Primary Health Care Centers Research Articles

Optimizing the role of pharmacists at the primary healthcare centres in Indonesia through an integrated information system

IntroductionThe role of pharmacists at primary healthcare centers (PHCs) in Indonesia still needs long-term improvement. Enhancing interprofessional collaboration through data-driven collaboration is essential to strengthening cooperation. This study aimed to identify the need for an integrated information system to enhance the role of pharmacists at PHCs in Indonesia.MethodsA desk review was applied as the initial step to analyze the role of pharmacists at the PHCs in Indonesia. Furthermore, a qualitative study was conducted using Walt and Gilson’s health policy analysis framework. Semi-structured interviews were conducted in four sections (context, content, process, and actors) with consideration of selected key respondents. All interviews were transcribed verbatim and then analyzed using Braun and Clarke’s thematic analyses, ensuring a comprehensive understanding of the situation.ResultsWe identified two significant challenges in optimizing the use of integrated systems at the PHCs to increase the role of pharmacists. Considering context-content-process-actors, implementing integrated pharmaceutical care standards relies significantly on human resources and infrastructures. Key challenges related to human resources are a limited number of human resources, a high workload, and insufficient use of working tools. We found several challenges regarding infrastructure, such as network connectivity issues, non-integrated systems or applications, and suboptimal benefits from the current systems.ConclusionVarious systems or applications in PHC involve reporting to the Ministry of Health, but detailed integration of these systems needs to be achieved immediately. According to informants, the criteria for desired applications are crucial to optimizing the integrated system, using it, and streamlining tasks for pharmacists at PHCs. Common expectations include an integrated system for monitoring drug usage and orders. Apart from usefulness, network connectivity must be assured for accessibility by all parties.

Differences between private and public primary health care centers and differences between men and women in antihypertensive care and cardiovascular prevention in all patients with hypertension treated in primary care in Stockholm County, Sweden

AimsTo study differences in cardiovascular prevention and hypertension management in primary care in men and women, with comparisons between public and privately operated primary health care (PHC).MethodsWe used register data from Region Stockholm on collected prescribed medication and registered diagnoses, to identify patients aged 30 years and above with hypertension. Age-adjusted logistic regression was used to calculate odds ratios (ORs) with 99% confidence intervals (99% CIs) using public PHC centers as referents.ResultsIn total, 119,267 patients with a registered hypertension diagnosis at their primary care center were included; 58,239 men and 61,028 women. In terms of co-morbidities and medications, there were some differences between privately and publicly run PHC: registered diagnosis of dementia, which was higher at private PHC, age-adjusted OR 1.80 (1.24–2.69). For lifestyle counseling, privately run PHC had a higher rate of registered counseling for tobacco 1.17 (1.06–1.29), physical activity 1.13 (1.06–1.17), unhealthy diet 1.08 (1.04–1.13), and counseling according to highest prioritized level of advice stated by national guidelines 1.14 (1.09–1.18). Differences in comorbidities between men and women were found, with higher frequencies of coronary heart disease, congestive heart failure, atrial fibrillation, stroke, diabetes, and gout among men. Regarding antihypertensive treatment, women received less treatment of calcium channel blockers and ACE inhibitors, but more of angiotensin receptor blockers.ConclusionsThese findings highlight the need for targeted preventive efforts in PHC, especially for male patients, to address disparities in cardiovascular health outcomes. Small differences in preventive measures between public and privately run PHC suggest generally consistent care across healthcare ownership models.

Quality of life among healthcare workers in the hospitals and primary healthcare centers in Gaza Strip: a cross-sectional study

BackgroundQuality of life (QoL) is an important measure of overall well-being linked to physical, mental, social, and environmental aspects of health. This study aimed to assess the QoL among healthcare workers (HCWs) in hospitals and primary healthcare centers (PHCs) in Gaza Strip, Palestine.MethodsA cross-sectional study was conducted among 1850 HCWs in Gaza Strip, Palestine. Data were collected by using self-administered questionnaires in the paper-based format containing a sociodemographic profile and the World Health Organization Quality of Life Brief questionnaire. Factors associated with QoL were examined using an independent t-test, Chi-square test, and multivariate logistic regression models.ResultsThe study included HCWs with a mean age of 38.62 years old, of whom 61.9% were male. The mean QoL score was 55.98 (standard deviation: 11.50), with 55.5% reporting a good QoL. Multivariate logistic regression analysis revealed that age, smoking status, workplace, and work shifts were associated with the overall QoL score (p < 0.05). Older age (≥ 35 years), working in a hospital, and working the morning shifts were identified as protective factors for QoL, while smoking and working the evening-night shifts were inversely associated with QoL.ConclusionsThis study found that HCWs in Gaza Strip exhibited moderate levels of QoL. Age, smoking status, workplace, and work shifts were associated with overall QoL. Strategies to improve HCWs’ QoL, such as lifestyle interventions, additional support through training or educational programs, and reducing work schedules, could be considered under high-pressure situations.

Deep Learning-Based Detection of Ocular Surface Squamous Neoplasia from Ocular Surface Images

Purpose: Ocular Surface squamous neoplasia (OSSN) is a broad entity encompassing a spectrum of squamous neoplasms of conjunctiva and cornea. This study aims to explore the utility of Artificial Intelligence (AI) models in detecting OSSN from slit lamp (SL) images. Methods: This is a retrospective observational study. Slit lamp (SL) images of OSSN disease, non-OSSN ocular surface lesions (OOSD) and normal ocular surfaces (N) were collected (2013-2023). Images with minimum resolution of 1024 x 1024 pixels, under diffuse illumination were included. Data was divided into training and testing sets (85:15). Deep learning (DL) algorithms were applied for ternary classification of the SL images (OSSN, OOSD and normal). Three AI models - MobileNetV2, Xception and DenseNet121 were used in the study. A five-fold cross-validation strategy was utilized for robust model evaluation. Results: 163 images in OSSN group, 202 in OOSD group and 269 normal ocular surface images were included (n=634). Data augmentation was performed to increase and balance the data. The average accuracies for OSSN detection for DenseNet121, MobileNetV2 and Xception were 83%, 88.8%, and 84.5% respectively. MobileNetV2 and Xception had a similar average sensitivity for OSSN detection (74%) while MobileNetV2 was the most specific DL algorithm (96.25%) for OSSN detection. Conclusions: AI models showed good performance in image-based OSSN detection. AI models may provide a promising tool for OSSN screening in primary health care centers and for teleconsultation from remote areas in the future.

P1167 Treatable traits (TTs) approach in the management of Inflammatory Bowel Disease: a new concept

Abstract Background Inflammatory bowel diseases (IBD) are highly prevalent and complex chronic conditions that affect the digestive tract and induce extra-intestinal manifestations and numerous comorbidities. Distinct IBD phenotypes and clinical manifestations differ individually1. The pathogenesis of the disease is complex and requires personalized therapies2. The World Health Organization (WHO) recommends a holistic approach that is defined as "perfect physical, mental and social well-being." “Treatable traits" (TT) is a personalized and multidimensional precision medicine approach created primarily to deal with the complexity and heterogeneity of chronic and complex conditions. Initially proposed for treating respiratory diseases, it has expanded to other areas3. The present abstract aims to shed light on, identify, and define the most prevalent TTs applied to IBD. Methods TTs were identified according to their clinical relevance and the possibility of being modifiable, enabling personalized and individualized treatment targeting. They were subdivided into three main domains following the concept of TT in IBD. Adopting the TT concept will be useful in primary health care and tertiary centers to aim for disease control, avoiding exacerbations, and maximizing results, as demonstrated in other diseases4. Results Gastrointestinal or intrinsic TTs are composed of laboratory investigations (biomarkers), endoscopic and radiological, to identify the phenotypic characteristics and the degree of inflammatory activity. Extra-intestinal TT: The main ones are rheumatological, dermatological, ophthalmological, and hematological. It is important to emphasize that many of these extra-intestinal manifestations appear as comorbidities. Psychological and behavioral TT: based on the patient's lifestyle and behavior and include obesity and malnutrition, diet and nutrients, smoking, sedentary lifestyle and physical activity, sleep quality, fatigue, adherence to treatment, and family support network) as well as the mental health including anxiety, depression, and suicidal ideation. The list of treatable characteristics is limited by the knowledge of the interactions identified to date and will expand as they are identified and targeted treatments approved by ECCO. Conclusion The definition and identification of TT in IBD are feasible and reported for the first time. Treatment based not only on pharmacological treatment aimed at mucosal healing and improves to address the limitations of existing treatment strategies to date. The holistic approach proposed by the authors will benefit not only in improving patients' QoL but also in providing a more effective, sustained, and long-lasting response.

A perinatal psychiatry access program to address rural and medically underserved populations using telemedicine

BackgroundAlthough highly prevalent, most perinatal mental health and substance use disorders often go unrecognized, undiagnosed, and untreated. Perinatal Psychiatry Access Programs have emerged as a successful model to increase the capacity of front-line maternal health care providers to address perinatal mental health conditions through education, consultation, and increased resources and referrals.MethodsThis model has been adapted in South Carolina to include direct access to mental health treatment in response to inadequate maternity care and mental health services, including a large proportion of rural, Medically Underserved Areas in Primary Care and Mental Health Healthcare Provider Shortage Areas throughout the state. Moms IMPACTT [Improving Access to Perinatal Mental Health and Substance Use Disorder Care Through Telehealth and Tele-mentoring] leverages statewide partnerships and a virtual care model to provide: 1) people who are pregnant or within 1 year postpartum with immediate access by phone or internet to a clinician trained in perinatal psychiatric care coordination to assess and refer to an appropriate level of perinatal psychiatry services; 2) communication and care coordination with the person’s healthcare provider, as appropriate; and 3) healthcare provider training and real-time psychiatric consultation for the management and treatment of perinatal mental health and substance use disorders. Adaptations to this care model have demonstrated benefit including increase access to care for patients with perinatal mental health and substance use disorders and support for frontline health providers serving this population.ResultsWithin the first 12 months, the Mom’s IMPACTT program served people from 45 of the 46 counties in South Carolina. There were 938 encounters, 96% of which resulted in telehealth or teleconsultation with a care coordinator or program psychiatrist. Treatment was provided to 881 perinatal patients (54.6% White, 26.1% Black, 6.2% Hispanic) of whom 51.8% were insured by Medicaid, 89.7% resided in counties designed as fully Medically Underserved Areas, and 38.9% lived in counties designed as fully rural. Most calls were received directly from perinatal patients, with 60.7% (548/903) of patients requesting mental health support. Additionally, the program completed 22 consultations, and trainings with 443 healthcare providers throughout the state.ConclusionsAdaptations made to psychiatry access program evident in Moms IMPACTT appear to be successful in meeting the specific needs of birthing people in the state of South Carolina. Suggestions and considerations are included to replicate the success of Moms IMPACTT program elsewhere.

Teleconsultations in Primary Healthcare Centres During COVID-19 Pandemic and Its Aftermath

Teleconsultations in Primary Healthcare Centres During COVID-19 Pandemic and Its Aftermath

Generalised anxiety disorder and its determinants amongst patients with diabetes in primary healthcare clinics: a cross-sectional study in Kuwait City, 2024

BackgroundAnxiety disorders are the second most common mental health disorders in terms of disability-adjusted life years and years of life lost across all age groups. A bidirectional relationship between anxiety disorders and diabetes mellitus has been documented. This study aimed to determine the prevalence of anxiety and its associated factors among patients with diabetes receiving care at public primary care clinics in Kuwait during the first quarter of 2024.MethodologyA cross-sectional study was conducted in the first quarter of 2024 at three primary healthcare centres within the Capital Governate in Kuwait City. Adults with diabetes mellitus for longer than six months duration were requested to participate by the health promoters and the Generalised Anxiety Disorder questionnaire was shared via a mobile link/QR scan. Data were collected through self-or interviewer-administered surveys, cleaned and coded in Microsoft Excel, and analysed using STATA version 18. Descriptive analysis was initially conducted followed by bivariate and multivariate analysis with a p < 0.05 and a 95% confidence interval used to determine the association between demographic and clinical factors and GAD.ResultsA total of 554 patients participated, yielding an 80% response rate. Anxiety symptoms were observed in 48% of respondents, though only 4% (n = 25) had a GAD score > 10. Among participants with moderate-to-severe anxiety (n = 21), 52% were aged 50–59 years, 90% were non-native Kuwaiti citizens, and 62% had an HbA1C measurement > 7 mmol/L. Multivariate analysis indicated that non-native Kuwait citizens were significantly more likely to have moderate-to-severe anxiety (AOR: 6.99, 95% CI: 1.42–34.43) compared to Kuwaiti nationals. Conversely, participants attending clinic visits every two months were less likely (AOR: 0.30, 95% CI: 0.00–0.50) to report moderate-to-severe anxiety symptoms than those attending monthly.ConclusionWhile nearly half of patients with diabetes displayed anxiety symptoms, only a small proportion (4%) experienced moderate-to-severe anxiety. Non-native Kuwaiti residents were significantly more likely to have GAD scores > 10. Integrating anxiety screening into diabetes care may improve outcomes for this high-risk group.

Nurses’ experiences of text-based digital triage at primary healthcare centres in Sweden: a qualitative interview study

BackgroundTelehealth services are becoming increasingly popular at primary healthcare centres. Some examples include text-based digital triage and health guidance using chats, emails, images and pre-filled forms. Telephone-based communication has until recent years been the predominant means for triage and health guidance, but now includes written communication via computer or smartphone. Hence conditions to perform triage and health guidance have changed, which may affect the quality of nurses’ work and patient safety. This motivates an in-depth exploration of the consequences of such changes for nurses working with telehealth. The study aimed to explore nurses’ experiences of digital triage and health guidance at primary healthcare centres in Sweden.MethodsA qualitative inductive design was chosen for the current study. Four registered nurses and two public health nurses, working at primary healthcare centres in southern Sweden, contributed with information about text-based digital triage and health guidance. Semi-structured interviews were conducted to collect data. Data were analysed using qualitative content analysis.FindingsOne main theme, “Adapting to a new professional toolbox to triage and give health guidance” was constructed based on three categories which describe the altered professional tools. They were: “Using one’s senses differently to collect information”, “Change of communication mode to convey messages” and “Change of timeframe and the use of time”. Six subcategories describe how the new toolbox was experienced by the nurses. They were: “Loss of clinical ear”, “Gain of viewing images”, “Difficulties in written communication of care and emotions”,“Seeing oneself as a writer or talker”, “Tardy asynchronous communication” and“Available time”. ConclusionThe findings tell of a substantial change in nurses’ professional toolbox that demanded other skills than they were used to working with. Due to limitations in communication and communication skills, digital triage alone may lead to an impaired workflow, quality of care, and patient safety as well as maintain the digital divide. However, digital triage may also enhance nurses’ work with the addition of attached images, convenient communication for those who are comfortable with writing, and a gain of time for consultation and reflection. The current study contributes insights regarding new competencies that nurses and patients must have or gain to be able to benefit from the possibilities of digitisation of primary healthcare.

Assessment of Cognitive Functions in Multimorbid Patients in Lithuanian Primary Care Settings: A Cross-Sectional Study Using MMSE and LT-GPCOG.

Background and Objectives: The aging population has led to a rise in cognitive impairments, including dementia, often associated with multimorbidity. Early diagnosis of cognitive decline is crucial, especially in primary care, where time constraints and the limitations of diagnostic tools may hinder accurate detection. This study aims to assess the cognitive functions of multimorbid patients using the Mini-Mental State Examination (MMSE) and the Lithuanian version of the General Practitioner Assessment of Cognition (LT-GPCOG). We hypothesized that the LT-GPCOG would perform similarly to the MMSE in suspecting cognitive impairments. Materials and Methods: This cross-sectional study, conducted from 2021 to 2022, included 796 patients aged 40-85, with arterial hypertension and at least one other chronic disease, recruited from seven Lithuanian primary health care centers. Cognitive function was assessed using the MMSE and LT-GPCOG, and statistical analyses were performed using SPSS to determine the association between cognitive impairment and various demographic and clinical variables. Results: Out of 796 participants, 793 completed the study. Cognitive impairment was suspected in 5.1% of participants based on MMSE and 4.2% based on the LT-GPCOG. Statistically significant associations were found between cognitive impairment and chronic obstructive pulmonary disease (COPD) (p = 0.008 and p = 0.003) in both tests and chronic kidney disease (CKD) (p = 0.005) while testing with the MMSE. Lower education and unemployment were also correlated with cognitive impairment (p = 0.008 and p < 0.001). Conclusions: The findings suggest that regular cognitive assessments should be integrated into the management of multimorbid patients, particularly those with COPD and CKD. The LT-GPCOG proved to be an efficient alternative to the MMSE in primary care settings, demonstrating comparable diagnostic accuracy. Further studies are also needed to assess the sensitivity and specificity of the LT-GPCOG test.

Costs of outpatient services at selected primary healthcare centers in Bangladesh: A cross-sectional study.

Upazila Health Complexes (UzHC) serve as the backbone of primary healthcare (PHC) at the sub-district level in Bangladesh, delivering comprehensive healthcare services including both inpatient and outpatient services to the grassroots levels. However, not all the prescribed medicines and diagnostics services are always available at these facilities for outpatient care. This results in out-of-pocket expenditure (OOPE) to the patients for getting prescribed medicines and diagnostics services which has not been properly explored. Thus, we aimed to estimate the overall provider and user costs for outpatient care services at selected UzHCs in Bangladesh. An ingredient-based costing approach was applied to estimate the costs for the most commonly reported illnesses at outpatient of UzHCs from a societal perspective. We conducted a health facility survey at four purposively selected UzHCs to estimate provider costs and a patient exit survey among 452 patients of selected illnesses to estimate the user costs. Commonly reported illnesses were identified in consultation with healthcare providers of these facilities. The difference between costs of prescribed and provided medicines at UzHCs was estimated using the market prices. Data was collected between February to March 2021. The societal costs of the common outpatient illness or symptoms varied significantly, ranging from BDT 642 to BDT 1,384 per episode. Antenatal care had the highest cost burden at BDT 1,384, followed by respiratory illness at BDT 783 and urinary tract infection at BDT 670. On average, the provider spent BDT 289 for treating an outpatient, while a patient incurred BDT 446 as OOPE. Further, a patient was expected to spend an average of BDT 341 for purchasing medicines not provided from UzHCs. Our study found significant gaps between prescribed and provided medicines at UzHCs, leading to higher OOPE for patients. The current healthcare resource allocation strategy does not consider the outpatient load and healthcare demand at PHC facilities, which further exacerbates this gap. Addressing this gap requires a fundamental shift towards a demand-driven resource allocation model within the healthcare financing strategy to improve healthcare access and achieve health for all.

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

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

Red cell distribution width as a cardiovascular risk predictor in adults with hypertension in sub-Saharan Africa.

Red cell distribution width (RDW) quantifies the degree of variation in erythrocyte size, is identified as a potential marker of adverse cardiovascular events, and may be a surrogate marker for assessing cardiovascular disease (CVD) risk in low-resource settings. We evaluated RDW as a predictor of CVD risk compared to the World Health Organization (WHO) CVD risk score among adults with hypertension attending primary healthcare centers (PHCs) in Ghana and Nigeria. Adults with hypertension attending selected PHCs in Ghana and Nigeria participated in a cross-sectional study. Each participant underwent blood pressure (BP) measurement and laboratory evaluation (RDW, total cholesterol, and fasting blood sugar) following standard methods. We recruited 319 adults aged 40-74 years from the study sites. The mean (standard deviation) RDW was 13.96 (1.1%). The median CVD risk score was 8.11% [interquartile range (IQR) 4.00 to 11.00]. For participants with hemoglobin (Hb) levels ≥ 12 g/dL, RDW showed positive correlations with age (r = 0.136; p = 0.042); systolic BP (r = 0.183; p = 0.006), diastolic BP (r = 0.206, p = 0.002) and WHO CVD risk scores (r = 0.166, p = 0.013). Multiple linear regression showed an independent association between RDW and WHO CVD risk scores with an upward gradient, and was most significant at 3rd quartiles. Using receiver operating characteristic curve, the C-statistic was 0.673 (95% confidence interval: 0.618 to 0.724), p = 0.031. With a cut-off of >14, the RDW demonstrated a sensitivity of 81.82% and specificity of 55.84%. This study shows that at Hb levels ≥ 12 g/dL, RDW modestly predicted CVD risk in adults with hypertension in sub-Saharan Africa.

Evaluation of the implementation in primary care of genetic testing for the screening of MODY2 (iMOgene): protocol for an implementation pilot study

IntroductionMODY2 (maturity-onset diabetes of the young type 2, MIM125851) is a monogenic diabetes with an autosomal dominant transmission caused by a variant of the GCK gene. MODY2 is often confused...

Testing the Recruitment Frequency, Implementation Fidelity, and Feasibility of Outcomes of the Heart Failure Activity Coach Study (HEALTHY): Pilot Randomized Controlled Trial.

Heart failure (HF) is a common and deadly disease, precipitated by physical inactivity and sedentary behavior. Although the 1-year survival rate after the first diagnosis is high, physical inactivity and sedentary behavior are associated with increased mortality and negatively impact the health-related quality of life (HR-QoL). We tested the recruitment frequency, implementation fidelity, and feasibility of outcomes of the Activity Coach app that was developed using an existing mobile health (mHealth) tool, Optilogg, to support older adults with HF to be more physically active and less sedentary. In this pilot clinical randomized controlled trial (RCT), patients with HF who were already using Optilogg to enhance self-care behavior were recruited from 5 primary care health centers in Sweden. Participants were randomized to either have their mHealth tool updated with the Activity Coach app (intervention group) or a sham version (control group). The intervention duration was 12 weeks, and in weeks 1 and 12, the participants wore an accelerometer daily to objectively measure their physical activity. The HR-QoL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and subjective goal attainment was assessed using goal attainment scaling. Baseline data were collected from the participants' electronic health records (EHRs). We found 67 eligible people using the mHealth tool, of which 30 (45%) initially agreed to participate, with 20 (30%) successfully enrolled and randomized to the control and intervention groups in a ratio of 1:1. The participants' daily adherence to registering physical activity in the Activity Coach app was 69% (range 24%-97%), and their weekly adherence was 88% (range 58%-100%). The mean goal attainment score was -1.0 (SD 1.1) for the control group versus 0.6 (SD 0.6) for the intervention group (P=.001). The mean change in the overall HR-QoL summary score was -9 (SD 10) for the control group versus 3 (SD 13) in the intervention group (P=.027). There was a significant difference in the physical limitation scores between the control (mean 45, SD 27) and intervention (mean 71, SD 20) groups (P=.04). The average length of sedentary bouts increased by 27 minutes to 458 (SD 84) in the control group minutes and decreased by 0.70 minutes to 391 (SD 117) in the intervention group (P=.22). There was a nonsignificant increase in the mean light physical activity (LPA): 146 (SD 46) versus 207 (SD 80) minutes in the control and intervention groups, respectively (P=.07). The recruitment rate was lower than anticipated. An active recruitment process is advised if a future efficacy study is to be conducted. Adherence to the Activity Coach app was high, and it may be able to support older adults with HF in being physically active. ClinicalTrials.gov NCT05235763; https://clinicaltrials.gov/study/NCT05235763.

The Role of Lifestyle and Environmental Factors in the Pathogenesis of Multiple Myeloma.

The study evaluated the impact of lifestyle and environmental exposure on the etiology of multiple myeloma (MM). A multicenter case-control study was conducted in 20 hematology centers and in 5 outpatient clinics in Poland. The questionnaire on exposure to potential risk factors including sociodemographic data, lifestyle, and environmental factors was completed. A total of 274 patients with newly diagnosed MM and 208 patients from primary healthcare centers in the control group were enrolled in the study. Regarding lifestyle, sports practiced systematically for at least half a year play a protective role in the development of myeloma (OR = 0.40, 95% CI, 0.28-0.58, p < 0.001). Among environmental factors harmful exposures that increase the likelihood of the development of MM include pesticides (OR = 3.29, p < 0.001), asphalt (OR = 2.42, p = 0.026), coal dust (OR = 2.27, p = 0.004), organic vapors (OR = 2.11, p = 0.001), metal dust (OR = 2.07, p = 0.023), exhaust fumes (OR = 2.03, p < 0.01), and chemicals (OR = 1.80, p < 0.01). The pathogenesis of MM is complex with the impact of modifiable factors. Lifestyle, with physical activity, seems to play a key role.

A comparative analysis of dengue, chikungunya, and Zika manifestations in a pediatric cohort over 18 years.

Dengue, chikungunya, and Zika are mosquito-borne diseases of major human concern. Differential diagnosis is complicated in children and adolescents by their overlapping clinical features (signs, symptoms, and complete blood count results). Few studies have directly compared the three diseases. We assessed clinical features of cases aged 2-17 years experiencing these diseases. We characterized 1,405 dengue, 517 chikungunya, and 522 Zika pediatric cases occurring from January 2006 through December 2023 in a Nicaraguan cohort study. Clinical records and laboratory results across the first 10 days of illness were examined from a primary care health center. All cases were laboratory-confirmed. Data were analyzed with generalized additive models, generalized mixed models, and machine learning models. The prevalence of many clinical features exhibited by dengue, chikungunya, and Zika cases differed substantially overall, by age, and by day of illness. Dengue cases were differentiated most by abdominal pain, leukopenia, nausea/vomiting, and basophilia; chikungunya cases were differentiated most by arthralgia and the absence of leukopenia and papular rash; and Zika cases were differentiated most by rash and lack of fever and lymphocytopenia. Dengue and chikungunya cases exhibited similar temperature dynamics during acute illness, and their temperatures were higher than Zika cases. Sixty-two laboratory-confirmed afebrile dengue cases, which would not be captured by any widely used international case definition, presented very similarly to afebrile Zika cases, though some exhibited warning signs of disease severity. The presence of arthralgia, the presence of basophilia, and the absence of fever were the most important model-based predictors of chikungunya, dengue, and Zika, respectively. These findings substantially update our understanding of dengue, chikungunya, and Zika in children while identifying various clinical features that could improve differential diagnoses. The occurrence of afebrile dengue warrants reconsideration of current case definitions. US National Institutes of Health R01AI099631, P01AI106695, U01AI153416, U19AI118610.

Awareness, attitude, and acceptance of newborn screening for sickle cell disease among health workers and caregivers at primary healthcare centers in Gwagwalada Area Council, Federal Capital Territory, Abuja, Nigeria.

Newborn Screening (NBS) is a public health program designed to identify and provide early interventions for infants with genetic disorders such as Sickle Cell Disease (SCD). Lack of awareness and unwillingness to participate in the NBS by caregivers and some healthcare workers are major contributing factors impeding NBS for SCD. To evaluate the level of awareness and acceptance of NBS for SCD and the determinant factors influencing caregivers in Gwagwalada Area Council of the Federal Capital Territory, Abuja, Nigeria. The study employed a descriptive, quantitative design using questionnaires administered to healthcare workers and caregivers at immunization and antenatal clinics of 10 selected Primary Healthcare Centers (PHC) in Gwagwalada Area Council of the Federal Capital Territory, Abuja, Nigeria. A total of 357 participants, comprising 301 caregivers and 56 health care workers responded to the questionnaires. Among the caregivers, 171 (57.2%) were not aware of NBS for SCD. Two hundred and ninety (97%) expressed willingness to participate in the NBS. However, 32 (10.6%) indicated reluctance to accept positive results of SCD. The majority, 175 (59.1%) of the caregivers strongly agreed that NBS for SCD helps in the early detection and management of SCD, while 7 (2.4%) disagreed. Notably 272 (90.4%) of the caregivers had secondary and tertiary education. Among the healthcare workers, 39 (73.6%) were aware of NBS for SCD and 30 (73.2%) have recommended it to caregivers. This study revealed a low level of awareness of NBS for SCD among caregivers. However, there was a high level of acceptance among them. The level of awareness is high among healthcare workers. Education emerged as the major factor determining the knowledge and attitude of caregivers toward NBS for SCD.

Assessing Gaps in Integrated HIV and STI Testing Among New York State-Funded Providers by Pre-Exposure Prophylaxis Status: Implications for Status-Neutral Programming.

In the United States, up to 75% of primary care patients go untested for HIV each year, and nearly two-thirds of adults report never having been tested for HIV. Integrated HIV and STI testing, combining these tests into a single visit, is recommended as a status neutral approach to prevention. Over 200 New York State Department of Health-funded primary care clinics, hospitals, health centers and community-based organizations funded to conduct integrated screening. We analyzed weekly testing data from December 2022 to January 2024 to prospectively evaluate whether integrated HIV and STI testing events and results occurred within 30 days of each other. We also assessed group differences in integrated testing by sex at birth, gender, race/ethnicity, risk, organization type, and pre-exposure prophylaxis (PrEP) status using Pearson's Chi-square tests and calculated prevalence ratios using log binomial models stratified be PrEP usage. Analyses were restricted to individuals with an HIV-negative status. Integrated testing was completed for 69% for individuals on PrEP and 39% for those not taking PrEP, with significant differences observed across all client-specific categories at p < 0.001. Except for age group, variations in integrated screening levels by client characteristics were similar by PrEP status. Individuals who identified as female at birth, as non-Hispanic Black, without an elevated risk, and those tested in non-hospital settings were significantly less likely to experience integrated screening. HIV-test reactivity was 0.04% among integrated testers and 0.15% for HIV-only testers. STI-test reactivity was 4.9% among integrated testers and 7.8% for STI-only testers. A significant gap was identified in integrated testing among providers specifically funded to perform it, resulting in missed opportunities for identification of HIV and other sexually transmitted infections. Integrating HIV and STI testing at a systems level will require significant changes to the perceived individual- and provider-level risks and benefits associated with testing.

Knowledge and Practice of Adverse Drugs Reaction Reporting Among Health Care Practitioners in Primary Health Care Centers in Kano Metropolis

Background and Aims: Adverse Drug Reactions are one of the factors that contribute to hospitalization and death and can be duly prevented and reduced through spontaneous reporting. The study aimed at assessing the knowledge and Practice of Adverse Drug Reaction Reporting among Health Care Practitioners in Primary Health Care Centers in Kano Metropolis. Methods: The cross-sectional study used a modified questionnaire that was adapted from similar previous studies with two sections. The total knowledge and practice scores were categorized as good for scores 80% and above, moderate for scores between 60-79% and poor for scores less than 60% using Bloom’s cut-off point. Pearson Chi-square and Fischer-Freeman-Halton Exact Tests, where necessary, were used to test the hypotheses with p &lt; 0.05 set as the level of statistical significance. Results: The outcome of the study revealed that though the respondents were aware of pharmacovigilance, only a few (13; 4.4%) understood what pharmacovigilance comprehensively entails. 213(71.7%) have in¬adequate knowledge and 161(71.7%) showed adequate practice of Adverse Drug Reaction reporting. Also, the participants’ cadre significantly influences their knowledge (P-value= 0.026&lt;0.05) and the knowledge of Adverse Drug Reaction significantly influences their practice of Adverse Drug Reaction reporting (P-value=0.031&lt; 0.05). Conclusions: Healthcare practitioners are aware of pharmacovigilance but show inadequate knowledge of pharmacovigilance and Adverse Drug Reactions. However, there is an adequate Adverse Drug Reaction reporting practice among the healthcare practitioners. There is a need for continuous mandatory training on Adverse Drug Reactions and reporting, irrespective of the cadre or years of work experience of the health workers.