Primary Health Care Settings Research Articles

The psychological impact of the ongoing COVID-19 pandemic on health-care workers in primary health-care centers in resource-poor settings.

Health-care workers' psychological status is essential to Preventive control measures in a weak and unstable health system with poor infrastructural constraints. This study examines the psychological impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic on the health-care providers working in primary health-care settings in Sudan. This is a health facility-based cross-sectional study conducted in primary health-care units in White Nile State, Sudan. The psychological impact of stress and anxiety was determined using the Depression Anxiety Stress Scale 21 (DASS-21). A self-administered questionnaire measured depression, anxiety, and stress. The population of this study included health professionals working in health centers, including physicians, nurses, technicians, pharmacists, and other support staff. A total of 167 health professionals were systematically recruited. The mean anxiety score in the study population was 8.26 & 9.0 (corresponding to mild anxiety). Participants without anxiety constituted 26.35% (n = 44) of the participants. Women were significantly more likely to be affected than men (P = 0.0). Age (21-40 years), female nurses, and other health-care workers (anesthesiology, public health, health education, occupational health, psychiatry, etc.) could be strong predictors of psychological disorders (P-value of 0.0). This study provided evidence for primary health care at its preparatory levels, as they are the first line of protection against the COVID-19 pandemic. Addressing the high-risk population is a high priority in the preliminary phase.

Relationship between diabetic knowledge, attitudes and practices among patients with diabetes in China: a structural equation model

ObjectivesWhether the routine delivery of diabetes-related knowledge can change patients’ attitudes and hence influence their self-management activities remains unknown in primary healthcare settings in China. Thus, this study aims to...

Evaluation of prescription review and feedback policy on rational antibiotic use in primary healthcare settings in Beijing, China: a qualitative study using the Theoretical Domains Framework and the behaviour change wheel.

To decelerate antibiotic resistance driven by inappropriate antibiotic prescribing, a prescription review and feedback (PRF) policy is implemented in primary healthcare institutions (PHIs) in Beijing, China. However, evaluation of PRF implementation in PHIs is scarce. This study aims to systematically identify the barriers and facilitators of PRF policy implementation to provide evidence for antimicrobial stewardship. We conducted key informant interviews with 40 stakeholders engaged in the implementation of PRF in Beijing, including physicians, pharmacists and administrators. Interviews were audio recorded and transcribed verbatim. We coded the interview transcripts and mapped informant views to domains of the Theoretical Domains Framework. We then used a behaviour change wheel to suggest possible behavioural interventions. Procedural knowledge (Knowledge) and skills (Skill) of PRF were possessed by stakeholders. They felt responsible to promote the appropriate use of antibiotics (Social/professional role and identity) and believed that PRF could help to change inappropriate provider behaviours (Behavioural regulation) in prescribing antibiotics (Beliefs about consequences) under increased intention on antibiotic use (Stages of change). Moreover, informants called for a more unified review standard to enhance PRF implementation (Goals). Frequently identified barriers to PRF included inadequate capacity (Skill), using punishment mechanism (Behaviour regulation), reaching consistently lower antibiotic prescription rates (Goals), lack of resources (Environmental context and resources) and perceived pressure coming from patients (Social influences). Stakeholders believed that PRF implementation promoted the rational use of antibiotics at PHIs in Beijing. Still, PRF was hampered by inconsistencies in review process and resources needed for PRF implementation.

Effect of COVID-19 pandemic on utilization of maternal healthcare services in a rural area of Haryana - A record-based comparative study.

The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres. This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017-2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017-2019). There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4-20.9%; P < 0.001), and examination at each visit (90.8-72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9-49.9%) and delivery by caesarean section (21.6-27.3%; P = 0.002). COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future.

The Correlation Of Medication Adherence In Patients With Type 2 Diabetes And The Incident Of Hypertension In Primary Health Care Setting

The global incidence and prevalence of type 2 diabetes mellitus has continued to increase over the past three decades and is expected to triple by 2030.1 Based on data from the World Health Organization (WHO), in 2021, 1.28 billion adults worldwide have hypertension.4 In relation to type 2 DM therapy, patient non-compliance in undergoing treatment can cause failure to control blood sugar levels and can cause cardiovascular complications.5 Objective: To determine the relationship between adherence to medication consumption in people with type 2 diabetes mellitus and the incidence of hypertension. Methods: This study used an analytical descriptive method with cross sectional design. Sampling used consecutive sampling techniques with the sample size obtained using the Slovin formula, where the population was 447, resulting in a total sample of 218 respondents who made the inclusion and exclusion criteria. Primary data was obtained from the Medication Adherence Rating Scale-10 (MARS-10) questionnaire which was filled in by the respondent and the respondent’s blood pressure was checked by automatic sphygmomanometer Kenz AC-05P. Data was analyzed using SPSS-25 software with the chi- square test. Results: From 218 respondents, 80 respondents were non-adherent in taking medication and suffered from hypertension (90.9%) and 8 respondents were non-adherent in taking medication and did not suffer from hypertension (9.1%). There were 29 respondents who adhered to taking medication and suffered from hypertension (22.3%) and 101 respondents who adhered to taking medication and did not suffer from hypertension (77.7%). These results obtained a p-value of 0.000 &lt;0.05, which means there is a relationship between adherence to drug consumption in patients with type 2 diabetes mellitus and the incidence of hypertension. Conclusion: There is a relationship between adherence to drug consumption in patients with type 2 diabetes mellitus and the occurrence of hypertension at Puskesmas Sentosa Baru and Puskesmas Sering in Medan City.

A lifestyle intervention to prevent hypertension in primary healthcare settings: A Saudi Arabian feasibility study

BackgroundHypertension is a leading cause of morbidity and mortality in Saudi Arabia, causing a significant public health challenge in the kingdom. In this study, we aimed to assess the feasibility of the Blood pressure LifeStyle Management (BLSM) program for preventing hypertension by making a significant changes in lifestyle interventions through controlling some risk factors such as behavior, diet, physical activities, and weight in Primary Care. AimThe aim of this study is to evaluate the effectiveness of the Blood pressure LifeStyle Management (BLSM) program in reducing blood pressure. MethodsThis is a cohort of three-month period feasibility study in a primary care setting in a before-and-after study design. ResultsA total of 100 individuals were recruited for the study, and 73 have completed the program. The overall systolic (SBP) and diastolic (DBP) blood pressure showed an increment of 0.75 and 1.67 mmHg, respectively. The subgroup analysis exhibited a decrease in SBP (−6.5 mmHg) for patients with hyperlipidemia, while a DBP average increased (+2 mmHg). Females showed a decrease in SBP (−1.04 mmHg) compared to males, who increased in their SBP (+1.69). Smokers showed a significant improvement in SBP and DBP with p < 0.05. ConclusionLifestyle intervention can improve and control blood pressure in primary care settings. The program can be tailored to include more participants, the length of the program could be modified, and the frequency of follow-ups could be increased to enable participants to change their habits and incorporate better life choices in their daily routines.

Older adults’ attitudes and motivations towards learning about personal dementia risk and their willingness to make changes to improve their health in primary care settings

ABSTRACT Objective This study assessed older adults’ preferences, attitudes, and motivations to understand and change their individual risk for developing dementia via screening in primary care settings. Method Eighty-six community-dwelling older adults (aged 60–91 years, M = 74.03, SD = 6.83) completed measures of behavioural intent to undergo dementia risk screening, response efficacy (i.e., belief that screening is useful), negative affective responses (e.g., risk screening results making individuals more scared about the future), motivation to change risk-related behaviours, level of social support, depression, and anxiety symptomatology. Results Overall, participants reported positive attitudes towards dementia risk screening and risk reduction. Two ordinal logistic regressions indicated that response efficacy was a significant predictor of behavioural intent to undergo dementia risk screening, whereas self-efficacy and family history of dementia were significant predictors of motivation to change risk-related behaviours. Barriers included lack of information, motivation, and self-control. Facilitators included access to formal and informal supports, and engagement with social and non-social activities. Conclusions Dementia risk screening and risk reduction in primary care may be more desirable for those with a family history of dementia, high response efficacy, and high self-efficacy. Addressing barriers such as lack of information, motivation, and self-control may improve older adults’ engagement with dementia risk reduction.

Diabetes-Related Microvascular Complications in Primary Health Care Settings in the West Bank, Palestine.

Worldwide, retinopathy, nephropathy, and neuropathy are the major diabetes-related microvascular complications. In Palestine, a low-middle-income country, diabetes is the fourth reason for death. However, a few studies examined diabetes microvascular consequences and its management. Therefore, we carried out a national study that aims to investigate the factors associated with diabetes-related microvascular complications among individuals seeking care in primary healthcare settings of the West Bank of Palestine. Using a cluster systematic sampling technique, 882 participants with diabetes patients were chosen for a cross-sectional study from primary healthcare facilities operated by the Ministry of Health (PMoH), the United Nations Relief and Works Agency (UNRWA), and the Palestinian Medical Relief Society (PMRS). Data about patients related to diabetes-related complications, medication use, and other diseases were extracted from patients' medical records. In addition, an interview face-to-face questionnaire was used to collect information about patients' sociodemographic variables, medical history, smoking habits, duration of the disease, presence of concurrent conditions previous referrals, and hospital admissions, as well as their level of knowledge regarding diabetes, complications, and treatments. Approximately 34.4% of persons with diabetes patients in Palestine encounter at least one microvascular complication associated with diabetes. The most prevalent diabetes-related microvascular complication was retinopathy (17.3%), 23.4% of participants had more than one microvascular complication, and 29% of male patients had erectile dysfunction. A higher probability of having any microvascular complications was associated with older age (over 60 years). Participants with diabetes patients with fundoscopy or ophthalmology reports, according to diabetes follow-up guidelines, were less likely to develop retinopathy. Also, those who performed regular kidney function testing were less likely to have nephropathy, and those who performed a regular foot exam were less likely to develop diabetic foot. Diabetes-related microvascular complications were associated with patient age, low education level, residency location, and adherence to diabetes follow-up guidelines of diabetes management; i.e., having been tested for HbA1c, consulting with specialists, regular kidney function, and foot examination. These factors can be utilized in setting up proper management protocols to prevent or delay microvascular complications in many patients.

Organisational and Structural Drivers of Childhood Immunisation in the European Region

Abstract Background Evaluating the immunisation program is vital to identify the inherent factors that impact the achievement of the intended countrywide vaccine coverage rates (VCRs). However, despite the implementation of widespread vaccination programs, the European Health Systems continue to experience care challenges attributable to organizational and structural issues. This study aimed to review the available data on aspects within the organizational and structural domains that might impact vaccination coverage. Results This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched a comprehensive range of databases from 1 January 2007 to 6 July 2021 for studies that reported quantitative or qualitative research on interventions to raise childhood vaccine coverage. Outcome assessments comprised organizational and structural factors that contribute to vaccine concerns among pediatric parents, as well as data reported influencing the willingness to vaccinate. To analyze the risk of bias, the Ottawa, JBI's (Joanna Briggs Institute) critical appraisal tool, and Amstar quality assessment were used accordingly. The inclusion criteria were met by 205 studies across 21 articles. The majority of the studies were conducted in the United Kingdom (6), the European Union (3), and Italy (3). Conclusions A range of interventions studied in primary health care settings have been revealed to improve vaccination coverage rates including parental engagement and personalization, mandatory vaccination policies, vaccine program redesign, vaccine supply chain design, administering multiple/combination vaccines, improved vaccination timing and intervals, parental education and reminders, surveillance tool and Supplemental Immunisation Activity (SIA), and child health information model. Key messages • Maintaining high vaccine uptake rates is critical to the success of any vaccination program and the improvement of children’s health. • Parents and the general public must be actively engaged by health planners and specialists, and process mechanisms must be implemented to guarantee that children receive primary prevention.

A mixed methods evaluation of a digital antenatal quality improvement intervention in Nepal

Abstract Background Quality antenatal care plays an important role in reducing maternal and perinatal mortality. Electronic decision support systems (EDSS) aim to promote adherence to evidence-based practices. The evaluation aimed to assess the effectiveness of the intervention on improving quality of antenatal care (ANC) and understanding of implementation process and intervention effects. Methods The study was conducted in primary health care settings in Nepal. Theory of change framework was used for mixed-method evaluation. Quantitative and qualitative data were collected at multiple time points. Data were integrated using concurrent triangulation to develop explanations about the implementation process and the observed effects. Results Guided by our theory of change, we identified eleven themes that help to understand how the EDSS was used in the real context, and why the EDSS was not much effective in bringing the desired changes that was required to improve quality of ANC. EDSS appear to slightly influence ANC staff behavior, however, training ANC staff in using the EDSS did not necessarily lead to confidence in using it and ANC staff used the EDSS as recordkeeping system. We found mixed evidence on ANC staff believe that the EDSS offers benefits to their work. Inflexibility of EDSS during ANC consultation caused difficulties adapting to women's need and challenging to integrate the EDSS in ANC staffs’ workflow and daily activities. Inadequate linkage of the EDSS with existing health systems impaired the EDSS guided clinical performance. Conclusions There is some indication that the EDSS have the potential to increase the quality of care. However, the EDDS alone are not enough to bring the adequate change in ANC staff delivery of quality care. Active participation of government and grassroot level understanding of health system would be essential considering conducting further research taking in account the resources, and other factors that hinders the EDSS utilization. Key messages • Concurrent triangulation helps to understand that digital health intervention is not enough to bring intended changes in the quality-of-service delivery at health facility. • Understanding of context and ground reality is essential to improve the quality of care and enhance the performance of healthcare providers.

Attitudes toward vaccination in the Croatian adult population

Abstract Background The COVID-19 pandemic emphasized vaccine hesitancy as one of the major threats to global health. Attitudes toward vaccination are important predictors of vaccination behaviour. This study aimed to investigate attitudes toward vaccination and factors which influence them in the Croatian adult population. Methods This cross-sectional questionnaire study was conducted from June 2020 to December 2020 in the convenience sample of adults from Split-Dalmatia County in the primary healthcare setting. The Vaccination Attitudes Examination Scale (VAX) was used to assess attitudes toward vaccination. The higher scores on the VAX scale reflect more negative attitudes toward vaccination. Results The study sample consisted of 632 subjects (52.7% males and 47.3% females). The median age of all subjects was 38.0 (interquartile range 29.0 - 48.0) years. The median VAX scale score was 42.0 (interquartile range 35.0-50.0). The more negative attitudes towards vaccination were found in females (p = 0.015), subjects aged 25-44 years (p = 0.026) and subjects living in suburban areas (p = 0.040). Conclusions The Croatian adult population displayed quite negative attitudes toward vaccination. The study showed that some sociodemographic characteristics such as gender, age group and place of living had influenced attitudes towards vaccination in the studied population. Bearing in mind that attitudes are closely connected with the practices the development of public health programs created to promote vaccination should take into consideration the sociodemographic characteristics of the population for which they are intended. Key messages • It is highly important to improve attitudes towards vaccination in the Croatian adult population. • Understanding the factors that influence attitudes towards vaccination is crucial to design an appropriate public health program that promotes vaccination in selected population groups.

MicroDoc: Developing a guide for managing infections in Zambian rural low-resource health settings

Abstract Lack of access to diagnostic tests and guidelines that are inappropriate for poorly resourced facilities can result in incorrect and excessive prescribing of antimicrobial therapy in rural healthcare settings. On Call Africa (OCA) and Virtual Doctors (VD) are two non-governmental organisations that work in healthcare in Zambia. Volunteers and staff from OCA and VD have collaborated with the Zambian Ministry of Health and local healthcare providers to design a guide to support decisions around management of infections specifically in rural primary healthcare settings in Zambia. Local staff were initially surveyed for their attitudes towards treatment of infections, the content they would like capacity building in, and preferred modes of learning. The team, comprising public health and infectious disease doctors and GPs from Ireland and the UK with experience working in Zambia, have created a guide called MicroDoc which encompasses workshops, PDFs, flowcharts and modules relating to management of infections and antimicrobial prescribing. All the content can be downloaded and accessed offline. The Zambian Standard Treatment Guidelines were consulted for antimicrobial choice, supplemented by NICE and WHO where necessary. Red flags for urgent hospital referral are also incorporated, as well as modules about risks of antimicrobial resistance. Early versions of the guide have been distributed to a range of facilities in Zambia's Southern Province, with promising feedback from healthcare providers. In collaboration with local partners and input from facility staff, MicroDoc will be finalised and rolled out to more health posts and health centres in the region, with a view to eventually expanding to other regions. The OCA team has been conducting clinical audits of prescribing practices in two rural health posts and it is hoped that the MicroDoc guide will contribute to improved antimicrobial stewardship as well as better outcomes for patients. Key messages • Management of infectious presentations is particularly challenging in rural low-resource primary healthcare settings in Sub-Saharan countries such as Zambia. • A team from On Call Africa and Virtual Doctors has created a guide called MicroDoc, in collaboration with Zambian health authorities, to support decision making in managing infections in primary care.

Expectant fathers' worries and needs: data from a primary mental health care setting in Greece

Expectant fathers' worries and needs: data from a primary mental health care setting in Greece

A wellness intervention to address weight gain in people living with HIV

Abstract Background Dolutegravir-based antiretrovirals are the cornerstone of HIV treatment in LMICs but has shown to be associated with excessive (≥10%) weight gain. Increased body mass index combined with fat redistribution poses increased risk for diabetes, hypertension, and cardiovascular disease. The South African Diabetes Prevention Program (SA-DPP) is a lifestyle intervention program, including nutrition education, physical activity, and other risky behaviors and has been adapted to poorly resourced communities in Cape Town. We aimed to adapt the SA-DPP intervention for people living with HIV (PLWH) and assess its acceptability and feasibility. Methods PLWH and health staff were drawn from three primary health clinics in Cape Town (n = 35). Purposive sampling was used. Five focus groups (FG) with PLWH; two individual interviews (II) with PLWH; five interviews with health staff, including two II with medical doctors; two with a pair of nurses each and a group of three lay counsellors and three II with experts on diet and exercise lifestyle (n = 6). The FG and interviews explored two parts 1) PLWH experience of HIV treatment, their lifestyle issues, the education and support received from clinics and 2) review, evaluation and perspectives on the current SA-DPP intervention and tools. FG and interviews were transcribed and thematically analyzed. Results The SA-DPP curriculum was positively reviewed by PLWH and health staff. This included acceptability of the content and structure of the material. The content was deemed thorough and detailed in relation to nutrition and exercise. “The physical active part here, is something that I need in my life, this is something that I need in my health, the improve your sleep and the stress”. Practical in its approach, gave options within reach, in terms of availability and cost. Conclusions The intervention content was deemed accessible and covered all important areas. Experts thought it a resource PLWH could use over time and across illnesses. Key messages • This study provides insight into the challenges faced by PLWH in trying to live a healthier lifestyle. • The result of this study will translate into a healthy lifestyle intervention that can easily be adopted in the current primary health care set up for PLWH.

Impact of implementing Dutch versus European guideline risk factor targets in older patients with ischaemic heart disease.

In patients with ischaemic heart disease (IHD) aged > 70years, Dutch and European guidelines recommend different treatment targets: low-density lipoprotein cholesterol (LDL-c) < 2.6versus < 1.4 mmol/l and systolic blood pressure (SBP) < 140 versus < 130 mm Hg, respectively. How this impacts cardiovascular event-free life expectancy has not been investigated. The study objective was to compare estimated lifelong treatment benefits of implementing Dutch and European LDL‑c and SBP targets. Data from patients aged 71-80years hospitalised for IHD in 2017-2019 were extracted from the PHARMO Database Network, which links primary and secondary healthcare settings, with follow-up until 31December 2020. Potential benefit according to treatment strategy (in gain in event-free years) was estimated using the SMART-REACH model. Of the 3003 eligible patients, 1186 (39%) had missing LDL‑c and/or SBP measurements. Of the 1817 included patients (36% women, median age at event: 74years (interquartile range (IQR): 72-77), 84% achieved the Dutch targets for both LDL‑c and SBP; for European targets, this was 23% and 61%, respectively. If Dutch targets were met for LDL‑c and SBP (n = 1281), the additional effect of reaching European targets was amedian gain of 0.6event-free life years (IQR: 0.3-1.0). The greatest effect could be reached in patients not reaching Dutch targets (n = 501), with amedian gain of 0.6(IQR: 0.2-1.2) and 1.7(IQR: 1.2-2.5) event-free years with Dutch versus European targets. In patients aged > 70years with IHD, implementation of European targets resulted in agreater gain of event-free years compared with Dutch targets, especially in patients with poorer risk factor control. The considerable number of patients with missing risk factor documentation suggested additional opportunities for risk reduction.

The perspectives of pharmacy student preceptors on a service-learning program in primary health care: A qualitative study

BackgroundThere are a few studies about preceptorship in primary health care settings, but they didn't assess all possible contributions of this experience, such as preceptor behavioral changes and impact on health services. ObjectiveThis study aimed to analyze the perspective of pharmacy student preceptors on a service-learning program carried out in a primary health care setting. MethodsThis was a qualitative descriptive study, with semi-structured interviews and thematic analysis. The themes were defined deductively, according to levels of Kirkpatrick's theory about the impact of educational activities. ResultsThe preceptors showed positive and negative reactions to the structure of the service-learning program, developed their knowledge, changed behaviors such as collaborative interprofessional practice, and reported improvements in the health units. ConclusionsFrom the perspective of pharmacy student preceptor preceptors, the service-learning program had an impact on all levels expected for an educational activity according to Kirkpatrick's theory: reaction, learning, behavior, and results. These findings may inform the design of service-learning programs.

Biblioterapija onkologiniams ligoniams ir jų artimiesiems

Cancer patients experience severe health issues and the resulting emotional and psychological complications; therefore, in addition to medical treatment, they also need emotional/psychological support. Bibliotherapy is one of the possible ways of support. The study is aimed at developing a concept of bibliotherapy for cancer patients and providing practical recommendations for service organizers. It uses a targeted information search on bibliotherapy services in Lithuanian public libraries and a questionnaire survey. The concept of bibliotherapy is based on the theories of nursing, social work and library of science. Bibliotherapy services for cancer patients can be provided in primary health care settings or public libraries. The bibliotherapy service in libraries must be conducted in cooperation with medical professionals. The bibliotherapy service, which can be didactic/informative bibliotherapy (recommended reading lists), personal development bibliotherapy (reading services in public libraries), and reading groups (clubs), can be organized in public libraries or in institutions that provide emotional/psychological support. A number of reading clubs with elements of bibliotherapy have been introduced in Lithuanian libraries. A similar service has been identified for a target group, i.e., cancer patients. On the one hand, naming the target audience of the club may traumatize the potential beneficiaries of the service, and on the other hand, it allows for better dissemination of information and better access for patients. Cooperation between institutions is needed to enable patients to learn about bibliotherapy and to have more confidence in the service.

Do illegitimate tasks matter for registered nurses’ work motivation? A cross-sectional study based on a nationally representative sample of Swedish nurses

BackgroundA challenge in Western countries is the growing need for registered nurses (RNs’) in hospitals, primary care and home healthcare. Decreasing illegitimate tasks and strengthening RNs’ work motivation are some strategies to address this challenge. ObjectiveOur overall aim was to explore the association between RNs' experiences of illegitimate tasks and work motivation operationalised as four dimensions: work engagement, opportunities to provide high-quality care, employer satisfaction and intention to remain at the workplace. To address this aim, three specific research questions were asked: (1) Is there an association between illegitimate tasks and work motivation? (2) Do the levels of reported illegitimate tasks differ between RNs working in hospitals and those working in primary care or home healthcare settings? (3) Do associations between illegitimate work tasks and work motivation differ with type of workplace? DesignA cross-sectional design. MethodsWe used responses from a stratified population of RNs in Sweden, n = 2,333, working either in hospitals, primary care or home healthcare. Calibrating weights were applied in all analyses to ascertain the generalisability of the findings. Illegitimate tasks were measured with the Bern Illegitimate Tasks Scale. Data were analysed using chi-squared tests and linear or logistic regression analysis. Interaction was measured on the multiplicative scale by adding an interaction term to the fully adjusted models. ResultsOverall, approximately 25 % of RNs reported frequently experiencing illegitimate tasks. There were statistically significant associations between higher perceptions of illegitimate tasks and lower ratings in the four dimensions of work motivation: work engagement [beta coefficient [beta] = -0.14, confidence interval [CI] 95 % = -0.18; -0.10], opportunities to provide high-quality care [beta = -0.46, CI 95 % = -0.51; -40] and employer satisfaction [beta = -0.60, CI 95 % = -0.67; -0.54]. Experiencing higher levels of illegitimate tasks also related to a decreased intention to remain at the workplace [illegitimate tasks: odds ratio = 0.32, CI 95 % = 0.27; 0.29]. RNs who worked in home healthcare reported higher levels of illegitimate tasks than RNs who worked in hospitals. ConclusionsReducing the amount of illegitimate tasks may contribute to counteracting the shortage of RNs by increasing work motivation and willingness to remain at the workplace.

Assessment of the Vitamin A supplementation protocol in primary health care settings: A case study of Mookgophong sub-district in South Africa

The Integrated Nutrition Programme in South Africa provides Vitamin A supplementation to targeted children. It began in 1994 when marginal vitamin A deficiency was 33 %. Since that time, malnutrition remains a serious problem in South Africa as one of the greatest contributors to childhood illness and death. It is estimated that about 27% of South African children are stunted from a lack of adequate nutrition in the early years of their lives. A poor intake of vitamin A is one of the cofactors in sight and contribute to blindness amongst children. In addition, it is required for cellular integrity. Furthermore, children with poor intake of vitamin A are underweight, fail to grow properly and are more likely to get infections and to die from them. The main purpose of this study was to assess the implementation process of the vitamin A supplementation protocol in primary health care institutions in the Mookgophong sub-district of Limpopo Province. The study design was descriptive and qualitative. All seven facilities, the clinics and the district hospital in the sub-district were purposefully selected. Data were collected from the seven health care facilities and 16 health care workers provided information on the implementation process of the Vitamin A programme, using a self-administered structured questionnaire. An observation questionnaire was also used by the researcher to validate some of the information and to check compliance with the protocol. The findings revealed poor availability of blue (100 000 IU), white (500 000 IU) and yellow (200 000 IU) capsules in stock (56.3%). Approximately half of the health care workers reported to know the preventative schedule, while most of them did not know the treatment schedule. There was generally good adherence to the implementation of preventative protocol. The health care workers complied with the Vitamin A protocol despite the lack of stock or resources in this low resource setting. Key words: Vitamin A supplementation protocol, health care workers, South Africa

Effects of a Therapeutic Exercise Protocol for Patients with Chronic Non-Specific Back Pain in Primary Health Care: A Single-Group Retrospective Cohort Study.

Back pain is highly prevalent; in Spain, it produces a very high economic cost and the scientific evidence supporting treatments shows low to moderate evidence for exercise. Therefore, the aim of this study was to assess the effectiveness of a therapeutic group exercise protocol in reducing pain intensity and disability in patients with back pain in primary health care setting. A total sample of 149 patients who suffered from chronic non-specific back pain was selected. Patients received a therapeutic exercise protocol, including auto-mobilization exercises for the neck and lumbar regions, as well as core stabilization exercises. Pain intensity and disability were evaluated before and after the therapeutic exercise protocol. Statistically significant differences (p < 0.05) were shown in pain intensity and disability for patients with non-specific neck and low-back pain, with an effect size from moderate to large. A therapeutic exercise protocol may provide beneficial effects upon disability and pain intensity in patients with chronic non-specific back pain, including neck and low-back pain conditions In addition, It could be considered for inclusion as a back-pain-approach program in primary healthcare.