Primary Care Centers Research Articles

Psychometric testing of the cross-culturally adapted Thai version of the Self-Care Self-Efficacy Scale version 3.0 in individuals with chronic illnesses

ObjectiveTo assess the psychometric properties of the Thai version of the Self-Care Self-Efficacy Scale version 3.0 (SCSES-v3.0) in individuals with chronic illnesses. Although originally developed and tested in a Western context, its applicability in Asian populations, including Thailand, remains inadequately explored. MethodsPsychometric tests were guided by COSMIN principles. This included the translation of the English version into Thai based on the ISPOR framework. Nine nursing experts evaluated the content validity. Data were obtained from a multicenter cross-sectional study conducted between July and November 2022. This study included individuals with chronic conditions from 16 primary care centers in Thailand. We tested the structural validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and concurrent validity in relation to the Self-Care of Chronic Illness Inventory version 4.c (SC-CII-v4.c). We tested the scale’s reliability with McDonald’s ω, Cronbach’s α, and the intraclass correlation coefficient (ICC). ResultsThe Thai SCSES-v3.0 demonstrated excellent content validity (k = 1.00). The final analysis included a total of 385 participants. The EFA with the first split-half subsample (n = 193) extracted a two-factor structure. One reflected SCSES for maintenance and monitoring behaviors and another captured SCSES for management behaviors (item 6–10). CFA with the second split-half subsample (n = 192) and the overall sample (n = 385) supported the scale’s two-factor model with high factor loadings. Each dimension and the overall SCSES-v3.0 positively correlated with each scale and the overall SC-CII-v4.c. McDonald’s ω and Cronbach’s α (both ranged 0.91–0.94) and ICC (ranged 0.95–0.96), indicated excellent internal reliability and test-retest reliability, respectively. ConclusionsThe identification of a valid and reliable two-factor model for the Thai SCSES-v3.0 renders it a valuable tool for clinicians and investigators, facilitating the assessment of self-efficacy in self-care across diverse contexts.

Primary care medicine in Germany at the crossroads

In addition to the existing social law options for primary care under medical responsibility for those with statutory health insurance, there are several projects to supplement the service structures: healthcare kiosks, primary care centers and community health nursing as well as general practitioner outpatient clinics in hospitals. These new projects amount to an institutionalization of services that were previously based at outpatient offices and partially to the transfer of medical services that were previously the responsibility of doctors to the responsibility of non-physician healthcare professionals, with additional financial outlay but without creating new care capacities. The constructs considered do not appear to be suitable for making arelevant contribution to compensating for the gap in doctors specialized in general or internal medicine and in other medical professionals in ademographically induced capacity phasing out process that is forecast to last until around 2036. The further development of German social law on primary care should instead focus on increasing the efficiency of resources which are becoming scarcer through guided and graduated access to doctors according to medical criteria.

Potentially inappropriate anticholinergic drug use among older adults in primary healthcare: prevalence and determinants

ABSTRACT Background Considering the vulnerability of older adults to adverse drug reactions, medications with strong anticholinergic properties are considered potentially inappropriate for this population. This study aims to characterize older adults’ profile of anticholinergics use and to identify the factors associated with their potentially inappropriate use. Research design and methods A retrospective study was conducted on 1200 older adults in primary health care centers of Portugal between April 2021 and August 2022. Potentially inappropriate use was assessed according to the 2023 Beers criteria. Logistic regression analyses were performed to determine associations between independent variables and potentially inappropriate use. Results A 8.9% (95% CI 0.074–0.107) of the older adults were exposed to one or more potentially inappropriate anticholinergics, and amitriptyline was the most used (2.0%). Multivariate analysis revealed that use was associated with a higher mean number of medications (OR 1.173, 95% CI 1.115–1.234), diagnoses of depression (OR 2.889, 95% CI 1.785–4.674) and psychiatric disorders (OR 1.654, 95% CI 1.003–2.729). Conclusions This study underscores the importance of vigilance in prescribing anticholinergic medications to older adults, particularly those with higher medication burdens and mental health diagnoses. By identifying factors associated with potentially inappropriate use, healthcare providers can better tailor medication regimens to mitigate risks and optimize the well-being of older adults.

Effects of exercise on bone marrow adipose tissue in children with overweight/obesity: role of liver fat.

Exercise reduces adiposity, but its influence on bone marrow fat fraction (BMFF) is unknown; nor is it known whether a reduction in liver fat content mediates this reduction. (i) To determine whether incorporating exercise into a lifestyle program reduces the lumbar spine (LS)-BMFF, and (ii), to investigate whether changes in liver fat mediate any such effect. Ancillary analysis of a two-arm, parallel, non-randomized clinical trial. Primary care centres in Vitoria-Gasteiz (Spain). A total of 116 children with overweight/obesity were assigned to a 22-week family-based lifestyle program (control group [n=57]) or the same program plus an exercise intervention (exercise group [n=59]. The compared interventions consisted of a family-based lifestyle program (two 90-minute sessions/month) and the same program plus supervised exercise (three 90-minute sessions/week). The primary outcome examined was the change in LS-BMFF between baseline and 22 weeks, as estimated by MRI. The effect of changes in hepatic fat on LS-BMFF were also recorded. Mean weight loss difference between groups was 1.4±0.5 kg favour of the exercise group. Only the children in the exercise group experienced a reduction in LS-BMFF (effect size [Cohen d] -0.42, CI: -0.86, -0.01). Importantly, 40.9% of the reductions in LS-BMFF were mediated by changes in percentage hepatic fat (indirect effect: β=-0.104, 95%CI=-0.213, -0.019). The impact of changes in hepatic fat on LS-BMFF was independent of weight loss. The addition of exercise to a family-based lifestyle program designed to reduce cardiometabolic risk improves bone health by reducing LS-BMFF in children with overweight or obesity. This beneficial effect on bone marrow appears to be mediated by reductions in liver fat.

Perceptions of Nurses Working in Primary Health Centres on Factors Influencing Their Readiness to Manage Family Violence in Kaduna State, Nigeria

Background. Family violence (FV) is a serious public health issue in Nigeria and globally. Despite being a public health issue, there is no literature indicating that FV has ever been investigated in Sabon-Gari, Kaduna State, Nigeria. Aim: This study aimed to assess nurses' perceptions of factors influencing their readiness to manage family violence. Methods: A descriptive cross-sectional study design was employed to collect information from the respondents in the selected primary health care facilities of Sabon-Gari L.G.A, Kaduna state, Nigeria. The collected data were coded, entered, and analysed using SPSS software version 24. Twenty-four (24) registered nurses working in 24 different primary health care centres were purposively selected out of 31primary health care centres of Sabon-Gari local government of Kaduna State Results: The majority of the nurses have a positive perception and high knowledge level on management of family violence victims (aggregate mean=3.4). The highest perception of the nurses was that nurses should be considered as the key figure in the management of family violence patients (mean value= 3.8), and the lowest perception of nurses was “nurses status within health care hierarchy (mean value= 2.9). The study also revealed a poor level of nurses’ involvement in managing family violence victims (aggregate mean= 2.42). Conclusion: The study concluded that despite having a positive perception and high knowledge level of management of family violence victims, nurses have a poor level of involvement in managing family violence victims. Recommendations: It was recommended, among other things, that the government should empower healthcare providers to support victims of family violence beyond counselling and treatment of injuries, expand education and training opportunities about FV, and enforce mandatory reporting policies for nurses and other healthcare providers to involve law enforcement. Keywords: Knowledge, Perception, Family Violence, Nurses involvement, Primary Health Centre.

Evaluation of aldosterone to direct renin ratio, low renin and related Phenotypes in Afro-Colombian patients with apparent treatment resistant hypertension

Apparent resistant hypertension (aTRH) is a significant public health issue. Once low adherence to antihypertensive treatment has been ruled out and true resistant hypertension is diagnosed, aldosterone-direct-renin-ratio (ADRR) aids in the screening of an aldosterone-producing adenoma (APA) and primary aldosteronism (PA). Once PA and other secondary causes have been ruled out, the values of aldosterone and renin allow patients to be classified into phenotypes such as low renin hypertension (LRH), Liddle’s-like (LLph), and primary hyperaldosteronism (PAph). These classifications could aid in the treatment decision-making process. However, optimal cut-off points for these classifications remain uncertain. This study aims to assess the prevalence of these phenotypes and the behavior of different cut-offs of the ADRR in an Afro-Colombian population with apparent resistant hypertension, as well to describe their sodium consumption. Afro-descendant individuals 18 years of age or older, diagnosed with resistant hypertension and attending to a primary care center in Colombia were recruited as volunteers. As part of the study, their plasma renin concentration (PRC) and plasma aldosterone concentration (PAC) were measured. The phenotypes were categorized into three groups based on multiple cut-off points from different authors: low renin and low aldosterone phenotype (LLph), low renin and high aldosterone phenotype (PAph), and high renin and high aldosterone phenotype, referred to as the renal phenotype (Rph). The prevalence of ADRR values exceeding the cut-off and phenotypes were calculated. A linear regression model was derived to assess the effect of sodium consumption with PAC, PRC and ADRR. A total of 88 patients with aTRH were included. Adherence to at least 3 antihypertensive medications was 62.5%. The median age was 56 years (IQR 48–60), 44% were female, and 20% had diabetes. The study found that the prevalence of ADRR values exceeding the cut-off ranged from 4.5 to 23%, while low-renin hypertension (LRH) varied from 15 to 74%, Rph was found in approximately 30 to 34% of patients, PAph in 30 to 51%, and the LLph in 15 to 41%, respectively, depending on the specific cut-off value by different authors. Notably, sodium consumption was associated with lower aldosterone (β − 0.15, 95% CI [− 0.27, − 0.03]) and renin concentrations (β − 0.75, 95% CI [− 1.5, − 0.02]), but ADRR showed no significant association with sodium consumption. There were no significant differences in prevalences between the groups taking < 3 vs ≥ 3 antihypertensive medications. Altered aldosterone-direct-renin-ratio, low renin hypertension, Liddle’s-like, and primary hyperaldosteronism are prevalent phenotypes in patients within Afro-Colombian patients with apparent treatment-Resistant hypertension.

Evaluating tuberculosis knowledge and awareness of effective control practices among health care workers in primary- and secondary-level medical institutions in Beijing, China

ObjectiveInadequate tuberculosis (TB) knowledge and awareness of proper TB control practices among health care workers (HCWs) may increase the risk of nosocomial TB transmission. This study aimed to assess HCWs’ TB-related knowledge and control practices to guide the development of more effective targeted TB health education and training programs.MethodsIn January 2023 a cross-sectional survey was administered to 323 HCWs employed by five primary health care centers and three secondary comprehensive medical institutions in Beijing, China. Survey data were collected using a standard questionnaire.ResultsAnalysis of survey responses revealed TB knowledge and practices awareness rates of 60.4% and 90.6%, respectively. The overall average awareness rate across all 19 TB knowledge- and practice-related questions was 70.0%. Intermediate- and senior-level HCW’s average TB knowledge score was respectively 2.225 and 8.175 times higher than that of primary-level HCWs, while the average TB knowledge score of HCWs in secondary comprehensive medical institutions was 3.052 times higher than that of HCWs in primary health care centers. Higher average TB knowledge score correlated with higher-level professional titles and higher level work units, but higher average TB control practices score correlated with employment at primary health care center rather than secondary comprehensive medical institution. Notably, 13.6% of HCWs had not received TB training during the past three years, while 86.1% expressed willingness to undergo online TB training.ConclusionThese findings highlight inadequate TB knowledge and awareness of proper TB control practices among HCWs in primary health care centers and secondary comprehensive medical institutions in Beijing, underscoring the urgent need for targeted educational and training initiatives to improve TB awareness and control efforts.

Child marriage and quality of marriage among young married women in a rural district, Lorestan Province, Iran

PurposeChild marriage remains a significant socio-cultural phenomenon with profound implications for the quality of marital relationships, particularly among young women. This study investigates the association between child marriage and the quality of marriage among young married women in Iran.MethodsThis study employed a population-based cross-sectional research design. A total of 70 young women, aged 18–20 years, who had married before reaching 18 years of age, were selected from four primary health care (PHC) centers in Papi District, Lorestan Province, Iran, employing a systematic random sampling approach. Subjects were categorized into women experiencing relationship distress and those without such distress using the Quality of Marriage Index (QMI). Concurrently, their level of sexual satisfaction was assessed utilizing the Hudson’s Index of Sexual Satisfaction (ISS). Furthermore, Social Support was evaluated using the Social Support Questionnaire (SSQ).ResultsThe mean age (SD) of women was 18.9 (0.7) years, and their mean age (SD) of marriage was 15.2 (2.1) years. Women experiencing distress showed significant differences in age of menarche (P = 0.006), education levels (P = 0.039), spouses’ education (P = 0.025), spouses’ occupations (P = 0.004), household income satisfaction (P = 0.041), and household structure (P = 0.045). Pearson’s correlation coefficient analysis revealed significant and positive correlations between sexual self-efficacy and social support with marital quality (r = 0.73, p < 0.001 and r = 0.55, p < 0.001, respectively). Conversely, there was a significant negative correlation between the score of indexes of sexual satisfaction and marital quality (r = -0.65, p < 0.001).ConclusionThese findings emphasize the complex factors affecting marital quality and underscore the urgent need for interventions to support young women in early marriages. It is essential to reinforce policies aimed at reducing child marriage to improve the quality of marriage among young married women.

A Randomized Trial of Virtual Reality Training to Improve Firearm Safety Counseling Skills

ObjectiveTo evaluate the efficacy of Resident Education And Counseling on Household (REACH) Firearm Safety, a novel virtual reality (VR) intervention. MethodsWe conducted a single-center, randomized controlled trial among pediatric residents in a Midwestern academic primary care center comparing REACH Firearm Safety with didactic training (intervention) to didactic training alone (control). In the intervention arm, participants practiced firearm safety counseling with virtual characters and received immediate feedback. All residents completed audio-recorded standardized patient (SP) encounters before and after the training as well as a retrospective pre-post survey. Two reviewers, blinded to the allocation arm, used a standardized assessment tool to generate performance scores. Outcomes of interest included the difference between groups in SP performance scores and self-reported confidence. ResultsFrom March to July 2023, 62% of eligible pediatric residents (n = 47/76) completed the allocated study tasks (intervention 19, control 28). In both groups, SP performance scores and self-reported confidence improved. Compared to the control group, the intervention group demonstrated improvement in sharing information on secure storage devices (P = 0.009) and increased confidence in providing information on secure storage (P = 0.002). ConclusionsCompared with didactic training alone, a VR intervention using deliberate practice improved residents’ skills and confidence related to firearm safety counseling.

Development and Use of Suicide Registry for Recording Patient Profile with Self-harm Visiting Tertiary Hospital of Nepal: A Descriptive Cross-sectional Study.

Suicide is a major public health concern globally as well as in Nepal. It is important to have baseline data regarding suicide attempts to develop a prevention strategy. This study aims to describe the methodology used to develop a suicide registry and use it to collect data from patient visiting emergency or psychiatric outpatient department with suicide attempts in a tertiary care hospital. This is a descriptive cross-sectional study conducted retrospectively after obtaining ethical approval (Reference number: drs2005211371) from institutional review committee. Total sampling was done from the database covering the period from October 1, 2017, to September 30, 2023. The database was in the form of suicide registry that was developed after reviewing the existing data of primary health care centres, private hospitals, and tertiary care centers and a series of discussions among mental health experts. Data was entered in Microsoft Excel and analysis was done. Among the 248 patients, there were 109 (43.95%) male and 139 (56.05%) female. There were 209 (84.27%) patients who attempted suicide inside home, poisoning was seen in 90 (36.29%) and 183 (73.79%) had impulsive intention. Out of total patients, 59 (23.79%) had prior communication and 84 (33.87%) had previous attempts, 109 (43.95%) patients had impulsive attempts as diagnosis and 75 (30.24%) had depression. As per the suicide registry, most of the patients attempted suicide inside home and the most common method used was ingestion of poison.

Factors associated with the willingness to provide telerehabilitation by physiotherapists treating older adults or people with neurological diseases during the COVID-19 pandemic in Sweden.

While telerehabilitation is a promising alternative to traditional rehabilitation, previous studies suggest that it is still underutilised by physiotherapists. The purpose of this study was to identify factors associated with the willingness, and use of, telerehabilitation among physiotherapists. An online survey, covering self-reported use of, and attitudes toward telerehabilitation during the COVID-19 pandemic, was distributed to physiotherapists who were members of the Swedish Association of Physiotherapists and working in geriatrics or neurology in Sweden. A total of 307 responding physiotherapists were included, most of whom were female (n = 277, 90.2%), working full-time (n = 225, 73.3%), had a bachelor's degree in physiotherapy as their highest education (n = 238, 77.8%) and working in community care settings (n = 131, 43.0%). Overall, 42.3% responded that they would be willing to work with telerehabilitation daily and 47% responded that they had previously worked with telerehabilitation to some degree during the COVID-19 pandemic. Logistic regression analysis revealed that feeling comfortable using digital tools (OR = 1.81, P = .043), believing that telerehabilitation increases the accessibility of rehabilitation (OR = 2.27, P = .009), and that patients will appreciate it (OR = 2.10, P = .025), were significantly associated with willingness to work daily with telerehabilitation. Working in primary care or rehabilitation centres (OR = 3.48, P < .012), having previously used telerehabilitation (OR = 55.86, P < .001), and perceiving the workplace reimbursement system as facilitating telerehabilitation (OR = 8.24, P = .003), were factors significantly associated with reported use of telerehabilitation during the COVID-19 pandemic. Among physiotherapists in Sweden, willingness to use telerehabilitation is largely associated with personal attitudes towards it, whereas reported use of telerehabilitation appears to be related to organisational factors. These findings could be used to shape future implementation of telerehabilitation practices in geriatric and neurorehabilitation in Sweden and contribute to the broader understanding of telerehabilitation among physiotherapists across different contexts.

Implementation of the clinical practice guidelines among family medicine doctors at primary health care facilities in Khartoum and Gezira states of Sudan

IntroductionThe health system in Sudan faces several challenges, including increasing numbers of patients, shortages of health supplies, and disparities in the distribution of health services. Guidelines implementation improves patients’ outcomes and ensures efficient use of the resources in such a resource limited country. The study aimed to assess the implementation of the clinical practice guidelines among family medicine doctors working in the primary health care centers in Khartoum and Gezira states to provide baseline data about the current practice in Sudan.MethodsDescriptive cross-sectional facility-based survey, conducted from April to December 2021, on 373 of the practicing family-medicine doctors. A total of 101 Primary health care centers were surveyed (77 centers in Khartoum state and 24 in Gezira state). The questionnaire was pilot tested on a small group of physicians to improve clarity and reduce response bias. Descriptive statistics were used to summarize the data and analyzed by frequency tables. Chi square and logistic regression tests were used to determine the association between categorized variables. P value < 0.05 was considered statistically significant.ResultsMost of the practicing family-medicine doctors (98.4%) reported implementation of the guidelines. Moreover, (68.6%) of them received training programs which were organized and funded by the Sudan Ministry of Health. The local Sudanese guidelines were difficult to access and not regularly updated. Services unavailability and inaccessibility (87.1%), health insurance factors (83.9%), and patient factors (81.2%) were the most frequent barriers to guidelines implementation. Service cost (79.9%), lack of regular training programs (79.9%), absence of local guidelines (77.2%), lack of continuity in the comprehensive care process (63.0%), and lack of time (57.1%) were also reported as barriers to guidelines implementation.ConclusionGuidelines implementation is limited by unavailability and inaccessibility of the health services and the health insurance limited coverage. Expansion of the health insurance coverage, organization of continuous training programs, encouragement of regular auditing and issuing regulations to ensure the use of updated guidelines, dissemination of the updated national guidelines along with establishing clinical governance in Sudan can be useful tools for policymakers in the optimum allocation of public health resources.

Infection prevention and control in conflict-affected areas in northeast Syria: A cross-sectional study

ObjectivesIn northeastern Syria (NES), the adherence of health care facilities to infection prevention and control (IPC) standards remains underexplored. This study evaluates the IPC performance of various health facilities against World Health Organization (WHO) benchmarks using the IPC Assessment Framework (IPCAF) and the Hand Hygiene Self-Assessment Framework (HHSAF). MethodsWe conducted a cross-sectional survey of 33 health care facilities, including primary (PHC), secondary (SHC), and tertiary health care centres (THC). Data were collected via on-site evaluations using the IPCAF and HHSAF tools. ResultsA significant 91% of facilities did not meet half of the WHO IPC minimum requirements. Specifically, 57% of PHCs met 26-50% of the standards, while none exceeded 75%. Among SHCs, 71% met 26-50% of the standards, while 44% of THCs fell within this range. Notably, 81.8% of facilities were classified as ‘inadequate’ per the IPCAF, with none achieving ‘intermediate’ or ‘advanced’ levels. The HHSAF results were similarly concerning, with 34.4% deemed ‘inadequate’ and 65.6% at the ‘basic’ level. A weak positive correlation (0.137) was found between IPCAF and HHSAF scores. ConclusionsNES health care facilities demonstrate substantial deficiencies in IPC compliance, with critical gaps in IPC programmes, health care–associated infection surveillance, and training. Urgent interventions are required to enhance IPC practices, leveraging local strengths and fostering international collaborations to improve patient safety and health care quality in the region.

Prevalence of obsessive-compulsive symptoms among adult population in primary care centers in Bahrain - A cross-sectional study.

The global increasing prevalence of obsessive-compulsive disorders and symptoms among various age groups and nationalities is considered a great clinical challenge. However, limited data are available on this topic in the Middle East and Gulf Council Countries. This study aimed to raise awareness of obsessive-compulsive symptoms among adults in Bahrain by determining its prevalence and risk factors among patients attending primary healthcare centers. A cross-sectional study was conducted among adult patients attending primary healthcare centers in Bahrain. A self-administered online questionnaire using Google form, a free online survey-creating website, was distributed through WhatsApp messages. A snowball sampling technique was used. The questionnaire consisted of three parts: the socio-demographic data of participants, the Maudsley Obsessional-Compulsive Inventory, and the Yale-Brown Obsessive-Compulsive Scale. Descriptive and inferential analyses were conducted. A total of 614 participants were included with a mean age of 30.04 ± 13.04 years. Most participants were females (82.5%) and single (n = 347, 56.5%). The estimated prevalence of obsessive-compulsive symptoms among the participants was 15%; most of them reported mild symptoms (85%). Significantly higher obsession and compulsion symptoms were found among non-Bahraini (P < 0.001 and P < 0.002), single (P < 0.001 and P < 0.033), and student participants (P < 0.001 and P = 0.002) compared to their counterparts, respectively. In addition, undergraduates reported higher obsessions compared to other participants (P = 0.005). Approximately, one in every eight people in Bahrain were found to suffer from obsessive-compulsive symptoms, especially single, students, and non-Bahraini participants. These findings highlight the need for raising awareness of obsessive-compulsive disorder and its symptoms as well as the importance of early detection and management of obsessive-compulsive disorder.

Sex differences in formal recommendation of assets for health (social prescribing) in Aragon

BackgroundIn primary health care, social prescribing is an important tool which is gaining popularity. It is being studied significantly, however there is not enough evidence about different related issues. The aim of this study is to analyse the differences by sex in the application of a social prescription protocol in Primary Care.MethodsThis is a cross-sectional study carried out with data from the Electronic Health Record between September 2018 and March 2021. Descriptive, bivariate and multivariate analyses of data from 2,109 records of Social Prescription protocol in primary health care centers located in Aragón in northern Spain (Europe) were performed using Jamovi Statistics software (version 2.3.28). The comparisons by sex were carried out using a Mann-Whitney U or chi-squared test to analyse differences.ResultsThe protocol was used correctly 1,482 times, where it was applied more in females (74.8% female vs. 25.2% male). The median age in females was higher than males (female 72 vs. males 70; p = 0.003). There were significant differences by sex in several aspects to strengthen with the social prescribing, physical, emotional and relational skills. Most females and males regularly attended the recommended asset and there were significant differences in the group that never attended. Mean satisfaction was statistically different, with 4.74 points out of 5 for females and 4.86/5 for males (p = 0.010). It can be observed that older females in rural areas (OR = 34.15), whose social prescription acts on Emotional Skills and Relational and Social Skills (OR = 6.10–8.23), with good prior self-care and greater participant satisfaction (OR = 8.96), have greater chance of improving their health.ConclusionsSome results showed sex differences in the use and outcomes of formal asset recommendation. However, further research is needed to assess the relationship between social prescription, sex and gender and their implications.

Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study

ObjectiveTo assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems.DesignA prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks’ gestation and followed at three different time points: at 12–14 weeks of pregnancy, at 29–30 weeks of pregnancy, and 4–6 weeks postpartum. All women completed a mental screening at week 12–14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS).SettingSeven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain.ParticipantsPregnant women (N = 335, age 18–45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020.FindingsThe most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12–14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner’s income. In weeks 29–30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4–6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems.ConclusionsEarly screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.

The Prevalence and Burden of Psychiatric Disorders in Primary Health Care Visits in Asir Region Saudi Arabia.

Psychiatric disorders encompass a wide range of conditions that affect an individual's mental health and well-being. These disorders can manifest in various ways. The recognition, diagnosis, treatment, and referral of psychological conditions heavily rely on general practitioners, who handle consultations that involve a psychological aspect in at least one third of cases. To assess the prevalence and burden of common psychiatric disorders at primary health care centers (PHCs) using the Kessler Psychological Distress Scale (K6) in the general population, aged 18-65, and examine their symptom patterns and comorbidity. A descriptive online cross-sectional survey was conducted over a one-month period, spanning from September to October 2023. The survey targeted the population living in the Asir region. To fulfill the objectives, the K6 scale was used. Data analysis was carried out using the Statistical Package for the Social Sciences (SPSS) version 25. P values were considered statistically significant when they were ≤0.05. The survey included a total of 1,595 participants. Of these, 21.3% of respondents were male, while 78.7% were female. The majority of respondents fall within the 18-25 age group, accounting for 50.5% of the total. A significant portion of the population experiences some form of psychological distress, with 4.6% reporting low psychological distress, 36.1% reporting mild psychological distress, and a substantial 59.2% reporting severe psychological distress. Age (p-value=0.024), gender (p-value=0.001), educational level (p-value=0.001), occupation (p-value=0.008), and monthly income (p-value=0.001) had significant associations with the psychological distress score of psychiatric disorders. The prevalence and burden of psychiatric disorders in primary health care visits in Saudi Arabia is a significant public health concern. Our findings showed that the majority of participants reported having severe to mild psychological distress.

Epidemiology of infectious diseases in migrant populations from endemic or high-endemic countries: A multicentric primary care-based study in Spain.

We aimed to evaluate the epidemiology of seven infections (Chagas disease, strongyloidiasis, schistosomiasis, human immunodeficiency virus, hepatitis B and C virus, and active tuberculosis) in migrant populations attended at primary care facilities in Catalonia, Spain. This is a cross sectional study conducted from March to December 2018 at eight primary care centres in Catalonia, Spain where health professionals were recommended to systematically screen multiple infections in migrants considering the endemicity of the pathogens in their country of birth. Routine health data were retrospectively extracted from electronic health records of the primary care centres. The proportion of cases among individuals tested for each infection was estimated with its 95% confident interval (CI). Mixed-effects logistics regression models were conducted to assess any possible association between the exposure variables and the primary outcome. Out of the 15,780 migrants that attended primary care centres, 2410 individuals were tested for at least one infection. Of the 508 (21.1%) migrants diagnosed with at least one condition, a higher proportion originated from Sub-Saharan Africa (207, 40.7%), followed by South-East Europe (117, 23.0%) and Latin-America (88, 17.3%; p value <0.001). The proportion of migrants diagnosed with Chagas disease was 5/122 (4.1%, 95%CI 0.5-7.7), for strongyloidiasis 56/409 (13.7%, 95%CI 10.3-17.0) and for schistosomiasis 2/101 (2.0%, 95%CI 0.0-4.7) with very few cases tested. The estimated proportion for human immunodeficiency virus was 67/1176 (5.7%, 95%CI 4.4-7.0); 377/1478 (25.5%, 95%CI 23.3-27.7) for hepatitis B virus, with 108/1478 (7.3%, 95%CI 6.0-8.6) of them presenting an active infection, while 31/1433 (2.2%, 95%CI 1.4-2.9) were diagnosed with hepatitis C virus. One case of active tuberculosis was diagnosed after testing 172 migrant patients (0.6%, 95%CI 0.0-1.7). We estimated a high proportion of the studied infections in migrants from endemic areas. Country-specific estimations of the burden of infections in migrants are fundamental for the implementation of preventive interventions.

Can flash glucose monitoring improve glucose management for Aboriginal and Torres Strait Islander peoples with type 2 diabetes? A protocol for a randomised controlled trial

BackgroundAboriginal and Torres Strait Islander peoples are disproportionately impacted by type 2 diabetes. Continuous glucose monitoring (CGM) technology (such as Abbott Freestyle Libre 2, previously referred to as Flash Glucose Monitoring) offers real-time glucose monitoring that is convenient and easy to use compared to self-monitoring of blood glucose (SMBG). However, this technology’s use is neither widespread nor subsidised for Aboriginal and Torres Strait Islander peoples with type 2 diabetes. Building on existing collaborations with a national network of Aboriginal and Torres Strait Islander communities, this randomised controlled trial aims to assess the effect of CGM compared to SMBG on (i) haemoglobin A1c (HbA1c), (ii) achieving blood glucose targets, (iii) reducing hypoglycaemic episodes and (iv) cost-effective healthcare in an Aboriginal and Torres Strait Islander people health setting.MethodsThis is a non-masked, parallel-group, two-arm, individually randomised, controlled trial (ACTRN12621000753853). Aboriginal and Torres Strait Islander adults with type 2 diabetes on injectable therapy and HbA1c ≥ 7.5% (n = 350) will be randomised (1:1) to CGM or SMBG for 6 months. The primary outcome is change in HbA1c level from baseline to 6 months. Secondary outcomes include (i) CGM-derived metrics, (ii) frequency of hypoglycaemic episodes, (iii) health-related quality of life and (iv) incremental cost per quality-adjusted life year gained associated with the CGM compared to SMBG. Clinical trial sites include Aboriginal Community Controlled Organisations, Aboriginal Medical Services, primary care centres and tertiary hospitals across urban, rural, regional and remote Australia.DiscussionThe trial will assess the effect of CGM compared to SMBG on HbA1c for Aboriginal and Torres Strait Islander people with type 2 diabetes in Australia. This trial could have long-term benefits in improving diabetes management and providing evidence for funding of CGM in this population.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12621000753853. Registered on 15th June 2021.

Identifying innovations produced by primary health care centers and evaluating their scalability: the SPRINT Occitanie cross-sectional study in France

BackgroundPractice-based research is one of the levers identified by the World Health Organization (WHO) to strengthen primary health care. The scaling of health and social care innovations has the potential to reduce inequities in health and to expand the benefits of effective innovations. It is now rapidly gaining the attention of decision-makers in health and social care, particularly in high-income countries.To meet the challenge of declining numbers of primary care physicians in France, Multi-professional Healthcare Centers (MHC) were created to bring together medical and paramedical professionals. They are a source of innovation in meeting the health challenges facing our populations.Specific methodology exists to identify health innovations and assess their scalability. A working group, including end-users and specialists, has adapted this methodology to the French context and the University department of general practice of Montpellier-Nîmes (France) launched a pilot study in Occitanie, a French region.ObjectiveTo identify and evaluate the scalability of innovations produced in pluri-professional healthcare centers in the Occitanie region.MethodsA pilot, observational, cross-sectional study was carried out. The SPRINT Occitanie study was based on a questionnaire with two sections: MHC information and the modified Innovation Scalability Self-Administered Questionnaire (ISSaQ), version 2020. The study population was all 279 MHC in the Occitanie region.Results19.3% (54) of MHC in the Occitanie region, responded fully or incompletely to the questionnaire. Four out of 5 U-MHCs were represented. Five MHC presented multiple innovations. The average per MHC was 1.94 (± 2.4) innovations. 26% of them (n = 9) had high scalability, 34% (n = 12) medium scalability and 40% (n = 14) low scalability. The main innovation represented (86%) were healthcare program, service, and tool.ConclusionsIn our cross-sectional study, a quarter of the innovations were highly scalable. We were able to demonstrate the importance of MHC teams in working on primary care research through the prism of innovations. Primary-care innovations must be detected, evaluated, and extracted to improve their impact on their healthcare system.