Provision Of Preventive Services Research Articles

Health System Factors and Morbidity Profiles as Determinants of Nutritional Status of Under 5 Orphans and Vulnerable Children in Isiolo County, Kenya

Malnutrition is the single most important threat facing those under 5 years with alarming associated morbidity and mortality. Whereas the assessment of malnutrition under 5 in the general population is commonly done, little is known about the nutritional quagmire facing Orphans and vulnerable children in the country. The study was a cross-sectional analytical study design administered at the community level. Data were collected from 394 OVCs and their caregivers. Simple random sampling was used to sample individual sample respondents from each of the 3 wards of Garbatulla Sub-County of Isiolo County. Both structured and semi-structured questionnaires were used to collect data. Data was then cleaned and analysed using SPSS version 26.0. Level one analysis involved the use of descriptive statistics whereas level 2 analysis entailed both bivariate and multivariate regression analysis. Acute malnutrition affected a third 127(32.9%) of under 5 OVC residing in Garbatulla sub county whereas 48(12.5%) were stunted. Underweight was noted to be 20(5.2%). Negative attitudes towards health workers increased the odds of malnutrition by 3.51 times with COR 3.51 (95% CI 1.74, 7.46). In addition, the lack of medicines and vaccines in the health facility increased the odds of malnutrition by 3.66 times: COR 3.66(95 CI 1.60, 9.14). Lastly, sickness in the previous month increased the chance of malnutrition in OVC by 58% COR 1.58 (95 CI 1.01, 2.50). The age group affected most is aged 2 to 5 years. In conclusion, negative attitudes towards healthcare workers, lack of basic medicines and immunization services and sickness in the previous 1 month increase the chance of malnutrition. Provision of basic preventive and curative services at health facilities, teaching the community about the role of healthcare work in community health and prompt treatment of common ailments are recommended to mitigate the effect of malnutrition on those under 5 OVC

Adolescent reproductive health care services: knowledge, perspectives, and challenges among service providers in Makurdi, Benue State Nigeria

Adolescence is a phase of life characterized by several reproductive health challenges that require support to navigate. However, access to adolescent and youth-friendly health service (AYFHS) centers to provide this support is limited. Perspective of healthcare workers (HCW) towards understanding the challenges to service provision has not been systematically documented. This study therefore documents the perspectives of HCWs on the types of services accessed by adolescents, and associated challenges in Makurdi, Benue State, Nigeria. The facility-based descriptive qualitative study used an in-depth interview guide among program officers in the 11 youth-friendly health centers. The interviews were recorded, transcribed, and analyzed thematically. The provision of HIV prevention services and AYFHS was appropriate while adolescents have preferences for facilities where their confidentiality is protected, and other needs are met. Reported challenges were lack of privacy, high cost of transportation to facilities, high staff attrition, poor awareness of the facilities and services, and parental consent. Suggestions for improvement included prolonged retention of youth-friendly trained staff, better client confidentiality, and economic empowerment of the adolescents to access services when needed. While the providers’ perspective on AYFHS for adolescents was positive, related challenges were also identified. Government and other stakeholders should collaborate to ensure the right environment for accessibility and utilization of AYFHS.

Factors influencing an advanced nursing practice service for people with intellectual disabilities

Abstract Background People with intellectual disabilities (PWID) have less access to preventive healthcare services and are therefore more likely to suffer from certain chronic diseases. Advanced Practice Nursing (APN) can be a suitable approach for this group. However, APN is not yet widespread in all European countries. This intervention focuses on PWID in Hamburg, Germany, who receive case management and prevention focusing on stress, nutrition, mobility and addiction through community-based APN to improve their health status. We aimed to explore the facilitators, barriers and experiences of stakeholders in the context of the APN intervention. Methods We conducted 90 semi-structured problem-centered interviews with PWID, family members, professional caregivers and prevention service providers in 2023 and 2024. We employed convenience sampling. Data were analyzed by qualitative content analysis with mixed inductive-deductive coding using MAXQDA. Results Overall interviewees were satisfied with the intervention. It was reported that the clients exercised more, ate healthier, learned techniques to reduce stress and coped better with addiction. In addition, barriers to preventive services were reduced. We identified factors that positively influenced the success of the intervention: good interprofessional collaboration, successful relationship building with clients, concise goal setting and target group-specific work materials. Barriers were: neglect of the professional care network, difussion of agreements, lack of available prevention services, and communication problems. The results are preliminary. Conclusions This is one of the first evaluation studies of an APN intervention for PWID in Germany. The results show that this new form of care can be implemented if the relevant stakeholders work together and good relationships with the clients are established. Specific goals should be defined and the professional carergivers should develop a community network. Key messages • APN is a suitable approach for disease prevention and health promotion for people with intellectual disabilities, given interprofessional collaboration and a well-established relationship with clients. • Preventive healthcare for the target group is difficult to implement if the stakeholders do not work together and if there are insufficient suitable preventive services available in the community.

Informing community pharmacists on COPD case-finding methods: A scoping review.

Early detection of chronic obstructive pulmonary disease (COPD) is a strategy to address the increasing human and economic costs of this condition. This study aimed to inform pharmacists' case-finding strategies by providing an overview of case-finding approaches by health care practitioners. A scoping review was conducted based on the Joanna Briggs Institute and the PRISMA Extension for Scoping Reviews (PRISMA ScR) guidelines. Included studies were analyzed under the following themes: population characteristics, inclusion and exclusion criteria, setting, case-finding strategies and yield, health care practitioners involved, interprofessional collaboration and the provision of preventive services. Studies were then characterized by highest yields (the weighted average of each approach expressed as a percentage of the total number of new COPD cases divided by the total number of patients screened using the same approach). The screening process produced 170 eligible studies. Twenty case-finding approaches with average yields of new COPD cases ranging from 3.8% to 29% were identified. The approach with the highest yield involved the use of a questionnaire, peak flow meter and pre-post spirometry. In 14 of these approaches, the process was initiated with the use of questionnaires. In many of the studies, case-finding was targeted at high-risk and/or symptomatic patients. Characteristics of studies with the highest case-finding yields included provider education/training, patient education, active screening, multistep approaches to case-finding, provider engagement, diagnostic criteria by guidelines and engagement of other health care practitioners. In our scoping review of case-finding methods for patients with COPD, we found the greatest yield from pre-post spirometry following initial screening with a peak flow meter and questionnaire. Pharmacists and health researchers can use these approaches to identify high-risk patients for interventions.

Stigmatised as ‘promoting’ with a duty to report: public healthcare workers providing services to criminalised ‘key populations for HIV’ under Uganda’s 2023 Anti-Homosexuality Act

This paper analyses the experiences of public healthcare workers in Uganda under the Anti Homosexuality Act (AHA) 2023, who specialise in the provision of HIV prevention and treatment services to criminalised ‘key populations’ for HIV, including men who have sex with men, transgender women, and female sex workers. Utilising in-depth semi-structured interviews with 17 public healthcare workers and participant observation with LGBTQ+ and HIV activists, public health officials, and development workers, this ethnographic study explored the legal, social and ethical challenges that public healthcare providers faced. Public healthcare workers have experienced various types of stigma from their work, including socio-legal stigma from the criminalisation of ‘promoting homosexuality’, stigma by association with key populations, concealment stigma, and denial. Legal ambiguities stemming from the AHA 2023 have led to security incidents for some public healthcare workers. The study highlights the ethical dilemmas that have arisen from the ‘duty to report’ clause, which conflicts with professional healthcare ethics of confidentiality, and the role the Ministry of Health played in passing the AHA 2023, instilling confusion about its enforcement, and minimising and denying the risks the legislation has had on Uganda’s HIV epidemic.

340B Participation and Safety Net Engagement Among Federally Qualified Health Centers

The 340B program provides discounts on outpatient drugs to certain hospitals and federally supported clinics (covered entities) that can be used to generate revenue to fund safety net care. While numerous studies have found no association between 340B and safety net care provision for most hospital covered entities, less is known about whether federally qualified health centers (FQHCs), the largest group of covered entities after hospitals, use the program to enhance safety net care. To assess whether a proxy for 340B revenue was associated with increased safety net care provision among FQHCs. This descriptive, retrospective cohort study examined care provided from 2005 to 2022 by 1468 FQHCs that submitted to the Health Resources and Services Administration Uniform Data System. FQHC and year-level fixed effects were included, as well as a control for differential Medicaid expansion over time. The data were analyzed between March and December 2023. One-year lagged number of locations registered to dispense or administer 340B-discounted drugs (registered locations), which included child sites, in-house pharmacies, and contract pharmacies in the 340B Outpatient Pharmacy Affairs Database. Natural logarithm of patient volume by payer, low-income status, and use of enabling services. Natural logarithm of visits in which low-profit preventive services were provided. An additional registered location was associated with increased patient volume, especially for uninsured (0.4%; 95% CI, 0.3%-0.5%) and privately insured (0.4%; 95% CI, 0.2%-0.5%) patients and low-income (0.4%; 95% CI, 0.2%-0.6%), unhoused (0.3%; 95% CI, 0.1%-0.5%), and non-English-speaking (0.3%; 95% CI, 0.1%-0.5%) patients. An additional registered location was associated with increased visits with an HIV test (0.7%; 95% CI, 0.4%-0.9%), serum lead test (0.8%; 95% CI, 0.6%-1.1%), seasonal influenza shot (0.4%; 95% CI, 0.3%-0.5%), Papanicolaou smear (0.5%; 95% CI, 0.4%-0.7%), and tobacco cessation counseling (1.0%; 95% CI, 0.5%-1.4%). Across the study period, the average annual increase in locations was 1.5. The results of this cohort study suggest that there are statistically significant increases in the provision of low-profit but high-value preventive services and care to safety net populations (those who lack insurance, have a low income, or require enabling services) and that, like public hospitals, FQHCs might use 340B revenues to enhance safety net care. This finding may inform debates on the 340B program by supporting differential 340B reforms across hospital and nonhospital covered entities.

Factors Influencing Community Decisions in Choosing Community Health Centers for Promotive and Preventive Health Services: Literature Review

Introduction: Minister of Health Regulation Number 43 of 2019 stated that Community Health Centers (Puskesmas) were health service facilities that provided community health efforts (UKM) and individual health efforts (UKP) at the first level, prioritizing promotive and preventive efforts in their working areas. The reason for composing this article was crucial, as Community Health Centers, as both general health services and providers of promotive and preventive services, were expected to attract public interest.. Objective: Analyzed factors influencing community choices of health centers for promotive and preventive services. Method: A qualitative research study was conducted, employing a literature review via electronic databases, particularly utilizing Scopus journal sources. Keywords like "Primary health care," "consumer attraction," and "decision to visit the health center" guided the search, Inclusion criteria set for articles published in English, freely accessible, and between 2019 and 2023. Result: Based on the literature search process through electronic databases, 7 articles were obtained. The selected articles met the predetermined criteria. These articles were related to the use of price transparency tools, community satisfaction and dissatisfaction, the Health Extension Program, the crucial role of good healthcare services, as well as the influence of income and grants. Conclusion: Factors influencing the community's choice of Community Health Centers as a health service included offering lower service costs through insurance or BPJS Kesehatan, the presence of the Health Extension Program (HEP), patient satisfaction with services, gender factors, income, access to grants, and contact with health education.

SWOT ANALYSIS OF INSTITUTIONS PROVIDING MANUAL THERAPY AND MEDICAL MASSAGE SERVICES

The article considers the SWOT-analysis methodology for assessing and comparing public and private institutions in Ukraine, in particular the arrangement of offices and the quality of services provided by specialists in manual therapy and therapeutic massage. This will help the administration to accept and correct the shortcomings for the future prospective development of institutions and health care activities in general. The study examines strengths and weaknesses, opportunities and threats that can affect the quality of providing preventive and health services in order to increase the number of visits. In this study, the SWOT-analysis has been considered as a diagnostic procedure for assessing the state and development trends of the institution. The method of expert assessment has been used in the study, in order to prevent incorrect assessment of factors, especially the internal environment due to its subjective approach, issues of completeness, validity and reliability of primary information, the bias of quantitative analysis over qualitative, poor adaptation to changing environmental conditions. As a result, comparative differences and similarities of internal and external factors of development between private and state institutions have been found in the study. The purpose of the study is to investigate and analyze the strengths, weaknesses, opportunities and threats of institutions, establishments that provide manual therapy, therapeutic and preventive massage services. The following methods have been used to solve the tasks of this study: analysis and generalization of data from scientific and methodological literature, analysis of normative and legal, internal statutory documentation, questionnaires, interviews, expert evaluation. The analysis of external factors of the SWOT -analysis demonstrates the same number of opportunities of public and private institutions. A number of priority opportunities for the development of private institutions are technical improvement and the possibility of improving the level of professionalism by undergoing advanced training abroad, increasing the quantitative spectrum of the provision of medical and preventive services. State institutions include the creation of competitive conditions, the purchase of modern equipment, salary increases, etc. Threats to the prospects of a state institution include threats to its financial situation, and to a private - reputation of an institution and its specialists.

Provision of educational psychological services under a high inflationary environment in Masvingo Province, Zimbabwe

The study employed a qualitative research approach using a phenomenological research design since the lived experiences of educational psychologists in Masvingo Province were scrutinized with the intention of establishing the extent to which educational psychologists matched the laid down specifications pertaining to their professional operations during a high inflationary environment. Three males and two females were purposely selected and in-depth interviews were utilized. Four themes emerged from the study: (a) vital roles, successful, and unsuccessful experiences, (b) diverse views on major policy documents, (c) barriers in rendering support services, and (d) perceived solutions. Results indicated that policy documents are outdated and need revision. Human and material resources were viewed a barriers to performance and perceived solutions included multidisciplinary team work, decentralization and increasing the number of psychologists, training of psychologists and reduced continuous professional development points. Educational psychologists focused more on diagnostic and behavioral consultations in urban schools. They distributed schools in urban areas depending on psychologists’ place of residences. Rural schools were minimally assessed with little provision of intervention, prevention, and health promotion services. The results provide important implications for resource provision and policy formulation.

Tuberculosis experience in possible respiratory infectious disease outbreaks with lessons learned during the COVID-19 pandemic

The analysis of the lessons learned during the COVID-19 pandemic was carried out and the provision of treatment and preventive services to the population in health care facilities was improved in case of possible emergencies in connection with possible outbreaks of respiratory infectious diseases in the Republic of Tajikistan using the experience of the anti-tuberculosis service.During the COVID-19 pandemic, individual employees of anti-tuberculosis facilities reflected the relationship of coronavirus infection with contacts at work. The relationship between the dynamics of reducing the incidence of tuberculosis among employees of specific medical institutions and the volume of implemented interventions for anti-tuberculosis infection control, which, in combination with other anti-epidemic measures, plays a significant role in reducing the risk of spreading tuberculosis infection and is an essential element of protecting the health of medical workers, has been scientifically proven. The experience of TB facilities in complying with infection control rules and regulations can be used to prepare health systems for various likely outbreaks of respiratory infections.

Improved prevention of female genital schistosomiasis: piloting integration of services into the national health system in Côte d’Ivoire

IntroductionFemale genital schistosomiasis (FGS) is a neglected gynecological condition, putting women at-risk of poor sexual and reproductive health (SRH), including pregnancy complications or infertility. Early treatment of schistosomiasis with praziquantel is important to avoid disease progression to FGS as it is not always possible to reverse these symptoms. However, prevention programs with praziquantel have historically focused on school-aged children. Therefore, there is a gap to provide prevention services for young women in endemic areas, including Côte d’Ivoire.MethodsWe piloted integration of FGS prevention services into routine SRH care in seven health centers (Soubré district, Côte d’Ivoire, November 2020 to April 2021) and enrolled 56 health workers. We used mixed methods including key informant interviews, focus group discussions, and questionnaires to determine effectiveness, feasibility and acceptability of integration across health system decision makers, health workers and female patients (15 to 29 years old). For qualitative data, we used an inductive coding process to analyze themes. We used descriptive statistics to analyze quantitative data.ResultsInterviewed health workers perceived that the integrated services increased access and improved health outcomes for women (15 to 29 years old) due to the more comprehensive approach, although barriers to access included lack of transportation. Female patients surveyed at baseline (n=448) indicated there were no routine FGS prevention services. During the pilot, FGS prevention services were provided to >8500 women at-risk. Health workers interviewed at the end of the pilot indicated they could feasibly provide FGS prevention services as part of routine patient consultations, and they maintained knowledge from training on the key FGS health education points and the consultation processes to follow. The greatest challenge expressed by health workers was the high workload.DiscussionProvision of integrated healthcare in the health center setting is an effective and acceptable way to increase access to prevention services and provide holistic care for women (15 to 29 years old) in this setting in Côte d’Ivoire. Future scale-up will require further streamlining of the strategy, building on existing platforms, whilst ensuring reduced impact on workload and consideration of how to overcome barriers to accessing health centers.

Preventive Legal Services for Kinship Care: Reducing the Need for Foster Care with Family First

This study examines the implementation of preventive legal services for kinship families within the Family First Prevention Services Act (FFPSA) service array. A university research team, contracted by the Title IV-E agency to evaluate the FFPSA programs, interviewed legal staff and kinship caregivers to understand how the provision of preventive legal services impacts the prevention-related needs of families. Findings suggest that the provision of free legal services can prevent children in kinship families from entering foster care by enhancing access to the services needed to ensure youth have legal membership in families that maintain their cultural and community ties. Future implementation should consider preventive legal services in the prevention service array, and how the referral mechanisms and systems of support surrounding kinship families can coordinate to ensure that more children can remain with their families.

Barriers and Facilitators to Cardiovascular Disease Prevention Following Hypertensive Disorders of Pregnancy in Primary Care: Cross-Sectional Surveys.

Women with a history of hypertensive disorders of pregnancy (HDP) have an increased risk of cardiovascular disease (CVD). Guidelines recommend that women diagnosed with HDP should be advised of their increased CVD risk, have regular blood pressure monitoring by their general practitioner (GP), and adopt healthy lifestyle behaviours. However, within Australia, the current practice in primary health care is unknown. The aim of this study was to describe current practices, barriers, and facilitators to the provision of CVD preventative services for women after HDP in the primary care setting and to identify potential strategies to support GPs in providing recommended care. Separate cross-sectional online surveys were undertaken with 35 GPs and 105 women with a history of HDP. Surveys included both closed- and open-ended questions. Closed-ended questions were analysed using basic descriptive statistics, and open-ended questions were themed and tallied. The survey of GPs revealed that GPs are more likely to assess traditional CVD risk markers than lifestyle risk factors or HDP history. GPs identified a lack of resources and skills as barriers to providing CVD preventative care post-HDP. The survey with women after HDP revealed that women with a history of HDP are more likely to be assessed for blood pressure than lifestyle CVD risk factors, and that the women's barriers to obtaining care included difficulty obtaining an appointment and time required for attending appointments. Strategies to improve CVD preventative care were consistent between surveys, where 70% of GPs and 59% of women chose 'increasing women's awareness of increased CVD risk' and 67% of GPs and 55% of women chose 'improving communication between hospitals and primary care' as their preferred strategies. While the findings suggest that women with a history of HDP are receiving advice consistent with guidelines for traditional CVD risk markers, such as blood pressure, they are less likely to receive CVD preventative care for lifestyle or female-specific CVD risk factors.

A RURAL-URBAN COMPARISON OF PERFORMANCE-BASED PRIMARY HEALTH CARE SERVICES IN ERZURUM

Objective: The aim of this study was to examine rural-urban differences in performance-based service data and evaluate the reasons family physicians are unable to provide service by performance exception forms. 
 Methods: We retrospectively evaluated 4187 performance exception forms sent to the provincial health directorate by family physicians between 2019 and 2021. The preventive health service not provided, the reason specified by the family physician, the year, and whether the setting was rural or urban were noted. 
 Results: Between 2019 and 2021, there were 2553 applications from urban areas and 1634 applications from rural areas. There were significantly fewer applications from rural areas. During this period, disruptions in immunization services were most frequent (61.1%), with a significantly greater frequency in urban (65.5%) than rural (54.3%) settings. Nearly one-third of service disruptions were attributed to migration out of the family physician’s service area. The most common reason reported for immunization service disruption was vaccine refusal (47.6%).
 Conclusion: Vaccine refusal and migration were identified as the main barriers to the provision of preventive health services. Although the global struggle against vaccine rejection continues, national legislative changes should be implemented to prevent a simple factor such as migration from interrupting health services in our country.

Colorectal cancer disparities in Latin America: Mortality trends 1990-2019 and a paradox association with human development.

Colorectal cancer mortality is growing in Latin America. It is known for a marked income disparity between its countries, and there is a consistent association with development. Our purpose was to describe trends in colorectal cancer mortality in Latin America between 1990 and 2019, identifying differences by human development categories. We extracted age-adjusted mortality rate from the Global Burden of Disease (GBD) Study from 22 Latin American countries, subregions, and country groups previously ranked by the GBD study due to Sociodemographic Index (SDI) between 1990 and 2019. We applied the segmented regression model to analyze the time trend. Also, we estimated the correlation between mortality rates and Human Development Index (HDI) categories for countries. Between 1990 and 2019, colorectal cancer adjusted mortality rate increased by 20.56% in Latin America (95% CI 19.75% - 21.25%). Between 1990 and 2004, the average annual percentage change (APC) was 0.11% per year (95% CI 0.10-0.12), and between 2004 and 2019 there was a deceleration (APC = 0.04% per year, 95% CI 0.03%- 0.05%). There is great heterogeneity among the countries of the region. Correlation between these two variables was 0.52 for 1990 and 2019. When separated into HDI groups, the correlation varied in the direction of the association and its magnitude, typifying an effect modification known as Simpson's Paradox. Human development factors may be important for assessing variation in cancer mortality on a global scale. Studies that assess the social and -economic contexts of countries are necessary for robust evaluation and provision of preventive, diagnostic and curative services to reduce cancer mortality in Latin America.

An introduction to gender affirming healthcare: What the family physician needs to know.

Gender affirming healthcare (GAHC) is a relatively new field in primary health care that describes a range of gender affirming practices, including hormone therapy, for transgender and gender diverse (TGD) people. In 2019, gender affirming hormones were approved by South African National Essential Medicine List Committee (NEMLC) for tertiary-level care, and in October 2021 the Southern Africa HIV Clinicians Society published a GAHC guideline for South Africa. Unfortunately, TGD people still experience discrimination and stigmatisation in healthcare facilities in South Africa, leading to poor access to care and higher health risks with poorer outcomes. Gender affirming care in the primary health care clinic can improve access to health care, with improved provision of preventative services. This article defines key transgender concepts, describes the informed consent process and outlines the initiation and monitoring of both feminising and masculinising hormone treatment for TGD people. Staff at healthcare facilities need to receive training on gender affirming practices and how to ensure a safe environment for TGD clients.

Community based peer-led TB screening intervention: an innovative approach to increase TB knowledge, presumptive case identification, and referral among sexual minority people in urban Bangladesh

IntroductionOne of the contributors to tuberculosis (TB) burden among vulnerable populations, such as sexual minority people, is the delay in case finding and notification. Given their socially excluded, hard-to-reach nature, community-led approaches need to be introduced to facilitate their screening of TB symptoms and their subsequent referral to TB healthcare providers. This article aimed to explore the existing challenges surrounding TB screening and referral, and the implementation facilitators and barriers of the proposed community-based TB screening model for sexual minority people in Dhaka, Bangladesh.MethodsThis study followed the quasi-experimental design using mixed methods (i.e., qualitative and quantitative) approach. The study participants who were also a part of the community-led TB screening model included sexual minority people enrolled in HIV prevention interventions. In addition to quantitative inquiry, in-depth interviews were conducted on sexual minority people, focus group discussions were also conducted on them and HIV prevention service providers, and key-informant interviews were conducted on service providers, programmatic experts and TB researchers. Data were analyzed using content, contextual and thematic approaches.ResultsThe ‘Six Steps in Quality Intervention Development’ framework was used to guide the development of the community-based TB screening model. In Step 1 (identifying the problem), findings revealed low rates of TB screening among sexual minority people enrolled in the HIV prevention intervention. In Step 2 (identifying contextual factors for change), various individual, and programmatic factors were identified, which included low knowledge, low-risk perception, prioritization of HIV services over TB, and stigma and discrimination towards these populations. In Step 3 (deciding change mechanism), community-based screening approaches were applied, thus leading to Step 4 (delivery of change mechanism) which designed a community-based approach leveraging the peer educators of the HIV intervention. Step 5 (testing intervention) identified some barriers and ways forward for refining the intervention, such as home-based screening and use of social media. Step 6 (collecting evidence of effectiveness) revealed that the main strength was its ability to engage peer educators.ConclusionThis study indicates that a community-based peer-led TB screening approach could enhance TB screening, presumptive TB case finding and referral among these populations. Therefore, this study recommends that this approach should be incorporated to complement the existing TB program.

О некоторых актуальных вопросах совершенствования профилактической деятельности центров общественного здоровья и медицинской профилактики

In actual conditions, increasing of health risks for population determines actuality of exploration of organization of preventive activities of centers of public health and medical prevention. Objective: to analyze particular actual issues of development of preventive activity of centers of public health and medical prevention in Russia. Material and methods. The topical selection of publications, analytical method, comparative analysis and systemic approach were applied. Results. The key measures required for effective preventive activity in centers of public health and medical prevention were established and aggregated. Within the framework of task of active involvement of population into unified preventive environment the implementation of new health care mobile technologies into activities of medical personnel of centers of public health and medical prevention is claimed to monitor patients with the purpose of treatment of various chronic non-communicable diseases and elimination of risk factors of their development. Conclusion. The provision of medical and preventive services to population on a free-of-charge basis is among advantages of preventive activities of centers of public health and medical prevention. The development of unified preventive environment in centers of public health and medical prevention applying mobile health care technologies permits to increase interest of population in health self-control and conscious implementation of medical recommendations about healthy life-style. The implementation of marketing measures can promote increasing of organizational and reputation status of “health center” among population.

Goals, Services, and Target Patient Populations of Community Paramedicine in Rural United States

Introduction: Rural areas contain one-fifth of the US population and only 10% of the nation’s physicians. Community paramedicine (CP) is a growing healthcare delivery model in which emergency medical personnel provide non-emergent medical care. Community paramedics may help fill the primary healthcare gap for rural residents. This literature review provides an overview of the common goals, services, target populations, and setbacks of rural CP programs in the US.
 Methods: A systematic search following PRISMA protocols was completed on PubMed and Google scholar using the search terms: “community paramedicine/paramedic” and “rural, remote, frontier” between 2000-2021.
 Results: Rural CP program goals are to aid patients in chronic disease management and reduce emergency department visits, hospital admissions/readmissions, and healthcare costs. Programs target services toward patients who are chronically ill, post-hospital discharge, and frequent EMS users.
 Conclusion: CP provision of preventative and primary care services has improved health outcomes for patients with chronic disease. Programs report cost savings for the healthcare payer and patient and a reduction in ED transports and hospital readmissions. The problems identified are acquiring sustainable funding to develop CP programs and reimburse CP services, lack of consistency between CP scope of practice and educational requirements across states, role tensions with other healthcare professions, and lack of research about the safety of CP programs for patients. Future research is needed to investigate patient outcomes secondary to CP preventative and primary care services, which may identify if CPs are an effective means of helping fill the primary care gap for rural communities.

Community-based HIV prevention services for transgender people in Ukraine: current situation and potential for improvement

BackgroundCommunity-based HIV-prevention services are a key approach to prevent HIV transmission among key population representatives. Transgender people have multiple specific needs and it is crucial to use prevention approaches that effectively respond to those needs and facilitate barriers on the way to use HIV prevention and related services. This study is aimed to explore the current state of community-based HIV prevention services among transgender people in Ukraine, its limitations and potential for improvement based on the experience and perceptions of transgender people, physicians, and community social workers providing services to transgender people.MethodsSemi-structured in-depth interviews were conducted among physicians providing services to transgender people (N = 10), community social workers (N = 6), and transgender people (N = 30). The objectives of the interviews were to explore: the relevance of the community-based HIV prevention services to the needs of transgender people; the key components of the most preferred (“ideal”) HIV-prevention package for transgender people; ways to optimize the existing HIV prevention package for transgender people including enrollment and retention. Systematically collected data were analyzed and coded into the main domains, thematic categories and subcategories using thematic analysis.ResultsThe current HIV prevention programs were well-evaluated by the majority of respondents. Gender-affirming care was found to be the key need of transgender people. Integration of HIV prevention services and gender-affirming care was perceived as the main way to address the needs of transgender people. Internet-based and peer word-of-mouth recruitment may improve enrollment in services. Optimization of existing HIV prevention package may include: psychological counseling, referral and navigation to medical services, legal services, pre- and post-exposure prevention, dissemination of tube lubricants, femidoms and latex wipes, use of oral fluid test systems for HIV self-testing.ConclusionsThe findings of this study suggest potential solutions to improve community-based HIV prevention services for transgender people by introducing a transgender people -oriented package, which integrates gender transition, HIV prevention and other services. Provision of prevention services based on assessed risk and referral/navigation to related services are the key options for optimization of the existing HIV prevention package.Trial registrationNot applicable.