Preventive Care Research Articles

Perceptions of Primary Care Among Women in Treatment for Opioid Use Disorder: A Qualitative Study.

Underutilization of primary care and receipt of preventive health services have been reported among women with opioid use disorder. The aim of this study was to describe perceptions of primary care among women in treatment for opioid use disorder. Between May and June 2022, 27 women who were receiving treatment for opioid use disorder from one opioid treatment program participated in this study. Participants completed one data collection session which involved a brief questionnaire followed by a semi-structured interview. Participants were asked questions about their overall experience with primary care as well as perceived facilitators and barriers to primary care utilization and quality. Interview transcripts were analyzed using an inductive thematic approach. Three themes emerged from the interviews within the domain of "Facilitators to Primary Care," including: (1) coordination of care, (2) continuity of care, and (3) relationship with health care providers. Four themes emerged from the interviews within the domain of "Barriers to Primary Care," including: (1) perceived judgment from health care providers, (2) childcare needs, (3) issues related to location, and (4) issues related to time. Approaches to primary care that help alleviate barriers to care and highlight the aspects of care that are valued may improve quality and utilization of care, thus enhancing the health and well-being of a vulnerable population.

Advancements and Future Directions in Prevention Based on Evaluation for Individuals With Clinical High Risk of Psychosis: Insights From the SHARP Study.

This review examines the evolution and future prospects of prevention based on evaluation (PBE) for individuals at clinical high risk (CHR) of psychosis, drawing insights from the SHARP (Shanghai At Risk for Psychosis) study. It aims to assess the effectiveness of non-pharmacological interventions in preventing psychosis onset among CHR individuals. The review provides an overview of the developmental history of the SHARP study and its contributions to understanding the needs of CHR individuals. It explores the limitations of traditional antipsychotic approaches and introduces PBE as a promising framework for intervention. Three key interventions implemented by the SHARP team are discussed: nutritional supplementation based on niacin skin response blunting, precision transcranial magnetic stimulation targeting cognitive and brain functional abnormalities, and cognitive behavioral therapy for psychotic symptoms addressing symptomatology and impaired insight characteristics. Each intervention is evaluated within the context of PBE, emphasizing the potential for tailored approaches to CHR individuals. The review highlights the strengths and clinical applications of the discussed interventions, underscoring their potential to revolutionize preventive care for CHR individuals. It also provides insights into future directions for PBE in CHR populations, including efforts to expand evaluation techniques and enhance precision in interventions.

Stability of Willingness to Pay: Does Time and Treatment Allocation in a Randomized Controlled Trial Influence Willingness to Pay?

Willingness-to-pay (WTP) estimates are useful to policy makers only if they are generalizable beyond the moment when they are collected. To understand the "shelf life" of preference estimates, preference stability needs be tested over substantial periods of time. We tested the stability of WTP for preventative dental care (scale and polish) using a payment-card contingent valuation question administered to 909 randomized controlled trial participants at 4 time points: baseline (prerandomization) and at annual intervals for 3 years. Trial participants were regular attenders at National Health Service dental practices. Participants were randomly offered different frequencies (intensities) of scale polish (no scale and polish, 1 scale and polish per year, 2 scale and polishes per year). We also examined whether treatment allocation to these different treatment intensities influenced the stability of WTP. Interval regression methods were used to test for changes in WTP over time while controlling for changes in 2 determinants of WTP. Individual-level changes were also examined as well as the WTP function over time. We found that at the aggregate level, mean WTP values were stable over time. The results were similar by trial arm. Individuals allocated to the arm with the highest scale and polish intensity (2 per year) had a slight increase in WTP toward the latter part of the trial. There was considerable variation at the individual level. The WTP function was stable over time. The payment-card contingent valuation method can produce stable WTP values in health over time. Future research should explore the generalizability of these results in other populations, for less familiar health care services, and using alternative elicitation methods. Stated preferences are commonly used to value health care.Willingness-to-pay (WTP) estimates are useful only if they have a "shelf life."Little is known about the stability of WTP for health care.We test the stability of WTP for dental care over 3 y.Our results show that the contingent valuation method can produce stable WTP values.

Cardiovascular disease risk assessment in patients with rheumatoid arthritis: A scoping review.

Patients with rheumatoid arthritis (RA) have an increased risk of developing cardiovascular disease (CVD). Identification of at-risk patients is paramount to initiate preventive care and tailor treatments accordingly. Despite international guidelines recommending all patients with RA undergo CVD risk assessment, rates remain suboptimal. The objectives of this review were to map the strategies used to conduct CVD risk assessments in patients with RA in routine care, determine who delivers CVD risk assessments, and identify what composite measures are used. The Joanna Briggs Institute methodological guidelines were used. A literature search was conducted in electronic and grey literature databases, trial registries, medical clearing houses, and professional rheumatology organisations. Findings were synthesised narratively. A total of 12 studies were included. Strategies reported in this review used various system-based interventions to support delivery of CVD risk assessments in patients with RA, operationalised in different ways, adopting two approaches: (a) multidisciplinary collaboration, and (b) education. Various composite measures were cited in use, with and without adjustment for RA. Results from this review demonstrate that although several strategies to support CVD risk assessments in patients with RA are cited in the literature, there is limited evidence to suggest a standardised model has been applied to routine care. Furthermore, extensive evidence to map how health care professionals conduct CVD risk assessments in practice is lacking. Research needs to be undertaken to establish the extent to which healthcare professionals are CVD risk assessing their patients with RA in routine care. Key Points • A limited number of system-based interventions are in use to support the delivery of CVD risk assessments in patients with RA. • Multidisciplinary team collaboration, and education are used to operationalise interventions to support Health Care Professionals in conducting CVD risk assessments in practice. • The extent to which Health Care Professionals are CVD risk assessing their patients with RA needs to be established.

Depression Symptoms Linked to Multiple Oral Health Outcomes in US Adults.

Individuals with mental illness have poor oral health compared to those without mental health conditions. However, the literature is still lacking regarding the specifics of this relationship. This study aims at examining the relationship between depression and oral health problems such as oral conditions, access to dental care, and oral hygiene measures. A cross-sectional study using a secondary data analysis of 9,693 participants from the 2017 to March 2020 prepandemic National Health and Nutrition Examination Survey (NHANES). The independent variable was severity of depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9). Proportional odds and binary logistic regression were used to calculate crude and adjusted odds ratios (AORs) between depression and 8 oral health outcomes and oral hygiene-related behaviors. After adjusting for sociodemographics, health conditions, and behaviors, individuals with depression were significantly more likely to have dental aches in the past year (AOR = 1.70; 95% confidence interval [CI], 1.13-2.56), difficulty getting dental care when needed (AOR = 1.93; 95% CI, 1.45-2.58), and difficulty at their jobs due to a problem in their mouth (AOR = 1.63; 95% CI, 1.07-2.49) compared to individuals without depression. Individuals with depressive symptoms often neglect oral hygiene and self-care practices and are less likely to seek medical care for oral health problems, making them at increased risk of poor oral health outcomes. These findings can be applied by dentists, psychologists, and therapists to increase awareness of links between depression and oral health and to encourage patients with depression to seek oral hygiene preventative care. Health care professionals can be on the frontline in creating awareness in the general public about the links between depression and oral health and hygiene. Applying the findings from this study can help communicate about the relationship between depression and poor oral health and relieve some burden on the American health care sector, which often struggles to provide medical care to patients with depression and oral health issues.

Kidney Cancer Incidence Among Non-Hispanic American Indian and Alaska Native Populations in the United States, 1999-2020.

Background Non-Hispanic American Indian and Alaska Native (NH-AI/AN) people experience a disproportionate incidence of kidney cancer. Nationally aggregated data does not allow for a comprehensive description of regional disparities in kidney cancer incidence among NH-AI/AN communities. This study describes kidney cancer incidence rates and trends among NH-AI/AN compared to non-Hispanic White (NHW) populations by geographic region. Methods Using the United States Cancer Statistics American Indian and Alaska Native (AI/AN) Incidence Analytic Database, we calculated age-adjusted incidence rates (per 100,000) of kidney cancers for NH-AI/AN and NHW people for the years 2011-2020 combined using SEER*stat software. Analyses were restricted to non-Hispanic persons living in purchased/referred care delivery area (PRCDA) counties. Average annual percent changes (AAPCs) and trends (1999-2019) were estimated using Joinpoint regression analyses. Results Rates of kidney cancer incidence were higher among NH-AI/AN compared to NHW persons in the U.S. overall and in 5 of 6 regions. Kidney cancer incidence rates also varied by region, sex, age, and stage of diagnosis. Between 1999 and 2019, trends in rates of kidney cancer significantly increased among NH-AI/AN males (AAPC = 2.7%) and females (AAPC = 2.4%). The largest increases in incidence were observed for NH-AI/AN males and females under age 50 and those diagnosed with localized stage disease. Conclusions Study findings highlight growing disparities in kidney cancer incidence rates between NH-AI/AN and NHW populations. Impact: Differences in geographic region, sex, and stage highlight opportunities to decrease prevalence of kidney cancer risk factors and improve access to preventive care.

Relato de experiência da participação de estudantes voluntários no inquérito soroepidemiológico da COVID-19 no Município de Jundiaí, Brasil

ObjectiveExperience report of medical and nursing students on participation in the seroepidemiological investigation of COVID-19 in the city of Jundiaí.MethodsIn the survey, resident of 1260 households were tested, and a questionnaire was filled out with information about the individual and family in June/20. The students clarified the situation of the pandemic, providing guidance on general preventive care. To assess the students’ perception of participation in the survey, a questionnaire was available online, including questions about the satisfaction, adherence to the survey proposal, feeling of security and risk, availability of individual protective equipment and personal motivation.ResultsThe 50 volunteers answered the form (100%). In the evaluation, they were very satisfied, with the health team, 86% (n=43); regarding the organization of activities, 66% (n=33); and with the availability of protection personal equipment, 64% (n=32); 70% said they did not feel afraid at any time and 45% (n=46) stated their main motivation for the desire to contribute to the pandemic, followed by the desire to learn (29%, n=30).ConclusionIt was evident the motivation of academics to act in the face of the pandemic of COVID-19, combined with satisfaction and the opportunity to include practical learning in activities with the population. Emphasis is placed on the importance of community outreach activities as a tool for social change and university education.

DEVELOPMENT OF SMART TOILET SYSTEM FOR OLD AGE AND SPECIALLY ABLED PERSON

This research paper presents the development of a novel smart toilet system designed to the unique needs of elderly individuals and persons with disabilities. The primary objective of the project is to monitor the health conditions of users while inside the toilet, this system incorporates advanced sensors, user-friendly interfaces, and automation to provide a seamless and dignified toileting experience for individuals with diverse mobility challenges. Integral to the system is a comprehensive health monitoring component. Utilizing sensors, the system measures the user's body temperature and heartbeat. This real-time health data is crucial for timely detection of potential health issues, promoting preventive healthcare and immediate response if needed. This research contributes to the evolving field of assistive technologies, specifically addressing the needs of aging populations and individuals with disabilities. The integration of mechanical design, health monitoring, and cloud-based connectivity exemplifies a holistic approach to smart healthcare solutions, fostering independence and improved quality of life for users. Key Words: Smart and healthy living, Emergency assistance, Care, Health.

Pediatric Facial Fractures: Demographics, Injury Patterns, and Associated Injuries in 3334 Patients.

Pediatric craniofacial fractures are fundamentally distinct from their adult counterparts because of unique injury patterns and effects on future growth. Understanding patterns and injury context informs management and risk mitigation. Previous studies include only inpatients, operative patients, or are specialty-specific. In contrast, our study presents a comprehensive assessment of all pediatric facial fracture patients seen at a single institution. Patients under 18 years old who were evaluated for facial fractures at a level I pediatric trauma center between 2006 and 2021 were reviewed. Subanalysis was performed for groups defined by age. Variables studied included demographics, etiology, fracture pattern, associated injuries, management, and outcomes. Three thousand thirty-four patients were included. Mean age at presentation was 11.5 to 4.9 years. The majority were Caucasian (82.6%) and male (68.4%). Sports were the leading cause of injury in older patients (42.2% of patients over 12y), compared with activities of daily living in patients under 6 years (45.5%). Thirty-two percent of patients were hospitalized, 6.0% required ICU care, and 48.4% required surgery. Frequency of ICU admission decreased with age (P<0.001), whereas operative intervention increased with age (P<0.001). Zygomaticomaxillary complex (P=0.002) and nasal fractures (P<0.001) were common in older patients, whereas younger patients experienced more skull (P<0.001) and orbital fractures (P<0.001). The most associated injuries were soft tissue (55.7%) and neurologic (23.6%). This large-scale study provides updated characterization of craniofacial fractures in the pediatric population, providing a necessary framework for future studies on outcomes assessments and preventative care.

'You never know when you will need an antibiotic': A qualitative study of structural barriers and cultural assumptions in antibiotic misuse among immigrants in the United States.

The use of nonprescribed antibiotics increases the risk of antibiotic resistance, which is a primary public health concern of the 21st century. This study explores structural and cultural determinants of antibiotic misuse among immigrants living in the United States who arrived from home countries with easier access to antibiotics. Adopting a qualitative approach, we interviewed 34 immigrants living in the United States and who had traveled back to their home countries within 1year of the interview. We followed the steps of constructive grounded theory to analyze the data. We found two primary influences of immigrants' use of nonprescribed antibiotics. The first was structural barriers to health care access in the host country, including insurance coverage, cost of an emergency department visit, cost of missing a paid day of work, complexity of the healthcare system, and communication issues with health care providers. The second was participants' cultural assumptions, including their experiences of antibiotics use, beliefs about antibiotics, a habit of self-medication, and uncertainty about future medical needs. This study informs policymakers concerned with combating antibiotic resistance. Promoting antibiotic stewardship among immigrants from countries with lax antibiotic-prescribing practices and improving access to appropriate channels for preventative and same-day care may reduce the inappropriate use of antibiotics.

Toward Realizing the Promise of AI in Precision Health Across the Spectrum of Care

Significant progress has been made in augmenting clinical decision-making using artificial intelligence (AI) in the context of secondary and tertiary care at large academic medical centers. For such innovations to have an impact across the spectrum of care, additional challenges must be addressed, including inconsistent use of preventative care and gaps in chronic care management. The integration of additional data, including genomics and data from wearables, could prove critical in addressing these gaps, but technical, legal, and ethical challenges arise. On the technical side, approaches for integrating complex and messy data are needed. Data and design imperfections like selection bias, missing data, and confounding must be addressed. In terms of legal and ethical challenges, while AI has the potential to aid in leveraging patient data to make clinical care decisions, we also risk exacerbating existing disparities. Organizations implementing AI solutions must carefully consider how they can improve care for all and reduce inequities.

Managing the quality of primary health care in urban China: the impact of organizational and physician features.

Global health care quality improvement efforts have focussed on management practices. However, knowledge in primary care settings, especially in developing countries, such as China, is lacking. To examine the organizational and physician features associated with health care quality in China's community health centres (CHCs). We conducted a cross-sectional survey of 224 primary care physicians (PCPs) in 38 CHCs in Jinan, Tianjin, Shenzhen, and Shanghai. Clinical and prevention care quality with a 5-level scale (1 = never, 5 = always) reported by the PCPs were used to measure the quality of care. Two-level hierarchical linear models were estimated to examine the organization and physician-level variables associated with primary care quality. The average clinical care quality score was 4.08 and 3.59 for preventative care out of 5. At the organizational level, organizational culture and organizational support were the strongest predictors of physician-reported quality of care. At the physician level, professional fulfilment, psychological safety, and organizational citizenship behaviour were positively associated with care quality. Chinese CHCs clinical quality ranked high by PCPs, but the quality of preventative care provision required improvement. To improve primary care quality, managers of CHCs should implement optimal organizational structures, supportive organizational cultures, and strong organizational support at the organization level and cultivate high professional fulfilment, safe, and trustful relationships with colleagues at the physician level.

Comparison of Two Methods, Gradient Boosting and Extreme Gradient Boosting to Pre- dict Survival in Covid-19 Data

Introduction: The present study discusses the importance of having a predictive method to determine the prognosis of patients with diseases like Covid-19. This method can assist physicians in making treatment decisions that improve survival rates and avoid unnecessary treatments. This research also highlights the importance of calibration, which is often overlooked in model evaluation. Without proper calibration, incorrect decisions can be made in disease treatment and preventive care. Therefore, the current study compares two highly accurate machine learning algorithms, Gradient boosting and Extreme gradient boosting, not only in terms of prediction accuracy but also in terms of model calibration and speed. Methods: This study involved analyzing data from Covid-19 patients who were admitted to two hospitals in Mashhad city, Razavi Khorasan province, over a span of 18 months. The k-fold cross-validation method was employed on the training dataset (K=5) to conduct the study. The accuracy and calibration of two methods (Gradient boosting and Extreme gradient boosting) in predicting survival were compared using the Concordance Index and calibration. Results: The Concordance Index values obtained for gradient boosting and Extreme gradient boosting models were 0.734 and 0.736, in the imbalanced and In the balanced data, the Concordance Index values were 0.893 for gradient boosting and 0.894 for Extreme gradient boosting. The surv.calib_beta index, the gradient boosting model had an estimated value of 0.59 in the imbalanced data and 0.66 in the balanced data. The Extreme gradient boosting model had an estimated value of 0.86 in the balanced data and 0.853 in the imbalanced data. The Extreme gradient boosting model was faster in the learning process compared to the gradient boosting model. Conclusion: The Gradient boosting and Extreme gradient boosting models exhibited similar prediction accuracy and discrimination power, but the Extreme gradient boosting model demonstrated relatively good calibration compare to Gradient boosting model.

Advanced Dietitian Using Machine Learning

The "Advanced Artificial Intelligence Dietitian" (AI-Dietitian) project explores the potential of AI to revolutionize personalized nutrition. Traditional dietary approaches often struggle with individual complexities and lack continuous guidance. We propose an AI-powered system that transcends these limitations, offering: · Comprehensive Data Integration: The AI-Dietitian analyzes diverse data sets, including medical records, genetic information, activity trackers, and food intake sensors, building a holistic understanding of individual needs and preferences. · Adaptive &amp; Personalized Plans: Leveraging advanced machine learning algorithms, the AI-Dietitian generates dynamic, personalized meal plans that adapt to real-time data and user feedback, ensuring continued effectiveness and adherence. · Continuous Coaching &amp; Support: The AI-Dietitian acts as a virtual coach, providing real-time feedback, nutritional education, and motivational support through natural language interaction and personalized content. · Predictive &amp; Preventative Healthcare: The AI-Dietitian leverages its predictive capabilities to identify potential health risks and recommend preventative dietary interventions, promoting long-term health and well-being. This project addresses the limitations of traditional dietetics and explores the ethical considerations of AI in healthcare. We believe the AI-Dietitian has the potential to democratize personalized nutrition, promoting healthier communities and reducing healthcare costs. Keywords: Artificial Intelligence, Machine Learning, Personalized Nutrition, Health Coaching, Predictive Healthcare, Ethical AI

Lifetime prevalence and correlates of colorectal cancer screening among low-income U.S. Veterans.

The Veterans Health Administration (VHA) is the largest integrated healthcare system in the U.S. While preventive healthcare services are high priority in the VHA, low-income U.S. Veterans experience adverse life circumstances that may negatively impact their access to these services. This study examined lifetime prevalence as well as demographic, socioeconomic, military-specific, and clinical correlates of colorectal cancer (CRC) screening among low-income U.S. Veterans ≥ 50years of age. Cross-sectional data on 862 participants were analyzed from the 2021-2022 National Veteran Homeless and Other Poverty Experiences study. Overall, 55.3% (95% confidence interval [CI] 51.3-59.3%) reported ever-receiving CRC-screening services. In a multivariable logistic regression model, never-receivers of CRC screening were twice as likely to reside outside of the Northeast, and more likely to be married (odds ratio [OR] = 1.86, 95% CI 1.02, 3.37), have BMI < 25kg/m2 [vs. 25- < 30kg/m2] (OR = 1.75, 95% CI 1.19, 2.58), or ≥ 1 chronic condition (OR = 1.46, 95% CI 1.06, 2.02). Never-receivers of CRC screening were less likely to be female (OR = 0.53, 95% CI 0.29, 0.96), aged 65-79y [vs. ≥ 80y] (OR = 0.61, 95% CI 0.40, 0.92), live in 5 + member households (OR = 0.33, 95% CI 0.13, 0.86), disabled (OR = 0.45, 0.22, 0.92), with purchased health insurance (OR = 0.56, 95% CI 0.33, 0.98), or report alcohol-use disorder (OR = 0.10, 95% CI 0.02, 0.49) and/or HIV/AIDS (OR = 0.28, 95% CI 0.12, 0.68). Nearly 55% of low-income U.S. Veterans reported ever screening for CRC. Variations in CRC-screening behaviors according to veteran characteristics highlight potential disparities as well as opportunities for targeted behavioral interventions.

A community health worker led approach to cardiovascular disease prevention in the UK—SPICES-Sussex (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and Sub-saharan Africa): an implementation research project

BackgroundThis paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support under-served populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions.MethodsA type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework.ResultsReach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme.ConclusionCommunity-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health.

Development of Oral Healthcare Plan for Children with Congenital Anomalies

Development of Oral Healthcare Plan for Children with Congenital Anomalies

Association of general anxiety and pediatric dental preventive examination utilization, National Survey of Children's Health, 2021.

Many factors influence preventive dental health service access for children. The objective of this research was to examine one factor, general anxiety, in accessing at least one preventive dental examination in the past 12 months in children with special healthcare needs (CSHCN) and children without special healthcare needs (CWSHCN). National Survey of Children's Health (NSCH) 2021 were obtained for this cross-sectional research. Chi-square and logistic regression analyses were used to determine association of anxiety and past 12-month preventive dental examinations. The sample included 10493 CSHCN, and 35675 CWSHCN. Overall, 72.7% had past 12-month preventive dental examinations, and 9.9% had a healthcare provider indicate they had general anxiety. CSHCN with anxiety, CWSHCN with anxiety, and CSHCN without anxiety were more likely to have a past 12-month preventive dental examination visit than CWSHCN without anxiety (Adjusted Odds Ratios: 1.86, 1.39, 1.32, respectively). Our results suggest children with general anxiety (both CSHCN and CWSHCN) are more likely to have had at least one regular preventive dental visit within the past 12 months than CWSHCN and without general anxiety. There is a need for further understanding the relationship of general anxiety and dental health to improve the health of all children. CWSHCN without anxiety need individualized, comprehensive care with enough time, attention, instruction, and rewards to demonstrate to parents/guardians the importance of making routine preventive dental examinations a priority for their child.

Holistic Approach in Strengthening of Primary Health Care Service

Sri Lanka is currently facing a demographic and epidemiological transition, which includes the rising burden of non-communicable diseases (NCD), immerging, and re-emerging of communicable diseases. Further, Population ageing in Sri Lanka is accelerating at a faster rate than in other South Asian countries. Primary Health Care, often abbreviated as ‘PHC’, has been defined by World Health Organization as “an approach that in whole society that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment". Currently, there is a dichotomy in PHC as preventive and curative aspects.Reversing the service utilization pattern would likely yield substantial efficiency gains that maximize the benefit of existing resources as well as maximal utilization of higher-level institution for needy critical patients, while changing PHC as popular first contact points closure to their homes providing comprehensive care package. The Key Result Areas are Strengthening Primary Health Care Service with reforms, Empowering individuals, families and communities, and Facilitating broader determinants of health. The Strategic Objectives are to meet people's health needs throughout their lives; promotive, preventive, curative, rehabilitation and palliative care ensuring availability, coverage, affordability and equitable access to quality health services with appropriate technology and facilities through a team of well-trained staff in adequate number. (Equitable distribution of health care with appropriate technology and developed Health workforce), To empower individuals, families and communities to take charge of their own health through community awareness and participation (Community participation and community engagement), and to address the broader determinants of health through Multisectoral policy and action ensuring the quality of available basic needs of citizens (Multi-sectoral approach). A strategic framework was designed based on above objectives.

Evaluation of the Oral Hygiene Ability Instrument (OHAI): Test of reliability.

To evaluate the reliability of the new Oral Hygiene Ability Instrument (OHAI) developed to assess the cause of any inability for older adults to manage oral hygiene self-care. Oral hygiene is an important part of oral health. The inability to manage oral hygiene, combined with other risk factors, often results in poor oral health and impaired quality of life. A reliable OHAI could benefit preventive oral health care. The preliminary OHAI uses 33 items in three parts: (I) interview, (II) clinical examination and (III) observation of oral hygiene activities. A total of 37 older adults participated in a test-retest study of Part I. Inclusion criteria were age ≥ 65 years, have at least one tooth and be able to oral hygiene self-care. The intra- and inter-rater reliability of parts II and III used films and photographs of OHAI assessments of 15 different individuals. These films/photographs were assessed twice by four dental professionals who had participated in the OHAI data collection. For statistical analyses of the reliability, per cent agreement, Krippendorff's alpha and E. Svensson's method were used. The test-retest for Part I items showed acceptable-to-good agreement and no systematic disagreement. In Part II, two items showed somewhat limited reliability. Part III showed good intra- and inter-rater reliability. The OHAI items seem stable and reliable for the intended sample, and the instrument may be a valuable tool to identify older adults at risk of impaired oral health. However, two items may need to be reformulated.