Primary Health Care Units Research Articles

Health Promotion and Health Literacy in the Legal Foundations of the Austrian Healthcare System

Health reform sees health promotion (HP) and health literacy (HL) as essential cornerstones for achieving health policy goals. This article examines the extent to which the legal foundation in the Austrian healthcare system provides a basis for orientation towards HP and HL. The focus of the analysis was set on medical professions, the health care and nursing professions, hospitals, and primary health care facilities. In a first step, legal and other relevant documents were reviewed. For this, a literature-based coding grid was created. In a second step, the legal bases were analyzed and interpreted using the coding grid. Recommendations were derived from the analysis of the legal basis and experts' assessments. Health promotion and health literacy are included in the general legal foundations. However, HP/HL is primarily conceived as a supplementary service with separate financing and is thus less understood as an integral part of any patient contact. The primary health care units and the nursing professions have a relatively clear mandate with regard to HP/HL compared to the hospitals and medical professions. Overall, it was recognized that terminology should be used more coherently and operationalized for the respective areas of cure and care. In particular, the legal bases relating to the medical professions do not build on one another in a coherent manner. Having adequate staff is the key to HP/HL. If these are in place, competencies in the field of HP/HL should be required, promoted, evaluated, and rewarded. HP/HL should be an integral part of any care setting. The concepts of health promotion and health literacy should be operationalized in the legal frameworks of health professions and organizations. This is especially true for the Physicians' Act and for hospitals. Furthermore, the role of patients should be strengthened and the involvement of users in the planning of health services should be further developed.

Mapping lymphatic filariasis morbidities in 24 endemic districts of Ethiopia through the health extension program.

The primary strategy for achieving the second goal of the Global Program to Eliminate Lymphatic Filariasis (GPELF) is morbidity management and disability prevention (MMDP), aimed at alleviating the suffering of affected populations. A significant challenge in many LF-endemic areas is the effective registration and identification of individuals with LF, which is crucial for planning and ensuring access to MMDP services. This study seeks to map the geographical distribution of LF-related morbidities across 24 endemic districts in Ethiopia. A community-based cross-sectional study was conducted to identify individuals affected by LF in 24 endemic districts using primary health care units (PHCUs). The study involved 946 trained health extension workers (HEWs) conducting house-to-house visits to identify and register cases of lymphedema and hydrocele, with support from 77 trained supervisors and 87 team leaders coordinating the morbidity mapping. Certified surgeons performed confirmatory evaluations through clinical assessments on a randomly selected sample of cases to validate HEW diagnoses, ensuring accurate identification of lymphedema and hydrocele. Statistical analysis of the data, including the severity of lymphedema and acute attacks, was conducted using STATA 17. This study involved 300,000 households with nearly 1.2 million individuals, leading to the identification of 15,527 LF cases-14,946 (96.3%) with limb lymphedema and 581 (3.7%) with hydrocele. Among those with lymphedema, 8396 (54.1%) were women. Additionally, 13,731 (88.4%) patients resided in rural areas. Of the 14,591 cases whose acute attack information was recorded, 10,710 (73.4%) reported experiencing at least one acute attack related to their lymphedema in the past 6months, with a notable percentage of males (74.5%; n = 4981/6686). Among the 12,680 recorded cases of leg lymphedema, the percentage of acute attacks increased with severity: 64% (n = 5618) mild cases, 68% (n = 5169) moderate cases and 70% (n = 1893) severe cases. This study successfully mapped the geographical distribution of LF morbidities across 24 LF-endemic districts in Ethiopia, identifying a substantial number of lymphedema and hydrocele cases, particularly in rural areas where healthcare access is limited. The findings underscore the potential of Ethiopia's health extension program to identify affected individuals and ensure they receive necessary care. The findings inform targeted interventions and access to MMDP services, contributing to Ethiopia's goal of eliminating LF by 2027.

Validation of the Mental Illness: Clinicians’ Attitudes Scale: The Factor Structure and Psychometric Properties of the Brazilian Version

Background/Objectives: In the literature, few instruments have been identified to measure the stigma of health professionals toward people with mental illness. In Brazil, until 2021, the literature did not indicate the validation of an instrument or the construction of an instrument for this purpose. Considering this gap, this study aimed to validate and estimate the reliability of the Mental Illness: Clinicians’ Attitudes Scale, version 4 (MICA-4) for the Brazilian context, examining the psychometric properties through the analysis of its internal consistency and factor structure. Methods: Psychometric testing was completed in a sample of health professionals from Primary HealthCare Units. Reliability analysis was conducted in SPSS v23. Cronbach’s Alpha and item total correlation were used. The dimensionality of the MICA was explored using exploratory factor analysis (EFA) in Mplus 8.2. Results: A total of 195 health professionals participated in the research. Cronbach’s Alpha was 0.68 and according to the reliability analysis, items 10 and 12 of the original version were deleted, resulting, therefore, in 14 items. In addition, we demonstrated that it is possible to have only two factors instead of five factors, which is the number of factors in the original version of the MICA-4. Conclusions: This validated instrument for the Brazilian context can serve as an important tool in understanding the phenomenon of the stigma of health professionals toward people with mental illness and, consequently, in promoting anti-stigma strategies in Brazil.

FREQUENCY OF INFECTIOUS AND NON-INFECTIOUS DISEASES DURING THE WAR IN UKRAINE BASED ON SOME PRIMARY MEDICAL CARE UNITS' DATA IN THE CHERNIVTSI REGION

Aim – to investigate the impact of the war in Ukraine and COVID-19 on the frequency of infectious (COVID-19, tuberculosis) and non-infectious diseases (hypertension (AH), diabetes mellitus (DM), obesity, thyroid pathology, chronic kidney disease (CKD)) according to data from primary health care units in Chernivtsi region..Material and methods. The statistical reports of Communal Non-commercial Enterprises (CNEs) "Kitsman Center of Primary Medical Care" of the Kitsman District Council and "City Polyclinic No. 1" of the Chernivtsi City Council for the years 2019-2023 with the number of observed population subject to medical care - 36,508 and 58,500, respectively, were analyzed.Results. During the COVID-19 pandemic (2021-2022), a surge in the incidence of tuberculosis was observed in separate communities, with an almost 7% increase per 100,000 residents in the Chernivtsi region as a whole (in 2022-2023), caused, in our opinion, by the war and an increased population migration. During the period of the COVID-19 pandemic and with the beginning of the full-scale invasion of the russian federation on the territory of Ukraine, a strict trend in the incidence of DM increase (mainly non-insulin-dependent) was established. The frequency of obesity in women increased as well by 17.5%, while in men, on the contrary, it decreased – by 17.42%. The frequency of diffuse goiter in the structure of thyroid diseases decreased by 3%, with a slight elevation in autoimmune thyroiditis.Conclusion. An obvious dependence of changes in the incidence of CKD and hypertension in linkage with the COVID-19 pandemic and the war in Ukraine was not established in the analyzed communities.

Dermatologic Manifestations in Patients with Metabolic Syndrome in Brazil

Metabolic syndrome (MS), a cluster of cardiovascular risk factors associated with increased mortality, exhibits systemic manifestations in various organs, including the skin. This study aimed to investigate the prevalence of dermatological manifestations in patients with MS attending primary healthcare units staffed by Family Health residents in Gurupi, Tocantins, Brazil. This descriptive, cross-sectional epidemiological study enrolled 93 men and women aged between the ages 25 and 60 y across four Basic Health Units and used a questionnaire administered during medical consultations. In total, 69.89% of samples exhibited dermatological manifestations. Morbid obesity was the leading factor linked to MS and skin alterations, with 100% of these patients presenting with some form of dermatosis, the most identified cutaneous manifestations by prevalence were erythematous lesions, papules and plaques, vesicles and blisters, scaling, and changes in pigmentation.

Teleconsultation on patients with type 2 diabetes in the Brazilian public health system: a randomised, pragmatic, open-label, phase 2, non-inferiority trial (TELECONSULTA diabetes trial)

This study addresses the rising burden of type 2 diabetes mellitus, and explores the potential of teleconsultation, as an alternative for diabetes management. The primary objective was to test the hypothesis that teleconsultation is non-inferior to face-to-face consultation in terms of glycaemic control measured as glycated haemoglobin (HbA1c) (non-inferiority margin for the upper confidence interval for the difference between groups of 0,5% in HbA1c) for type 2 diabetes mellitus patients referred from Primary Healthcare to Specialized Care within the SUS. TELECONSULTA, is a randomized, pragmatic, phase 2, single-centre, open-label, non-inferiority trial conducted in Joinville, Brazil. A total of 278 participants diagnosed with type 2 diabetes were randomized through mandatory teleconsulting services from primary care health units. The randomization was 1:1 to teleconsultation or face to face consultation. The study was registered at the Brazilian Clinical Trial Register-REBEC, under the code RBR-8gpgyd. Study status is "Completed". This study included 278 participants in the intention-to-treat (ITT) analysis. The median age was 61 (54-68) years, 167 (60%) were women. The between-groups comparative average reduction in HbA1c was-0.6% (90% CI-1.0;-0.1) at 3-months and-0.5% (90% CI-0.9; 0.0) at 6-months in Modified Intention-to-Treat (mITT) population with imputed data, showing the non-inferiority of teleconsultation. Results with no missing data imputation and in the per protocol population were similar. The frequency of hypoglycaemia and other adverse events was well balanced between groups. The results underscore the transformative potential of telemedicine in addressing the complexities of diabetes management within the framework of a universal healthcare system, contributing with valuable insights for healthcare policymakers and practitioners seeking innovative solutions to tackle the growing diabetes epidemic. This study was funded by the Brazilian Ministry of Health, through the Unified Health System-Institutional Development Support Program (PROADI-SUS).

Uncontrolled chronic pain: can a pain consultation in primary care be a solution?

Chronic pain is one of the most frequent medical problems in Portuguese primary health care. These patients significantly show poorer functioning capabilities and quality of life than the general population. The importance of improving the quality of life in patients suffering from chronic pain is paramount, and a holistic approach must be implemented. However, proper pain evaluation and management may be time-consuming in a routine primary health care consultation. Given the significant impact of this disease, we initiated a dedicated consultation for patients with chronic pain in our primary health care unit. A complete evaluation is performed, and, among other questionaries, the Brief Pain Inventory is applied to evaluate pain impact on functioning at the first appointment and re-evaluated after six months of follow-up. In the first six months, 31 patients with uncontrolled pain were referred by their family physicians to this consultation. Non-pharmacological strategies were strongly recommended alongside pharmacological therapies. Although this consultation is relatively recent, our patients with longer follow-ups showed improvement in both maximum and minimum pain levels and substantial improvement in all the measured interferences in the Brief Pain Inventory. Even though there is literature that thoroughly describes the impact of pain on patients’ quality of life, there is much to be done to change this problem. Since family physicians know their patients and their contexts well, they are in a privileged position to manage this problem, and a specific pain consultation in primary health care can be one of the best services for managing pain.

Productivity and consultation times in Portuguese primary care: trends and payment model variations

Abstract Background Portugal faces a shortage of primary care workforce resulting in an increase in patients without Family Physician (FP). While expanding the patient list per FP may help, it could also result in excessive workloads, compromising Consultation Times (CT) and quality of care. Furthermore, it is important to study the role of the primary healthcare (PHC) financing model in incentivizing their productivity. This study aims to analyse the productivity and CT in PHC units in Portugal, variation over time, and differences across PHC unit payment models. Methods 6,563 PHC units with different payment models (salary at UCSP, salary and group pay-for-performance at USF-A, and salary, capitation, and individual pay-for-performance at USF-B) from 2015 to 2022 were analysed, including the annual numbers of medical and nursing consultations and full-time equivalents (FTE) of physicians and nurses. Weekly productivity (WP) was calculated using the consultations per FTE physician and nurse. CT were determined by dividing each FTE’s weekly workload by WP. Multivariate analysis explored differences in CT between PHC units, temporal variations, and the influence of the patient population characteristics. Results FTE physicians had a mean WP of 117 consultations (SD 39) lasting 22.4 minutes (SD 7.0). FTE nurses had a mean WP of 56 consultations (SD 18) lasting 41.0 minutes (SD 14.3). Compared to UCSPs, USF-A and USF-B had shorter CT (p < 0.05) by 2.48 to 4.05 minutes for medical consultations and by 5.51 to 8.04 minutes for nursing consultations. CT increased over time, decreased with higher PHC age and favorable socio-demographic context, and increased with higher population density and elderly patients’ proportion (p < 0.05). Conclusions USF-B professionals showed higher productivity and shorter CT, suggesting that financial incentives are effective in enhancing productivity but that gains may be obtained with losses in visit duration. Key messages • Effective workforce management is crucial given the current primary care professionals shortages. • Physicians and nurses in PHC units pay-for-performance exhibit higher productivity and shorter consultation time.

Optimizing vaccination to reduce waste and boost coverage in Primary Health Care Units

Abstract Background In immunization, vaccine consumption typically exceeds the number of recipients. The number of doses per vial influences wastage and vaccination coverage goals. In Brazil, 48% of the National Immunization Program’s vaccines are multidose, with 4 having limited shelf-life post-opening. Strategies to reduce wastage aim to optimize dose utilization, enhance process quality, and broaden coverage effectiveness. The objective was to outline strategies for reducing wastage and expanding coverage for children under 5 in 14 São Paulo city Primary Health Care Units (PHCUs). Methods The Lean Six Sigma approach guided the stages. A group conducted contextual analysis to identify PHCU barriers. Data on wasted doses and vaccination were gathered. Weekly meetings for data analysis began in May 2023, following DMAIC phases: Define, Measure, Analyze, Improve, Control. An action plan stemmed from these phases for PHCU implementation. Results Data analysis, from January 2022 to June 2023, revealed a significant vaccine wastage trend, reaching 59% from January to December 2022 and increasing to 63% from January to June 2023. This wastage incurs an average annual cost of R$614,416.26, due to lost doses from expiration after vial opening and expiration of shelf life. The vaccines analyzed were BCG, Oral Polio Vaccine (OPV), Measles, Mumps, and Rubella (MMR), and Yellow Fever. At the project start in May 2023, vaccination coverage was 90%, increasing to 93% afterward. This rise resulted from actions taken and improved data monitoring. Post-project, vaccine wastage reduced by 7 percentage points (from 62% to 56%). Conclusions Addressing vaccine wastage and expanding vaccination coverage for children under 5 are critical in healthcare. Utilizing Lean Six Sigma, key issues in PHCUs were identified, leading to an action plan that reduced wastage, increased coverage, and standardized processes. Key messages • Vaccines are valuable resources and wasting them means reducing financial resources in health. • Vaccination coverage is crucial to protect the population’s health, prevent disease outbreaks, and maintain the country’s economic health, reducing costs for treating preventable diseases.

Social prescribing for healthy ageing: insights from older people referral and uptake in Portugal

Abstract The population ageing presents multifaceted challenges for health systems, with implications for healthcare delivery and health and well-being outcomes. Innovative integrated-care approaches are needed to promote healthy aging and the quality of life of older people. Social Prescribing (SP) has emerged as a promising strategy to address the complex health and social needs of populations, including those older, offering non-medical interventions that encompass social, cultural, and community-based activities. SP has been implemented in Portugal since 2018 and currently target different subgroups, including elderly. This study aims to examine referral and uptake of older people to SP in Portugal. This cross-sectional study analysed sociodemographic, health condition, referral and uptake-related data from older patients (≥65 years) engaged in SP, collected through a survey and registries at primary healthcare units in Lisbon between 2018-2023. Of the 1060 patients referred to SP, 43.9% (n = 465) were aged 65 years or older. Within this age group, 38.1% were 71-80 years old and 36.1% were 81-90 years old; 67.5% were female. Around 48% were referred to SP for social isolation, 40% for social and financial support, and 32.5% for functional dependency. Two thirds had two or more chronic conditions, with cardiovascular disease (59,1%), mental health disorders (29,2%), and obesity (27,1%) being the most frequent. The SP consultations uptake rate was 59.1%, and patients were referred to a range of activities provided by third-sector organisations, as psychosocial support, home care, senior university classes, arts activities, and support in medicine management. The elderly population accounts for a large proportion of SP referrals. Further efforts are needed to identify the factors that influence patients’ acceptability and adherence and to promote the sustainability of SP and the well-being of the population. Key messages • Older people referred to SP initiative in Portugal have complex health-social needs, which reinforces the relevance of adopting a holistic centred-care approach to respond to the aging challenges. • Through SP older people have been integrated in community-based activities that promote their health and wellbeing, thus it is needed to develop tailored strategies to improve patient uptake.

Understanding Hand Hygiene Knowledge Gaps: Insights from Primary Healthcare in Portugal

Abstract Background Healthcare-associated infections cause a significant burden of disease globally. Hand hygiene is crucial for preventing these infections but despite recommendations, compliance with hand hygiene protocols among healthcare professionals is often inadequate. In Portugal, there have been several initiatives aiming to increase awareness on the importance of hand hygiene practices amongst healthcare professionals including in primary healthcare facilities. Nationally, there are two models of organization of primary healthcare facilities with differences in funding and allocation of resources. Methods In this study, the World Health Organization’s Hand Hygiene Knowledge Assessment Questionnaire for Healthcare Professionals was translated into Portuguese and validated with infection control specialists. It was then distributed to primary healthcare professionals in the Northern Lisbon area, in March 2024 to assess knowledge on hand hygiene practices and highlight potential training needs. The responses were analyzed, with the Kruskal-Wallis test carried out, followed by the Mann-Whitney U test when required. Results A response rate of 21,5% (65/302) was obtained, with most participants being nurses (58%), followed by physicians (34%). There was a statistically significant difference depending on the model of organization of the primary healthcare unit to which the participant belonged (χ2 = 8.428, p = 0.014, df = 2)., There was no significant difference between the score and the professional category of the participant (χ2 = 5.76, p = 0.12, df = 3). Conclusions The findings of this study show that the model of organization of a primary healthcare unit can impact the knowledge of professionals and not just practices. This study also underscores the significance of comprehensive assessments of the context before interventions and the need for further studies to understand how we can better inform future training initiatives. Key messages • Organizational differences in primary healthcare units impact hand hygiene knowledge among professionals, emphasizing the need for tailored training initiatives. • Comprehensive assessments of healthcare contexts, coupled with validated linguistic tools, are crucial for reliable intervention strategies in infection control.

Use of herbal medicinal products among patients in primary health care in a Brazilian southeastern city: evidence from the Prover project.

To determine the prevalence and factors associated with herbal medicinal product use among primary healthcare patients in southeastern Brazil. A cross-sectional study combined with documentary research was conducted between August and November 2017, involving interviews with 1,221 adults following dispensing from primary healthcare units. The characterization of herbal medicinal product usage included assessing the prevalence, redundancy, and interaction indicators, as well as identifying sources of recommendation and acquisition. Descriptive statistics were used for variable analysis and logistic regression was used to estimate the factors associated with herbal medicinal product usage, calculating odds ratios at a significance level of 5%. The prevalence of herbal medicinal product usage was 3.8%, with 60% of them prescribed by physicians. Private pharmacies (53%) were the main sources, and Valeriana officinalis (42%) was the most cited plant species and the sole herbal medicinal product on the municipal list. The indicators of redundancy and interactions between concurrently prescribed pharmaceutical and herbal medicinal products were 42.9% and 28.6%, respectively. Herbal medicinal products usage correlated with the female sex (OR= 2.50; 95%CI= 1.11-5.59), non-white race (OR= 0.52; 95%CI= 0.28-0.94), monthly income above 1 minimum wage (OR= 3.48; 95%CI= 1.51-8.01), and self-reported of anxiety, mood disorder or depression (OR= 2.97; 95%CI= 1.55-5.66). Despite the low use of herbal medicinal products, users face a high potential for interactions and therapeutic redundancy. Special attention should be paid to patients taking herbal medicinal products and allopathic medicines concurrently. Women with anxiety, mood disorders, or depression were more likely to use herbal medicinal products, whereas non-white people were 48% less likely to use them, suggesting potential socioeconomic disparities in access.

Pregnancy-Induced Hypertensive Disorders predictors among pregnant and delivery mothers receiving care in public health institutions in Sidama, Ethiopia: a multicenter case control study

BackgroundPregnancy-Induced Hypertensive Disorders (PIHD) include conditions like Pre-Eclampsia, Eclampsia, and Gestational Hypertension, impacting 5–10% of pregnancies globally. These disorders are responsible for 16% of maternal deaths in Sub-Saharan Africa and account for 16.9% of maternal mortality in Ethiopia, representing 10% of the country's total maternal deaths.ObjectiveTo identify predictors of PIHD among pregnant and delivery women in public hospitals and primary health care units (health centers) in Sidama, Ethiopia.MethodsA multi-center unmatched case–control study was conducted on women in antenatal care and obstetrics/gynecology departments at 12 randomly selected public health institutions, including one specialized teaching hospital, two general hospitals, three primary hospitals, and six health centers. The study involved 920 women (230 cases and 690 controls) selected from December 2023 to February 2024. Cases included pregnant or delivery women at 20 + weeks gestation with PIHD such as pre-eclampsia, eclampsia, gestational hypertension, and chronic hypertension with superimposed preeclampsia. Controls were normotensive pregnant women or delivering mothers without PIHD after 20 weeks gestation. Data was manually verified, entered, and validated using Epidata software, followed by analysis with SPSS 22. Univariate analysis assessed predictors of PIHD, while binary logistic regression evaluated the relationships between factors. Model fitness was checked using collinearity assessments and the Hosmer–Lemeshow test, with variables having a P value < 0.05 deemed independent predictors.ResultsOut of 920 planned participants, 686 were included, resulting in a response rate of 94.35%. Factors associated with PIHD in women included age at first conception (AOR = 1.26), mid (AOR = 6.05) and high (AOR = 5.01) wealth index levels, multigravidity (AOR = 4.34), pregnancy age ≥ 42 weeks (AOR = 3.65), maternal mid-upper arm circumference (MUAC) (AOR = 1.29), hemoglobin levels of 6.5–10.9 g/dL (AOR = 5.59), pre-pregnancy Body Mass Index (BMI) ≥ 25 kg/M2 (AOR = 0.81), preexisting hypertension (AOR = 8.97), family history of diabetes mellitus (AOR = 20.02), former alcohol consumption (AOR = 0.27), and total physical activity during pregnancy (AOR = 0.54).ConclusionsThe study identifies key predictors of PIHD in women, including age at conception, wealth index, multigravidity, gestational age, and pre-pregnancy BMI. It underscores the link between socioeconomic status and maternal health, highlighting that financial resources alone don’t ensure better outcomes without educational access. The research advocates for a health intervention strategy focusing on socioeconomic factors and public health initiatives to reduce maternal health disparities while exploring the role of partner stability and psychosocial aspects.

USO CRÔNICO DE BENZODIAZEPÍNICOS POR IDOSOS E A DIFICULDADE DE DESMAME NA UNIDADE BÁSICA DE SAÚDE: UM RELATO DE EXPERIÊNCIA

INTRODUCTION: The use of benzodiazepine drugs is extremely useful in modern medicine, especially considering the broad application of these medications. However, due to the rapid action of these drugs, indiscriminate use could be obser Benzodiazepines; Deprescribing; Tapering; Elderly; Primary careved, particularly among the elderlypopulation. OBJECTIVE: To present the challenges related to the process of deprescribing benzodiazepines in the elderly at a primary healthcare unit in the city of Anápolis-GO, during the period from March 2023 to July 2024. RESULTS AND DISCUSSION: While the relative and temporary benefits of benzodiazepineswere noticed, the difficulties associated with their adverse effects and the challenging deprescribing process became evident. CONCLUSION: It is clear that the difficulty is widespread, and the best strategy is to exercise more caution when managing comorbidities in the elderly.

USO CRÔNICO DE BENZODIAZEPÍNICOS POR IDOSOS E A DIFICULDADE DE DESMAME NA UNIDADE BÁSICA DE SAÚDE: UM RELATO DE EXPERIÊNCIA

INTRODUCTION: The use of benzodiazepine drugs is extremely useful in modern medicine, especially considering the broad application of these medications. However, due to the rapid action of these drugs, indiscriminate use could be obser Benzodiazepines; Deprescribing; Tapering; Elderly; Primary careved, particularly among the elderlypopulation. OBJECTIVE: To present the challenges related to the process of deprescribing benzodiazepines in the elderly at a primary healthcare unit in the city of Anápolis-GO, during the period from March 2023 to July 2024. RESULTS AND DISCUSSION: While the relative and temporary benefits of benzodiazepineswere noticed, the difficulties associated with their adverse effects and the challenging deprescribing process became evident. CONCLUSION: It is clear that the difficulty is widespread, and the best strategy is to exercise more caution when managing comorbidities in the elderly.

Health Literacy and Adherence to Therapy in Type 2 Diabetes: A Cross-Sectional Study in Portugal.

Therapy adherence is a key factor in the control of type 2 diabetes mellitus (T2DM). Optimal self-care requires skills in health literacy (HL). This study aims to analyze the relationship between HL and adherence to therapy and to understand the possible influence of other sociodemographic and disease variables. A multicenter, cross-sectional study was conducted in Portuguese in 13 different primary health care units in both rural and urban environments. A sociodemographic questionnaire and two validated instruments, "Medical Term Recognition Test" and "Summary of Diabetes Self-Care Activities," were applied. The last value of hemoglobin A1c (HbA1c) and the number of chronic medications were collected from clinical records. Descriptive statistics and bivariate correlations were performed as well as multivariable linear regression to assess the association between HL and adherence to therapy. Participants (n = 354) were on average age 63.67 ± 10.39 years, 57.1% male and 42.9% female, 68.4% with inadequate HL and an average HbA1c of 7 ± 1.18%. Better HL was correlated with higher adherence to the total of self-care activities, nonpharmacological therapy, and foot care. In multivariable linear regression analyses, better HL (β = 0.176, p = .003), less than minimum wage (β = -0.197, p = .001) and insulin therapy (β = 0.272, p = .001) were independently associated with increased adherence to overall self-care activities. In a representative sample of people with T2DM in Portugal, HL was a key factor for greater adherence to demanding self-care activities. [HLRP: Health Literacy Research and Practice. 2024;8(4):e194-e203.].

A novel predictive model for optimizing diabetes screening in older adults.

The fasting blood glucose test is widely used for diabetes screening. However, it may fail to detect early-stage diabetes characterized by elevated postprandial glucose levels. Hence, we developed and internally validated a nomogram to predict the diabetes risk in older adults with normal fasting glucose levels. This study enrolled 2,235 older adults, dividing them into a Training Set (n = 1,564) and a Validation Set (n = 671) based on a 7:3 ratio. We employed the least absolute shrinkage and selection operator regression to identify predictors for constructing the nomogram. Calibration and discrimination were employed to assess the nomogram's performance, while its clinical utility was evaluated through decision curve analysis. Nine key variables were identified as significant factors: age, gender, body mass index, fasting blood glucose, triglycerides, alanine aminotransferase, the ratio of alanine aminotransferase to aspartate aminotransferase, blood urea nitrogen, and hemoglobin. The nomogram demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.824 in the Training Set and 0.809 in the Validation Set. Calibration curves for both sets confirmed the model's accuracy in estimating the actual diabetes risk. Decision curve analysis highlighted the model's clinical utility. We provided a dynamic nomogram for identifying older adults at risk of diabetes, potentially enhancing the efficiency of diabetes screening in primary healthcare units.

Diarrheagenic Escherichia coli in Stool Specimens Collected from Patients Attending Primary Healthcare Facilities in Ethiopia: Whole-Genome Sequencing-Based Molecular Characterization.

The diarrheagenic Escherichia coli (DEC) is the major cause of diarrheal diseases in Africa, including Ethiopia. However, the genetic diversity of E. coli pathotypes found in Ethiopia has not been studied well. This study aimed to characterize potential DEC belonging to enteropathogenic (EPEC), Shiga toxin-producing (STEC), enteroaggregative (EAEC), enterotoxigenic (ETEC), and enteroinvasive (EIEC) E. coli pathotypes from stool specimens of patients attending primary healthcare units (n = 260) in Addis Ababa and Hossana using whole-genome sequencing. Real-time PCR assays were used to identify DEC isolates belonging to EPEC, STEC, EAEC, ETEC, and EIEC pathotypes, which were then subjected to whole-genome sequencing on the Illumina platform. Twenty-four whole-genome nucleotide sequences of DEC strains with good enough quality were analyzed for virulence-associated genes (VAGs), antibiotic resistance genes (ARGs), phylogenetic groups, serogroups, and sequence types. The majority (62.5%) of DEC isolates belonged to the phylogenetic group B1. The identified DEC isolates belonged to 21 different serogroups and 17 different sequence types. All tested DEC isolates carried multiple VAGs and ARGs. The findings highlight the high diversity in the population structure of the studied DEC isolates, which is important for designing targeted interventions to reduce the diarrheal burden in Ethiopia.

Effectiveness of group-based psycho-education on preventing postpartum depression among pregnant women by primary healthcare provider in primary healthcare institution: a cluster-randomized controlled trial.

In Ethiopia, one in five mothers suffers from postpartum depression, which needs to be prevented through interventions. According to the World Health Organization, maternal healthcare providers have a unique opportunity to provide psychosocial interventions to prevent the damaging effects of perinatal depression. Hence, this study assessed the effectiveness of prenatal group-based psycho-education in preventing postpartum depression (PPD) in primary healthcare units. We conducted a two-arm cluster-randomized controlled trial, enrolling 550 pregnant women at 12-20 weeks of gestation with a normal score (0-4) and a mild score (5-9) on the Patient Health Questionnaire-9 (PHQ-9). The study utilized simple randomization techniques to assign clusters between arms in a 1:1 ratio. The data was collected through face-to-face interviews conducted at 12-20 weeks of gestation and 6 weeks postpartum. The intervention group received usual care plus five prenatal group-based psycho-education (PGBPE) classes, while the control group received only usual care. The PPD status between arms was compared using the chi-square test of association. A mixed-effects multilevel logistic regression model was also used to examine the predictors of the outcome variables. The overall response rate at the end line was 92.9%. Thus, compared to that in controls, the PPD in the intervention clusters was considerably lower (20 (7.6%) vs. 74 (28.9%)), P = 0.001)/65% (AOR = 0.35, 95% CI = 0.13-0.99), although no difference was detected at baseline. Social support (AOR = 0.04, 95% CI = 0.01-0.15), partner emotional support (AOR = 0.24, 95% CI = 0.12-0.51), PPD literacy (AOR = 0.25, 95% CI = 0.11-0.62), and self-esteem (AOR = 0.22, 95% CI = 0.11-0.47) were more likely to protect mothers from PPD. On the contrary, domestic work (AOR = 9.75, 95% CI = 3.37-28.16), neonates with complications (AOR = 5.79, 95% CI = 2.04-16.45), and unhealthy coping (AOR = 2.39, 95% CI = 1.06-5.42) exposed mothers to PPD. The implementation of a PGBPE in primary healthcare units (PHCUs) was effective at preventing PPD. Therefore, this intervention method has to be promoted and used in PHCUs to prevent PPD. [Pan African Clinical Trial Registry], identifier [PACTR 202203616584913].

Relationship Between Smoking and Lipid Profile in Four Primary Health Care Units: A Research Study.

Introduction Smoking is the most preventable cause of cardiovascular disease (CVD).Dyslipidemia is also an important risk factor for CVD. Yet, research has provided contradicting findings regarding the association between smoking and blood lipids. This study aims to assess the relationship between smoking and dyslipidemia, as well as compliance with the previously established treatment target. Materials and methods This was a cross-sectional study. Apparently, healthy users aged 40 or over, were from four primary health care units (PHCU) in Portugal. The inclusion criteria were: age between 40 and 69 and active enrollment in one of the four PHCU. The exclusion criteria were: background of atherosclerotic disease, heart failure, chronic kidney disease, diabetes mellitus, and a history of acute myocardial infarction; no record of lipid profile or triglyceride value of more than 400 mg/dL.Cardiovascular risk levels were determined using the Systematic Coronary Risk Evaluation (SCORE) 2 risk. The low-density lipoprotein cholesterol (LDL-c) target was considered the recommendation by the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2019. Results From an initial population of 16,939 patients, 12,076 apparently healthy patients were included.The difference between cholesterol values is statistically significant, with total cholesterol, LDL-c, and triglyceride values tending to be higher in the smoking group and the high-density lipoprotein cholesterol (HDL-c) value tending to be higher in the non-smoking group. Regarding the LDL target, there is also a statistically significant difference between smokers and non-smokers. Discussion Smoking and dyslipidemia are two isolated cardiovascular risk factors. Their association has been questioned. This study demonstrated that there is an association between smoking and the lipid profile, but also with the LDL target. However, there are some biases that must be considered, and which do not allow for generalization. Conclusions This study concludes that smoking negatively influences the lipid profile, with lipids being found less frequently on target. However, more studies are needed in this area, particularly studying other relevant factors such as body mass index.