Health Center Research Articles

Derivation and validation of a simple prognostic risk score to predict short-term mortality in acute cardiogenic pulmonary edema: SABIHA Score.

In the context of acute cardiogenic pulmonary edema (ACPE), a frequently encountered medical emergency associated with high early mortality rates, there is a need to predict short-term outcomes for risk stratification.Our aim was to derive and validate a model, a simple clinical scoring system using baseline vital signs, clinical and presenting characteristics, and readily available laboratory tests, that allows accurate prediction of short-term mortality in individuals experiencing ACPE. This retrospective cohort study included 1088 patients with ACPE from six health centers. Subjects were randomly allocated into derivation and validation cohorts at a 4:3 ratio, facilitating comprehensive examination and validation of prognostic model. Independent predictors of mortality (p<0.05) from the multivariable model were included in the risk score. The discriminant ability of the score was tested by ROC analysis. In the derivation cohort (n=623), age, blood urea nitrogen, heart rate, intubation, anemia, and systolic blood pressure were identified as independent predictors of mortality in multivariable analysis. These variables were used to develop a risk score ranging from 0 to 6 by scoring 0 and 1. The SABIHA score provided a good calibration with a concordance index of 0.879 (95% CI: 0.821-0.937). While the probability of short-term mortality was 80.0% in the high risk group, this rate was only 3.3% in the low risk group. This score also performed well on the validation set. A simple clinical score consisting of routinely obtained variables can be used in risk stratification to predict short-term outcomes in patients with ACPE.

Analysis of DNA cox1 barcoding revealed novel haplotype in Schistosoma haematobium isolated from Western Sudan

Schistosomiasis poses a significant global health threat, particularly in tropical and subtropical regions like Sudan. Although numerous epidemiological studies have examined schistosomiasis in Sudan, the genetic diversity of Schistosoma haematobium populations, specifically through analysis of the mtcox1 gene, remains unexplored. This study aimed to investigate the risk factors associated with urogenital schistosomiasis among school pupils in El-Fasher, Western Sudan, as well as the mtcox1 genetic diversity of human S. haematobium in this region. A cross-sectional study was conducted among school pupils aged 4 to 19 years. In total, 196 urine samples and 196 fecal samples were collected from participants across schools, health centers, and refugee camps in El-Fasher. Samples were examined using simple centrifugation/sedimentation technique and formol-ether concentration method to detect S. haematobium and S. mansoni eggs, respectively. S. haematobium mtcox1 partial gene was amplified and sequenced by the Sanger technique. A neighbor-joining phylogenetic tree was generated by MEGA software, and a haplotype network was constructed using PopART v.1.7 with the median-joining network method. In this study, S. haematobium was detected in 6.1% (12/196) of the participants while no S. mansoni ova were observed in fecal samples. The infection was more common among those who relied on indirect water supply like tankers (6, 50%). No infection was observed among residents of refugee camps. Only eight samples were PCR-positive, which were successfully sequenced, and included in the genetic diversity analysis. A unique haplotype (Hap_1) with no sequence diversity was found among cox1 sequences from El-Fasher strains. Both El-Fasher S. haematobium haplotype (Hap_1) and Gezira haplotype (Hap_31) fall within the mainland Africa group (group 1). In conclusion, this study identified a novel S. haematobium strain and provides insights into the evolutionary history and phylogeography of S. haematobium in Sudan, particularly in the western region. This genetic data could help in the control and monitoring of urogenital schistosomiasis in this region. For the first time, we utilized the DNA mtcox1 barcoding to investigate S. haematobium haplotypes in Western Sudan.

Deep learning reveals diverging effects of altitude on aging.

Aging is influenced by a complex interplay of multifarious factors, including an individual's genetics, environment, and lifestyle. Notably, high altitude may impact aging and age-related diseases through exposures such as hypoxia and ultraviolet(UV) radiation. To investigate this, we mined risk exposure data (summary exposure value), disease burden data (disability-adjusted life years (DALYs)), and death rates and life expectancy from the Global Health Data Exchange (GHDx) andNational Data Management Center for Health of Ethiopiafor each subnational region of Ethiopia, a country with considerable differences in the living altitude. We conducted a cross-sectional clinical trial involving 227 highland and 202 lowland dwellers from the Tigray region in Northern Ethiopia to gain a general insight into the biological aging at high altitudes. Notably, we observed significantly lower risk exposure rates and a reduced disease burden as well as increased life expectancy by lower mortality rates in higher-altitude regions of Ethiopia. When assessing biological aging using facial photographs, we found a faster rate of aging with increasing elevation, likely due to greater UV exposure. Conversely, analysis of nuclear morphologies of peripheral blood mononuclear cells(PBMCs) in blood smears with five different senescence predictors revealed a significant decrease in DNA damage-induced senescence in both monocytes and lymphocytes with increasing elevation. Overall, our findings suggest that disease and DNA damage-induced senescence decreases with altitude in agreement with the idea that oxidative stress may drive aging.

Association between self-reported eye conditions in patients at rural federally qualified health centers and vision-targeted health-related quality of life: the AL-SIGHT study

BackgroundFederally Qualified Health Centers (FQHCs) are safety-net primary health care clinics in the US serving medically underserved areas and populations. We administered the National Eye Institute Visual Function Questionnaire – 9 (VFQ-9), a vision-targeted, health-related quality of life questionnaire, to patients in 3 FQHCs in rural Alabama at risk for glaucoma. We examined demographic factors and self-reported eye conditions associated with VFQ-9 scores.MethodsThe VFQ-9 (score range 0–100) was administered to patients at-risk for glaucoma including African Americans or Hispanics ≥40 years, white persons ≥50 years, persons with diabetes ≥18 years, ≥18 years with glaucoma or glaucoma suspect, and/or ≥ 18 years with a family history of glaucoma. Demographic variables were collected -- age, gender, race/ethnicity, employment, marital status, health insurance, education, and driving status. Patients reported the presence of eye conditions including glaucoma and many other eye conditions. Stepwise linear regression modeled which variables accounted for the greatest variance of the VFQ-9 score.ResultsComposite VFQ-9 scores averaged 82.4. The best fitting model for VFQ-9 scores included being a driver, insurance type/status, self-reported glaucoma or glaucoma suspect, blurry vision, and double vision.ConclusionPatients at-risk for glaucoma seeking care at FQHCs in rural Alabama have moderate impairment in quality of life as assessed by the VFQ-9. Factors negatively influencing scores are self-reported glaucoma or glaucoma suspect, blurry vision, double vision, not being a driver, and having no health insurance. The VFQ-9 is a good candidate as a vision-targeted quality of life outcome for eye health interventions at rural FQHCs in those with glaucoma.

Assessment of Mothers' Knowledge of Childhood Malnutrition Prevention Practices at Ugbor Primary Health Centre in Benin City, Nigeria

Assessment of Mothers' Knowledge of Childhood Malnutrition Prevention Practices at Ugbor Primary Health Centre in Benin City, Nigeria

The Lived Experiences of Mothers Living with HIV in West Papua, Indonesia: A Qualitative Study.

Mothers living with human immunodeficiency virus (HIV) may experience adjustment issues due to their illness progression and the risk of intergenerational transmission of the disease. Existing research on women living with HIV has focused on how psychological transitions such as child care and breastfeeding influence maternal life, and how socioeconomic status, stigma, and social support impact psychological transitions. Little is known about the experiences of mothers living with HIV in Indonesia. This study employed interpretive phenomenological methods to learn about the experiences of mothers living with HIV in West Papua, Indonesia. Twenty mothers with HIV were invited to participate in a study at a public health center. Themes identified were emotional reaction to HIV diagnosis, destruction of relationships, treatment burden, emotional coping, motherhood, and uncertainty about their child's future status. Formal and informal peer-led support groups may be practical tools for increasing partner communication and antiretroviral therapy uptake and decreasing HIV vertical transmission, especially in low-resource contexts.

The Identification of Relationships of the Quality of Lives of Puerperal Women, Who are Registered to Certain Family Health Centers in Tokat Province of Türkiye, With Their Support Needs and The Support Received by Them in the Postpartum Period

Background: The postpartum period is of critical importance to the health of the mother and newborn. It is presumed that the social support given during this period is likely to provide numerous benefits for the health of the mother, newborn, family, and accordingly the society. Objectives: This research was conducted to evaluate puerperal women’s needs for support, the support received by them, and the quality of their lives and identify the relationships between these variables. Methods: This descriptive and correlational research included a sample of 270 puerperal women registered at nine family health centers in Tokat province of Türkiye. The research data were collected by using the Introductory Information Form, the Postpartum Support Questionnaire, and the Maternal Postpartum Quality of Life Questionnaire. In the evaluation of the data; descriptive statistics, independent samples t-test, Mann Whitney U test, one-way ANOVA, Kruskal-Wallis H test, LSD Post Hoc test and Pearson correlation analysis were used. Results: In this research, the mean scores obtained by puerperal women from the “importance of the need” scale and the “received support” scale of the Postpartum Support Questionnaire were found respectively as 122.24±49.51 and 140.54±43.57 whilst the mean of puerperal women’s Maternal Postpartum Quality of Life Questionnaire scores was 23.51±3.25. Also, in the research, it was found that puerperal women’s Maternal Postpartum Quality of Life Questionnaire scores had statistically significant negative relationships with scores obtained by them from the “importance of the need” scale of the Postpartum Support Questionnaire (r=-.30, p=.000) and its material support sub-scale (r=-.30, p=.000), emotional support sub-scale (r=-.30, p=.000), and informational support sub-scale (r=-.25, p=.000). Besides, it was identified that puerperal women’s Maternal Postpartum Quality of Life Questionnaire scores had statistically significant positive relationships with scores obtained by them from the material support sub-scale (r=.24, p=.000) and emotional support sub-scale (r=.12, p=.000) of the “received support” scale of the Postpartum Support Questionnaire. Conclusion: In this research, it was found that the need for support felt by puerperal women was not at a significant level whilst the support received by puerperal women for this need was excessive. There was a relationship between the support needs of the postpartum women in the postpartum period and the support they receive and their quality of life. In order to improve the quality of life of puerperal women, health professionals working in primary health care, especially midwives and nurses, should inform the woman and her family about the importance of postpartum social support and help plan the social support program in line with the needs of puerperal women.

DOMINANT FACTORS INFLUENCING THE LEVEL OF COMPLIANCE WITH THE USE OF PPE (AMONG CONSTRUCTION WORKERS IN REHABILITATION AND MAINTENANCE OF COMMUNITY HEALTH CENTER IN TUBAN DISTRICT)

Compliance to always wear personal protective equipment is one of the important factors in reducing the number of work accidents. Factors that become the basis for compliance behavior in wearing personal protective equipment are very diverse, one of which is company regulations, supervision, worker knowledge, availability of personal protective equipment, rewards and punishments, and worker attitudes. Research at the Tuban Regency Health Center aims to analyze the dominant factors that influence the level of compliance with the use of PPE in rehabilitation and maintenance construction workers. Quantitative research using observational methods and cross-sectional design. The study population involved rehabilitation and maintenance construction workers of Puskesmas in Tuban Regency, with a sample of 53 workers selected using probability sampling technique with simple random sampling. The level of compliance with the use of PPE as the dependent variable while knowledge, attitude, peer encouragement, HSE inspection, reward, and punishment as independent variables. The instrument used a questionnaire. Data analysis using Multiple Logistic Regression statistical test with SPSS. The test results obtained ap value &lt;0.05, with the attitude variable having the highest Exp(B) value (14.423) compared to other variables, meaning that there is an influence of knowledge, attitude, peer encouragement, reward and punishment on the level of compliance with the use of PPE, and attitude is the most dominant factor. The suggestion for improvement is for the workforce to be more open to the concept of safety culture in the workplace.

Realizing Quality Health Services through Ergonomic Re-Design of the Medical Records Room at the Kedungkandang Community Health Center

This community service activity aims to redesign the medical records room at the Kedungkandang Community Health Center by applying ergonomic principles. The main goal of this redesign is to improve the quality of health services by creating a more comfortable and efficient work environment for medical records staff, as well as improving service flow to reduce patient waiting times. The methods used include in-depth interviews with staff, direct observation in the medical records room, and needs analysis based on ergonomic principles. Based on the data collected, various problems were found, such as non-optimal layout and inefficient equipment placement. The result of this activity was a new, more ergonomic design, which included reorganizing the registration counter, improving lighting, and improving ventilation. Although this design has not yet been implemented, the results of the service are expected to increase staff work efficiency and patient satisfaction after implementation. It is also hoped that this design can become a model for other health centers to improve the quality of health services.

Screening for diabetic retinopathy at a health centre in South Africa: A cross-sectional study

Background: In South Africa, screening for diabetic retinopathy (DR) is non-existent at the primary healthcare (PHC) level because of the absence of a screening programme. This leads to preventable vision loss.Aim: To describe the clinical characteristics and outcomes of eye screenings and subsequent referrals.Setting: Laudium Community Health Centre (CHC), a PHC facility in Tshwane.Methods: We conducted a cross-sectional study from February 2022 to August 2022. Individuals with diabetes were screened for eye complications using visual acuity testing, intraocular pressure measurement, and fundoscopy with a non-mydriatic digital fundus camera. Fundus images were analysed by an optometrist and an artificial intelligence (AI) programme. Demographic and clinical data were collected.Results: A total of 120 participants were included, with the majority (60.7%) from Laudium CHC. Most participants (64.2%) were on oral agents, and 66.7% were women. The mean haemoglobin A1c (HbA1c) was 8.3%, with a median diabetes duration of 8 years. Artificial intelligence detected more glaucoma cases (17.5% vs 9.2%) and DR (23.3% vs 15.8%) compared to the optometrist. In contrast, the optometrist identified more cases of macula pathology (29.2% vs 19.2%). Participants (n = 79) were referred to an ophthalmologist for diagnosis confirmation and management.Conclusion: The study revealed that while DR was not highly prevalent among PHC patients with diabetes, there was a significant referral rate for other ocular complications. Artificial intelligence can enhance early detection and improve efficiency.Contribution: The findings underscore the need to integrate diabetes eye screening programmes into PHC services for people living with diabetes.

Prevalence of Being Obese, Overweight, and Underweight Among Jordanian Children and Adolescents Based on International Growth Standards.

The rise of obesity and other nutrition-related conditions among children and adolescents is a global challenge, particularly in the Middle East. This study aimed to determine the prevalence of being underweight, overweight, and obese among Jordanian children and adolescents using the body mass index (BMI) percentiles of the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) standards. This retrospective cross-sectional/longitudinal study analyzed 58,474 (42.6% males; 57.4% females) height, weight, and BMI-for-age records from 31508 healthy Jordanian children and adolescents aged 2-19 years. The data were retrieved from the Ministry of Health's nationwide electronic database (2017-2023) and assessed using the CDC and WHO growth standards. Logistic regression was performed to assess the variables associated with overweight/obese status. The prevalence of being underweight, overweight, and obese varied by the reference used, as more cases of being obese and underweight were reported when applying the CDC standards. The regression models showed the males had significantly lower odds of being overweight and obese than the females. Increased age was associated with higher odds of being overweight and obese, with annual increases observed across all age groups. Using the WHO and CDC standards, the prevalence of being underweight was higher in the males aged 6 years and older, while being overweight and obese was more prevalent in the females. The observed annual increase in the prevalence of being overweight and obese underscores the need for targeted strategies. Growth references tailored to regional profiles may improve national nutrition policies for Jordanian children and adolescents.

Is the Family Health Center Professionals' Knowledge Level About Child Abuse and Neglect Sufficent? A Comprehensive Field Study.

Child abuse and neglect bring lots of undesirable consequences for the future of children and societies with it. It is expected that health service providers have sufficient knowledge about that subject in order to determine abuse and neglect. In this study, a 67-item scale with a Cronbach's alpha value of 0.92 was used. A score of more than 3 on the scale meant that the score was at a sufficient level. The universe of this descriptive study is health professionals working in 512 family health units in Mersin, Türkiye. Interviews were conducted with 97.26% (n = 249) of family physicians and 98.04% (n = 251) of family health workers working in the 256 units included in the sample. Since the overall scale score of the study group was above 3, it (3.77 ± 0.36) was determined that the average score of the participants was sufficient. 46.2% (n = 231) of the group did not receive training on child neglect and abuse during their education, and 45.2% (n = 226) during their work. 95.8% stated that they paid attention to signs of abuse and neglect in children brought for examination and follow-up, while 83.4% stated that they had not encountered any cases in the last year. 42% (n = 210) of the group thought that the relevant authorities would not take the necessary action even if they observed signs of child neglect and abuse, while 37.4% (n = 187) stated that they did not know when and how to report. Although the findings of the study suggest that the group's level of knowledge is sufficient, it is of great importance to increase their knowledge about reporting processes and to encourage them in this regard.

Engaging Students as Health Cadres in the Implementation of a Healthy Campus

Background: The younger generation has a very important role in determining the success of health development. Efforts to mobilize youth in public health development can be made in the form of participation as health cadres. Universities or campuses as student affairs have a strategic role in creating a healthy and superior young generation. To describe the implementation of student health cadre training as part of healthy campus activities at one of the private universities in Yogyakarta, Indonesia. Methods: Student health cadre training is part of the healthy campus program which was implemented on October 28, 2021, in collaboration with the Public health office dan Public Health Center at Sleman Regency Yogyakarta. Training materials include healthy living skills education, the urgency of student health cadres, and smoke-free area ambassadors. 30 student representatives were invited to attend the training but participation was voluntary. The criteria for training participants are students who are active in student activities and taken purposively. Results: The student health cadre training was carried out as planned and 30 students participated from start to finish. Participants were enthusiastic during the training and at the end of the session it was agreed to create a WhatsApp group as a follow-up to the program. Based on the pre-test and post-test, there was an increase in student knowledge about healthy life skills education from a score 69,67 to 78,67 after training with P value &lt; 0,05. In addition, training participants are committed to helping realize a healthy campus, such as admins on healthy campus social media. Conclusion: Student health cadre training is an important activity in the implementation of a healthy campus. This activity is a form of student involvement as a healthy campus course. Students who have attended the training are expected to be pioneers of peer educators for other students in terms of practicing a healthy lifestyle.

Predictors of Pulmonary Tuberculosis Prevention in Surabaya, Indonesia

Background: Pulmonary tuberculosis (TB) continues to pose a critical public health challenge in Indonesia, characterized by high transmission rates, particularly within household settings. Despite extensive efforts to mitigate the spread of TB, persistent barriers such as low adherence to prevention and treatment protocols hinder progress. Identifying the factors that influence adherence is essential to optimizing the efficacy of intervention strategies. This study aims to investigate the key predictors influencing adherence to preventive measures for pulmonary TB transmission in Surabaya City. Methods: A quantitative research design employing a cross-sectional approach was utilized. Data were collected from 225 pulmonary TB patients attending community health centers in Surabaya City between September and December 2023. The variables examined included demographic characteristics, perceived benefits, barriers, susceptibility, severity, and self-efficacy. Statistical analysis was conducted using multiple logistic regression, with significance set at p&lt;0.05. Results: Significant predictors of adherence included age (p=0.048; OR=0.413), gender (p=0.009; OR=0.328), socioeconomic status (p=0.033; OR=3.052), perceived benefits (p=0.009; OR=10.086), barriers (p=0.007; OR=0.704), and self-efficacy (p=0.005; OR=29.335). Patients aged above 45 years, those reporting higher perceived benefits, and those with greater self-efficacy demonstrated higher adherence to TB prevention measures. These findings underscore the importance of self-efficacy, perceived benefits, and socioeconomic factors as significant determinants of adherence. The study's contribution lies in its exploration of adherence predictors within a high-risk population, offering valuable insights to inform targeted public health interventions. Conclusion: Age, perceived benefits, barriers, and self-efficacy emerged as critical predictors of adherence to pulmonary TB prevention strategies in Surabaya City. Interventions aimed at strengthening self-efficacy and providing targeted educational programs for younger populations are recommended to enhance TB control efforts. Additionally, integrating these findings into broader public health frameworks, such as national TB control strategies, can amplify their impact and contribute to improved health outcomes.

Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living.

Functional dependence on the performance of basic activities of daily living (ADLs) is associated with increased mortality. In this study, the Barthel index and its activities discriminate long-term mortality risk, and whether changes in this index are necessary to adapt it to detect mortality risk is examined. Longitudinal study, carried out at the Orcasitas Health Center, Madrid (Spain), on the functional dependent population (Barthel ≤ 60). It included 127 people, with a mean age of 86 years (78.7% women and 21.3% men). Functional capacity was assessed using the Barthel index, and this index and each item it contains were analyzed as a test in relation to survival at three years, using tools that evaluate precision, discrimination, and calibration. The date of death was obtained from the health system. Greater dependency to perform chair-to-bed transfers was associated with an increased mortality risk (HR 2.957; CI 1.678-5.211). Also, individuals with severe (HR 0.492; CI 0.290-0.865) and moderate (HR 0.574; CI 0.355-0.927) ADL dependence had a reduced mortality risk when more independent in chair-to-bed transfers. Among people with moderate ADL dependence, this percentage was 48%. Using dependence-independence for chair-to-bed transfer as a screening test for mortality, the test showed high sensitivity (0.91) and specificity (0.83), a positive likelihood ratio of 5.45, and a negative likelihood ratio of 0.11. The area under the ROC curve was 0.814 (CI 0.658-0.970; p = 0.001), with a χ 2 = 0.235; p = 0.889, according to the Hosmer-Lemeshow test. The concordance C index was 0.814. According to Nagelkerke's R2, the model explained 53.1% of the variance in survival. As a screening test, "chair-to-bed transfer" was superior to the Barthel index. ADL dependence for chair-to-bed transfers is an independent risk factor for mortality for any level of dependency. Therefore, a new classification of the Barthel index is proposed, in which "being dependent or requiring great assistance to perform chair-to-bed transfers" is considered severe dependence, even when the total score obtained via the Barthel Index is ≥40. We propose its use as a screening test in parallel to the Barthel index. The study suggests that the Barthel Index may have limitations in adequately discriminating mortality risk.

An Explorative Study on Knowledge, Attitudes, and Coronavirus Disease 2019 Vaccine Intention among Parents in India.

India's National COVID Vaccination Program recommended vaccination of children ages 6-12 years in April 2022. This study assessed vaccine acceptance among mothers to better understand potential barriers and facilitators of national acceptance of pediatric coronavirus disease 2019 (COVID-19) vaccination. Qualitative data were collected through three focus group discussions (FGDs) with mothers who had children younger than 12 years of age; FGD-1 was composed of mothers who worked at a tertiary medical center in India, whereas FGD-2 and FGD-3 were composed of mothers who sought care at urban and rural community health centers. Investigators recorded, transcribed, translated, and analyzed FGDs by inductive thematic analysis. Emerging themes related to pediatric COVID-19 vaccination were categorized as knowledge and awareness, attitudes and perception, vaccine intent and facilitators, and future recommendations to promote vaccine uptake. FGD-2 and FGD-3 participants displayed limited knowledge and false beliefs regarding the pediatric COVID-19 vaccine, but mothers in FGD-1 demonstrated adequate knowledge, likely because they are health care providers. Mothers in all three FGDs expressed COVID-19 vaccine hesitancy because of concerns of side effects and low disease prevalence in children. They reported much more fear about giving the vaccine to their children than they felt about receiving it themselves. Overall, education was negatively correlated with vaccine knowledge, but mothers in all groups shared similar hesitancy about their intention to accept the vaccine for their children. Educating parents in India about the COVID-19 vaccine, especially its safety and efficacy in children, is crucial to the success of a national vaccine program.

Barriers and Facilitators to Video Telehealth Use in Low-Income Hispanic Patients: A Theory of Planned Behavior Perspective.

As telehealth grows in ubiquity, it is important to understand the barriers and facilitators to telehealth utilization in historically marginalized populations. This study utilizes the Theory of Planned Behavior (TPB) to assess correlates of the intention to utilize video consultations among low-income Hispanic patients. This cross-sectional observational study included participants (N=138) recruited from a federally qualified health center affiliated with a large university health system. Components of the TPB were assessed using an in-person survey. Participant survey responses were analyzed using multiple logistic regression to identify correlates of participants' intention to utilize video consultations. Multiple logistic regression revealed subjective norms (adjusted odds ratio (aOR [95% CI])=3.29 [1.66, 6.52], P =.001) as the only significant correlate of participants' intention to utilize video consultations. Attitudes toward video consultations (aOR [95% CI]=1.32 [0.60, 2.89], P =.49) and perceived behavioral control (1.72 [0.89, 3.32], P =.11) did not independently correlate with behavioral intention. Ratings of subjective norms were independently correlated with intention to utilize video consultations among low-income, predominantly Spanish-speaking Hispanic adults. These results suggest a potentially central role of relational influences in determining telehealth engagement in this population.

HUBUNGAN KECEMASAN DAN PENGETAHUAN PENGGUNAAN OBAT DENGAN KEPATUHAN MINUM OBAT PENDERITA HIPERTENSI

Background: Hypertension is a major cause of cardiovascular disease and premature death worldwide. Compliance with hypertension treatment plays an important role because it is long term process to control the blood pressure. This study aims to see whether anxiety and knowledge of drug use can affect medication adherence in patients with hypertension. Methods: This study was an analytic observational design with a cross-sectional approach. The sample was patients with hypertension who visited Grogol Health Center. The sample selection technique was consecutive non-random sampling. Data were obtained through interviews and questionnaire. Anxiety variable data was obtained through the Hamilton Anxiety Rating Scale (HARS) questionnaire, the knowledge variable was obtained through a drug use knowledge questionnaire and the medication adherence variable was obtained through the Morisky Medication Adherence Scale (MMAS) questionnaire . Data obtained were analyzed using the Chi-square test and Fisher's exact. Results: Study on the relationship between anxiety and knowledge of drug use with drug compliance in hypertension was conducted on 134 respondents showing a value of p=0.986 and p=0.403. Conclusion: There was no significant relationship between anxiety and knowledge of drug use with antihypertensive drug compliance in patients with hypertension at Grogol Community Health Center.

Implementation and evaluation of a novel community-based urban mobile health clinic in Toronto, Ontario.

Despite Canada's single-payer health system, marginalized populations often experience poor health outcomes and barriers to healthcare access. In response, mobile health clinics (MHCs) have been deployed in several cities across Canada. MHCs are wellestablished in the United States; however, little is known about their role and impact in a country with universal healthcare. We describe the implementation of an urban MHC and early learnings from a mixed methods process and outcome-oriented evaluation. In February 2021, Parkdale Queen West Community Health Centre, TELUS Health for Good, and University Health Network's Gattuso Centre for Social Medicine partnered to launch a nurse practitioner‒led, community-based MHC in Toronto, Ontario. The MHC provides low-barrier primary healthcare, harm reduction, and mental health services at five convenient locations. Through an intercept survey (n = 49) and semi-structured interviews (n = 10), we sought to understand the sociodemographic characteristics of clients, their experiences at the MHC, and barriers and facilitators to the MHC in comparison to traditional healthcare settings. Most clients surveyed reported being homeless (61%). Without the MHC, 37% of clients would have accessed care at an emergency department and 18% would not have sought care. Thematic analysis revealed two structural and two relational factors that improved care experiences and care access. We demonstrate that in a single-payer health system, MHCs alleviate major barriers to care access for marginalized populations. Learnings provide context to the most salient factors influencing clients' decisions to seek care at MHCs and can inform how these outreach models are designed.

Bilingual Perspectives of Functional Dyspepsia Management in People from Underserved Areas.

Disorders of gut-brain interaction (DGBIs), like functional dyspepsia (FD), are prevalent and challenging conditions. In other gastrointestinal (GI) disorders, individuals from underserved areas (UAs) have difficulty accessing care. Little is known about UA FD patient perspectives of their care, especially in those with limited English proficiency (LEP). We aimed to characterize patients' experiences with FD management with the goal of informing future studies targeting DGBI management in potentially vulnerable communities residing in UAs. Participants meeting FD criteria were identified in two community health centers affiliated with a large academic medical center in the northeastern United States. Semi-structured interviews were conducted in English and Spanish. Transcripts were reviewed by a bilingual panel of investigators using the constant comparative method of iterative data acquisition. Psychosocial stressors and GI symptom severity were assessed. A total of 26 participants were interviewed (12 English-speaking, 14 Spanish-speaking). Broadly, GI symptoms were mild and there was mild-to-moderate psychological distress present. Adverse social determinants of health were highly prevalent. Despite mild symptom severity on objective scales, FD severely impacted quality-of-life and interfered with physical, psychological, and social wellbeing, including avoidance of certain foods and professional/social situations. Study subjects (particularly those of LEP status) reported difficulty in receiving care. Thematic saturation was achieved. Even when symptoms were mild, interviewees from UAs reported significant FD-related impairment, along with psychological distress. Education interventions targeting FD-related care in UAs should be designed to improve shared decision-making in FD, sensitive to the burden of social determinants of health.