Primary Care Protocol Research Articles

Management of acute sexual assault presenting to a large Australian sexual health clinic in 2012-2021: a retrospective clinical audit.

Background The incidence of sexual assault continues to rise in Australia. This study aimed to describe the nature of assault, HIV/STI positivity, and its management at a sexual health clinic. Methods We performed a chart review of 516 sexual assault cases presenting to Melbourne Sexual Health Centre between 2012 and 2021, collecting data on victim demographics, details of assault, HIV/STI testing and positivity, police involvement, and offer of counselling. Results We included 516 cases: 124 males (24.0%); 384 females (74.4%); and eight transgender (1.6%) victims. The proportion of assault cases presenting to Melbourne Sexual Health Centre increased from 0.1% (37/37,070) in 2012 to 0.2% (56/36,514) in 2021 (P trend =0.006). HIV post-exposure prophylaxis was prescribed for 64.5% (80/124) of males and 12.5% (48/384) of females. Among victims, 69.4% (358/516) were tested for HIV and no one tested positive, while 71.9% (371/516) were tested for syphilis, with 1.6% (6/371) positive. Gonorrhoea and chlamydia were tested at the oropharynx (44.8% [231/516] vs 28.7% [148/516]), genitals (83.7% [432/516] vs 92.4% [477/516]) and anorectum (35.3% [182/516] vs 35.3% [182/516]). Positivity for gonorrhoea and chlamydia were: 2.6% (6/231) vs 2.0% (3/148) at oropharynx, 1.4% (6/432) vs 2.9% (14/477) at genitals, and 5.5% (10/182) vs 7.1% (13/182) at anorectum. According to clinical records, 25.2% (130/516) of victims sought police involvement, and 71.7% (370/516) were offered counselling. Conclusions Sexual assault was an uncommon presentation at Melbourne Sexual Health Centre, with diverse circumstances surrounding assault; however, clinical documentation varied, indicating a need for a standard primary care protocol for clients presenting with acute sexual assault.

Efficacy of implementing a BRCA screening protocol in primary care.

Breast cancer is the second leading cause of cancer death for women, whereas ovarian cancer is the deadliest gynecological cancer. Breast cancer gene 1 ( BRCA1 ) and breast cancer gene 2 ( BRCA2 ) mutations can increase the risk of developing breast and ovarian cancer. Screening can assist in prevention and early detection. This study aimed to increase provider knowledge of BRCA mutations, the use of BRCA screening tools, and genetic referrals. An Institutional Review Board-approved study was implemented for providers for training on BRCA1 and BRCA2 mutations and the importance of screening and referral for those at risk. Measures included provider confidence and knowledge after training as well as number of patient referrals. A standardized webinar was required with further education provided in multiple modalities. The number of BRCA screenings and referrals for genetic screening was monitored through the electronic health record (EHR). Eight providers including five nurse practitioners and three medical doctors participated in the complete project. As a result, 56 patients were BRCA screened, and four referrals were made to receive genetic counseling. Education enhanced knowledge, increased screening tool use, and resulted in improvement in genetic referrals through the EHR.

OSTEOPONTIN AS EFFECTIVE PROGNOSTIC AND THERAPEUTIC MARKER OF BRONCHIAL ASTHMA IN CHILDREN

Bronchial asthma is one of the most common non-infectious diseases among children. According to the official statistics of the Ministry of Health of Ukraine, the number of cases among Ukrainian children is about 5.61 per 1000 children. In recent years, more and more attention of specialists has been devoted to the study of inflammatory mediators such as osteopontin.
 Purpose of the study is to improve the prevention and treatment of bronchial asthma in children based on assessing prognostic levels of osteopontin.
 Materials and methods: 96 children aged 6 to 18 were examined. The diagnosis was verified according to the unified clinical protocol of primary and secondary medical care "Bronchial asthma in children" (order of the Ministry of Health of Ukraine dated October 8, 2013 No. 868). Assessment of osteopontin was carried out during remission by ELISA among 80 patients with bronchial asthma, the control group consisted of 16 healthy children. The study was conducted in adherence to human rights in accordance with prevailing legislation in Ukraine and aligns with international ethical standards. The results were analyzed utilizing non-parametric statistical methods through Microsoft Excel and IBM SPSS Statistics.
 Results and discussion. Boys constituted the majority of the subjects studied, comprising 73%. In the main group, all patients were diagnosed with a mixed form of asthma, categorized by severity as follows: intermittent - 30% (40), mild persistent - 31% (29), moderate persistent - 26% (21), and severe - 13% (10). Upon analyzing osteopontin levels based on age, within the bronchial asthma group, values were nearly identical between early and late school-age children (27.6 ng/ml and 27.7 ng/ml, respectively). In contrast, the control group exhibited different patterns: higher values in early school-age children at 10.6 ng/ml and 8.9 ng/ml in the high school group. Notably, the significantly elevated level of osteopontin in the main group at 27.6 ng/ml compared to the control group at 9.8 ng/ml warrants attention, suggesting that osteopontin could serve as a marker for the inflammatory process.
 Conclusions: Physiologically, the level of osteopontin is higher in children of early school age. Osteopontin is a marker of inflammation in BA in children, which is probably higher in patients of the main group and its level has no age difference. The level of osteopontin is directly proportional to the severity of the disease and can serve as its prognostic criterion. The higher the level of osteopontin, the more powerful anti-inflammatory therapy the patient may need.

ACTIVATION OF THE PARASYMPATHETIC NERVOUS SYSTEM IN PSYCHOTRAUMATED PERSONS USING THE KORPAN MASK

The article presents the results of using an innovative tool for stabilizing the autonomic nervous system in psychological practice - "Korpan's salt mask". The obtained scientific data are presented in the context of modern research on current global issues of humanity regarding gaps in the field of mental health. Purpose: to highlight the results of the study of the impact of the innovative tool "Korpan's mask" on the activation of the parasympathetic nervous system in people who suffered from psychotraumatic situations as a result of the war in Ukraine. Research methods: theoretical orientation: theoretical-methodological interdisciplinary analysis of scientific literature in order to determine the state of development of the problem; synthesis, generalization of research results; summarizing the research results; methods of empirical orientation: use of standardized psychodiagnostic methods: observation, conversation, questionnaire, formative experiment. The unified Ukrainian clinical protocol of primary, secondary and tertiary medical care according to ICD-10, diagnostic and statistical manual for mental disorders of the 5th edition of DSM-5 was also applied; "Pittsburgh Sleep Quality Questionnaire" (PSQI); "Hospital Anxiety and Depression Scale" (HADS); questionnaire "Diagnosis of PTSD"; methods of mathematical statistics: Wilcoxon's T-test. The results. The search for alternative effective models and tools of psychological assistance to people with post-traumatic stress disorders contributed to the application of Korpan's innovative mask, which is a simple, affordable, safe and reliable means of restoring the basic element of a person's stress resistance - its psychophysiological component. The authors present their own algorithm for providing primary psychological assistance to people who have experienced psychological trauma: psychophysiological stabilization of the autonomic nervous system by applying a Korpan mask, psychoeducation (explaining the cause of the symptoms to the victim); regulation of emotional balance (application of stress management practices), recovery of cognitive cognitive processes and acquisition of constructive coping strategies for mastering stress (methods of CBT, catathymic-imaginative psychotherapy); restoration of the meaning of life, which provides an opportunity to survive the crisis period of life. Conclusions. Through a scientific experiment, the effectiveness of using the Korpan salt mask was proven on a wide sample of subjects: military personnel (diagnosed with acute stress disorder, contusion, post-traumatic stress disorder), children with re-traumatic experiences, people who survived the occupation and live in the zone of constant shelling, internally displaced persons (who survived the loss of property and loved ones), volunteers (who were burnt out at work). The versatility of the mask is that it is effective for people of various age categories, gender, status, psychological diagnosis with post-stress symptoms.

Assessment of the availability of medicines for patients with mental and behavioral disorders according to the results of a survey of physicians and pharmacists in Ukraine

The aim: to analyze the results of a questionnaire survey of secondary care physicians and pharmacy pharmacists, participants of the government program "Affordable Medicines" (hereinafter the Program) regarding the assessment of the availability of medicines for patients with mental and behavioural disorders.
 Materials and methods: in the research process, legal acts, protocols for the treatment of patients with mental and behavioural disorders, the results of a questionnaire survey of doctors and pharmacists - participants of the Program, scientific publications related to questionnaires of doctors and pharmacists on the topics of generic drug replacement and co-payment were used patients. The research was conducted using the methods of questionnaire survey, systematization and generalization of data.
 Research results: 134 doctors and 336 pharmacists from 22 regions of Ukraine took part in the questionnaire survey. According to the results of the survey, it was established that doctors of 11 specialties prescribe medicinal products (pharmaceuticals) for the treatment of patients with mental and behavioural disorders with depressive disorders. Most patients with this disease turn to a secondary care physician without visiting a primary care physician, which negatively affects the availability of medicines for patients, as well as the reliability of statistical indicators of the prevalence and incidence of patients with depressive disorders.
 The main problem affecting the availability of drugs for patients with depressive disorders is the lack of drugs in the Program in the presence of the corresponding INN in the Unified Clinical Protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care "Depression", which forces patients to buy drugs on their own cost, and as a result, it leads to a decrease in the availability of medicines for vulnerable sections of the population under the conditions of the war in Ukraine.
 As for the issue of generic replacement of drugs according to the results of the questionnaire: 72.4 % of doctors believe that such replacement can only be carried out by a specialist doctor, while 67.9 % of pharmacists confirmed that they carry out generic replacement of prescribed drugs in case of their absence in pharmacies 76.1 % of doctors and 80.6 % of pharmacists support the need for regulatory and legal settlement of the issue of generic drug replacement in order to increase their access and availability for patients. 74.4 % of the surveyed pharmacists confirmed the desire of patients to receive medicines free of charge due to the Program.
 Conclusions: The results of the conducted questionnaire survey of doctors and pharmacists showed the importance of the regulatory settlement of issues regarding drug prescriptions under INN, generic substitution of drugs and patient co-payment, as all the listed mechanisms have an impact on increasing the availability of drugs for patients with mental and behavioural disorders. The obtained results also indicate the need to conduct a questionnaire in the future to evaluate the work of the Program and the changes that affect the work of all project participants

Use of the World Health Organization primary eye care protocol to investigate the ocular health status of school children in Rwanda

To assess the ocular health status of primary and secondary schoolchildren in Rwanda and to explore the use of the World Health Organization (WHO) primary eye care screening protocol. This was a cross-sectional population-based study across 19 schools in Rwanda. Initial screening was carried out using the WHO screening protocol, whereby visual acuity was measured using a tumbling E Snellen chart (6/60 and 6/12). Abnormal ocular features were identified using a flashlight and history against a checklist. All children with abnormal screening were referred to an on-site ophthalmic clinic for full examination. Those who could not be treated on-site were referred to an ophthalmologist at a hospital for specialist care. A total of 24,892 children underwent ocular health screening. Of those, 1,865 (7.5%) failed the primary screening; 658 (2.6%) were false positives (35.3% of those who failed screening), and 1,207 (4.8%) true positives. The most frequently observed ocular diagnoses were allergic conjunctivitis (3.11%) and strabismus (0.26%). Refractive error was very rare (0.18%). The WHO primary eye care curriculum provides existing health personnel with an approach to school-based vision screening that uses a standardized checklist and low-cost resources. In our study cohort, results indicated a low frequency of refractive error; the overwhelming majority of ocular problems could be identified on visual inspection.

НОВІ ПІДХОДИ ДО ВЕДЕННЯ ХВОРИХ НА САРКОЇДОЗ ЛЕГЕНЬ (методичний посібник)

Sarcoidosis is an inflammatory multi-systemic disease of unknown origin with wide spectrum of clinical manifestations. Sarcoidosis may affect practically any organ — predominantly lungs, lymphatic system, skin, eyes alone or in combination. The disease is characterized by formation of non-caseous granuloma. In 1999 American Thoracic society (ATS), European Respiratory society (ERS) and World Association of Sarcoidosis and Other Granulomatous diseases (WASOG) adopted an international consensus statement on diagnosis and treatment of sarcoidosis «Statement on Sarcoidosis». Based on ATS, ERS and WASOG 1999 Statement the national documents such as “Evidence-based adapted clinical guideline on sarcoidosis” and “Unified clinical protocol of primary, secondary (specialized) and tertiary (highly-specialized) medical care for sarcoidosis” approved by MOH of Ukraine (decree # 634 dated 08 Sep 2014) were developed by current authors in Ukraine. For a more detailed description of the principles of diagnosis and treatment of pulmonary sarcoidosis, we have developed and published methodological guidelines "Diagnosis of respiratory tract sarcoidosis" (2014) and "Treatment of pulmonary sarcoidosis" (2018). In 2020 ATS experts published an updated «Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline», according to which the diagnosis of sarcoidosis was based on 3 criteria: compatible clinical symptoms, presence of non-necrotizing granulomatous inflammation in one or more tissue samples (not always required) and exclusion of alternative causes of granulomatous disorder. Finally, in 2021 ERS task force report was published “ERS clinical practice guidelines on treatment of sarcoidosis”, which outlined completely new approaches to management of sarcoidosis patients. According to this document, a decision about treatment of patient depends on 2 major factors: risk of death or organ failure and deterioration of quality of life of a patient. In addition, main principle of management of sarcoidosis patients is a balance between: a) minimization of risk of disability or death due to lung injury and decrease of quality of life, and b) risk of comorbidity and reduction of quality of life due to corticosteroid or other therapies. Methodical guideline focuses on analysis of major statements of these documents, disputable questions of initial therapy choice in patients with pulmonary sarcoidosis.

Feasibility study of a Behavioural Intervention for Opioid Reduction (BIOR) for patients with chronic non-cancer pain in primary care: a protocol

IntroductionAround 30%–50% of adults suffer moderate to severe chronic pain not caused by cancer. Significant numbers are treated with opioids which over time may cease to be effective and produce...

ПЕРВИННА ПСИХОЛОГІЧНА ДОПОМОГА ПОТЕРПІЛИМ ІЗ СИМПТОМАМИ ГОСТРОГО СТРЕСОВОГО РОЗЛАДУ

Considering the high level of stressogenicity in the conditions of the existing war threat in Ukraine, the ability of psychologists to differentiate post-stress symptoms and to provide initial psychotherapeutic help to the victims in a timely manner is important and relevant. Analyzing the psychotherapeutic experience of Israeli, German, Czech, American, and Lithuanian colleagues, the article highlights the features of initial psychotherapeutic help that is in demand in Ukraine today. The author presents and compares the symptoms that arise as a result of psychological trauma, which are identified in the unified Ukrainian clinical protocol of primary, secondary and tertiary medical care and in IKH-10. The purpose of the article is to determine the psychological features of providing initial psychotherapeutic assistance to victims, in particular to military personnel. Research methods: theoretical analysis of scientific sources, observation of servicemen in hospital conditions, conversations with servicemen and doctors, interviews with foreign colleagues. As a result of theoretical and empirical research, it was found that initial psychological assistance is more effective if it is provided in a timely and comprehensive manner in cooperation with medical assistance; if the recommended exercises are performed systematically by the victim; if a certain algorithm for providing initial psychotherapeutic assistance is used. Conclusions. The author presents his own algorithm for providing initial psychological assistance to military personnel: psychophysiological stabilization – adjustment of emotional balance – restoration of cognitive processes and acquisition of constructive coping strategies – formation of life meanings that provide an opportunity to survive the crisis period of life. In the article, the author also notes the importance of providing psychological first aid to victims of extreme situations in a timely manner, which helps reduce the intensity of symptoms of acute stress disorder and reduces the likelihood of posttraumatic stress disorder.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil.

This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

THE UKRAINIAN EXPERIENCE FOR EFFECTIVE MANAGEMENT OF SEVERE PREECLAMPSIA

Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality worldwide, accounting for more than 70,000 maternal deaths each year. Of all maternal deaths, 10–15% are directly associated with preeclampsia (PE) and eclampsia. The new version of the Ukrainian National Clinical Guideline and Clinical Protocol «Hypertensive disorders during pregnancy, childbirth and the postpartum period» 2022 presents a synthesis of the scientific evidence that is relevant to the concerning severe PE treatment strategies. It was presented the new algorithm of clinical management for severe pre-eclampsia «CALM DOWN» that implemented to the new Ukrainian clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care. CALM DOWN is the special mnemonic that means «step by step strategy» for the medical teamwork. Conclusions. The algorithm «CALM DOWN» have been proposed for the optimal timing of severe PE, offers to systematize the participation of each member of the team in the provision of emergency care and should be implemented in clinical practice based on the peculiarities of the specifics of work, resources, functioning and localization of the maternity facilities when forming personal route of the patient.

Protocolo de fisioterapia y educación para la salud en dolor crónico de hombro de origen musculoesquelético. Experiencia en atención primaria

ObjectiveTo evaluate the experiencie with a health education program in Primary Care in patients with chronic shoulder pain of musculoskeletal origin, on pain and disability and establish the protocol in primary care. DesignQuasi-experimental longitudinal descriptive observational study.Location: Arroyo de la Vega Health Center, Alcobendas, Madrid. ParticipantsPatients referred by their Primary Care Physician to the Primary Care Physiotherapy Unit for shoulder pain of musculoskeletal origin. Intervention7 group sessions of health education and therapeutic exercise. Main measurementsPain intensity was assessed through the Visual Analogue Scale (VAS), the disability of the upper limb with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the level of disability and shoulder pain with the Shoulder Pain and Disability Index (SPADI) questionnaire. ResultsStatistically significant differences were found in the reduction of pain and disability (P<.01), in addition, drug use and recurrences were reduced. ConclusionsThe shoulder physiotherapy protocol with health education was effective in reducing pain and disability in patients with chronic shoulder pain of musculoskeletal origin in Primary Care.

НОВІ ПІДХОДИ ДО ВЕДЕННЯ ХВОРИХ НА САРКОЇДОЗ ЛЕГЕНЬ

Sarcoidosis is an inflammatory multi-systemic disease of unknown origin with wide spectrum of clinical manifestations. Sarcoidosis may affect practically any organ — predominantly lungs, lymphatic system, skin, eyes alone or in combination. The disease is characterized by formation of non-caseous granuloma. In 1999 American Thoracic society (ATS), European Respiratory society (ERS) and World Association of Sarcoidosis and Other Granulomatous diseases (WASOG) adopted an international consensus statement on diagnosis and treatment of sarcoidosis «Statement on Sarcoidosis». Based on ATS, ERS and WASOG 1999 Statement the national documents such as “Evidence-based adapted clinical guideline on sarcoidosis” and “Unified clinical protocol of primary, secondary (specialized) and tertiary (highly-specialized) medical care for sarcoidosis” approved by MOH of Ukraine (decree # 634 dated 08 Sep 2014) were developed by current authors in Ukraine. In 2020 ATS experts published an updated «Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline», according to which the diagnosis of sarcoidosis was based on 3 criteria: compatible clinical symptoms, presence of non-necrotizing granulomatous inflammation in one or more tissue samples (not always required) and exclusion of alternative causes of granulomatous disorder. Finally, in 2021 ERS task force report was published “ERS clinical practice guidelines on treatment of sarcoidosis”, which outlined completely new approaches to management of sarcoidosis patients. According to this document, a decision about treatment of patient depends on 2 major factors: risk of death or organ failure and deterioration of quality of life of a patient. In addition, main principle of management of sarcoidosis patients is a balance between: a) minimization of risk of disability or death due to lung injury and decrease of quality of life, and b) risk of comorbidity and reduction of quality of life due to corticosteroid or other therapies. Current review focuses on analysis of major statements of these documents, disputable questions of initial therapy choice in patients with pulmonary sarcoidosis. Key words: pulmonary sarcoidosis, diagnosis, treatment, glucocorticosteroids, immunosuppressants, cytokine inhibitors.

Screening for diabetes and prediabetes: the newest communication opportunities

Type 2 diabetes mellitus (DM-2) and prediabetes are serious diseases that can lead to early disability and death. DM-2 can remain undiagnosed for many years; therefore, screening is one of the main assistants of a doctor in establishing a diagnosis, allowing to start treatment as early as possible.Research objective: early identification of patients with prediabetes and DM-2 using an online questionnaire.Materials and methods. The study was carried out online using the Google Forms platform, where a questionnaire was created based on Appendix 3 “Form of risk assessment of diabetes mellitus-2” of the Unified clinical protocol of primary and secondary (specialized) medical care “Type 2 diabetes mellitus”, approved by order of the Ministry of Health of Ukraine No. 1118 dated 12.21.2012, as well as additional questions on nutrition and physical activity. As of June 2021, the study involved 209 patients (151 women and 58 men) who did not have a documented diagnosis of DM-2 or prediabetes.Results. Most of the respondents (89 people) were overweight. 51 respondents had grade I obesity, 31 respondents had grade II, and 7 patients had a body mass index &gt; 40 kg/m2, which corresponds to grade III obesity. Only 49 respondents had a healthy weight, which corresponds to a body mass index 18.5–24.9 kg/m2. 29 (19.21%) women had a history of childbirth with a child weighing more than 4 kg. The diagnosis of polycystic ovary disease (a risk factor for the DM-2) was in 34 (22.52%) women. Upon receipt of laboratory tests, we established a diagnosis of prediabetes in 28 (13.40%) patients, and a diagnosis of DM-2 in 17 (8.13%) people.Conclusions. It is necessary to search for new opportunities in communicating with patients during the COVID-19 pandemic, one of which is online questionnaires based on regulatory documents.

9.4 CHALLENGES AND CONSIDERATIONS FOR SCREENING FOR PARENT ADHD IN PEDIATRIC PRIMARY CARE

ADHD is common in both parents and children, yet African American families are less likely to be diagnosed or treated, or to participate in clinical trials. Parent ADHD can significantly impact child development and treatment response. Most children receive primary care annually, presenting an opportunity to screen for ADHD in children and parents. Although pediatric providers are familiar with screening and managing ADHD in children, there is little guidance on how to effectively approach parents about their own ADHD. The current qualitative study describes challenges encountered and lessons learned when implementing a parent ADHD screening protocol in primary care serving a large population of African American youth and families. The study occurred within the context of a hybrid effectiveness-implementation trial treating parents and children with ADHD with parental stimulant medication and behavioral parent training. To guide study implementation, a stakeholder advisory group was formed including pediatricians, behavioral health providers, clinic staff, and parents with ADHD or with a child with ADHD. Meetings were held before and during the study to seek feedback from stakeholders regarding factors that may influence recruitment and implementation of the treatment trial. Two meetings were held with 9 stakeholders during June and November 2020. Meetings were recorded, transcribed, coded, and analyzed for themes. Stakeholder members were predominantly female (89%) and White (44%). Thematic analyses identified 6 themes: 1) centering Black people’s experiences with mental health care; 2) the value of integrating parent mental health with child mental health care; 3) sensitivity required when talking about parent mental health; 4) attention to medication hesitation; 5) effective vs ineffective strategies to identify parent mental health; and 6) structural barriers for screening parent ADHD in pediatric primary care. Findings provide suggestions (eg, describing symptoms vs using clinical labels, having conversations initiated by trusted providers) for pediatricians on how to engage parents effectively and sensitively in discussions about their own ADHD in the context of working with underserved multiplex families in primary care.

Implementation of an Oral Care Protocol for Primary Diabetes Care: A Pilot Cluster-Randomized Controlled Trial

Although diabetes care guidelines recommend paying attention to oral health, the effect on daily practice has been limited, and patients with diabetes have yet to benefit. We investigated whether implementation of an oral care protocol for general practitioners (GPs [family physicians]) can improve patient-centered outcomes for patients with type 2 diabetes. Twenty-four GP offices were randomly assigned to the experimental or control group (12 offices each). In the experimental group, GPs and nurse practitioners implemented an oral care protocol. No extra attention was given to oral health in the control group. The primary outcome parameter was oral health-related quality of life (QoL) assessed with the 14-item Oral Health Impact Profile at baseline and 1 year later. Other outcomes were self-reported oral health complaints and general health-related QoL (36-item Short Form Health Survey). Of 764 patients with type 2 diabetes, 543 (71.1%) completed the 1-year follow-up. More patients reported improved oral health-related QoL in the experimental group (35.2%) compared to the control group (25.9%) (P = .046; P adj = .049). In a secondary post hoc analysis including GP offices with ≥60% patient follow-up (n = 18), improvement was 38.3% and 24.9%, respectively (P and P adj = .011). Improvement of self-reported oral health complaints did not differ between groups. The intervention had no effect on general health-related QoL, with the exception of the concept scale score for changes in health over time (P adj = .033). Implementation of an oral care protocol in primary diabetes care improved oral health-related QoL in patients with type 2 diabetes.

Assistência à mulher com queixas relacionadas a infecções sexualmente transmissíveis: conhecimento de enfermeiros da atenção básica

Objetivo: Identificar o conhecimento de enfermeiros da Atenção Básica acerca da assistência à mulher com queixas relacionadas a Infecções Sexualmente Transmissíveis (verrugas anogenitais, úlcera genital, cervicite e corrimento vaginal), tendo como base o “Protocolos de Atenção Básica: Saúde das mulheres”. Metodologia: Trata-se de estudo descritivo e qualitativo realizado com 39 enfermeiros da Atenção Básica do município de Campina Grande/Paraíba. Os dados foram coletados entre os meses de maio e junho de 2017, e analisados segundo o referencial metodológico de Bardin. Resultados: Da análise das entrevistas emergiram quatro categorias: “Condutas do enfermeiro no manejo de verrugas anogenitais”; “Assistência nos casos de úlcera genital causadas por sífilis e cancro mole” e “Atuação do enfermeiro no manejo de cervicite e corrimento vaginal”. Conclusões: Os resultados do presente estudo permitiram observar lacunas no conhecimento dos enfermeiros da Atenção Básica acerca da assistência à mulher com queixas relacionadas a Infecções Sexualmente Transmissíveis, sendo relatado, na maioria dos casos, apenas encaminhamento para o médico da Unidade Básica de Saúde ou serviço especializado. O desconhecimento das condutas que deveriam ser realizadas foi justificado pela carência de prática profissional. Além disso, foi verificado que as atividades laborais do enfermeiro são influenciadas pela disponibilidade de insumos e dificuldades no que concerne a prescrição de medicamentos.

The assessment of the rationality of the pharmacotherapy of acute respiratory viral infection in the outpatient practice

Acute respiratory viral infections (ARI) and influenza occupy a leading place in the structure of the overall morbidity of the population in most countries.&#x0D; Aim. To assess the rational prescription of drugs for etiotropic therapy of ARI in the outpatient practice.&#x0D; Materials and methods. The following materials for research were used: case histories; treatment sheets; the Unified clinical protocol of primary care for adults and children “Acute respiratory infections”; data of the State Formulary of Medicines as of January 2021; the Register of wholesale prices; the weekly “Apteka” (Pharmacy). The methods of retrospective, descriptive, frequency, and VEN-analysis were applied.&#x0D; Results. According to the research results, using patient histories, it was found that family doctors prescribed 67 drugs by trade names. For etiotropic therapy, 24 drugs were used; it was 37 % of the total number, and 63 % – for symptomatic therapy. Such drugs as Amizon, Aflubin, Amixin, Resistol, Umkalor were for etiotropic therapy (more than 5 prescriptions). None of these drugs is included in the State Formulary of Medicines and the Unified clinical protocol for the treatment of influenza and SARS. Thus, these drugs are without the proven efficiency, safety and cost-effective use.&#x0D; Conclusions. The study conducted has shown that the drugs prescribed most often do not have an evidence base of efficacy and safety; none of the most frequently prescribed drugs is included in the State Formulary of Medicines and the Unified clinical protocol. A direct relationship between an increase in the number of prescriptions and an increase in price has been proven.&#x0D; Key words: acute respiratory viral infections; influenza; frequency analysis; VEN-analysis; family doctor.

Research of the range of medication for pulmonary hypertension pharmacotherapy in adults in the pharmaceutical market of Ukraine

Pulmonary hypertension (PH) is a group of rare diseases, malignant in nature, without optimal treatment quickly lead to death. Such patients usually require expensive, continuous and lifelong treatment. Therefore, the study of the assortment structure of drugs used for the treatment of drugs in adults in the domestic market of medicines (drugs) is very relevant.&#x0D; The aim of the study was to analyze the range of drugs for the pharmacotherapy of drugs in the modern pharmaceutical market of Ukraine. The object of the study was information on drugs registered in Ukraine, which are included in the protocol of treatment of patients with PH. In the process of research, system-review, graphic, documentary and marketing research methods were used. The result of the study showed that in the pharmaceutical market of Ukraine there are no drugs based on INN Epoprostenolum, Treprostinil, Beraprostum, Selexipagum, Macitentan, Tadalafilum, Vardenafilum, recommended by the Adapted clinical guidelines for the treatment of adult patients with PH and Unified clinical protocol of emergency, primary, secondary (specialized) and tertiary (hypersensitivity) medical care «Pulmonary hypertension in adults». Simultaneously INN Rivaroxabanum, Apixabanum, Dabigatranum etaxilatum, Iloprostum, Torasemide, Bosentanum, Ambrisentanum, Riociguat are included in the Unified clinical protocol of emergency, primary, secondary (specialized) and tertiary (hypersensitivity) medical care «Pulmonary hypertension in adults» and tertiary (hypersensitivity) Ukraine, however, are not included in the National List of Essential Medicines, which legally limits the possibility of their purchase by health care institutions for budget funds, but only centrally by the Ministry of Health of Ukraine. The structure of drugs for the treatment of PH in adults according to the ATX classification indicates that the largest share have groups С03С – Diuretics – 36.47%, С08С – Selective calcium antagonists with a predominant effect on blood vessels – 32.94%.&#x0D; The import dependence of the pharmaceutical market of medication for PH treatment is relatively high and constitutes about 60% of the number of trade names of medication for PH pharmacotherapy that needs research in the directions of its expansion through import substitution and legislative settlement of questions of improving the accessibility of this medication group.

Mental Health Consequences of Intimate Partner Violence Against Women in El Salvador.

Violence against women (VAW) is currently one of the main problems in El Salvador, which leads the ranking of femicides in the world. We conducted the first national survey on VAW in El Salvador following the World Health Organization (WHO) methodology, to determine the impact of violence on women's mental health (N = 1,274). Women who had experienced intimate partner violence showed significantly poorer mental health and more suicidal ideations. Common mental disorders were significantly associated with the experience of all forms of violence, after adjusting for sociodemographic variables and stressful life experiences. The results are discussed in connection with the primary care protocols and the design of public policies.