Primary Care Level Research Articles

Health systems responsiveness towards needs of pregnant women in Vietnam

BackgroundHealth systems that are responsive to maternal mental health recognise the importance of integrating mental health services into maternal care. Studies from Vietnam have reported particularly high rates of common perinatal mental health disorders (CPMDs) in both rural and urban areas of the country. Despite the increasing burden of maternal mental health conditions, there is currently no guidance on the screening for CPMDs within maternal care, both antenatal and postnatal. In this paper, we report the findings from a survey that examined health systems responsiveness to the needs of pregnant women at the primary care-level in Vietnam, utilising the WHO’s validated responsiveness questionnaire.MethodsCluster sampling was used in two districts, in Bac Giang Province. Data were collected using the WHO responsiveness tool, including questions on the domains of responsiveness relating to pregnant women’s last antenatal visit. SPSS (version 24) software was used for data entry and analysis, respectively. Bivariate and multivariable logistic regression were computed to identify the associated factors of health system responsiveness in maternity care at 95% CI.ResultsWe found that the overall mean health systems responsiveness score was 2.86 (out of maximum 4), with 30.4% pregnant women rating responsiveness as “poor” for maternal health care (based on the cutoff point of 60 for overall score). The three highest scoring domains were “social support”, “trust”, and “dignity” and lowest scoring domains were “choice of providers”, “prompt attention”, and “communication”. There is a strong preference for seeking maternal health care at private facilities which meet women’s needs of “confidentiality” and “basic amenities”. Household income was found to have a significant impact on the six responsiveness domains. Finally, only a small proportion of pregnant women self-reported having CPMDs and accessed mental health facilities.ConclusionsThese findings highlight the need to improve the responsiveness of the Vietnamese health system to meet pregnant women’s expectations, mainly in relation to prompt attention and communication. This study also highlights the importance of specifically targeting efforts towards improving the responsiveness of the public health sector. Integrating maternal and mental health at the primary care-level can be one approach to tackle the mental health treatment gap experienced by pregnant women in Vietnam. This can promote early detection and intervention of CPMDs, but may also contribute towards reducing mental health-related stigma.

Основные направления совершенствования диабетологической помощи в условиях поликлиники (по результатам социологического исследования).

A sociological assessment of satisfaction with outpatient care for patients with diabetes mellitus in the Republic of North Ossetia-Alania was carried out. The results of the study make it possible to identify the main problems faced by patients at the primary health care level and identify possible ways to level them. The purpose of the study: to assess the satisfaction of patients with diabetes mellitus with the quality of medical care provided in outpatient settings. Materials and methods. The questionnaires of 450 patients with diabetes mellitus, urban (66%) and rural (34%) residents were analyzed. Of these, 45% are men and 55% are women aged 39–59 years (39.0%), 60–79 years (36.0%), over 80 years (6.0%). The questionnaire included 12 questions on various aspects of the clinic’s activities. Data processing and analysis were performed using the IBM SPSS Statistics 27.0.1 software and analytical complex. Results. A study of the satisfaction of patients with diabetes mellitus with outpatient medical care has revealed a number of organizational and medical problems. The regularity of visits to the endocrinologist by patients is one of their main conditions for the effectiveness of therapeutic and preventive measures and dispensary supervision. A fairly high percentage (72%) visit the clinic from 2 to 5 times a year. It is alarming that 28% of patients visit an endocrinologist only once a year, which is a sign of low adherence to treatment on the part of patients. Rural residents visit an endocrinologist less often than urban residents. Young people are more often dissatisfied with the time that the doctor spends at the reception and more often face rude treatment from the medical staff. The comorbidity of diabetes mellitus requires the provision of high-quality medical care in accordance with the expectations of patients, which is provided with logistical equipment and staffing Conclusion. The results obtained are an indicator of the quality of medical care and indicate the presence of problem areas in the activities of medical organizations providing outpatient care to patients with diabetes mellitus. Special attention should be paid to the organization of dispensary follow-up in order to reduce the risks of developing complications of the disease. It is necessary to increase the availability of primary health care by making appropriate management decisions at the level of regional health authorities.

Recommendations to strengthen hybrid mental health policy in primary care services in Chile

AbstractThis article presents the main results of a qualitative study proposing guidelines for a hybrid public policy on mental health at the primary care level that faces the challenge of improving access under conditions of quality. The empirical evidence was constructed from semistructured interviews with users, decision makers, and professionals from Chile's central, regional, and local healthcare levels and a review of specialized literature. The study shows that strengthening a hybrid telehealth policy at the primary care level is an outstanding strategy to contribute to reduce accessibility, acceptability, and availability barriers. Yet, to be effective, it is necessary to take on some guidelines in terms of remote care management in Primary Healthcare centers, training of professionals, and skill building of civil servants in the use of technology, regulatory framework, infrastructure and technology; financing; inclusion of the user's perspective; and clinical guidelines and technical standards for hybrid care. The leadership of the Ministry of Health is fundamental to promote relevant regulation and the coordination and active participation of different stakeholders.

Prevalence and demographic distribution of anaemia among those visiting a teaching hospital located in tribal predominant block of Jharkhand: Retrospective record based analysis

ABSTRACT Background: Anaemia is a major public health concern in developing countries, with cases increasing rapidly among women, young girls, and children under age 5. Aims: This study aimed to estimate the prevalence of anaemia and to identify the age and gender distribution of anaemia among those attending IPD/OPD of a teaching hospital located in the tribal block. Methodology: The study was conducted at a multispecialty tertiary care hospital in tribal predominant area, Jharkhand, India. A retrospective, chart-based study design was adopted to achieve the objectives. All inpatient case records available from the Department of Laboratory Medicine and the electronic hospital information system of the institute were reviewed between January 1, 2021, and January 31, 2024. Result: A total of 15004 reports were screened for detecting anaemia, of them 7095 (47.3%) were males and 7909 (52.7%) were females. The overall prevalence of any grade of anaemia was found in 6579 (43.8%; 95% CI: 43.1–44.6). Univariate logistic regression analysis to predict status of anaemia among study participants showed the odds of being anaemic was 1.5 times (95% CI: 1.2–2.1) higher among those with age >60 years compared to those who were in the age group of 1–4 years. Females had 2.3 times (95% CI: 2.2–2.5) higher odds of having anaemia than males. Conclusion: This study shows that half of the patients attending hospital are anaemic and the burden increases as the age increases and highest among elderly >60 years. The results of our secondary data analysis should contribute to better screening and identifying the cases among people attending the hospital and also could aid planning services at the primary care level.

Determinants of glycemic control among persons living with type 2 diabetes mellitus attending a district hospital in Ghana

Determinants of glycemic control among persons living with type 2 diabetes mellitus attending a district hospital in Ghana

Healthcare Trajectories of Adolescent Patients With Cleft Lip and/or Palate According to Health Insurance Coverage in Medellin, Colombia.

To describe and compare the healthcare trajectories of patients with CL/P under two different income-based programs for health coverage in Colombia, known in Colombia as a health insurance regime (contributory and subsidized), in Medellín, 2021. Non-experimental, cross-sectional questionnaire-based study. Primary level of clinical care in Medellín, Colombia. Twenty-eight 15- to 21-year-olds with CL/P and primary caregivers. Individuals with CL/P answered the survey. Patients with syndromic CL/P and patients with cognitive disabilities were excluded. The calculation of the probabilistic sample was performed based on the formula for finite populations using databases from 2 health insurance companies. The analysis was descriptive and bivariate. Chi-square and Fisher tests were used to analyze the variables of interest. Continuity of the care pathway was measured with proxy indicators: (1) access to comprehensive CL/P treatment; (2) timeliness of access to comprehensive CL/P treatment; (3) differences in access to and timeliness of comprehensive CL/P treatment between patients under both health insurance coverage. No differences were found when comparing the healthcare trajectories of young patients with CL/P who were in both health coverage. Differences were observed in the timeliness of care for patients with CL/P under the subsidized coverage who were more economically vulnerable. Delays in care were mainly linked to administrative procedures required for orthodontic procedures, bone grafts, and maxillofacial surgeries. Despite the health system's guarantee of equal care across income levels, differences in the timeliness of care persist for patients from lower-income families.

Effectiveness of autism training program introduction at primary health care (PHC) level

Background: Autism spectrum disorder (ASD) has become a public health issue in many countries especially in developing countries. Family members who have a toddler with ASD face significant physical, emotional, and financial challenges. Early detection is crucial to achieve improvement in children with ASD. Objectives: The aim of the current research is to study the implementation of a training program for Autism in 4 health care facilities and to evaluate its initial outcomes. Methodology: An interventional study conducted among 63 health care workers dealing with children 18-30 months in 4 health care facilities (2 urban health care facilities and 2 rural health care facilities) in Giza governorate. A tailored autism health education message as well as training on using the Arabic validated version of the Modified Checklist for Autism in Toddlers (M-CHAT) were provided to the HCWs. Results: 58.7% of participating primary health care workers (HCWs) had a satisfactory level of awareness about childhood autism prior to the intervention, and 71.4% had a satisfactory level of understanding following it. When comparing the study subjects' pre-intervention knowledge scores to their post-intervention knowledge scores, there was a statistically significant improvement in their knowledge about autism (p < 0.001). Conclusion: The study's findings validate the value of specialized training programs in raising healthcare workers' awareness of childhood autism. Recommendations: Incorporation of autism spectrum disorder (ASD) within the educational curriculum of medical and nursing schools and ongoing education and training in ASD for health care workers.

PROBLEMS OF THE ORGANIZATION OF THE STATE POLICY OF THE PROVISION OF MEDICAL SERVICES BY THE PRIMARY LINK OF MEDICAL AID IN UKRAINE

The article highlights key issues related to management at the level of primary health care in Ukraine. The focus is on aspects such as the growing role of primary care. Primary care is the foundation of the health care system, providing a patient's first contact with health services, prevention, diagnosis and treatment. It is especially important in the conditions of limited financial resources to continue the reforms of the medical industry in Ukraine. The article raises the issue of the availability of medical care: the relevance of management problems is due to uneven access to medical services in rural areas and remote regions. Improving the management of the medical field is necessary to overcome these difficulties. The article examines current problems in the field of primary medical care and ways to overcome them through the reform of state policy in the field of health care. The authors explore key challenges facing primary care, including insufficient funding, lack of qualified staff, uneven distribution of resources, and lack of effective governance mechanisms at various levels. Attention is paid to the issues of ensuring the availability of medical services, the quality of medical care and the implementation of new models of the organization of medical institutions. The article analyzes the reformative steps aimed at improving the functioning of the primary health care system, in particular, the introduction of family medicine and increasing the role of general practitioners. The role of state funding and the involvement of local communities in the management of medical institutions is considered separately. The conclusions emphasize the importance of improving the state's primary health care policy by strengthening financial support, infrastructure development, and improving the qualifications of medical workers to ensure a sustainable and effective health care system in Ukraine. The topic of economic challenges and management efficiency is interesting for analysis. Optimizing the use of financial resources requires their effective use, finding ways to increase the economic sustainability of healthcare institutions.

Improving Diagnosis and Management of Opioid-Induced Constipation (OIC) in Clinical Practice: An Italian Expert Opinion.

Opioid-induced constipation (OIC) is a very common and troublesome gastrointestinal side effect following the use of opioids. Despite existing international guidelines, OIC is largely underdiagnosed and undertreated. ECHO OIC is a European project designed to improve the diagnosis and management of OIC at the primary care level. The next phase of the ECHO OIC project is to review and adapt the proposed European pathway at national level, considering the local patient journey and clinical practice. A multidisciplinary group of 12 Italian experts reviewed and discussed the European path and formulated a seven-step guide for the practical management of OIC that is also easily applicable in primary care: 1. When prescribing long-term opioids, the physician should inform the patient of the possibility of the onset of OIC; 2. At opioid prescription, doctors should also prescribe a treatment for constipation, preferably macrogol or stimulant laxatives; 3. The patient should be evaluated for OIC within the second week of initiating opioid treatment, by clinical history and Rome IV criteria; 4. In the presence of constipation despite laxatives, prescription of a PAMORA (Peripherally Acting Mu Opioid Receptor Antagonist) should be considered; 5. When prescribing a PAMORA, prescribing information should be carefully reviewed, and patients should be accurately instructed for appropriate use; 6. Efficacy and tolerability of the PAMORA should be monitored regularly by Bowel Function Index, considering a cut-off of 30 for the possible step-up of OIC treatment; 7. After 4 weeks of treatment, if the efficacy of PAMORA is deemed inadequate, discontinuation of the PAMORA, addition of an anti-constipation drugs, change of opioid type, or referral to a specialist should be considered. Spreading knowledge about the OIC problem as much as possible to the health community is crucial to obtain not only an early treatment of the condition but also to promote its prevention.

Association of Urinary Epidermal Growth Factor, Fatty Acid-Binding Protein 3, and Vascular Cell Adhesion Molecule 1 Levels with the Progression of Early Diabetic Kidney Disease

Introduction: Diabetic kidney disease (DKD) is a common cause of chronic kidney disease with around 25–40% of patients with diabetes being affected. The course of DKD is variable, and estimated glomerular filtration rate (eGFR) and albuminuria, the currently used clinical markers, are not able to accurately predict the individual disease trajectory, in particular in early stages of the disease. The aim of this study was to assess the association of urine levels of selected protein biomarkers with the progression of DKD at an early stage of disease. Methods: We measured 22 protein biomarkers using the Mesoscale Discovery platform in 461 urine samples of the PROVALID cohort, an observational study of patients with type 2 diabetes mellitus followed at the primary health care level for a minimum of 4 years. Odds ratios (ORs) were estimated for the effect of marker values above median on fast progression using unadjusted and adjusted logistic regression models. RNA expression at the single-cell level in kidney biopsy samples obtained from a cohort of young persons with type 2 diabetes mellitus was in addition determined for markers showing significant associations with disease progression. Results: Increased urinary levels of epidermal growth factor (EGF) were linked to lower odds of fast progression (defined as annual eGFR decline greater than 2.58 mL/min per 1.73 m2) with an OR of 0.60 (95% CI: 0.46, 0.78). The association with outcome was even stronger when adjusting for a set of 14 baseline clinical parameters including age, biological sex, eGFR, body mass index, albuminuria, and HbA1c. Elevated urinary levels of fatty acid-binding protein 3 (FABP3) and vascular cell adhesion molecule 1 (VCAM1) were each significantly associated with fast progression with an OR of 1.44 (95% CI: 1.11, 1.87) and an OR of 1.41 (95% CI: 1.08, 1.83), respectively. Enriched expression of EGF and FABP3 was observed in distal convoluted tubular cells and VCAM1 in parietal epithelial cells at single-cell level from biopsies of patients with early DKD. Conclusion: In summary, we show that lower urinary levels of EGF and higher urinary levels of FABP3 and VCAM1 are significantly associated with DKD progression in early-stage disease.

Effectiveness of XBB.1.5 Vaccines Against Symptomatic SARS-CoV-2 Infection in Older Adults During the JN.1 Lineage-Predominant Period, European VEBIS Primary Care Multicentre Study, 20 November 2023-1 March 2024.

We estimated XBB.1.5 vaccine effectiveness (VE) against symptomatic SARS-CoV-2 infection among adults aged ≥ 65 years during the 2023/2024 JN.1 lineage-predominant period in a European multi-country test-negative case-control study at primary care level. We estimated VE adjusted by study site, age, sex, chronic conditions and onset date. We included 220 cases and 1733 controls. The VE was 48% (95% CI: 12-71), 23% (95% CI: -11-48) and 5% (95% CI: -92-56) among those with symptom onset 1-5, 6-11, and ≥ 12 weeks after vaccination, respectively. XBB.1.5 vaccine provided short and moderate protection against JN.1 symptomatic infection.

Internet Addiction Scale for School and College Students – Construction, validation, and cutoff derivation

ABSTRACT Background: With young people and teenage children, India has recently become a hotspot for a multiple-fold increase in internet users. The objective of our study was planned to create a psychometric scale specially targeting school and college students with appropriate validation and cut-off derivation, as these groups are collective and also holds a major burden of internet addiction and also a potential risk group for developing internet addiction disorder. Methods: This was a cross-sectional study with a sample size of 1530 done among college students and school students studying between IX to XII standard with habit of internet usage. A google form survey questionnaire was used and study was conducted for a period of 2 months. Domain identified was Internet addiction which was followed by Item generation done by both Inductive, Deductive method and Content validity obtained from the field experts. After Cognitive Interviewing, survey was conducted by circulating the constructed scale in the Google form questionnaire to the eligible participants. After collecting the required data from the participants, the scale was subjected to Item Reduction Analysis. Results: The mean age of the study participants was 18.96 ±3.68 years and most of them were females. All the individual items had discrimination index value of higher than 0.75 and Cronbach’s alpha of 0.75. The total weighed score calculated by adding the individual weighed score came as 21078. Correction factor obtained by dividing the weighed score to the raw score was 0.89. Using the Internet Addiction Scale for School and College Students (IASSCS) having a cut off value of 16 to delineate a person to have Internet addiction and No Internet addiction, around 63% of the study participants were found to have internet addiction and 37% of them were not having Internet addiction and among them a greater number of Internet addicts were found to be male compared to females. Conclusion: Due to the fact that internet addiction is linked to numerous physical and mental health problems, it may be more beneficial to use scale reports as screening tools at the primary health care level in order to identify high-risk groups for health problems caused by internet addiction at the earliest.

Prevalence of anxiety disorders among visitors at a military primary health center in UAE

ABSTRACT Background: Anxiety disorders are common. However, individuals suffering from anxiety disorders often do not seek treatment. These disorders impose a high individual and societal burden, especially on military personnel and their families, and place a significant burden on healthcare systems as care is often sought from primary care physicians rather than specialized professionals. This study was undertaken to determine the prevalence and correlates of anxiety among visitors at a Military Primary Health Center. Results: Anxiety disorders were high in our study population. Generalized Anxiety Disorder (GAD) was the most common, while social phobia was less prevalent. 72.5% were 18-40 years old and 63.5% were males. 68% were military personnel, 23% were military personnel family, and the rest were retired. The most common symptoms were sleep disturbances (60.4%), irritability (55%), and restlessness (51.4%). GAD, specific phobia, and panic disorder were more likely in divorced people, and chronic diseases were more likely in people suffering from GAD. Conclusions: The prevalence of anxiety disorders was considerably higher among visitors at a Military Primary Health Center due to the high stress levels and occupational difficulties associated with an unstable social and family life. Counseling services and follow-up of diagnosed cases should be available at the primary health care level for improved healthcare delivery by the primary care or family health physicians.

FAMILY AND COMMUNITY MEDICINE AND WORK WITH NEGLECTED POPULATIONS: CHALLENGES AND OPPORTUNITIES IN CARING FOR THE INVISIBLE

Considered specialists in people, Family and Community Medicine has in its constitution of values ​​and principles comprehensive, humanistic and person-centered care, seeking to develop ideas and people with a view to equity and transformation of patients into protagonists. In this context, the specialty works directly with neglected populations, both at the level of primary care in family health units and in street clinics, prisons, assistance to refugee populations, migrants and a comprehensive approach to the LGBT population. This work within the scope of social medicine, beyond a strictly biological view of illness and human beings, dialogues with the pillars of training of the specialty, based on primary care, medical education, humanism, and mainly on the training of leaders. This work seeks to discuss in a reflective way, through a narrative review of the literature, the challenges, opportunities and fields of action of Family and Community Medicine with neglected populations.

Using Existing Clinical Data to Measure Older Adult Inpatients' Frailty at Admission and Discharge: Hospital Patient Register Study.

Frailty is a widespread geriatric syndrome among older adults, including hospitalized older inpatients. Some countries use electronic frailty measurement tools to identify frailty at the primary care level, but this method has rarely been investigated during hospitalization in acute care hospitals. An electronic frailty measurement instrument based on population-based hospital electronic health records could effectively detect frailty, frailty-related problems, and complications as well be a clinical alert. Identifying frailty among older adults using existing patient health data would greatly aid the management and support of frailty identification and could provide a valuable public health instrument without additional costs. We aim to explore a data-driven frailty measurement instrument for older adult inpatients using data routinely collected at hospital admission and discharge. A retrospective electronic patient register study included inpatients aged ≥65 years admitted to and discharged from a public hospital between 2015 and 2017. A dataset of 53,690 hospitalizations was used to customize this data-driven frailty measurement instrument inspired by the Edmonton Frailty Scale developed by Rolfson et al. A 2-step hierarchical cluster procedure was applied to compute e-Frail-CH (Switzerland) scores at hospital admission and discharge. Prevalence, central tendency, comparative, and validation statistics were computed. Mean patient age at admission was 78.4 (SD 7.9) years, with more women admitted (28,018/53,690, 52.18%) than men (25,672/53,690, 47.81%). Our 2-step hierarchical clustering approach computed 46,743 inputs of hospital admissions and 47,361 for discharges. Clustering solutions scored from 0.5 to 0.8 on a scale from 0 to 1. Patients considered frail comprised 42.02% (n=19,643) of admissions and 48.23% (n=22,845) of discharges. Within e-Frail-CH's 0-12 range, a score ≥6 indicated frailty. We found a statistically significant mean e-Frail-CH score change between hospital admission (5.3, SD 2.6) and discharge (5.75, SD 2.7; P<.001). Sensitivity and specificity cut point values were 0.82 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.85. Comparing the e-Frail-CH instrument to the existing Functional Independence Measure (FIM) instrument, FIM scores indicating severe dependence equated to e-Frail-CH scores of ≥9, with a sensitivity and specificity of 0.97 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.92. There was a strong negative association between e-Frail-CH scores at hospital discharge and FIM scores (rs=-0.844; P<.001). An electronic frailty measurement instrument was constructed and validated using patient data routinely collected during hospitalization, especially at admission and discharge. The mean e-Frail-CH score was higher at discharge than at admission. The routine calculation of e-Frail-CH scores during hospitalization could provide very useful clinical alerts on the health trajectories of older adults and help select interventions for preventing or mitigating frailty.

Exploring methodologies and frameworks for best practice transfer at the primary care level

Abstract Background In Feb 2023, the EU’s Joint Action on the transfer of best praCtices In pRimary CarE (CIRCE-JA) was launched with the objective of effectively transferring and implementing six best practices (BPs) among Member States (MS). Transferability from one primary care (PC) setting to another can be challenging given organizational, legal, cultural, social, economic, and environmental factors, requiring robust a methodological framework to guide the transfer process. A scoping review was conducted to identify conceptual models and methodological frameworks for context-relevant and evidence-informed BP transfer in PC settings. Methods The study aimed to identify models or frameworks to guide BP transfer in PC settings, whilst maximizing transferability. The JBI methodology was used, and an extensive search was conducted in PubMed (time limit: Jan ‘13-May ‘23). All publications of original research, systematic reviews, and text and opinion papers in English were eligible for inclusion. Key exclusion criteria were set, i.e., intervention type, level of care and reporting quality. The search was supplemented by gray literature review. Results From a total of 369 publications, 9 met eligibility criteria, reporting on 10 conceptual and methodological models/framework largely varying. These included transfer models applicable to all BPs as well as elements specific to some BPs, i.e., addressing integration, patient-centered care, care coordination, and health promotion. Strengths and weaknesses were identified for all. Conclusions Transferability of health interventions is complex, requiring systematic consideration of setting and intervention characteristics to inform and support local adaptation, implementation, and decision-making. Key elements identified can support the CIRCE-JA BP transfer and are largely relevant for further BP transfer across PC settings in EU MS, incl. for local adaptation, stakeholder engagement and effective implementation monitoring. Key messages • Innovative BPs are successfully deployed in many EU MS. To best support transformation for strong EU primary care and resilient health systems, it is important to ensure evidence-informed BP transfer. • This review reports on the selection of appropriate frameworks and models, and key elements thereof, to allow successful transfer of CIRCE-JA BPs and other BP transfer across PC settings in Europe.

Multidisciplinary approach to asylum seekers health assessment: a 5-year experience in Modena, Italy

Abstract Background Asylum seekers’ well-being represents a global health issue. They face significant challenges to their physical and mental health due to their migratory path. In the Modena province (Northern Italy), a multidisciplinary approach has been applied to the care of asylum seekers by Department of Public Health (DPH), with a team of specialists in infectious diseases, dermatology, gynaecology, obstetrics, psychology and preventive medicine. Asylum seekers receive a first visit, including medical and psychological assessment and screening for infectious diseases. Ad hoc pathways are also active for asylum seekers who need secondary-level care. This study aims to investigate the health status of asylum seekers referred to Modena Centre. Methods This cohort study enrolled asylum seekers hosted in Modena between November 2018 and May 2023. During the first visit, personal and anamnestic data were collected aided by cultural mediators, along with clinical assessment. Furthermore, Tuberculin-Skin-Test (TST) and blood tests for HBV-HCV-HIV-Syphilis were performed. Results A total of 646 migrants were included, 94% were males with a median age of 26 years (range: 15-50), the majority from Bangladesh (39%). Females were mostly from Ivory Coast (36%), median age of 30 years (range: 17-45). Most conditions were treated at the primary care level and were related to cutaneous disease (22%), only 11% of subjects required second-level diagnostics. Positive TSTs were 41% (N = 265). Of them, 55.5% (N = 147) also tested positive for QuantiFERON-TB. Screening for infectious diseases revealed positivity rates of 4% for HBsAg, 1% for HCVAb, 0.8% for HIV and 1.4% for TPPA+RPR. Conclusions The multidisciplinary approach is the innovative and strength point of this protocol for asylum seekers’ health ensuring prompt management of pathologies after their arrival. Moreover, data collection is useful for improving intake services and implementing public health programs for vulnerable individuals. Key messages • The innovation of this protocol for asylum seekers’ health lies in its multidisciplinary approach. • Clinical data collection will support health policies’ choices to protect vulnerable individuals.

Dual-tiered insights: cross-examining entities in free text electronic health records

Abstract Background Poor determination and processing of actions at the primary care level are found to be associated with unstructured and cluttered electronic health records (EHRs). Physicians recommend that EHRs must highlight entities, such as action items, findings, follow-ups, and reasons for medication changes. There’s consensus around the success of large language models (LLMs) in detecting clinical and non-clinical entities in EHRs. However, end-to-end systems make limited efforts to go beyond entity and relationship detection to support clinical decision-making. Methods We propose a two-tier system that generates case-based comparative reports for entities highlighted by physicians in EHRs. First, we fine-tuned a custom Bidirectional Encoder Representations from Transformers (BERT) model that detects the required entities within the EHRs. Second, a clustering-based service generates a report comparing the detected entities of a specific EHR with other EHRs sharing the same conditions determined by the healthcare professional. Results The system leverages the MIMIC IV deidentified free-text clinical notes dataset. The first-tier successfully classified entities with a macro-score average range of [0.87 - 0.94]. For the second tier, preliminary simulations on a set of test samples were made to cluster the entities. The simulations leverage a custom statistical tests engine offering a suite of entity-type specific tests. The results of these tests are used to generate the case-based detected entities comparative report. Conclusions Highlighting clinical and non-clinical entities bridges the communication gap between primary and secondary care. Clustering these entities extends the capability of LLMs in clinical support decision systems by providing healthcare professionals with the ability to run comparative analyses between EHRs. The comparative analysis reports provide a factual comparison between a selected number of detected entities and their thresholds. Key messages • Clustering clinical and non-clinical entities extends the capacity of named entity recognition in clinical decision-making systems. • Ability to generate a comparative analysis report based on figures extracted from recognised entities in free-text electronic health records.

Community mental health care in Croatia: Mobile team for psychosocial support in the community

Abstract The Republic of Croatia has initiated numerous reforms in the mental health care system in the community. Within the framework of EU JA Implement, a mobile team was formed to provide interventions in the community, that is, in the homes of persons discharged from psychiatric hospitals. The mobile team was formed during 2023. The team includes: one psychiatrist, leader and coordinator of the mobile team, three graduate nurses, a case manager, a social worker, three experienced experts who are employed in the team as peer workers, and one social pedagogue and psychologist. The wider composition of the team includes a psychiatrist who provides outpatient psychiatric treatment, who is familiar with the individual recovery plan and, if necessary, participates in the development of the plan. The goal of establishing a mobile team is to implement an individual recovery plan in the community, that is, in the patient’s home, using biopsychosocial interventions, with the aim of better and faster recovery of the user and inclusion in the community, as well as prevention of rehospitalization and disability. Before the patients home visits, the experts in the team were trained. 15 patients were included in the pilot project, with whom 96 home visits or interventions were carried out in the time period from the establishment of the team to April 2024. As a result of the effectiveness of the pilot project, in 2024, in accordance with the Strategic Framework for the Development of Mental Health until 2030, the Republic of Croatia adopted a new network of health institutions, within which 30 mobile psychiatric teams and 24 psychological teams at the primary level of health care are planned. Empowerment of users, engagement of people with experience in the implementation of interventions, increase in mental health literacy of the population and destigmatization are additional results of the implementation of mental health protection in the community through JA impleMENTAL.

Comparison of hospital treatments of the Roma settlements’ inhabitants in Slovenia

Abstract Background Roma ethnic minority in Slovenia was recognized as a vulnerable group with worse health indicators and significantly shorter life expectancy. The vast majority of Roma population in Slovenia have health insurance. We were investigating the use of hospital services in Roma population according to their age and comparing it with the rest of the population. Methods We determined the inhabitants of Roma settlements from the Slovenian register on residents. The data on hospital treatments used were from Slovenian national register on hospital treatments for the period 2018 to 2022. We compared different ratios according to certain hospital treatments within age categories of patients and co-pared those two groups. The frequency statistics, ANOVA and comparison of column proportion tests were used (p-value&amp;lt;0.005, 95% CI). Results Inhabitants of Roma settlements were more often treating in hospitals that rest of population. If comparing the frequency of hospital treatments between age groups only in Roma population, the percentage of hospital treatments steeply declines with age as well as the number of persons in age groups. The highest percentages and numbers of services are in the youngest age group of 0-15 years, and the lowest in the oldest group (75+). Therefore, significantly higher ratios of hospital treatments were detected in younger then in older age groups. Conclusions Roma children and youngsters (0-15 years old) had the highest rate of hospital treatments and it declined with the age. It was consistent with age pyramid of Roma as young population as well as emphasized care for children in culture. The steady decline rate of hospital treatments with age could be explain with delayed seeking of health care services in adult age and higher premature mortality that leads to smaller adult population. Additional and in-depth research is necessary to explain the root causes of higher premature mortality and use of primary and preventive health services. Key messages • Higher use of hospital treatments was caused by higher morbidity. It is necessary to explore the leading causes of hospital treatments and premature mortality. • It is necessary to explore the use of primary health care service, preventive service and level of health literacy of inhabitants of Roma settlements.