, and carbon footprint emissions as an environmental metric using life cycle assessment with daily dietary intake as the functional unit. Initially, 250 families were randomized (574 participants; mean [SD] age, 46.8 [15.7] years; 231 males [40.2%] and 343 females [59.8%]). The intervention group included 126 families (287 participants) and the control group, 124 families (287 participants). Ultimately, 231 families completed the trial. The intervention significantly reduced the risk of incident cases of MetS (rate ratio, 0.32; 95% CI, 0.13-0.79) and had fewer MetS components (proportional odds ratio, 0.58; 95% CI, 0.42-0.82) compared with the control condition. The intervention group did not have a significantly reduced environmental impact in terms of carbon footprint emissions compared with the control group (-0.17 [95% CI, -0.46 to 0.12] kg CO2 equivalents/person/d). These findings provide important evidence that a family-focused dietary intervention based on a traditional diet can reduce the risk of incident MetS. Further research is needed to understand the underlying mechanisms and determine the generalizability to other populations, taking into account regional cultural and dietary variations. ClinicalTrials.gov Identifier: NCT02391701.

The Gyan Burman Fellowship in gastrointestinal surgery at Sir Ganga Ram Hospital: A global perspective based on feedback from former fellows

ABSTRACT Background: The 3-month Gyan Burman Fellowship (GBF) in Surgical Gastroenterology and Liver Transplantation at Sir Ganga Ram Hospital in New Delhi has been offered to aspiring surgeons worldwide since 2003. Using a questionnaire, we evaluated whether the experience had been useful to its past candidates. Aims: Our aim was to evaluate how useful the experience had been to its past candidates. Materials and Methods: We sent a standard questionnaire online to 100 of the 138 fellows whom we were able to contact and who had graduated up to 31st December 2022. The data were collected on pre-designed data sheets, entered in a computer and analysed. Results: We received 69 responses. Sixty-one (88.4%) were male, and 8 (11.6%) were female. They came from 15 different developing countries. The GBF was the primary choice for training for 59 (85.5%), and 40 (58%) came because they did not have any equivalent training available locally. They said that overall the 3-month fellowship had had a positive impact on both the careers of the trainees and their respective regions’ healthcare. The experience was reported to have been excellent by 40 (60%). Conclusion: The 3-month GBF has been useful to most of its candidates and has provided them with knowledge on the quality of their surgical care in their local healthcare centres.

Biliary Ascariasis Causing Obstructive Jaundice: A Case Report on ERCP-Assisted Management

BACKGROUND: Biliary tract disorders are predominantly caused by cholelithiasis (gallstones). However, in regions endemic for parasitic infestations, or areas with poor hygiene and sanitation, hepatobiliary disorders may be due to an underlying worm infestation. THE CASE A 55-year-old female from Skardu, Pakistan, an Ascariasis-endemic area, presented to a tertiary care hospital with right hypochondrial pain and jaundice. Her condition did not respond to conservative treatment. Ultrasound (USG) and Magnetic Resonance Cholangiopancreatography (MRCP) identified multiple worms obstructing the common bile duct. Subsequently, an Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure was performed, successfully retrieving the worms and achieving complete ductal clearance. The patient was discharged with oral anthelmintics and made a full recovery. CONCLUSION: This case underscores the importance of considering biliary ascariasis as a differential diagnosis for obstructive jaundice in endemic regions. MRCP emerges as a valuable diagnostic tool, providing a non-invasive and precise way to identify worm infestations of the biliary system. It effectively reduces the dependence on ERCP and its associated risks, reserving ERCP for therapeutic interventions. Equipping local healthcare centers in Ascariasis-endemic regions with the necessary resources to diagnose and treat these conditions is essential for mitigating patient suffering. This may lessen the need for travel to larger hospitals, minimising physical and financial inconveniences to the patient while also decreasing the burden on tertiary care hospitals.

Exploring the interactive effects of oral contraceptive use and dietary fat intake on blood pressure, cardiovascular reactivity, and glucose tolerance in normotensive women.

Objective: To understand how dietary fat consumption and the use of oral contraceptives interact to affect blood pressure, cardiovascular reactivity, and glucose tolerance in normotensive women. Study Design: Cross-section study. Setting: Hayatabad Medical Complex, Peshawar. Period: December 2022 to April 2023. Material & Methods: A total of 120 normotensive women aged between 18 and 35 years were recruited from local healthcare centers, clinics, and educational institutions. Demographic characteristics, oral contraceptive use, and dietary fat intake were assessed through self-reporting and validated food frequency questionnaires. Resting blood pressure measurements, cardiovascular reactivity during standardized stressors, and glucose tolerance through oral glucose tolerance tests were recorded. Results: The study found no significant associations between oral contraceptive use and blood pressure, cardiovascular reactivity, or glucose tolerance. Similarly, dietary fat intake did not significantly influence these health parameters. Conclusion: The results emphasize the importance of personalized healthcare recommendations for women using oral contraceptives, considering individual variations and other lifestyle factors. Further research with larger, longitudinal studies is warranted to elucidate the potential long-term effects of these interactions and promote cardiovascular health for women worldwide.

Edukasi Stunting pada Kelompok Anak Melalui Poster dengan Menggunakan Kalimat Persuasif di Kelurahan Mompang Jae Kabupaten Mandailing Natal

Stunting education is crucial for children to grasp the perils of stunting and uphold their health and well-being. Educating children about this matter is challenging, given their susceptibility to boredom and difficulty in comprehending complex concepts. Innovative approaches are essential to captivate their attention and facilitate comprehension. In Mompang Jae Village, Mandailing Natal Regency, stunting education was conducted for a cohort of children using persuasive posters and videos. The study involved 30 child participants, employing a persuasive educational method. The percentage of respondents with limited knowledge plummeted from 67% to 33%, while those with a strong grasp of the topic surged from 17% to 67%. Effective knowledge enhancement can be achieved through diverse methods, including education. Incorporating visually appealing educational aids, such as persuasive posters, aids information absorption due to their visually intuitive nature. These posters are prominently displayed at the local healthcare center (posyandu), designed to engage children's attention and reinforce the significance of combating stunting. Keywords: Education, Stunting, Persuasive Poster.

Comparison of habitual and meal-specific dietary patterns identified by latent class analysis and confirmatory factor analysis in adults: A cross-sectional study

ObjectiveThe aim of this study was to compare characteristics of habitual and meal-specific dietary patterns identified by latent class analysis (LCA) and confirmatory factor analysis (CFA). MethodsParticipants included 778 adults selected for the present cross-sectional study from local health care centers in Tehran, Iran. Three 24-h dietary recalls evaluated dietary intake. LCA was used to group study participants into exclusive subgroups of individuals with similar patterns of dietary intake. CFA was applied to identify patterns of habitual and meal-specific dietary intake. Analysis of variance was used to compare the average scores of habitual and meal-specific CFA-derived dietary patterns across classes identified by LCA. ResultsUsing habitual dietary intake, CFA grouped correlated food items into three major factors: fruits and vegetables, mixed, and Western dietary patterns. LCA grouped study participants with similar patterns of habitual intake into four subgroups of individuals: fruits and vegetables, mixed, Western, and low consumer classes. LCA-fruits and vegetables, LCA-Western, and LCA-mixed classes had, respectively, higher mean scores of CFA-fruits and vegetables, CFA-Western, and CFA-mixed dietary patterns compared with other classes (P < 0.001). Similar findings were observed for meal-specific dietary intake, where classes identified by LCA had the highest mean scores of their corresponding dietary pattern identified by CFA. ConclusionHabitual and meal-specific classes identified by LCA were well characterized by the dietary patterns derived by CFA, suggesting that LCA may be an appropriate statistical approach to classify study participants with similar patterns of intake into exclusive subgroups of individuals.

Health effects of shrinking hyper-saline lakes: spatiotemporal modeling of the Lake Urmia drought on the local population, case study of the Shabestar County

Climate change and its respective environmental impacts, such as dying lakes, is widely acknowledged. Studies on the impact of shrinking hyper-saline lakes suggest severe negative consequences for the health of the affected population. The primary aim was to investigate the relationship between changes in the water level of the hyper-saline Lake Urmia, along with the associated salt release, and the prevalence of hypertension and the general state of health of the local population in Shabestar County north of the lake. Moreover, we sought to map the vulnerability of the local population to the health risks associated with salt-dust scatter using multiple environmental and demographic characteristics. We applied a spatiotemporal analysis of the environmental parameters of Lake Urmia and the health of the local population. We analyzed health survey data from local health care centers and a national STEPS study in Shabestar County, Iran. We used a time-series of remote sensing images to monitor the trend of occurrence and extent of salt-dust storms between 2012 and 2020. To evaluate the impacts of lake drought on the health of the residences, we investigated the spatiotemporal correlation of the lake drought and the state of health of local residents. We applied a GIScience multiple decision analysis to identify areas affected by salt-dust particles and related these to the health status of the residents. According to our results, the lake drought has significantly contributed to the increasing cases of hypertension in local patients. The number of hypertensive patients has increased from 2.09% in 2012 to 19.5% in 2019 before decreasing slightly to 16.05% in 2020. Detailed results showed that adults, and particularly females, were affected most by the effects of the salt-dust scatter in the residential areas close to the lake. The results of this study provide critical insights into the environmental impacts of the Lake Urmia drought on the human health of the residents. Based on the results we suggest that detailed socioeconomic studies might be required for a comprehensive analysis of the human health issues in this area. Nonetheless, the proposed methods can be applied to monitor the environmental impacts of climate change on human health.

Impact of the COVID-19 pandemic on primary care delivery in a remote Aboriginal community.

The coronavirus disease 2019 (COVID-19) pandemic has disrupted the delivery of primary health care internationally, particularly for the most marginalised groups. This project investigated the impact of the initial response to the COVID-19 pandemic on the delivery of primary health care in a remote First Nations community in Far North Queensland with a high chronic disease burden. There were no confirmed cases of COVID-19 circulating in the community at the time of the study. A comparison was conducted of patient numbers presenting to a local primary healthcare centre (PHCC) in the periods before, during and after the initial peak of Australian COVID-19 restrictions in 2020, compared to the same period in 2019. A significant proportional decrease was observed in the number of patients that presented from the target community during the initial restrictions. A sub-analysis of preventative services delivered to a defined high-risk group found that services delivered did not decrease to this particular group during the periods of interest. This study has highlighted that there is a risk of underutilisation of primary healthcare services during a health pandemic in remote settings. Strengthening the primary care system to adequately provide ongoing services during natural disasters requires further consideration to reduce the risk of long-term impacts of service disengagement.

Reasons for dropout in the transition from hospital to municipality during exercise-based cardiac rehabilitation in a Danish cross-sectorial setting: a qualitative study

ObjectivesDespite documented benefits of cardiac rehabilitation (CR), attrition rates remain relatively high. Insights on patient perspectives concerning dropout during transition phases are deficient. This deeper understanding may help to inform...

Theories-based determinants analysis of Hib-combined vaccine hesitancy in China: A multi-group structural equation modeling

ABSTRACT Objectives To explore determinants of Hib-combined vaccine hesitancy in Chinese parents, and to provide scientific intervention measures to tackle vaccine hesitancy. Methods 2,531 parents were recruited from local healthcare centers in Zhejiang Province by accidental sampling, and completed the self-developed online questionnaire with voluntary participation. Health Belief Model and Model of Determinants of Vaccine Hesitancy were applied to construct the framework of research. Multi-group Structural Equation Modeling was performed to explore the effects of determinants of vaccine hesitancy across various socio-economic status (SES). Results Hib-combined vaccine hesitancy for total sample was 2.184 ± 0.777 (95%CI: 2.153–2.214), and most of them were in low (n = 1436, 56.7%) level. Low SES group (2.335 ± 0.763, 95%CI: 2.271–2.400) had significantly highest vaccine hesitancy. For total sample, Self-Efficacy and Cues to Action presented −0.517 and −0.437 of standard total effect on Vaccine Hesitancy, respectively. The Multi-group Structural Equation Model with satisfying goodness of fit in SES groups ( = 1616.074, df = 314, /df = 5.147, CFI = 0.973, TLI = 0.966, SRMR = 0.027, RMSEA = 0.041) showed that Cues to Action imposed −0.621 (95%CI: −0.867–0.389, p < .001) of major standard total effect on Vaccine Hesitancy in low SES group, while Self-Efficacy imposed −0.560 (95%CI: −0.668–0.444, p < .001) and −0.685 (95%CI: −0.841–0.454, p < .001) of principal standard total effect on Vaccine Hesitancy in middle and high SES groups, respectively. Conclusions Hib-combined vaccine hesitancy in Chinese parents was low, and the lower the SES, the higher the vaccine hesitancy. Cues to Action and Self-Efficacy played primary role in declining vaccine hesitancy for parents at low SES, and at middle and high SES, respectively.

Seeking to improve access to COVID-19 therapeutics in the remote Torres and Cape communities of Far North Queensland during the first COVID-19 omicron outbreak.

The first outbreak of the omicron variant of COVID-19 in the Torres and Cape region of Far North Queensland in Australia was declared in late December 2021. A COVID-19 Care at Home program was created to support the health and non-health needs of people with COVID-19 and their families throughout the mandatory isolation periods and included centralising the coordination and delivery of COVID-19 therapeutics. The therapeutics available included one intravenous monoclonal antibody (sotrovimab) and two oral antiviral therapies: nirmatrelvir and ritonavir (Paxlovid®) and molnupiravir (Lagevrio®). This article describes the uptake and delivery of this therapeutics program. COVID-19 cases were documented in a notification database, screened to determine eligibility for COVID-19 therapies and prioritised based on case age, vaccination status, immunosuppression status and existing comorbidities, in line with Queensland clinical guidelines. Eligible cases were individually contacted by phone to discuss treatment options, and administration of therapies were coordinated in partnership with local primary healthcare centres and hospitals. A total of 4744 cases were notified during the outbreak period, of which 217 (4.6%) were deemed eligible for treatment after medical review. Treatment was offered to 148/217 cases (68.2%), with 90/148 cases (60.8%) declining treatment and 53/148 cases (35.8%) receiving therapeutic treatment for COVID-19. Among these 53 cases, 29 received sotrovimab (54.7%), 20 received Paxlovid (37.7%) and four received Lagevrio (7.5%). First Nations people accounted for 48/53 cases (90.6%) who received treatment, and COVID-19 therapeutics were delivered to cases in 16 remote First Nations communities during the outbreak period. The COVID-19 Care at Home program demonstrated a novel, public health led approach to delivering time-critical medications to individuals across a large, remote and logistically complex region. The application of similar models to outbreaks and chronic conditions of public health importance offers potential to address many health access inequities experienced by remote Australian First Nations communities.

Impact of Inperson Training on Health Care Provider Knowledge of the Symptoms and Treatment of Pediatric Cancer in Mwanza Region

PURPOSE In Tanzania, &lt; 20% of the estimated 3,500 children who develop cancer each year present to one of the three cancer treatment centers. Of those who do present, there is an average of 89 days between when they present to the local health care center and their cancer center evaluation. Our aim was to assess the baseline pediatric cancer knowledge among medical providers at health centers and district hospitals in the Mwanza region and evaluate the impact of a training program on cancer knowledge and symptom recognition, and ultimately reduce referral delay. METHODS One provider from each of the 69 Mwanza region health care centers and district hospitals was selected by district non communicable disease coordinators to participate in a one day training program. Training education strategies included didactic, small group discussions and interactive sampling. Topics included childhood cancer epidemiology, symptoms recognition, diagnostic evaluation, and referral options. Participants completed re- and post-training surveys to determine knowledge change. RESULTS A total of 80% (n = 56) of invited health centers participated in the training. In the pre survey, while all participants knew what cancer was (uncontrolled cellular division), 82% of were not aware that there was potentially curative treatment available, and 35% did not know which hospitals provided cancer treatment in their region. Post training, overall knowledge scores significantly increased (73%-81%, P &lt; .001), with a &gt; 20% score change for key content areas including symptom recognition and appropriate referral location hospital. CONCLUSION Community medical provider knowledge about childhood cancer is low within the Mwanza Region. In person short training is an effective strategy to increase key knowledge areas that are known to contribute to referral delay. Future research will evaluate the impact of this training on referral rates and referral delay to the regional cancer referral hospital.

A Food Poisoning Outbreak Caused by Shigella in Al-Mafraq, Jordan, in 2019

Background On October 6, 2019, 55 residents of Bala'ama town in Al-Mafraq, Jordan, were admitted to the local health care center with symptoms of food poisoning. Objective This study aimed to identify the cause of the food poisoning outbreak. Methods This descriptive study is a cross-sectional study. Data were obtained from the Directorate of Communicable Diseases in the Ministry of Health. A total of 25 stool samples from patients and an additional 2 samples from workers in the restaurant were collected and tested. An environmental survey of the food and water was also conducted. Results The period of the outbreak was from October 6 to 10, 2019. The highest proportion of patients were children under 5 years of age. More females than males were affected. Stool test results were positive for Shigella sonnei in 15 samples and rotavirus in 7 samples. Chloride concentration was 0 in the water samples. Conclusions The food poisoning outbreak was caused by consumption of hummus from a neighborhood restaurant, which was contaminated with S. sonnei.

Dropout during a 12-week transitional exercise-based cardiac rehabilitation programme: a mixed-methods prospective cohort study.

Investigate the dropout rate during a 12-week transitional exercise-based cardiac rehabilitation (exCR) programme focusing on a halfway transition phase between hospital and the municipality-based cardiac rehabilitation. Secondly, investigate patient characteristics associated with dropout at the transition. Patients with coronary heart disease, heart failure, or heart valve surgery referred to exCR were included in a prospective cohort study conducted between 1 March 2018 and 28 February 2019 at Zealand University Hospital. Exercise-based cardiac rehabilitation was initiated at the hospital with a halfway transitional to local healthcare centres in the municipalities. Dropouts were identified every third week through telephone interviews. A Kaplan-Meier time-to-event analysis was used to investigate time to dropout, while multiple logistic regression assessed associations between patient characteristics and dropout at the transition. Of 560 patients eligible for exCR, 279 participated in the study. Fourteen patients were lost to follow-up and 103 dropped out, resulting in a dropout rate of 39% [95% confidence interval (CI) 33-45%]. Of the 103 dropouts, 72 patients (70%) dropped out at the transition. In the adjusted analysis, patients attached to the labour market were associated with dropout at the transition [odds ratio (OR) = 6.31 (95% CI 2.04-19.54)]. Furthermore, odds of dropping out at transition were reduced for each extra exercise session attended [OR = 0.79 (95% CI 0.66-0.94)]. The transition phase constitutes a critical dropout period in exCR, in which increased attention on patient adherence is needed. In clinical practice, communication and strategies addressing patient retention across settings could be essential to prevent dropout in transitional exCR.