Primary Health Care Level Research Articles

ИССЛЕДОВАНИЕ ЭФФЕКТИВНОСТИ МОТИВАЦИОННЫХ ВМЕШАТЕЛЬСТВ ПРИ ЛЕЧЕНИИ ПАНИЧЕСКОГО РАССТРОЙСТВА: КЛИНИЧЕСКИЕ ОСОБЕННОСТИ

The aim of the study is to evaluate the effectiveness of motivational and individualized interventions in treating patients with panic disorder at the primary health care level. Materials and methods. The study was conducted from March 1, 2023 to July 1, 2024. This randomized, parallel-design trial was conducted to minimize physician impact. Participants were screened using OASIS and PHQ, and participation was confirmed through diagnostic interviews and MKB-10 checklists. The intervention group received specific CBT-based training and accompaniment. Assessment was performed at 6 and 12 months using BAI and PHQ-9. Results. The study found that the use of individualized and motivational approaches significantly increased patient adherence in the intervention group, increasing it to 80%. This indicates a more active participation of patients in the process of therapy and an increase in their motivation. In addition, there was a significant decrease in depression: PHQ-9 scores decreased from 9 to 6 at 12 months, indicating an improvement in the psycho-emotional state of the participants. These results highlight the effectiveness of implemented strategies in improving the condition of patients with panic disorder and comorbid depression. Conclusions. The effectiveness of individualized and motivational interventions was confirmed: they improved treatment adherence and reduced the severity of symptoms. Long-term observations confirmed the robustness of the effect, suggesting the importance of a comprehensive approach to panic disorder therapy at the primary health care level.

Screening for diabetic retinopathy at a health centre in South Africa: A cross-sectional study

Background: In South Africa, screening for diabetic retinopathy (DR) is non-existent at the primary healthcare (PHC) level because of the absence of a screening programme. This leads to preventable vision loss.Aim: To describe the clinical characteristics and outcomes of eye screenings and subsequent referrals.Setting: Laudium Community Health Centre (CHC), a PHC facility in Tshwane.Methods: We conducted a cross-sectional study from February 2022 to August 2022. Individuals with diabetes were screened for eye complications using visual acuity testing, intraocular pressure measurement, and fundoscopy with a non-mydriatic digital fundus camera. Fundus images were analysed by an optometrist and an artificial intelligence (AI) programme. Demographic and clinical data were collected.Results: A total of 120 participants were included, with the majority (60.7%) from Laudium CHC. Most participants (64.2%) were on oral agents, and 66.7% were women. The mean haemoglobin A1c (HbA1c) was 8.3%, with a median diabetes duration of 8 years. Artificial intelligence detected more glaucoma cases (17.5% vs 9.2%) and DR (23.3% vs 15.8%) compared to the optometrist. In contrast, the optometrist identified more cases of macula pathology (29.2% vs 19.2%). Participants (n = 79) were referred to an ophthalmologist for diagnosis confirmation and management.Conclusion: The study revealed that while DR was not highly prevalent among PHC patients with diabetes, there was a significant referral rate for other ocular complications. Artificial intelligence can enhance early detection and improve efficiency.Contribution: The findings underscore the need to integrate diabetes eye screening programmes into PHC services for people living with diabetes.

Knowledge, Attitudes, Motivations, Expectations, and Systemic Factors Regarding Antimicrobial Use Amongst Community Members Seeking Care at the Primary Healthcare Level: A Scoping Review.

Antimicrobial resistance (AMR) is a major global health challenge, particularly in low- and middle-income countries (LMICs). Understanding the knowledge, attitudes, motivations, and expectations of community members regarding antimicrobial use is essential for effective stewardship interventions. This scoping review aimed to identify key themes relating to the critical areas regarding antimicrobial use among community members in primary healthcare (PHC), with a particular focus on LMICs. OVID Medline, PubMed, and CINAHL databases were searched using Boolean operators and Medical Subject Headings (MeSH) terms relevant to antimicrobial use and community behaviors. The Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework guided study selection, which focused on community members seeking care in PHC in LMICs. Data management and extraction were facilitated using the Covidence platform, with the Critical Appraisal Skills Programme (CASP) qualitative checklist applied for qualitative studies. A narrative synthesis identified and grouped key themes and sub-themes. The search identified 497 sources, of which 59 met the inclusion criteria, with 75% of the studies conducted in outpatient primary care settings. Four key themes were identified: (1) the 'patient' theme, highlighting beliefs, knowledge, and expectations, which was the most prominent (40.5%); (2) the 'provider' theme, emphasizing challenges related to clinical decision-making, knowledge gaps, and adherence to guidelines; (3) the 'healthcare systems' theme, highlighting resource limitations, lack of infrastructure, and policy constraints; and (4) the 'intervention/uptake' theme, emphasizing strategies to improve future antibiotic use and enhance access to and quality of healthcare. Stewardship programs in PHC settings in LMICs should be designed to be context-specific, community-engaged, and accessible to individuals with varying levels of understanding, involving the use of information and health literacy to effectively reduce AMR.

Mapping evidence on screening for Primary Open Angle Glaucoma (POAG) at primary health care level: A scoping review protocol

Mapping evidence on screening for Primary Open Angle Glaucoma (POAG) at primary health care level: A scoping review protocol

A Novel Approach to Assessing the Potential of Electronic Decision Support Systems to Improve the Quality of Antenatal Care in Nepal.

Electronic decision-support systems (EDSSs) aim to improve the quality of antenatal care (ANC) through adherence to evidence-based guidelines. We assessed the potential of the mHealth integrated model of hypertension, diabetes, and ANC EDSS and the World Health Organization EDSS to improve the quality of ANC in primary-level health care facilities in Nepal. From December 2021 to January 2023, we conducted a mixed-methods evaluation in 19 primary-level ANC facilities in Bagmati Province, Nepal. Implementation was from March 2022 to August 2022. We conducted a health facility survey, ANC clinical observations, longitudinal case studies and validation workshop, in-depth interviews, monitoring visits, research team debriefing meetings, health care provider attitude survey, and stakeholder engagement and feedback meetings. Results were integrated using concurrent triangulation to develop explanations about the EDSS implementation process and the effects observed. We identified 9 themes on implementation challenges that hindered the EDSS from generating the desired improvements to ANC quality. Facility readiness and provider confidence in using the EDSS were mixed. It was not always used or used as intended, and the approach to ANC provision did not change. EDSS inflexibility did not reflect how staff made decisions about pregnant women's needs or ensure that tests were done at the right time. There was mixed evidence that ANC staff believed that the EDSS benefited their work. The EDSS did not become fully integrated into existing health systems. Engagement of essential stakeholders fell short. Different understandings of and inconsistent use of the EDSS highlighted the need for increased training and support periods, greater stakeholder engagement, and further integration into existing health systems. Our novel approach to integrating findings from multiple substudies offers uniquely valuable insights into the many factors needed for the successful implementation of an EDSS to improve the quality of ANC in Nepal.

Trends in Diabetic Retinopathy Severity among Patients at A Tertiary Care Eye Hospital: A Call to Strengthen Preventive Care

Purpose: To analyze trends in diabetic retinopathy (DR) and its management at a tertiary healthcare center from January 2016 to December 2019. Study Design: Descriptive study. Place and Duration of Study: National Eye Center, Cicendo Eye Hospital, from August to September 2020. Methods: Data were obtained from the diabetic retinopathy database in the vitreo-retina unit. Information on patients’ sex, age, diagnosis, and treatment from each year was retrospectively reviewed. Inclusion criteria encompassed all first-time DR patients scheduled for pan-retinal photocoagulation (PRP) laser, anti-VEGF injection, or pars plana vitrectomy (PPV). Patients with incomplete data or repeated visits were excluded. Among 63,824 records analyzed, 22,169 met the inclusion criteria. Patients were categorized into vision-threatening diabetic retinopathy (VTDR), requiring treatment at the first visit, and non-VTDR. Results: Of the 22,169 patients included, 53.88% were female, and the majority were aged between 50 and 59 years. VTDR accounted for 19.12% of cases, while 80.88% were non-VTDR. Annual trends revealed changes in DR management approaches, with an increasing prevalence of VTDR and PPV emerging as the most frequently performed treatment. Conclusion: The predominance of non-VTDR cases highlights the urgent need for improved DR management at primary and secondary healthcare levels. Strengthening early detection and intervention protocols is essential to prevent disease progression and alleviate the burden on tertiary care facilities.

Optimizing data collection for obstetrical ultrasound research at the primary health care level in rural Uganda

ABSTRACT Background Neonatal and maternal mortality remains high in low- and middle-income countries (LMIC), especially in sub-Saharan Africa. Quality data collection is crucial to understand the magnitude of these problems and to measure the impact of interventions aimed at improving neonatal and maternal mortality. However, data collection in the low-income country setting, especially in rural areas, has been a challenge for researchers, policy makers, and public health officials. Here, we describe the methodology, experience and lessons learned while collecting data at lower-level primary health care facilities in rural Uganda. Methods Data collection was performed at Health Center III sites in rural Uganda, in partnership with Imaging the World and its affiliate Imaging the World Africa. The primary purpose of the data collection was to study the efficacy and clinical effect of introducing prenatal ultrasound services at these sites. Local data clerks were hired to perform the data collection through a combination of intensive training and on-the-ground support. Frequent oversight was used to support data collection. Results Of 2,397 enrolled pregnant women, 1,977 (82.5%) had complete outcome data. Upon independent expert audit, the data were >80% accurate for 10/11 variables and >90% accurate for 6/11 variables. Overall, the data collected at the rural HCs were 90% accurate. Discussion Accurate and complete data collection is possible in an LMIC setting if appropriate training and oversight are employed.

Understanding Interpersonal Influences on Maternal Health Service Utilization at Community Health Centers: A Mixed-Methods Study in Indonesia.

Background/Objective: The utilization of maternal health services at the primary healthcare level is still considered an effective approach despite the critical role in improving maternal health outcomes. The study aimed to assess the influence of sociodemographic characteristics and interpersonal support on the use of maternal health services in three regions of the Province of Jambi, Indonesia. Methods: Using a mixed-methods sequential explanatory design, a quantitative survey of 432 women and qualitative focus group discussions with nine families were conducted. Quantitative data were analyzed using bivariate analysis, while the qualitative data were examined through conventional content analysis. Results: The research results show no significant association between sociodemographic factors (education, employment, residence) and the use of maternal health services for antenatal care and delivery. Direct support, such as accompaniment by spouses, and indirect support, including emotional encouragement and shared knowledge, were pivotal in influencing women's decisions to seek care. Conclusions: Targeted interventions focusing on improving social support, addressing service accessibility barriers, and raising awareness about the benefits of community health centers are essential to enhancing maternal health outcomes. Policymakers and healthcare providers should integrate family-centered strategies to ensure women receive adequate maternal healthcare.

Impact of training on knowledge of pharmacy students regarding animal bite management and rabies

Background: Rabies is a highly fatal viral zoonotic disease but preventable by timely and appropriate post exposure prophylaxis. Most animal bite cases are found in rural areas where victims of animal bite don’t get proper treatment due to shortage of doctors. Pharmacists are important part of primary level health care. Methods: A cross-sectional study was conducted between February to May 2023. 100 pharmacy students, posted for their internship in ARC of MKCG Medical College were included in the study. Their knowledge was assessed by pre-test using a self-administered questionnaire. Training was given for 7days on animal bite management and prophylaxis against rabies, then post-test was administered. Data was analysed using Jamovi software. Results: The number of correct responses to questions about animal causing rabies, correct schedule, site and mode of vaccination improved from 16 to 33, 33 to 89, 72 to 93, 68 to 88 respectively after training. Conclusions: Training was effective in improving the knowledge regarding animal bite management and rabies among pharmacy students. Therefore, regular training should be conducted for updated knowledge of pharmacists as well as all medical professionals to achieve elimination of rabies by 2030.

The Role of a Nurse in a Multidisciplinary Team in Primary Health Care: Literature Review

Introduction. The primary health care system is facing the challenge of polymorbidity in aging population and a shortage of general practitioners. In many countries, advanced practice nurses can be a potential solution, since such specialists have the appropriate professional competencies and additional education which allows them to work autonomously and partly perform doctor’s role. At the same time, the organization of high-quality, patient-oriented and affordable medical care at the primary health care level is possible mainly through the work of multidisciplinary teams, which include not only doctors, but also qualified nurses.The purpose was to study the role of a nurse in a multidisciplinary team that provides primary medical care.Materials and methods. In this review, reporting method for systematic reviews and meta-analyses (PRISMA) was used. The search was carried out in eLibrary, PubMed, MEDLINE, Google Scholar bibliographic databases by keywords “primary health care”, “nurse”, “the role of a nurse”, and “multidisciplinary teams”. In addition, an analysis of Russian and foreign regulatory and methodological documents on official Internet portals with elements of information structuring was carried out.Results and discussion. All over the world, researchers emphasize the important role of nurses in the transition to new models of care and treatment aimed at improving the quality of medical services. For example, an extended access model was developed to improve the timely provision of medical services tailored to the needs and preferences of patients. Within the framework of the extended access model, nurses jointly work with family doctors and other specialists and manage patients with chronic diseases, thus reducing the number of visits to the doctor.Conclusion. There is a steady global trend towards teamwork in primary care medical organizations. Teamwork enables the provision of high-quality medical services, including those provided by enhanced practice nurses. The transformation of nursing practice in primary health care is considered a promising strategy to improve the quality and effectiveness of primary health care and address the unmet health needs of individuals, families and communities.

Advances in Basic and Clinical Research on Diabetic Foot Ulcers

Diabetic foot ulcer (DFU) is one of the most severe complications of diabetes, involving complex pathological mechanisms such as neuropathy, vascular abnormalities, and infections. In recent years, with advances in treatment technologies and the promotion of multidisciplinary team (MDT) care, DFU diagnosis and treatment have improved significantly. Traditional therapies, including dressings, debridement, and negative pressure wound therapy (NPWT), remain critical in basic treatment. Meanwhile, emerging therapies such as stem cell therapy, growth factor therapy, continuous oxygen diffusion therapy (CODT), and antimicrobial materials offer new hope for treating refractory ulcers. However, DFU's high recurrence rate and poor long-term prognosis remain major challenges, closely associated with blood glucose fluctuations, infections, and psychosocial factors. MDT approaches have significantly improved cure rates and quality of life but face limitations in implementation at primary healthcare levels. Future research should focus on large-scale, multicenter studies with long-term follow-up while strengthening psychological support and personalized management. This would promote comprehensive advancements in DFU diagnostic and therapeutic strategies, ultimately improving patient outcomes and quality of life.

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.

Innovating using mHealth for people with dementia and co‐morbidity and their carers: Screening and economic assessment at the population level

AbstractBackgroundDementia is a global health challenge, especially in low‐ and middle‐income countries like Peru, where diagnosis, access, and awareness are limited. Within the IMPACT Dementia project, a component focuses on developing, testing, and implementing an mHealth‐enabled system for dementia screening and diagnosis, and assessing its cost‐effectiveness.MethodsPhase I. To develop a dementia diagnostic screening mHealth system: The features of the screening tool will be locally adapted using a co‐design approach including community members and community health workers (CHW) in four regions in Peru (Lima, Tumbes, Iquitos, and Huancayo) to enhance adaptability and efficacy. The final tool will be applied to older adults (60+) in the community by CHW.Phase II. To assess the accuracy and acceptability, and characterization of older adults (60+) at the population level in Peru (n≈32,000): Using the mHealth system developed in Phase I, assessments including AD8, RUDAS‐PE, and PFAQ, will be conducted. Accuracy for dementia diagnosis will be determined through gold‐standard assessments involving interviews, neuropsychological testing, and the CDR in a subgroup of participants conducted by neurologists. The system will also collect data on socio‐demographic information, carers, co‐morbidities, quality of life, resource usage and costs.Phase III. To integrate the mHealth diagnostic system into Peru’s primary healthcare (PHC) level: After validation, a 3‐month quasi‐experimental study in 2 centres per region will assess system performance, using waiting room recruitment and provider‐conducted screenings for older adults. Indicators will evaluate integration success, sensitivity, and specificity of the tool, cost‐effectiveness, and stakeholder perspectives through a process evaluation, guiding future scalability.ResultEarly phases suggest that the IMPACT Dementia project will offer insights into dementia challenges in Peru. The co‐design phase prioritises cultural relevance. Phase II anticipates a comprehensive dataset characterising older adults, informing prevalence and risk factors, and validating the mHealth diagnostic system. Phase III aims to assess the integration feasibility of the diagnostic system into PHC.ConclusionThis component of IMPACT Dementia addresses the challenges of dementia in Peru, emphasizing diagnosis, comorbidity, and resource optimization through mHealth. The participation of CHW means a strategic change, which aims to alleviate the burden on health systems.

Conceptualising maternal mental health in rural Ghana: A realist qualitative analysis.

In low-and-middle income countries, maternal mental health needs remain neglected, and common mental disorders during pregnancy and after birth are routinely associated with hormonal changes. The psycho-social, and spiritual components of childbirth are often downplayed. A qualitative study was conducted as part of a wider realist evaluation on health systems responsiveness to examine the interrelationships between pregnant and postnatal women, their families, and their environment, and how these influence women's interactions with healthcare providers in Ghana. Data collection methods combined six qualitative interviews (n= 6) and 18 focus group discussions (n= 121) with pregnant and postnatal women, their relatives and health care providers (midwives, community mental health nurses) at the primary healthcare level. Data analysis was based on the Context-Mechanism-Outcome heuristic of realist evaluation methodology. A programme theory was developed and iteratively refined, drawing on Crowther's ecology of birth theory to unpack how context shapes women's interactions with public and alternative health care providers. We found that context interacts dynamically with embodiment, relationality, temporality, spatiality, and mystery of childbirth experiences, which in turn influence women's wellbeing in three primary areas. There is an intricate intersection of pregnancy with mental health impacting women's expectations of temporality, which does not always coincide with the timings provided by formal healthcare services. Societal deficiencies in social support structures for women facing economic challenges become particularly evident during the pregnancy and postnatal period, where women need heightened assistance. Socio-cultural beliefs associated with the mystery of childbirth, support the role of private providers in offering women a feeling of protection from uncertainty. Co-production of context specific interventions, including the integration of maternal and mental health policies, with relevant stakeholders can help formal healthcare providers accommodate women's perspectives on spirituality and mental health, which can subsequently help to make health system responsive to maternal mental health conditions.

Barriers and facilitators for strengthening primary health systems for person-centred multimorbid care in low-income and middle-income countries: a scoping review

ObjectiveTo understand barriers and facilitators for strengthening health systems for person-centred care of people with multiple long-term conditions-multimorbidity (MLTC-M) at the primary healthcare (PHC) level in low-income and middle-income countries...

Challenges and Strategies for Mainstreaming Neglected Tropical Diseases Campaign Interventions in Ethiopia.

Mainstreaming neglected tropical diseases (NTDs) interventions in national health systems is one of the key strategies emphasized in the WHO Roadmap for NTDs. However, there is limited evidence on implementing the proposed mainstreaming approaches effectively. We used a participatory ranking methodology in Ethiopia, using consultative workshops with purposively selected stakeholders, including NTDs program leaders from the government and partners, primary health care (PHC) workers, and community leaders and volunteers. Our aim was to identify, rank, and contextualize mainstreaming challenges and strategies, which were then synthesized using the Primary Health Care Performance Initiative framework. Thirty-three stakeholders at the national, regional, district, PHC, and community levels participated in two consultative workshops conducted in the Adama and Shashemene towns in Ethiopia. The stakeholders identified 73 mainstreaming challenges related to service delivery (32 [43.8%]), inputs (22 [30.1%]), systems (18 [24.7%]), and outputs (1 [1.4%]). The top three most frequently cited and ranked challenges were poor data recording and reporting, poor drug management and logistics, and weak supportive supervision and monitoring. Among the 185 strategies identified to address these challenges, the three most frequently cited were establishing a strong, supportive supervision and monitoring system, continuous on-the-job training to build workforce competence, and performance-based motivation. Multifaceted NTDs campaign intervention mainstreaming challenges that are deep-rooted in the health system were identified. The suggested strategies to address them should be given due consideration not only to guide future mainstreaming efforts but also to facilitate health system strengthening.

Development of a Physiotherapist-Coordinated Interdisciplinary Rehabilitation Intervention for People with Suspected Axial Spondyloarthritis: The SPINCODE Rehabilitation Intervention.

Background: People with early axial spondyloarthritis experience a diagnostic delay and a similar disease burden as people with axial spondyloarthritis at a later stage of the disease. In many European countries, patients with early axial spondyloarthritis do not have access to an interdisciplinary rehabilitation team. The objective of this study was to develop a new evidence-based physiotherapist-coordinated interdisciplinary rehabilitation intervention for individuals suspected of axial spondyloarthritis. This development of the rehabilitation intervention is part of the SPINCODE project which focusses on early diagnosis and treatment for people with axial spondyloarthritis. Methods: The development of the intervention encompasses: (i) identifying the evidence base and program theories; (ii) modeling and remodeling the intervention; and (iii) describing the developed intervention. Results: The six-month SPINCODE rehabilitation intervention is a physiotherapist-coordinated, interdisciplinary, outpatient rehabilitation intervention at a specialized rheumatology hospital. The intervention consists of: (i) individual physiotherapist-coordinated consultations with assessment, goal setting, tailored physical activity support, and the defined goals, and coordination across the interdisciplinary team at the hospital and across primary and secondary healthcare levels; (ii) group sessions, encompassing patient education and peer support; and (iii) optional individual support from the interdisciplinary team. Physiotherapists from private care working with the patient enrolled in the SPINCODE study are offered digital support from the hospital-based physiotherapists. Conclusions: The developed physiotherapist-led interdisciplinary SPINCODE rehabilitation intervention is ready for feasibility testing.

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.

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.