Primary Health Care Institutions Research Articles

Application and Prospects of Artificial Intelligence Technology in Early Screening of Chronic Obstructive Pulmonary Disease at Primary Healthcare Institutions in China

Application and Prospects of Artificial Intelligence Technology in Early Screening of Chronic Obstructive Pulmonary Disease at Primary Healthcare Institutions in China

A survey on the application of convolutional neural networks in the diagnosis of occupational pneumoconiosis

Pneumoconiosis ranks first among the newly-emerged occupational diseases reported annually in China, and imaging diagnosis is still one of the main clinical diagnostic methods. However, manual reading of films requires high level of doctors, and it is difficult to discriminate the staged diagnosis of pneumoconiosis imaging, and due to the influence of uneven distribution of medical resources and other factors, it is easy to lead to misdiagnosis and omission of diagnosis in primary healthcare institutions. Computer-aided diagnosis system can realize rapid screening of pneumoconiosis in order to assist clinicians in identification and diagnosis, and improve diagnostic efficacy. As an important branch of deep learning, convolutional neural network (CNN) is good at dealing with various visual tasks such as image segmentation, image classification, target detection and so on because of its characteristics of local association and weight sharing, and has been widely used in the field of computer-aided diagnosis of pneumoconiosis in recent years. This paper was categorized into three parts according to the main applications of CNNs (VGG, U-Net, ResNet, DenseNet, CheXNet, Inception-V3, and ShuffleNet) in the imaging diagnosis of pneumoconiosis, including CNNs in pneumoconiosis screening diagnosis, CNNs in staging diagnosis of pneumoconiosis, and CNNs in segmentation of pneumoconiosis foci to conduct a literature review. It aims to summarize the methods, advantages and disadvantages, and optimization ideas of CNN applied to the images of pneumoconiosis, and to provide a reference for the research direction of further development of computer-aided diagnosis of pneumoconiosis.

Service Quality and Residents' Preferences for Facilitated Self-Service Fundus Disease Screening: Cross-Sectional Study.

Fundus photography is the most important examination in eye disease screening. A facilitated self-service eye screening pattern based on the fully automatic fundus camera was developed in 2022 in Shanghai, China; it may help solve the problem of insufficient human resources in primary health care institutions. However, the service quality and residents' preference for this new pattern are unclear. This study aimed to compare the service quality and residents' preferences between facilitated self-service eye screening and traditional manual screening and to explore the relationships between the screening service's quality and residents' preferences. We conducted a cross-sectional study in Shanghai, China. Residents who underwent facilitated self-service fundus disease screening at one of the screening sites were assigned to the exposure group; those who were screened with a traditional fundus camera operated by an optometrist at an adjacent site comprised the control group. The primary outcome was the screening service quality, including effectiveness (image quality and screening efficiency), physiological discomfort, safety, convenience, and trustworthiness. The secondary outcome was the participants' preferences. Differences in service quality and the participants' preferences between the 2 groups were compared using chi-square tests separately. Subgroup analyses for exploring the relationships between the screening service's quality and residents' preference were conducted using generalized logit models. A total of 358 residents enrolled; among them, 176 (49.16%) were included in the exposure group and the remaining 182 (50.84%) in the control group. Residents' basic characteristics were balanced between the 2 groups. There was no significant difference in service quality between the 2 groups (image quality pass rate: P=.79; average screening time: P=.57; no physiological discomfort rate: P=.92; safety rate: P=.78; convenience rate: P=.95; trustworthiness rate: P=.20). However, the proportion of participants who were willing to use the same technology for their next screening was significantly lower in the exposure group than in the control group (P<.001). Subgroup analyses suggest that distrust in the facilitated self-service eye screening might increase the probability of refusal to undergo screening (P=.02). This study confirms that the facilitated self-service fundus disease screening pattern could achieve good service quality. However, it was difficult to reverse residents' preferences for manual screening in a short period, especially when the original manual service was already excellent. Therefore, the digital transformation of health care must be cautious. We suggest that attention be paid to the residents' individual needs. More efficient man-machine collaboration and personalized health management solutions based on large language models are both needed.

The comparison of spatial patterns and factors associated with healthcare provider knowledge in palliative care in various regions of China

As an integral part of the overall life cycle, it is crucial to ensure equity and accessibility to palliative care services at the end of life. The knowledge of healthcare providers has a significant beneficial impact on the quality of palliative care services. This study aimed to compare the nationwide geographic distribution of healthcare providers’ knowledge of palliative care at the provincial level in China and identify the possible factors associated with its geographic disparities. A descriptive cross-sectional study was conducted in all provinces (n = 29) that implemented palliative care pilot programs in China. Data were collected online using a structured questionnaire. The possible factors associated with healthcare providers’ knowledge including economy, demographics, and health, were explored by using exploratory regression and ordinary least squares. In addition, spatial autocorrelation was also examined with Moran’s I, LISA, and Geographically Weighted Regression. A total of 18,272 participants from 903 health institutions in 87 palliative care pilot cities were included across 29 out of 31 provinces in China. The average knowledge score (mean ± standard deviation [SD]) was 8.61 ± 2.85. A positive spatial correlation was observed in healthcare providers’ palliative care knowledge level in China. The high level of knowledge was significantly associated with fewer hospitals per 10,000 population (β = −0.384, 95% CI: −0.601 to −0.168, p = 0.001), more primary healthcare institutions per 10,000 population (β = 0.220, 95% CI: 0.032–0.407, p = 0.024), and more community health center visits (β = 0.259, 95% CI: 0.054–0.465, p = 0.016), with higher coefficients being observed in the northwest and northeast regions. This study suggested that the knowledge level of palliative care among healthcare providers nationwide was relatively low, indicating the existence of a disparity between the supply and demand of palliative care services. There may be regional disparities in palliative care services based on the substantial geographical variation in healthcare provider knowledge, emphasizing the necessity of tailored interventions targeting areas with the greatest need.

Design and Implementation of a Primary Healthcare Cloud Platform

This paper presents the design and implementation of a primary healthcare cloud platform that aims to optimize primary medical services through informatization. The cloud platform integrates multiple functional modules including patient information management, diagnostic and treatment processes, pharmaceutical inventory, online appointments, financial management, and data analysis to meet the daily operational needs of primary healthcare institutions. Starting with the project background and current situation analysis, the paper details user needs research and functional design, and gives key discussions on the selection of system architecture and critical technology modules. During system development, technologies such as Spring Boot, Spring Cloud, and MySQL were used to build an efficient, stable, and secure platform. The system's reliability was ensured through unit testing, integration testing, system testing, and user acceptance testing. The paper concludes with a look into the future development direction of the platform, including further optimization of user experience, introduction of natural language processing and artificial intelligence technologies, and expansion of collaborative functions between primary healthcare institutions.

Evaluation of smoking cessation counseling practices of physicians working in primary health care institutions

Evaluation of smoking cessation counseling practices of physicians working in primary health care institutions

Linkage to HIV care and early retention in HIV care among men in the ‘universal test-and-treat’ era in a high HIV-burdened district, KwaZulu-Natal, South Africa

IntroductionDespite the numerous efforts and initiatives, males with HIV are still less likely than women to receive HIV treatment. Across Sub-Saharan Africa, men are tested, linked, and retained in HIV care at lower rates than women, and South Africa is no exception. This is despite the introduction of the universal test-and-treat (UTT) prevention strategy anticipated to improve the uptake of HIV services. The aim of this study was to investigate linkage to and retention in care rates of an HIV-positive cohort of men in a high HIV prevalence rural district in KwaZulu-Natal province, South Africa.MethodsFrom January 2018 to July 2019, we conducted an observational cohort study in 18 primary health care institutions in the uThukela district. Patient-level survey and clinical data were collected at baseline, 4-months and 12-months, using isiZulu and English REDCap-based questionnaires. We verified data through TIER.Net, Rapid mortality survey (RMS), and the National Health Laboratory Service (NHLS) databases. Data were analyzed using STATA version 15.1, with confidence intervals and p-value of ≤0.05 considered statistically significant.ResultsThe study sample consisted of 343 male participants diagnosed with HIV and who reside in uThukela District. The median age was 33 years (interquartile range (IQR): 29–40), and more than half (56%; n = 193) were aged 18–34 years. Almost all participants (99.7%; n = 342) were Black African, with 84.5% (n = 290) being in a romantic relationship. The majority of participants (85%; n = 292) were linked to care within three months of follow-up. Short-term retention in care (≤ 12 months) was 46% (n = 132) among men who were linked to care within three months.ConclusionWhile the implementation of the UTT strategy has had positive influence on improving linkage to care, men’s access of HIV treatment remains inconsistent and may require additional innovative strategies.

Willingness of healthcare providers to perform population-based cancer screening: a cross-sectional study in primary healthcare institutions in Tianjin, China

ObjectiveTo evaluate the willingness of healthcare providers to perform population-based screening in primary healthcare institutions in China.MethodsHealthcare providers of 262 primary healthcare institutions in Tianjin were invited to fill out...

Health-care professionals’ barriers to anemia prevention among pregnant women in Oman

ABSTRACT Background: The incidence of gestational anemia is increasing in pregnant women. The factors affecting health-care professionals’ ability to prevent anemia among pregnant women in Oman remain unknown. Therefore, this study aimed to explore the barriers faced by health-care professionals in preventing anemia among pregnant women. Methods: This study used a qualitative design directed by the constructivist grounded theory. The researchers communicated with health-care professionals about the barriers faced within health-care institutions for anemia prevention among pregnant women. Semi-structured interviews were conducted with 22 health-care professionals. The researchers selected five primary health-care institutions, intending to reach health-care professionals who provide antenatal care to pregnant women. Purposive sampling was used at the beginning of the data collection. Subsequently, theoretical sampling was performed to achieve data saturation. Results: Data analysis identified two themes: “Internal and external challenges.” The data analysis revealed that health-care professionals faced many barriers that impacted the prevention of anemia among pregnant women, both within and outside health-care institutions. Conclusion: Understanding the barriers faced by health-care professionals could help the Ministry of Health formulate the best approach to providing health education and services for pregnant women with gestational anemia in Oman, thereby solving deficits regarding antenatal services within health-care institutions.

Electronic Health Record Adoption in Oral and Dental Health Centres in Turkey

The digitalisation studies in public hospitals in Turkey started with the Health Transformation Program in 2003. The Ministry of Health has been measuring the dissemination of meaningful usage and adoption of electronic health record (EHR) using Electronic Medical Record Adoption Model (EMRAM) and Outpatient Electronic Medical Record Adoption Model (O-EMRAM). Using a comprehensive survey, our study intends to measure the stage of EHR adoption in oral and dental health centres (ODHCs) providing primary healthcare services in Turkey. The results obtained were classified by basic and comprehensive EHR functions and benchmarked against the studies addressing EHR adoption in primary healthcare institutions of other countries. In 2021, 167 ODHCs/oral and dental health hospitals (ODHHs) actively operating in Turkey completed the O-EMRAM survey. The data obtained from the survey results were analysed with QlikView Personal Edition. The availability and prevalence of medical information systems and EHR functions and their use were measured. It is observed that 59 (40.7%) of ODHCs/ODHHs have comprehensive EHR functions, while the remaining 86 (59.3%) have basic EHR functions. Under these circumstances, it can be stated that all ODHCs/ODHHs in Turkey use at least basic EHR functions. All ODHCs/ODHHs in Turkey have at least basic EHR functions. The integration of e-prescription, electronic authorisation system and e-Pulse used throughout Turkey and Health Information Management System Society (HIMSS) used in ODHCs/ODHHs can be listed as one of the decisive factors in this result. ODHCs/ODHHs still have a long way to go in adopting EHR, but the current circumstances are also promising. It is considered that this study will serve as a baseline for future measurements and produce a notable result for decision-makers.

Güncel Kılavuzlara Göre Aspirinin Birincil Korunmadaki Rolü: Aile Hekimleri için Öneriler

Family physicians, who are the leaders of primary health care institutions that patients can access easily, should recommend aspirin to patients with suitable indications for primary or secondary protection by evaluating the benefit-harm relationship via the principle of "Primum non nocere". Studies which were conducted in Turkish primary care settings mentioned that there is an irrational and inappropriate use of aspirin in the primary prevention of atherosclerotic cardiovascular diseases. Aspirin has a role in the primary prevention of cardiovascular diseases, in reducing the incidence of colorectal cancer, in protection related to increased thrombosis risk by some oncology drugs, and in protection from pregnancy complications. Recommendations from current guidelines will lead the way to family physicians regarding the use of aspirin.

Knowledge of Pregnant Women on Gestational Anemia Attending Primary Healthcare Institutions in Oman

Purpose: It is well known that anemia is one of the medical problems during pregnancy and it can be encountered through health education. However, the rate of iron deficiency anemia is increasing among pregnant women. This study sought to find the knowledge of pregnant women who were attending primary healthcare institutions in Oman regarding gestational anemia. Also to find out if there is an association between demographic data and women’s knowledge about gestational anemia during pregnancy.&#x0D; Methodology: This study used a quantitative study, descriptive cross-sectional design. The researchers selected five primary healthcare institutions (Antenatal Clinics) in Sohar Wilayate in North Batinah Governorate in Oman to reach pregnant women who had been diagnosed with anemia. The data was collected via a questionnaire including two sections: participants’ sociodemographic characteristics and knowledge sections with 235 participants. The Cronbach's alpha coefficient of the scale was 0.72 and measured in different studies.&#x0D; Findings: The results of this study showed that women in Oman had lack of knowledge regarding many aspects related to gestational anemia. For example, they did not know about the signs and symptoms, nutrition that prevent anemia, and the effect of anemia on pregnancy outcomes. Data also showed that knowledge was significantly associated among pregnant women who were above 40, highly educated, working, and multigravida.&#x0D; Unique Contribution to Theory, Practice and Policy: Knowing pregnant women's knowledge regarding gestational anemia could help the policymakers in the Ministry of Health formulate the best approach to offer health education and services for pregnant women with gestational anemia in Oman. This study came with many recommendations regarding knowledge, practice, and policy. Programs related to gestational anemia should be implemented to inform healthcare professionals, women, and their families about Iron deficiency anemia. Also, gestational anemia policy and guidelines are needed in healthcare institutions, and all healthcare professionals should be informed of the policy regularly. Healthcare professionals should be trained to educate and support women with gestational anemia during the antenatal and postnatal periods.

Relationship between Family Income and Access to Primary Care of Senior Citizens in Kaytapos, Indang Cavite

The research investigates the relationship between family income and access to primary care among senior citizens in Kaytapos, Indang Cavite. A combined self-administered survey and an in-person interview was conducted to analyze the multifaceted factors shaping the accessibility of primary care for seniors. The study examined the socio-economic status, health conditions, and the extent of their access to primary healthcare services. The study mainly aimed to assess the relationship between family income and access to primary care of senior citizens in Kaytapos, Indang. This study further seeks to identify the respondents' socio-demographic profile and determine senior citizens' access to primary care in terms of awareness, accessibility, affordability, availability, acceptability, and accommodation. Based on the findings, it was revealed that senior citizens have good access and high awareness of primary care. The affordability and accessibility of related goods and services were also moderate. Additionally, primary care providers and healthcare institutions were deemed moderately accessible, very acceptable, and highly accommodating to senior patients. Moreover, the existing relationship between family income and senior citizens' access to primary care was statistically significant, yet there was a weak positive correlation. Hence, these findings could aid the government in policy-making planning to promote a more equitable and inclusive healthcare system. Overall, it was recommended that the government address the insufficient access to primary care by proposing free monthly check-ups, medicines, food, and allowances, especially for senior citizens in the lower income bracket.

Analysis of health service utilization and influencing factors due to COVID-19 in Beijing: a large cross-sectional survey

BackgroundIn the wake of China’s relaxed zero-COVID policy, there was a surge in coronavirus disease 2019 (COVID-19) infections. This study aimed to examine the infection status and health service utilization among Beijing residents during a widespread outbreak, and to explore the factors that affected utilization of health services due to COVID-19.MethodsA cross-sectional survey was conducted among Beijing residents from 13 January to 13 February 2023, collecting information on socio-demographic characteristics, health behaviours, COVID-19 infection status, utilization of health services and depressive symptoms. Multivariate Tobit regression was used for data analysis.ResultsAmong the 53 924 participants, 14.7% were older than 60 years, 63.7% were female and 84.8% were married. In total, 44 992 of the 53 924 individuals surveyed (83.4%) contracted COVID-19 during 2020–2023, and 25.2% (13 587) sought corresponding health services. The majority of individuals (85.6%) chose in-person healthcare, while 14.4% chose internet-based healthcare. Among those who chose in-person healthcare, 58.6% preferred primary healthcare institutions and 41.5% were very satisfied with the treatment. Factors affecting health service utilization include being female (β = −0.15, P < 0.001), older than 60 years (β = 0.23, P < 0.01), non-healthcare workers (β = −0.60, P < 0.001), rich self-rated income level (β = 0.59, P < 0.001), having underlying disease (β = 0.51, P < 0.001), living alone (β = −0.19, P < 0.05), depressive symptoms (β = 0.06, P < 0.001) and healthy lifestyle habits, as well as longer infection duration, higher infection numbers and severe symptoms.ConclusionAs COVID-19 is becoming more frequent and less severe, providing safe and accessible healthcare remains critical. Vulnerable groups such as the elderly and those with underlying conditions need reliable health service. Prioritizing primary healthcare resources and online medical services have played a vital role in enhancing resource utilization efficiency.

New Directions, New Perspectives, and New Pathways in the Development of Subspecialties in General Medicine

Research Background: General medicine integrates content from clinical medicine, rehabilitation medicine, and social humanities. In the field of clinical medicine, its horizontal scope encompasses internal medicine, surgery, obstetrics and gynecology, pediatrics, emergency medicine, and other related disciplines. Research Objectives: The subspecialty development of general medicine aims to establish a specialized field with distinctive features based on the foundation of general medicine. It provides an explanation for the in-depth development and research in general medicine. This approach makes it easier to retain and attract outstanding talents, fully unleashing the interests of general practitioners. The development of subspecialties in general medicine aligns with the practical needs of China&amp;apos;s primary healthcare institutions. It seeks to break the deadlock of general medicine being broad but not precise, addressing issues such as reducing patient medical expenses, improving patient satisfaction, and truly solving difficulties in seeking medical care. This allows large specialized hospitals to focus on researching tumor diseases and various specialized surgical procedures, thereby enhancing the diagnosis and treatment rates of tumors and rare diseases. Research Results: With the progress and practical experiences in society, the development of subspecialties in general medicine is set to become a goal, a new direction, a new perspective, and a new pathway for the global development of primary healthcare institutions. Research Conclusions: Cultivating doctors with expertise in subspecialties of general medicine for grassroots healthcare is essential to address the spectrum of specialized diseases, truly embodying a patient-centric approach and ensuring tangible benefits for patients. Currently, the development of subspecialties in general medicine is still in the exploration stage.

Research on User Satisfaction in Kayseri Province Primary Health Care Buildings

The design criteria determining the spatial quality of family health centres, one of the primary health care institutions where diagnostic, therapeutic and rehabilitation services and preventive health services are provided together, were determined as the subject of the study. Within the scope of the field study, the location, number and distribution of family health centers, where primary health care services are provided in the central districts of Kayseri city, were investigated. The selected family health centers were examined according to the evaluation criteria. A survey was conducted to understand how family health centers are perceived by patients, one of their users, and to evaluate their satisfaction rates regarding space quality. It was determined that these small-scale health centers are produced as structures that have no relation to the context since most of them are derived from typical projects. It was concluded that health buildings, where only physicality is considered while the psychological and social needs of the users are ignored, are inadequate in terms of healing spaces. Based on all the findings obtained as a result of the study, suggestions were made on the design criteria for family health center buildings, which concern the whole society, to become qualified buildings that contribute to healing in the future.

Complaint management system and patient satisfaction in grassroots hospitals.

Primary healthcare institutions face limitations in medical resources, leading to concerns from patients and their families regarding the quality of medical services, resulting in complaints against these institutions. This study aims to analyze the causes of complaints and implement improvement measures to enhance the service quality of primary healthcare institutions, increase satisfaction among patients and their families, and reduce the number of complaints. Relevant data were collected, and verified complaints were categorized based on departments, administrative office, and category. Pearson Chi-square test, Spearman correlation analysis, as well as univariate logistic regression were employed to analyze factors influencing patient satisfaction. A complaint-handling process was established, and regulations pertaining to complaints were formulated. Pearson Chi-square test results indicated a significant correlation between satisfaction and departments (P = .016) and administrative office (P = .022). Spearman correlation analysis revealed a significant correlation between satisfaction and departments (ρ = 0.157, P = .017) and administrative office (ρ = 0.151, P = .021). Univariate logistic regression analysis demonstrated a significant correlation between satisfaction and other related complaints in administrative office (OR = 3.321, 95% CI = 1.196-9.218, P = .021). Complaints related to departments and administrative offices are significantly correlated with satisfaction. After the implementation of a complaint management system in primary healthcare institutions, there is a notable improvement in service quality, enhanced patient experience, increased satisfaction, and a reduction in hospital complaints.

Common maternal health problems and their correlates in early post-partum mothers.

Mothers experience a wide range of maternal health problems after childbirth, which in turn, affect their well-being and ability to care for their newborn. These problems may be influenced by factors such as mode of delivery or socio-economic status. This study aims to investigate the prevalence of common maternal health problems and their correlates in a public primary healthcare institution in Singapore. This was a cross-sectional study, based on a self-administered questionnaire. A total of 373 mothers (mean age 31.9 years) who accompanied their infants for their 4- to 8-week development assessments at a public primary care clinic in Singapore completed a self-administered questionnaire from June 2021 to December 2021. The questionnaire assessed demographic factors, mode of delivery, number of children, number of individuals providing significant help, and the frequency of common physical and mental maternal health problems using a 5-point Likert-type scale. The five most common maternal health problems were fatigue (77.7%), lower back pain (59.3%), Caesarean wound pain (54.3%), upper back pain (53.0%) and vaginal pain (41.2%). The prevalence of depression and anxiety was 22.0% and 11.3%, respectively. With respect to the symptoms' correlates, pain on passing urine was more frequent after assisted vaginal deliveries than all other forms of deliveries (all pairwise p < 0.01), and pain on passing motion was more frequent in vaginal deliveries than in Caesarean deliveries (all pairwise p < 0.05). Mothers having a larger number of children more frequently experienced headaches (β = 0.17, SE = 0.05, p = 0.002) and less frequently experienced breastfeeding difficulties (β = -0.28, SE = 0.08, p < 0.001). Mothers experienced a high prevalence of maternal health problems in multiple domains during the first 8 weeks after childbirth. Mode of delivery and number of children were associated with increased prevalence of certain problems. Mothers' physical and mental well-being should be investigated early after delivery and addressed with adequate treatments and resources.

Factors associated with infant feeding intention among usual-risk pregnant women.

To identify the factors associated with infant feeding intention among usual-risk pregnant women. A quantitative cross-sectional study was conducted in two primary healthcare institutions in Fortaleza, Ceará, Brazil, with usual-risk pregnant women. A non-probabilistic convenience sampling method was used, and 119 pregnant women participated. Data collection took place from May 2022 to February 2023. The data collection process involved using forms and the Infant Feeding Intention Scale. Ethical considerations were strictly adhered to. The study revealed statistically significant differences in the infant's means. The majority of pregnant women (96.6%) declared that they would breastfeed after giving birth. The intention to breastfeed exclusively was statistically higher in mothers with younger children and previous experience of breastfeeding or complications in the current pregnancy. This study clarified that the intention to breastfeed up to 6 months is influenced by variables encompassing the age of the youngest child, previous breastfeeding experience, and pregnancy complications, emphasizing the intricate nature of the determinants of intention to breastfeed.

National nonprofit offering mental health training for PCPs

Observing the mental health workforce shortage, a national nonprofit organization is continuing its mission to ensure that children and families receive appropriate mental health care and is doing so by training primary care providers (PCPs), therapists and health care institutions in evidence‐based therapies to better diagnose, treat and manage child and adult mental health issues.