Primary Health Care Units Research Articles

Prevention of risky sexual behavior in primary healthcare: a best practice implementation project.

Sexually transmitted infections are a public health problem affecting 45% of adolescents and young adults worldwide. The evidence suggests that primary care settings are uniquely positioned to provide an opportunity for these preventive interventions. The aim of this project is to improve nurses' interventions for preventing risky sexual behaviors in adolescents attending nursing consultations in a primary healthcare unit. An audit and feedback were conducted by the JBI Model and Implementation Framework. Five audit criteria representing best practice recommendations for preventing risky sexual behaviors in adolescents were used. Barriers to compliance with the best practices were identified, and strategies were adopted to overcome them. A follow-up audit was conducted using the same approach as the baseline audit. Compliance rates improved in four criteria from baseline audit to follow-up audit. Through auditing and feedback, evidence-based interventions were implemented to prevent sexual risk behavior in adolescents in primary care settings. Further best practice implementation projects should be conducted to improve adolescent health outcomes.

Analysis of traditional feeding practices and stunting among children aged 6 to 59 months in Karanganyar District, Central Java Province, Indonesia

BackgroundTraditional feeding practices are widespread in Indonesia. Therefore, using traditional feeding practices commonly used among mothers, this study examined the association between these practices and stunting along with other relevant factors (i.e., sociodemographic factors, feeding practices, vaccination status, and place of residence).MethodsThis cross-sectional study was conducted in Karanganyar District, Central Java Province. Data from a total of 706 children aged 6 to 59 months (352 children with stunting and 354 children without stunting) were obtained from the medical records of 10 primary health care units (PHCUs) in 9 subdistricts. Descriptive analysis and binary logistic regression (BLR) were performed to explore the association between the dependent (stunting) and independent variables.ResultsThe BLR results from children 6 to 59 months indicated that children of mothers with food restrictions during pregnancy (AOR = 5.87, 95% CI: 3.03, 11.38), children with prelacteal feeding (AOR = 4.27, 95% CI: 2.16, 8.41) and children with food restrictions (AOR = 7.74, 95% CI: 1.22, 49.16) were more likely to experience stunting. Those from children 6 to 23 months revealed that food restrictions during pregnancy (AOR = 17.55, 95% CI: 2.86, 107.80) and prelacteal feeding (AOR = 10.58, 95% CI: 2.06, 54.41) were related to stunting. The reasons for traditional feeding practices were related to cultural beliefs. For example, mothers believed that red meat could cause high blood pressure; thus, the consumption of red meat could trigger miscarriage or bleeding during delivery. In addition, this study showed that low sociodemographic status, inappropriate feeding practices, incomplete vaccination, and residence in rural areas were related to stunting.ConclusionsThe findings reflect the importance of education for mothers to correct misconceptions of traditional feeding practices. The government should strengthen counseling services in PHCUs to improve mothers’ knowledge of and attitudes toward appropriate feeding practices. Additionally, public relations practices through the mass media should continue for family members, especially senior members, as they influence mothers’ autonomy in decision-making regarding feeding practices in Indonesia.

Eating Habits of People with Type 2 Diabetes Mellitus in Portugal: A Cross-Sectional Study

Nutrition is a cornerstone of diabetes mellitus prevention and management; therefore, it is essential to enable patients to adopt healthy eating habits. Previous studies have not yet documented the main errors in the eating habits of Portuguese people with type 2 diabetes mellitus. This study aims to identify the main errors in the eating habits of people living with type 2 diabetes mellitus in Portugal and to evaluate its associations with sociodemographic variables. Cross-sectional multicentric study in a convenience sample of people with type 2 diabetes mellitus in Primary Health Care Units. The UK Diabetes and Diet Questionnaire (UKDDQ) - translated and adapted, was applied from July to October 2022. Descriptive and inferential statistical analyses were conducted. Of the 550 participants, 52.2% were female, 68.3% were 65 years or over, 55.8 % had an education level up to the fourth grade, 24.7% had economic deprivation, and the mean time since diagnosis was 10.60 ± 8.13 years. Only 36.2% of the sample had a healthy UKDDQ score. Less than 50% of the sample had healthy scores for the items "high-fiber rice or pasta", "high-fiber bread", "butter, margarine and vegetable oils" and "vegetables and pulses". Only 8.9% of the sample had a healthy consumption of fiber. About 70.4% reported healthy scores for the consumption of "high-added-sugar foods" and 54.7% for "high-saturated fat". A statistically significant weak positive correlation was found between the UKDDQ score and age (ρ = 0.201, p < 0.001) with a more frequent choice of healthy foods with increasing age. Female respondents reported healthier habits, particularly in the consumption of "high-saturated fat" and "high-fiber foods". The majority of our sample did not take advantage of the potential benefits of healthy eating habits. The main food groups whose consumption should be emphasized or discouraged were individualized, particularly the need to encourage the consumption of high-fiber foods. Targeted educational actions must focus especially on younger and/or male patients.

Comparative analysis of primary health care attributes between children under and over 3 years of age using the primary care assessment tool

IntroductionChild health actions in Brazil have their primary focus on early childhood. A new epidemiological profile is emerging for children after the first one thousand days: an increase in non-communicable chronic diseases. This research aimed to analyze the attributes of Primary Health Care comparatively among different age groups, using three years of age as the cutoff point. MethodsThe study design was cross-sectional and conducted in three Primary Health Care Units and three Ambulatory Medical Assistance facilities in the Western Region of São Paulo. The PCA Tool Brazil was used as the assessment instrument. ResultsA total of 311 interviews were conducted with caregivers of children aged 0 to 12 years; 153 children were under three years old, and 158 were three years or older. The attributes that showed statistically significant differences between age groups (< 3 years and > 3 years) were affiliation (4.9 × 3.8), longitudinality (5.7 × 5.2), information system (7.4 × 6.3), and services provided (5.4 × 4.5). Through linear regression analysis, it was observed that there was a trend for better overall and essential scores in the evaluations of the group of children under three years old who attended Primary Health Care Units. ConclusionThe comparative analysis of Primary Health Care attributes among pediatric age groups revealed a trend towards higher scores, according to caregivers' perceptions, for children under three years old. This study suggests the need for the implementation of programs that can better address the healthcare needs of children beyond early childhood.

Pessoas com tuberculose pulmonar na atenção primária à saúde: redes sociais e repercussões do adoecimento

ABSTRACT Objective: to analyze the perceptions of people with pulmonary tuberculosis about their social support networks and the repercussions of becoming ill. Method: a qualitative, descriptive study, conducted with 41 individuals undergoing treatment for pulmonary tuberculosis, in Primary Health Care units in two Brazilian capitals: Belém/Pará and Campo Grande/Mato Grosso do Sul. Semi-structured individual interviews were carried out from July to December 2019. The thematic content analysis technique was applied. Results: among the participants, 21 (51.22%) were from Belém and 20 (48.78%) from Campo Grande. Males (n=23/56.10%), age group from 21 to 40 years old (n=16/39.02%), unemployed status (n=28/68.29%) and who did not receive social benefits (n=23/56.10%) predominated. Three thematic categories emerged, presenting perceptions about social networks and the types of support they offer, the impact of the disease on family budget and its impact on work activities. Final considerations: social support networks were characterized by the diversity of people and family or emotional ties maintained with the participants, as well as the diversity of types of support. In this context, they found the necessary human support to face the impact of the illness and deal with their socioeconomic condition.

VALIDAÇÃO DO INSTRUMENTO BONN PALLIATIVE CARE KNOWLEDGE TEST PARA PROFISSIONAIS DA ATENÇÃO PRIMÁRIA À SAÚDE

ABSTRACT Objective: to perform the translation, back-translation, content validity through analyses of internal consistency, reliability, reproducibility, and suitability of the name of the Bonn Palliative Care Knowledge Test, which assesses healthcare professionals’ knowledge and self-efficacy on palliative care in the context of Primary healthcare in Brazil. Method: translation, cross-cultural adaptation, and content validity were carried out, with the participation of eight expert judges, 50 target audience judges, and 149 healthcare professionals, in addition to analyses of internal consistency, reliability, and reproducibility. The study was conducted in Primary Health Care units in the city of São Paulo, Brazil, between February 2021 and October 2022, being answered remotely via internet and approved by the Research Ethics Committees of the institutions involved. Results: the Bonn Palliative Care Knowledge Test translation and cross-cultural adaptation in the Brazilian context were adequate, presenting good content validity (CVI&gt;0.83), medium internal consistency for the knowledge construct (Cronbach’s alpha=0.486) and excellent internal consistency for the self-efficacy construct (Cronbach’s alpha=0.852), in addition to good overall reliability (ICC&gt;0.5), excellent reproducibility (p-value=0.046), and was named as Questionário de Conhecimento e Autoeficácia sobre Cuidados Paliativos (BPW-BR). Conclusion: the instrument proved to be valid for use in knowledge and self-efficacy assessment about palliative care by Primary Health Care professionals and may help improve teaching about palliative care for this audience.

Women's empowerment for active labor: A qualitative study with nurse-midwives in antenatal education for childbirth.

Recognizing the positive impact of movement and positions on labor progression and maternal and neonatal outcomes, there is a strong recommendation to empower women for active labor during antenatal education. This study investigates nurse-midwives' interventions in empowering women for active labor, during antenatal education within primary healthcare settings. A qualitative descriptive study was conducted in Primary Healthcare Units that provide antenatal education for childbirth in Portugal. Semi-structured interviews were conducted with 10 nurse-midwives between August and October 2023. Content analysis, utilizing NVIVO software, was employed for data analysis, and the study adhered to the COREQ reporting guidelines. Six themes emerged: 1) Perspective of nurse-midwives and contextual influences; 2) Assessment of women's needs; 3) Enhancing women's knowledge; 4) Enhancing women's capabilities; 5) Supporting women in decision-making; and 6) Nurse-midwives' perspective on intervention outcomes. It is necessary to create environments conducive to knowledge and skill acquisition and invest in developing body awareness and its impact on labor progression. Encouraging women's involvement in decision-making is crucial, especially in less flexible hospital environments. This study highlighted the value nurse-midwives place on empowering women for active labor. Interventions featured sharing evidence-based practices and birth stories to foster reflection, emphasizing pelvic mobility training and partner involvement. Reflective practices could enable women to explore options and communicate effectively with healthcare professionals during labor.

Strategies used by nurses regarding underreporting of rural work accidents due to pesticide use.

To learn the strategies used regarding underreporting of pesticide use in rural areas. A qualitative study was carried out in eight primary healthcare units in rural areas and two emergency care units in a municipality in southern Brazil. Data collection took place in 2023 through interviews. Twenty professional nurses participated. The data was submitted to content analysis. The strategies identified were lifelong and continuing education for the professionals who carry out the notification, active search and training of workers who deal directly with this type of substance, computerizing the notification by filling in the forms online, and carrying out research on the subject. Nurses play an important role in reporting occupational accidents caused by the use of pesticides, improving occupational safety in rural areas.

Associação entre insuficiência cardíaca e consumo de alimentos ultraprocessados em idosos: um estudo transversal

Abstract Objective To estimate the prevalence of heart failure (HF) and explore its potential association with the consumption of ultra-processed foods (UPF) in older adults. Method This cross-sectional study utilized medical records of 1,322 older adults (55% women; mean age of 70.4 years) treated in primary health care facilities in the state of Roraima, Brazil. A cardiologist diagnosed HF based on diagnostic tests such as echocardiography, clinical evaluation, and analysis of medical history. Nutritionists assessed UPF consumption using a nationally standardized form commonly employed in Brazilian primary health care units. Results The findings revealed that 15.4% of older adults had HF. Significant associations were observed between UPF groups and HF, with the probability of HF ranging from OR=1.97 (95% CI=1.36–2.84) for the consumption of hamburgers and/or sausages to OR=2.59 (95% CI=1.73–3.74) for the consumption of filled biscuits, sweets, and treats. Conclusion The consumption of UPF was associated with a high prevalence of HF in this sample of Brazilian older adults. Policymakers and healthcare professionals directly involved with this population should collaborate on targeted interventions and guidelines to reduce UPF consumption and increase the intake of unprocessed foods.

Compreensão de cuidadores de pessoas idosas acamadas acerca da assistência recebida pela atenção primária à sua saúde

Abstract Objective To identify caregivers' understanding of healthcare assistance received from primary health care regarding their own health. Method A qualitative study based on Alfred Schütz's phenomenology was conducted. The approach to caregivers of bedridden older adults was carried out by community health agents within their coverage area in a primary health care unit located in the northern region of Espírito Santo, Brazil. The choice of location was convenience-based. Data collection took place between September and December 2022 in households. A questionnaire containing questions about the participants' sociodemographic profile, along with six phenomenological questions to understand the typical experiences of each caregiver of older adults and their intentionality, was administered. Data were analyzed using phenomenological methods. Results Sixteen caregivers of bedridden older adults participated, with fifteen being female, fifteen having a family relationship with the care recipient, and fifteen lacking training qualifying them for the caregiver role. 37.5% of caregivers were aged 61 years or older. Regarding the typical experiences, the following categories emerged from the participants' narratives: 1- Physical, emotional, and social impacts on the caregiver's health; 2- Need for qualification; 3- Support from the healthcare team, with a subcategory: 3.1- Absence of medical and/or nursing professionals. Conclusion It was understood that caregivers are invisible and do not receive healthcare assistance from the healthcare team for their own health. When home visits occur, professionals focus on attending to the older adult, fragmenting the assistance that should be extended to the needs of the family community, including the caregiver.

Persistence with medical glaucoma therapy in newly diagnosed patients.

Monotherapy, age, and side effects are significant risk factors for the discontinuation of antiglaucoma therapy. Long-term therapy persistence is crucial for slowing disease progression and preventing irreversible blindness. Therefore, it is essential to identify patients at higher risk of discontinuation. In this study, we aimed to evaluate the real-world persistence of antiglaucoma therapy in patients diagnosed with glaucoma in the primary healthcare units of the Lisbon and Tagus Valley regions. We conducted a retrospective longitudinal study by collecting data from the prescription records of new antiglaucoma drug users diagnosed with glaucoma between 2012 and 2013 in the Primary Health Care Units of the Lisbon and Tagus Valley Region. These patients were followed over 3 years. Therapy persistence was measured as the proportion of patients remaining on any antiglaucoma drug, regardless of any modifications or switching of drugs over time. Persistence was assessed at three time points: the end of the first, second, and third years of the observation period. A total of 2138 patients treated using new antiglaucoma drugs (867 [40.6%] male patients; 1271 [59.4%] female patients) were included in the study. Over the observation period, the overall persistence rate decreased from 91.9% (n = 1965) in the first year to 67.3% (n = 1439) in the third year. Older patients (≥ 65 years) showed higher persistence rates, although there was a decrease over the 3-year follow-up period (from 1481 [92.7%] to 1124 [70.4%]). Additionally, participants initially treated with monotherapy showed higher persistence rates, ranging from 92.4% (n = 1186) in the first year to 70.2% (n = 901) in the third year. The findings highlight the importance of patient follow-up over time, as almost one in three new antiglaucoma therapy users completely discontinued treatment, potentially risking disease progression. This could be mitigated with proper use of these drugs. Further studies should utilize recent health information systems to explore the impact of medication adherence and persistence on the functional and structural outcomes in patients with glaucoma.

Prevalence and Associated Factors of Jaundice Among Neonates Admitted to Neonatal Intensive Care Units at Public Specialized Hospitals in Bahir Dar City, Northwest Ethiopia.

Background. Neonatal jaundice is more common and complicated in low and middle-income countries. However, there is no adequate evidences on the prevalence of neonatal jaundice and associated factors in Ethiopia. Methods. An institution-based cross-sectional study was conducted from 15 April to 15 June 2021 among 340 neonates admitted to neonatal intensive care unit at public specialized hospitals in Bahir Dar city. Results. The prevalence of neonatal jaundice was found to be 38.8%. Conclusion. The prevalence of neonatal jaundice was relatively high. Being male, prematurity, maternal Rh negative, neonatal Rh positive, maternal blood type AB, and ABO incompatibility were predictor variables of neonatal jaundice. Therefore, healthcare facilities in Bahir Dar city should provide opportunities for testing blood groups and Rh factors of all women early during antenatal care follow-up. Moreover, the treatment of neonatal jaundice has to be easily accessible in all primary health care units of the district.

Magnitude of Neonatal Sepsis and Factors Associated with It among Neonates Admitted to the Intensive Care Units of Neonate in the Primary Hospital of Hawzen, Tigray, Ethiopia, 2020.

Neonatal sepsis contributes substantially to neonatal mortality and morbidity and is an ongoing major global public health problem particularly in developing countries. A significant proportion of mothers give birth in primary health care, but studies regarding neonatal sepsis and its associated factors among admitted neonates are limited to the hospital which may not be generalized to the primary health care unit. Therefore, this study aimed to assess the proportion of neonatal sepsis and associated factors in the study areas. To assess the magnitude of neonatal sepsis and its associated factors among neonates admitted to Neonatal Intensive Care Units (NICUs) of Hawzen Primary Hospital, Eastern Zone, Tigray, North Ethiopia, 2020. An institution-based cross-sectional study design was carried out among 290 study participants in Hawzen Primary Hospital in January-March/2020. A systematic random sampling method was applied to select the study participants, and pretested and structured questionnaires were used to collect data. The collected data were coded, entered, cleaned, and analyzed using SPSS version 20.0 software. Binary logistic regression analyses with a confidence interval of 95% were used to select determinant factors. Statistically significant factors were identified using the adjusted odds ratio (AOR). Statistical significance was determined at p value <0.05. Binary and multivariable logistic regression analyses were applied to see the association of the variables at a p < 0.05. In this study, the overall proportion of neonatal sepsis was (60.2%) 95% CI (56, 68)]. Birth asphyxia [AOR = 2.04; 95%CI (1.07, 3.93)], maternal age of 15-19 [AOR = 2.00; 95% CI (1.81, 11.93)], duration of labor greater or equal to 24 hours [AOR = 3.00; 95% CI (2.67, 14.21)], history of oxygen administration [AOR = 2.37; 95% CI (1.18, 4.75)], neonatal age of greater or equal to seven days [AOR = 4.0595% CI (1.07, 3.93), and home delivery [AOR = 5.00; 95% CI (2.34, 18.92)] were the predictor variables for neonatal sepsis. In this study, neonatal sepsis was high. Birth asphyxia, intranasal oxygen administration, age of the mother, home delivery, and duration of labor were associated with neonatal sepsis.

Use of insect repellent as personal protection among women of childbearing age in an arbovirus endemic area in Northeastern Brazil.

To analyze the factors associated with the individual use of insect repellent by women of childbearing age living in area endemic for arboviruses in Fortaleza, Brazil. This is a cohort study carried out between 2018 and 2019 with women aged between 15 and 39 years in Fortaleza, state of Ceará, Brazil. A total of 1,173 women users of one of the four selected primary health care units participated in the study. The outcome was divided into: continued use, discontinued use, and nonuse of insect repellent. Crude and adjusted multinominal logistic regression analysis was carried out guided by a hierarchical model, with presentation of the respective odds ratio (OR) and 95% confidence intervals (95%CI). The independent variables include: socioeconomic and demographic data, environmental and sanitary characteristics, knowledge of the insect repellent, and behavioral and pregnancy-related aspects. Only 28% of the participants reported using insect repellent during the two waves of the cohort. Women with higher education (OR=2.55; 95%CI 1.44-4.51); who are employed (OR=1.51; 95%CI 1.12-2.03); who received guidance from healthcare professionals (OR=1.74; 95%CI 1.28-2.36) and the media (OR=1.43; 95%CI 1.01-2.02); who intensified precautions against mosquitoes during the epidemic (OR=3.64; 95%CI 2.29-5.78); and who were pregnant between 2016 and 2019 (OR=2.80; 95%CI 1.83-4.30) had increased odds for continued use of insect repellent. The use of insect repellent among women of childbearing age was associated with a higher level of education, employment, guidance on insect repellent provided by healthcare professionals and the media, behavioral changes to protect against mosquitoes during the Zika virus epidemic, and pregnancy when occurring as of the beginning of the epidemic period.

Procena rizika u korelaciji sa gojaznošću i laboratorijskim monitoringom najčešćih tipova karcinoma dojke kod žena u Kantonu Sarajevo

Abstract: Introduction: Breast cancer (BC) is a malignant disease that predominantly affects women, with known genetic components such as mutations in tumor suppressor genes BRCA1 and BRCA2. Other risk factors include unhealthy lifestyles, lack of physical activity, and consumption of alcohol and cigarettes. Aging also plays a role in BC development, with hormonal influences such as estrogen and progesterone promoting cancer growth. Material and Methods: Research was conducted using data collection tools for risk factors and tumor markers from primary healthcare unit records. The sample comprised 200 women, divided into two groups based on BC diagnosis, with complete medical documentation. Male BC cases were excluded. Results: Statistical significance was found between genetic components, family history, aging, obesity, alcohol and cigarette consumption, longer hormone exposure, and female BC development using the Chi-Square test, confirmed by Fisher's Exact test. Tumor markers CA 15-3, CEA, CA 19-9, and CA 125 were useful for BC screening and metastasis detection, as determined by the One Sample T-test. In Sarajevo Canton, invasive ductal BC was the most common type among women, while lobular carcinoma in situ was the least common. Conclusion: Correlations between risk factors, including aging, unhealthy lifestyles, and hormone exposure, and increased BC risk were confirmed. Tumor markers CA 15-3, CEA, CA 19-9, and CA 125 were effective in diagnosis, screening, and metastasis detection in females, with sensitivity for regression detection at 81.8% and specificity at 100%.

Knowledge and Attitudes toward Colorectal Cancer among Healthcare Workers: A Pilot Cross-Sectional Survey in Thailand.

Colorectal cancer is an important public health problem in Thailand. The health workforce is one of the key strategies to reduce the burden of cancer. They are not only involved in patient care, but they can improve public knowledge of cancer within their community. This study aimed to explore the knowledge and attitudes toward colorectal cancer among Thai healthcare workers. A cross-sectional pilot study was conducted from October 2021 to March 2022. Convenience sampling was used to recruit study participants who worked in selected primary healthcare units or hospitals located in different regions across the country. The data on demographics and health behavior, knowledge of using the Fecal Immunochemical Test (FIT), and knowledge and attitudes toward colorectal cancer were collected using self-administered questionnaires. Descriptive statistics were used for data analysis. A total of 300 healthcare workers were recruited in the study. The majority of participants presented a healthy lifestyle: 74% were in the healthy weight range, 68% had never consumed alcohol, and 99.3% were never smokers. More than 70% of participants provided correct answers to questions about the use of a FIT kit. The mean score for knowledge of colorectal cancer was 12.16 + 2.16 (out of 14) and 240 (80%) participants were considered to have adequate knowledge. Also, colorectal cancer knowledge was associated with age of participants (p<0.05). Most of the participants (76.2-92.3%) had positive attitudes toward colorectal cancer screening, however about half of them thought that a colonoscopy could be painful, uncomfortable, and embarrassing. Overall, the majority of participants had adequate knowledge of colorectal cancer and positive attitudes toward its screening. The present study provided overview information on practical guidance for undertaking a nationwide survey in the future.

Community diagnostic services @ proximity care units: The experience of a Portuguese hospital

Background Summary: This co-design approach project was implemented focusing on the elder and vulnerable population of Cantanhede region. On a weekly basis, a team from Hospital Arcebispo João Crisóstomo (HAJC) provides Diagnostic Services (DS) to patients at primary health care units and third sector organizations (TSO), located on the outskirts of the region.&#x0D; We pursued a strategy of integration between levels of care and articulation with the municipality and TSO. This person-centred project adapts the public response in an area with an ageing population, fragile socio-economic background, and scarce public transport. &#x0D; Goals: &#x0D; - Rapid diagnose - capacitate GP´s to refer patients for the appropriate diagnostic test, diverting patients from hospital (reducing waiting times or allowing sooner referral of patients.&#x0D; - Proximity - Moving diagnostic services into the community makes access for patients easier, reducing travel, improved parking options and physical access.&#x0D; Methodology: A team of the hospital´s professionals (radiologist, radiographers, lab, and EEG technicians) to perform DS (echographs, blood tests, electrocardiograms, etc), in a variety of community settings, and referral of patients for an ambulatory response.&#x0D; Results: This collaboration runs in most of the primary care units and 11 nursing homes, allowing to improve access to health care to particularly vulnerable population (elder and people with mobility limitations).&#x0D; A Day Hospital (DH) was created because of the need of an outpatient articulated treatment to chronic disease complications (e.g., patients over 65 y/o (60%) shown a higher percentage of co-morbidities, including hypertension (80%), dyslipidaemia (71%) or obesity (38%)).&#x0D; We facilitated an agile communication between professionals of the various setting of care.&#x0D; Efficiency improvement by increasing the number of exams performed - a total of 300 patients/year (efficiency gains to 53% increase in external exams, representing 35% of production in this area vs 26%, in 2020).&#x0D; &#x0D; &#x0D; Conclusion: To reduce health inequalities, it is crucial to provide tailor-made solutions.&#x0D; The satisfaction level of the patients’ experience was high: classification of “Good” or “Very Good” by 97,7% of respondents.&#x0D; We believe that we deliver a better diagnostic service and more personalised experience by providing multiple point of access to the citizens.&#x0D; We increased productivity and were able to track several pathologies, separating acute diagnostic activity in hospital settings from outpatient requests by primary care clinicians and streamlining access in both settings by removing the need for diagnostic departments to triage requests and re-arrange appointments.&#x0D; Future: HAJC intends to replicate this good practice as a community centred integrated model. There for, the hospital is planning to expand the diagnostic capacity to other settings in the region.&#x0D; The hospital is working on engaging other relevant stakeholders as patient and caregivers’ associations.&#x0D; We intend to prove the impact on the streamlining of the local diagnostic pathways because of the greater access to diagnostic testing for GPs to speed up diagnoses and reduce the need for some outpatient appointments, or even extend the diagnostic interval for some patients, if they need a specialist referral.

The Benefit of Air Conduction Pure-Tone Audiometry as a Screening Method for Hearing Loss over the VAS Score.

Hearing loss is commonly encountered by general practitioners. We aimed to evaluate the screening benefit of air conduction pure-tone audiometry over visual analogue scale (VAS) scores for hearing loss. Moreover, we intended to perform the first cross-sectional study in Greece to assess hearing loss with pure-tone audiometry in young adults of the general population. We evaluated Greeks between 15 and 40 years old in a high school in Karditsa, Greece, and a primary health care unit in a nearby community. Subjects filled out a VAS score sheet and underwent pure-tone audiometry in a room without sound isolation, with air conduction only. We named the latter procedure modified pure-tone audiometry (mPTA). Subjects with pathologic results were examined via otoscopy and standardized pure-tone audiometry (sPTA). Of the 286 subjects evaluated, the VAS score revealed 5 subjects (1.7%) with hearing loss. mPTA (100 s duration) doubled this percentage (in total 3.8%; Pearson Chi-Square test; p < 0.001). Based on sPTA, the sensitivity and positive predictive value of the VAS score were 40% and 13%, respectively. For mPTA, they were 100% and 37%, respectively. mPTA filtered out pathologic cases in a proper, rapid, cheap and simple way and may be considered a proper screening method for hearing loss in primary health care.

Community-based COVID vaccination center ready for the switch towards a broad community-based prevention center: In Jan'21 the Flemish Region started the COVID vaccination in a public health mode, at 60 primary health care units.

Framework: Each local “unit of care” has an average population of 100.000 people and is managed by local caregivers. Within two months (Jan-Feb'21), 80 vaccination centers were set up and launched. A central strategic center and logistic/financial support were created. A local team of municipal representatives and caregivers was composed. It resulted in a management team which launched the operational vaccination sessions.&#x0D; All citizens were invited by email, letter or SMS. An individual appointment was booked in the vaccination center matching the zip code of the citizen’s residence. Specific software enabled vaccination agenda management and its registration in Flanders’ central vaccination database.&#x0D; The initial goal was to cover at least 70% of the target population, but in the primary care unit “Voorkempen”, a coverage of 95,45% was reached.&#x0D; Vaccination center “Voorkempen” ‘s results: The health unit “Voorkempen” is a defined area, situated in the province of Antwerp and is composed of 6 municipalities which give home to 111.102 inhabitants.&#x0D; The campaign consisted of four periods :&#x0D; - Feb-Sep'21 : basic vaccination (97.763 citizens)&#x0D; - Oct'21-Feb'22 : 1st booster campaign for all 12+ ( 93.316 citizens).&#x0D; - May-June'22: extra booster exclusively for 80+ (7.153 citizens)&#x0D; - Sept-Oct'22 : 2nd booster for all 18+, (90.473 citizens)&#x0D; Lessons learned: &#x0D; 1.Flexible management by a limited number of managers (4) with daily meetings and quick decision making is essential and covers :&#x0D; A.The infrastructure in time and space.&#x0D; B.The IT environment including call center, vaccination agenda and HR management.&#x0D; C.Vaccination sessions planning : stock control and ordering, session planning and unfolding of a mobile team.&#x0D; D.HR management : staff recruitment &amp; selection, training, coaching, contracting, team composition, insurance, payroll.&#x0D; E.Operational vaccination sessions: reception and flow inside the vaccination center, problem solving, administrative check-in, vaccination, registration, surveillance.&#x0D; F.Vaccination registration : group registration in Vaccinnet as a base for COVID certification&#x0D; 2.The support of the municipalities was crucial : accountancy, logistic support, mass communication.&#x0D; 3.The primary healthcare providers’ trust and cooperation was established by constant communication, information and feedback.&#x0D; 4.The mobilization of local volunteers was overwhelming - it became a flexible group coping with unforeseen circumstances and unexpected events.&#x0D; 5.Population management: the data collection concerns local infection rates, hospitalizations and vaccination rates. Its analysis allowed quick reactions.&#x0D; Future: The broad experiences of the central management, people management and population management in this vaccination center can be used to improve preventive actions and early detection programs in different domains:&#x0D; -Infectious diseases including influenza: testing and vaccinations in a similar center as the COVID vaccination center, - new vaccines will be on the market soon.&#x0D; -Chronic diseases: early risk detection and risk management: lifestyle, healthy diet, exercising,…&#x0D; -Improvement of oncological screening programs (breast cancer, cervix cancer and colorectal cancer).&#x0D; -Geriatric stratification and early support&#x0D; -Mental health&#x0D; For the permanent switch to a local “prevention center”, political decisions, a legal framework and structural support is absolutely necessary.&#x0D;

Therapeutic itinerary of individuals who use alcohol and other drugs: an integrative review

This study aimed to understand the trajectory of individuals who use alcohol and other drugs towards healthcare services. It is an integrative literature review that sought to answer the question: "What are the trajectories followed by drug users until they reach a healthcare service?". The descriptors "trajectory," "drug users," "qualitative research," and "health services" were used in the databases Pubmed, BVS, Web of Science, Scopus, and Science Direct, resulting in a total of seven articles. Drug use can be motivated by various factors, including peer influence, traumatic experiences, and the pursuit of well-being. Family can represent both a risk and a protective factor. Seeking help is often motivated by family concern and typically begins at the primary healthcare unit. Therefore, nurses play an important role, operating in different drug use contexts and encouraging the treatment and rehabilitation of users, as well as the support of their families.