Primary Units Research Articles

Evidence-based digital support during 1 year after an Interdisciplinary Pain Rehabilitation Programme for persons with chronic musculoskeletal pain to facilitate a sustainable return to work: a study protocol for a registry-based multicentre randomised controlled trial

IntroductionChronic musculoskeletal pain (CMSP) severely affects the individual’s quality of life, functioning and ability to work, and comes with significant societal costs for sick leave and productivity loss. After rehabilitation,...

OXYGEN UPSTREAM FROM PATIENT END TO PRODUCTION

The world has been facing unprecedented times for last two years, owing to one of the deadliest medical crises- the war against corona virus. In such gleamy situation, the medical fraternity is trying hard to leave no stones unturned for ensuring proper healthcare delivery. Despite making good progress with the vaccination policy, the current situation requires effective management of healthcare services and supplies at the ground level facilities such as hospitals, primary healthcare units, nursing homes, and others. In response, the judicious use of oxygen or oxygen management in these health care facilities can save lives by ensuring proper supply to meet patient requirements. This article pinpoints the rational and viable oxygen management process for handling the load on medical professionals as well as production plants. Based on the analysis of the problems at hand, the article provides insights and suggestions to ensure unrestricted and timely oxygen supply in the healthcare units.

Prevalence of blindness and its determinants in Bangladeshi adult population: results from a national cross-sectional survey

ObjectiveThe objective of this study was to determine the prevalence of blindness and its determinants in Bangladeshi adult population.Study designA cross-sectional population-based survey conducted at household level with national representation....

Discrete Simulation Model of Industrial Natural Gas Primary Reformer in Ammonia Production and Related Evaluation of the Catalyst Performance

The catalytic steam reforming process of natural gas consumes up to approximately 60% of overall energy used in ammonia production. The optimisation of the reforming catalyst performance can significantly improve the operation of the whole ammonia plant. An online model uses actual process parameters to optimise and reconcile the data of primary reforming products with possibility to predict the catalyst performance. The model uses a combination of commercial simulator and open-source code based on scripts and functions in the form of m-files to calculate various physical properties of reacting gases. The optimisation of steady-state flowsheet, based on real-time plant data from the distributed control system (DCS), is essential for the application of the model at the industrial level. The simplicity of the calculation method used by the model provides the fundamental basis for industrial application in the frame of digitalisation initiative. The principal aim of the optimisation procedure is to change the working curve for methane regarding its equilibrium curve as well as methane outlet molar concentration. This is the critical process parameter in reforming catalyst operation. An industrial top fired primary reformer unit based on Kellogg Inc technology design served for the validation of the model. Calculation procedure is used for continuous online evaluation of the most commercially available primary reformer catalysts. Based on the conducted evaluation, the model can indicate possible recommendations which can mitigate marginal performance and prolong reformer catalyst lifetime.

New Insights into Neuropeptides Regulation of the Immune System and Hemopoiesis: Effects on Hematologic Malignancies.

Several neurotransmitters and neuropeptides were reported to join in or cooperate with different cells of the immune system, bone marrow, and peripheral cells. Numerous data support that neuroactive molecules might control immune system activity and hemopoiesis operating on lymphoid organs and the primary hematopoietic unit, the hematopoietic niche. Furthermore, many compounds seem to be able to take part in the leukemogenesis and lymphomagenesis process and in the onset of multiple myeloma. In this review, we will assess the possibility that neurotransmitters and neuropeptides may have a role in the onset of haematological neoplasms, may affect the response to treatment, or may represent a useful starting point for a new therapeutic approach. More in vivo investigations are needed to evaluate neuropeptide's role in haematological malignancies and their possible utilization as an antitumor therapeutic target. Comprehending the effect of the pharmacological administration of neuropeptide modulators on hematologic malignancies opens up new possibilities in curing clonal hematologic diseases to achieve more satisfactory outcomes.

Impact on interprofessional collaboration and oral health-related quality of life from a prenatal care protocol: a mixed method study

Objective. The aim was to evaluate the potential impact on interprofessional collaboration and oral health-related quality of life from a prenatal care protocol. Method. We conducted an intervention study, with a post-test control group within a mixed-methods approach. The study population comprised 60 pregnant and health professionals enrolled in primary healthcare units. In the tested protocol, oral health technician was an important link with other members of multi-professional teams in the conversation wheels within which values, perceptions, behaviors and needs of pregnant women were shared about changes experienced during the pregnancy. Numerical data and narratives were used to assess self-rated oral health, oral health-related quality of life measured by OHIP-14, perception of pregnant women on interprofessional practices. Results. Patients were young and had incomplete or complete high school with no significant differences between the test and control groups. The perception of women in relation to interprofessional collaboration was greater in the intervention group than in control group. Self-rated oral health and oral health-related quality of life improved after intervention. Conclusions. The intervention encouraged the empowerment of the team to refocus the work process with greater involvement and collaborative professional interaction favored by oral health technician performance. The service organization protocol caused tensions and produced positive effects on interprofessional collaboration and on oral health-related quality of life. Clinical Relevance. The findings showed the relevance of the oral health technician’s performance integrating the activities between dental team and multidisciplinary professional team for quality of life related to oral health and interprofessional collaboration.

Primary care provider notions on instituting community-based geriatric support in Uganda

BackgroundUnderstanding of the most economical and sustainable models of providing geriatric care to Africa’s rising ageing population is critical. In Uganda, the number of old adults (60 years and above) continues to rise against absence of policies and guidelines, and models for providing care to this critical population. Our study explored public primary health care provider views on how best community-based geriatric support (CBGS) could be instituted as an adaptable model for delivering geriatric care in Uganda’s resource-limited primary public health care settings.MethodsWe interviewed 20 key informants from four districts of Bukomansimbi, Kalungu, Rakai, and Lwengo in Southern Central Uganda. Respondents were leads (in-charges) of public primary health units that had spent at least 6 months at the fore said facilities. All interviews were audio-recorded, transcribed verbatim, and analysed based on Hsieh and Shannon’s approach to conventional manifest content analysis.ResultsDuring analysis, four themes emerged: 1) Structures to leverage for CBGS, 2) How to promote CBGS, 3) Who should be involved in CBGS, and 4) What activities need to be leveraged to advance CBGS? The majority of the respondents viewed using the existing village health team and local leadership structures as key to the successful institutionalization of CBGS; leveraging community education and sensitization using radio, television, and engaging health workers, family relatives, and neighbors. Health outreach activities were mentioned as one of the avenues that could be leveraged to provide CBGS.ConclusionProvider notions pointed to CBGS as a viable model for instituting geriatric care in Uganda’s public primary healthcare system. However, this requires policymakers to leverage existing village health team and local governance structures, conduct community education and sensitization about CBGS, and bring onboard health workers, family relatives, and neighbors.

Organizational e-Health Readiness: How to Prepare the Primary Healthcare Providers’ Services for Digital Transformation

The COVID-19 pandemic has had two main consequences for the organization of treatment in primary healthcare: restricted patients’ access to medical facilities and limited social mobility. In turn, these consequences pose a great challenge for patients and healthcare providers, i.e., the limited personal contact with medical professionals. This can be eased by new digital technology. While providing solutions to many problems, this technology poses several organizational challenges for healthcare system participants. As the current global situation and the outbreak of the humanitarian crisis in Europe show, these and other likely emergencies amplify the need to learn the lessons and prepare organizations for exceptional rapid changes. Therefore, a question arises of whether organizations are ready to use modern e-health solutions in the context of a rapidly and radically changing situation, and how this readiness can be verified. The aim of this article is to clarify the organizational e-heath readiness concept of Polish primary healthcare units. This study employs the triangulation of analytical methods, as it uses: (i) a literature review of e-health readiness assessment, (ii) primary data obtained with a survey (random sampling of 371 managers of PHC facilities across Poland) and (iii) the Partial Least Squares Structural Equation Modeling (PLS-SEM) method, employed to estimate the structural model. The evaluation of the model revealed that its concept was adequate for more mature entities that focus on the patient- and employee-oriented purpose of digitization, and on assuring excellent experience derived from a consistent care process. In the context of patients’ restricted access to medical facilities and limited social mobility, a simpler version of the research model assesses the readiness more adequately. Finally, the study increases the knowledge base of assets (resources and capabilities), which will help healthcare systems better understand the challenges surrounding the adoption and scaling of e-health technologies.

Prevalence, Awareness, Treatment and Control of Diabetes in India From the Countrywide National NCD Monitoring Survey.

BackgroundTo determine the prevalence, awareness, treatment and control of diabetes mellitus (DM) and associated factors amongst adults (18–69 years) in India from the National Noncommunicable Disease Monitoring Survey (NNMS).MethodsNNMS was a comprehensive, cross-sectional survey conducted in 2017–18 on a national sample of 12,000 households in 600 primary sampling units. In every household, one eligible adult aged 18–69 years were selected. Information on NCD risk factors and their health-seeking behaviors were collected. Anthropometric measurements, blood pressure and fasting capillary blood glucose were measured. DM was defined as fasting blood glucose (FBG) ≥126 mg/dl including those on medication. Awareness, treatment, and control of DM were defined as adults previously diagnosed with DM by a doctor, on prescribed medication for DM, and FBG <126 mg/dl, respectively. The weighted data are presented as mean and proportions with 95% CI. We applied the Student t-test for continuous variables, Pearson's chi-square test for categorical variables and multivariate regression to determine the odds ratio. For statistical significance, a p-value < 0.05 was considered.ResultsPrevalence of DM and impaired fasting blood glucose (IFG) in India was 9.3% and 24.5% respectively. Among those with DM, 45.8% were aware, 36.1% were on treatment and 15.7% had it under control. More than three-fourths of adults approached the allopathic practitioners for consultation (84.0%) and treatment (78.8%) for diabetes. Older adults were associated with an increased risk for DM [OR 8.89 (95% CI 6.66–11.87) and were 16 times more aware of DM. Better awareness, treatment and control levels were seen among adults with raised blood pressure and raised cholesterol.ConclusionsThe prevalence of DM and IFG is high among adults, while the levels of awareness, treatment and control are still low in India, and this varied notably between the age groups. Multifaceted approaches that include improved awareness, adherence to treatment, better preventive and counseling services are crucial to halt diabetes in India. Also, expanding traditional systems of medicine (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy [AYUSH]) into diabetes prevention and control practices open solutions to manage this crisis.

Research protocol for a before-during comparison of the Impact of COVID-19 on Physical Activity, sedentary and dietary behaviour of School-going Adolescents in Punjab, India (ICPASA study)

Background: The COVID-19 pandemic has exacerbated the already existing pandemic of physical inactivity. In adolescents, the effect of COVID-19 related governmental measures may be even more pronounced, as they experience school closures, home confinement, social distancing and possible mental health issues as a result. The current study uses the COVID-19 pandemic and associated governmental measures as a natural experiment to understand its impact on the lifestyle of adolescents with relation to physical activity, sedentary and dietary behaviour. We also aim to describe the determinants of change in lifestyle behaviours. Methods/Design: A before-during experimental study design will be followed in which baseline measurements have been undertaken in 2018-19 before the COVID-19 pandemic, and the follow-up measurements will be repeated during the COVID-19 pandemic. Twenty schools of Punjab, India form the primary unit of participation from which 1086 adolescents participated in the study. Validated questionnaires are used to measure physical activity, sedentary behaviour, and dietary behaviour. Additionally, objective measures of physical activity will be performed using accelerometer over a 7-day period on a sub-sample. Body mass index (BMI) and waist circumference will be assessed objectively as a measure of central obesity. Qualitative interviews and focus group discussions will be conducted to have a better understanding for reasons of change in physical activity, sedentary and dietary behaviour or any possible differences between groups. Discussion: The study aims to reveal the impact of COVID-19 related governmental measures on physical activity, sedentary and dietary behaviour of adolescents. It is one of the first studies to show both subjective and objective measures of physical activity levels and sedentary time of school-going adolescents during COVID-19. Due to the mixed method approach we will be able to identify reasons for changes in lifestyle behaviours and possibly find innovative ways of staying physically active during the era of physical distancing.

Analysis of the Coping Strategies of Primary Health Care Professionals: Cross-Sectional Study in a Large Brazilian Municipality.

Objective: To analyze the coping strategies used by primary healthcare (PHC) professionals. Methods: A cross-sectional, descriptive-analytical study realized with professionals working in primary healthcare units in São José do Rio Preto, a large city in the interior of São Paulo, Brazil. For data collection, we used an instrument developed by the researchers containing sociodemographic and professional variables, as well as the Problem Coping Modes Scale (EMEP). Results: We evaluated 333 PHC professionals. A difference was observed between the scores of the four coping strategies (p < 0.001), with the highest score for the problem-focused strategy (3.8) and the lowest score for the emotion-focused strategy (2.4). Physicians had the lowest scores in coping strategies focused on religious practices/fantastical thinking (p < 0.001) and pursuit of social support (p = 0.045), while community health agents had the highest scores in these coping strategies. Conclusions: Professionals working in PHC have different coping strategies for the problems and stressful situations experienced in the work environment. These strategies can involve more positive attitudes focused on confrontation and problem solving, and on emotional responses that involve attitudes of avoidance and denial of the problem.

Population genomics of Sitka black-tailed deer supports invasive species management and ecological restoration on islands

Invasive mammals represent a critical threat to island biodiversity; eradications can result in ecological restoration yet may fail in the absence of key population parameters. Over-browsing by invasive Sitka black-tailed deer (Odocoileus hemionus sitkensis) is causing severe ecological and cultural impacts across the Haida Gwaii archipelago (Canada). Previous eradication attempts demonstrate forest regeneration upon deer removal, but reinvasion reverses conservation gains. Here we use restriction-site associated DNA sequencing (12,947 SNPs) to investigate connectivity and gene flow of invasive deer (n = 181) across 15 islands, revealing little structure throughout Haida Gwaii and identifying the large, central island of Moresby (>2600 km2) as the greatest source of migrants. As a result, the archipelago itself should be considered the primary eradication unit, with the exception of geographically isolated islands like SGang Gwaay. Thus, limiting eradications to isolated islands combined with controlled culling and enhanced biosecurity may be the most effective strategies for achieving ecological restoration goals.

Real-Time Object Detection and Classification by UAV Equipped With SAR.

The article presents real-time object detection and classification methods by unmanned aerial vehicles (UAVs) equipped with a synthetic aperture radar (SAR). Two algorithms have been extensively tested: classic image analysis and convolutional neural networks (YOLOv5). The research resulted in a new method that combines YOLOv5 with post-processing using classic image analysis. It is shown that the new system improves both the classification accuracy and the location of the identified object. The algorithms were implemented and tested on a mobile platform installed on a military-class UAV as the primary unit for online image analysis. The usage of objective low-computational complexity detection algorithms on SAR scans can reduce the size of the scans sent to the ground control station.

Sociodemographic characteristics of patients and their use of post-bariatric contouring surgery in the US

BackgroundExpansion of healthcare insurance coverage to bariatric surgeries has led to an increased demand from patients for post-bariatric contouring surgeries. This study examined the relationship between the use of contouring procedures on post-bariatric surgery patients, clinical need and sociodemographic factors.MethodsData were extracted from the Healthcare Cost and Utilization Project (HCUP) Nationwide Ambulatory Surgery Sample (NASS) regarding hospital-owned ambulatory surgical centres in the US. Episodes without missing values relating to patients, 18 years old or above were the primary unit of analysis. Episodes were excluded if the field regarding expected payer was reported as “no charge.” The primary outcome was the likelihood of panniculectomy, abdominoplasty, and mastopexy among post-bariatric surgery patients; and the degree to which uptake of these types of contouring surgery were associated with age, gender, median households’ income, expected payer, patient’s location, and comorbidity.ResultsA total of 66,368 weighted episodes of care received by patients who had had bariatric surgery were extracted (54,684 female [82.4%]; mean age, 51.3 [SD, 12.1]; 6219 episodes had contouring surgeries [9.37%]). Panniculectomy was the most common post-bariatric contouring procedure (3.68%). Uptake of post-bariatric contouring procedures was associated with age, sex, payment type, area-based measures of median household income, and patient location. Compared to Medicare insured patients, the odds of receiving contouring surgery among self-payers were 1.82 (95% CI, 1.47 to 2.26) for panniculectomy, 14.79 (95% CI, 12.19 to 17.93) for abdominoplasty and 47.97 (95% CI, 32.76 to 70.24) for mastopexy. Rank order of comorbidity profiles also differed between insured and self-paying recipients of contouring surgery.ConclusionsInsurance status of bariatric surgery patients and their sex were strongly associated with receipt of a range of contouring procedures. Self-payments were associated with a doubling of the odds of having panniculectomy and an increase in the odds to approximately 14 times for abdominoplasty and 48 times for mastopexy. Thus, access to contouring surgery by post-bariatric patients may be disproportionately dependent on personal preference supported by ability to pay rather than clinical need. Further research is needed to examine the impact of contouring or delayed/denied contouring on health status.

Crude oil emulsion breaking: An investigation about gravitational and rheological stability under demulsifiers action

Emulsions are common in the oil industry, being present in the extraction and production stages. Its formation occurs with the contact of brine and crude oil under intense flow. The presence of emulsified water (dispersed droplet size, φ ≤ 50 μm) in crude oil can negatively impact its exploration, transportation, and refining, making transportation more expensive, requiring more energy for heating, and causing equipment corrosion on all processes. In addition, crude oil has salts and sediments that encrust and corrode equipment of the primary oil treatment unit and distillation towers, also causing catalyst poisoning in the cracking step. Therefore, such components need to be removed for subsequent refining processes. To prevent these problems, the dehydration/desalting of crude oils is a strategy adopted to reach adequate values of water, salts, and sediments required in the refineries for the next steps after primary treatment. However, the emulsion breaking is influenced by several factors that affect the stability of crude oil (W/O emulsion), such as viscosity, contents of water, salts, sediments, and natural surfactants, among others. Given this perspective, this work investigated the stability of two different types of crude oils with demulsifier under the action of gravity (bottle test) and shear stress (rheology). The comparisons of gravitational and rheological techniques concluded that the shear stress sweep analyses are useful to evaluate the demulsifier performance in the emulsion breaking, being a reliable and fast methodology. Such studies allowed the identification of adequate parameters: temperature (80 °C) and, demulsifier type and quantity (500 ppm) for efficient crude oil phase separation, without using washing water. The physicochemical and rheological characterizations clarified the crude oil's colloidal stability behavior to understand the impurities' influence on the oils' properties (crude and desalted).

Neighbourhood and the Perception of the Quality of Medical Treatment

Numerous studies have explored the role of the economic characteristics of a neighbourhood on the health status of its residents. We contribute to this work by examining the effects of the change in concentration of affluence on the perception of the quality of medical treatment received by the poor. We consider different neighbourhoods characterised by their level of prosperity. Based on the Asset Index, a particular primary sampling unit is identified as poor, middle or rich neighbourhoods to capture regional differences in the level of poverty. In each of these regions, we measure how the percentage of poor who claim that they were treated nicely varies with the change in the percentage of rich. The results reveal that, after a point, the probability of the perception of receiving superior treatment initially increases with an increase in the percentage of rich people and then starts declining. The principal component analysis is used to create weights in the asset index. The estimation is based on the nationally representative India Human Development Survey-2 (IHDS-2) household data collected in 2011–2012. We employ an ordered logit model for the analysis, as the perception of the quality of treatment, the dependent variable, is ordered in nature. Furthermore, we use Heckman’s two-step correction method to control for the plausibility of ‘self-selection’. JEL: I14, I39

Clinical manifestation and current therapeutics in X-juvenile retinoschisis.

X-linked juvenile retinoschisis (XLRS) is one of the common early-onset hereditary retinal degenerative diseases in men. The common symptoms of XLRS range from mild to severe central vision loss and radial stripes created by the fovea, the division of the inner layer of the retina in the peripheral retina and the significant decrease in b-wave amplitude (ERG). Retinoschisin, the 224-amino-acid protein product of the retinoschisis 1 (RS1) gene, contains a discoid domain as the primary structural unit, an N-terminal cleavable signal sequence, and an oligomerization-area component. Retinoschisin is a homo-octamer complex with disulfide links that are released by retinal cells. It helps preserve the retina's integrity by binding to the surface of photoreceptors and bipolar cells. As a recessive genetic disease, XLRS was usually treated by prescribing low vision aids in most clinical cases. A gene replacement therapy based on adeno-associated virus vectors was initiated and showed a breakthrough in treating XLRS in 2014. Understanding the revolution of gene therapy for treating XLRS may accelerate its development and make this gene therapy the template for developing therapeutics against other inherited retinal diseases.

Fast-track referral for health interventions during pregnancy: study protocol of a randomised pragmatic experimental study to reduce low birth weight in Portugal (STOP LBW)

IntroductionLow birth weight (LBW) is associated with a wide range of short-term and long-term consequences and is related to maternal psychosocial and behavioural determinants. The objective of this study is...

A qualitative study to explore health literacy skills in older people from a disadvantaged community in Brazil.

We aim to describe older peoples' experiences of accessing, understanding, communicating and appraising health information in the context of primary care in a disadvantaged community in North-East Brazil. A qualitative interview study was conducted with 42 older people at two primary healthcare units in the city of Arapiraca, Brazil. Semi-structured interviews were guided by a qualitative health literacy instrument, translated and adapted for use in Brazil. Of the 42 participants, 30 were women and the majority (n = 32) were 60-69 years of age. Qualitative analysis identified that participants had difficulties accessing, understanding and communicating health information, often in the context of chronic disease. Few participants demonstrated an understanding about their specific health concerns, and most had difficulty explaining and interpreting health conditions more generally. Most participants indicated that they did not actively seek health information and this was compounded by physicians who were reported to provide limited information about diagnosis and treatment of health conditions. More than half of the participants reported that they did not understand medical terms included in health information, but most reported that they took no action to clarify understanding. In conclusion, we observed that conventional health literacy skills are very poor in this population of older Brazilians living in a disadvantaged community, with many resigned to not receiving health information or relying on sources other than health professionals. The findings from this study speak to the need for health literacy interventions targeting older adults in Brazil. A two-tiered approach which seeks to reduce the demands and complexities placed upon patients within the healthcare system but also targets interventions toward building the skills and capacities of individuals is likely to be most effective.

Bioarchaeological Analysis of Skeletal Remains from Nadin Necropolis

This contribution presents the results of the bioarchaeological analysis of human skeletal remains from excavations at the Nadin necropolis, focusing on the reconstruction of population demographics and pathological conditions. This site has represented a methodological challenge for traditional individual-level skeletal analyses because the primary architectural unit in the necropolis, parcela, contain commingled and fragmentary elements with evidence of repeated use, multiple inhumations, and cremations. Therefore, landmark-based methods for the determination of MNI have been applied in the analysis of skeletal remains from the 2013 and 2015 excavations. This allowed a more accurate construction of the demographic profile for the site in combination with estimates from previous reports. The minimum number of individuals for the Nadin necropolis, combined with the previously published MNI from within the space delineated as parcela (“cela”) 1 (n=45), is estimated to be 196. These data also show a higher count of subadult remains (51%, n=99), compared to reports for other Iron Age sites in the region. Based on paleodemographic evaluations of the connections among younger age cohorts in skeletal collections, fertility, and population size, high infant and child mortality suggest population growth.