Public Health Care Centers Research Articles

Analysis of Factors Affecting the Workload of Health Workers in the Namrole Public Health Center and Wamsisi Public Health Center in South Buru Regency

The workload on health workers in Public health centers can be seen from aspects such as tasks that arecarried out based on their main functions. The purpose of this study was to analyze the factors that influencethe workload of health workers in the Namrole Public health center and the WamsisiPublic health center inSouth Buru Regency. This type of research is a quantitative cross-sectional study design. The populationin this study were all health workers with the status of civil servants who worked in the NamrolePublichealth center as many as 73 officers and WamsisiPublic health center as many as 27 officers. The samplingtechnique in this study was proportional random sampling to obtain a sample of the NamrolePublic healthcenter as many as 58 officers and WamsisiPublic health center as many as 22 officers. The results showedthat there was no influence of the level of education on the workload of health workers in the Namrolepublichealth center and the Wamsisipublic health center in South Buru regency (p = 0.622> 0.05). Working timesignificantly affected the workload (p = 0.000 <0.05) and years of service are protective factors for theworkload of employees at the Namrolepublic health center and the Wamsisipublic health center in SouthBuru regency (p = 0.053> 0.05). To the Regional Government of South Buru Regency to emphasize moreregulations related to working hours, especially for employees at public health care centers, so that they areable and comfortable to carry out their duties and functions effectively and efficiently with optimal worktime and not excessive.

The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa.

Cervical cancer is one of the most common causes of morbidity and mortality among women in developing countries including Ethiopia. Unlike other types of cancers, the grave outcomes of cervical cancer could be prevented if detected at its early stage. However, in Ethiopia, awareness about the disease and the availability of screening and treatment services is limited. This study aims to determine the role of health education on cervical cancer screening uptake in selected health facilities in Addis Ababa. Two-pronged clustered randomized controlled trial was conducted in 2018 at eight public health centers that provide cervical cancer screening services using visual inspection with acetic acid (VIA) in Addis Ababa, Ethiopia. Each of the eight health centers were randomly assigned to serve as either an intervention or a control center. A two-pronged clustered randomized controlled trial was conducted in eight public health care centers. All the selected facilities provided cervical cancer screening services using visual inspection with acetic acid (VIA). Four health centers were randomly assigned to the intervention and control arms. The study participants were women aged 30-49 years who sought care at maternal and child health clinics but who had never been screened for cervical cancer. In the intervention health centers, all eligible women received one-to-one health education and educational brochures about cervical cancer and cervical cancer screening. In the control health centers, participants received standard care. Baseline data were collected at recruitment and follow-up data were collected two months after the baseline. For the follow-up data collection, participants (both in the intervention and control arms) were interviewed over the phone to check whether they were screened for cervical cancer. From the 2,140 women who participated in the study, 215 (10%) screened for cervical cancer, where 152(71%) were from the intervention health centers. Seventy-four percent of these participants reported that they learned about the benefits of screening from the one-to-one health education or the brochure. Women from the intervention health centers had higher odds of getting screened (AOR = 2.43,95%CI;1.58-2.90) than the controls. Women with the educational status of the first degree and those who have a history of sexually transmitted infections (STIs) had higher odds of getting screened (AOR = 2.03,95%CI;(1.15-2.58) and (AOR = 1.55,95%CI;1.01-2.36), respectively. Providing focused health education supported by printed educational materials increased the uptake of cervical cancer screening services. Integrating one-to-one health education and providing a take-home educational material into the existing maternal and child health services can help increase cervical cancer screening uptake.

Challenges in the Management of Diabetes in Primary Care

Diabetes management in primary care is critical to reducing the occurrence and severity of complications through blood sugar management and early detection. A chronic disease management in primary care pilot project, based on the Chronic Care Model (CCM) model that provides patient education on, regular monitoring blood glucose level, medication intake, healthy lifestyle practice, and complications has been developed and applied. Primary care in Korea should provide appropriate education to patients with diabetes and increase the rate of complication testing. In addition, it is of the utmost importance to establish an infrastructure for medical staff to manage patients on a team basis and to establish a patient management system in the community by strengthening primary center (private) and public health care center (public) cooperation activities. Keywords: Care coordinator, Chronic Care Model, Diabetes management in primary center, Private-public cooperation

Interventions for prudent antibiotic use in primary healthcare: an econometric analysis

BackgroundRational antibiotic prescribing is crucial to combat antibiotic resistance. Optimal strategies to improve antibiotic use are not known. Strama, the Swedish strategic program against antibiotic resistance, has been successful in reducing antibiotic prescription rates. This study investigates whether two specific interventions directed toward healthcare centers, an informational visit and a self-evaluation meeting, played a role in observed reduction in rates of antibiotic prescriptions in primary healthcare.MethodsThe study was a retrospective, observational, empirical analysis exploiting the variation in the timing of the interventions and considering past prescriptions through use of estimations from dynamic panel data models. Primary healthcare data from 2011 to 2014 were examined. Data were from public and private primary healthcare centers in western Sweden. The key variables were prescription of antibiotics and indicator variables for the two interventions.ResultsThe first intervention, an educational information intervention, decreased the number of prescriptions among public healthcare centers, but this effect was only temporary. We found no proof that the second intervention, a self-evaluation meeting at the healthcare center, had an impact on the reduction of prescriptions.ConclusionsSingle educational interventions aimed at influencing rates of antibiotic prescriptions have limited impact. A multifaceted approach is needed in efforts to reduce the use of antibiotics in primary health care.

Facility readiness for basic emergency obstetric and neonatal care at PHC centres in Nigeria

Abstract Background Functionality of essential delivery services at primary health care (PHC) centres is crucial to achieving targeted improvements in maternal and neonatal outcomes in Nigeria. However, evidence suggests that PHC centres are often unable to adequately render basic emergency obstetric and neonatal care (BEmONC) services. This study assessed BEmONC availability and facility readiness at PHC centres in Edo State, Nigeria. Methods This facility-based cross-sectional survey was conducted in Edo State, Nigeria among 36 public primary health care centres selected by multistage sampling. The WHO service availability and readiness assessment tool was adapted to obtain data from PHC centres. BEmONC availability index was derived using 6 indicators (intravenous oxytotics, intravenous anticonvulsants, intravenous antibiotics, assisted deliveries, removal of retained products of conception and neonatal resuscitation). A composite readiness index was developed based on 26 indicators across five domains (trained staff, basic amenities, basic equipment, diagnostic tests and essential medicines). Indices were summarized as mean percentages and 95% confidence intervals. Results Among 36 facilities assessed, the mean BEmONC availability index score was 48.6% (CI = 41.7 - 55.5%) while the mean composite readiness index score was 58.9% (CI = 54.5 - 63.2%). Domain specific readiness indices showed marked variations with low mean scores for basic amenities (45.8%, CI = 38.4 - 55.3%) and trained staff (43.5%, CI = 33.1 - 53.9%), moderate score for basic equipment (53.5%, CI = 48.6 - 58.5%) and high scores for diagnostic tests (71.2%, CI = 60.5 - 82.1%) and essential medicines (80.1%, CI = 72.4 - 87.8%). Conclusions BEmONC availability and readiness at PHC centres in Edo State was suboptimal. Current efforts to improve services at PHC centres should strategically target availability of emergency obstetric functions, enhancing staff capacity and upgrading basic amenities. Key messages There are crucial gaps in the provision of BEmONC at primary health care level in Edo State, Nigeria that may negatively impact the quality of maternal and neonatal care. This study highlights the need for stakeholders to intensify PHC strengthening initiatives geared towards better pregnancy outcomes.

Facing a blind alley - Experiences of stress-related exhaustion: a qualitative study

IntroductionMental illness is a major concern in many countries. In Sweden, stress-related mental illness is currently the most frequent reason for sick leave.ObjectiveThis study aimed to explore patients’ experiences of...

Effects of terrorist attacks on access to maternal healthcare services: a national longitudinal study in Burkina Faso

IntroductionMost of the literature on terrorist attacks’ health impacts has focused on direct victims rather than on distal consequences in the overall population. There is limited knowledge on how terrorist...

Understanding patient satisfaction and loyalty in public and private primary health care.

Background: The quality of health centers, patient satisfaction, and loyalty are three key factors that enable health care providers to improve their services and cost-effectiveness. This study, therefore, aims to determine patient satisfaction and loyalty in public and private primary health care centers.Design and Methods: Data were obtained from a cross-sectional design of 1470 self-administered questionnaires and analyzed based on mean, standard deviation, and correlation coefficients.Results: The results showed respectively a strong and moderate correlation between patient satisfaction and loyalty in private (r=0.767) and public (r=0.54) primary health care centers, respectively. In addition, in both centers patients received adequate medical services, with social aspects as the least important factors affecting patient satisfaction.Conclusions: In conclusion, primary health care practices need to recognize the needs that influence patients’ satisfaction and loyalty, to improve the quality of their services.Significance for public healthPatient satisfaction affects all dimensions of healthcare services, including patient retention, which is the key factor that determines their return to the same center. The provision of high standard health services, staff motivation, and showing appreciation help to retain patients. It is important to determine the driving forces that influence patients’ choice to return for more services in order to implement effective strategies for maintaining their loyalty. This paper describes the correlation between patient satisfaction and loyalty in public and private primary health care.

Eye patching after cataract surgery is associated with an increased risk of short-term corneal oedema.

To evaluate the effect of postoperative eye patching after routine cataract surgery on corneal oedema and visual acuity on the first postoperative day. One public healthcare centre. This randomized controlled trial included patients undergoing uneventful cataract surgery in one medical centre. Patients were randomized into two groups: the surgical eye was patched with a single dose of a local steroid and antibiotic for 24hr in the first group, and a plastic shield was used in the second with local steroid and antibiotic drops. The eyes were examined preoperatively and on the first postoperative day. Examination included the following: best-corrected visual acuity (BCVA), full slit lamp examination, intraocular pressure (IOP), anterior chamber depth (ACD) and central corneal thickness (CCT) using the IOL Master 700 (Zeiss, Germany). Cumulative dissipated energy (CDE) and operation time were recorded for all cases. One hundred eyes of 100 patients were included in the study. The postoperative increase in CCT 24hr after surgery was 138 and 70µm in the patched group as compared to the non-patched group, respectively (p=0.001). Best-corrected visual acuity (BCVA) on the first postoperative day was 0.5±0.45 LogMAR and 0.3±0.3 LogMAR in the patched and non-patched group, respectively (p=0.01). There was no difference in CDE (11.33±9.2 and 10.22±7.3; p=0.94) between the two groups. Eye patching after routine cataract surgery is associated with an increase in corneal oedema and slower visual recovery on the first postoperative day.

Examination of WHO/INRUD Core Drug Use Indicators at Public Primary Healthcare Centers in Kisii County, Kenya.

Background Irrational drug use is a global problem. However, the extent of the problem is higher in low-income countries. This study sets out to assess and characterize drug use at the public primary healthcare centers (PPHCCs) in a rural county in Kenya, using the World Health Organization/International Network for the Rational Use of Drugs (WHO/INRUD) core drug use indicators methodology. Methods Ten PPHCCs were randomly selected. From each PPHCC, ninety prescriptions from October to December 2018 were sampled and data extracted. Three hundred (30 per PPHCC) patients and ten (1 per PPHCC) dispensers were also observed and interviewed. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use. Results The average number of drugs per prescription was 2.9 (SD 0.5) (recommended: 1.6–1.8), and the percentage of drugs prescribed by generic names was 27.7% (recommended: 100%); the percentage of prescriptions with an antibiotic was 84.8% (recommended: 20.0–26.8%), and with an injection prescribed was 24.9% (recommended: 13.4–24.1%). The percentage of prescribed drugs from the Kenya Essential Medicines List was 96.7% (recommended: 100%). The average consultation time was 4.1 min (SD 1.7) (recommended: ≥10 min), the average dispensing time was 131.5 sec (SD 41.5) (recommended: ≥90 sec), the percentage of drugs actually dispensed was 76.3% (recommended: 100%), the percentage of drugs adequately labeled was 22.6% (recommended: 100%), and the percentage of patients with correct knowledge of dispensed drugs was 54.7% (recommended: 100%). Only 20% of the PPHCCs had a copy of KEML available, and 80% of the selected essential drugs assessed were available. Conclusion The survey shows irrational drug use practices, particularly polypharmacy, nongeneric prescribing, overuse of antibiotics, short consultation time, and inadequacy of drug labeling. Effective programs and activities promoting the rational use of drugs are the key interventions suggested at all the health facilities.

Adherence to key domains in low back pain guidelines: A cross-sectional study of Danish physiotherapists.

ObjectiveThe aim of the study was threefold: Firstly, to investigate the adherence to clinical practice guidelines for low back pain (LBP) among Danish physiotherapists with regard to three key domains: (a) activity, (b) work and (c) psychosocial risk factors. Secondly, to investigate whether adherence differed between physiotherapists working in private clinics (private physiotherapists) and physiotherapists working at public healthcare centres (public physiotherapists). Thirdly, to describe the physiotherapists' treatment modalities for patients with LBP.MethodsA cross‐sectional online survey was conducted with 817 physiotherapists working in the Central Denmark Region. Adherence to the guideline domains was assessed using two vignettes. The difference in adherence between the groups was assessed using the Chi‐squared test. Treatment modalities were reported using descriptive statistics.ResultsA total of 234 physiotherapists responded, hereof 163 private physiotherapists and 71 public physiotherapists (response rate 29%). The proportions of physiotherapists managing the patients strictly in line with the guideline domains were 32% (activity), 16% (work) and 82% (psychosocial risk factors) for Vignette 1 and 6% (activity), 53% (work) and 60% (psychosocial risk factors) for Vignette 2. Public physiotherapists were more likely to manage patients strictly in line with guidelines for assessing the psychosocial risk factors compared to private physiotherapist (Vignette 1: 92% vs. 77% p = .030; Vignette 2:70% vs. 55% p = .035). Regarding the other two domains, there was no significant difference between the two groups in terms of adherence (p > .05). Concerning treatment modalities, the majority of physiotherapists instructed the patients in adopting an exercise program or informed the patients about the benign nature and prognosis of LBP.ConclusionOverall, the participating Danish physiotherapists strictly adhered to only one out of three key domains. This underlines the importance of bringing focus on implementing the current guidelines' recommendations in clinical practice.

AVAILABILITY ASPECT OF HEALTHCARE ACCESS IN HUNSUR TALUK, MYSURU DISTRICT- A SPATIAL ANALYSIS

This paper aims to attempt the study of availability, accessibility and Infrastructure of public healthcare Facilities in Hunsur taluk, Mysuru District. It also tries to find out the gap between existing public health care facilities and normative requirement of public health care facilities as set by the government of India. The base map of study area has been geo-referenced and digitized using ARC GIS software. The Global positioning system (GPS) was adopted to take the coordinate of all the existing Public health centers in the study area. Data is analyzed though simple quantitative techniques like ratios, percentage and the spatial disparity of health centers were measured with the help of Nearest Neighbour Techniques. The results show that the availability of Public healthcare center is unequally distributed and there is scarcity in the availability of infrastructure and workforce among the study area. A large proportion of the residents have to travel a long way to access the health care facilities. There is a high inequality in the distribution of public Health centers, Health infrastructure facilities and Health Workforce in the hoblis of Hunsur taluk, Mysuru District. The Public Healthcare centers are not increasing with the population so there we can identify the gap between them. To reduce the imbalance in the health centres, the establishment of new health care centres should be based on structured criteria and geographical aspects, and there is need to improve the infrastructure of existing healthcare centers and increase the number of staffs in the study area for balanced regional development. Keywords: Availability; Accessibility; Nearest Neighbour Techniques; GIS and GPS

Antioxidant dressing therapy versus standard wound care in chronic wounds (the REOX study): study protocol for a randomized controlled trial

ABSTRACTBackgroundA wound that does not heal in the orderly stages of the healing process or does not heal within 3 months is considered a chronic wound. Wound healing is impaired when the wound remains in the inflammatory stage for too long. A range of factors can delay the healing process: imbalance between proteases and protease inhibitors in the wound bed; bacterial colonization and the presence of biofilm; and oxidative stress. Recently, wound management has improved significantly. A new antioxidant dressing has been developed, which combines an absorbent matrix obtained from locust bean gum galactomannan and a hydration solution with curcumin and N-acetylcysteine. This dressing combines the advantages of moist healing in exudate management and free radical neutralization, achieving wound reactivation. The primary aim of this study is to compare the effect of the antioxidant dressing on chronic wound healing against the use of a standard wound dressing in patients with hard-to-heal wounds.MethodsWe will conduct a multicentre, single-blind, randomized controlled trial with parallel groups. Participants will be selected from three primary public health care centres located in Andalucía (southern Spain). Patients will be randomized into an intervention group (antioxidant dressing) or a control group (standard wound dressing). Assessments will be carried out at weeks 2, 4, 6 and 8. Follow-up will be for a period of 8 weeks or until complete healing if this occurs earlier.DiscussionThe findings from this study should provide scientific evidence on the efficacy of the antioxidant dressing as an alternative for the treatment of chronic wounds. This study fills some of the gaps in the existing knowledge about patients with hard-to-heal wounds.Trial registrationClinicalTrials.gov: NCT03934671. Registered on 2 May 2019.

Portraits of HIV: a pilot photovoice study of adolescent experiences with HIV treatment in South Africa

Background Adolescents are one of the fastest growing groups of people living with HIV (PLWH) in South Africa. They are also more likely than PLWH in other age groups to report poor adherence to antiretroviral therapy (ART). This trend is likely due to a confluence of factors including life stage and transition from child to adult care. Solutions are urgently needed to support adolescent adherence, since ART can improve the lives of PLWH and limit HIV transmission. We explored adolescents’ facilitators and barriers to ART adherence via photovoice, to pilot the method with South African youth and gain information to inform future interventions. Methods The pilot study included three Photovoice groups, with 10 adolescents, who were enrolled in ART at two urban public primary health care centres in the Western Cape province of South Africa. Groups were organized by age and sex (group 1: 10-14 years, girls; group 2: 15-19 years, girls; group 3: 15-19 years, boys). Participants were given cell phones with cameras, and instructed to take pictures representing their experiences with HIV and treatment. Results Youth’s pictures and discussions focused on four key themes related to treatment and ART adherence. These themes included motivations for taking medicine, forming an identity with HIV, managing disclosure and treatment, and relationships between living conditions and HIV treatment. Treatment motivation was informed by familial support. Themes shed light on participants’ challenges and resilience in the face of HIV. Conclusion Adolescents found expressing their views through photos ‘exciting’ and were encouraged to share personal meanings in discussion with peers and researchers. Older adolescents needed less direction and encouragement than younger adolescents, to fully participate in photo-taking and discussions. Findings pave the way for future, larger Photovoice studies. Themes reiterate the importance of personal motivation including aspects of positive identity with HIV in helping youth adhere to medicine, as well as the need to address relational (e.g. family, disclosure) and structural (e.g. living conditions) factors in adherence interventions for this age group. Despite challenges, youth also have strengths (e.g. desire to commit to treatment) that interventionists can capitalize on to support adolescent treatment outcomes.

Physical activity and sedentary behaviour of ambulatory older adults in a developed Asian community: a cross-sectional study.

Physical activity (PA) and sedentary behaviour (SB) independently influence the health outcomes of older adults. Both provide interventional opportunities for successful ageing. We aimed to determine levels of PA and SB in ambulatory older adults and their associated factors in a developed Asian population known for its longevity. We conducted a cross-sectional observational study in a Singapore public primary healthcare centre. Multi-ethnic Asian adults aged ≥ 60 years took an interviewer-administered questionnaire survey. PA and SB were assessed using the Physical Activity Scale for the Elderly (PASE; score range 0 to > 400) and the Sedentary Behaviour Questionnaire for the Elderly, respectively. Among 397 participants (50.9% female; 73.2% Chinese; 47.9% aged ≥ 70 years; 33.5% employed, including voluntary work), 58.7% had ≥ 3 chronic illnesses and 11.1% required walking aids. The median PASE score was 110.8 (interquartile range 73.8-171.6) and decreased significantly with increasing age. Higher PASE score was associated with higher educational level, employment, independent ambulation without aid, and fewer chronic illnesses (p < 0.01). Employment status significantly influenced PASE score (β = 84.9, 95% confidence interval [CI] 66.5-103.4; p < 0.01). 37.0% spent ≥ 8 hours daily on sedentary activity and were twice as likely to do so if they were employed (odds ratio 2.19, 95% CI 1.34-3.59; p < 0.01). The PA of the older adults decreased with increasing age and increased with employment. One-third of them were sedentary for ≥ 8 hours daily. Those who were employed were twice as likely to have SB.

Knowledge, attitudes and practices of health care professionals towards adverse drug reaction reporting in public sector primary health care facilities in a South African district

PurposeAdverse drug reactions (ADRs) have an appreciable impact on patients’ health. Little is known however about ADR reporting in ambulatory care environments especially in low- and middle-income countries. Consequently, our aim was to determine knowledge, attitudes and practices (KAP) among health care professionals (HCPs) towards ADR reporting in primary health care (PHC) facilities in South Africa. The findings will be used to direct future activities.MethodsDescriptive, cross-sectional design using quantitative methodology among 8 public sector community health care centres and 40 PHC clinics in the Tshwane Health District, Gauteng Province. A self-administered questionnaire was distributed to 218 HCPs, including all key groups.ResultsA total of 200 responses were received (91.7%). Although an appropriate attitude towards ADR reporting existed, the actual frequency of ADR reporting was low (16.0%). Of the respondents, 60.5% did not know how to report, where to report or when to report an ADR and 51.5% said the level of their clinical knowledge made it difficult to decide whether or not an ADR had occurred. Over 97.5% stated they should be reporting ADRs with 89% feeling that ADR reporting is a professional obligation and over 70% that ADR reporting should be compulsory. When results were combined, the overall mean score in terms of positive or preferred practices for ADR reporting was 24.6% with pharmacists having the highest scores.ConclusionUnder-reporting of ADRs with gaps in KAP was evident. There is a serious and urgent need for education and training of HCPs on ADR reporting in South Africa.

¡Sí, Yo Puedo Vivir Sano con Diabetes! A Self-Management Randomized Controlled Pilot Trial for Low-Income Adults with Type 2 Diabetes in Mexico City.

BackgroundType 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system.ObjectivesWe aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City.MethodsParticipants were recruited at public primary healthcare centers (Seguro Popular), and randomly allocated to treatment (n = 26) or wait-list control groups (n = 21) with data collected at 3 and 6 mo. The program included 7 weekly sessions and 6 mo of daily text/picture messages. Descriptive statistics and a generalized linear mixed model with intent-to-treat analysis were calculated.ResultsParticipants were 55.5 ± 8.8 y of age (mean ± SD), 68% female, 88.6% overweight/obese, and 57% lived in food-insecure households. Mean ± SD T2D duration was 11.9 ± 7.8 y and HbA1c was 9.2% ± 1.5%. There was 89% attendance at sessions and 6.4% attrition across both groups at 6 mo. Group-by-time effects were seen in self-monitoring of blood glucose (P < 0.01) and diabetes self-efficacy (P < 0.04); and a trend for lower HbA1c was seen in the intervention group at 6 mo (P = 0.11). Significant improvements in dietary behavior (P < 0.01) were demonstrated in the intervention group over time, but this did not reach statistical significance compared with the control group.ConclusionsThe program was associated with clinically significant improvements in T2D self-management, self-efficacy, and HbA1c over time. Thus, T2D self-management skills, including diet, were improved in a vulnerable metropolitan population.This trial was registered at clinicaltrials.gov as NCT03159299.

Prevalence of Mood and Anxiety Disorders Among Adults Seeking Care in Primary Healthcare Centers in Cordoba, Argentina.

ObjectiveTo estimate the prevalence of mood and anxiety disorders among adults seeking care in primary healthcare centers in Cordoba city, Argentina.MethodsCross-sectional analysis of a random sample of adults 18–69 years of age seeking care for general health problems in public (i.e., government-funded) primary healthcare centers in Cordoba city, Argentina in 2010–2011. Mood and anxiety disorders were assessed in the participants’ lifetime, and in the last 12 months and 30 days using the World Mental Health Composite International Diagnostic Interview 3.0, and defined following the International Classification of Diseases, tenth revision.ResultsOverall, 1,067 participants were included in the current analysis [mean age 35.6 (SD 13.2) years, 83.7% female]. The lifetime, 12-month and 30-day prevalence of any mood or anxiety disorder was 40.4% [95% confidence interval (95%CI) 37.4–43.4%], 20.1% (17.8–22.7%) and 7.8% (6.2–9.6%), respectively. The prevalence of anxiety disorders was higher compared to mood disorders when assessed in the participants’ lifetime [29.7% (95%CI 27.0–32.5%) versus 19.3% (17.0–21.8%)], and in the last 12 months [14.9% (12.8–17.2%) versus 8.7% (7.1–10.6%)] and 30 days [5.8% (4.5–7.4%) versus 2.3% (1.5–3.4%)]. Age and marital status-adjusted odds ratios for any mood or anxiety disorder in the participants’ lifetime and in the last 12 months and 30 days comparing women versus men were 1.19 (95%CI 0.85–1.67), 1.70 (1.07–2.69), and 2.26 (1.02–5.00), respectively.ConclusionThe prevalence of mood and anxiety disorders is high among adults seeking care in primary healthcare centers in Cordoba city, particularly among women. Integration of primary and mental health services is warranted.

Violence against Health-Care Workers in Governmental Health Facilities in Arar City, Saudi Arabia.

Background Violence against health-care workers (HCWs) showed increasing worldwide concern. No previous studies addressed violence against HCWs in the Northern region, Saudi Arabia. Objectives To determine the prevalence of violence against HCWs in public hospitals and primary health-care centers in Arar city, KSA, and to identify its associated factors. Methods A cross-sectional study was conducted on 352 HCWs in the Ministry of Health (MOH) facilities in Arar city from 1st October to 31st December 2018. Consented HCWs completed a structured self-administered questionnaire which was modified from the WHO questionnaire for violence. Results Out of 352 health-care workers, 171 (48.6%) reported exposure to violence during work in the past year. The verbal violence was the most common form experienced (83%). Physicians were the main exposed group (59%). Being non-Saudi HCWs, older with longer duration of experience, working in hospitals, working in the emergency room, and working in evening or night shifts were significantly associated with more exposure to violence. The unmet demand for the patient and deficient staff number were the leading reasons for aggression. Only 16.4% of assaulted HCWs reported the violent acts to the higher health affairs authority with the most frequent reasons for nonreporting were their perception that it was useless and their fear of negative consequences. Conclusions Violence against HCWs in Arar city, KSA, is a prevalent problem. Improving health security system and increasing staffing and their training on proper dealing with violence are highly recommended. Also, enforcing rules and regulations is an important demand to control and prevent violence against HCWs.

Economic impact of dry eye disease in Spain: A multicentre retrospective insurance claims database analysis.

To analyse the occurrence and cost of dry eye disease in Spain in the recent years. A cross-sectional analysis based on anonymised data from an insurance claims database that includes data from 1997 to 2015 from public and private hospitals and healthcare centres; 36,081 patients were eligible for the study after duplicate elimination. Five ICD9 codes associated with dry eye were used for patient selection, including vitamin A deficiency with xerophthalmic scars of cornea, xerophthalmia due to vitamin A deficiency, keratoconjunctivitis sicca not specified as Sjögren's, dry eye syndrome and keratoconjunctivitis sicca Sjögren's disease. Over 88% of the patients were female, and the mean age was 66 years. Patients with keratoconjunctivitis sicca Sjögren's disease represented more than 89% of all patients and had the highest percentage of women. Both the annual number of patients and the number of admissions have increased exponentially since 1997 raising from 1079 to 3097 and from 1344 to 5938, respectively. The in-hospital length of stay was 9.6 (standard deviation = 11.6) days where more than 65% of the admissions were due to emergencies. Total costs were found to increase from €4.9 to €30.3 million during the study period; in parallel, there was an increase in the mean annual cost per patient, which was on average €7379. Disease incidence is likely to increase due to the influence of modern-day workplace, and it is important to take into account the high economic burden and the large decrease in quality of life in regards to Spanish society and health policies.