Health Problems In Primary Care Research Articles

Implementing primary care behavioral health in Swedish primary care – study protocol for a pragmatic stepped wedge cluster trial

BackgroundMental health problems represent a large and growing public health concern. Primary care handles most of the patients with mental health problems, but there are many barriers to detection and treatment in this setting, causing under-recognition and under-treatment of patients. The service delivery model Primary Care Behavioral Health (PCBH) shows promise to manage mental health problems in primary care, but more research is needed regarding its effects on multiple levels.MethodsThis project investigates the effectiveness and implementation of a large-scale implementation of PCBH in Region Östergötland, Sweden. The aim is to generate new knowledge concerning the impact of a real-world implementation and use of PCBH in routine primary care. A Pragmatic Stepped-Wedge Cluster Trial will be used: 24 PCBH primary care centres in one region will be compared with 48 standard care centres in three other regions. The model will be implemented sequentially at the PCBH centres according to a staggered timetable. Results will be investigated at patient, staff and organization levels and various forms of data will be collected: (1) local and national registry data; (2) questionnaire data; (3) interview data; and (4) document data.DiscussionThis project investigates the effectiveness and implementation of PCBH in routine primary care. The project could result in improved mental health care for the included patients and contribute to the general good for a wider population who have mental health problems. The project’s study design will make it possible to assess many important effects of the PCBH service delivery model at different levels, providing evidence of the effectiveness (or not) of the PCBH model under routine conditions in primary care. The project has the potential to generate clinically meaningful results that can provide a basis for decisions concerning further implementation and use of the model and thus for future development of mental health care provision in primary care.Trial registrationNCT05633940, date of registration: 2021–04-21.

Adjusting the 15-method to Danish general practice: identification of barriers, facilitators, and user needs

BackgroundThe 15-method is an opportunistic screening and brief intervention tool for alcohol-related problems in primary healthcare. A Danish feasibility study of the 15-method indicated that adjustments were needed to improve its contextual fit to Danish general practice. This adjustment process was conducted in two parts. The first part focused on identifying barriers, facilitators, and user needs for addressing alcohol using the 15-method. The second part will address the identified barriers and user needs to finalize a Danish version of the method. This study reports on part one of the adjustment process.MethodsSemi-structured individual interviews and focus group interviews with healthcare professionals (n = 8) and patients (n = 5) from general practice in Denmark. Data analysis was conducted using thematic content analysis. The results were condensed into two focus areas that will form the basis for user workshops in part two of the adjustment process.ResultsThe main barriers for addressing alcohol using the 15-method were patients and healthcare professionals not having the same agenda, having difficulty opening a conversation on alcohol, and workflow in the practices. Main facilitators included high interpersonal skills, taking the patient’s perspective, and good routines and interdisciplinary work. Suggested adjustments and additions to the method included digitalization, visual icebreakers, quotes and examples, and development of a quick guide. The identified focus areas for user workshops were Communication and Material, and Integration to Workflows.ConclusionHealthcare professionals found the opportunistic screening approach exemplified by the 15-method to be beneficial in identifying and addressing alcohol-related problems. They appreciate the method’s structured framework that assists in presenting treatment options. Identified adjustment areas to the 15-method will lay the groundwork for future efforts to develop a finalized Danish version of the 15-method.

Prevalence of common mental health problems in primary care: A cross-sectional study in Switzerland

Prevalence of common mental health problems in primary care: A cross-sectional study in Switzerland

A Cross-Sectional Study of the Prevalence and Determinants of Common Mental Health Problems in Primary Care in Switzerland.

Objective: This study investigated the prevalence of the most common mental health symptoms in a large primary care patient population and characterized their determinants. Methods: Data came from a 2015-16 cross-sectional study of a primary care population in Switzerland. An investigator presented the study to patients in waiting rooms, and 1,103 completed a tablet-based questionnaire measuring stress in daily life, sleep disorders and anxiety and depressive symptoms. Diagnoses and treatments were recorded. Results: Moderate-to-high anxiety and depressive symptoms concerned 7.7% of patients; 27.6% felt stressed at least once a week; 17.2% had severe sleep disorders. Sociodemographic determinants were associated with psychiatric symptoms: female sex, young age, and frequency of consultations with a GP. Participants taking psychotropics had high levels of mental distress. Conclusion: Even though most patients were regularly monitored by their GP, a significant number of mental health problems were found. GPs should be provided with concrete tools to manage these patients better. Collaboration with mental health specialists should be encouraged in primary care settings.

The patient’s first point of contact (PINPOINT) – protocol of a prospective multicenter study of communication and decision-making during patient assessments by primary care registered nurses

BackgroundA major challenge for primary care is to set priorities and balance demands with available resources. The registered nurses in this study are practice nurses working in primary care offices, playing a large role in initial assessments. The overall objective of this research is to investigate practices of communication and decision-making during nurses’ initial assessment of patients’ health problems in primary care, examine working mechanisms in good practices and develop feasible solutions.MethodsProject PINPOINT aims for a prospective multicenter study using various methods for data collection and analysis. A purposive sample of 150 patient‒nurse consultations, including 30 nurses and 150 patients, will be recruited at primary care centers in three different geographic areas of southwest Sweden. The study will report on outcomes of communication practices in relation to patient-reported expectations and experiences, communication processes and patient involvement, assessment and decision-making, related priorities and value conflicts with data from patient questionnaires, audio-recorded real-time communication, and reflective interviews with nurses.DiscussionThis research will contribute to the knowledge needed for the guidance of first-line decision-making processes to best meet patient and public health needs. This knowledge is necessary for the development of assessments and decisions to be better aligned to patients and to set priorities. Insights from this research can empower patients and service providers and help understand and enhance feasible person-centered communication strategies tailored to patients’ level of health literacy. More specifically, this research will contribute to knowledge that can strengthen nurses’ communication, assessments, and clinical decision-making in primary care. In the long term, this will contribute to how the competencies of practice nurses and other professionals are organized and carried out to make the best use of the resources within primary care.Trial registrationClinicalTrials.gov Identifier: NCT06067672.

PRimary carE digital Support ToOl in mental health (PRESTO): Design, development and study protocols

BackgroundAbout 30–50% of Primary Care (PC) users in Spain suffer mental health problems, mostly mild to moderate anxious and depressive symptoms, which account for 2% of Spain's total Gross domestic product and 50% of the costs associated to all mental disorders. Mobile health tools have demonstrated to cost-effectively reduce anxious and depressive symptoms while machine learning (ML) techniques have shown to accurately detect severe cases. The main aim of this project is to develop a comprehensive ML digital support platform (PRESTO) to cost-effectively screen, assess, triage, and provide personalized treatments for anxious and depressive symptoms in PC. MethodsThe project will be carried out in 3 complementary phases: First, a ML predictive severity model will be built based on all the cases referred to the PC mental health support programme during the last 5 years in Catalonia. Simultaneously, a smartphone app to monitor and deliver psychological interventions for anxiety and depressive symptoms will be developed and tested in a clinical trial. Finally, the ML models and the app will be integrated in a comprehensive decision-support platform (PRESTO) which will triage and assign to each patient a specific intervention based on individual personal and clinical characteristics. The effectiveness of PRESTO to reduce waiting times in receiving mental healthcare will be tested in a stepped-wedge cluster randomized controlled trial in 5 PC centres. DiscussionPRESTO will offer timely and personalized cost-effective mental health treatment to people with mild to moderate anxious and depressive symptoms. This will result in a reduction of the burden of mental health problems in PC and on society as a whole. Trial registrationThe project and their clinical trials were registered in Clinical Trials.gov: NCT04559360 (September 2020).

Dancing with the patient: a qualitative study of general practitioners’ experiences of managing patients with multimorbidity and common mental health problems

BackgroundPatients with multimorbidity, having two or more chronic diseases, suffer frequently from undiagnosed common mental health problems and are an increasing challenge in primary care. There is a call to improve care delivery to address all these patients’ needs at the same time. The aim of this study was to identify general practitioners’ experiences of managing patients with multimorbidity and common mental health problems in primary care.MethodsWe conducted five focus group interviews with 28 physicians (3–8 participants in each group) in 5 primary care practices in and outside of Stockholm, Sweden. We used a semi-structured interview guide, and we analysed the data using reflexive thematic analysis. The methodological orientation of the study was inductive, latent constructivism.ResultsWe generated two themes from the data: Unmet patient needs and fragmented care send patients and physicians off balance and Dancing with the patient individually and together with others leads to confident and satisfied patients and physicians. The two themes are related as general practitioners expressed a need to shift from disease-specific fragmentation to relational continuity, teamwork, and flexibility to meet the needs of patients with multimorbidity and common mental health problems.ConclusionsThese findings can provide guidance in developing future interventions for patients with multimorbidity and common mental health problems in primary care in general, and in Sweden in particular.

Healthy lifestyle promotion via digital self-help for mental health patients in primary care: a pilot study including an embedded randomized recruitment trial.

This study piloted a digital self-help intervention facilitating healthy lifestyle for patients with mental health problems in primary care. Patients with mental health problems show more unhealthy lifestyle behaviors than the general population and prior research indicates that healthy lifestyle behaviors can improve mental health. This pilot study assessed use of a self-help digital intervention for healthy lifestyle promotion and included an embedded randomized recruitment trial, where all patients were randomized to digital self-help plus treatment as usual (TAU) or to TAU only. Patients seeking help for mental health problems were recruited from two primary care clinics in Stockholm, Sweden, and offered participation in a healthy lifestyle promotion study via digital self-help. Outcome measures included use-related assessment of inclusion and follow-up rates at both clinics, participant characteristics, and intervention adherence. Secondary outcomes included depression (the Patient Health Questionnaire-9) and anxiety (the GAD-7) up to 10 weeks, and changes in alcohol and tobacco use, physical activity, and diet. The study included 152 patients. The recruitment rate, initially low, increased after involving the clinicians more and maintaining more frequent contact with the patients. The 10-week missing data rate was 33/152 (22%). Participants were 70% (106/152) women, with a mean age of 42 years (SD = 14); fewer than half (38%, n = 58/152) had one or more high-risk unhealthy behaviors at inclusion. Psychiatric symptoms were moderate at baseline and declined in both groups after 10 weeks (d = 0.57-0.75). No between-group effects over time occurred on depression (b = 0.3 [95% CI -1.6, 2.2]; d = 0.06), anxiety (b=-0.7 [-2.5, 1.2]; d = 0.13), or lifestyle behaviors (b = 0.01 [-0.3, 0,3]; d=-0.01). Recruitment routines seemed to be decisive for reaching as many patients as possible. The relatively low rate of unhealthy lifestyle behaviors and small effect sizes suggests that the intervention may only suit patients at risk. ClinicalTrials.gov NCT03691116 (01/10/2018), focusing on the embedded trial. Retrospectively registered for the first clinic and prospectively for the second clinic.

PS-C31-8: UNCONTROLLED HYPERTENSION AND ITS ASSOCIATED FACTORS AT PRIMARY HEALTH CARE FACILITIES IN MAPUTO CITY, MOZAMBIQUE

Objective: the main objective of this study was to estimate the prevalence of uncontrolled hypertension in patients being followed up at primary health care facilities of Maputo City, and to identify factors associated to poor blood pressure control. Design and Methods: a cross-sectional study was conducted from September to December 2021 in nine primary health care facilities randomly selected in Maputo City. Five hundred consecutive hypertensive patients aged 18 years or older, on medical therapy and being followed up for more than six months who consented to participate were enrolled. Data was collected through face-to-face interviews, review of medical records and anthropometric and blood pressure measurements to the participants. Three blood pressure measurements were taken in the same arm, with two minutes of interval. The mean of the last two readings was considered for analysis. Uncontrolled hypertension was defined as blood pressure ≧ 140/90 mmHg. Therapeutic inertia was defined as non-increase in antihypertensive therapy after two or more follow-up consultations in patients with a blood pressure ≧ 140/90 mmHg. Hill Bone scale was used to assess adherence to antihypertensive therapy. Data analysis was performed using SPSS 22. Logistic regression was performed to estimate age- and education-adjusted Odds Ratios (OR) and 95% confidence intervals (95%CI) for uncontrolled hypertension. A p-value less than 0.05 was considered significant. Results: among the 500 participants, 385 (77%) were female, the mean age was 59.7 years [standard deviation (SD) ± 10.4] and the mean duration of hypertension was 8.9 years (SD ± 8.2). Most participants had primary education 300 (60%). The prevalence of uncontrolled hypertension was 73.2%. It was more common in patients 60 years or older compared to younger patients (adjusted OR 2.42; 95%CI: 1.30–4.52); among patients without formal education compared to those with higher levels (adjusted OR 0.45, 95%CI: 0.22–0.92, for secondary or higher education); in patients that referred difficulties in having access to the antihypertensive medication (adjusted OR 1.76, 95%CI 1.16 -2.69) and when therapeutic inertia was found (adjusted OR 2.53, 95%CI 1.10–5.86). Conclusions: uncontrolled hypertension is an important problem in primary health care in Maputo City and is associated to advanced age, lower levels of education, difficulty to access anti-hypertensive medication and therapeutic inertia. Training of health professionals and greater availability of anti-hypertensive medication in primary health care centers could improve blood pressure control.

Effect of selected physical exercises on low back pain

Abstract Background: Men and women are equally affected by low back pain (LBP), which can range in intensity from a dull, constant ache to a sudden, sharp sensation that hinders the person. Pain can begin abruptly due to an accident or by lifting something heavy, or it can develop over time due to age-related changes in the spine. LBP is one of the primary healthcare problems in all developing countries; nurses play a vital role in giving different interventions to treat back pain effectively. This study aims to study the effect of selected physical exercise on LBP among patients attending the outpatient department (OPD) in selected hospitals. Materials and Methods: A quasi-experimental, one-group pretest–posttest time series research design was used to conduct a study among the patients attending OPD in selected hospitals. A total of 160 respondents were studied from October 2021 to February 2022. A numerical pain scale and a semistructured self-administered questionnaire were used to collect data. Only respondents who gave informed consent were issued the questionnaire to complete at their convenience. Physical exercises were demonstrated and done by patients for 6 weeks, thrice a day in a week for 30 min regularly. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 24.0. Descriptive data were presented in the form of bar graphs and frequency tables. Results: The study showed that 59.37% of the respondents had severe LBP in the pretest. After doing selected physical exercises, the severe pain level reduced to 56.25% in post-test-1, 32.5% in post-test-2, and 14.37% in post-test-3. The t value of the difference in mean reduction of LBP was tabulated, and the calculated t values were (0.78, 5.60, 9.64) statistically significant at 0.05 level of significance (P < 0.05). Conclusion: LBP is seen as an issue for all ages and all sectors of society. One common component of pain treatment programs focuses on increased physical exercise reconditioning, and exercise would increase strength and concomitantly decrease pain as a long-term effect. The investigator found that physical activities were very effective and beneficial in reducing back pain among patients with LBP.

Primary Health Care Problems and Necessities In Georgia

In the article it is discussed the essence, purpose of primary health care and the results of the reforms that have been implemented in it since Georgia gained independence. As it is well known, primary health care in highly developed countries receives the special attention from the government because it is responsible for taking care of the health of patients, their families and the community it serves. In 2014, the government of Georgia declared primary health care as a priority for Europe, but this is not reflected in its state funding. Primary health care accounts for 23.2% of the state funding of health care, and the hospital sector - 65.5%. The referral rate of patients in primary healthcare is 3.6 in Georgia, and 7.5 in Europe. In addition, in primary healthcare in Georgia, out-of-pocket payments account for 47%, in Germany 5%, etc. The goal of the reforms implemented in the primary health care of Georgia (the formation of the "Family Doctor" Institute, the implementation of the "Village Doctor" program, etc.) was to raise the image of the primary health care organizations, to turn patients to them, but this did not happen. Today, only 51% of patients refer to primary healthcare clinics in Georgia. In-depth reforms of primary healthcare in Georgia started in 2000. Financially, Great Britain, the World Bank, the European Union and others participated in it. The general plan for the development of primary health care for the years 200-2009 was developed, the department of primary health care was also established, which was abolished again a year later, etc. Although after that, the referral rate of primary care institutions increased by 25%, but this did not mean the final victory in the regulation of primary care. As a result, in 2015, the relevant ministry announced a new, fundamental reform of primary healthcare and adopted the 2016-2023 project for the development of this field. Today is 2022, that is, six years have passed since the announcement of this supposedly fundamental reform, during which the number of patients referred to primary health care rose to 3.6. But even this is not enough - the institution of "family doctor" and "rural doctor" in Georgia is still underdeveloped: studies show that 18% of respondents evaluated the institution of "family doctor" negatively, 47% call for cardinal changes in it and etc. Moreover, in order to respond to these challenges, the article emphasizes the need for the relevant bodies of Georgia to familiarize themselves with the European framework - "Health 2020" and to build the primary health care of Georgia in a European manner. Keywords: Primary health care; the patient; "Family doctor"; "Village Doctor"; "Health - 2020".

Patient characteristics and changes in anxiety symptoms in patients with panic disorder: Post-hoc analysis of the PARADIES cluster randomised trial.

Anxiety disorders are among the most common mental health problems in primary care. The PARADIES (Patient Activation foR Anxiety DIsordErS) intervention combined elements of cognitive behavioural therapy with case management and has demonstrated efficacy. Our aim was to explore patient characteristics, which may influence the course of anxiety symptoms over a 12 months period. Multiple linear regression was used to quantify associations of baseline characteristics (demographics, clinical parameters, medication use) with changes in anxiety symptoms as measured by the Beck anxiety inventory. Treatment modalities (e.g. adherence to appointment schedules) were considered as confounders. We examined univariate associations between dependent and independent variables before considering all independent variables in a multivariate final model. To find the best model to explain BAI score changes, we performed step-wise selection of independent variables based on Akaike information criteria. We tested for interaction terms between treatment allocation (intervention vs control) and independent variables using the multivariate model. We repeated these analyses in control vs intervention groups separately. From the original trial (N = 419), 236 patients (56.3%) were included. In the multivariate model, receiving the intervention (p<0.001), higher anxiety symptom severity (p<0.001) and longer illness duration at baseline (p = 0.033) were significantly associated with changes in anxiety symptom severity to the better while depression severity at baseline (p<0.001) was significantly associated with changes in anxiety symptoms to the worse. In stratified analyses, the control group showed significant associations between depression symptom severity and illness duration with anxiety symptom changes while baseline severity of anxiety symptoms remained significantly associated with anxiety symptom changes in both groups. A brief primary-care-based exposure training combined with case management is effective in a broad range of patients with panic disorder with/without agoraphobia, including those with longer illness duration and co-existing symptoms of depression at baseline.

Test with recombinant tuberculosis allergen (Diaskintest®) in the diagnosis of pulmonary tuberculosis in pulmonological practice

Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia remains an urgent problem in primary health care despite the improvement of radiological and laboratory diagnostic methods.The aimof study was to evaluate the possibility of using a skin test with recombinant tuberculosis allergen (Diaskintest®, Generium, Russia) for the differential diagnosis of pulmonary tuberculosis and pneumonia.Methods.119 cases of pulmonary tuberculosis first detected in the pulmonology department during differential diagnosis were analyzed. The diagnosis was verified by a liquid media culture in the BACTEC MGIT 960 system (BD, USA). All patients with suspected tuberculosis had a skin test with recombinant tuberculosis allergen upon admission. Statistical analysis was carried out using the statistical software package IBM SPSS Statistics 22.0. The differences were considered statistically significant atp&lt; 0.05.Results.Most patients were of working age and had aggravating social risk factors 49 (41.2%), HIV-infection 75 (63.0%), drug addiction 44 (36.9%), or viral hepatitis C 33 (24.2%). As for the clinical forms, infiltrative and disseminated tuberculosis prevailed. Evaluation of the results of the «fast» methods of the diagnostic minimum showed that a positive result of the test with Diaskintest®was almost three times more likely than the positive result of bacterioscopy of a sputum smear with Ziehl–Neelsen staining.Mycobacterium tuberculosisDNA was detected in sputum using the GeneXpert MTB/RIF cartridge technology in 92.6% patients with a positive result of Diaskintest®skin test and a negative sputum bacterioscopy analysis.Conclusion.Is advisable to use Diaskintest®skin test in patients of a pulmonological hospital in the early stages and confirm the positive result with GeneXpert MTB/RIF to reduce the time for diagnosing tuberculosis and the patient’s bed-days in a non-specialized medical institution.

Costus afer Ker Gawl (Costaceae): A Review on Its Medicinal uses with Focus on Potential Anti-Inflammatory Effect

More than 80% of the population in Africa by the World Health Organization (WHO) leans on endogenous knowledge to solve their primary health care problems. In this study, we examined the relevance of Costus afer Ker Gawl, a plant called ginger lily, spiral ginger or bush cane. It is believed to be used in traditional medicine practice (TMP) to treat and manage many conditions including diabetes mellitus, stomach ailments, arthritis, inflammation. These alleged traditional incited large researchers to conduct studies on the plant to amass scientific evidence. However, these results are sparse, and thus, an inventory through the present search using online search engines such as Google Scholar, PubMed, Science Direct, Web of Science, Scopus and Chemical Abstracts for the period from 1990 to 2021; provides a bibliographic actualization on the plant, taking into account its traditional uses, phytochemical and nutritional constituents, pharmacological activities and toxicological effects. The online search included the use of the keywords, "Costus afer Ker-Gawl" or "Costus afer". It should be noted that the stem and leaves of the plant contain consistent amounts of micronutrients and macronutrients. The leaves, stem, rhizomes of C. afer contain several steroidal sapogenins, aferosides, dioscin and paryphyllin C and a flavonoid glycoside, kaempferol-3-O- \(\alpha\)-L-rhamnopyranoside. Experimental studies on various parts of the plant have shown biological activities such as anti-hyperglycemic, hepatocellular protection, cardioprotection, nephroprotection, CNS depressant, analgesic, antiarthritis, antibacterial and antioxidant. This wide range of biological properties of Costus afer Ker Gawl would be largely attributed to the essential oil compounds such as Sabinene, \(\beta\) -pinene and \(\beta\) -caryophyllene which are among the major compounds of this plant. Based on these obvious data, it is concluded that the plant could be used as an alternative and complementary therapy for many diseases related to oxidative stress so will guide us future research on the use of Costus afer Ker Gawl as an anti-inflammatory.&#x0D;

Patients’ attitudes to and experience of the use of technology in mental health in Ireland

Abstract Mental health issues represent a significant proportion visits to GPs. It is estimated that 90% of mental health issues in Ireland are addressed in general practice, with an international trend towards making mental health services available in primary care. However, at present the mental health services, both locally in Ireland and internationally, are unable to meet the growing needs of those suffering mental ill health. Healthcare services internationally have examined novel and innovative ways of bridging with gap between patient needs and the available mental health services including e-mental health - “the use of information and communication technology to support and improve mental health”. The aim of this research was to explore patients' attitudes towards and experience of the use of technology and online resources with regard to mental health. Data was gathered by means of a patient survey. 8 point questionnaires were distributed and completed anonymously by 61 patients at the Carlton Clinic in Bray, Co. Wicklow. The objectives of the questionnaire were to ascertain patients' levels of awareness of the technology based resources available; whether they were using them; what patients' experience of using this technology was. The research showed low levels of awareness and usage with 39% of respondents aware of technology based resources and only 11% having ever used them. 15% of respondents reported that a GP had recommended digital resources to them. 72% of those surveyed reported they would find it useful if a GP recommended digital resources to them with regard to mental health issues. Conclusions Awareness and usage of digital resources in primary care population is low. However, the majority of patients were positive towards the option of digital resources and are willing to discuss them in mental health consultations. Key messages Readinzess of patients to embrace technology as means of delivering care and treatment for mental health problems in primary care in Ireland. Need for improved awareness of e-health options.

Experiences with an educational program for patients with chronic widespread pain: a qualitative interview study.

Chronic widespread pain (CWP) is a common problem in primary health care, with a prevalence of 10-15%. An educational program called Pain School has been developed for use in primary health care, comprising four educational group sessions and 10 weeks of physical activity. The purpose of this study was to explore patients' experiences with participating in an educational program that aims to increase their understanding of pain, self-efficacy, tools in daily life, and physical activity. Twelve women (age 25-72 years) with CWP were included in this qualitative interview study set in primary health care. Semi-structured individual interviews were held 10 weeks after the completion of the four educational group sessions. Data was analyzed through the established method of content analysis, and the results are presented as a theme with categories and subcategories. An overarching theme that described the participants' experiences with the educational program was evolvement of skills and perspectives to master pain. This theme covered four categories: understanding one's body and mind, experiencing the value of participation, applying strategies and ways of thinking, and evaluating and adding to one's personal framework. Participation contributed to an increased understanding of one's body and mind and to experiencing the individual and social value of participation. The participants applied new strategies and ways of thinking related to pain and physical activity. An evaluation of the relevance for the individual and the value of being in the group could reinforce or add to the participants' personal framework. The educational program Pain School that was used in this study appears to give knowledge and support for women with CWP in primary health care and provide them with applicable skills and perspectives to manage pain.

Tricuspid Regurgitation in Left Ventricular Systolic Dysfunction: Marker or Target?

Far from being historically considered a primary healthcare problem, tricuspid regurgitation (TR) has recently gained much attention from the scientific community. In fact, in the last years, robust evidence has emerged regarding the epidemiological impact of TR, whose prevalence seems to be similar to that of other valvulopathies, such as aortic stenosis, with an estimated up to 4% of people >75 years affected by at least moderate TR in the United States, and up to 23% among patients suffering from heart failure with reduced ejection fraction. This recurrent coexistence of left ventricular systolic dysfunction (LVSD) and TR is not surprising, considered the multiple etiologies of tricuspid valve disease. TR can complicate heart failure mostly as a functional disease, because of pulmonary hypertension (PH), subsequent to elevated left ventricular end-diastolic pressure, leading to right ventricular dilatation, and valve tethering. Moreover, the so-called “functional isolated” TR can occur, in the absence of PH, as a result of right atrial dilatation associated with atrial fibrillation, a common finding in patients with LVSD. Finally, TR can result as a iatrogenic consequence of transvalvular lead insertion, another frequent scenario in this cohort of patients. Nonetheless, despite the significant coincidence of these two conditions, their mutual relation, and the independent prognostic role of TR is still a matter of debate. Whether significant TR is just a marker for advanced left-heart disease, or a crucial potential therapeutical target, remains unclear. Aim of the authors in this review is to present an update concerning the epidemiological features and the clinical burden of TR in the context of LVSD, its prognostic value, and the potential benefit for early tricuspid intervention in patients affected by contemporary TR and LVSD.

Proangiogenic Effect of 2A-Peptide Based Multicistronic Recombinant Constructs Encoding VEGF and FGF2 Growth Factors

Coronary artery disease remains one of the primary healthcare problems due to the high cost of treatment, increased number of patients, poor clinical outcomes, and lack of effective therapy. Though pharmacological and surgical treatments positively affect symptoms and arrest the disease progression, they generally exhibit a limited effect on the disease outcome. The development of alternative therapeutic approaches towards ischemic disease treatment, especially of decompensated forms, is therefore relevant. Therapeutic angiogenesis, stimulated by various cytokines, chemokines, and growth factors, provides the possibility of restoring functional blood flow in ischemic tissues, thereby ensuring the regeneration of the damaged area. In the current study, based on the clinically approved plasmid vector pVax1, multigenic constructs were developed encoding vascular endothelial growth factor (VEGF), fibroblast growth factors (FGF2), and the DsRed fluorescent protein, integrated via picornaviruses’ furin-2A peptide sequences. In vitro experiments demonstrated that genetically modified cells with engineered plasmid constructs expressed the target proteins. Overexpression of VEGF and FGF2 resulted in increased levels of the recombinant proteins. Concomitantly, these did not lead to a significant shift in the general secretory profile of modified HEK293T cells. Simultaneously, the secretome of genetically modified cells showed significant stimulating effects on the formation of capillary-like structures by HUVEC (endothelial cells) in vitro. Our results revealed that when the multicistronic multigene vectors encoding 2A peptide sequences are created, transient transgene co-expression is ensured. The results obtained indicated the mutual synergistic effects of the growth factors VEGF and FGF2 on the proliferation of endothelial cells in vitro. Thus, recombinant multicistronic multigenic constructs might serve as a promising approach for establishing safe and effective systems to treat ischemic diseases.

Correlation between Body Mass Index to Hypertension in A Rural Area in East Java

Hypertension is one of the most commonly encountered problems in primary health care and a major risk factor for other lethal diseases. Obesity, another arising problem in developing and developed countries, is another major risk factor for metabolic disease. However, studies about both diseases and their intercorrelation in rural areas are still limited. Therefore, we conducted this study to investigate the correlation between body mass index (BMI) and blood pressure in a rural area. This study was an observational, cross-sectional study performed in outpatients at Community Health Care of Ngronggot, a rural area in East Java for one month with inclusion criteria aged 18 years old, systole blood pressure (SBP) ≥140 and/or diastole blood pressure (DBP) ≥90, or a history of anti-hypertensive treatment. Information including age, gender, SBP, DBP, mean arterial pressure (MAP), body weight, and height was collected and calculated for its distribution and correlation using the Spearman rank-order correlation test. There were 201 subjects in this study, 65.7% of which were female, while 34.3% of which are male, and the median age was 59 years old. We also found that more than 60% of our participants were overweight and obese. The results of the Spearman test showed that BMI significantly correlated with SBP (p=0.029), DBP (p=0.016), and MAP (p=0.008). In conclusion, BMI had a positive correlation with blood pressure, and obesity was prevalent in our rural area population.

A importância da Atenção Primária à Saúde na detecção e terapêutica de sintomas depressivos em idosos

O aumento expressivo do número de idosos é um acontecimento global, que vêm ocorrendo de maneira constante. Dados remontam que essa população se aproximará de 2 bilhões de pessoas até 2050. Associado a esse crescimento, sintomas depressivos e a depressão, propriamente dita, revelam preocupação com uma epidemia incidente, principalmente no grupo etário dos idosos, que costumeiramente negligencia os sintomas com a crença de serem inerentes ao processo natural do envelhecimento. O presente estudo é uma revisão integrativa da literatura e teve como objetivo demonstrar a importância da atenção primária à saúde na detecção de sintomas depressivos em idosos, conhecer os agravos relacionados com os sintomas, identificar o melhor instrumento para detecção precoce da problemática e descrever as terapêuticas empregadas nos idosos com sintomas depressivos. A busca foi realizada nas bases de dados eletrônicas SCIELO, LILACS e BIREME, incluindo trabalhos publicados entre 2011 e 2019, em língua portuguesa. A seleção dos estudos, extração de dados e validação foram realizadas de forma independente por dois autores, obtendo amostra de 37 artigos. Constatou-se, através dos dados analisados, os principais métodos utilizados para rastreio dos sintomas depressivos, comorbidades mais associadas relatados na literatura e os principais métodos abordados para tratamento. Assim, foi possível estruturar de forma sistemática os relatos mais recentes da problemática na atenção primária à saúde e lançar base para elucidação, escolha e possível padronização dos métodos de rastreio.