Role Of Healthcare Professionals Research Articles

Assessment of Knowledge and Perceptions of Pakistani Adults about Non-nutritive Sweeteners

Non-nutritive sweeteners are used as a substitute for sugar and have strong sweetening properties. They can be helpful in weight management, diabetes, and other insulin sensitivity-related metabolic disorders. Objective: This survey intended to analyze the knowledge and risk perceptions related to the safety and benefits of Non-nutritive sweeteners in a population of Pakistani adults. The impact of knowledge dissemination on the consumption of Non-nutritive sweeteners was also assessed. Methods: An online survey was conducted, and 680 responses were received. Results: Results indicated that 55.7% reported Non-nutritive sweeteners consumption, while 44.3% denied any usage. Only 27.4% of respondents showed trust in regulatory bodies while only 26.2% had any idea about the laws surrounding their use. The second part of the study aimed to examine the effect of knowledge dissemination on Non-nutritive sweeteners consumption, but the result showed that the participants were still not convinced about the safety levels of Non-nutritive sweeteners (p < 0.05). The only statement that participants were persuaded by was that Non-nutritive sweeteners does not pose any risk of cancer. The main reason for consumption was attributed to the low caloric properties of Non-nutritive sweeteners. Conclusions: The results showed that effective communication by regulatory authorities and health professionals via the internet, social media and leaflets can be beneficial in educating the public about Non-nutritive sweeteners. The role of health care professionals is also important to assure the public of the safety of Non-nutritive sweeteners.

Real-life experience on COVID-19 and seasonal influenza vaccines co-administration in the vaccination hub of the University Hospital of Palermo, Italy

ABSTRACT With the pandemic, there has been a global reduction in influenza virus circulation, with WHO reporting, during 2021/22 season, laboratory testing positivity rate for influenza of less than 3%. Influenza surveillance systems anticipated a peak of influenza cases in the Northern Hemisphere during 2022/2023 season and the Italian Ministry of Health recommended the routinary co-administration of influenza with bivalent COVID-19 vaccines for the 2022/2023 season. At the Vaccination Hub of the University Hospital (UH) of Palermo, more than 700 subjects received influenza and COVID-19 booster doses in co-administration, during the 2021/2022 season. A cross-sectional study analyzing attitudes and factors associated with adherence to influenza and COVID-19 seasonal vaccines co-administration was conducted at the Vaccination Hub of the UH of Palermo, from October to December 2022. Among the 1,263 respondents, 74.7% (n = 944) received the co-administration of seasonal influenza and COVID-19 vaccines. The main reason reported for accepting it was confidence in the recommendations of the Health Ministry (41.3%). At the multivariable analysis, subjects aged ≤ 59 y old (AdjOR: 2.48; CIs95%: 1.89–3.65), male (AdjOR: 1.51; CIs95%: 1.27–1.75), Health-care professionals (HCPs) (AdjOR: 1.66; CIs95%: 1.08–2.57) and those who received co-administration during 2021/2022 (AdjOR: 41.6; CIs95%: 25.5–67.9) were significantly more prone to receive co-administration during 2022/23 season. From data obtained, the role of HCPs in accepting and then promoting co-administration of COVID-19 and influenza vaccines is crucial, as well as receiving co-administration in the previous season that represented the main drive for accepting it in the following seasons, supporting safety and effectiveness of this procedure.

Do we recognize oral cancer? Primary professional delay in diagnosis of oral squamous cell carcinoma.

The occurrence and causes of primary professional delay in diagnosis of oral squamous cell carcinoma (OSCC) were examined. Factors related to initial diagnosis or malignancy suspicion were evaluated in patients with primary OSCC. The outcome variable was primary professional delay for missed suspicion of malignancy or wrong diagnosis or delayed referral. The primary predictor variable was active care-seeking. Secondary predictor variables were patients' symptoms and clinical findings. Primary professional delay was found in 9.5% of the 528 patients included. Professional delay was 6.6 times more likely to occur in patients actively seeking care than in those whose tumor was an incidental finding (95% CI 1.58-27.58, p = 0.010). Pain (OR = 2.0, 95% CI 1.07-3.87, p = 0.031), ulceration (OR = 2.3, 95% CI 1.29-4.19, p = 0.005), denture fit problem (OR = 3.1, 95% CI 1.25-7.56, p = 0.014), and unhealed tooth extraction socket (OR = 29.6, 95% CI 8.89-98.71, p < 0.001) were significant predictors for primary professional delay. OSCC patients seek care actively. Primary professional delay affects the care of every tenth OSCC patient. The role of health care professionals is essential for early OSCC diagnosis, especially in urgent care. Clinicians' knowledge of the typical symptoms and findings of OSCC should be improved.

The Epidemic of Gun Violence and the Role of Health care Professionals

The Epidemic of Gun Violence and the Role of Health care Professionals

Nurses' and physicians' perceptions of the impact of eHealth and information systems on the roles of health care professionals: A qualitative descriptive study.

The increased use of eHealth and information systems impacts health care work broadly, including cultural and social aspects of work such as the roles of health care professionals. This qualitative descriptive study examined the perceptions of health care professionals in terms of how eHealth and information systems have changed their roles. The data was collected via 15 semi-structured thematic interviews and analysed using content analysis with an inductive approach. The analysis indicated mainly unconscious changes in the roles of professional groups. The professionals perceived that the role of digitally competent professionals in the working community was important. Moreover, high digital competency was seen to have led to an increase or change in work tasks. Professionals' own working environments and job opportunities were seen to have affected to their roles when using information systems. eHealth was perceived to have created inequalities in work tasks, increased skills gaps and complicated work. However, eHealth made cooperation between professionals easier than before. Organisations should pay more attention to equal opportunities to increase professional's digital competency, even out workloads between professionals, and provide equal access to eHealth and information systems.

THE BIO-PSYCHO-SOCIAL PHILOSOPHY OF CARE: THOUGHTS FROM RESEARCH INTO A FREESTANDING MIDWIFERY UNIT

The philosophy of care underpinning maternity services impacts tremendously on the way care is conceptualised, delivered and the position that women and birthing people assume in this context. The philosophy of care determines how health care systems are designed and the role of health care professionals. In this article I will explore the importance of embedding a Bio-Psycho-Social as opposed to the Medical-Industrial Philosophy of care. I will also reflect on the opportunities offered by designing maternity services which are founded on a public health ethos and address the biological, psychological and sociological needs of women, birthing people and their families.

Role of primary care for individuals with childhood-onset neurologic conditions

BackgroundIndividuals with childhood-onset neurologic conditions often face challenges in the pediatric-to-adult health care transition (HCT). Furthermore, the importance of implementing primary care is unrecognized. We investigated the situation of adults with childhood-onset neurologic conditions from the perspective of health care professionals (HCPs) in community- and hospital-based primary care practice. Design and methodsOverall, 1334 HCPs in medical facilities across Tokyo (mainly in Kita, Nerima, and Itabashi Cities) were surveyed regarding their experience caring for adults with childhood-onset neurologic conditions. Snowball sampling was also deployed to enhance the input from various health professions. The questionnaire included quick response codes linked to web-based questionnaires identical to paper-based ones, enabling additional HCPs to answer the questionnaire. The survey included questions about the care provided by HCPs, the perceived challenges and worthwhileness of the care, and their views on HCT. ResultsWe collected 276 responses (response rate, 20.7%): 224 by mail and 52 online. In total, 94 HCPs of the respondents (75 doctors, 11 nurses, 5 therapists, 2 care workers, and 1 medical social worker) involved in caring for this population were analyzed. Doctors and nurses managed medical devices, educated patients, and provided consultation and care. Doctors cited the management of comorbidities outside of their expertise and difficulties securing hospitalization during emergencies as barriers to care. HCPs found the valuable opportunities to enrich their clinical experience and long-term relationships with patients worthwhile. HCPs expressed the need for systems that guarantee patient hospitalization and multidisciplinary conferences between HCPs and specialists. ConclusionWe described the roles of HCPs in community- and hospital-based primary care, which are vital components of HCT for adults with childhood-onset neurologic conditions. Their practice includes multidisciplinary involvement, patient education, and care coordination. For better HCT in this population, efforts are required to enhance HCPs’ capability to respond to patients with disabilities, patients’ multiple comorbidities, and families’ needs. Practice implicationsFurther efforts to deepen community-based care are desired to improve HCT for people with childhood-onset neurologic conditions.

Recommendations for the Implementation of the Self-Administration of Alpha-1 Antitrypsin.

Administration of exogenous alpha-1 antitrypsin (AAT) is the only specific therapy for the management of pulmonary morbidity in patients with AAT deficiency. It requires weekly or biweekly intravenous infusions, which may impact patient independence and quality of life. Self-administration of AAT therapy is an alternative to reduce the burden for patients who require AAT therapy. We presented herein experts' recommendations for the implementation of a program for the self-administration of AAT. This project was conducted using a modified nominal group technique and was undertaken in two online meetings involving the participation of 25 experts: specialists in pulmonology (n=17), nurses (n=5) and hospital pharmacists (n=3). The following issues were discussed, and several recommendations were agreed upon on the following topics: a) patient profile and clinical evaluation, establishing selection criteria that should include clinical as well as social criteria; b) role of health care professionals, suggested roles for specialists in pulmonology, nurses, and hospital pharmacists; c) training by the nurse, including recommendations before initiating the training and the content of the training sessions; and d) logistic issues and follow-up, adherence, and patient support. We expect this proposal to increase awareness of this therapeutic alternative and facilitate the implementation of self-administration programs, thus contributing to optimizing the patient experience with AAT therapy. Further research on the outcomes of these programs, especially from the patient perspective, will also help to improve their design and implementation.

The importance of screening for depression and anxiety in ambulatory patients with chronic heart failure and the role of health care professionals

Abstract Funding Acknowledgements Type of funding sources: None. Background Depression and anxiety are very common in patients with heart failure, both as risk factors and complications. The intensive follow-up by health care specialist is extremely important for screening of these conditions and for reducing their impact on the heart failure (HF) course. Aim to screen for depression and anxiety attitudes and to assess the effect of structured out-patient program for reducing the probability of their occurrence. Participants and methods: Overall, 71 patients were included in a structured follow-up program for ambulatory management of patients with HF, according to the OPTIMIZE-HF Care Program protocol. All participants answered standardized questionnaires PHQ-9 and GAD-7 for screening of depression and anxiety at discharge from hospital (baseline) and after 6 months. Score more than 8 points for GAD-7 and &amp;gt;10 points of PHQ-9 were considered clinically important. Paired samples t-test and Wilcoxon’s signed rank test were used to test statistical significance. Results the mean depression score decreased from mean 5.47±5,22 points to 3.65±6.05, with a mean difference between two visits 2.35±3.9, 95%CI 1.37-3.33, р&amp;lt;0.0001. At 6 months, the participants with PHQ-9&amp;gt;10 points decreased from 21% to 7.8% (Figure 1). There were 8 (14%) patients who were more prone to depression at baseline but who decreased their score to &amp;lt;10 points at the end (p = 0.04). Similar results were found for anxiety. The mean difference in GAD-7 score was -2.35±3.90 points, 95%CI -1.37—-3.33, p&amp;lt;0;0001. At the end of the study, the participants without anxious moods increased from 52.3% to 69.8%. (Figure 1) Only 3 patients worsened their anxiety results after 6 months while 27% of those with initial GAD-7&amp;gt;8 points successfully decreased their score to minimal or none. Conclusions Every 1 in 5 patients with HF have some depression attitudes at discharge and more than 1 in 3 were anxious. The structured ambulatory management program decreased these trends just after 6 months. The role of nurse in achieving the positive effects on the psychological well-being of the patients with HF is essential.Figure 1

Parents' Experiences and Perspectives of Their Child's Sleep Quality During Hospitalization.

Sleep is essential for maintenance and restoration of health, yet studies exploring this in hospitalized children are scarce. In a qualitative study, we assessed the perceived quality of sleep, factors affecting sleep, and the role of health care professionals in the sleep environment for hospitalized children aged 1 to 12 years. Data were obtained from 11 semi-structured, audio-recorded, and verbatim-transcribed interviews with parents, and analyzed using a systematic thematic analysis. The interviews were coded based on iterative assessment of transcripts. Subsequently, categories and interpretative main themes were identified. Four themes emerged: (1) being informed, keeping informed; (2) coordination of care; (3) parents as main advocates for their child's sleep; and (4) environmental disturbers. Parents reported differences in their child's sleep quality during hospital compared with home. Sleep is substantially affected during hospitalization, prompting the need for interventions to improve the quality of sleep of children. Parents provided valuable suggestions for improvements.

Underestimated Factors Regarding the Use of Technology in Daily Practice of Long-Term Care: Qualitative Study Among Health Care Professionals.

Increasing life expectancy is resulting in a growing demand for long-term care; however, there is a shortage of qualified health care professionals (HCPs) to deliver it. If used optimally, technology can provide a solution to this challenge. HCPs play an important role in the use of technology in long-term care. However, technology influences several core aspects of the work that HCPs do, and it is therefore important to have a good understanding of their viewpoint regarding the use of technology in daily practice of long-term care. The aim of this study was to identify the factors that HCPs consider as relevant for using technology in daily practice of long-term care. In this qualitative study, 11 focus groups were organized with 73 HCPs. The focus group discussions were guided by an innovative game, which was specifically developed for this study. The content of the game was categorized into 4 categories: health care technology and me; health care technology, the patient, and me; health care technology, the organization, and me; and facilitating conditions. The perspectives of HCPs about working with technology were discussed based on this game. The focus groups were recorded and transcribed, followed by an inductive thematic analysis using ATLAS.ti 9x (ATLAS.ti Scientific Software Development GmbH). Overall, 2 main domain summaries were developed from the data: technology should improve the quality of care and acceptance and use of technology in care. The first factor indicates the need for tailored and personalized care and balance between human contact and technology. The second factor addresses several aspects regarding working with technology such as trusting technology, learning to work with technology, and collaboration with colleagues. HCPs are motivated to use technology in daily practice of long-term care when it adds value to the quality of care and there is sufficient trust, expertise, and collaboration with colleagues. Their perspectives need to be considered as they play a crucial part in the successful use of technology, transcending their role as an actor in implementation. On the basis of the findings from this study, we recommend focusing on developing technology for situations where both efficiency and quality of care can be improved; redefining the roles of HCPs and the impact of technology hereon; involving HCPs in the design process of technology to enable them to link it to their daily practice; and creating ambassadors in care teams who are enthusiastic about working with technology and can support and train their colleagues.

Enabling Adults With Severe Asthma to Exercise: A Qualitative Examination of the Challenges for Patients and Health Care Professionals

Adults living with severe asthma have lower physical activity levels, particularly high intensity physical activity, compared to their healthy peers. Physical inactivity is associated with increased morbidity and mortality. We aimed to understand patient and healthcare professional attitudes to exercise to inform future strategies for the improvement of healthy lifestyle behaviours, including exercise. Participants recruited from a specialist Difficult Asthma Service were interviewed individually, and healthcare professionals (HCPs) from primary care, secondary care and a tertiary centre were invited to attend focus groups. Interviews and focus groups were transcribed verbatim. Thematic analysis was performed on interviews and focus groups separately, followed by an adapted framework analysis to analyse datasets together. Twenty-nine people with severe asthma participated in a semi-structured interview. 51 HCPs took part in 8 focus groups across the East Midlands, UK. Final analysis resulted in 3 major themes: Barriers to exercise and exercise counselling whereby patients and HCPs identified disease and non-disease factors impacting on those living with severe asthma; Attitudes towards HCPsupportfor exercise highlighting education needs for HCPs and preference for supervised exercise programmes; Areas for system improvement insupportingHCPs describing the challenges existing across services that limit patient support. The important role of HCPs in supporting and advising on lifestyle change was identified by patients. Despite a preference for supervised exercise programmes, both patient and HCP barriers existed. To meet patients' varied support needs, improved integration of services is required and HCP skills need extending.

Acceptance of a Digital Assistant (Anne4Care) for Older Adult Immigrants Living With Dementia: Qualitative Descriptive Study.

There is a need to develop and coordinate dementia care plans that use assistive technology for vulnerable groups such as immigrant populations. However, immigrant populations are seldom included in various stages of the development and implementation of assistive technology, which does not optimize technology acceptance. This study aims to gain an in-depth understanding of the acceptance of a digital personal assistant, called Anne4Care, by older adult immigrants living with dementia in their own homes. This study used a qualitative descriptive research design with naturalistic inquiry. A total of 13 older adults participated in this study. The participants were invited for 2 interviews. After an introduction of Anne4Care, the first interview examined the lives and needs of participants, their expectations, and previous experiences with assistive technology in daily life. Four months later, the second interview sought to understand facilitators and barriers, suggestions for modifications, and the role of health care professionals. Three semistructured interviews were conducted with health care professionals to examine the roles and challenges they experienced in the use and implementation of Anne4Care. Content analysis, using NVivo11, was performed on all transcripts. All 13 participants had an immigration background. There were 10 male and 3 female participants, with ages ranging from 52 to 83 years. Participants were diagnosed with an early-stage form of dementia or acquired brain injury. None of the older adult participants knew or used digital assistive technology at the beginning. They obtained assistance from health care professionals and family caregivers who explained and set up the technology. Four themes were found to be critical aspects of the acceptance of the digital personal assistant Anne4Care: (1) use of Anne4Care, (2) positive aspects of Anne4Care, (3) challenges with Anne4Care, and (4) expectations. Assistance at first increased the burden on health care professionals and families. After the initial effort, most health care professionals and families experienced that Anne4Care reduced their tasks and stress. Contributions of Anne4Care included companionship, help with daily tasks, and opportunities to communicate in multiple languages. On the other hand, some participants expressed anxiety toward the use of Anne4Care. Furthermore, the platform required an internet connection at home and Anne4Care could not be used outside the home. Although older adult immigrants living with dementia had no previous experience with digital assistive technology specifically, the acceptance of the digital personal assistant, called Anne4Care, by older adult immigrants living with dementia was rather high. The digital assistant can be further developed to allow for interactive conversations and for use outside of one's home. Participation of end users during various stages of the development, refinement, and implementation of health technology innovations is of utmost importance to maximize technology acceptance.

PCR98 A Literature Review Assessing the Most Common Attributes Used in Stated-Preference Studies Assessing Influenza Vaccination: Do We Know What Health Care Professionals Value?

Several attributes may be important in flu vaccine and since Covid-19, the role of health care professionals (HCPs) may have become more important in increasing flu vaccine uptake. We conducted a literature review to assess if previous preference research could inform future flu vaccination policies. We conducted a literature review to assess the most common attributes used in stated-preference studies to determine seasonal flu vaccination preferences. PubMed with key terms such as “discrete choice“, “stated preference“ and “flu/vaccin*” was used to retrieve relevant research. In total, twelve studies investigating consumer and HCP preferences for flu vaccines using a discrete-choice experiment were included. Six studies were conducted in vaccine-eligible populations, three were conducted with parents (specifically, two focused on older adults and one elicited preferences directly from HCPs in Hong Kong). Three studies were conducted in the Netherlands, two in Japan and four in China. Vaccine efficacy was most often framed in terms of percentage (n=7). Out of pocket cost and duration of immunity were common attributes. Source of recommendation for vaccination (i.e., regulatory or public health body) was assessed in 25% of the studies. In studies assessing parental preferences for their children influenza vaccination, risks of fewer side effects were, unsurprisingly, preferred. Finally, among HCPs, vaccine effectiveness and vaccination location (staff clinic/mobile vaccination center) were most important and could increase the probability of vaccination. Information incompleteness and asymmetry could play a role in vaccine hesitation and/or aversion. To increase vaccination rates, evidence on the attributes perceived to be important to both HCPs and the general population may help the design and delivery of vaccines that match consumers’ preferences. Currently, there is a critical need for more stated-preference studies among HCPs to better understand the attributes likely to increase vaccination rates against seasonal influenza.

Cognitive Bias Modification Training Targeting Fatigue in Patients With Kidney Disease: Usability Study.

Fatigue is an important symptom for many patients, including patients with kidney disease. Cognitive biases, such as attentional bias and self-identity bias, are thought to influence fatigue. Cognitive bias modification (CBM) training is a promising technique to counter fatigue. We aimed to evaluate a CBM training among patients with kidney disease and health care professionals (HCPs) and assess acceptability and applicability in the clinical setting using an iterative design process to evaluate expectations and experiences with the training. This was a longitudinal, qualitative, and multiple stakeholder-perspective usability study in which we interviewed end users and HCPs during the prototyping phase and after the end of training. We conducted semistructured interviews with 29 patients and 16 HCPs. The interviews were transcribed and analyzed thematically. Next to a general evaluation of the training, the acceptability of the training was evaluated using the Theoretical Framework of Acceptability, and applicability was assessed by evaluating obstacles and solutions for implementation in the kidney care setting. Generally, participants were positive about the training and its applicability. The biggest negatives were doubts about effectiveness and annoyance about the repetitive character of CBM. Acceptability was judged with a mixed evaluation, with a negative evaluation of perceived effectiveness; mixed results for burden, intervention coherence, and self-efficacy; and positive results for affective attitude, ethicality, and opportunity costs. Barriers for applicability were patients' varying computer skills, subjectivity of fatigue, and integration with regular treatment (eg, the role of HCPs). Possible solutions included assigning representatives among nurses, offering training on an app, and providing assistance via a help desk. The iterative design process, including repeated waves of testing user expectations and experiences, yielded complementary data. To the best of our knowledge, this study is the first to introduce a CBM training targeting fatigue. Furthermore, this study provides one of the first user evaluations of a CBM training, both among patients with kidney disease and their care providers. Overall, the training was evaluated positively, although acceptability showed mixed results. Applicability was positive although barriers were identified. The proposed solutions require further testing, preferably following the same frameworks, as the iteration in this study contributed positively to the quality of the training. Therefore, future research should follow the same frameworks and consider stakeholders and end users in eHealth intervention design.

Impacts of Symptom Checkers for Laypersons' Self-diagnosis on Physicians in Primary Care: Scoping Review.

Symptom checkers (SCs) for laypersons' self-assessment and preliminary self-diagnosis are widely used by the public. Little is known about the impact of these tools on health care professionals (HCPs) in primary care and their work. This is relevant to understanding how technological changes might affect the working world and how this is linked to work-related psychosocial demands and resources for HCPs. This scoping review aimed to systematically explore the existing publications on the impacts of SCs on HCPs in primary care and to identify knowledge gaps. We used the Arksey and O'Malley framework. We based our search string on the participant, concept, and context scheme and searched PubMed (MEDLINE) and CINAHL in January and June 2021. We performed a reference search in August 2021 and a manual search in November 2021. We included publications of peer-reviewed journals that focused on artificial intelligence- or algorithm-based self-diagnosing apps and tools for laypersons and had primary care or nonclinical settings as a relevant context. The characteristics of these studies were described numerically. We used thematic analysis to identify core themes. We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to report the study. Of the 2729 publications identified through initial and follow-up database searches, 43 full texts were screened for eligibility, of which 9 were included. Further 8 publications were included through manual search. Two publications were excluded after receiving feedback in the peer-review process. Fifteen publications were included in the final sample, which comprised 5 (33%) commentaries or nonresearch publications, 3 (20%) literature reviews, and 7 (47%) research publications. The earliest publications stemmed from 2015. We identified 5 themes. The theme finding prediagnosis comprised the comparison between SCs and physicians. We identified the performance of the diagnosis and the relevance of human factors as topics. In the theme layperson-technology relationship, we identified potentials for laypersons' empowerment and harm through SCs. Our analysis showed potential disruptions of the physician-patient relationship and uncontested roles of HCPs in the theme (impacts on) physician-patient relationship. In the theme impacts on HCPs' tasks, we described the reduction or increase in HCPs' workload. We identified potential transformations of HCPs' work and impacts on the health care system in the theme future role of SCs in health care. The scoping review approach was suitable for this new field of research. The heterogeneity of technologies and wordings was challenging. We identified research gaps in the literature regarding the impact of artificial intelligence- or algorithm-based self-diagnosing apps or tools on the work of HCPs in primary care. Further empirical studies on HCPs' lived experiences are needed, as the current literature depicts expectations rather than empirical findings.

How does the quality of care for type 2 diabetic patients benefit from GPs-nurses' teamwork? A staggered difference-in-differences design based on a French pilot program.

In many countries, policies have explicitly encouraged primary care teams and inter-professional cooperation and skill mix, as a way to improve both productive efficiency gains and quality improvement. France faces barriers to developing team working as well as new and more advanced roles for health care professionals including nurses. We aim to estimate the impact of a national pilot experiment of teamwork between general practitioners (GPs) and advance practitioners nurses (APN)-who substitute and complement GPs-on yearly quality of care process indicators for type two diabetes patients (T2DP). Implemented by a not-for-profit meso-tier organisation and supported by the Ministry of Health, the pilot relied on the voluntary enrolment of newly GPs from 2012 to 2015; the staffing and training of APNs; skill mixing and new remuneration schemes. We use latent-response formulation models, control for endogeneity and selection bias by using controlled before-after and quasi-experimental design combining coarsened exact matching-prior to the treatment, at both GPs (435 treated vs 973 control) and T2DP levels -, with intention to treat (ITT; 18,310 in each group) and per protocol (PP, 2943 in each group) perspectives, as well as difference-in-differences estimates on balanced panel claims data from the National Health Insurance Fund linked to clinical data over the period 2010-2017. We show evidence of a positive and significant positive impact for T2DP followed-up by newly enrolled GPs in the pilot compared to the pretreatment period and the control group. The effect magnitudes were larger for PP than for ITT subsamples.

Barriers and facilitators to breast self-examination in women under 50 in an international context: A qualitative systematic review

ABSTRACT The stage and grade of a breast cancer diagnosis is a significant determinant of patient prognosis. Therefore, early detection via screening is recommended. Breast self-examination is a screening and breast health promotion technique that empowers women to be familiar with what their breasts look and feel like normally and be more confident to detect any changes. Self-examination is also a gateway to lifelong breast health awareness in young women who have not yet engaged with formal screening programmes. Globally, breast self-examination engagement is low and this study aims to identify the barriers and facilitators of breast self-examination in women globally under 50 years. Databases MEDLINE, PUBMED and CIANHL were searched. 3984 results were produced and 22 full texts were assessed. Eleven studies were included. Methodological quality was assessed using the JBI Critical Appraisal checklist and each study was assigned a ConQual grade. A meta-synthesis using a thematic analysis approach produced six over-arching themes that represented the barriers and facilitators identified: knowledge, attitudes and beliefs, influence of others, education, routine and emotions. Knowledge, attitudes and beliefs, and emotions were identified as the greatest barriers to self-examination. Contrastingly, routine appeared to have the greatest facilitatory impact, with the role of health care professionals and education also being facilitatory. The introduction of demonstrative teaching programmes at schools or universities, or guidelines specific to breast self-examination for health care professionals could be considered as next steps.

Assessment of Women's Knowledge of the Impact of Smoking During Pregnancy

Smoking affects women’s health and increases their risk for some diseases. Women who smoke have problems with the reproductive system, and if women are pregnant have a high risk for fetal, and neonatal problems and consequences on their health. Quitting smoking at any time during pregnancy improves the condition of mother and baby. This study aims to identify the level of knowledge women have about smoking and effects on pregnancy aged between 1545 years. This study is cross-sectional and was implemented for the period of August-November 2021 was conducted at UHOG “Queen Geraldine” Tirana, Albania. The survey included 200 pregnant women, who agreed to complete the questionnaire. Data were coded and elaborated using IBM SPSS Statistics 26 software. Descriptive results on each question, comparison between important topics, and binary logistic regression for the five final questions were performed. Nevertheless, 30% of the total women in the study were smokers, 16% of them were pregnant smokers, and 14% were smokers before pregnancy. The women who continued to smoke were from urban areas, we do not have heavy smokers, and only 2.9% of them smoked &gt;10 cigarettes a day. Women with secondary education report that the chance of ectopic pregnancy from smoking increases OR = 0.73. As the weeks of pregnancy pass, the likelihood of discovering that smoking increases the risk of having a baby with birth defects (OR = 0.78) increases. There were women in the first pregnancy and younger age groups that represented the highest level of knowledge related to the birth of an underweight baby because of smoking p = 0.003. In 31.6% of cases, the cessation of smoking had come because of the nursing counseling that they had received in the primary service. The trend of smoking among Albanian women is growing and information on the consequences of smoking is a necessity for a healthy population in the future. Women who smoke need assistance and counseling to quit smoking before becoming pregnant. The role of health care professionals in informing women about the risks of smoking to the baby and the mother should be expanded.&#x0D; Keywords: pregnancy, knowledge, smoking, smoking cessation, counseling

Influence of Nutrition Training, Eating Habits, and Culinary Skills of Health Care Professionals and Its Impact in the Promotion of Healthy Eating Habits

The promotion of healthy habits is thought to be an important element in the role of health care professionals (HCPs). The aim of this study was to analyze eating habits and culinary skills of HCPs, and how they transfer those skills during clinical practice. A total of 95 HCPs participated in a cross-sectional descriptive question-based survey, which assessed HCPs' eating habits, culinary skills, and promotion of habits. HCPs who received previous training in nutrition had better eating habits and generally promoted healthy eating to patients.