Implementing integrated care for older adults in primary health care: A systematic scoping review.

Typhoid fever remains a significant public health challenge in many low- and middle-income countries, including Indonesia, where inadequate sanitation, limited access to clean water, and suboptimal hygiene practices continue to facilitate disease transmission. Although typhoid fever is more commonly reported in school-aged children and adolescents, its occurrence in toddlers poses unique diagnostic and management challenges due to atypical clinical presentations and increased vulnerability to dehydration and complications. Early recognition and comprehensive management at the primary health care level are therefore critical. This study describes the holistic primary care–based management of typhoid fever in a 14-month-old boy presenting to a community health center in Bandar Lampung, Indonesia. The patient was brought with a three-day history of persistent fever and a one-week history of watery diarrhea, accompanied by decreased appetite, irritability, and generalized weakness. A holistic diagnostic approach integrating clinical symptoms, physical examination, environmental exposure, and family hygiene practices was applied. Key clinical features included a fever pattern worsening in the late afternoon to evening, prolonged diarrhea, and a coated tongue with erythematous margins, strongly suggestive of typhoid fever in the absence of other focal infections. Management combined pharmacological and non-pharmacological interventions tailored to the toddler age group and primary care setting. Pharmacological therapy consisted of first-line antibiotic treatment with cotrimoxazole, antipyretic therapy, zinc supplementation, and oral rehydration therapy to prevent dehydration. Non-pharmacological interventions emphasized continued breastfeeding, adequate fluid intake, safe food preparation, access to clean drinking water, and strict hand hygiene practices within the household. Family members were actively involved in the care process to ensure adherence to treatment and implementation of preventive measures. Clinical improvement was observed following the integrated intervention, with resolution of fever and gastrointestinal symptoms and restoration of appetite and activity levels. This approach highlights the importance of combining clinical management with family-centered hygiene education and environmental risk assessment. The findings underscore the critical role of primary health care services in early detection, effective treatment, and prevention of typhoid fever among vulnerable pediatric populations.

A qualitative inquiry about end-of-life care for people with advanced dementia: "Planning ahead not in reality".

Oral disorders are among the most prevalent diseases globally, yet their burden in Southeast Asia remains poorly characterized. Understanding regional patterns is critical for health planning and prevention. We analysed data from the Global Burden of Disease 2021 study to assess the prevalence, incidence, and disability-adjusted life years of oral disorders across the 10 Association of Southeast Asian Nations (ASEAN) member states from 1990 to 2021. Indicators were age-standardized and analysed by sex, age, country, and socio-demographic index. Oral disorders accounted for nearly half of all-cause prevalence and around 1% of total disease burden in 2021. From 1990 to 2021, prevalent cases rose by over 50% and incident cases by more than 30%, while age-standardized rates showed slight declines. Population growth and ageing were the primary drivers of these increases. Caries of permanent teeth contributed the largest share, followed by periodontal disease and edentulism. Higher socio-demographic index correlated with lower overall burden but a higher proportion of periodontal disease. These findings indicate that oral health remains a major source of morbidity across ASEAN despite modest epidemiologic improvement. Demographic pressures continue to offset gains from prevention and care. Expanding prevention and primary oral healthcare - including sugar reduction, fluoridation, and sealant or varnish programs - could substantially reduce disability and unmet need. Routine regional surveillance using harmonized indicators is essential to guide equitable policy and investment within the post-2025 ASEAN health agenda.

Introduction: Lipids form an important constituent of the human cell membrane with wide functional importance. The alterations in lipid levels can result in an imbalance of the homeostatic reserve and, therefore, can result in a diseased state. Aim: To analyse and compare lipid profiles between diabetic and non diabetic individuals amongst the study group and find an association between diabetic status and lipid parameters. Materials and Methods: A cross-sectional study was conducted in the Outpatient Department (OPD) of a primary care health setting, Sakthi Multi-speciality clinic, Poonamallee, Chennai, South India, between July 2024 to September 2024. The present study included 55 patients who attended a primary health care setting. A convenient consecutive sampling technique was followed in recruiting both male and female patients above 18 years of age with or without co-morbid illness. The elements of lipid profile analysis were presented as median and interquartile range. The Mann-Whitney U test was employed for comparing continuous variables between diabetic and non diabetic groups and Fisher’s exact test for associations between categorical variables. Kendall’s Tau-B correlation was used to assess associations among continuous variables within the diabetic subgroup. A p-value <0.05 was considered statistically significant. Results: Of the total 55 participants who consented to participate in the study, 41 were males and 14 were females. Among them, 11 participants were known cases of Diabetes Mellitus (DM). A total of 44 participants with capillary blood glucose levels less than 126 mg/dL and no prior history of co-morbid illness were considered to be apparently normal. The median and Interquartile range of Total Cholesterol (TC), Triglycerides (TG), Very Low-Density Lipoprotein (VLDL), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) and ratio of cholesterol to HDL were found to be 160 (IQR=40), 105 (IQR=37.5), 34 (IQR=8), 108 (IQR=54.5), 21 (IQR=7.5), 4.7 (IQR=0.0), respectively. The analysis revealed a significant difference in the LDL (p-value <0.01) and ratio of cholesterol to HDL (p-value-0.054) in the diabetic group compared to the non diabetic group. The association between diabetic status and independent variables revealed a significant association between diabetic status and LDL. TC/HDL was moderately correlated with Fasting Blood Sugar (FBS) (τ=0.59, p-value=0.03) and Postprandial Blood Sugar (PPBS) (τ=0.57, p-value=0.03). A positive correlation was observed between FBS and TC (τ=0.41, p-value=0.08), TGs (τ=0.44, p-value=0.06), HDL cholesterol (τ=0.41, p-value=0.08), LDL cholesterol (τ=0.55, p-value=0.02) and VLDL (τ=0.44, p-value=0.06) although not statistically significant. Conclusion: Strong association between altered lipid parameters and Diabetic status, with the presence of moderate effect sizes, suggests potentially meaningful relationships that warrant a greater insight into the discernment of the disease. The current pilot study may direct future research to comprehensively understand the metabolic derangements playing a causative role in the pathogenesis of DM and Metabolic Syndrome.

Adequacy of pharmacological prescriptions in women with postmenopausal osteoporosis attended in a Primary Care center

Contraceptive methods: Knowledge and factors influencing their choice among women of reproductive age-A cross-sectional study in Portugal.

Introduction: The increased prevalence of Chronic Obstructive Pulmonary Disease (COPD) worldwide, and particularly in India, is of major concern as it causes a high economic burden. It also leads to disability, impairs the quality of life, loss of productivity, increased hospital admissions, and premature death. Therefore, understanding the true burden of COPD to plan healthcare policies and provide disease-specific strategies for prevention and management, an accurate estimate of the prevalence of COPD in India is critical for healthcare planning. Aim: To estimate the pooled prevalence of COPD in India (2012- 2025) and to examine patterns by region and population type. Materials and Methods: This systematic review and metaanalysis followed the PRISMA 2020 guidelines. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Google Scholar, and local journals for studies published between 2012 and 2025, using relevant MeSH terms and Boolean operators. Eligible studies included populationbased, spirometry-confirmed, or questionnaire-based prevalence reports. Hospital-based studies, disease-specific cohorts, reviews, conference abstracts, and those without complete prevalence data were excluded. Data extraction and Joanna Briggs Institute (JBI) risk-of-bias assessment were performed independently by two reviewers. A meta-analysis was performed to estimate the pooled prevalence of COPD across Indian studies using a random-effects model with 95% confidence intervals. Subgroup analyses were conducted by region, age group, gender, population setting, exposure type (biomass fuel use, smoking, occupational dust), and diagnostic criteria (post-bronchodilator spirometry versus symptom-based diagnosis). Statistical heterogeneity was assessed using the I² statistic, and potential publication bias was evaluated through funnel plot inspection and Egger’s regression test. Results: Out of 1,462 records identified, 26 studies met the inclusion criteria and were included in both the qualitative synthesis and meta-analysis. The pooled prevalence of COPD was estimated to be 11.3% (95% CI 9.4-13.4%), with the highest estimates in northern and eastern regions of India. Subgroup analyses revealed a higher prevalence among the elderly, smokers, and households exposed to biomass fuel. Conclusion: Early diagnosis of COPD at the primary healthcare level is essential to initiate timely management and reduce disease burden. Reliable estimate of the true prevalence of COPD in India is required, for which a nationwide populationbased survey for screening of COPD with adequate training and resources.

We describe a novel curriculum designed to build capacity for public health and primary care collaboration. Since the Northwest Public Health & Primary Care Leadership Institute began in 2020, 119 participants have completed the seven-month hybrid curriculum. Application of knowledge and skills learned to workplace or community projects was reported by 84% of participants. Case-based learning and the critical friends group were valued learning methodologies. A cross-sectoral leadership curriculum can promote public health and primary care integration. (Am J Public Health. 2026;116(4):443-446. https://doi.org/10.2105/AJPH.2025.308377).

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Indonesia’s National Health Insurance system (BPJS Kesehatan) continues to face persistent administrative challenges in primary healthcare, including limited accessibility, bureaucratic complexity, long waiting times, and patient dissatisfaction. To address these issues, digital transformation initiatives have introduced electronic modules (e-modules) aimed at improving administrative efficiency, service quality, and data accuracy. This qualitative study collected data through in-depth interviews with twenty participants: twelve BPJS beneficiaries and eight primary healthcare officers from four community health centers in Sibolga City, North Sumatra. Participants were purposively selected based on their experience with BPJS e-module services. Interviews were transcribed verbatim and analyzed thematically using NVivo 12 through open coding, categorization, and theme development. Four themes emerged: 1) Administrative accessibility improved as e-modules simplified access to procedural information; 2) Service efficiency increased through shorter waiting times and faster processing; 3) User satisfaction improved, especially among digitally literate participants who perceived greater transparency and predictability, and 4) Administrative accuracy strengthened due to standardized digital documentation, reducing manual errors. Nonetheless, barriers persisted, including limited digital literacy, uneven internet connectivity, and insufficient technical support at facility level. E-modules represent an effective administrative innovation that reduces procedural complexity and enhances service consistency in primary healthcare. However, uneven benefits resulting from infrastructural constraints, organizational inertia, and varying user capacity underscore the need to align technological implementation with institutional readiness and user support to prevent widening service disparities</em><em></em></p><p><em> </em></p></td></tr></tbody></table></div><strong><em>Keywords: BPJS Health, Primary Healthcare, E-Module, Digital Health Administration, Service Quality</em></strong>

Objective Polymyalgia rheumatica (PMR) is diagnosed in both primary and secondary healthcare. However, general practitioners (GPs) do not report diagnostic codes to national health registers, limiting the representation of primary healthcare patients in register-based studies. We estimated the positive predictive value (PPV) of a register-based algorithm for identifying patients with PMR across healthcare sectors in Denmark. Method Potential patients were aged ≥50 years between 2003 and 2024. In primary healthcare, potential patients were identified by a first-time prescription of prednisolone/prednisone (PDN) issued by a GP and ≥375 mg PDN redeemed within 1 month. If other diagnoses, treated with PDN, were registered within 3 months of identification, patients were excluded. In secondary healthcare, potential patients were identified by a PMR diagnosis code in the Danish National Patient Registry (DNPR). Diagnoses were confirmed through chart review: in primary healthcare by GPs, and in secondary healthcare at two secondary hospitals and one tertiary hospital in Central Denmark Region (2013–2024). We estimated PPV with 95% confidence intervals (CIs) using the exact binomial method. Results PMR diagnoses were confirmed in 62% (95% CI 54–69) of patients in primary care, and 89% (95% CI 84–93) in secondary care. Among primary care patients redeeming 1000–2000 mg PDN within 2 months following diagnosis, PPV was 84% (95% CI 76–90). Among secondary care patients redeeming PDN within 2 months of diagnosis, PPV was 91% (95% CI 86–94). Conclusion The algorithm provides a robust framework for register-based epidemiological studies of patients with PMR.

Over the past 45 years, the publication of original research in the South African Family Practice journal has steadily increased from humble beginnings in the 1980s to approximately 40–50 articles per year. This reflects the growth of the discipline and new speciality of family medicine as well as the shift in national policy towards primary health care as the foundation of the health system. Despite this growth, the profile of the research remains largely descriptive with surveys, audits and exploratory qualitative studies. The implication of this is that the discipline may not be addressing critical research questions on effectiveness, efficiency or identifying risk factors for common or important conditions. There is diversity of research questions and topics, although some areas remain relatively neglected, such as research on children, pregnant mothers, palliative care, rehabilitation, continuity and coordination. Contribution: As we look forward to the future, the discipline should be ready to analyse new electronic sources of ‘big data’, develop capacity for clinical trials and cost-effectiveness studies, launch more practice-based research networks, strengthen the whole research capacity-building pipeline and set priorities at a national level.

Evidence-based physician-pharmacist collaborative clinics have demonstrated significant short-term benefits for patients with type 2 diabetes (T2D), but their long-term effectiveness remains unclear, especially in primary health care settings. This study aimed to explore the long-term effectiveness and cost-effectiveness of a novel, digital-driven, multifaceted physician-pharmacist collaborative model for managing patients with T2D in underresourced settings. We conducted a 12-month cluster randomized controlled trial from May 2021 to December 2022 across 6 primary health care settings in China. Guided by the theory of planned behavior, the intervention involved routine therapy from physicians along with pharmaceutical interventions from pharmacists. These were delivered through a combination of face-to-face visits and mobile health care. The intervention group received 4 face-to-face visits and biweekly remote education sessions over the 12 months. We conducted intention-to-treat analyses to estimate differences in clinical and behavior indicators between the intervention and control groups. Primary outcomes included glycosylated hemoglobin and 10-year atherosclerotic cardiovascular risk. Data were analyzed using adjusted generalized estimation equations. This study included 574 patients (291 in the intervention group and 283 in the control group). Over 12 months, patients in the intervention group had significant reductions in hemoglobin A1c (-2.57 vs -1.96, respectively; P<.001; 95% CI -1.027 to -0.238) and 10-year atherosclerotic cardiovascular risk (-1.35 vs 0.01, respectively; P<.001; 95% CI -1.690 to -0.630) compared with the control group. Substantial improvements were also observed in several secondary outcomes, including fasting blood glucose, 2-hour postprandial blood glucose, waist circumference, waist-to-hip ratio, blood pressure, triglyceride, and total cholesterol. Total diabetes-related costs decreased, and patient satisfaction improved significantly in the intervention group. There were no significant differences in BMI, high-density lipoprotein, or low-density lipoprotein. These findings suggest that the physician-pharmacist collaborative model could improve the long-term quality and efficiency of T2D management and reduce medical costs in underresourced areas globally. Patients with T2D, especially those with central obesity or high cardiovascular risk, may benefit more from collaborative clinics. Chinese Clinical Trial Registry ChiCTR2000031839; https://www.chictr.org.cn/showproj.html?proj=51910.

Breast density influences both breast cancer risk and the sensitivity of mammographic screening. Several countries routinely notify women of their breast density in community-based screening programmes and provide guidance directly or through general practitioners. In contrast, BreastScreen Aotearoa (BSA) does not currently notify breast density to women, resulting in limited awareness and raising concerns relating to equitable care, patient autonomy in decision making, trust in health professionals and uncertainty regarding clinical pathways. Although the recent Health New Zealand - Te Whatu Ora technical review provides a comprehensive evidence summary and identifies areas for further investigation, policy progression has not occurred as anticipated. An implementation timeline, governance responsibility, communication planning and culturally responsive approach have not yet been specified. Although emerging evidence suggests that artificial intelligence may offer more consistent and reproducible breast density assessment than radiologists, planning for its integration has not been outlined. Research from the comparable settings suggests that misunderstanding, rather than notification itself, drives anxiety. This highlights the importance of communication design, health literacy considerations and primary care readiness. Ethical considerations around transparency and informed decision making remain relevant for screening equity. Addressing the implementation barriers is now crucial, and a coordinated and equity-driven approach is required to inform future policy on breast density notification.

The realisation of the right to health in Nigeria, aimed at achieving universal health coverage, is increasingly obstructed by various factors, such as considerable financial risks, inadequate healthcare service delivery and disparities in healthcare access. The Nigerian government's efforts to tackle these issues have led to the implementation of the National Health Act in 2014, aimed at improving access to healthcare services for all citizens and reinforcing protections against financial strain through the Basic Health Care Provision Funds, which serve as the primary healthcare insurance framework. Nonetheless, the execution remains considerably far from achieving the goal of ensuring the right to health. This study employs a scoping review methodology to investigate a broader spectrum of perspectives on the systemic challenges that impede the achievement of the right to health in Nigeria. Insufficient healthcare funding, a lack of political will and commitment and capacity constraints were found to be the primary challenges hindering the advancement of the right to health in Nigeria. Also, cultural and religious nuances were notably identified as contributing factors to unmet health rights in the North, which are absent in the South. Likewise, it has been observed that lived experiences often clash with established rights frameworks, intensifying the challenges related to the right to health within primary health centres. This study critically mapped out key issues and gaps in literature that would form the bedrock of future studies as well as serve as a guide to policymaking.

This study evaluates the impact of Law No. 12,858/2013, known as the "royalties law", on the allocation of resources for healthcare in Brazilian municipalities that receive oil revenues. This law, which has not been empirically evaluated before, changes the way oil revenues are allocated and mandates that a portion be directed to healthcare and education to promote sustainable development and intergenerational equity. Using the difference-in-differences method combined with propensity score matching, we investigate whether there was an increase in expenditures on primary healthcare and whether this resulted in improvements in both primary care and more complex healthcare services. To achieve this goal, we use a large set of disaggregated health indicators, such as expenditures on primary care, child vaccination, infant mortality, hospital admissions, and inpatient mortality. The results indicate that the royalties law is associated with a positive impact on healthcare services in the benefiting municipalities. The increase in primary care investments in the treated municipalities is associated with the improvement of this sector, strengthening preventive actions and reducing the need for more complex services. More effective monitoring of pregnant women and expanded child vaccination contributed to lower infant mortality rates. In medium and high complexity healthcare services, there was a reduction in hospital admissions and inpatient mortality. This suggests that strengthening primary care can optimize the functioning of the entire healthcare system. Furthermore, it is important for policymakers in Brazil to reassess the minimum 15% of own revenue that municipalities must allocate to healthcare. The robustness of our conclusions is confirmed by a triple difference model, which indicates that the observed effects are not driven by pre-existing trends or other confounding factors. Additionally, our findings are not sensitive to tests for parallel trends, falsification in treatment assignment, or variables unrelated to primary care. This study contributes to understanding how natural resource revenues can be used to promote sustainable development and improve public health. It also offers valuable insights for policymakers in resource-rich countries, helping to design effective strategies to manage revenues and invest in human capital sustainably.

ABSTRACT Aims To characterise practice managers’ perspectives on the interplay between worker well-being and organisational health in veterinary and human healthcare contexts. Methods Using a convergent mixed-methods design, we analysed data from 38 Australian practice managers who completed an anonymous online survey. Participants accessed the survey via links distributed using social media and email. The survey included the General Practice-Organisational Health (GP-OH) measure, along with items on professional duties, perceptions of worker well-being, current and desired supports, and perceived interactions between the two domains of interest. Quantitative analyses were exploratory and descriptive; qualitative responses were characterised using a conventional approach to content analysis. Results Practice managers described responsibilities spanning five domains of managing a health clinic: resources, operations, leadership, strategy, and governance. They typically rated staff well-being as “neutral/normal” or “high/good,” based on observations of workers’ health and welfare, team and culture, formal feedback, and employee performance. Ratings of organisational health were similarly favourable, with mean scores above the mid-point of the GP-OH scale. Ratings of staff well-being were positively correlated with GP-OH scores (ρ = 0.59; p < 0.01). Practice managers described a mutually reinforcing relationship between worker well-being and organisational health, centred on team morale, workforce stability, clinical performance, operational efficiency, and financial outcomes. Current organisational strategies to support well-being were primarily reactive and policy-driven, but participants desired more holistic, proactive approaches. Themes were largely consistent across the two health sectors, with some small differences. Conclusions Findings were generally consistent with existing models of organisational health and employee well-being, while suggesting important contextual adaptations, particularly to settings outside the USA. Parallels in accounts from veterinary and human health practice managers suggest that organisational and managerial demands are often shared across these settings, with minor variations potentially arising from structural differences between the two sectors. Clinical relevance Practice managers are key drivers of organisational and employee welfare, and future efforts to strengthen veterinary workplaces will benefit from engaging them as partners in design and implementation. Interventions to improve professional well-being in veterinary and human healthcare may be most effective when they emphasise social connection, systemic reform, and regular staff check-ins.

Over the past several years, states began formally enacting telehealth policies to avail audio-only services for those unable to receive care in-person or over video. Such policies may be especially important in community-based health centers (CHCs) where, when telehealth is provided, it is primarily via audio-only. This retrospective study examined whether codified policies for Medicaid reimbursement and payment parity of audio-only telehealth were associated with greater use of telehealth. Electronic health records for Medicaid-insured adults 18-64 years with visits to primary care (n = 700,051) and to behavioral health care (n = 95,136) in 433 primary care and 279 behavioral health care CHCs from April 1, 2021, to March 31, 2023, were analyzed. We collected policies using standardized legal mapping methods to identify audio-only telehealth policies having: (1) no reimbursement for telehealth, (2) reimbursement for telehealth, but no payment parity, or (3) reimbursement for telehealth, at parity. One-third of primary care visits were telehealth, most of which were audio-only. Two-thirds of behavioral health care visits were telehealth, half of which were audio-only. Primary care visits in states with audio-only telehealth reimbursement policies not at parity were 4.8 percentage points more likely, and behavioral health care visits in states with reimbursement at parity were 3.2 percentage points more likely to use telehealth. While audio-only telehealth reimbursement only modestly impacted overall telehealth utilization, Medicaid policies remain one of the few mutable factors important for primary care and behavioral health care access among safety-net populations.

The significant morbidity and mortalities from, and the recurrent outbreaks of, the vaccine-preventable infectious diseases (VPDs) of childhood could be due not only to non-receipt of recommended vaccinations but also to untimely receipt, which impairs the validity of immunisation coverage and protection against VPDs. This study explored the determinants of untimely receipt and non-receipt of routine childhood immunisation and made recommendations for policy and practice. This qualitative study was based on the Adapted Omale INDEPT FORCIS Framework - Determinants of Routine Childhood Vaccination Receipt Conceptual Framework. From 22 August 2022 to 9 September 2022, 15 semi-structured, face-to-face focus group discussions were conducted in English, pidgin English and the local language with 127 purposively selected consenting parents of infants aged 0-2 months (with other key community members) and primary healthcare workers involved in the provision of routine childhood immunisation in Ebonyi state, Nigeria. Data analysis involved deductive (and some inductive) thematic analysis. There were many underlying determinants of untimely receipt and non-receipt of routine childhood immunisation, which included individual-related factors (mothers' unfavourable experiences and perceptions and lack of knowledge about childhood diseases, vaccines/vaccinations and the vaccination system, relocation/travel from place of residence, children and/or mothers being ill); childhood disease-related, vaccination-related and the vaccination system-related factors (diseases not always severe/fatal, vaccinations causing side-effects, vaccination system constraints in availability, accessibility, affordability and acceptability); family and other individual-related factors; and broader context-related sociopolitical, cultural, economic, infrastructural, historic and health system factors. The evidence demonstrates many specific and fundamental complex and interrelated determinants of untimely receipt and non-receipt of routine childhood immunisation and emphasises the need for multifaceted and innovative actions in dealing with the determinants in the drive to address the high morbidity and mortalities and recurring outbreaks of VPDs in Ebonyi state, Nigeria, and similar settings.

Factors associated with digital tools use among primary healthcare professionals in Burkina Faso: a cross-sectional study of the minimal digital ecosystem.