Health Care Research Articles

Working practices and integration of primary health care doctors in remote rural areas in Brazil: a qualitative study.

Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas.

Real-Time Workload Assessment to Enhance Performance.

Workforce shortages, increasing costs, decreased reimbursement, and focus on quality outcomes are crucial issues for health care leaders. To remain competitive, profitable, and productive, health care organizations need to provide structure, a safe working environment, and an acceptable leader workload to guarantee effective leader performance. Poorly designed work environments and interfaces can increase workload resulting in decreased performance and satisfaction. Excessive workload has led to reduced job satisfaction, productivity, and resilience. Due to leadership turnover and vacancy rates, leader workload was perceived to be unreasonable in the respiratory therapy (RT) department of an academic medical institution in central North Carolina. The aim of this quality initiative was to explore the workload of health care leaders in the RT department to identify the factors that influenced workload as well as implement strategies to decrease perceived workload. A workload assessment was performed, which identified inefficiencies and opportunities to partner with ancillary departments to align the workload with appropriate clinical teams. The redistribution of workload provided alignment, top of scope practice, and improved satisfaction among the RT department leaders. This article identifies the strategies utilized which can be translated to other institutions.

Burden of noncommunicable diseases and COVID-19 pandemic prevention and control strategies

Noncommunicable diseases (NCDs) are the leading cause of death in 21st century. The risk factors for development and progression of NCDs include sedentary lifestyle, inadequate fruits and vegetables intake, tobacco use, high blood pressure, high total cholesterol levels, obesity, high salt intake, low physical activity, and air pollution. People with NCDs and comorbidities like hypertension, cardiovascular diseases, diabetes, chronic respiratory infection and cancer are more vulnerable to severe COVID-19 infection that ultimately results into mortality. To reduce the impact of NCDs on COVID-19 cases, prevention is the best measure. Primary and secondary level prevention of NCDs plays a main role to control bad outcome in COVID-19 cases. The strategies that are required to address this comorbidity includes integration and convergence of the existing communicable and NCD programs, strengthening health care systems by giving major focus on primary health care services, health and wellness centers, universal health coverage, updating guidelines, enhancing community participation, capacity building, appropriate policy making, multi-sectoral participation and coordination.

Effectiveness of a Smartphone-Based Stress Management Program for Depression in Hospital Nurses During COVID-19 in Vietnam and Thailand: 2-Arm Parallel-Group Randomized Controlled Trial.

During the COVID-19 pandemic, health care professionals experienced high levels of depression. However, extant research has not highlighted effective internet-based psychological interventions to improve the mental health in this population during the pandemic. It remains unclear whether self-guided, internet-based cognitive behavioral therapy (iCBT) programs are effective in improving the mental health of health care workers during the COVID-19 pandemic. The aim of this study was to evaluate the effectiveness of a smartphone-based iCBT stress management program for reducing the depression experienced by nurses in Vietnam and Thailand. From March to April 2022, a 2-arm, parallel-group randomized controlled trial was implemented. One arm offered a 7-week self-guided iCBT program, and the other offered treatment as usual as a control arm. Full-time nurses were recruited from 6 hospitals: 2 hospitals in Vietnam and 4 hospitals in Thailand. The primary outcome of this program was the severity of depression measured by the Depression Anxiety Stress Scale-21 items. Follow-up surveys were conducted to measure the change in depression severity at 3 months (July-August 2022) and at 6 months (October-November 2022) after baseline. Mixed modeling for repeated measures was used to test the effects of the intervention compared with the control for the follow-up. A total of 1203 nurses were included in this study: 602 in the intervention group and 601 in the control group. The follow-up rate at 3 and 6 months ranged from 85.7% (515/601) to 87.5% (527/602). The completion rate for the program was 68.1% (410/602). The group difference in depression was significant at the 3-month follow-up (coefficient=-0.92, 95% CI -1.66 to -0.18; P=.02) and nonsignificant at the 6-month follow-up (coefficient=-0.33, 95% CI -1.11 to 0.45; P=.41). The estimated effect sizes were -0.15 and -0.06 at the 3- and 6-month follow-ups, respectively. Our study shows that the smartphone-based iCBT program was effective in reducing depression at the 3-month follow-up among hospital nurses in Vietnam and Thailand during the COVID-19 pandemic. However, the effect size was small, and therefore, these results may not be clinically meaningful. UMIN Clinical Trials Registry UMIN000044145; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050128. RR2-10.20944/preprints202303.0450.v1.

Evaluation of Digital Mental Health Technologies in the United States: Systematic Literature Review and Framework Synthesis.

Digital mental health technologies (DMHTs) have the potential to enhance mental health care delivery. However, there is little information on how DMHTs are evaluated and what factors influence their use. A systematic literature review was conducted to understand how DMHTs are valued in the United States from user, payer, and employer perspectives. Articles published after 2017 were identified from MEDLINE, Embase, PsycINFO, Cochrane Library, the Health Technology Assessment Database, and digital and mental health congresses. Each article was evaluated by 2 independent reviewers to identify US studies reporting on factors considered in the evaluation of DMHTs targeting mental health, Alzheimer disease, epilepsy, autism spectrum disorder, or attention-deficit/hyperactivity disorder. Study quality was assessed using the Critical Appraisal Skills Program Qualitative and Cohort Studies Checklists. Studies were coded and indexed using the American Psychiatric Association's Mental Health App Evaluation Framework to extract and synthesize relevant information, and novel themes were added iteratively as identified. Of the 4353 articles screened, data from 26 unique studies from patient, caregiver, and health care provider perspectives were included. Engagement style was the most reported theme (23/26, 88%), with users valuing DMHT usability, particularly alignment with therapeutic goals through features including anxiety management tools. Key barriers to DMHT use included limited internet access, poor technical literacy, and privacy concerns. Novel findings included the discreetness of DMHTs to avoid stigma. Usability, cost, accessibility, technical considerations, and alignment with therapeutic goals are important to users, although DMHT valuation varies across individuals. DMHT apps should be developed and selected with specific user needs in mind.

Prevalence of alcohol use disorders documented in electronic health records in primary care across intersections of race or ethnicity, sex, and socioeconomic status.

Diagnosis of alcohol use disorder (AUD) in primary care is critical for increasing access to alcohol treatment. However, AUD is underdiagnosed and may be inequitably diagnosed due to societal structures that determine access to resources (e.g., structural racism that limits opportunities for some groups and influences interpersonal interactions in and beyond health care). This study described patterns of provider-documented AUD in primary care across intersections of race, ethnicity, sex, and community-level socioeconomic status (SES). This cross-sectional study used EHR data from a regional healthcare system with 35 primary care clinics that included adult patients who completed alcohol screenings between 3/1/2015 and 9/30/2020. The prevalence of provider-documented AUD in primary care based on International Classification of Diseases-9 (ICD-9) and ICD-10 diagnoses was compared across intersections of race, ethnicity, sex, and community-level SES. Among 439,375 patients, 6.6% were Latine, 11.0% Asian, 5.4% Black, 1.3% Native Hawaiian/Pacific Islander (NH/PI), 1.5% American Indian/Alaska Native (AI/AN), and 74.2% White, and 58.3% women. The overall prevalence of provider-documented AUD was 1.0% and varied across intersecting identities. Among women, the prevalence was highest for AI/AN women with middle SES, 1.5% (95% CI 1.0-2.3), and lowest for Asian women with middle SES, 0.1% (95% CI 0.1-0.2). Among men, the prevalence was highest for AI/AN men with high and middle SES, 2.0% (95% CI 1.1-3.4) and 2.0% (95% CI 1.2-3.2), respectively, and lowest for Asian men with high SES, 0.5% (95% CI 0.3-0.7). Black and Latine patients tended to have a lower prevalence of AUD than White patients, across all intersections of sex and SES except for Black women with high SES. There were no consistent patterns of the prevalence of AUD diagnosis that emerged across SES. The prevalence of provider-documented AUD in primary care was highest in AI/AN men and women and lowest in Asian men and women. Findings of lower prevalence of provider-documented AUD in Black and Hispanic than White patients across most intersections of sex and SES differed from prior studies. Findings may suggest that differences in access to resources, which vary in effects across these identity characteristics and lived experiences, influence the diagnosis of AUD in clinical care.

Advancements in NMN biotherapy and research updates in the field of digestive system diseases.

Nicotinamide mononucleotide (NMN), a crucial intermediate in NAD + synthesis, can rapidly transform into NAD + within the body after ingestion. NMN plays a pivotal role in several important biological processes, including energy metabolism, cellular aging, circadian rhythm regulation, DNA repair, chromatin remodeling, immunity, and inflammation. NMN has emerged as a key focus of research in the fields of biomedicine, health care, and food science. Recent years have witnessed extensive preclinical studies on NMN, offering valuable insights into the pathogenesis of age- and aging-related diseases. Given the sustained global research interest in NMN and the substantial market expectations for the future, here, we comprehensively review the milestones in research on NMN biotherapy over the past 10 years. Additionally, we highlight the current research on NMN in the field of digestive system diseases, identifying existing problems and challenges in the field of NMN research. The overarching aim of this review is to provide references and insights for the further exploration of NMN within the spectrum of digestive system diseases.

Perceived health and working life in caregivers from nursing homes that used or did not use nighttime personalized non-pharmacological therapies to address residents’ behavioral and psychological symptoms of dementia.

Dementia is frequent in nursing home (NH), affecting between 40 and 50% of the residents and is associated in 90% of the cases with behavioral and psychological symptoms (BPSD) which are detrimental to caregivers’ working life and perceived health. We compared perceived health and working life between NHs that used or did not use nighttime personalized non-pharmacological therapies (PNPT) to address BPSD. This anonymous survey included 96 caregivers from 25 NHs which used (n = 69) or not (n = 27) nighttime PNPT. Perceived health, nursing and medical care, quality of care and internal motivation were significantly higher, stress symptoms and workload were significantly lower and there was a tendency to enhanced satisfaction with work in caregivers from NHs which used nighttime PNPT. Our present data open a new window on the benefits of PNPT.

The relationship between oral health and dental care usage behavior and health-related quality of life (EQ-5D) in women who have experienced pregnancy and childbirth

Objectives: This study analyzed raw data from the 8th National Health and Nutrition Examination Survey (2019-2021) to assess the impact of oral health problems and dental care usage patterns of women who have experienced pregnancy and childbirth. Methods: Out of the 2,389 participants with pregnancy and childbirth experience, 1,301 were included in the final analysis. Multiple regression analysis was conducted using to determine the influencing factors on EQ-5D. Results: Factors influencing EQ5D include general characteristics (age, family income (5 quintile), status of basic living subsistence, education level), oral health problems (chewing problems, complaints of chewing discomfort, speaking problems) (p<0.001). Conclusions: The oral health problems and dental care usage patterns of women who experience pregnancy and childbirth have a significant impact on their health-related quality of life. This study provides basic data for women’s ongoing oral care.

Mental health disparities among first generation immigrants to the US

Mental health disparities among first-generation immigrants to the United States are intricately linked to the historical and sociopolitical context of immigration. The Immigration and Nationality Act of 1965 and policies such as Deferred Action for Childhood Arrivals (DACA) have shaped the demographic and experiential landscape of first-generation immigrants, influencing their mental health outcomes. Objective: This study aims to examine the mental health disparities experienced by first-generation immigrants in the United States, identifying the contributing factors and exploring effective strategies for addressing these disparities. Methods: A comprehensive literature review was conducted, analyzing studies on mental health outcomes among first-generation immigrants. The review focused on factors contributing to mental health disparities, including pre-migration experiences, migration-related stressors, post-migration challenges, and systemic barriers to mental health care access. The review also explored intersectionality and its impact on mental health, as well as case studies and examples of successful interventions. Results: The "immigrant paradox" suggests that immigrants often exhibit better mental health outcomes than native-born individuals, though this effect diminishes over time. Factors such as strong family ties and community support initially contribute to this mental health advantage. However, post-migration challenges, including acculturation stress, socioeconomic hardship, and discrimination, often lead to a decline in mental health. Certain mental health conditions, such as PTSD and anxiety disorders, are more prevalent among specific immigrant groups, particularly those fleeing conflict or persecution. Structural, cultural, and systemic barriers hinder access to mental health care, exacerbating disparities. Successful interventions often involve community-based approaches, culturally competent care, and integrated service models. Conclusion: Addressing mental health disparities among first-generation immigrants requires a multifaceted approach, including community engagement, policy interventions, and culturally competent care. By investing in research and implementing evidence-based interventions, it is possible to reduce mental health disparities and improve outcomes for first-generation immigrants. Future research should focus on long-term mental health trajectories, the impact of digital technologies, and the role of social networks.

Is COVID-19 related workload related to Chinese social workers’ mental health? A moderated mediation model of compassion burnout and emotional regulation

COVID-19-related workload is a significant determinant of social worker mental health, with limited exploration of the underlying mechanisms. This study investigates the mediating role of compassion burnout and the moderating effect of emotional regulation among 1023 Chinese social workers. Compassion burnout partially mediates the COVID-19 workload–depression relationship, while emotional regulation moderates this link and the impact of compassion burnout on depression. Notably, social workers with higher emotional regulation exhibit reduced susceptibility. This research advances our understanding of the COVID-19 workload’s impact on mental health and offers policy and organizational-level recommendations for safeguarding Chinese social workers’ well-being.

A study on scenario and assessment of health camps in north Karnataka by KLE’s Dr. Prabhakar Kore hospital: facilitate health care to community people

Background: Health-camps offering specific populations brief medical interventions could be helpful as 60% of India’s population lacks access to basic medical facilities. This study provides useful insights for organizing, planning, and implementing health-camps by epidemiologically analyzing a health-camp event in a rural area in southern India; arranging and planning health-camps, as well as using exit interviews to gauge participants’ expectations and levels of satisfaction; determine the health issues that impoverished residents of Belagavi district. Health-camp is a strategy for universal health coverage used by highly qualified doctors to offer the underprivileged affordable care. Methods: A self-structured questionnaire was utilized to interview 219 beneficiaries for the research. These were divided into sections containing participant sociodemographic data, 21 items that evaluate satisfaction of health camps and question concerning expectations of post camps. 4-point rating system was employed to collect the responses: poor (1) to excellent (4). Ages ≥14 for men or women. Along with medical or non-medical services, the questionnaire also included questions about camp site accessibility, reception counters, initial medical check-ups, screening tests, behavior of doctors and other staff, waiting times, drug supply, preliminary information, referrals, length of health camp, cleanliness, and camp performance overall. The participants’ average age was 40.2 years. Results: Both genders participated equally in study, 76% married and 46% participants studied up to high school. 59% of the participants, belong to a nuclear family, rural residence (81%), occupation 33% housewife and 26% business. More number of participants (46.51%) received information about camps through the village announcement. Conclusions: The health camp was conducted and appreciated by most of the participants and suggested to continue the same health camps programme to promote good health every one the area.

Are we making the most of safe staffing research.

The uptake of research evidence on staffing issues in nursing by nursing leadership, management and into organizational policies seems to vary across Europe. This study wants to assess this uptake of research evidence. Scoping survey. The presidents of twelve country specific Sigma Chapters within the European Region answered written survey questions about work organisation, national staffing levels, national skill mix levels, staff characteristics, and education. Seven of the 12 chapters could not return complete data, reported that data was unavailable, there was no national policy or only guidance related to some settings. Enhancing the awareness of nursing research and of nursing leaders and managers regarding staffing level evidence is not enough. It seems necessary to encourage nurse leaders to lobby for staffing policies. Research evidence on staffing issues in nursing and how it benefits health care is available. In Europe this evidence should be used more to lobby for change in staffing policies.

Increasing Knowledge About the Utilization of Public Health Insurance with Education RW 11 Jayagiri Village, Lembang District, West Bandung Regency

The community service aim to increase public understanding of the importance of health insurance. The implementation of activities carried out in August-October consists of preparation, implementation and closing which is carried out in the community in RW 11 of Jayagiri Village. Jayagiri Village is located in Lembang District, West Bandung Regency. The target number of community service activities is 40 people, consisting of elements: Jayagiri Village community, especially in RW 11, health cadres, and village governments and related agencies. The result of the analysis showed that before the implementation of counseling, only 54% of the public understood about health insurance and after counseling it rose to 63%, or an increase of 9%. The number of respondents was 29 people, with answers considered valid amounting to 28 respondents. It can also be seen below public understanding of health insurance increased by 7%, understanding of the components of health insurance increased by 11%, thus significantly encouraging understanding of health insurance by 25%. It also boosted public understanding of the risks in life which increased quite sharply by 21%. By having enough information about health insurance, people are better able to maintain health, prevent disease, and use preventive services provided by health insurance programs. Proper information about health insurance helps people understand the level of financial protection they have in relation to health care costs, so they can avoid unwanted financial surprises and better manage their family budgets.

Barriers in providing quality end-of-life care as perceived by nurses working in critical care units: an integrative review.

Despite increasing interest in quality end-of-life care (EOLC), critically ill patients often receive suboptimal care. Critical care nurses play a crucial role in EOLC, but face numerous barriers that hinder their ability to provide compassionate and effective care. An integrative literature review was conducted to investigate barriers impacting the quality of end-of-life care. This review process involved searching database like MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, EBSCO, and ScienceDirect up to November 2023. Search strategies focused on keywords related to barriers in end-of-life care and critical care nurses from October 30th to November 10th, 2023. The inclusion criteria specified full-text English articles published between 2010 and 2023 that addressed barriers perceived by critical care nurses. This integrative review employs an integrated thematic analysis approach, which combines elements of deductive and inductive analysis, to explore the identified barriers, with coding and theme development overseen by the primary and secondary authors. Out of 103 articles published, 11 articles were included in the review. There were eight cross-sectional descriptive studies and three qualitative studies, which demonstrated barriers affecting end-of-life care quality. Quality appraisal using the Mixed Method Appraisal Tool was completed by two authors confirmed the high credibility of the selected studies, indicating the presence of high-quality evidence across the reviewed articles. Thematic analysis led to the three main themes (1) barriers related to patients and their families, (2) barriers related to nurses and their demographic characteristics, and (3) barriers related to health care environment and institutions. This review highlights barriers influencing the quality of end of life care perceived by critical care nurses and the gaps that need attention to improve the quality of care provided for patients in their final stages and their fsmilies within the context of critical care. This review also notes the need for additional research to investigate the uncover patterns and insights that have not been fully explored in the existing literature to enhance understanding of these barriers. This can help to inform future research, care provision, and policy-making. Specifically, this review examines how these barriers interact, their cumulative impact on care quality, and potential strategies to overcome.

Role of Platelets and Their Interaction with Immune Cells in Venous Thromboembolism.

Venous thromboembolism (VTE) represents a significant global health challenge, ranking as the third leading cause of cardiovascular-related mortality. VTE pervades diverse clinical specialties, posing substantial risks to patient well-being and imposing considerable economic strains on health care systems. While platelets have long been recognized as pivotal players in hemostasis, emerging evidence underscores their multifaceted immune functions and their capacity to engage in crosstalk with other immune cells, such as neutrophils, thereby fostering immune-related thrombosis. Notably, investigations have elucidated the pivotal role of platelets in the pathogenesis of VTE. This review provides a comprehensive overview of platelet physiology, encompassing their activation, secretion dynamics, and implications in VTE. Moreover, it delineates the impact of platelet interactions with various immune cells on the initiation and progression of VTE, explores the correlation between platelet-related laboratory markers and VTE, and elucidates the role of platelets in thrombosis regression.

Variation in patient-sharing network characteristics of health care professionals treating different mental and substance use disorder patient sub-groups in primary care.

Providing efficient and targeted services for patients with mental health problems requires efficient collaboration and coordination within healthcare providers, but measuring collaboration using traditional methods is challenging. To explore the patient-sharing networks of professionals taking care of different groups of patients with mental or substance use disorders. We used data that covered adult patients' visits to the primary care service providers of seven municipalities in Finland during year 2021. Data included 8,217 patients (147,430 visits) with mental or substance use disorders who were treated by 1,566 health care professionals. We calculated descriptive network metrics to examine the connectivity of professionals in three different patient groups (patients with substance use disorders, psychotic disorders, and depressive disorders) and compared these characteristics to a network based on all patients. We also analyzed whether patient sharing was associated with the health care professionals' attributes (occupational group, municipality) using Exponential Random Graph Models (ERGM). Diagnosis-specific networks were denser and more connected compared to the all-patients network. Nurses were the most central occupation in all the diagnosis-specific networks and especially in the substance use disorder patients network. When examining all patients, two professionals were more likely to share patients when they belonged to the same occupational group. However, in the network with depressive disorder patients we found the opposite: professionals were more likely to share patients if they were of different occupational groups. Patient-sharing networks within patients with a specific mental or substance use disorders are denser and more connected than networks based on all patients with mental or substance use disorders. In the substance use disorder patients network particularly, nurses were the most central occupation. Multi-professional connections were more likely in depressive disorder networks than in the all-patients network.

Witzenberg Women's experience of health care after a miscarriage: A descriptive qualitative study.

Although some evidence is available from low- and middle-income countries, no South African data are available on how women experience healthcare during treatment for an incomplete miscarriage. This study sets out to explore and describe the experiences of healthcare among women who suffered an incomplete spontaneous miscarriage in the Witzenberg subdistrict, a rural area in the Western Cape province of South Africa. Witzenberg subdistrict, Western Cape province, South Africa. This study used a descriptive exploratory qualitative study design. In-person interviews were held with women who experienced a miscarriage. Interviews followed a semi-structured format by a single interviewer to explore the various aspects involving experiences of healthcare. Eight interviews were conducted and analysed. The five themes that arose from transcribed data were: (1) a need for safety, (2) pain management, (3) moderating behaviours and attitudes, (4) disorienting healthcare systems and (5) abandonment. Several factors contributed to the loss of physical and emotional safety in the emergency centre environment. Timeous emotional and pharmacological pain management were found to be a gap while patients awaited care. Clear communication and staff attitude were found to be integral to the patient's experience and could avoid the perception of abandonment. There is a universal need for basic respectful, supportive and safe care in patients who attend an emergency centre for early pregnancy complications in rural South African. Specific focus should be given to clear communication and appropriate emotional support during and after the miscarriage.Contribution:This study can be used as a guide to improve services by ensuring respectful, transparent, informed, and appropriate continuity of care.

Assessing and Comparing Musculoskeletal Knowledge and Red Flag Identification Skills: A Cross-Sectional Study of Physical Therapists and Primary Care Physicians

Background: Musculoskeletal disorders are one of the most common health issues often managed at the level of primary health care. Enabling physical therapists to be first-contact practitioner for patients with musculoskeletal disorders could improve patient access, expedite management, enhance outcomes and reduce costs. However, this role requires a high level of musculoskeletal knowledge and the ability to detect red flags. Objectives: To assess and compare the musculoskeletal knowledge and abilities to identify red flags between physical therapists and primary care physicians (PCPs). Methods: A cross-sectional study was undertaken using an electronic survey assessed participants’ musculoskeletal knowledge and ability to identify red flags. Study participants included physical therapist and PCPs practicing at Ministry of Health hospitals and/or primary care centers in Riyadh, Saudi Arabia. Results: A total of 60 physical therapists and 76 PCPs participated. Good knowledge levels (total score ≥ 75%) were found for 7% of physical therapists compared to 18% of PCPs, and moderate knowledge levels (total score 60-75%) were found in 70% of physical therapists compared to 62% of PCP participants (P=.003). Conclusion: Physical therapists and PCPs demonstrated an overall moderate level of musculoskeletal knowledge and the ability to identify red flags. The results suggest that with further education on red flags identification, physical therapists in Saudi Arabia could potentially act as first-contact practitioners for patients with musculoskeletal conditions.

Type 2 Diabetes Mellitus Patients, Profile, Achievement and Complications in Primary Health Care in Surabaya, Indonesia

Type 2 Diabetes Mellitus Patients, Profile, Achievement and Complications in Primary Health Care in Surabaya, Indonesia