Primary Health Care Institutions Research Articles

Machine and deep learning-based clinical characteristics and laboratory markers for the prediction of sarcopenia.

Sarcopenia is an age-related progressive skeletal muscle disorder involving the loss of muscle mass or strength and physiological function. Efficient and precise AI algorithms may play a significant role in the diagnosis of sarcopenia. In this study, we aimed to develop a machine learning model for sarcopenia diagnosis using clinical characteristics and laboratory indicators of aging cohorts. We developed models of sarcopenia using the baseline data from the West China Health and Aging Trend (WCHAT) study. For external validation, we used the Xiamen Aging Trend (XMAT) cohort. We compared the support vector machine (SVM), random forest (RF), eXtreme Gradient Boosting (XGB), and Wide and Deep (W&D) models. The area under the receiver operating curve (AUC) and accuracy (ACC) were used to evaluate the diagnostic efficiency of the models. The WCHAT cohort, which included a total of 4057 participants for the training and testing datasets, and the XMAT cohort, which consisted of 553 participants for the external validation dataset, were enrolled in this study. Among the four models, W&D had the best performance (AUC = 0.916 ± 0.006, ACC = 0.882 ± 0.006), followed by SVM (AUC =0.907 ± 0.004, ACC = 0.877 ± 0.006), XGB (AUC = 0.877 ± 0.005, ACC = 0.868 ± 0.005), and RF (AUC = 0.843 ± 0.031, ACC = 0.836 ± 0.024) in the training dataset. Meanwhile, in the testing dataset, the diagnostic efficiency of the models from large to small was W&D (AUC = 0.881, ACC = 0.862), XGB (AUC = 0.858, ACC = 0.861), RF (AUC = 0.843, ACC = 0.836), and SVM (AUC = 0.829, ACC = 0.857). In the external validation dataset, the performance of W&D (AUC = 0.970, ACC = 0.911) was the best among the four models, followed by RF (AUC = 0.830, ACC = 0.769), SVM (AUC = 0.766, ACC = 0.738), and XGB (AUC = 0.722, ACC = 0.749). The W&D model not only had excellent diagnostic performance for sarcopenia but also showed good economic efficiency and timeliness. It could be widely used in primary health care institutions or developing areas with an aging population. Chictr.org, ChiCTR 1800018895.

Primary Healthcare Pharmacists' Perceived Organizational Support and Turnover Intention: Do Gender Differences Exist?

This study aims to explore the relationship between the four-dimensional structured perceived organizational support (emotional support, instrumental support, supervisor support, and coworker support) and the turnover intention of pharmacists in primary healthcare institutions. The gender differences between perceived organizational support and turnover intention will also be examined. A cross-sectional study was conducted in primary healthcare institutions of 31 cities in China from 2 July to 1 September 2021. And the binary logistic regression model was employed for data analysis. 937 valid questionnaires are allocated from pharmacists in primary healthcare institutions. The regression results indicated that emotional support (b=0.073, p<0.001) has a significant influence on pharmacists' turnover intention, and the effect of supervisor support (b=0.173, p=0.046) on pharmacists' turnover intention differs by gender. These findings offer suggestions for the management and stabilization of pharmacists in primary healthcare institutions. It is suggested that specific measures should be taken to increase pharmacists' perceived organizational support and reduce their turnover intention. At the same time, gender differences need to be taken into consideration by the managers when providing perceived organizational support to reduce their turnover intention through adaptive management.

PUBLIC OPINION TOWARDS ADOLESCENT PREGNANCIES AND EXPECTATIONS FROM HEALTHCARE PROFESSIONALS

Objectives: Complications arising from pregnancies during adolescence bring along very important health problems in terms of both women's health and babies' health. Therefore, society's perspective on adolescent pregnancies and expectations from healthcare professionals will guide the measures to be taken to protect maternal health under the age of 18. This study aims to identify the determinants of society’s point of view regarding adolescent pregnancies and to determine expectations from healthcare workers. Methods: This descriptive cross-sectional study enrolled randomly selected 980 subjects who volunteered to join the study, and answered a questionnaire composed of 39 questions. The questionnaire was consulted by multi-disciplinary to confirm the accuracy of the questions. Results: The mean age was 41.0 (range: 19-64, Male-Female ratio 1:1.15) and 71.6% were married. The majority (80.3%) argued that girls under the age of 19 should not have children, and this is significantly affected by income level and education. It has been observed that the view that reducing adolescent pregnancies will positively affect maternal and neonatal mortality rates is related to the education and income level of the participants. (p=0.001 and p=0.024). 66.1% of the respondents stated that adolescent pregnancies could be reduced by providing adequate information from primary healthcare institutions rather than other sources. In addition, primary healthcare institutions were shown as the primary center in the follow-up of these pregnancies by .66.1% of the participants. Conclusion: It is important to inform society about this issue in the prevention of adolescent pregnancies, which have significant risks for maternal and infant health. Society believes that the solution to this problem can be provided by primary health care services.

Follow-up survey of general practitioners in Zhejiang Province post-completion of position transition training in 2017–2020

BackgroundPosition transition training for general practitioners in Zhejiang Province started in 2017 and has since been held once a year. By the beginning of 2022, four training sessions were completed. The purpose of this survey was to establish the current situation of trainees after their graduation and provide reference for the evaluation of the training effect.MethodsOf the 738 trainees who completed the training, 253 were contacted and followed up. A self-designed questionnaire was used to conduct the survey through online filling in. The content included questions to elucidate the following information: whereabouts after the training, registration as a general practitioner, undertaken general practice teaching and scientific research work, current occupational environment, improvement of post competence after receiving position transition training, willingness to complete survey, willingness to participate in future training programs, etc.ResultsA number of 253 valid questionnaires were collected with a recovery rate of 100%. Notably, 93.68% of the participants successfully completed their training and obtained the Training Certificate of General Practitioners. Further, 83.4% were registered as general practitioners, 82.94% of which added on the basis of the original registered scope of practice. Currently, most of them work in primary health care institutions, primarily occupied with medical treatment, chronic disease management, COVID-19 prevention and control, health education, and prevention and health care. Of them, 27.01% were currently undertaking teaching work, and only 3.32% of them were conducting scientific research work related to general practice. The overall satisfaction of the trainees in the three theoretical training bases was above 90%, with no statistically significant difference among them (P > 0.05). Importantly, 84.11% of the followed-up personnel hoped to continue to participate in similar training in the future to improve their general practitioner core competences.ConclusionThe position transition training in Zhejiang Province has achieved good results, but the details of training and the implementation of policies in individual regions need to be improved. Most of the graduates were willing to continue their education, especially in general practitioners with special interests.

LEVELS OF ACCESSIBILITY OF PRIMARY MEDICAL SERVICES IN THE CONDITIONS OF THE REFORM OF THE MEDICAL INDUSTRY: A MARKETING APPROACH

The reform of the primary medical care link of the health care system became an indicator of changes in the health care system of Ukraine. Considering the fact that the primary link of the medical system was reformed as a priority, the feedback of the population, its assessment of the availability of quality medical care, is important, which will allow determining the consequences and prospects of the reform. The marketing analysis conducted in the article of such three criteria (levels) of the availability of primary medical care services as quality, financial and territorial or temporal availability of medical services in their dynamics for 2018-2020 made it possible to find out positive and negative development trends based on surveys of respondents units of primary medical care. In particular, it was established that during the specified period there is a general tendency to improve the quality of medical services, combined at the same time with an insufficient level of ensuring their financial and territorial or temporal availability. The marketing analysis of the respondents' opinions regarding the main indicators of quality criteria, financial and territorial or time availability made it possible to more objectively assess the consequences of the reform of the primary medical care link. The increase in the quality of medical services, which respondents attributed mainly to the improvement of the attitude of medical staff doctors to patients and the material conditions for the provision of medical services, is actually explained by the socio-psychological factors of the establishment of the "doctor-patient" interaction and the positive effect of the financial independence of medical institutions. The positive trend of increasing the financial availability of medical services, expressed in the survey by indicators of the ability to purchase drugs and receive effective treatment, is due to the practical implementation of the "Affordable Medicines" program, the availability of a significant range of free medical services (under the contract with the National Health Service) and the optimal pricing policy for additional medical services. In the end, the criterion of territorial or temporal availability of medical services, having received a wide range of evaluations (from positive to negative among respondents, testifies, on the one hand, to the positive consequences of the increase in temporal availability and opportunities for patients to choose a doctor, and on the other hand, it demonstrates the unresolved issue of territorial convenience placement of primary care facilities, especially in the conditions of reduction of their network in rural areas. We consider the development of practical recommendations for primary and secondary specialized health care institutions to improve individual indicators of quality, financial and territorial or temporal availability of medical services as a perspective for the study of the problem.

Improving interaction of primary health care facilities and narcological service to provide care to patients with riskу, harmful use or dependency from alcohol or other psychoactive substances

This article provides description of the existing regulatory framework for interaction between medical organizations that provide health to people with risky, hazardous (harmful) use of alcohol or other psychoactive substances in the Russian Federation.Aim. Exploring existing opportunities to improve interaction of primary health care institutions and narcological service to provide care to patients with risky use, harmful use or dependence on psychoactive substances.Materials and methods. The article presents results of implementing the action plan to organize medical prevention in 71 regions of the Russian Federation, based on data provided by chief narcologists of these regions during 2017–2018. The analysis of the existing practice of the interaction of medical institutions for the prevention of the harmful use of psychoactive substances was carried out; were studied the principles of organizing screening and preventive counseling in primary health care; the features of training and education of specialists of medical organizations in the methodology of screening, preventive and motivational counseling were studied in different regions of the Russian Federation.Discussion. During 2017–2018 more than 14.5 million patients were screened in primary health care. Problems alcohol and other psychoactive substances use were identified in more than 300,000 patients (2.4 %). The highest rates of identified substance use disorders’ risks were observed in primary specialized medical care settings (5.1 %); lower rates were observed among those who were undergoing screening in primary health care settings (1.8 %), during preventive health assessment (2.3 %) and during preventive medical check-ups (2.4 %). More than 19,000 health workers have been trained in motivational counseling techniques.Conclusion. The problem of substance abuse and related medical and social consequences remains highly relevant, and therefore requires further implementation of preventive technologies with proven effectiveness.

A study of primary health care service efficiency and its spatial correlation in China

BackgroundChina’s primary health care system has undergone major changes since the new round of medical reform in 2009, but the current status of primary health care institution service efficiency is still unsatisfactory. The purpose of this study is to compare and evaluate the China’s primary health care institution service efficiency and provide a reference for improving the efficiency and promoting the development of primary health care institution.MethodsBased on panel data of 31 provinces (municipalities directly under the central government and autonomous regions) in mainland China from 2011 to 2020, using the super efficiency slack-based measure-data envelopment analysis model, to analyze the data from a static perspective, and the changes in the efficiency of primary health care services were analyzed from a dynamic perspective by using the Malmquist index method. Spatial autocorrelation analysis method was used to verify the spatial correlation of primary health care service efficiency among various regions.ResultsThe number of Primary health care institutions increased from 918,000 in 2011 to 970,000 in 2020. The average primary health care institution service efficiency in the northeastern region including Jilin (0.324), Heilongjiang (0.460), Liaoning (0.453) and northern regions such as Shaanxi (0.344) and Neimenggu (0.403) was at a low level, while the eastern coastal regions such as Guangdong (1.116), Zhejiang (1.211), Shanghai (1.402) have higher average service efficiency levels. The global Moran’s I showed the existence of spatial autocorrelation, and the local Moran’s I index suggested that the problem of uneven regional development was prominent, showing a contiguous regional distribution pattern. Among them, H–H (high-efficiency regions) were mainly concentrated in Jiangsu, Anhui and Shanghai, and L-L regions (low-efficiency regions) were mostly in northern and northeastern China.ConclusionThe service efficiency of primary health care institution in China showed a rising trend in general, but the overall average efficiency was still at a low level, and there were significant geographical differences, which showed a spatial distribution of “high in the east and low in the west, high in the south and low in the north”. The northwestern region, after receiving relevant support, has seen a rapid development of primary health care, and its efficiency was steadily improving and gradually reaching a high level. The average primary health care institution service efficiency in the northeastern region including the northern region of China was at a low level, while the average efficiency in the eastern coastal region and some economically developed regions was high, which also verifies the dependence and high symbiosis of primary health care institution service efficiency on regional economy.

Technical Efficiency Evaluation of Primary Health Care Institutions in Shenzhen, China, and Its Policy Implications under the COVID-19 Pandemic.

(1) Background: Primary health care institutions (PHCI) play an important role in reducing health inequities and achieving universal health coverage. However, despite the increasing inputs of healthcare resources in China, the proportion of patient visits in PHCI keeps declining. In 2020, the advent of the COVID-19 pandemic further exerted a severe stress on the operation of PHCI due to administrative orders. This study aims to evaluate the efficiency change in PHCI and provide policy recommendations for the transformation of PHCI in the post-pandemic era. (2) Methods: Data envelope analysis (DEA) and the Malmquist index model were applied to estimate the technical efficiency of PHCI in Shenzhen, China, from 2016 to 2020. The Tobit regression model was then used to analyze the influencing factors of efficiency of PHCI. (3) Results: The results of our analysis reflect considerable low levels of technical efficiency, pure technical efficiency, and scale efficiency of PHCI in Shenzhen, China, in 2017 and 2020. Compared to years before the epidemic, the productivity of PHCI decreased by 24.6% in 2020, which reached the nadir, during the COVID-19 pandemic along with the considerable reduction of technological efficiency, despite the significant inputs of health personnel and volume of health services. The growth of technical efficiency of PHCI is significantly affected by the revenue from operation, percentage of doctors and nurses in health technicians, ratio of doctors and nurses, service population, proportion of children in the service population, and numbers of PHCI within one kilometer. (4) Conclusion: The technical efficiency significantly declines along with the COVID-19 outbreak in Shenzhen, China, with the deterioration of underlying technical efficiency change and technological efficiency change, regardless of the immense inputs of health resources. Transformation of PHCI such as adopting tele-health technologies to maximize primary care delivery is needed to optimize utilization of health resource inputs. This study brings insights to improve the performances of PHCI in China in response to the current epidemiologic transition and future epidemic outbreaks more effectively, and to promote the national strategy of Healthy China 2030.

The Influence of Social Capital: A Trigger for Increasing Job Satisfaction.

Evidence suggests that social capital in medical and health institutions is associated with the job satisfaction of medical staff. We examined the relationship between the social capital of Primary Healthcare Institutions (PHI) and the job satisfaction of pharmacists within it. From August 24 to September 1, 2021, we visited a total of 253 PHIs in 31 provinces of China. The social capital of healthcare organizations reported by employees (SOCAPO-E) scale was used to measure the social capital level of PHIs. And the Minnesota short-form job satisfaction scale was used to obtain pharmacists' job satisfaction. We employed multiple linear regression to explore the relationship between the social capital of PHI and pharmacists' job satisfaction. We also examined the effects of pharmacists' individual characteristics and job-related factors on pharmacists' job satisfaction. It was statistically significant that the higher the social capital stock of PHI, the higher the job satisfaction level of pharmacists becomes. In addition, the regression analysis revealed that work hours, employment form, license acquired condition, disputes with patients and training frequency were significantly associated with the job satisfaction of pharmacists in PHI. Social capital in PHI has a significant impact on pharmacists' job satisfaction, suggesting that investing in social capital in PHI is a valuable investment in China. Furthermore, trust, which can be divided into affective trust and cognitive trust, and reciprocity are vital to the fulfillment of pharmacists' job satisfaction as core elements of social capital.

Calcium and vitamin D supplementation to pregnant women in urban hospital and community settings

In India, calcium intake is low and the prevalence of Vitamin D deficiency in pregnant women is high. The National Guidelines envisage elemental calcium 500 mg (as calcium carbonate salt) and 250 IU vitamin D supplements should be provided to pregnant and lactating women. In Delhi, iron folic acid tablets are given twice a day after meals in anaemic women and one tablet of calcium and vitamin D daily after a meal in all pregnant women. A study was taken up to assess the availability and compliance with calcium and vitamin D supplementation in primary health care institutions under research (Group 1 - 387 women) and service conditions (Group 2 - 400 women) and in urban community setting (Group 3 - 448 women). Women in Group 1 received Ca and Vitamin D tablets regularly from the research staff. In Group 2 and Group 3 tablets, were provided as and when government supplies were available and prescriptions were given when they were not available. Ca and Vitamin D tablets were expensive; families bought the tablets as and when they had the funds. As a result, the number of tablets available for consumption was lower in Group 2 and 3. In all three groups, side effects were rare and nearly all available tablets were consumed. In Group 1, Vitamin D estimation was done at enrolment and after supplementation for three months; 83% of women at enrolment and 68% of women after three months of supplementation had serum vitamin D levels below 20 ng/ml. These data suggest that one tablet of Ca and Vit D per day is insufficient for correcting maternal vitamin D deficiency. It is essential to carry out studies to assess the impact of supplementation with two tablets of Ca and Vit D on maternal vitamin D levels.

A study on the relationship between sociodemographic characteristics and job stress and satisfaction among healthcare workers in Turkey during the COVID-19 pandemic.

The aim of this study was to determine the sociodemographic characteristics that affect job stress and job satisfaction in 454 healthcare workers (physicians, nurses, midwives, technicians, and other healthcare personnel) working with COVID-19 patients in primary healthcare institutions in Turkey with a cross-sectional, web-based survey between 9 and 30 August 2021. The survey included a personal information form, a standard job stress scale, and the Minnesota Satisfaction Questionnaire. The levels of job stress and job satisfaction did not differ between male and female respondents. Singles reported lower job stress and higher job satisfaction than the married respondents. Job stress did not differ between departments, but respondents on the front line who worked in a COVID-19 intensive care unit (ICU) (at any point and/or at the time of the study) or the emergency department reported lower job satisfaction than those working in other departments. Similarly, while stress did not differ by educational status, satisfaction of respondents with bachelor's or master's degree was lower than that of the rest. Our findings also suggest that working in a COVID-19 ICU and age are significant predictors of higher stress, whereas lower education, working in a COVID-19 ICU, and being married are good predictors of lower satisfaction. Further research should include other sociodemographic variables that may affect stress and satisfaction at work, and similar studies should follow up to see what was left in the wake of the pandemic.

Impact of work-family support on job burnout among primary health workers and the mediating role of career identity: A cross-sectional study.

In China, medical workers in the primary sector shoulder the task of providing people with the basic medical and public health services, and are the "gatekeepers" of the public health. This study aims to analyze the current situation of job burnout among primary health workers of China, and shed light on the effect of work-family support and career identity on job burnout among them and their relationships. This may provide a new perspective for primary health care institutions and health administrative departments so as to formulate policies to "attract, retain and stabilize" primary health workers. A multi-stage sampling method was adopted to select 8,135 primary health workers from 320 primary health care institutions in a province of central China. A descriptive statistical analysis, univariate analysis, Pearson correlation analysis, and mediation effect analysis were applied to analyze the effects of work-family support and career identity on job burnout among primary health workers as well as the mediating role of career identity. Among 8,135 primary health workers, 4,911 (60.4%) participants had mild to moderate levels of job burnout, 181 (2.2%) participants had severe job burnout, and the burnout detection rate is 62.6%. Work-family support was negatively correlated with job burnout (r = -0.46, p < 0.01) and positively correlated with career identity (r = 0.42, p < 0.01). Work-family support (β = -0.346, p < 0.01) and career identity (β = -0.574, p < 0.01) were negative predictors of job burnout respectively. In addition, career identity had a mediating effect between work-family support and job burnout, with the mediating effect contributing 33.7% to the overall effect. The findings of this study demonstrate that work-family support is a protective factor against job burnout in primary health workers and reveal that career identity is a critical mediating mechanism linking work-family support to burnout. We propose to reduce job burnout by strengthening work-family support (especially work support), enhancing career identity, increasing the number of primary health workers and reducing the workload of existing incumbents, which can provide important practical implications for the future prevention and intervention programs.

Prevalence and factors of discordance attitudes toward advance care planning between older patients and their family members in the primary medical and healthcare institution.

This study aimed at investigating the prevalence and factors of the discordant attitudes toward advance care planning (ACP) among older patients and their family members toward patients' engagement in ACP in the primary medical and healthcare institution. In a cross-sectional study, a total of 117 older patients and 117 family members from Jinhua Fifth Hospital in China were enrolled. The questionnaire included sociodemographic characteristics, functional capacity assessment, and attitudes toward patients' engagement in ACP. Functional capacity assessment scales included the Modified Barthel Index (MBI), the Short-Form Mini-Nutritional Assessment (MNA-SF), the 15-item Geriatric Depression Scale (GDS-15), the Mini-Mental State Examination (MMSE), the Clinical Frailty Scale (CFS), and the SARC-F questionnaire. The discordance attitudes toward patients' engagement in ACP between patients and family members accounted for 41(35.0%). In the multivariate logistic analysis, factors associated with higher odds of discordance attitudes toward patients' engagement in ACP included greater age differences between patients and family members (OR = 1.043, 95% CI: 1.007-1.081), lower educational level for family members (OR = 3.373, 95% CI: 1.239-9.181), the patient's higher GDS-15 score (OR = 1.437, 95% CI: 1.185-1.742), and patient's higher MNA-SF score (OR = 1.754, 95% CI: 1.316-2.338). Older patients and their family members had little ACP knowledge, and factors that influence discordance attitudes toward patients' engagement in ACP included the age gaps between patients and family members, family members' educational level, patients' depressive symptoms, and patients' nutritional status.

The Relationship between Family Doctor Contract Services Policy and Perceived Participation in Primary Health Care among Chronic Disease Patients in China: The Mediating Role of the Patient Trust

Participation by patients with chronic diseases under primary health care requires more attention to achieve effective disease management and better health outcomes. In 2016, China proposed accelerating the establishment of a system of family doctors (FDs) and strengthening doctor-patient communication to better meet residents’ health service needs. This study aimed to describe perceived participation in primary health care among patients with chronic diseases in northeastern China and explore the impact of FD contract services and patient’s trust on patients’ perceived participation. A cross-sectional survey of 847 patients with chronic diseases in 16 primary healthcare institutions was conducted in Jilin Province, China. Among all participants, 453 patients reported signing up for FD contract services (62.93%). The perceived participation of patients with chronic diseases was at a low level (mean = 6.71 and SD = 3.35). After controlling for sociodemographic variables and health-related variables, FD contract services directly and indirectly influenced patients’ perceived participation. The patient’s trust was a mediator in the relationship between FD contract services and perceived participation. This study confirmed the valuation of family doctor contract services and provided a theoretical basis for the formulation of primary health service policies. Health organizations should continue to enhance the capacity of primary health services and attract more chronic disease patients to contract with FD teams, thereby enhancing doctor-patient trust and increasing patient’s participation in primary health care.

Construction and Validation of a Nomogram Clinical Prediction Model for Predicting Osteoporosis in an Asymptomatic Elderly Population in Beijing.

Based on the high prevalence and occult-onset of osteoporosis, the development of novel early screening tools was imminent. Therefore, this study attempted to construct a nomogram clinical prediction model for predicting osteoporosis. Asymptomatic elderly residents in the training (n = 438) and validation groups (n = 146) were recruited. BMD examinations were performed and clinical data were collected for the participants. Logistic regression analyses were performed. A logistic nomogram clinical prediction model and an online dynamic nomogram clinical prediction model were constructed. The nomogram model was validated by means of ROC curves, calibration curves, DCA curves, and clinical impact curves. The nomogram clinical prediction model constructed based on gender, education level, and body weight was well generalized and had moderate predictive value (AUC > 0.7), better calibration, and better clinical benefit. An online dynamic nomogram was constructed. The nomogram clinical prediction model was easy to generalize, and could help family physicians and primary community healthcare institutions to better screen for osteoporosis in the general elderly population and achieve early detection and diagnosis of the disease.

Analyzing the efficiency of Chinese primary healthcare institutions using the Malmquist-DEA approach: Evidence from urban and rural areas.

China has been increasing the investment in Primary Health Care Institutions (PHCIs) since the launch of the New Health Care System Reform in 2009. It is a crucial concern whether the PHCIs can meet residents' need both in urban and rural with the limited government finance, especially encountering the challenge of the COVID-19. This study aimed to reveal the trend of the primary health service efficiency in the past decade, compare the urban-rural differences, and explore relevant factors. DEA and Malmquist models were applied to calculate the health service efficiency of PHCIs among 28 provinces in China, with the input variables including the number of institutions, number of beds, number of health technicians, and the outputs variables including the number of outpatients and emergency visits, number of discharged patients. And the Tobit model was used to analyze the factors on the efficiency in urban and rural. A sensitivity analysis for model validations was also carried out. The average technical efficiency (TE) of urban PHCIs fluctuated from 63.3% to 67.1%, which was lower than that in rural (75.8-82.2%) from 2009 to 2019. In terms of dynamic efficiency, the urban PHCIs performed better than the rural, and the trends in the total factor productivity change were associated with favorable technology advancement. The population density and dependency ratio were the key factors on TE in both of the urban and rural PHCIs, and these two factors were positively correlated to TE. In terms of TE, it was negatively correlated with the proportion of total health expenditure as a percentage of GDP in urban PHCIs, while in rural it was positively correlated with the urbanization rate and negatively correlated with GDP per capita. Besides, the tests of Mann-Whitney U, and Kruskal-Wallis H indicated the internal validity and robustness of the chosen DEA and Malmquist models. It needs to reduce the health resource wastes and increase service provision in urban PHCIs. Meanwhile, it is necessary to strengthen medical technology and gaining greater efficiency in rural PHCIs by technology renovation.

The Psychosocial Well-being of Frontline Nurses During the COVID-19 Pandemic in South Africa

Healthcare workers have been under tremendous psychosocial strain since the advent of the COVID-19 pandemic, particularly those on the frontlines such as nurses. This is especially true in low- and middle-income countries such as South Africa, where lack of resources and support exacerbate challenges. Five focus group discussions were conducted with frontline nurses at primary, secondary, and tertiary healthcare institutions in Cape Town, South Africa. Participants reported significant stress emanating from all spheres of their life, with the acute stressors of their work having largely adverse consequences on their lives in their homes and communities. A lack of organisational support was evident, with participants highlighting various ways in which the psychosocial strain they were under may be alleviated. Healthcare facilities should investigate both individual and organisational interventions aimed at better supporting their invaluable frontline teams. These include tailored psychological support services, sufficient time for rest, adequate staffing and medical supplies, effective leadership, COVID-19 specific training, and the promotion of teamwork. However, facilities should also extend their concern to the families of staff by reducing potential risk of exposure through a variety of measures including providing transport and voluntary isolation accommodation. Such interventions are important not only for the healthcare workers and their families, but also for the smooth functioning of healthcare institutions as the pandemic draws on into an uncertain future.&#x0D;

Determination of Multiple Cancer Risk Behaviors Among Adult Population in Turkey: A Cross-sectional Study

Background: Modifiable cancer risk behaviors are general not seen alone but in combination in individuals.&#x0D; Purpose: This study aims to investigate the factors associated with combinations of cancer risk behaviors, including tobacco use, obesity, and low physical activity that cause cancer in adults.&#x0D; Methods: A total of 720 adults were selected using the multi-stage cluster sampling method. Data were collected using the World Health Organization STEP-wise protocols.&#x0D; Results: It was found that 46.9% of the participants showed one, 46.3% two or more types of risk behavior. The percentage of married individuals was higher among those who engaged in one, two, or three risky behaviors than those who did not engage in risky behaviors. Among participants with two risk behaviors, the percentage of those who rated their health as very good was lower than those without risk behaviors; those who had friends or relatives with cancer were high. Those who engaged in three risk behaviors were less educated and had lower incomes than those who did not engage in risk behaviors.&#x0D; Conclusions: Health intervention strategies should be increased in primary health care institutions for individuals who are married, has low level of education and income and has weak perception of health.

Characterizing No-shows in the Omani Primary Healthcare Setting.

Patient 'no-shows' (failure to keep or cancel appointments) is a global problem that impacts healthcare systems by delaying patient access to healthcare, reducing quality of care, and wasting resources. The no-show phenomenon has not yet been studied in Oman despite it having grown in importance ever since the appointments system was implemented in 2014. This study aimed to characterize the no-shows in primary healthcare facilities in Oman. We collected and analyzed administrative data during the period 2014-2017 from 14 primary healthcare institutions in Oman focusing on the ophthalmology, ear, nose, and throat, and dermatology clinics therein. The overall no-show rates were > 50.0%. No-show probabilities were higher in males, younger adults, new appointments, early morning appointments, appointments during Ramadan, and appointments scheduled farther in advance. Patient experience with the appointment system reduced the no-show probability. Policymakers should consider these trends to optimize the number of appointments per day, and researchers should further investigate no-shows for other specialties and levels of care.

Correlation between input on public health services and work motivation among primary health workers in China

BackgroundThe integration of public health services into primary health care has been advocated and practiced worldwide for better management of preventable diseases. Health policy makers in China have started the reforms to better integrate public health services and clinical services, but public health services in China still remained neglected in primary health system. This study aimed to explore the input of Chinese primary health workers on delivering public health services and its association with their intrinsic working motivation in China.MethodsData were collected from a cross-sectional survey conducted in 2019. Participants in this survey included 803 primary health workers in 75 primary health institutions in China. Questions about the input on clinical and public health services delivery and intrinsic working motivation were asked. A multiple linear regression model was adopted to investigate the correlation between intrinsic working motivation and the time input on public health service. The robustness of this model was checked with a generalized linear model.ResultsIntrinsic motivation was found to have negative association with health workers’ input on public health (β: -1.01, p < 0.05), with the robustness checked with a generalized linear model. The significance of this association differed in the group of urban community health centers and rural township health center. Other factors that had significant relationship with the input on public health services include the being nurses instead of doctors (p < 0.01), being a member of family doctor team (p < 0.01), recognition on relative importance of clinical services (p < 0.01), and perception on better exterior support (p < 0.01).ConclusionWith higher intrinsic working motivation, primary health workers tended to spend less time on public health services. It reflected that doctors and nurses in primary healthcare institutions still perceived clinical treatment services as their main work responsibility and source of career recognition. Organizational level supports and system level policies should guide the primary health workers to increase their awareness on the importance of public health services and to cultivate their internal interests on public health services, in order to ensure sustainable input and performance improvement on public health services in primary health system in China.