Secondary Care Facilities Research Articles

Beliefs surrounding the use of inhaled asthma medication in The Gambia: a qualitative study of asthma patients and healthcare workers

Asthma-related mortality is high in low- and middle-income countries. Little is known about public perceptions of inhaled medicines. We conducted semi-structured interviews with asthma patients and healthcare workers at three secondary care facilities in The Gambia, between August and November 2022. Thematic analysis was used to interpret these data. A total of 20 patients and 15 healthcare workers were interviewed. Both groups noted limited access to inhalers was an issue resulting in continued use of oral medications. Some patients recognised the benefits of inhalers, yet beliefs that inhalers were dangerous were common. Reliance on oral short-acting beta agonists meant patients saw asthma as a recurrent acute condition resulting in an emphasis on hospital management with little awareness of inhaled preventative medicines. Increasing access to inhaled medicines has the potential to reduce costly avoidable admissions, but socio-cultural factors, in addition to medication supply, need addressing.

Treatment of ocular surface squamous neoplasia in an Indian rural facility: a study of 38 eyes

PurposeTo report the demographic profile, clinical presentation, and management outcomes of ocular surface squamous neoplasia (OSSN) treated with primary topical chemotherapy in a limited resource secondary eye care facility in rural parts of South India.MethodsRetrospective interventional study of 38 eyes of 37 patients with OSSN treated with topical 1% 5-Fluorouracil (5FU), over a period of two years.ResultsThe median age at presentation with OSSN was 44 years (mean, 46 years; range 13 to 74 years). Majority (76%) were males. The most common morphological variant was placoid OSSN (18, 47%). Limbus was the most common epicenter (31, 82%). Corneal OSSN was the most initially misdiagnosed variant (n = 3). Of the 38 eyes receiving one week on and 3-weeks off cycles of 5FU regimen, complete tumor resolution was achieved in 36 (95%) eyes. The median number of topical 5FU cycles for tumor resolution was 2 (mean, 2; range, 1 to 4). Over a median follow-up period of 5 months (mean, 6 months; range, 1 to 27 months), tumor recurrence was noted in 3 eyes (8%), of which one case had xeroderma pigmentosum with bilateral multifocal recurrence. Complication rate was 5% (n = 2), which included transient conjunctival hyperemia (n = 1), and bacterial keratitis (n = 1) which resolved with fortified antibiotics.ConclusionPrimary chemotherapy with topical 1% 5FU is a safe and effective management modality for OSSN at limited resource settings in rural India.

Impact of pharmacist-driven antimicrobial stewardship interventions in a secondary care facility in Japan: A pragmatic quasi-experimental study

BackgroundEfforts to promote antimicrobial stewardship aimed at reducing antimicrobial resistance are necessary regardless of hospital scale owing to delays in new antimicrobial development. We aimed to evaluate the effects of pharmacist-driven interventions on broad-spectrum antimicrobial usage and the prognosis of patients with bacteremia in a medium-sized hospital lacking infectious disease physicians and a microbiology laboratory. MethodsThis single-center, retrospective, pragmatic, quasi-experimental study was conducted to compare pre- and post-intervention effects at Saiseikai Futsukaichi Hospital. We analyzed the days of therapy (DOT) for carbapenems and days of antibiotic spectrum coverage (DASC) for antimicrobials using an interrupted time series analysis. Cox proportional hazards analysis was performed to assess 30-day mortality using propensity score and inverse probability of treatment weighting in patients with bacteremia. ResultsPharmacist-driven interventions significantly reduced the DOT (incidence rate ratio [IRR]: 0.53, 95 % confidence intervals [CI]: 0.33−0.81, p = 0.003) and DASC (IRR: 0.87, 95 % CI: 0.78−0.97, p = 0.016). The 30-day mortality due to bacteremia did not significantly differ between pre- and post-intervention in all patients (adjusted hazard ratio [HR]: 0.92, 95 % CI: 0.56−1.51, p = 0.74). Conversely, pharmacist-driven interventions significantly reduced the 30-day mortality owing to bacteremia with Pitt bacteremia score (PBS) ≥4 (adjusted HR: 0.52, 95 % CI: 0.28−0.99, p = 0.047). ConclusionsPharmacist-driven interventions may represent a valuable approach for optimizing antimicrobial treatment and improving prognosis, especially in patients with PBS ≥4, which will potentially benefit patients in similar healthcare environments facing challenges related to antimicrobial stewardship and patient prognosis.

May Measurement Month 2021: an analysis of blood pressure screening results from Hungary.

Elevated blood pressure (BP) is the most important risk factor for cardiovascular diseases (CVDs), which are still the leading cause of mortality in Hungary. Therefore, screening programmes identifying subjects with hypertension have an important role in CVD prevention. In 2017, the International Society of Hypertension initiated May Measurement Month (MMM) aimed at raising awareness of elevated BP. Hungary joined the MMM campaigns in 2017, 2019, and 2021, and a summary of the results from 2021 is presented here. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in September 2021. Measurement of BP, the definition of hypertension, and statistical analysis followed the standard MMM protocol. In Hungary, 30 sites were set up in primary and secondary care facilities, in pharmacies, and in malls. Both cities and villages were involved in all regions. A total of 1414 individuals were screened, and 558 subjects (39.5%) had hypertension. Out of 1065 participants not on antihypertensive medication, 209 (19.6%) had elevated BP. Among treated individuals (n = 349), 206 (59.0%) had controlled BP (<140/90 mmHg). Almost 40% of the participants had hypertension. Among untreated participants, one in five had elevated BP, while among patients on antihypertensive medication, 41% had uncontrolled BP. These results confirm the importance of screening of hypertension in untreated individuals and that efforts are required to adequately control BP in treated hypertensive patients.

Association Between Childhood Asthma and Gastroesophageal Reflux Disease in Children: A Systematic Review.

This study aims to comprehensively investigate the association between childhood asthma and gastroesophageal reflux disease (GERD) in children. A thorough search of pertinent databases was done in order to find studies that satisfied the requirements for inclusion. A thorough search of PubMed, Web of Science, SCOPUS, and Science Direct was conducted to find pertinent literature. Twelve studies, including a total of 176,678 patients - 91,447 (51.8%) of them were males - were included in our data. The prevalence of GERD in asthmatic children ranged from 0.7% to 65.3%, with a total prevalence of 3317 (3.6%). The included studies documented that GERD increases the chance of asthma, while asthma raises the risk of GERD. Obesity in asthmatic patients was an independent risk factor for the incidence of GERD. Controlling asthma is significantly impacted by comorbidities like obesity and GRED. The findings of our comprehensive review point to a possible link between juvenile patients with asthma who are referred to secondary and tertiary care facilities and having GERD. Nevertheless, the evidence for this link is weak in a number of situations. Lack of longitudinal research establishing the proper temporal sequence, studies indicating no severity-response relationship, and insufficient data showing a treatment-response relationship all contribute to the uncertainty around the nature and direction of the association. Our findings highlight the need for additional epidemiologic research to investigate the connection between GERD and asthma, including long-term follow-up.

Evaluation of viral suppression and medication-related burden among HIV-infected adults in a secondary care facility

BackgroundPeople living with HIV/AIDS (PLHIV) are prone to other health issues that may result from the disease or antiretroviral medicines. These persons experience other psychosocial aspects of the illness, which may negatively affect their quality of life and overall treatment outcomes. This study assessed the medication-related burden and virological response of adult PLHIV. MethodThis cross-sectional study involved 417 HIV-positive adults who had been on combined antiretroviral therapy for at least a year at the State Specialist Hospital Gombe. Nigeria. Patient medication experience was measured using the Living with Medication Questionnaire version-3 (LMQ-3). Virological suppression was assessed at viral loads <1000 copies/ml and 20 copies/ml for undetectable HIV RNA levels. The LMQ-3 scores were compared with the participants' characteristics using independent t-tests or one-way analysis of variance (ANOVA). Regression analyses was employed to identify the predictors of viral suppression and medication-related burden. P value <0.05 at 95% confidence interval was considered statistically significant. ResultsOf the 417 PLHIV included in this study, 271 (65%) were classified as WHO Stage 1 ART initiation, 93.8% achieved viral suppression with 291 (69.5%) whom were females. The majority of patients 382 (91.6%) were on a dolutegravir-based regimen, had no tuberculosis diagnosis at antiretroviral therapy (ART) initiation (82.5%) and were 6–10 years on ART (46.3%). Only 67.6% of the population had a moderate medication-related burden. Female sex (p < 0.0005), unsuppressed viral load (p = 0.01), second-line ART (p = 0.03), tuberculosis at ART initiation (p = 0.02), and employment (p = 0.003) were significantly associated with medication-related burden. The predictor of viral suppression was high degree of medication-related burden (AOR, 0.12; 95% CI, 0.02–0.59) while unsuppressed viral load (p = 0.01) and female gender (p = 0.002) were independent predictors of medication related burden. ConclusionThe findings from this study revealed that majority of the patients achieved viral suppression with moderate degree of medication-related burden. Targeted interventions should be directed toward younger patients, females and patients with unsuppressed viral loads.

Seroprevalence of Dengue and Hepatitis B infections among young adults attending a secondary health care facility at Olabisi Onabanjo University, Ogun State, Nigeria

Hepatitis B and Dengue virus infections carry significant public health implications due to their potential to cause illness and death. This study focused on examining the prevalence of these infections among young adults seeking care at a secondary health facility at Olabisi Onabanjo University. Ninety samples obtained from study participants underwent screening using Enzyme-linked Immunosorbent Assay (ELISA) for both HBsAg and Dengue IgM. The participants, predominantly female, were aged between 15 and 30 years. The analysis revealed a 13.3% prevalence of Dengue IgM, a 4.5% prevalence of HBsAg, and a 4.4% prevalence for both infections. Regarding age distribution, the highest prevalence occurred among participants aged 15-20 years for both single infections and the co-occurrence of Hepatitis B and Dengue viral infections. Examining gender distribution, female participants exhibited higher seropositivity across all infection categories. Although not statistically significant, these findings lay the groundwork for a comprehensive surveillance study on the Hepatitis B and Dengue viral infections in young adults. This study provides valuable insights into the prevalence patterns of Hepatitis B and Dengue virus, offering a basis for further research and public health interventions in this population.

Formative qualitative research on the potential for digital solutions to address diabetes care gaps in Tanzania and Sri Lanka

ObjectivesDiabetes care remains unavailable and unaffordable for many people. Adapting models of care to low-income and middle-income country contexts is a priority. Digital technology offers substantial potential yet must surmount...

Application of Mobile Telephony to Improve Medication Adherence in Type 2 Diabetes Patients

Therapeutic failure, poor quality of life and high economic costs have been linked to poor adherence to medication in Type 2 diabetes (T2D) patients. This paper aims to assess patients’ glycemic control, knowledge of T2D and adherence to medications, and evaluate the impact of mobile telephone-based intervention on these indices. A one-year retrospective review of pharmacy refill records was followed by a 6-months’ randomized controlled intervention conducted among 121 T2D patients in a secondary health care facility in Nigeria. Participants were assigned to control (n = 60) and intervention (n = 61) groups. The intervention comprised twice-weekly short message service (SMS) follow-up messaging to the intervention group alongside usual healthcare services. Control group received no SMS. Primary (HbA1c) and secondary (knowledge and adherence) outcome indicators were measured and compared pre- and post-intervention. The same copy of questionnaire was administered at baseline and post-intervention to both groups. Chi-square test was used to examine association of variables while two-sample t-test was conducted to compare mean pre- and post- intervention scores in both groups at p&lt;0.05. The study revealed that intervention significantly improved glycemic control (HbA1c reduction) (p = 0.01). For the control group, mean pre- and post- intervention knowledge scores were 2.798 and 3.118 respectively (t = 1.1368, p = 0.2705) while intervention group recorded 2.714 and 4.193 respectively (t = 5.6772, p&lt;0.001) on a 5-point Likert scale. Pre- and post- intervention adherence scores for control group were 3.804 and 4.013 respectively, (t = 0.2343, p = 0.8182) while intervention group had 3.430 and 6.859 respectively (t = 6.3216, p&gt;0.001) on the 8-point Morisky Medication Adherence Scale (MMAS-8). The study concluded that patients initially had poor glycemic control, fair knowledge of T2D and low adherence to medications. SMS intervention significantly improved all three indices. Policy reforms in healthcare financing is recommended for sustainable provision of mhealth follow-up in diabetes care.

May Measurement Month 2021: an analysis of blood pressure screening results from Bulgaria.

Cardiovascular disease is not only the leading cause of mortality in Bulgaria, but the associated mortality rate is twice the European Union average, so screening programmes that identify subjects with elevated blood pressure (BP) are of utmost importance. May Measurement Month (MMM) is an annual global initiative that began in 2017 that aims to raise awareness of high BP. Bulgaria first joined the third campaign of MMM in 2019, and an overview of the results of Bulgarian participation in MMM21 is presented in this paper. Hypertension was defined as receiving BP-lowering medications or having a systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. Statistical analysis followed the standard MMM protocol. In Bulgaria, 155 screening sites were set up in primary and secondary care facilities, in pharmacies, and outdoor spaces across 16 administrative districts. Out of 3908 individuals screened, 2896 participants (74.1%) had hypertension. Of 2896 participants with hypertension, 76.4% were on treatment of whom 48.5% had controlled BP (<140/90 mmHg). Out of 1696 participants not on antihypertensive medication, 684 (40.3%) had elevated BP. Men were found to have higher rates of undiagnosed hypertension and lower rates of control than women. By identifying almost two-thirds of the whole screened cohort with the possibility of newly diagnosed or uncontrolled hypertension, our results confirm the importance of BP screening.

Characteristics, clinical manifestations and management of leprosy in KwaZulu-Natal, South Africa: A 20-year retrospective study.

Although leprosy, a neglected tropical disease, has been eliminated (<1 case per 10 000 population) in South Africa (SA) since 1926, according to the World Health Organization, new cases continue to be reported. The management of leprosy poses several challenges, including patient adherence, education and insufficient training of healthcare practitioners. To describe the biographical profile, clinical manifestations and treatment outcomes in patients with leprosy in KwaZulu-Natal Province. This retrospective study aimed to analyse the clinical data of leprosy patients in SA from 2002 to 2022. Data collected included patient demographics, comorbidities, cutaneous and neurological manifestations of leprosy, complications, treatment and adverse reactions. Descriptive statistics were used to summarise the data. The study analysed the clinical data of 194 leprosy patients from 2002 to 2022. The majority of patients were male and middle aged, with a disproportionate representation of black South Africans. Regarding socioeconomic status, 80% were unemployed and 40% were social grant recipients. Most cases were clustered in urban centres and diagnosed at secondary care facilities, with 15% being HIV positive. The majority of patients (90%) were classified as having multibacillary leprosy. Common symptoms included upper respiratory tract involvement, hair loss and painful nerves, with the face and limbs being most frequently affected. Cutaneous morphology predominantly included plaques and hypopigmented patches, while neurological signs included ulnar nerve tenderness, muscle weakness and sensory deficits. Debilitating neurological complications were found in one-fifth of patients. Despite initiation of multidrug therapy in most patients, a significant proportion (27.3%) did not complete the full course of treatment, and treatment reactions were noted in 33.5% of patients. These findings emphasise the urgent need for enhanced patient and healthcare worker education, particularly in primary healthcare settings, to improve adherence to treatment, advocate for prophylactic measures and prevent new cases. Achieving leprosy-free status in SA requires the collaboration of many role-players to address these challenges and improve healthcare practices.

Common mental disorders among patients with diabetes in a secondary care facility: nature, prevalence, and explanatory models

Background: Diabetes is a chronic medical condition which is psychologically and behaviourally demanding in nature. Persons with diabetes may be particularly vulnerable to developing mental health disorders. This study was conducted to estimate the prevalence and factors associated with common mental disorders (CMDs) in patients with diabetes and understand their explanatory models of illness. Methods: One hundred and seventy patients who attended the diabetic clinic at a secondary care hospital were recruited to participate in this cross-sectional study. Psychiatric morbidity and the individual's conceptualization of the illness were assessed using the clinical interview schedule-revised and the modified short explanatory model interview (SEMI) respectively. Socio-demographic and clinical details were recorded using a structured proforma. Results: CMDs were observed in 14.7% of the sample and were significantly associated with female gender, longer duration of diabetic illness and treatment, use of insulin and past treatment for psychiatric illness. Illness attributions included unhealthy diet, heredity, and stress, as well as punishment from God. Religious and traditional healing methods were cited as potential sources of help in addition to medical interventions and lifestyle modification. Conclusions: Diabetes can significantly impact the emotional health of an individual in addition to its myriad physical consequences. Understanding patient perspectives regarding their illness and identifying and providing appropriate interventions for those with emotional disorders are an important component of diabetes care programs.

An educational intervention for improving knowledge, attitude, and practice of dietary salt intake among individuals with hypertension in public sector secondary care facilities, Agra, India, 2021.

We conducted a pre-post intervention study to determine knowledge, attitude, and practice toward dietary salt intake before, immediately, and 1-month after nurse-led one-on-one counseling. We purposively selected three public health facilities in Agra, India, and enrolled all eligible hypertensive patients aged 18-60 under treatment for ≥6 months. Of the 153 patients at the 1-month follow-up, counseling improved knowledge (4%vs. 42%, p<.001), a greater prioritization of a low salt diet (34%vs. 52%, p<.001), and practice of adding less salt to the dough (48% to 41%, p<.001). The counseling intervention improved knowledge, attitude, and practice toward dietary salt intake.

NATIONAL HEALTH INSURANCE POLICY AND PROGRAMME AND ACCESS TO HEALTH CARE SERVICE AMONG FEDERAL GOVERNMENT WORKERS IN NIGERIA

The study examined the effect of National Health Insurance on health care service delivery Among Federal Workers in Nigeria. This mixed research design study investigates the relationships between primary and secondary health care service providers and the provision of essential healthcare services to enrollees in Nigeria. The population of the study encompasses federal governamnt workers with primary and secondary health care facilities across various regions in Nigeria. A sample size of 400 enrollees and 50 health care providers was selected using stratified random sampling techniques. Data were collected through structured interviews and surveys, focusing on the perceptions and experiences of both health care providers and enrollees regarding the provision of affordable health care, testing and diagnostic services, and referral services. The collected data were analyzed usingboth qualitative and quantitative methods, including thematic analysis and correlation analysis. The findings reveal significant relationships between primary health care service providers and the provision of affordable health care and testing and diagnostic services to enrollees in Nigeria. Moreover, the study identifies a significant relationship between secondary health care service providers and the provision of referral services to enrollees, highlighting the importance of collaboration between primary and secondary healthcare sectors to ensure comprehensive healthcare delivery in Nigeria. These results underscore the need for policy interventions and resource allocation strategies aimed at strengthening primary and secondary healthcare systems to improve access to essential healthcare services for all enrollees in Nigeria. The study recommends that Federal Government through the NHIA shouldimplement policies that aim to increase the affordability of healthcare services for all citizens, especially those in lower socioeconomic strata. This may involve subsidizing healthcare costs, expanding insurance coverage, or introducing targeted assistance programs for vulnerable populations. Additionally, encourage healthcare providers to offer transparent pricing structures and explore innovative payment models, such as sliding-scale fees or income-based discounts, to improve access for individuals with varying financial capacities.

Perioperative Anaphylaxis in Japanese Secondary Care Institutions: Incidence, Causes, and the Imperative for Improved Diagnostic Practices.

Background This research investigates the incidence, suspected causes, and diagnostic procedures for perioperative anaphylaxis (POA), a potentially severe complication, in secondary care hospitals across Japan. Methodology We surveyed Saiseikai hospitals and gathered data on surgical procedures, POA occurrences, potential triggers, and diagnostic methods. Results Among 70,523 surgeries, seven were associated with POA, resulting in an approximate incidence rate of 0.01%. Rocuronium was the most commonly suspected trigger, followed by sugammadex, latex, and angiography contrast agents. Despite the importance of skin tests as the most basic and crucial diagnostic method, they were conducted in only three instances. No in vitro tests for drug identification were conducted, and in four cases, the cause was determined merely based on the timing of drug administration, indicating significant diagnostic limitations. Conclusions The study underscores the critical situation in Japan regarding insufficient diagnostic practices and difficulties in identifying triggering drugs rather than the consistent prevalence of POA in secondary care facilities. The findings emphasize the need for improved diagnostic proficiency and more rigorous drug identification practices to ensure prompt and accurate POA diagnosis. It is essential to conduct further research and interventions to increase patient safety during the perioperative period in secondary care settings.

IJCM_289A: Determination of factors favouring the snake bite mortality in Himachal Pradesh

Background: Snake bite is an established important cause of morbidity and mortality among the poor and rural population across the world including India. India accounts for the highest number of snakebites and related mortality globally. Objective: Identification of factors favoring the mortality due to snake bite. Methodology: A descriptive cross-sectional study was conducted from April 2022 to March 2023, and deaths due to snake bites reported from different health care facilities and community were included in the study. Results: A case-fatality rate of 5.9% due to snake bite was documented in the study. The factors identified as favorable for mortality were delayed treatment, followed by suboptimal care at primary and secondary health care facilities and traditional beliefs of the community. Conclusion: Provision of emergency service as point of care delivery, focusing on provision of training to strength point of care emergency services, co-ordination and linkages with the community members can strengthen the efforts toward reducing the mortality due to snake bites.

India Hypertension Control Initiative: Blood Pressure Control Using Drug and Dose-Specific Standard Treatment Protocol at Scale in Punjab and Maharashtra, India, 2022.

Hypertension treatment coverage is low in India. A stepwise simple treatment protocol is one of the strategies to improve hypertension treatment in primary care. We estimated the effectiveness of various protocol steps to achieve blood pressure (BP) control in public sector health facilities in Punjab and Maharashtra, India, where the India Hypertension Control Initiative (IHCI) was implemented. We analyzed the records of people enrolled for hypertension treatment and follow-up under IHCI between January 2018 and December 2021 in public sector primary and secondary care facilities across 23 districts from two states. Each state followed a different treatment protocol. We calculated the proportion with controlled BP at each step of the protocol. We also estimated the mean decline in BP pre- and post-treatment. Of 281,209 patients initiated on amlodipine 5 mg, 159,292 continued on protocol drugs and came for a follow-up visit during the first quarter of 2022. Of 33,450 individuals who came for the follow-up in Punjab and 125,842 in Maharashtra, 70% and 76% had controlled BP, respectively, at the first step with amlodipine 5 mg. In Punjab, at the second step with amlodipine 10 mg, the cumulative BP control increased to 75%. A similar 5% (76%-81%) increase was seen in the second step after adding telmisartan 40 mg in Maharashtra. Overall, the mean (SD) systolic blood pressure (SBP) decreased by 16 mmHg from 148 (15) mmHg at the baseline in Punjab. In Maharashtra, the decline in the mean (SD) SBP was about 15 mmHg from the 144 (18) mmHg baseline. Simple drug- and dose-specific protocols helped achieve a high control rate among patients retained in care under program conditions. We recommend treatment protocols starting with a single low-cost drug and escalating with the same or another antihypertensive drug depending on the cost and availability.

Heart failure outcomes by left ventricular ejection fraction in a contemporary region-wide patient cohort.

This study aimed to characterize a contemporary population with subtypes of incident or prevalent heart failure (HF) based on reduced (HFrEF), mildly reduced, or preserved (HFpEF) left ventricular ejection fraction (LVEF) and to assess how outcomes, healthcare, treatments, and healthcare costs vary between each subtype of incident HF. Using Swedish data from the CardioRenal and Metabolic disease Heart Failure (CaReMe HF) study, updated to cover a more recent time period, this population-based study characterized patients from Stockholm County, Sweden, with incident HF (patients with a first HF diagnosis between 1 January 2015 and 31 December 2019) or prevalent HF (patients with a first HF diagnosis before 1 January 2020). Patients with incident HF had LVEF measured by echocardiography within ±90days of their first HF diagnosis, and patients with prevalent HF within 5years prior to the index date. The 13375 patients with prevalent HF (39.2% women, mean age 73.9years) had multiple comorbidities (cardiovascular diseases, chronic kidney disease, diabetes, and cancer). These were already highly prevalent at the time of the first HF diagnosis in the 8042 patients with incident HF (40.5% women, mean age 72.3years). Patients with incident HFpEF received less specialist HF care at outpatient secondary care facilities following their first HF diagnosis than those with incident HFrEF. Patients with HFrEF had higher risks of complications and exerted a higher burden, in terms of care for and costs of HF, on the healthcare system. This study of contemporary patients with incident HF demonstrates that those with HFpEF and HFrEF differ considerably in terms of clinical presentation, prognosis, and care, highlighting a potential to improve HF outcomes.

Current understanding of children's head shape and its impact on health: a cross-sectional study among pediatric medical staff in China.

Head shape problems are common in infancy and early childhood, and thus their early identification and management can benefit the health of children. This study aimed to investigate pediatric healthcare professionals' existing knowledge of children's head shape abnormalities and their associated effects in China, providing guidelines for future clinical interventions, training, and interdisciplinary collaboration. We conducted a survey among pediatric medical staff, encompassing various age groups, genders, hospitals, and professional levels. The electronic questionnaire queried respondents' basic information, knowledge pertaining to head shape issues, diagnosis and treatment approaches, and the clinical development status of head shape problems. All surveys and data collection were conducted anonymously. A total of 214 valid questionnaires were collected. Differences in the level of understanding among medical staff regarding head shape issues were observed. Medical staff in tertiary care facilities showed the highest proficiency in diagnosing and treating positional plagiocephaly and cranial asymmetry (P<0.05), while those in primary care facilities exhibited the lowest competency in diagnosing head shape abnormalities (P<0.05). Most medical staff had a partial understanding of specific aspects of head shape issues, such as identifying high-risk individuals (n=144, 67.29%), making diagnoses (n=176, 82.24%), and understanding the consequences (n=151, 70.56%), with no significant differences across medical facilities of various levels. Additionally, 99.07% (n=212) of the medical staff believed that head shape measurements should be included as a routine component of pediatric physical examinations, and 75.23% (n=161) incorporate head shape assessment as part of their routine physical examination. Furthermore, 91.12% (n=195) of the medical staff received consultations on children's head shape issues, with a higher prevalence in secondary and tertiary care facilities. Finally, 93.97% (n=201) of the participants expressed the need for further education and knowledge on pediatric head shape, with no significant differences across medical facilities of various levels. There is a limited understanding among medical personnel in China regarding children's head shape issues. Therefore, it is imperative to enhance training and educational initiatives for medical staff in China, with the goal of enhancing their awareness and knowledge regarding children's head shape problems.

Protocol for an evaluation of the initiation of an integrated longitudinal outpatient care model for severe chronic non-communicable diseases (PEN-Plus) at secondary care facilities (district hospitals) in 10 lower-income countries

IntroductionThe Package of Essential Noncommunicable Disease Interventions—Plus (PEN-Plus) is a strategy decentralising care for severe non-communicable diseases (NCDs) including type 1 diabetes, rheumatic heart disease and sickle cell disease, to...