Primary Management Research Articles

Evaluating the World Health Organization's HEARTS Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala.

The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study's objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guatemala. We conducted a single-arm pilot implementation trial over 6 months from October 2023 to May 2024 in 11 Guatemalan Ministry of Health primary care facilities in two districts. The pilot evaluated a package of five HEARTS-aligned implementation strategies to improve the pharmacological treatment of hypertension and diabetes. The primary outcomes were feasibility and acceptability, measured through 20 structured interviews with Ministry of Health employees and by examining enrollment and retention. Secondary outcomes included a suite of implementation and clinical outcomes, including treatment rate. The study enrolled 964 patients, of whom 58.8% had hypertension only, 30.4% had diabetes only, and 10.8% had both conditions. Surveys on feasibility and acceptability among Ministry of Health staff had a median score of 5.0 (IQR: 5.0 to 5.0) and 5.0 (IQR range: 4.8 to 5.0), respectively, exceeding the prespecified benchmark of ≥3.5. Both districts achieved the prespecified benchmark of enrolling ≥25 hypertension patients and ≥25 diabetes patients. Only 36% of patients attended a follow-up visit within three months, lower than the prespecified benchmark of ≥75%. M treatment rates during the pilot increased by 22.3 (95% CI: 16.2 to 28.4; P<0.001) and 3.5 (95% CI: -1.6 to 8.7; P=0.17) patients per month for hypertension and diabetes, respectively. Implementation of an integrated hypertension and diabetes model based on HEARTS was generally feasible and acceptable in the Ministry of Health in Guatemala. Findings can refine national scale-up in Guatemala and inform HEARTS implementation projects in other settings.

Component-resolved diagnostics of fruit and vegetable allergy: precise identification and individualized treatment strategies

Vegetable and fruit allergies are common types of food allergies worldwide, most of them are triggered by primary sensitization to pollen. Most allergens in vegetables and fruits belong to a few cross-reactive proteins such as PR-10 proteins, profilins, and nsLTPs. The presence of these allergens in various plants can lead to widespread cross-reactive allergic responses. Component-resolved diagnostics (CRD) can improve diagnostic accuracy by precisely identifying specific allergenic proteins, aiding physicians in making more accurate treatment and management decisions, and reducing unnecessary food avoidance. This article, based on the "Molecular Allergology User's Guide 2.0 (MAUG 2.0)" issued by the European Academy of Allergy and Clinical Immunology (EAACI), analyzes the primary mechanisms, relevant allergens, and diagnostic and clinical management strategies for vegetable and fruit allergies. By detailing and analyzing these allergenic components, this article may help the healthcare professionals to deep the understandings of vegetable and fruit allergies, offer new perspectives and practical guideline for the research and treatment of these allergies, and promot the development of precise diagnostics and personalized treatment strategies.

Smart pain relief: Harnessing conservative Q learning for personalized and dynamic pain management

Pain represents a multifaceted sensory and emotional experience often linked to tissue damage, bearing substantial healthcare costs and profound effects on patient well-being. Within intensive care units, effective pain management is paramount. However, determining suitable dosages of primary pain management drugs like morphine remains challenging due to their reliance on diverse patient-specific factors, including cardiovascular responses and pain intensity. To date, only a singular effort has explored personalized pain treatment recommendations through reinforcement learning. Regrettably, this pioneering study faced limitations stemming from incomplete patient state observations, a restricted action space, and the use of Deep Q-Networks, known for their sample inefficiency and lack of clinical interpretability. In our work, we introduced a Conservative Q-learning-based system for pain recommendation, enriching it with expanded state and action spaces. Additionally, we developed a comprehensive pipeline for both qualitative and quantitative evaluations, focusing on assessing the trained model’s performance. Our findings indicate a slight performance improvement over the clinician’s policy, offering a more clinically sensible and understandable approach compared to the current state-of-the-art methodologies.

Comparative outcomes of surgical and conservative management in carotid artery dissection.

Carotid artery dissection (CAD) is a significant cause of strokes in young individuals, leading to severe complications and socioeconomic burdens. Despite antithrombotic therapy being the primary management strategy, optimal treatment for patients with recurrent or worsening symptoms remains undefined. This study aims to describe the characteristics and evaluate the outcomes of conservative versus surgical management in CAD patients. A total of 23 patients presenting with CAD from November 2014 to December 2021 were reviewed retrospectively. Patient demographics, vascular risk factors, symptoms, imaging results, treatment details, and follow-up information were collected and analyzed. Propensity score matching (PSM) was utilized to enhance comparability. The mean age of the patients was 46.4 ± 9.4 years, with a median follow-up of 12 (range 3-90) months. Of the 23 patients reviewed, seven underwent endovascular treatment or open surgery due to unresponsiveness to conservative therapy, while 16 received conservative management. All patients showed regression of symptoms. Surgical patients showed a significant improvement with a 100% patency rate during the follow-up. PS matching adjusted for baseline differences, yielding comparable groups for analysis. No significant difference between treatment approaches was observed in stroke recurrence rates, although surgical intervention showed promising outcomes in symptom resolution and stroke prevention. Both conservative and surgical management of CAD can lead to favorable outcomes. While conservative therapy remains the initial approach and proves effective, surgery appears beneficial and safe in certain cases unresponsive to conservative treatment. Further investigation through larger prospective and randomized trials is necessary to establish its safety and efficacy.

Routine health data use for decision making and its associated factors among primary healthcare managers in dodoma region

BackgroundData demand and use culture have a tremendous impact on the proper allocation of scarce resources and evidence-based decision making. However, primary healthcare managers in the majority of Sub-Saharan African countries continue to struggle with using routine health data for decision-making.Purpose/objectiveThis study aimed to assess routine health data use for decision making among primary healthcare managers in Dodoma region.MethodsCross-sectional study design involved 188 primary healthcare managers from Dodoma City Council, Kondoa Town Council and Bahi District Council was conducted. A self-administered questionnaire adapted from the Performance of Routine Information System Management (PRISM) tools was used to collect the data. Data was analysed by using the Statistical Package for Social Science (SPSS) program. Principal Component Analysis was used to find the level of routine health data use, binary logistic regression analysis was used to determine factors associated with routine health data use for decision making among primary healthcare managers. The study was conducted from May to June, 2022.ResultsThe level of adequate routine health data use for decision making among healthcare managers was 63.30%. Factors associated with adequate routine health data use for decision making among healthcare managers were; respondents characteristics: years of working experience (OR = 1.955, 95% CI= [0.892,4.287]), district surveyed (OR = 4.760, 95%CI= [1.412,16.049]), level of health facility (OR = 3.867, 95%CI= [1.354,7.122]) and male gender (OR = 1.901, 95%CI= [1.027,3.521]). Individual factors: comparing data with strategic objectives (OR = 2.986, 95%CI= [1.233–7.229]), decision based on health needs (OR = 7.330, 95%CI= [1.968–27.295]) and decision based on detection of outbreak (OR = 3.769, 95%CI= [1.091–13.019]). Technical factors: ability to check data accuracy (OR = 3.120, 95%CI= [1.682–5.789]), ability to explain findings and its implication (OR = 2.443, 95%CI= [1.278–4.670]) and ability to use information to identity gaps and targets (OR = 2.621, 95%CI= [1.381–4.974]). Organizational factors: organizational support (OR = 3.530, CI= [1.397–8.919]), analyse data regularly (OR = 2.026, 95%CI= [1.075–3.820]) and displays information on key performance indicators (OR = 3.464, 95%CI= [1.525–7.870]).Conclusion and recommendationThe level of routine health data use for decision making among primary healthcare managers was found to be modest. The level of data demand and use culture may increase more quickly if capacity building is strengthened and issues that de-motivate primary health care managers from using data are addressed.

Association of Physicians of India: National Expert Opinion and Clinical Practice Recommendations for Primary Care Cough Management in India.

Pathological cough in primary care is a significant concern. With a prevalence ranging from 5 to 10% in India, cough is the second most common symptom seen by general practitioners (GPs). The existing algorithms and tools that are available are generally meant for cough categorization in specialized fields; their limited adoption by GPs results in insufficient screening and categorization of cough, which results in the use of irrational fixed drug combination formulations. Formulation of recommendations for GPs to enable them to appropriately screen and categorize cough for efficient management and avoid irrational treatments. An expert panel (seven experts specializing in pulmonology and internal medicine) held a virtual discussion to assess the necessity for cough categorization and develop user-friendly tools, along with a simplified format for history taking in cough evaluation and management. Panel discussions were based on a questionnaire that contained items related to the categorization of cough, assessment tools, and approaches to treating cough. After deliberations, simplified clinical practice recommendations and assessment tools were developed by the experts to facilitate the categorization of cough into wet or dry categories, thereby helping in the symptom-based management of cough. By adhering to these principles and using assessment tools, primary care practitioners can optimize cough management, avoid irrational drug combinations, minimize potential risks, and improve patient well-being.

Evaluation of an electronic clinical decision support algorithm to improve primary care management of acute febrile illness in rural Cambodia: protocol for a cluster-randomised trial

IntroductionAcute febrile illness (AFI), traditionally attributed to malaria, is a common reason for seeking primary healthcare in rural South and Southeast Asia. However, malaria transmission has declined while health workers...

Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis.

Improving access to primary care physicians' services may help reduce hospitalizations due to Ambulatory Care Sensitive Conditions (ACSCs). Ontario, Canada's most populous province, introduced blended payment models for primary care physicians in the early- to mid-2000s to increase access to primary care, preventive care, and better chronic disease management. We study the impact of payment models on avoidable hospitalizations due to two incentivized ACSCs (diabetes and congestive heart failure) and two non-incentivized ACSCs (angina and asthma). The data for our study came from health administrative data on practicing primary care physicians in Ontario between 2006 and 2015. We employ a two-stage estimation strategy on a balanced panel of 3710 primary care physicians (1158 blended-fee-for-service (FFS), 1388 blended-capitation models, and 1164 interprofessional team-based practices). First, we account for the differences in physician practices using a generalized propensity score based on a multinomial logit regression model, corresponding to three primary care payment models. Second, we use fractional regression models to estimate the average treatment effects on the treated outcome (i.e., avoidable hospitalizations). The capitation-based model sometimes increases avoidable hospitalizations due to angina (by 7 per 100,000 patients) and congestive heart failure (40 per 100,000) relative to the blended-FFS-based model. Switching capitation physicians into interprofessional teams mitigates this effect, reducing avoidable hospitalizations from congestive heart failure by 30 per 100,000 patients and suggesting better access to primary care and chronic disease management in team-based practices.

The Adoption and Impact of Climate-Smart Water Management Technologies in Smallholder Farming Systems of Sub-Saharan Africa: A Systematic Literature Review

Agriculture plays a significant role in global water consumption, accounting for approximately 70% of the world’s freshwater usage. This makes this sector a critical factor in the depletion of water resources. Accordingly, this paper explores potential mitigatory impacts of climate-smart water management (CSWM) technologies in sub-Saharan Africa. About 70% of the population in sub-Saharan Africa is dependent on agriculture for sustaining their livelihoods. This is despite the low agricultural output in smallholder farming systems (SFS) due to water scarcity. This has spurred several attempts to promote the adoption of climate-smart agriculture (CSA) to raise agricultural outputs and improve smallholder farmers’ livelihoods. However, there has not been a comprehensive analysis of data categorised by various aspects of climate-smart water management technologies. In this systematic literature review, climate-smart water management technologies in sub-Saharan Africa’s agricultural sector were identified and analysed to determine strategies that could enhance their adoption and impact. To this end, academic articles reporting on the adoption of climate-smart water management technologies in databases were reviewed. Four significant literature databases were used. These were limited to Springer Link, ScienceDirect, MDPI, Wiley Online, and Google Scholar. The findings demonstrate that rainwater harvesting and micro-irrigation are the primary climate-smart water management technologies used by smallholder farmers. The literature review shows that adoption of CSWM practices is constrained by inadequate technological infrastructure, financial implications, unsuitable policies, and low user skills, particularly. It is therefore recommended that government agricultural departments and relevant advocates of CSA should incentivise and subsidise smallholder farmers to encourage CSWM technology adoption. This can be achieved through the implementation of suitable policies directed at technological infrastructure development, financial support for adoption, and technical skills training.

Increased rate of anoxic brain damage with laryngeal tube compared to endotracheal intubation in patients with shockable out-of-hospital cardiac arrest – Experience from the HAnnover COoling REgistry (HACORE)

BackgroundSupraglottic airway devices such as the laryngeal tube (LT) are recommended in current guidelines for simplified airway management in patients during and immediately after out-of-hospital cardiac arrest (OHCA). Trials evaluating LTs included predominantly OHCA patients with non-shockable rhythms and low survival rates. Hence, LTs are widely used, but their impact on preventing hypoxic brain damage during resuscitation has not been evaluated yet. MethodsWe analysed 452 OHCA-patients with shockable-rhythms from the HAnnover COoling REgistry (HACORE) who had return of spontaneous circulation prior to transport. Of those, 405 patients received primary airway management by endotracheal intubation (ETI) and 47 by LT. Patients were afterwards treated according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) applying a strict post-resuscitation management including therapeutic hypothermia and avoiding routine prognostication. ResultsWhile mortality in this group was moderate with both airway strategies (ETI 29 % vs LT 34 %, p = 0.487), the rate of anoxic brain damage was much higher in the LT compared to the ETI group (38 % vs 21 %, p = 0.011). Survivors in the ETI group were more likely to have good neurological outcome (cerebral performance category 1&2) compared to the LT group (35 % vs 17 %, p = 0.013). Pneumonia was more common in the LT vs ETI group (81 % vs 53 %, p < 0.001). ConclusionsWhile the original prehospital pragmatic trials comparing LT to ETI mostly included patients with non-shockable rhythm in settings with high mortality, our analysis is based on a real-world registry and focuses on successfully resuscitated patients, whose cause of arrest was most probably not due to hypoxia. In this cohort, use of LT was associated with a higher rate of anoxic brain damage and worse functional neurological outcome compared to use of ETI.

Evaluating Dyslipidemia and Atherogenic Indices as Predictors of Coronary Artery Disease Risk: A Retrospective Cross-Sectional Study.

The frequency of coronary artery disease (CAD) has alarmingly increased in India accounting for the majority of all fatalities. The primary risk factor for CAD, acute myocardial infarction, and stroke is dyslipidemia. CAD risk can be ascertained by the lipid profile as well as atherogenic risk indices. Due to the current scenario of increased CAD prevalence and the established role of dyslipidemia as a risk factor for CAD, this study aimed at identifying the prevalent lipid abnormalities in a tertiary care hospital in Telangana and studying the predictive value of atherogenic indices for assessing CAD risk. This is a retrospective cross-sectional study. Data pertaining to the subjects from January 2021 to December 2021 was retrieved from the hospital records. Serum triglycerides (TG) were in the higher range for 47 % (n= 235) of total subjects and isolated Low-density lipoprotein (LDL) was higher in 12.6% (n = 63). The overall burden of dyslipidemia was 72.20% (n=361) with 57.6 % (n=208) in males and 42.4% (n=153) in females). The most common dyslipidemia found was Familial Combined Hyperlipidemia in 42.8% (n=214) of individuals. The second most common pattern of dyslipidemia was Primary Familial Hypercholesterolemia which was observed in 25% (n=125) of subjects. Dysbetalipoproteinemia was seen in 24.2% (n=121) of the study subjects. ROC analysis found the Atherogenic Coefficient (AC) to be the most sensitive and specific cardiovascular risk index. 57.8% of the subjects had AC >2.44 and were at the highest risk for developing CAD. The overall burden of dyslipidemia was 72.2%. AC was found to be the most sensitive and specific cardiovascular risk index by ROC curve analysis. Around 57.8% of the subjects had AC >2.44 and were at the highest risk for developing CAD. This study emphasizes the importance of atherogenic indices in the primary prevention and management of CAD, a growing non-communicable disease.

Treatment of a Radiation-Associated Femur Fracture with an Intercalary Endoprosthesis

Case: A 72-year-old woman with undifferentiated pleomorphic sarcoma of the thigh received neoadjuvant chemotherapy and radiotherapy. She underwent wide resection and was scheduled for prophylactic fixation of the femur. However, prophylactic fixation was deferred secondary to COVID-19 pandemic. Unfortunately, when stepping out of an elevator, she sustained femur fracture. The fracture was treated with a cemented intercalary endoprosthesis. Three-year follow-up reveals stable fixation without any failure. Conclusion: Postradiation fractures are challenging. Delayed union, nonunion, and infection are associated with internal fixation. To the best of our knowledge, this is the first report of intercalary endoprosthesis used for primary management of radiation-associated femur fracture.

Road Traffic Crash-Related Musculoskeletal Injuries in Bafoussam, Cameroon: Exploring the Gaps in Physiotherapy Access and Utilization: A pilot study

Background: Road traffic crashes worldwide result in significant morbidity and mortality, with musculoskeletal injuries often neglected in primary management. This study aims to investigate the prevalence and management of Road Traffic Crash-Related Musculoskeletal Injuries (RTCMI) in Bafoussam, Cameroon. Methods: We conducted a prospective cross-sectional study in Bafoussam's hospital emergency units from January to June 2024. Using an exhaustive sampling, we enrolled 120 road traffic traumatic victims who provided informed consent to participate in the study. We excluded patients unable to communicate due to trauma status. Data analysis employed Excel 2016 with a 95% confidence interval. Results: Our study revealed a RTCMI prevalence of 73%, with fractures being the most common injury (80%). Notably, physiotherapy was not prescribed in primary management, and only 11% received Physiotherapy prescriptions in secondary care. A mere 17% of respondents requested physiotherapy, citing prescription failure (100%), lack of knowledge (83.6%), preference for traditional treatment (21.9%), and high costs (2.7%) as barriers. Conclusion: This study highlights the need for further research into RTCMI management and physiotherapy integration in Cameroon. Our findings suggest significant gaps in prescription, awareness, and accessibility, emphasizing the importance of scaling up this study to inform healthcare policy and practice.

OPTimising MEDicine information handover after Discharge (OPTMED-D): protocol for development of a multifaceted intervention and stepped wedge cluster randomised controlled trial

BackgroundGeneral practitioners (GP) and community pharmacists need information about hospital discharge patients’ medicines to continue their management in the community. This necessitates effective communication, collaboration, and reliable information-sharing. However, such handover is inconsistent, and whilst digital systems are in place to transfer information at transitions of care, these systems are passive and clinicians are not prompted about patients’ transitions. There are also gaps in communication between community pharmacists and GPs. These issues impact patient safety, leading to hospital readmissions and increased healthcare costs.MethodsA three-phased, multi-method study design is planned to trial a multifaceted intervention to reduce 30-day hospital readmissions. Phase 1 is the co-design of the intervention with stakeholders and end-users; phase 2 is the development of the intervention; phase 3 is a stepped wedge cluster randomised controlled trial with 20 clusters (community pharmacies). Expected intervention components will be a hospital pharmacist navigator, primary care medication management review services, and a digital solution for information sharing. Phase 3 will recruit 10 patients per pharmacy cluster/month to achieve a sample size of 2200 patients powered to detect a 5% absolute reduction in unplanned readmissions from 10% in the control group to 5% in the intervention at 30 days. The randomisation and intervention will occur at the level of the patient’s nominated community pharmacy. Primary analysis will be a comparison of 30-day medication-related hospital readmissions between intervention and control clusters using a mixed effects Poisson regression model with a random effect for cluster (pharmacy) and a fixed effect for each step to account for secular trends.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12624000480583p, registered 19 April 2024.

Impact of implementing primary care-based medication for opioid use disorder on provider and staff perceptions

Abstract Medication for opioid use disorder (MOUD) is the management of opioid use disorder (OUD) on an outpatient basis with buprenorphine or buprenorphine/naloxone (or methadone, which is limited to federally certified opioid treatment programs). Primary care practices are well poised to provide comprehensive care for patients with OUD, including provision of MOUD. The aim of this study was to assess provider and staff OUD attitudes and role perceptions before and after implementation of a MOUD clinical service line. A survey was distributed to evaluate attitudes and perceptions of patients with OUD and provision of MOUD among providers and staff in an academic family medicine clinic. Surveys were distributed in December 2020 (73% response rate), prior to a substance use disorder educational training and MOUD service line implementation, which provided patients with OUD both primary care services and management with buprenorphine/naloxone. A follow-up survey was distributed in February 2022 (69% response rate).Training and implementation of the MOUD service line demonstrated improvements in the domains of motivation (+0.63), attitudes (+0.32), satisfaction (+0.38), role support (+0.48), role adequacy (+0.39), and safety (+0.79) among surveyed participants. The change in satisfaction and safety domains was statistically significant (P &amp;lt; .05). There was no change in the role legitimacy domain.Implementation of a primary care-based MOUD service line positively affected provider and staff motivation, attitudes, satisfaction, sense of safety, role support, and adequacy when working with patients with OUD. This highlights the benefits of MOUD-specific clinical support to optimize care delivery within primary care.

Characterizing medical decision-making in sickle cell disease during childhood: Qualitative perspectives of caregivers.

Sickle cell disease (SCD) is the most common genetic disorder among children. As the most common type of SCD, sickle cell anemia (SCA) is associated with severe complications across the lifespan. As parents/caregivers hold primary disease management responsibility during childhood, their involvement in disease management activities, including medical decision-making, is critical to successful and timely management of pediatric SCD. However, the processes through which caregivers make SCD-related decisions remain unknown. The current paper examined caregivers' decision-making processes and priorities when managing their child's SCD. Parents and primary caregivers (N=27) of children with SCA (ages 0-12) completed individual semi-structured qualitative interviews exploring links between caregivers' decision-making and both daily and ongoing SCA management practices. Data were transcribed verbatim, cleaned, systematically coded, and analyzed using applied thematic analysis. Participating caregivers were primarily Black or African American (88.9%), mothers (81.5%), publicly insured (55.6%), and single (51.9%). Caregivers described medical decision-making across acute symptom response, preventive disease management, and treatment initiation and/or discontinuation. Across these contexts of disease management, caregivers overarchingly prioritized protecting and improving their child's quality of life. Caregivers' medical decision-making processes were influenced by their SCA management experience, acquisition of SCA knowledge, and trust in medical providers. The extent to which these influences impacted caregivers' decision-making varied based on disease severity, disease management experience, and time since diagnosis. Findings highlight how processes underlying caregivers' decision-making are directly influenced and informed by caregivers' lived experiences. Future work should develop provider-initiated collaborative interventions to support medical decision-making.

Urethral caruncles

Key content: Urethral caruncle is a common post‐menopausal finding. This common benign lesion can be mistaken as a malignancy. Management should be based on the patient's symptoms. Vaginal estrogen should be considered as first‐line management before surgical excision. Learning objectives: To evaluate the symptomatic presentation of urethral caruncle. To establish the differential diagnosis of a mass in the urethra. To review the management options of urethral caruncle including medical and surgical excision. To highlight primary care management of urethral caruncle. Ethical issues: Owing to poor recognition of urethral caruncle, many patients are put through the emotional distress of referral to cancer pathways. Surgery should be considered first line for large urethral caruncle or in symptomatic patients.

Prevalence and Awareness of Medication Overuse Headache among Undergraduate Students at the University of Belgrade.

Medication overuse headache (MOH) is a prevalent and potentially preventable secondary headache disorder linked to the excessive use of medications intended for primary headache management, particularly migraine. The aim of our study was to assess the prevalence of MOH among undergraduate students and explore their awareness. This observational cross-sectional study included 401 active undergraduate students from the University of Belgrade. Data were collected through an anonymous online questionnaire which was distributed among student groups and via social media. The questionnaire specially designed for this study was developed in accordance with established guidelines for headache epidemiological research. Among the surveyed students, 10 of them (2.5%) met the criteria for the diagnosis of MOH. Awareness of MOH was noted in 149 (37.2%) students, with higher awareness among medical students and those aged 22-25 years. Despite this awareness, there was no significant difference in MOH occurrence between those aware and unaware of the condition (aware 2.7% vs. unaware 2.4%, p = 1.000). Additionally, significant gaps in education and communication about MOH were evident. Participants were recruited through convenience sampling from a single university at one time point. The questionnaire was not specifically validated in the student population, and the data relied on self-reporting. Our study highlighted a notable prevalence of MOH among undergraduate students, with a substantial portion exhibiting awareness of its risks. Despite this awareness, our findings suggest ongoing gaps in education and communication regarding MOH, emphasizing the need for targeted interventions.

Organizational resilience and primary care nurses' work conditions and well-being: a multilevel empirical study in China.

Resilience is crucial for a health system to better prevent and respond to public health threats and provide high-quality services. Despite the growing interest in the concept of resilience in health care, however, there is little empirical evidence of the impact of organizational resilience, especially in primary care settings. As the largest professional group in primary care, primary care nurses are taking more and more responsibilities during their daily practice, which influences both their work conditions and well-being. This study aims to examine the association between organizational resilience and primary care nurses' working conditions and well-being. Using a convenience sampling approach, we recruited 175 primary care nurses from 38 community health centres (CHCs) in four cities in China. Organizational resilience was operationalized as comprising two domains: adaptive capacity and planning capacity, and measured using a 16-item scale. The primary care nurses' working condition indicators comprised variables of psychological safety, organizational commitment, professional commitment, and self-directed learning; well-being indicators included depression and burn-out. Hierarchical linear regression models were built for analysis. We found that the sampled CHCs have a relatively high level of organizational resilience. The organizational resilience was positively associated with the four indicators of working conditions: psychological safety (β = 0.04, P < 0.01), organizational commitment (β = 0.38, P < 0.01), professional commitment (β = 0.39, P < 0.01), and self-directed learning (β = 0.28, P < 0.01). However, organizational resilience was not significantly associated with the two well-being indicators. Furthermore, we found that the adaptive capacity has stronger association compared with planning capacity. Therefore, primary care manager should build resilient organizations, especially the adaptive capacity, in order to enhance primary care nurses' psychological safety, commitment and learning behaviours. Further studies should also be conducted to understand the link between organizational resilience and primary care nurses' well-being.

Profile of Primary Care Managers in A Municipality in Northern Brazil and their Leadership Styles

Objective: Know the profile and leadership style of managers of Basic Health Units (BHU). Theoretical Framework: The 2017 National Primary Care Policy (NPCP) suggested the inclusion of managers in BHU to perform technical-managerial functions, based on the manager's assessment and according to the needs of the territory and coverage of Basic Care (BC). Method: Descriptive, cross-sectional and quantitative research, carried out in the municipality of Barcarena, in the state of Pará. The sample was 22 AB managers, carried out from October 2022 to May 2023. The data obtained from a questionnaire with sociodemographic and of experiences in Primary Health Care (PHC) and another on leadership style, the Multifactorial Leadership Questionnaire (MLQ). Results and Discussion: Most BC managers are female (86.4%), aged 20 to 39 (54.5%), married (59.1%), with higher education (90.9%) in Nursing (59 .1%) and 50.0% have a postgraduate degree at Lato sensu level and have a temporary employment relationship (59.1%). They had previous experience in management (59.1%) and had experience in PHC (72.7%). Regarding leadership styles, transformational leadership was more self-perceived (m=3.33) and was statistically significant (p=0.020), as an attribute, motivational inspiration (m=3.67). Research Implications: This study is one of the few works involving research focused on the leadership profile of BC managers. Originality/Value: This study contributes to the literature by understanding the aspects associated with the leadership style of BC managers, and the relationship between leadership and the guidance suggested by the 2017 NPCP.