Primary Care Institutions Research Articles

Spinal Osteoarthritis Is Associated With Stature Loss Independently of Incident Vertebral Fracture in Postmenopausal Women.

Retrospective observational study from the Nagano Cohort Study. Clarify the association between spinal osteoarthritis and loss of stature in postmenopausal women. Loss of stature with aging is known to deteriorate health-related quality of life and has been implicated with increased mortality. Although the association of vertebral fracture with height loss has been well documented, the relationship between stature loss and spinal osteoarthritis remains unclear. We retrospectively investigated Japanese postmenopausal women recruited from the Nagano Cohort Study. The participants were outpatients at a primary care institute in Nagano prefecture, Japan. A total of 977 postmenopausal patients (mean age: 65.8 yr) completed a minimum of 1 year of follow-up, with an average observation period of 7.6 years. Quartile analysis on the prevalence of spinal osteoarthritis and occurrence of incident fracture was performed based on the rate of stature change per year (Δ cm/yr). Multiple regression analysis was also conducted to identify the determinants of stature change. The lower quartiles of stature change rate (i.e., more rapid stature loss) displayed a significantly higher prevalence of spinal osteoarthritis (P < 0.001) and incident vertebral fracture (P < 0.001). A statistically significant independent negative association for spinal osteoarthritis prevalence with change in stature was revealed by multiple regression analysis after adjusting for confounders including incident vertebral fracture. The partial regression coefficient for spinal osteoarthritis was -0.18 (95% confidence interval -0.33 to -0.03; P = 0.016). This study demonstrated an independent association of spinal osteoarthritis with stature loss in postmenopausal women. Adequate understanding of this relationship and appropriate treatment approaches will help improve health-related quality of life in elderly patients. 3.

Mycosis fungoides-type cutaneous T-cell lymphoma (MF-CTCL) epidemiology and treatment pathway in Spain: new insights for an accurate description.

BackgroundMycosis fungoides-type cutaneous T-cell lymphoma (MF-CTCL) is a rare lymphoma localized in the skin. Due to its indolent nature and similarity to other skin conditions, diagnosis is often delayed or incorrect. Consequently, accurate calculations of incidence and prevalence are difficult to make. The treatment pathway taken by MF-CTCL patients can differ depending upon local healthcare systems, clinical policies and guidelines.AimsThis study aims to (1) provide an estimate for the prevalence of treated MF-CTCL patients in Spain, (2) describe the Spanish patient treatment pathways for MF-CTCL, including quantification of the distribution of patients between primary, secondary and tertiary care institutions, and (3) investigate and quantify the treatment preferences of physicians.MethodologyThis study employed primary market research methodologies to facilitate the collection of patient numbers and treatment practices from healthcare professionals (HCPs) and patients.LimitationsPoor diagnosis of MF-CTCL may mean that actual prevalence levels in the broader population are higher than those estimated by this analysis of treated patients. This study was reliant upon accurate reporting by HCPs of patient numbers and their personal treatment practices. The rarity of the condition means the patient sample size is relatively small and limits possible accuracy of the quantitative analyses of patient-derived data, although this is supplemented by HCP-derived data in the analysis.FindingsAround 75% of MF-CTCL patients in Spain report that the initial diagnosis by their general practitioner is incorrect. This is usually due to underestimation of severity or type of skin disease. Once they have been correctly diagnosed (usually by a dermatologist) in secondary care, the management of MF-CTCL is led by dermatologists. In 39% of patients, shared care teams are also involved in patient management. Following diagnosis, the majority of patient management is conducted by secondary or tertiary care centers.ConclusionsIncidence rates have increased in recent years, and possible reasons for this include improving levels of diagnosis. Survival in MF-CTCL has also increased over the last few decades. This trend appears to be reflected in the prevalence reported in this study, which is higher than suggested by some other estimates. However, it is still likely that there are further undiagnosed MF-CTCL patients in Spain due to the challenges of diagnosis at the primary care level.

Two adipocytokines, leptin and adiponectin, independently predict osteoporotic fracture risk at different bone sites in postmenopausal women

Although associations among obesity, adipocytokines, and bone mineral density have been reported, the influence of adipocytokines on osteoporotic fractures remains unclear. This study aimed to assess the impact of the adipocytokines leptin and adiponectin on the risk of incident vertebral and long-bone fractures in postmenopausal women. Clinical data were obtained from the retrospective Nagano Cohort Study of outpatients followed at a single primary care institute in Nagano Prefecture, Japan, between 1993 and 2018. The primary outcome was the occurrence of incident vertebral or long-bone fractures. In total, 1167 Japanese postmenopausal women (mean age: 65.9years) completed the follow-up and the average observation period was 7.2years. The subjects were divided into 4 groups (quartile 1 to 4) based respective leptin and adiponectin values. Kaplan-Meier analysis demonstrated a significantly lower incident long-bone fracture rate in the higher quartiles of serum leptin levels (p=0.002). A significantly higher and more rapid occurrence of incident vertebral fractures, but not long-bone fractures, was found in the highest adiponectin quartile (p<0.001). A Cox proportional hazards model adjusted for confounders including age, body weight, and either leptin or adiponectin revealed lower leptin levels and higher adiponectin levels as significant independent risk factors for incident long-bone fractures (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.50-0.96; p=0.03) and vertebral fractures (HR 1.18, 95% CI 1.02-1.37; p=0.02), respectively. Therefore, serum leptin and adiponectin may be independent risk factors for osteoporotic fractures affecting different bone types and sites. Determining patient adipocytokine levels may help predict the occurrence of specific osteoporotic fractures, thereby enabling optimal treatment for osteoporosis and improving quality of life.

Examining health disparities and characteristics in general practice utilization: based on outpatient data from 2014 - 2018 in Shanghai

BackgroundSince 2000, China has been developing primary care institutions to serve as the gateway to the healthcare system. However, the investment of resources in primary care institutions is not based on the actual medical demands of the public. This study analysed primary care utilization to provide targeted guidance for the improvement of primary healthcare delivery in China.MethodsWe extracted outpatient visit data from all community healthcare centres in Shanghai from 2014 to 2018. Diseases were then classified according to ICD-10 codes. The disease spectrum (frequency, proportion, rank) was stratified by sex, age, and region.ResultsMost primary care outpatients were female (58.20%), 60–79 years old (57.91%), and in suburban regions (62.18%). Chronic diseases accounted for the majority (91.41%). Hypertension, chronic ischaemic heart disease, diabetes, and acute upper respiratory tract infections were the top four disorders for primary care visits regardless of sex. In the group aged 0–18 years, symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified accounted for 37.96% of the top 20 reasons. Acute upper respiratory tract infections were the most common diseases in the groups aged 0–18 (11.20%) and 19–39 (11.14%) years. However, hypertension was the most common disease in the group aged > 39 years old (> 20%). There were more outpatients with respiratory and digestive diseases in suburban areas than in urban areas. In addition, problems associated with medical equipment and other healthcare deficiencies were relatively more common in suburban areas (suburban: 4.13%, rank 5; urban: 2.29%, rank 10).ConclusionsTo meet the patients’ needs and to develop the primary care system, the Shanghai government should focus on diseases with regionally high proportions. Disease diagnosis and treatment should be improved in the younger and suburban populations.

On the conundrum of cognitive impairment due to depressive disorder in older patients.

ObjectivesDepressive symptoms and cognitive impairment often concur in older persons. Differentiating the cause of cognitive impairment in older persons with Depressive Disorder (DD) from other diseases such as Alzheimer’s Disease (AD) is challenging. The goal of this study was to characterize cognitive impairment in older persons with DD.DesignCross-sectional retrospective observational clinical cohort study using patient records from 2014 to 2018.SettingGerontopsychiatric services of Ulm University at Bezirkskrankenhaus Günzburg serving as primary psychiatric care institution and tertiary referral center for psychiatric care for older persons.PartcipantsDD was diagnosed according to ICD-10 criteria. When indicated by the medical history or neuropsychological assessment further diagnostic procedures were initiated. Cerebrospinal fluid (CSF) tap was routinely the first additional procedure. If patients did not consent to CSF tap or contraindications were present, 18F-fluordesoxyglucose-PET (FDG-PET) or Amyloid-PET (Am-PET) were performed.Materials and methodsExtensive neuropsychological test battery to assess cognitive profile.Results457 subjects were diagnosed with DD (DD-all; age 50–94; 159 males, 298 females). Biomarkers were assessed in 176 persons; in 90 of these subjects AD-biomarkers were negative (DD-BM-; age 54–89; 40 males, 50 females), and in 86 subjects at least one biomarker was compatible with AD (DD-BM+; age 60–90; 31 males, 55 females). Cognitive performance was below healthy controls (HC; n = 56; age 50–80; 30 males, 26 females) for all groups of patients with DD. With case-control matching of HC and DD-BM- we find that executive functions are impaired in about one out of three and delayed recall in about two out of three patients with DD.ConclusionCognitive impairment is frequent in older persons with DD. Cognitive profile in older patients with DD without and with biomarkers of AD is not distinguishable. Therefore, cognitive impairment due to DD should be diagnosed after exclusion of comorbid AD.

Zika virus: clinical manifestations and treatment at a primary care institution in Colombia

Introduction: Although Zika virus cases have been reported in Colombia since 2015, its clinical and pharmacological characteristics have not yet been described.Objective: To describe the main clinical manifestations and sociodemographic characteristics of patients diagnosed with Zika and the treatment provided to them at a primary care hospital in a municipality of Colombia.Materials and methods: Descriptive cross-sectional study. The study population consisted of patients diagnosed with Zika between January 1 and July 25, 2016 at a first-level hospital. Sociodemographic, clinical and pharmacological variables, as well as adverse clinical and paraclinical outcomes associated with the infection were included. Descriptive statistics were performed. A χ² test was used for categorical variables, and a multivariate analysis was conducted using Epi info 7.1 software.Results: 254 individuals infected with Zika virus during the study period were identified, and Zika diagnosis was more frequent in women (68.5%). Regarding treatment, 90.9% of the cases were treated using acetaminophen. The most commonly reported symptoms were rash (81.1%) and pruritus (55.9%). In addition, antihistamines were the most frequent comedication (31.9%). Factors such as being a woman, being pregnant and inpatient treatment were associated with adverse clinical and paraclinical outcomes.Conclusion: The clinical manifestations described here are similar to those reported in other populations. Furthermore, inappropriate pharmacological management practices that can lead to complications in this population, such as bleeding, were observed in some cases, thus educational interventions on the proper prescription of medications for treating this disease aimed at general physicians working in Zika affected areas must be implemented in order to improve the prognosis of these patients.

Barriers to Confidentiality Protection in Adolescent Health Care: A Survey of Serbian Primary Healthcare Paediatricians and Gynaecologists

Objective − To explore the perceived barriers to confidentiality of adolescent patients among paediatricians and gynaecologists who work in the primary healthcare setting in Belgrade, Serbia. Materials and Methods − A cross-sectional survey was carried out in 13 primary healthcare institutions in Belgrade, Serbia. A total of 152 paediatricians and gynaecologists filled a self-administered questionnaire. The study instrument was developed for the purpose of this study. Beside socio-demographic characteristics, the questionnaire included a 5-point Likert’s scale to assess the respondents’ degree of agreement with potential barriers to confidential healthcare services. Results were analyzed using t-test, Chi-square test and linear regression models. Results − The majority of respondents (67.1%) indicated that limited time per patient posed a significant barrier to confidential consultation with adolescent patients. This was observed as a consequence of insufficient number of physicians working in primary care institutions. More than a half of respondents recognized a lack of adolescent gynaecologist and inadequate legal definitions as factors that may breach adolescents’ right to confidentiality. Conclusion − This study highlights specific obstacles within the healthcare system that need to be addressed in order to respect confidentiality as one of the key characteristics of a safe and supportive adolescent healthcare service. Physicians working with adolescents need to be informed about comprehensive legal guidelines. At a national level, addressing human resources in healthcare could improve adolescent healthcare service.

URBAN NETWORK OF PRIMARY CARE FACILITIES.

The urban health system, as an important component of the urban environment, requires understanding and updating in accordance with the changing political, economic, socio-demographic and other circumstances and requirements of society. Since 2015, a comprehensive healthcare reform has been taking place in Ukraine, which concerns all aspects of the organization, operation and further development of the system, including solutions to the problems and issues of architectural and urban reorganization and rethinking of the existing structure in Soviet times. Today, the first important steps have been taken to upgrade the town-planning system of primary care facilities for the population. These significant changes require further development to enhance the role of pre-hospital care for patients, which is in line with WHO recommendations and the progressive countries' experience in the development of the medical industry. The problems of the existing state of the urban planning network of institutions of the primary level of medical care for the population (therapeutic and pediatric profiles) of Ukraine are considered. Based on the world progressive experience, the introduction of family medical services is justified, the ways of further development of the network are outlined in the context of modern requirements and needs of society. The city-planning network of primary health care institutions should be developed on the principles of family medicine, that is, the medical institution should be universal in terms of age categories of patients. Also, the primary medical link should be the most extensive urban planning network providing the most convenient access for patients in order to prevent morbidity at the prehospital level. From this position, the following typological varieties of primary care institutions are offered: basic (family doctor's offices, outpatient clinics, primary medical care centers) and auxiliary (consultative and diagnostic medical centers at secondary and tertiary care hospitals, medical centers of maternity hospitals and perinatal centers).

Perspectives, Experiences, and Practices in the Use of Digital Information Technologies in the Management of Depression and Alcohol Use Disorder in Health Care Systems in Colombia.

Digital information technologies are increasingly used in the treatment of mental health disorders. Through this qualitative study, researchers illuminated perspectives, experiences, and practices among diverse stakeholders in the use of digital information technologies in the management of depression and alcohol use disorders in Colombia. In-depth interviews and focus groups were conducted in five primary care institutions across Colombia. Thematic analysis was used to analyze the data. The use of technology in the treatment of mental health disorders can facilitate the evaluation and diagnosis, treatment, and promotion and prevention of mental health disorders, as well as multiple nonmental health applications in the primary care setting. Potential barriers to the use of technology in this setting include challenges of digital literacy, access to technology, confidentiality, and financing. This study can inform the implementation of digital information technologies in the care of depression and problematic alcohol use within health care systems in Colombia.

Relationship between Morbidity and Health Behavior in Chronic Diseases

This study aimed to analyze the demographic characteristics and health behaviors related to chronic diseases and to identify factors that may affect chronic diseases. Data from the Seventh Korea National Health and Nutrition Examination Survey were used, and 3795 adults aged above 40 years were included. The following demographic variables were obtained: sex, age, education, income, type of health insurance, and private insurance. The following health behavior factors were also analyzed: medical checkup, drinking, smoking, exercise, obesity, and hypercholesterolemia. Participants with lower socioeconomic status had a higher risk of developing chronic diseases. Meanwhile, those with private health insurance had a lower risk of developing chronic diseases. In addition, participants who underwent medical checkups and performed exercises had a lower risk, while those with obesity and hypercholesterolemia had a higher risk of developing chronic diseases. It is necessary to manage chronic diseases through comprehensive programs, rather than managing these diseases individually, and through community primary care institutions to improve health behaviors.

A pilot study of the ‘PSGCloud’ — A cloud-based care service delivery and sleep disorders diagnosis system. Part I: Sleep structure and arousal analysis

ObjectivesThe high prevalence of sleep disorders has greatly increased the demands for diagnosis and treatment; while the imbalance in geographical distribution of necessary medical resources coupled with lacking of specialist care expertise in China raise the challenges further. This study aims to explore the effectiveness of our proposed innovative PSGCloud system in providing or enhancing primary care institutions with sleep medicine service capabilities. We will introduce the entire study through a series of three research papers: this first one focuses on sleep structure and arousal analysis, and the other two ensuing papers will cover respiratory as well as limb movement issue, respectively. MethodsFirstly, the three Sleep Medical Centers involved in the study uploaded their respectively recorded polysomnography (PSG) data to the PSGCloud system. Secondly, the designated PSG technicians ran the cloud-integrated PSG scoring client of the PSGCloud to download and score PSG recordings, while the same technicians also used the standalone PSG systems built-in scoring software to score the data of the corresponding patient to generate two PSG monitoring reports, respectively. Finally, the two corresponding reports for each patient were compared and analyzed in respect of 20 parameters related to sleep structure and arousal analysis as per their differences, correlations, and agreements. ResultsThe dataset in this study included PSG recordings of 30 patients’ (17 male, 13 female, aged 40.8 ± 12.63 years, Body Mass Index 26.37 ± 4.34 kg/m2). For the parameters related to sleep structure, there was no significant difference between the two systems with regard to total sleep time, sleep efficiency, wake time after sleep onset, sleep latency, and so on. For the parameters concerning arousal, there was no statistically significant difference either. Significant correlations (all ICC > 0.8, and most ICC > 0.9, ICC stands for intra-class correlation) were found in parameters of the two systems. The Bland-Altman analysis showed positive agreements between the two systems. ConclusionsThis study demonstrated clearly that the sleep scoring agent of our proposed PSGCloud system exhibited high agreement with that of the clinically recognized gold standard of the standalone PSG systems’ in terms of sleep structure and arousal analysis parameters within a limited sampling scope. And it would motivate the implementation of a large-scale validation study for the PSGCloud’s sleep care service delivery model.

STATUS OF ADOLESCENTS WITH SYMPTOMS OF IRON DEFICIENCY IN UKRAINE

The aim: The purpose of this research was to study the reasons adolescents are underdiagnosed in iron deficiency in Ukraine. Materials and methods: We provided a data analysis of medical records on the reasons and frequency of requests for medical assistance among teenage children, including the age group10-19 years. The group of exclusion criteria included patients with traumatic brain injury, burns, eye diseases, congenital abnormalities of development, childhood infirmities, persons who had contact with radiation, oncological patients, patients who had surgery within the last 3 months. Moreover, the researched cases were provided by private medical institutions as we needed to compare the laboratory tests, which are not available in governmental primary care institutions. In this research were used such key methods as basic data analysis, correlation-analysis and summarizing of gathered results. Results: The number of referrals dominated initially to ENT (36.8%), family physicians (25.6%) and pediatricians (23.3%), with a nearly equal distribution of patients by gender. From all the cases there were 162 cases where clinical laboratory blood test was performed (56,8% male, 43,2% female). The distribution among specialties of doctors, who prescribed a blood test was: 64,2% family doctors , 9,3% ENT, 20,4% pediatricians, 6,1%- other specialists. Serum ferritin was discovered in 22 cases. They were found in 19,1% and there was no correlation between inflammation changes and number of erythrocytes, hemoglobin and qualitative signs of red blood cells. Conclusions: The analysis of medical records revealed the expediency of the syndromic distribution of causes of treatment, as well as the identification of risk groups and early diagnosis of pathologies among adolescent children in the practice of a family doctor. A fifth part of adolescent patients appointments was made up of healthy individuals, of whom (69.5%) belonged to the age group of 10-13 years. Inflammatory changes in the blood are not related to the amount of hemoglobin, erythrocytes and erythrocyte characteristics. Hemoglobin, hematocrit and erythrocyte counts are not informative in the diagnosis of iron deficiency.

IDENTIFICATION OF RISKS IN THE FIELD OF HEALTHCARE AND THEIR INFLUENCE ON THE FUNCTIONING OF TERRITORIAL COMMUNITIES IN THE CONDITIONS OF IMPLEMENTATION OF MODERN REFORMS

Introduction. Among the measures to ensure the well-being of communities, one of the most important is health care, which in Ukrainian reality is largely due to high mortality rates, reduced life expectancy and low satisfaction of community residents with the quality of health care. Goal. Identification of health risks, identification of their impact on the functioning of local communities and development of a set of measures aimed at their leveling. Method (methodology). Methods of logical generalization, analysis, comparison and synthesis are used to identify risks in the health care system and justify measures to minimize them. Results. Identified organizational and institutional, functional, financial risks in the health care system; an analytical study was carried out and the peculiarities of their influence on the functioning of territorial communities were clarified. A set of measures aimed at the effective functioning of health care at the territorial community level and minimization of negative consequences in terms of identified risks, namely: organizational and institutional (legislative definition of secondary and tertiary levels of health care, taking into account administrative and territorial features of primary health care). Assistance in determining the capitalization rate and the abolition of limitation of declarations in rural areas); financial (establishment of an effective mechanism for financing primary health care in the local community, elimination of inefficient expenditures, application of financial incentives for employees of health care facilities of the local community); functional risks (establishing partnerships between local governments and the management of the primary care institution, stimulating and encouraging local governments to develop medicine in the local community, control over the conditions of remuneration of primary care physicians).

Evaluation and design of public health information management system for primary health care units based on medical and health information

ObjectiveThe objective is to understand the role of information management systems in the public health perspective of primary care units more accurately. MethodsA public health information management system for primary medical units, which is based on electronic health records, virtual private network technology, real-time data storage, and other technologies, is designed on the premise of economical and straightforward operation. Besides, Xinhua Community Health Service Center Around the Wulong Street, Longsha District, Qiqihar City is selected as the experimental unit of the public health information management system, and the work efficiency of the system in the public health perspective of the primary medical unit is evaluated after 12 months of system operation. ResultsThe public health information management system of primary medical units has following comprehensive management functions: health record management, child health, maternal health, health of the elderly, health of patients with chronic diseases, health of severe psychiatric patients, health education, infectious diseases and public emergencies, health events, health supervision, and management information. In addition, after 12 months of information management system operates in the grassroots units, the results show that patients and doctors have a very high satisfaction rate with the system. The system not only cultivates the excellent health and disease prevention awareness of residents but also improves the efficiency of primary care institutions, as well as reducing the number of patients seeking medical cares. ConclusionThe public health information management system of primary health care units based on medical and health information design is rich in functions with prominent work efficiency, which significantly improves the public health of grass-roots medical units. The research is useful and significant for follow-up studies on public health care systems.

Trends in access to health services, financial protection and satisfaction between 2010 and 2016: Has China achieved the goals of its health system reform?

Guided by the principle of universal health coverage, China began its complex health system reform in 2009. Using data from the China Family Panel Studies (CFPS), this study assesses trends in healthcare utilization, financial protection, and satisfaction between 2010 and 2016. We use difference-in-means tests and regression analysis to evaluate overall trends and compare subsample results by urban/rural residence and income quartiles to examine changes in inequity. Our results show that China has achieved substantial improvements in access to healthcare services and financial protection since the health system reform in 2009. First, China has experienced a substantial increase in both inpatient and outpatient care utilization between 2010 and 2016. Second, people receive better financial protection by measures of health insurance coverage, inpatient reimbursement rate, the likelihood of incurring catastrophic health expenditure, and the likelihood of medical impoverishment. Third, inequity in financial protection by income quartiles has significantly decreased, though poorer groups remain more vulnerable. However, we do not observe a concurrent increase in satisfaction towards the health system. We also find that people are more willing to seek medical services in hospitals rather than primary care institutions. All these results suggest that China's ongoing health system reform should pay more attention to establishing a tiered health delivery system, strengthening financial protection for the poor, and increasing responsiveness to rising expectations.

Chinese Minority Perceives the Doctor-Patient Relationship Differently: A Cultural and Economic Interpretation.

In China, doctor-patient relationships (D-P relationships) are cited frequently and attracted international attention. This study assesses whether the D-P relationship experienced by the Chinese is associated with ethnicity, hospital hierarchies, and socioeconomic factors. In a national cross-sectional survey, multi-stage random sampling was adopted to assess regional and socio-economic differences between year 2016 and year 2017. Each area surveyed consisted of about 250 randomly chosen households, and valid results were obtained from 4,173 adults aged 16–99. When provided a choice of eight types of D-P relationship, for doctors in primary care institutions, 63.8% of ethnic minorities indicated having a friend-type relationship with their physicians, with 23.3% having a trading/reciprocal relationship. Han Chinese, however, predicts the opposite relationship between doctors from different hierarchy and the types of D-P relationship. For physicians working in hospitals, this difference in relationship was more pronounced, where 52.9% of ethnic minorities indicated having a friend-type relationship with their physicians, and 30.1% indicated the presence of a trading/reciprocal relationship. For Han Chinese, however, 53.3% indicated having a reciprocal relationship with their doctor. Overall, the prevalence of friendly D-P relationships was correlated with ethnic minorities, lower levels of education, and lower incomes. Ethnic minorities are most likely to perceive their physicians as friends, while Han Chinese are more likely to perceive a trading relationship with their physicians. The primary contribution of this research is the finding that D-P relationships differ for Han Chinese and other ethnic minorities.

Moderating role of job satisfaction on turnover intention and burnout among workers in primary care institutions: a cross-sectional study

BackgroundGlobal countries are suffering from a shortage of health professionals. Turnover intention is closely related to job satisfaction and burnout, making good use of these relationships could alleviate the crisis. Our research aims to examine the mediating role of job satisfaction in the relationship between burnout and turnover intention.MethodsThis research was conducted in Huangpi, China. The convenience sampling method and self-administereded questionnaires were used. 1370 of valid samples were collected with 97.72% effective rate. Descriptive analyses were conducted to describe social demographic factors. The structural equation model (SEM) was performed to adjust model fitting, and the mediation effect test was carried out by using the bootstrap method. Sobel-Z test was used to verify the significance of mediation effect.ResultsThe mean age was 36.98 (SD = 9.84). The fitting indices of hypothetical model are not good. After the adjustments, χ2/df = 5.590, GFI = 0.932, AGFI = 0.901, CFI = 0.977, NFI = 0.973, IFI = 0.977, TLI = 0.970, RESEA = 0.058. The revised model fitted well, and the SEM was put up by using the bootstrap method. The mediating effect is partial, and Soble-Z test indicates that the mediation effect is significant. Burnout is negatively correlated with job satisfaction (p < 0.01) and the standardized path coefficient is − 0.41. Job satisfaction is also negatively correlated with turnover intention (p < 0.01) and the standardized path coefficient is − 0.18. Burnout is positively correlated with turnover intention (p < 0.01) and the standardized path coefficient is 0.83.ConclusionsJob satisfaction is a mediating variable that affects the relationship between burnout and turnover intention. The mediating effect was a partial mediating effect and has a low impact of 7.4%. Improving treatment and giving more promotion opportunities for workers to improve job satisfaction, conducting career planning course and paying attention to employee psychological health to reduce job burnout. The above measures may be helpful to reduce employee turnover rate and alleviating the current situation of a shortage of health personnel in China.

Prescribing patterns of encounters in fourteen general practice clinics in rural Beijing: a cross-sectional study

BackgroundGeneral practice clinics are the main primary care institutions providing ambulatory care in the rural areas of Beijing, rational use of medicines is crucial for the rural primary care system. This study investigated the prescribing patterns of general practice clinics in rural Beijing to provide a baseline for monitoring and promoting the rational use of medicines.MethodsWe performed a cross-sectional study at 14 rural community health service centers in 6 non-central districts of Beijing sampled through a multistage approach, 85 general practitioners were selected from the 14 centers. Total 8500 prescriptions were derived by recording 100 consecutive patients of each the general practitioner. The World Health Organization drug use indicators and an additional indicator were adopted to assess the prescribing patterns.ResultsThe median number of medicines per encounter was 2.0 (1.0, 2.0); the percentage of generics and essential medicines prescribed were 97.0 and 58.2%, respectively; the percentage of encounters with antibiotics prescribed was 15.1%; the percentage of encounters with injections prescribed was 3.7%; the percentage of encounters with traditional Chinese patent medicines prescribed was 52.5%; the median duration of consultation time was 6.0 (4.0, 10.0) minutes. The most frequently prescribed medicine was aspirin (low dose, 4.6%). The prescribing indicators were influenced by different patient characteristics, patients with new cooperative rural medical scheme were less likely to be prescribed with ≥3 medicines (OR 0.865), essential medicines (OR 0.812) and traditional Chinese patent medicines (OR 0.631), but were more likely to be prescribed with injections (OR 1.551) in the encounter. Patients with ≥3 problems were more likely to be prescribed with ≥3 medicines (OR 6.753), antibiotics (OR 2.875) and traditional Chinese patent medicines (OR 2.926) in the encounter.ConclusionsMost indicators in this study showed similar or fair performance in comparison with World Health Organization and domestic reports, except the percentage of medicines prescribed from the essential medicine list. Regular monitoring on the prescription quality of general practice clinics in rural Beijing should be maintained.

Naming Nutrition Injustice: How Might Dietitians Articulate a Socially Just Dietetic Practice?

This paper invites readers to consider how the ideals, concepts, and language of nutrition justice may be incorporated into the everyday practice of clinical dietitians whose work is often carried out within large, conservative, primary care institutions. How might clinical dietitians address the nutritional injustices that bring people to their practice, when practitioners are constrained by the limits of current diagnostic language, as well as the exigencies of their workplaces. In the first part of this paper, I draw on Cadieux and Slocum’s work on food justice to develop a conceptual framework for nutrition justice. I assert that a justice-oriented understanding of nutrition redresses inequities built in to the biomedicalization of nutrition and health, and seeks to trouble by whom and how these are defined. In the second part of this paper, I draw on the conceptual framework of nutrition justice to develop a politicized language framework that articulates nutrition problems as the outcome of nutritional injustices rather than individuals’ deficits of knowledge, willingness to change, or available resources. This language framework serves as a counterpoint to the current and widely accepted clinical language tool, the Nutrition Care Process Terminology, that exemplifies biomedicalized understandings of nutrition and health. Together, I propose that the conceptual and language frameworks I develop in this paper work together to foster what Croom and Kortegast (2018) call “critical professional praxis” within dietetics.

A strategy for improvement in diagnosis and treatment of bronchial asthma in primary care

Recently, bronchial asthma is considered as a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms, which vary in time and intensity and manifest together with variable obstruction of the airways. Asthma is one of the most common chronic respiratory diseases in primary care. Patients with certain respiratory symptoms seek for medical aid initially in primary care physicians, such as therapeutists, general practitioners, and family physicians, who can suspect and diagnose chronic respiratory diseases such as bronchial asthma, chronic obstructive pulmonary disease (COPD), allergic rhinitis, etc. Currently, untimely diagnosis of asthma and late initiation of anti-inflammatory treatment are widespread, mainly due to insufficient knowledge of primary care physicians on diagnostic criteria and therapeutic standards for asthma. Feasible and convenient algorithms for asthma diagnosis and treatment in primary care were developed by experts of Russian Respiratory Society and Russian Association of Allergologists and Clinical Immunologists. A therapeutic algorithm for asthma treatment in primary care institutions uses an approach considering symptom severity both in patients with newly diagnosed and previously treated for asthma. Diagnostic tools, such as a questionnaire for asthma diagnosis and an algorithm for differential diagnosis between asthma and COPD are mainly intended to facilitate diagnosis of chronic respiratory disease, particularly bronchial asthma, by a primary care physician and to improve the healthcare quality for these patients.