Primary Health Care Professionals Research Articles

Clinical presentations and microbiological analysis of cerebrospinal fluid samples in cases of suspected bacterial meningitis patients attending a 1600 bedded teaching hospital from 2019 to 2022: A retrospective study.

Meningitis can be attributed to bacterial, fungal, or viral agents. In this study, we demonstrate the common bacterial agents causing meningitis along with their antibiotics susceptibility pattern in patients of all age groups. This retrospective, observational study was carried out in the Department of Microbiology with cerebrospinal fluid (CSF) samples collected from November 2019 to May 2022. We collected 1986 nonrepeat CSF samples from clinically suspected patients of bacterial meningitis, and clinical information about the patients was extracted from the hospital information system. Out of the 1986 CSF samples included in our study, 150 (7.55%) were found to be positive on bacterial culture. Most of our patients were in the age group of 0-20 years. Common clinical manifestations observed in our patients were: high-grade fever, 87 patients (58%); severe headache, 126 patients (84%); neck rigidity, 47 patients (31.3%); altered mental status, 76 patients (50.7%) and photophobia, 83 patients (55.3%). The most commonly isolated bacteria was Acinetobacter species (30%). The mean length of hospitalization (37.76 ± 25.30), the mean total cell count, high levels of protein (mg/dl) and low levels of glucose (mg/dl) of CSF were statistically significant in meningitis caused by multidrug-resistant bacteria. We recognized the spectrum of pathogens causing meningitis at our center along with the antibiotic resistance pattern to guide and facilitate early treatment by primary health care professionals and family medicine practitioners.

Job satisfaction of primary healthcare professionals (public sector): A cross-sectional study in Morocco

Healthcare professionals (HCPs) are indispensable for improving the availability and quality of healthcare services. Therefore, the present cross-sectional study aimed to measure the job satisfaction of HCPs working in primary care (PC) centers in Marrakech, according to the job satisfaction scale. Using census sampling, this study involved HCPs working in PC centers. Data were collected using an electronic questionnaire and analyzes were performed using Jamovi (version 1.6). The Warr-Cook-Wall scale was used to assess the satisfaction of these professionals. Student's t-test, Kruskal–Wallis test and Mann–Whitney non-parametric tests were used for group comparisons (p < 0.05). The lowest satisfaction scores were recorded for general practitioners (GPs) and nurses. These were work safety (1.54 ± 0.85 vs. 1.51 ± 0.82), salary (1.58 ± 0.79 vs. 1.72 ± 0.87), chance of promotion (1.68 ± 0.87 vs. 1.80 ± 0.93), possibility of using its capacities (1.90 ± 1.04 vs. 2.01 ± 1.08), and workload (1.88 ± 1.10 vs. 2.05 ± 1.06). A statistically significant difference was observed between different professional statuses regarding facility management (p = 0.049). The overall job satisfaction of HCPs was low, especially among GPs and nurses: the scores for intrinsic job satisfaction with respect to sociodemographic characteristics were low, whereas they were medium for extrinsic job satisfaction. Further research is warranted to clarify the intrinsic and extrinsic factors of job satisfaction in Morocco's healthcare sector.

Orthopaedic Out of Bed Project (OOBP): improving early mobilisation following femoral fracture using a therapy-led education programme

Delayed mobilisation following hip fracture surgery is detrimental to patients and health systems. Prolonged hospital stay additionally results in decreased function and increased mortality. Our hospital was underperforming against the...

Perceptions of primary health care nurses and general practitioners in the care of older people with urinary incontinence.

To identify the challenges and opportunities among primary health care nurses and general practitioners (GPs) in the care of older people with urinary incontinence (UI) and other chronic conditions in China. UI is highly prevalent among community-dwelling older people with chronic conditions but is underreported and poorly managed. Understanding the factors that affect primary health care professionals' practices in their care for this population is imperative to foster nurse-led UI care services. A qualitative descriptive study. Four focus groups were held with 24 primary health care nurses and GPs in Changsha, Hunan Province, China, between July and September 2021. A reflective thematic analysis was used to identify themes. This study revealed misconceptions regarding older people living with UI and other chronic conditions in primary care health professional participants. Moreover, primary health care nurses had very limited autonomy in UI diagnosis and initiating care interventions for this patient population. By reflecting on practices, participants recognized various practical solutions to improve the detection and management of UI. Participants also identified barriers to accessing care services in older people with UI. They suggested changes in the health care system to achieve universal access to UI care services for older people. Nurse-led UI care services in primary health care for community-dwelling older people with chronic conditions are in high demand but are underdeveloped due to professional and health care system factors. Findings from this study provide new insights into challenges faced by primary health care professionals and illuminate practical solutions to address these challenges. Adherence to COREQ guidelines was maintained. No patient or public contribution.

Promoção da saúde no puerpério: avaliação da assistência na Atenção Primária

The objective was to evaluate healthcare actions developed by Primary Health Care (PHC) professionals for women in the postpartum period. An evaluative study of the implementation analysis type with a quantitative and qualitative approach was carried out in a municipality in each state in the South region of Brazil. Thirty-one puerperal women and 28 primary care professionals participated. Data analysis was performed by evaluating the degree of implementation determined by the Analysis and Judgment Matrix, followed by categorical content analysis. The results showed that one case was considered incipient implantation and the other two partial ones. A lack of physical examination during consultations, of exclusive attention to the newborn, of guidance on warning signs and common problems, and late performance of the first postpartum consultation were observed. It is concluded that physical health care must be improved by professionals to guarantee better care.

Implementation, service effectiveness and satisfaction with teleconsultation services in China during the COVID-19 pandemic: from the Perspective of Primary Health Care Professionals

ObjectiveThis study aims to evaluate satisfaction and service effectiveness of primary hospital physicians participating in the National Telemedicine Center of China during the COVID-19 period, and to identify potential improvement suggestions. MethodsAn online questionnaire was developed to assess the impact and satisfaction of teleconsultation services. A teleconsultation manager from each of the 98 hospitals randomly invited the medical staff involved in teleconsultation to complete the online questionnaire. ResultsA total of 379 health care professionals responded to the online questionnaire, with a mean age of 36.74 years. Out of these respondents, 95.5% had a positive attitude towards teleconsultation during the epidemic. Only 6.6% believed that teleconsultation systems were not useful in preventing and controlling the COVID-19 pandemic. Those respondents who were very satisfied with teleconsultation participated in it 1.81 times per week averagely. Factors related to satisfaction included weekly participation frequency（P=.003）, patient data quality(P=.023), equipment operation proficiency（P=.006）, audio and video clarity and smoothness（P=.004, P=.020）, environmental satisfaction（P=.032）, and incentive measures of title promotion（P=.003）. The main challenges in teleconsultation were the lack of understanding of medical staff and the public, insufficiently advanced software and hardware equipment, and the lack of optimization of service processes. ConclusionsPrimary hospital doctors demonstrate high satisfaction levels, suggesting that teleconsultation could be an effective tool for patients seeking medical care in areas under lockdown during the COVID-19 pandemic. The primary barriers to teleconsultation include lack of public understanding and unadvanced equipment. These findings should inform future efforts to establish regional telemedicine programs in the post-COVID-19 era.

Barriers and facilitators for implementing lifestyle-related treatment modalities in osteoarthritis: A cross-sectional study among primary and secondary healthcare professionals

PurposeTo identify barriers and facilitators as perceived by primary and secondary healthcare professionals (HCPs) when implementing lifestyle-related treatment modalities (LRTMs) in patients with hip/knee osteoarthritis (OA). MethodsA cross-sectional study. A Dutch online survey was distributed among eight different disciplines of primary and secondary HCPs. Potential barriers and facilitators were identified based on participants’ responses to 32 research-derived statements on implementing LRTMs, and presented as factors with “major agreement” (≥75%), “minor agreement” (60–75%) or “no agreement” (<60%). Results213 participants completed the survey. Seven “barriers” and 20 “facilitators” were identified. There were three “major agreement barriers”: organization of Dutch healthcare system, audits within organization, and lifestyle climate in Dutch society. The top three “major agreement facilitators” were: health effects on patients, safety of increasing physical activity, and personal attitude. The total number of “barriers” differed per HCP discipline, with the highest number (12) among orthopedic surgeons (or in-training) and the lowest number (4) among dieticians, physiotherapists, and lifestyle counselors. ConclusionsThe findings suggest that implementing LRTMs within OA care could be improved by focusing on societal rather than individual HCP factors. National preventive policies on health promotion could counteract the expected increase in healthcare demand and costs due to OA and other chronic diseases. Future research is needed to match relevant implementation strategies to all barriers identified.

Mental health of health professionals and their perspectives on mental health services in a conflict-affected setting: a qualitative study in health centres in the Gaza Strip during the COVID-19 pandemic

ObjectivesTo explore how primary care health professionals perceive their own mental health in a conflict-affected setting during and beyond the COVID-19 pandemic and to explore their perspectives on mental health...

Translating and adapting the Alcohol Use Disorders Identification Test (AUDIT) for use in the Russian Federation: A multicentre pilot study to inform validation procedures

Aims: The Alcohol Use Disorders Identification Test (AUDIT) is one of the most widely used screening instruments worldwide. Although it was translated into many languages, not many country-specific adaptations exist, and a formal validation procedure of the Russian version has been carried out only recently. The present contribution documents the different steps taken to formally translate and adapt a Russian-specific version of the AUDIT (RUS-AUDIT). Methods: The AUDIT was translated into Russian following an established protocol, revised and adapted to the country context using an expert panel, and field-tested in an iterative approach, in line with WHO rules on instrument translation and adaptation A total of three pilot phases were carried out on 134 patients from primary healthcare (PHC) and 33 patients from specialised alcohol treatment facilities (narcology), guided by a specially established advisory board. Changes in each version were informed by the findings of the previous pilot phase and a thorough panel discussion. Results: Based on the findings of three different pilot phases, the RUS-AUDIT was developed as a paper-and-pencil interview for PHC professionals. Since various issues with representation and counting of standard drinks for the second test item arose, a special show card was developed to support the assessment. Preliminary AUDIT-C scores indicated that more than one-third of the screened women (34.2%) and about half of the screened men (50.9%) from PHC facilities have exceeded risk thresholds. Conclusions: The RUS-AUDIT was constructed as a feasible assessment tool for interviewers and patients. The large number of PHC patients who exceed the risk threshold has corroborated the need for formal validation and Russia-specific cut-off scores, considering the specific drinking patterns.

De la consulta presencial a la teleconsulta: experiencias de profesionales de atención primaria del País Vasco durante la pandemia

ObjectiveTo explore the perceptions of Primary Health Care (PHC) professionals on changes in consultation modalities and their impact on PHC fundamentals during the pandemic. DesignQualitative exploratory research conducted between October and November, 2021. LocationFour urban and one rural primary health care centers with different socioeconomic profiles in the threeterritories of the Basque Country. ParticipantsForty-six professionals from different categories of the PHC team and health centre directors. MethodPurposive sampling. Five focus groups and fourin-depth interviews. Thematic analysis with the support of the Atlas.ti programme. Triangulation of results among the research team. ResultsExperiences with the development of teleconsultation appear to be directly conditioned by the pandemic context in its different phases and by the PC situation. The professionals identified communication barriers, as well as potentialities of its use that require adequate training and evaluation. Risks of inequity were perceived in the use of teleconsultations that could be affecting the quality of care. Longitudinality was assessed as a facilitating factor and problems of coordination and communication through teleconsultation between care levels were identified. ConclusionsThe replacement of face-to-face consultation by teleconsultation had an impact on fundamental aspects of PHC such as quality, accessibility, equity, coordination and longitudinality. Teleconsultation in PHC should always be evaluated considering the specific circumstances and contexts of its implementation.

Improvement in Quality of Life With the Use of a Technological System Among Patients With Chronic Disease Followed Up in Primary Care (TeNDER Project): Protocol for a Randomized Controlled Trial.

Among chronic diseases, cognitive, neurological, and cardiovascular impairments are becoming increasingly prevalent, generating a shift in health and social needs. Technology can create an ecosystem of care integrated with microtools based on biosensors for motion, location, voice, and expression detection that can help people with chronic diseases. A technological system capable of identifying symptoms, signs, or behavioral patterns could provide notification of the development of complications of disease. This would help the self-care of patients with chronic disease and save health care costs, promoting the autonomy and empowerment of patients and their caregivers, improving their quality of life (QoL), and providing health professionals with monitoring tools. The main objective of this study is to evaluate the effectiveness of a technological system (the TeNDER system) to improve quality of life in patients with chronic diseases: Alzheimer disease, Parkinson disease, and cardiovascular disease. A multicenter, randomized, parallel-group clinical trial will be conducted with a follow-up of 2 months. The scope of the study will be the primary care health centers of the Community of Madrid belonging to the Spanish public health system. The study population will be patients diagnosed with Parkinson disease, Alzheimer disease, and cardiovascular disease; their caregivers; and health professionals. The sample size will be 534 patients (380 in the intervention group). The intervention will consist of the use of the TeNDER system. The system will monitor the patients by means of biosensors, and their data will be integrated into the TeNDER app. With the information provided, the TeNDER system will generate health reports that can be consulted by patients, caregivers, and health professionals. Sociodemographic variables and technological affinity will be measured, as will views on the usability of and satisfaction with the TeNDER system. The dependent variable will be the mean difference in QoL score between the intervention and control groups at 2 months. To study the effectiveness of the TeNDER system in improving QoL in patients, an explanatory linear regression model will be constructed. All analyses will be performed with the 95% CI and robust estimators. Ethics approval for this project was received on September 11, 2019. The trial was registered on August 14, 2020. Recruitment commenced in April 2021, and the expected results will be available during 2023 or 2024. This clinical trial among patients with highly prevalent chronic illnesses and the people most involved in their care will provide a more realistic view of the situation experienced by people with long-term illness and their support networks. The TeNDER system is in continuous development based on a study of the needs of the target population and on feedback during its use from the users: patients, caregivers, and primary care health professionals. ClinicalTrials.gov NCT05681065; https://clinicaltrials.gov/ct2/show/NCT05681065. DERR1-10.2196/47331.

Breast Self-examination and Mammography: Assessing Knowledge, Attitudes, and Behaviors among Female Primary Health-care Workers in Southern Saudi Arabia

Background: Insufficient knowledge about breast cancer risk factors and suboptimal practice of screening methods among female health-care professionals necessitated this study. We aimed to assess the knowledge, attitude, and behaviors of breast self-examination (BSE) and mammography among female primary health-care workers in the southern region of Saudi Arabia. Methodology: This descriptive, cross-sectional observation study was conducted in the southern region of Saudi Arabia, specifically focusing on female primary health-care workers. The study was executed between March 2023 and May 2023, utilizing online self-administered questionnaires for data collection. Results: The analysis included 252 participants, with the majority 144 (57.1%) falling within the 20–29 age range. In terms of personal history, 207 (82.1%) reported no previous breast problems, while the prevalence of breast problems in first- and second-degree relatives was 43 (17.1%) and 45 (17.9%), respectively. Regarding BSE, 126 (50.0%) reported never having performed it, and 201 (79.8%) reported never undergoing screening mammography. Knowledge levels varied, with 156 (61.9%) classified as having poor knowledge and 96 (38.1%) as having good knowledge. Conclusion: This research highlights the insufficient understanding and suboptimal implementation of BSE and mammography among female primary health-care professionals in the southern part of Saudi Arabia.

Burnout Syndrome in Primary Health Care professionals during the COVID-19 pandemic

Workers in Primary Health Care (PHC) play a key role in coping with COVID-19, which required personal and work-flow changes, causing physical and emotional overload and stress, which could lead to Burnout Syndrome (BS). The objective of this study was to check the prevalence of BS in health professionals working in PHC in the municipality of Curitibanos, state of Santa Catarina, Brazil. The research was carried out between November 2020 and May 2021, a sociodemographic questionnaire, and the Brazilian version of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), which contains 22 questions and three dimensions - Emotional Exhaustion (EE), Depersonalization (DP) and Personal Fulfillment (PF), were applied. Data were collected and analyzed descriptively with subsequent statistical comparison. Participants were50 volunteers aged 40.1 ± 9.5 years, time in the profession of 10.8 ± 7.9 years. Results of the MBI-HSS showed the prevalence of risk was moderate for EE and high for DP and PF. However, no significant difference was detected between the MBI-HSS dimensions and sociodemographic variables. In conclusion, the prevalence of risk was 17.6+11.4 points in EE (moderate); 6.6+5.0 points in DP (moderate) and 36.8+6.6 points in RP (high), indicating that the evaluated population already demands some need for contingency or preventive care because it has a clear predisposition to BS. However, there was no statistical association with sociodemographic variables.

BT16 A service evaluation of dermatology Clinical Assessments, Services, Education and Support which aims to reduce referrals from primary to secondary care through peer review and education

Abstract Clinical Assessments, Services, Education and Support (CASES) is a collaboration between primary and secondary care to aid management of routine referrals via the National Health Service e-Referral Service (eRS) by providing clinical support and education to primary care through peer review, advice and guidance from local general practitioners (GPs) since 2016. The service covers 10 specialities. The CASES is optional, and primary care can choose to bypass the service, referring directly to secondary care. Three GP peer reviewers work under the supervision of dermatology consultants. They review elective referrals from primary healthcare professionals (GPs, advanced clinical practitioners and physician associates) via the eRS. Referrals are either sent back to the referrer with advice and educational resources or sent on to secondary care, often with interim advice. Monthly mentoring meetings enable the assessors to discuss difficult cases. Data were recorded for dermatology referrals from January 2022 to December 2022. Within the 12-month period, 3940 referrals were processed via CASES (mean 328 referrals a month). Of the referrals received, 90.0% (n = 3545) were routinely referred on to secondary care and 1.4% (n = 55) required a 2-week wait. However, 6.9% (n = 273) were returned to the referrer with advice and guidance. Further information was requested for 1.1% (n = 44) of the referrals that had been returned to the referrer. Twenty-three (0.6%) had been referred to the wrong specialty. Lesions (n = 1835; 46.6%) made up the bulk of the referrals, alongside rashes referred for diagnosis (n = 573; 14.5%). Chronic disease management (acne, eczema, psoriasis, contact dermatitis, etc.) made up 36.1%. Overall, the results suggest that 6.9% (n = 273) of referrals were managed in primary care. Almost half of the referrals were related to lesions. We have not yet been able to establish the proportion of cases where referrals were returned with advice and guidance and were then later referred to secondary care for the same issue, which is currently a limitation. Secondary care dermatology is overwhelmed with the current workload and waiting times. Peer review services like CASES, using a digital platform like the eRS, have the potential to be extremely beneficial to help manage the workload. However, the sharing of information between primary and secondary care needs to be improved in our service, and we would aim to make images mandatory to enable triage, although our beleaguered primary care colleagues currently feel that this is not possible.

BT24 Use of specialist advice and guidance for dermatology services: the importance of high-quality images in reducing double activity

Abstract The use of specialist advice and guidance (A&amp;G), where primary care healthcare professionals request diagnostic and management advice from specialists, is advocated as the ‘front door’ to dermatology services, to optimize referral management. This approach provides the opportunity for a two-way interchange between primary and specialist services, and can facilitate triage to appropriate dermatology services in a timely fashion. For A&amp;G to work effectively, the expectation is that images will accompany the A&amp;G interaction. Ideally, dermoscopic images would accompany skin lesion A&amp;G requests. It is important that the images are of a high enough quality to enable the reviewing clinician to provide a diagnosis and management plan so that ‘double activity’, where an A&amp;G request is reviewed and the patient needs to be seen because of poor-quality images, is avoided. We introduced specialist A&amp;G in August 2021 and developed referral forms for skin lesions. Dermatoscopes were provided to practices. The aim of this study was to review the quality of skin lesion A&amp;G requests and, in particular, to identify whether a diagnosis and management plan was possible based on the information and images provided. Consecutive skin lesion A&amp;G requests were reviewed over a 4-week period, and information was collected on the images accompanying the request and whether the reviewing clinician was able to make a diagnosis and management plan. In total, 160 skin lesion A&amp;G requests were reviewed over the 4-week period. A skin lesion referral form accompanied 42% of the requests, and 92% were accompanied by macroscopic images (42% clearly labelled) and 59.5% by dermoscopic images. In 32% of the requests, it was not possible to make a diagnosis and management plan. This study highlights the fact that the quality of images accompanying A&amp;G skin lesion referrals is often not good enough to make a diagnosis and management plan. Many of these patients will therefore need to be seen for a face-to-face appointment, which leads to ‘double activity’. If A&amp;G services are to work effectively, then it is essential that high-quality images, ideally including dermoscopy images for skin lesions, accompany the A&amp;G requests. Systems need to identify appropriate models to support image-taking services. Such models can be developed locally and might include community image-taking hubs based in agreed primary care settings or community diagnostic centres. A suitably trained workforce needs to be developed to take and send the images.

BT23 Outcomes of skin lesion referrals assessed via teledermoscopy

Abstract Skin lesion referrals from primary care comprise a significant proportion of the dermatology workload. Urgent suspected cancer (USC) referrals are prioritized, which adds strain to outpatient capacity and impacts on waiting lists for less urgent and routine referrals. Our department provides a teledermoscopy diagnostic service to allow for timely diagnosis of skin lesions. This results in fast detection of USC and a reduction in unnecessary hospital visits for patients with benign lesions. The aim of this study was to review the outcomes of USC and routine referrals received from primary care and assessed via our teledermoscopy service. We randomly selected 381 skin lesion referrals triaged for teledermoscopy between January and March 2022. In total, 189 (49.6%) of these were referred as routine and 192 (50.4%) were urgent/USC. High-resolution clinical and dermoscopic photographs of all skin lesions were taken by qualified clinical photographers and stored in the patients’ electronic records. Two separate consultant dermatologists reviewed the images along with the information provided in the referrals for diagnosis. A total of 47 diagnoses were observed in both cohorts. Only 16% of patients referred as urgent/USC had suspected high-risk cancer, including squamous cell carcinoma (SCC; 8.8%), melanoma (5.7%) and lentigo maligna (1.5%). The remainder of urgent/USC referrals were identified as nonurgent or benign, with an overwhelmingly low risk of basal cell carcinoma (23.9%), seborrhoeic keratoses (20.8%) and benign naevi (9.3%). For routine referrals, 11 patients (5.8%) were suspected to have USC. Of these, five had histological confirmation of melanoma (n = 3), SCC (n = 1) and melanoma in situ (n = 1). Of all referrals, 44.6% were reassured and discharged; 20.8% required clinic review for a diagnostic biopsy or treatment; 20.7% were booked directly for minor surgery; 8.3% were referred to the community local enhanced services for the treatment of low-risk lesions on the torso and limbs; 1.3% were referred to other specialties; and 4.1% required digital monitoring by repeating photographs 3–6 months later. An ever-increasing prevalence of skin cancer, together with suboptimal dermatology training for primary care healthcare professionals, anxiety over misdiagnosing malignancy and pressure from anxious patients all contribute to the pressure on dermatology services. We have shown that a teledermoscopy service is a useful tool for triaging skin cancer referrals to maximize the utilization of outpatient capacity and ensure timely treatment for patients with USCs.

Care management in primary health care for women victi of violencems

Objective: To systematize strategies from the review of existing literature to develop recommendations to be incorporated into the work process of Primary Health Care professionals in the health care of women victims of violence, from Care Management. Method: This is an integrative literature review study, of qualitative approach, where 32 scientific papers present in the BVS and Lilacs databases were selected. Results: The results were twelve dimensions of recommendations for care management in PHC with a focus on comprehensive care to women in situations of violence. Final considerations: It is concluded, therefore, that there is accumulation in experiences reported in the collected studies, however the difficulties of expansion of these actions and implementation of systematic, continuous and integrated way, these are challenges that remain. It is recommended the deepening of studies on care management in the context of primary care with a focus on gender violence to support policies and improvement programs.

Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon.

The detection of leprosy in children is an important epidemiological marker of the disease, indicating the community's early exposure to Mycobacterium leprae and active transmission of the infection. In order to detect new cases among children by combining clinical evaluation and laboratory tests, we conducted an active case finding among individuals under 15 years old on Caratateua Island, located in the city of Belém, in the Pará state, an endemic region in the Amazon. Dermato-neurological examination, collection of 5 mL of peripheral blood for IgM anti-PGL-I antibody titration, and intradermal scraping for bacilloscopy and amplification of the specific RLEP region by qPCR were performed. Out of the 56 examined children, 28/56 (50%) new cases were identified. At the time of evaluation, 38/56 (67.8%) children presented one or more clinical alterations. Seropositivity was detected in 7/27 (25.9%) new cases and 5/24 (20.8%) undiagnosed children. DNA amplification of Mycobacterium leprae was observed in 23/28 (82.1%) of new cases and in 5/26 (19.2%) of non-cases. Out of the total cases, 11/28 (39.2%) were exclusively diagnosed by clinical evaluation performed during the active case finding. Seventeen new cases (60.8%) were detected considering the clinical alterations found in addition to positive results for qPCR. In this group, 3/17 (17.6%) qPCR-positive children presented significant clinical changes 5.5 months after the first evaluation. Our research detected a number of cases 5.6 times higher compared to the total number of pediatric cases recorded throughout the year 2021 in the municipality of Belém, which shows a critical scenario of underdiagnosing of leprosy among children under 15 years old in the region. We propose the use of qPCR technique to identify new cases among children with oligosymptomatic or early disease in endemic areas, in addition to the training of Primary Health Care professionals and the implementation of the Family Health Strategy coverage in the visited area.

Identifying psychosocial problems, needs, and coping mechanisms of adolescent Syrian refugees in Jordan.

Refugees who have fled war zones are at a heightened risk of psychosocial problems that can impact their ability to function in day-to-day life and place a significant burden on the family structure. This study aimed to assess the psychosocial problems and needs and coping mechanisms of Adolescent Syrian refugees in Jordan. Between October and December 2018, we conducted a qualitative study using semi-structured interviews with a sample of key and individual informants. Our sample included 20 primary healthcare professionals, 20 schoolteachers, 20 Syrian parents, and 20 adolescents aged 12-17 years. All interviews were transcribed verbatim, and we utilized thematic analysis to group, categorize, and analyze the original Arabic language transcripts. To ensure thorough analysis, we adopted a bottom-up inductive approach that covered the six-phase iterative process proposed by Braun and Clarke. The main psychosocial problems encountered by Syrian adolescents included stress, depression, loneliness, lack of a sense of security, isolation, aggressiveness, fear of war, and family disintegration. Almost all schoolteachers reported that they observed that Jordanian adolescents are more settled, self-confident, and financially stable relative to their Syrian peers. The Jordanian government and community were praised for their support, including education, recreational centers, health services, and awareness campaigns. Going to school, praying and reading the Holy Quran, listening to music, and talking to friends and engaging with them were reported as the main coping mechanisms. The majority of respondents said that more services are still needed for adolescents, including more places for entertainment, psychosocial support and psychological counseling, medical care, job creation, and providing health insurance. Syrian refugees are aware of the psychological aspects of their situation, but they are not always able to access clinic-based humanitarian assistance for mental health and psychosocial support. Stakeholders must interact with refugees to learn about their needs and develop services that are appropriate for their culture.

Effectiveness of coordinated care to reduce the risk of prolonged disability among patients suffering from subacute or recurrent acute low back pain in primary care: protocol of the CO.LOMB cluster-randomized, controlled study.

Low back pain (LBP) is a common musculoskeletal condition and, globally, a leading cause of years lived with disability. It leads to reduced social participation, impaired quality of life, and direct and indirect costs due to work incapacity. A coordinated approach focusing on psychosocial risk factors, active reeducation, and the early use of tools to maintain employment, may be effective for improving prognosis of patients with LBP. Primary care professionals and multidisciplinary teams, who see patients in the early stages of LBP may be in the best position to implement such a coordinated approach. We designed this study to assess a coordinated multi-faceted strategy in primary care for patients with subacute or recurrent acute LBP. The CO.LOMB study was designed as a multicentric, cluster-randomized, controlled study. Patients aged 18-60 years, with subacute or recurrent acute LBP are eligible. Patients also need to be employed (but can be on sick leave) with access to occupational health services. The clusters of GPs will be randomized (1:1) to either the Coordinated-care group or the Usual-care group. Patients will be assigned the group allocated to their GP. The healthcare professionals (GPs and associated physiotherapists) allocated to the Coordinated-care group will perform a 2-session study training. The following interventions are planned in the Coordinated-care group: exploration and management of psychosocial factors, active reeducation with a physiotherapist, the implementing of tools to maintain employment, and a reinforced cooperation between primary healthcare professionals. The primary objective is to assess the benefit of coordinated primary care to reduce disability in LBP patients at 12 months after enrollment: measure using the validated French version of the Roland Morris Disability Questionnaire. Secondary objectives include the evaluation of pain, work status, and quality of life at various time points. The study plans to enroll 500 patients in 20 GP clusters. Patients will be followed up for 12months. This study will evaluate the benefit of a coordinated multi-faceted strategy in primary care for patients with LBP. Notably whether this approach will alleviate the associated disability, attenuate pain, and promote the maintenance or return to work. NCT04826757.