Municipal Clinics Research Articles

Exploring Biochemical and Hematological Variations in Malaria Cases: A Retrospective Analysis at a Health Center at Mumbai City India

Introduction: In Mumbai, an overpopulated metropolis with tropical conditions, malaria poses a persistent challenge, particularly in damp slum areas. Despite reported declines in death and incidence rates, the city faces a significant burden. Our project focuses on an unusual aspect: a heightened incidence among males, especially during sporadic monsoon outbreaks and in areas undergoing extensive redevelopment. Through an epidemiological survey of infected populations in municipal clinics, supported by microscopic, hematological, and microbiological evidence, we aim to provide insights into this atypical pattern. Materials and Methods: A cross-sectional, partly retrospective study was designed with participants being sourced from regional slums and chawls, during the immediately preceding three-year period of project completion. Patients attending OPDs were randomly selected from amongst those with febrile symptoms related to malarial disease and tested. Symptomatic individuals were tested for malaria microscopically using peripheral blood smear (PBS) and confirmed by employing the malaria antigen test (RMAT). Blood urea by enzymatic method and serum creatinine by Jaffes method. Results: Out of 1651 participants, 8.18% were malaria-positive, predominantly males (87.41%). P. vivax was the main parasite (87.41%), followed by P. falciparum (6.67%) and mixed infections (5.93%). ANOVA revealed significant RBC count differences (F = 6.32, p = 0.003). Tukey's HSD test showed P. vivax patients had higher RBC counts than mixed infection (p = 0.002), while P. falciparum counts were similar to P. vivax (p = 0.089) but higher than mixed infection (p = 0.014). Predominance of P. vivax emphasizes its impact on RBC counts and diagnostic complexities. The p values indicate that for all parameters, except serum creatinine in males, there is a statistically significant difference in the mean values between the malaria positive and negative groups Conclusion: This study highlights high malaria prevalence in urban India, with males more susceptible, possibly due to increased mosquito exposure. P. vivax is predominant, aligning with national data, emphasizing the need for tailored control measures. Surprisingly, P. vivax is associated with higher RBC counts than P. falciparum or mixed infection, suggesting differences in erythrocytic cycles. These findings have critical implications for regional malaria management, prompting further research into underlying mechanisms.

Refer rather than treat: coping with uncertainty in municipal primary care clinics in India

PurposeThe institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical uncertainty in municipal clinics in urban India. As street-level bureaucrats, the municipal doctors occupy two roles simultaneously: medical professional and state agent. They operate under conditions that characterize health systems in low-resource contexts globally: inadequate state investment, weak regulation and low societal trust. The study investigates how, in these conditions, the doctors respond to clinical risk, specifically related to noncommunicable diseases (NCDs).Design/methodology/approachThe analysis draws on year-long ethnographic fieldwork in Pune (2013–14), a city of three million, including 30 semi-structured interviews with municipal doctors.FindingsInterpreting their municipal mandate to exclude NCDs and reasoning their medical expertise as insufficient to treat NCDs, the doctors routinely referred NCD cases. They expressed concerns about violence from patients, negative media attention and unsupportive municipal authorities should anything go wrong clinically.Originality/valueThe study contextualizes street-level service-delivery in weak institutional conditions. Whereas street-level workers may commonly standardize practices to reduce workload, here the doctors routinized NCD care to avoid the sociopolitical consequences of clinical uncertainty. Modalities of the welfare state and medical care in India – manifest in weak municipal capacity and healthcare regulation – appear to compel restraint in service-delivery. The analysis highlights how norms and social relations may shape primary care provision and quality.

Capturing growth indices on the road to health booklets in clinics in Free State, South Africa.

Growth monitoring plays an essential role in the development of young children. Anthropometric indices are of utmost importance for healthcare professionals to identify children at risk of inadequate growth and malnutrition. This study aimed to assess the capturing of the growth indices in the Road to Health Booklets (RTHB) in clinics. The study was carried out in Mangaung Metropolitan municipal clinics in the Free State province, South Africa. A descriptive quantitative study was conducted using a checklist to audit 264 RTHBs. Descriptive statistics were used to analyse data. The findings showed that birth weight was recorded in most 99% (n = 262) of the RTHBs. The mid-upper arm circumference (MUAC) was not recorded in 58% (n = 153) of the cases during the last visit. Weight-for-Age (WfA) was routinely plotted in 91% (n = 241) of the RTHB. The length or Height-for-Age (LHfA) was plotted in 38% (n = 99) of the RTHB and Weight-for-Length or height (WfLH) was plotted in 31% (n = 81) of the RTHB. The results demonstrated that certain anthropometric measures including MUAC, length, or height were absent from the records of the RTHB. Consequently, RTHB may not be effectively used as a means of evaluating nutritional status, affecting early detection of malnutrition in children. The research makes a valuable addition to the existing body of knowledge for monitoring growth and measurement of anthropometric indices in the RTHB, as well as the appropriate execution of these practices.

Primary care gatekeeping during the COVID-19 pandemic: a survey of 1234 Norwegian regular GPs.

In the Nordic healthcare systems, GPs regulate access to secondary health services as gatekeepers. Limited knowledge exists about the gatekeeper role of GPs during public health crises seen from the perspective of GPs. To document GPs' gatekeeper role and organisational changes during the initial COVID-19 lockdown in Norway. A cross-sectional online survey was addressed to all regular Norwegian GPs (n = 4858) during pandemic lockdown in spring 2020. Each GP documented how patients with potential COVID-19 disease were triaged and handled during a full regular workday. The survey also covered workload, organisational changes, and views on advice given by the authorities. A total of 1234 (25.4%) of Norway's GPs participated. Together, they documented nearly 18 000 consultations, of which 65% were performed digitally (video, text, and telephone). Suspected COVID-19 symptoms were reported in 11% of the consultations. Nearly all these patients were managed in primary care, either in regular GP offices (55.7%) or GP-run municipal respiratory clinics (40.7%), while 3.7% (n = 73) were admitted to hospitals. The GPs proactively contacted an average of 0.8 at-risk patients per day. While 84% were satisfied with the information provided by the medical authorities, only 20% were able to reorganise their practice in accordance with national recommendations. During the early stage of the COVID-19 pandemic in Norway, the vast majority of patients with COVID-19-suspected symptoms were handled in primary care. This is likely to have protected secondary health services from potentially detrimental exposure to contagion and breakdown of capacity limits.

Postpartum depression: The prevalence and associated factors among women attending postnatal clinics in the Bawku municipality, Upper East Region of Ghana.

This study examined postpartum depression (PPD) among mothers in the Bawku municipality of Ghana, aiming to assess its prevalence and associated risk factors. A total of 242 women, 2-12 weeks postpartum, were randomly recruited for this cross-sectional analytical study. The Edinburgh Postnatal Depression Scale was used for depression screening, and multivariate logistic regression analysis was employed to assess the factors associated with PPD. The study showed that 34.7% of the postpartum mothers were within the age range of 25-29, with a mean age of 27.9 (standard deviation [SD] ± 6.33). The prevalence of PPD was 50.4% (95% confidence interval [CI] 43.9-56.9). Several significant risk factors were identified, including inadequate prenatal visits (adjusted odds ratio [aOR] = 13.44, 95% CI 3.66-49.37, P < 0.001), obstetric complications (aOR = 3.39, 95% CI 1.23-11.19, P = 0.019), less than 3 weeks postpartum (aOR = 8.14, 95% CI 1.95, 33.94, P = 0.004), 6-8 weeks postpartum (aOR = 7.72, 95% CI 1.71-34.80, P = 0.008), and stressful life events (aOR = 3.30, 95% CI 1.23-8.89, P = 0.018). The study concluded that the prevalence of PPD in the Bawku municipality is higher than previously reported in Ghana, emphasizing the need for early identification of pregnant women at risk for PPD.

Laboratory characterization of patients with chronic renal failure in resource-limited settings, with special reference to the post-COVID-19 milieu

Chronic kidney disease (CKD), a known global burden involving costly diagnostic and therapeutic modalities, is rampant in urban Indian localities. This study attempts to characterize a subset of proven CKD patients attending out-patient municipal clinics and dispensaries in Mumbai, with an emphasis on the post-COVID scenario. A cross-sectional and longitudinal study was executed in 60 such subjects along with an appropriate number of normal, healthy controls, who were routinely monitored i) up to March 2020, and ii) post-April 2022, the intervening period overlapping with extremely poor and even negligible patient attendance during the COVID-19 pandemic. CKD was estimated by its two most often utilized surrogate markers, serum creatinine and blood urea nitrogen. Amongst the participants, we observed slightly increased values in the aforesaid biomarkers, the underlying aetiology of which has not, to our knowledge, been studied in detail. We recommend comprehensive additional studies in order to corroborate our findings.

The concept of preventive care in the pediatric population with risk factors for the malocclusion development and prevention of severe malocclusion in children aged 3-12 years old

Relevance. Malocclusion prevention in Russian children is an urgent medical and social problem. The results of Russian epidemiological studies show malocclusion prevalence and severity increase in children with age. Postgrowth orthodontic treatment is costly and often inaccessible for the most population. In the current situation, malocclusion prevention organization in children is one of the most important tasks of public healthcare.Purpose. To propose and substantiate a new model for the prevention of severe malocclusion in children.Materials and methods. We have created a new conceptual model for the prevention of severe malocclusion in children to develop a methodology that provides unified approaches to malocclusion prevention.Results. The model involves the construction of a two-level system of pediatric preventive care based in the city, municipal multidisciplinary dental clinics. The model novelty is determined by the new concept of the primary prevention of malocclusion and early orthodontic treatment (EOT) processes to prevent severe malocclusion (secondary prevention) as a single system that provides a positive result in maxillofacial development in children. The introduction of a pediatric dentist as an operator and a coordinator of the prevention program implementation into the structure of preventive care for children's malocclusion determines the novelty of the prevention system conceptual model. The proposed conceptual model prioritizes an orthodontist who provides secondary prevention of severe malocclusion by early orthodontic treatment (EOT) to children during the growth and development of malocclusions. The introduction of a malocclusion assessment to identify the EOT need score also determines the novelty of the malocclusion secondary prevention subsystem. The model places a high value on the management function/ management issues. Severe malocclusion prevention program implementation in children requires changing the paradigm of doctors, namely, pediatric dentists and orthodontists.Conclusion. The presented concept of the two-level malocclusion prevention organization (primary prevention of malocclusion in toddlers and preschoolers and secondary prevention of severe malocclusion by EOT in children aged 3-12 years) will allow for the reduction of the number of severe malocclusions during dental and facial development and for the need of complex treatment at later stages, will contribute to children health preservation, their social adaptation and the child and family quality of life increase.

Introducing a Sexual Wellness Clinic to an At-Risk Population Through the Emergency Department.

Rates of sexually transmitted infections (STIs) in the United States have continued to increase for nearly a decade as state and local health departments across the country have divested from sexual health services. The resulting closure of municipal STI clinics has led many uninsured and underinsured patients to rely on emergency departments for their sexual health needs. The authors describe the creation of the novel Sexual Wellness Clinic at University of Chicago Medicine in February 2019. The clinic provides comprehensive sexual health care to establish linkage to pre-exposure prophylaxis (PrEP) for HIV, primary care, and other essential services to patients presenting to the emergency department for STI care. Since operationalization, the Sexual Wellness Clinic has served 560 unique patients; 50.5% (n = 283) were cisgender male and 49.5% (n = 277) were cisgender female. The majority of patients were African American (93.4%, n = 523), non-Hispanic or Latinx (96.1%, n = 538), between 18 and 29 years old (62.3%, n = 350), and had Medicaid or were uninsured (84.3%, n = 472). New syphilis diagnoses were identified in 23.5% (132/560) of patients; gonococcal and chlamydial infections were confirmed in 14.6% (82/560) and 13.4% (75/560) of patients, respectively. Same-day PrEP was initiated for 16.1% (90/560) of patients, of which 56.7% were cisgender female. The Sexual Wellness Clinic identified unique candidates for PrEP, notably a large proportion of Black cisgender women; however, further work is needed to support the ongoing PrEP cascade. Identifying these new populations with untreated STIs and other HIV risk factors for targeted, innovative interventions is integral to HIV elimination and STI control efforts.

Exploring intersectionality and HIV stigma in persons receiving HIV care in nurse-led public clinics in Durban, South Africa

BackgroundAlthough stigma associated with South African people living with HIV has declined since the 1980s when HIV/AIDS was first identified, it still persists. Stigma is associated with poor health outcomes and avoidance of interactions with healthcare systems. The HIV stigma framework distinguishes three HIV-related self-stigma mechanisms. AimsThe aims of this study were to explore intersectionality between HIV-stigma mechanisms and selected sociodemographic as well as HIV factors, and interrelationships between three HIV-related self-stigma mechanisms. Setting and methodThis study was a secondary analysis of data collected from a cross-sectional sample of people receiving HIV-related primary health care at different municipal clinics in Durban, South Africa (N = 100). ResultsThe average participant was Black African, female, unemployed, with a monthly income below R2 500, most had completed primary school. No sociodemographic or HIV-related factors were significantly related to total or subscale HIV stigma scores. Respondents reported experiencing (enacted) no stigmatization, did not expect to experience (anticipated) much stigmatization from their social interactions with family, community, healthcareworkers, and reported no strong stigmatizing beliefs about themselves (internalized). ConclusionIntersectionality did not identify any particular socio-demographic or HIV-related factor associated with greater HIV stigma. Participants reported low HIV stigma arising from interactions with healthcare and social service providers or families. Although no socio-demographic or HIV-related factors were significantly associated with HIV stigma mechanisms in this relatively homogeneous sample, being marginalized can nevertheless result from living with other differences compared to societal norms and result in particular vulnerability when living with HIV/AIDS.

ВКЛАД ЛОКУСА КОНТРОЛЯ И ПРЕДПОЧИТАЕМЫХ КОПИНГ-СТРАТЕГИЙ В УДОВЛЕТВОРЕННОСТЬ ТРУДОМ У ДЕТСКИХ ВРАЧЕЙ

The article shows the results of an empirical study which purpose was to examine the contribution of locus of control and preferred coping strategies to the level of job satisfaction among pediatricians. Psychodiagnostic tools of the research included standardised methods adapted for the Russian sample: questionnaire “Coping Behavior” (R. Lazarus, adapted by T. L. Kryukova), questionnaire “Level of Subjective Control” (E. F. Bazhin, E. A. Golynkina, A. M. Etkind), questionnaire “Integral Job Satisfaction” (A. V. Batarshev). The empirical study involved 119 pediatricians of various specialties working in municipal children's clinics of the Moscow Department of Health. A literature review showed that locus of control and coping strategies of medical workers may be related to job satisfaction and contribute to the variability of pediatrician’s job satisfaction level. As a result of the study, it was shown that the higher the level of internality and the more pediatricians tend to use adaptive coping strategies aimed at solving the problem, the higher their level of job satisfaction they perform. At the same time, the locus of control mostly contributes to the variability of the job satisfaction level than adaptive or non-adaptive coping strategies.

Cervical cancer screening management practices and prevention in uMsunduzi Local Municipality primary care clinics.

Although cervical cancer is preventable, it remains the most feared and second most common cancer in women worldwide, as well as the leading cause of cancer deaths in many low- and middle-income countries, including South Africa. Numerous studies conducted globally, in Africa and in South Africa revealed a knowledge gap about cervical cancer and its preventive strategies, including cervical cancer screening, among nurses and the general population. The purpose was to investigate and describe nurses' knowledge and management practices regarding cervical cancer screening in uMsunduzi Local Municipality, KwaZulu-Natal. The study was directed by a positivism paradigm. A quantitative research approach and nonexperimental descriptive design was used in this study. Probability random sampling was used, and a self-administered questionnaire was used to collect data. Eighty-three professional nurses participated in the study. The study discovered that professional nurses working in selected clinics in uMsunduzi Local Municipality, KwaZulu-Natal, had a high level of knowledge about cervical cancer and its screening. Nonetheless, despite the high level of knowledge demonstrated, the level of practice remained low. Cervical cancer morbidity and mortality have long been a major health concern in South Africa's general population. The study found that PNs are knowledgeable about cervical cancer screening; conversely, practice was low. This paper includes recommendations for future research, nursing practice, nursing education and the Department of Health. This study contributed vastly to the body of knowledge in managing cervical cancer screening practices, particularly in health promotion and prevention of diseases at primary care level.

Assessment of the Impact of Occupational Risk Factors on the Development of Glaucoma

Background: Glaucoma is a large group of eye diseases characterized by a constant or periodic increase in intraocular pressure followed by the development of typical visual field defects, decreased visual acuity and atrophy of the optic nerve. Glaucoma affects about 3 % of the population and is the cause of blindness in 15 % of the blind all over the world. The study of the mechanisms of glaucoma development indicates the multifactorial nature of this disease and the role of the threshold effect in its occurrence. It has been established that specific occupational risk factors determine the frequency of glaucoma, which must be taken into account in elaboration of appropriate preventive measures. Objective: To characterize occupational risk factors and their impact on the development of glaucoma. Materials and methods: To study the prevalence of glaucoma among the population of the city of Kazan, we used data on seeking specific ophthalmic advice for glaucoma in municipal outpatient clinics. To study adverse eye health effects of occupational risk factors, a special “Map for Studying the Impact of Occupational Risk Factors on the Development of Glaucoma in the Population of Kazan in 2012–2021” was developed. The strength of the influence of occupational risk factors was determined using the multivariate analysis of variance. Results: Glaucoma patients are often exposed to such occupational risk factors as high neuropsychiatric tension (29.7 %), heavy physical labor (10.7 %), chemicals (6.2 %), and night shifts (3.9 %). Conclusions: Our findings indicate the importance of early detection of adverse health effects of occupational risk factors; necessitate appropriate preventive measures, follow-up, and planning of therapeutic and preventive care for patients with glaucoma.

Neighborhood Disadvantage, Greenness, and Population Density as Predictors of Breastfeeding Practices: A Population Cohort Study from Finland

ABSTRACTBackgroundMany environmental factors are known to hinder breastfeeding, yet the role of the family living environment in this regard is still poorly understood.ObjectivesWe used data from a large cohort to identify associations between neighborhood characteristics and breastfeeding behavior.MethodsOur observational study included 11,038 children (0–2 years) from the Southwest Finland Birth Cohort. Participant information was obtained from the Medical Birth Register and municipal follow-up clinics. Neighborhood socioeconomic disadvantage, greenness, and population density were measured for a period of 5 years prior to childbirth within the residential neighborhood on a 250 × 250-m grid. Any breastfeeding and breastfeeding at 6 months were the primary outcomes. Binary logistic regression models were adjusted for maternal health and socioeconomic factors.ResultsAdjusted analyses suggest that mothers living in less populated areas were less likely to display any breastfeeding (OR: 0.46; 95% CI: 0.36, 0.59) and breastfeeding at 6 months (OR: 0.37; 95% CI: 0.34, 0.40). Mothers living in highly disadvantaged neighborhoods were less likely to display any breastfeeding if the neighborhood was less populated (OR: 0.54; 95% CI: 0.30, 0.95) but more likely to breastfeed at 6 months if the neighborhood was highly populated (OR: 3.74; 95% CI: 1.92, 7.29). Low greenness was associated with higher likelihood of any breastfeeding (OR: 3.82; 95% CI: 1.53, 9.55) and breastfeeding at 6 months (OR: 4.41; 95% CI: 3.44, 5).ConclusionsOur results suggest that neighborhood characteristics are associated with breastfeeding behavior in Finland. Unravelling breastfeeding decisions linked to the living environment could help identify interventions that will allow the appropriate support for all mothers and infants across different environmental challenges.

Folate Status as a Nutritional Indicator among People with Substance Use Disorder; A Prospective Cohort Study in Norway.

Substance use disorder (SUD) is associated with poor nutrition. Vitamin B9, or folate, is an important micronutrient for health. The aim of this prospective longitudinal cohort study was to assess serum folate levels among people with SUD and to investigate the impact of factors related to substance use severity on folate status. Participants were recruited from outpatient clinics for opioid agonist therapy (OAT) and municipal health-care clinics for SUD in Western Norway. They were assessed annually, including blood sampling for determination of micronutrient status. Overall, 663 participants with a total of 2236 serum folate measurements were included. A linear mixed model was applied, and measures are presented as β-coefficients with 95% confidence interval (CI). Forty-eight percent (CI: 44–51) of the population had low serum folate levels (s-folate < 10 nmol/L), and 23% (CI: 20–26) were deficient (s-folate < 6.8 nmol/L) at baseline. Sixty percent (CI: 53–65) sustained their poor folate status in at least one subsequent assessment. Except for weekly use of cannabis (mean difference in serum folate [nmol/L]: −1.8, CI: −3.3, −0.25) and alcohol (1.9, CI: 0.15, 3.6), weekly use of no other substance class was associated with baseline differences in serum folate when compared to less frequent or no use. Injecting substances was associated with a reduction in serum folate over time (−1.2, CI: −2.3, −0.14), as was higher dosages of OAT medication (−1.1, CI: −2.2, −0.024). Our findings emphasize the need of addressing nutrition among people with severe SUD.

Early detection of childhood overweight and related complications in a Danish population-based cohort aged 2–8 years

BackgroundOverweight in early childhood often tracks into adolescence and adulthood and early childhood is a critical period for developing sustained overweight. This study aims to investigate the early detection of childhood overweight (including obesity) and related cardiometabolic complications in a Danish population-based cohort of children aged 2.5–8 years in collaboration with primary care municipal dental clinics and public health nurses. MethodsIn this prospective population-based cohort study, 335 pre-school children (age 2.5 and 5 years) were recruited from municipal dental clinics, and 657 school children (age 6–8 years) by public health nurses. A subgroup of 392 children (40%) participated in additional hospital-based examinations including blood pressure measurement and a blood sample. Children were re-examined approximately one year later. ResultsThe prevalence of overweight was 13.73% in pre-school children and 13.69% in school children at baseline. In the pre-school children, differences in cardiometabolic risk markers between children with and without overweight were minor, whereas in school children with overweight, cardiometabolic derangements were manifest including significantly higher levels of fasting glucose, insulin, homoeostasis model of assessment for insulin resistance, triglycerides, and alanine aminotransferase and lower levels of high-density lipoprotein cholesterol. During follow-up the prevalence of overweight did not change in pre-school children but increased to 17.0% in school children. ConclusionsExisting contacts with the primary health care sector, including dental care, can successfully be used for detection of overweight. This study suggests that early detection should be initiated at pre-school ages since overweight-related complications are already established by school ages.

Impact of the COVID-19 pandemic on the work of urological departments

BACKGROUND: The pandemic of a new coronavirus infection has had a significant impact on the work of the entire medical service, including urological departments.&#x0D; AIM: to assess the impact of the COVID-19 pandemic on the work of urological departments in private and public medical institutions.&#x0D; MATERIALS AND METHODS: We assessed the impact of the restrictions imposed by the pandemic on the work of the urology department of a private clinic (MC Avicenna, Novosibirsk) and the urogenital department of the Novosibirsk Research Institute of Tuberculosis for 2019 and 2020. We assessed the change in the range of surgical interventions, as well as the structure visits to the urologist.&#x0D; RESULTS: The urogenital department of the Novosibirsk Research Institute of Tuberculosis in March 2020 was redesigned into an observational one. The Avicenna Medical Center also established the procedure for anti-epidemic measures, which made it possible not only not to reduce, but in a number of positions to increase the volume of surgical care provided.&#x0D; CONCLUSION: Thus, thanks to anti-epidemic measures: separation of flows, introduction of mandatory testing of patients, early detection of patients and carriers among employees, mask regimen, opening of an observational department, single rooms, lack of contact between patients, short stays, it was possible to prevent an outbreak of infection among patients and staff. Both in the municipal and private urological clinics, well-organized work did not allow the negative impact of the pandemic to manifest itself.

Blended Treatment for Alcohol Use Disorder (Blend-A): Explorative Mixed Methods Pilot and Feasibility Study

BackgroundIn Denmark, approximately 150,000 people have alcohol use disorder (AUD). However, only approximately 10% seek AUD treatment, preferably outside conventional health care settings and opening hours. The AUD treatment area experiences low adherence to treatment, as well as high numbers of no-show and premature dropouts.ObjectiveThe purpose of the Blend-A (Blended Treatment for Alcohol Use Disorder) feasibility and pilot study was to describe the process of translating and adapting the Dutch treatment protocol into Danish and Danish culture with a high amount of user involvement and to report how patients and therapists perceived the adapted version, when trying it out.MethodsThe settings were 3 Danish public municipal outpatient alcohol clinics. Study participants were patients and therapists from the 3 settings. Data consisted of survey data from the System Usability Scale, individual patient interviews, and therapist group interviews. Statistical analyses were conducted using the Stata software and Excel. Qualitative analysis was conducted using a theoretical thematic analysis.ResultsThe usability of the treatment platform was rated above average. The patients chose to use the blended treatment format because it ensured anonymity and had a flexible design. Platform use formed the basis of face-to-face sessions. The use of the self-determined platform resulted in a more thorough process. Patient involvement qualified development of a feasible system. Managerial support for time use was essential. Guidance from an experienced peer was useful.ConclusionsThis study indicates that, during the processes of translating, adapting, and implementing blended, guided, internet-based, and face-to-face AUD treatment, it is relevant to focus on patient involvement, managerial support, and guidance from experienced peers. Owing to the discrete and flexible design of the blended offer, it appears that it may reach patient groups who would not otherwise have sought treatment. Therefore, blended treatment may increase access to treatment and contribute to reaching people affected by excessive alcohol use, who would not otherwise have sought treatment. In addition, it seems that the blended offer may enhance the participants’ perceived satisfaction and the effect of the treatment course. Thus, it appears that Blend-A may be able to contribute to existing treatment offers. Such findings highlight the need to determine the actual effect of the Blend-A offer; therefore, an effectiveness study with a controlled design is warranted.

Factors Influencing Rapid Antiretroviral Therapy Initiation at Four eThekwini Clinics, KwaZulu-Natal, South Africa

Timely uptake of Antiretroviral therapy considerably improves the health of people living with the Human Immunodeficiency virus. We conducted a cross-sectional study of newly HIV diagnosed individuals in four clinics in eThekwini municipality, KwaZulu-Natal. Data was collected between June 2020 and December 2020. Participants completed an interviewer-administered questionnaire after HIV testing, on the day of HIV diagnosis. We evaluated factors influencing uptake of same-day ART initiation in eThekwini clinics, KwaZulu Natal, South Africa. Demographic information, health status, sexual behaviour, knowledge of universal test and treat (UTT), ART initiation uptake, and disclosure data was collected. Among the 403 participants, same-day initiation (SDI) was 69.2% (n = 279). We observed the number of sexual partners (aOR 0.35; 95% CI 0.15–0.81), HIV status of the partner (aOR 5.03; 95% CI 2.74–9.26) and knowledge of UTT (aOR 1.97; 95% CI 1.34–2.90) were identified as major factors influencing uptake of same-day ART initiation. More strategies are needed to achieve the SDI uptake within the framework of UTT.

ИНДИВИДУАЛЬНЫЙ ПОДХОД В НАЗНАЧЕНИИ СРЕДСТВ ГИГИЕНЫ ПОЛОСТИ РТА ПРИ ОРТОДОНТИЧЕСКОМ ЛЕЧЕНИИ

Relevance: The use of fixed orthodontic structures increases the risk of developing dental diseases. An effective way to prevent dental diseases is personalized training and monitoring of individual oral hygiene. Purpose of the work: To increase the effectiveness of the prophylaxy of dental diseases in patients undergoing orthodontic treatment. Materials and Methods: The analysis of 60 medical records in the municipal and private clinics of Saratov was carried out. The age of the patients was 13–18 years old. There also was a survey among 15 orthodontists on the subject of the identifying difficulties of using the personification of an integrated approach. A questionnaire was given to the patients. The age of the respondents was 13–18 years old. Results: According to the analysis of data from medical records in municipal and private clinics, a low prevalence of the use of an individual approach in the prescription of personal oral hygiene products in patients undergoing treatment with the use of fixed orthodontic structures was revealed, which is associated with an insufficient amount of time for admission within the framework of the compulsory medical insurance system, and also with low compliance of patients and their parents, as well as low hygienic education of patients, insufficient government attention to preventive dentistry, and lack of labor rates for dental hygienists. When questioning patients, difficulties in adhering to recommendations for personal oral hygiene was revealed. Conclusions. We have developed an algorithm of actions to improve the effectiveness of individual oral hygiene among adolescents undergoing orthodontic treatment. The proposed measures will increase the level of motivation and compliance of patients.

Neighborhood Socioeconomic Disadvantage and Childhood Body Mass Index Trajectories From Birth to 7 Years of Age.

The epidemic of increasing childhood overweight and obesity is a major global health concern, with local contextual factors identified as possible contributors. Robust research is needed to establish an evidence base supporting health policy decisions to reverse the trend. We aimed to examine the association between neighborhood socioeconomic disadvantage and trajectories of body mass index (BMI) from birth to age 7. The present study included 11,023 children born within the Southwest Finland Birth Cohort who were free of severe conditions affecting growth with adequate exposure and growth data. We obtained child growth data until school age from municipal follow-up clinics. We based cumulative childhood neighborhood socioeconomic disadvantage on the average annual income, unemployment, and level of education in a residential area defined using a geographic grid at a spatial resolution of 250 m by 250 m. Cumulative neighborhood socioeconomic disadvantage was associated with distinct childhood BMI z score trajectories from birth to age 7. Despite being born in the lowest BMI z scores, children growing up in disadvantaged neighborhoods subsequently exhibited a trajectory of increasing BMI z scores starting at 4 years of age, ending up with a higher risk of overweight at the end of the follow-up (30%) as compared with children living in more affluent neighborhoods (22%). The corresponding risk of obesity was 5 % for those in affluent neighborhoods and 9 % and those in disadvantaged neighborhoods. Cumulative exposure to neighborhood socioeconomic disadvantage is independently associated with unfavorable BMI development and obesity in childhood.