Secondary Care Level Research Articles

Sociodemographic Correlates and Prevalence of Work-Related Stress among Child Healthcare Workers in Nigeria

Background: Work-related stress (WRS) refers to the harmful physical and emotional responses that occur when job demands exceed workers' capabilities, resources, or needs. WRS in healthcare is associated with low job satisfaction, reduced efficacy, and poor health outcomes. This study aimed to assess WRS and its sociodemographic correlates among child healthcare workers in Nigeria. Methods: A cross-sectional descriptive study was conducted among 231 child healthcare workers attending the 51st Paediatric Association of Nigeria conference in Kano, Nigeria. Respondents were from all six geopolitical zones and included pediatric consultants, residents, and nurses. WRS was assessed using a validated Cohen’s Perceived Stress Scale. Data were analyzed using SPSS version 20. Results: Of the respondents, 138 (59.7%) were female, and 93 (40.3%) were male. Consultants made up 41.6% of the sample, while 83.1% were married. Most respondents (41.6%) were aged 30-39 years. WRS prevalence was 37.7%. It was significantly higher among females, participants aged 30-39, unmarried individuals, and those working in facilities below secondary care level. Conclusion: Work-related stress among child healthcare workers in Nigeria is prevalent, particularly in women, younger professionals, and those in primary healthcare settings. Regular stress management programs and interventions aimed at improving work-life balance are recommended to mitigate WRS in this group.

Where is Batho Pele? The perspective of child and adolescent mental health service users in the Western Cape Province of South Africa

BackgroundMental health disorders of children and adolescents represent a key area of concern, yet child and adolescent mental health services (CAMHS) are neglected, especially in low- and middle-income countries. There is a clear need to provide services that are relevant to the needs of service users, but little research to date has explored their needs and experiences of services, or to identify their recommendations for service strengthening. In 1997 the South African Government introduced the “Batho Pele” (‘People First’) initiative in all public sector services, with the aim of putting the voices of service users at the centre of decision-making of policy development and implementation. This study sought to explore user perspectives about CAMHS in the Western Cape, one of the nine provinces of South Africa.MethodsUsing focus group discussions and semi-structured interviews, qualitative data were collected from purposively sampled CAMHS users (caregivers and adolescents) across the Western Cape Province. Data were entered into NVivo, and thematic analysis was performed by two independent raters.ResultsResults highlighted slow, inappropriate and unacceptable CAMHS at primary level of care, and lack of dedicated CAMH resources and staff rudeness at primary and secondary levels of care. Only one positive theme was identified about a new service initiative at primary care. Only specialist CAMHS (tertiary level) were regarded as well-organised. To improve CAMHS, users recommended that the processes and procedures should be restructured to become child- and family-friendly, separate CAMHS should be developed at primary and secondary levels, CAMHS should be prioritized to provide equitable services to young people with mental health disorders, and better communication and information, including formal psychoeducation should be provided to caregivers.ConclusionsThe data from this study provided very little support for the “Batho Pele” principles and highlighted a clear need for CAMHS strengthening in the Western Cape, and in South Africa as a whole. These findings may be similar in other low-resource settings and highlight the importance of putting “people first” by listening to their voices on an ongoing basis and at all levels of service and systems strengthening.

P0245 Analysis of quality measurements of colonoscopy at different levels of care in IBD

Abstract Background High-quality endoscopy in IBD is associated with better clinical outcomes, while quality measurement supports effective quality control. The European Society of Gastrointestinal Endoscopy recommends using nine performance measures, depending on the indication for endoscopic examination in IBD. Our study aimed to compare colonoscopy quality between tertiary and secondary referral centers for IBD patients, based on endoscopic reports. Methods In this cross-sectional study, colonoscopy reports of IBD patients were analyzed. At our tertiary center, we consecutively enrolled patients over 18 years old with established IBD between July and October 2024, using their available colonoscopy reports. The secondary care group included patients referred to our tertiary center, with the last existing report from secondary care used for analysis, while the tertiary care group consisted of our patients whose most recent report was similarly used. Nine key performance measures (indication, bowel preparation, photo documentation, ileal intubation, biopsy, endoscopic activity score, high-definition and chromoendoscopy use, and neoplasia detection) were evaluated based on colonoscopy reports. Patients were stratified by procedure indication (diagnostic, activity assessment, or surveillance) as well. Descriptive statistics, Welch’s, and Fisher’s exact tests were used to compare groups, with p-values <0.05 considered significant. Results Overall, 207 colonoscopy reports were assessed, of which 68/207 were performed at secondary care level. A total of 78/207 patients were diagnosed with Crohn’s disease, while unclassified diagnoses were noted only at secondary centers. Activity control (88% vs. 38%, p<0.001) and surveillance (8% vs. 0%, p=0.02) examinations were more common at the tertiary level. Bowel preparation was better at tertiary centers (Boston Bowel Preparation Scale [BBPS] 8.3±2.3 vs. 7.2±1.2; p=0.003), and use of BBPS was more frequent at higher levels of care (p<0.001). Disease activity scores were more commonly used at the tertiary level during activity control examinations (51.2% vs. 19.2%, p=0.004), while ileal intubation was also more frequent at the tertiary level (53% vs. 28%; p<0.001). Procedure and withdrawal times did not differ between levels in diagnostic or activity control examinations. Neoplasia detection was low, and biopsy rates were similar. Conclusion Quality indicator targets were met in neither secondary nor tertiary centers; however, wider investigation is needed to verify these results. Broad education can help to improve the quality of colonoscopy in IBD care.

Mitigation of Air Pollution and its Impact on the Lung Health of Tuberculosis Patients, a Prospective Cohort Study from Rural India

Our respiratory system is a primary target of the harmful effects of poor indoor and outdoor air quality; therefore, the present study was undertaken in rural settings of Solan district of HP on 23 Pulmonary tuberculosis patients diagnosed at the Secondary Care level hospital of Solan in 2018 and 2019. Their lung function assessment was undertaken with Spirometry at the beginning and after six months of anti-tubercular treatment (ATT). Accordingly, air quality (indoor and outdoor) was assessed and the Air Quality Index (AQI) was computed. In total 300 participants in ten villages of the selected patients were selected to create awareness vis a vis literacy on the significance of air quality management for ensuring human health, especially tuberculosis management. Air pollution-abating plants were introduced in residential settings (indoor and outdoor) of selected patients. The study indicated that per unit AQI improvement of 16.6, 11.86 and 13.91 due to created literacy and environmental amelioration by introducing plants and enhancing air circulation/ventilation resulted per unit increase in the lung health index of tubercular patients with each of 0.0005 units of improvement in air quality. Capacity building on air quality management improved air quality as well as lung health of tubercular patients.

Consistency between headache diagnoses and ICHD-3 criteria across different levels of care

BackgroundDiagnosing headache disorders poses significant challenges, particularly in primary and secondary levels of care (PSLC), potentially leading to misdiagnosis and underdiagnosis. This study evaluates diagnostic agreement for migraine, tension-type headache (TTH), and cluster headache (CH) between PSLC and tertiary care (TLC) and assesses adherence to the International Classification of Headache Disorders 3rd edition (ICHD-3) guidelines.MethodsA retrospective, cross-sectional analysis was conducted at Charité - Universitätsmedizin Berlin’s tertiary headache center. The patients’ self-reported diagnoses from the PSLC were compared with those in TLC and with ICHD-3 criteria. Cohen’s kappa (κ) and R² were used to assess diagnostic agreement.ResultsAmong 1,468 patients (43.4 ± 14.4 years; 74.5% women), 69.5% reported a diagnosis in PSLC, and 99.5% were diagnosed at their first TLC visit. Overall agreement between PSLC and TLC was 80% (κ = 0.55; R²=30%). Agreement between the PSLC and ICHD-3 was 77% for migraine, 82% for TTH, and 96% for CH (κ = 0.65; R²=41%). TLC diagnoses aligned with ICHD-3 in over 90%.ConclusionOur findings indicate a significant degree of diagnostic agreement across different levels of care according to the ICHD-3 guidelines. However, there remains insufficient reliability in clinical diagnostics, highlighting the need for continued efforts to improve the early recognition and diagnostic accuracy and consistency of primary headaches to optimize patient care and treatment outcomes in Germany.

Birth defects reporting and surveillance in India: a narrative review.

Mortality attributable to birth defects (congenital anomalies, congenital disorders) is increasing in low and middle-income countries, including India. Surveillance is essential to inform strategies to address these disorders. The objective of this narrative review was to document the birth defects surveillance/reporting systems in India, their current status, structures and reporting formats. The review used empirical analysis of retrieved literature to answer the framed research questions. Publications on birth defects surveillance in India was negligible. Website searches yielded information on two surveillance systems. The WHO South East Asia Region-Newborn-Birth Defects (SEAR-NBBD) surveillance for congenital disorders uses a non-representative sample of hospitals to conduct passive surveillance for eight congenital anomalies. The system has a hierarchy of quality control measures to assure data accuracy. The second system is a child screening and early intervention service (the Rashtriya Bal Swasthya Karyakram, RBSK), which reports data on nine birth defects among children screened at birth, in the first six weeks of life, and till 18 years of age. The RBSK uses existing community-based staff and competency-appropriate screening tools that incorporate defined referral routes to secondary or tertiary level of care. Data from neither of these systems is available in the public domain. The review identified that the strengths and weaknesses of both these systems can be utilized to put in place a potentially sustainable sentinel surveillance for monitoring birth defects in India.

Case Report: Mustardé Flap Perfom for Reconstruction of the Cheek in a Patient with Basal Cell Carcinoma in a Second Level of Care

Case Report: Mustardé Flap Perfom for Reconstruction of the Cheek in a Patient with Basal Cell Carcinoma in a Second Level of Care

Migrants and refugees’ health financing in Morocco: How much is the hidden contribution of the government through free services?

BackgroundThe health of migrants and refugees is a key component in achieving Universal Health Coverage (UHC). This paper aims to assess the scale of financing mobilized by the Moroccan government for migrants and refugees health, and addressing health issues related to these populations within the ongoing health reforms.MethodsThe primary objective of this study was to estimate the financial resources allocated by the government for migrants’ and refugees’ healthcare. A bottom-up approach was used to assess the unit costs of all services provided across five primary healthcare (PHC) centers and three hospitals in two regions of Morocco. A detailed costing methodology was applied, accounting for all cost components at the health facility level, including depreciation of capital assets. By combining unit costs and service volumes, we estimated the total government expenditure on healthcare for migrants and refugees. As the free service provision shifts to a third-party payment system with the expansion of health insurance, this financing must be accounted for. To better prepare for future contracting, we also calculated the disease-specific costs for migrants and refugees using activity-based costing (ABC) methods, which allowed us to develop a database of costs per disease associated with migrant and refugee healthcare. Data from 2022 were used for the analysis.ResultsThe study found that the government mobilizes approximately 5% of its total annual primary healthcare budget for migrants and refugees, amounting to $141,652.66. For secondary-level care, the cost was $184,921.92 (3% of total hospital costs) for one hospital, $46,778.20 (0.37% of the total cost) for a second hospital, and $78,193.53 for a teaching hospital. These findings are crucial for informing the development of alternative financing mechanisms following the expansion of health insurance coverage, with the cost per pathology serving as a foundation for designing these mechanisms.ConclusionThe study also highlighted that hospitals across different levels of care manage costly diseases, further underscoring the importance of government investment in migrant and refugee healthcare. The nondiscriminatory access to healthcare services and the model of care established in Morocco could serve as a foundation for developing sustainable healthcare financing models for migrants and refugees.

Access points to different levels of health care over 13 years. Utilization behaviour in a changing health care system. Results of a three-wave cross-sectional series in Austria.

Providing health care is a balancing act among human resources, financial pressures and system-intrinsic factors. Understanding the utilization behaviour of primary and secondary care facilities [general practitioners (GPs) vs. specialists, as well as in- and outpatient hospital care] is crucial for a country like Austria, which has free access to all levels of care. The aim of this study was to reassess access point consultations in relation to sociodemographic variables over time. The databases used for this cross-sectional analysis were the Austrian Health Interview Surveys 2006/07, 2014, and 2019, with sample sizes of 15 474, 15 770, and 15 461 persons, respectively. Analyses included patterns of utilization behaviour, multivariable logistic regression models, and diff-in-diff analyses highlighting differences between the observation periods. GP and secondary care consultations increased from 2014 to 2019. While there were fewer GP visits in 2014 than in 2006/07, GP consultation rates grew by 3.2% between 2014 and 2019. Secondary care utilization increased by 5.4%-8.2% between 2006/07 and 2019, with the highest growth in older and less-educated persons. Secondary-level utilization without prior GP visits decreased again in 2019 after peaking in 2014. Utilization of all access points increased over the entire observation period, especially regarding secondary-level care. Higher GP visit rates do not seem to result in a drop in secondary-level consultations. These results emphasize the coordinator role of primary care in ongoing structural health reforms in European countries, such as Austria.

Enhancing digital health competencies: insights from european human resources for health

Abstract Background Mixed-skills for digital health transformation are critical for human resources for health (HRH). This study aimed to inform the design of new training programmes that address soft, hard and digital health skills. Methods Using a mixed-methods design science approach, focus groups were conducted by invitation and with informed consent, online or in-person. A script was prepared with key questions for orientation and facilitation, addressing the topics of current situation, desired situation, desired skills, practical and organisational needs to implement continuous training in healthcare. The collected data were analysed using Nvivo. Results Focus groups (14) had 87 participants (Norway, Latvia, Belgium, Italy and Portugal): 26 healthcare professionals (nurses, midwives, nutritionists, pharmacists, assistants and doctors); 27 managers or directors of hospitals and care centres; 34 experts (digital health specialists, researchers, technical officers, members of professional societies and national authorities). Real needs were identified, with 2 direct sub-themes that were best related to each other (Pearson coefficient, p > 0.40 - cluster analysis): 1. ‘Current situation’: Cybersecurity (eg. privacy, law and ethics); Time (work time versus private time, p = 0.69); Type (informal versus formal training, p = 0.32); Programmes (graduation, continuing education and post-graduation levels). 2. ‘Desired situation: Desired skills (eg. digital - basic ICT, data analysis, soft - communication, emotional intelligence, and hard skills - medication administration, catheters, ECG, vital signs, telehealth - digital stethoscope); Learning design and objectives (eg. collective learning, simulations, location - peer-to-peer and hybrid); Emergency care and the link between primary and secondary levels of care were considered important. Conclusions These findings of convergence among HRH inform Program design process to support the training programs and course syllabus design. Key messages • The identified needs and priorities inform Program design further to support Digital Health Transformation training programs and course syllabus design. • Real needs points to Current and Desired situation, where HRH give important insights that need to be considered to engage people to perform training courses.

Multidisciplinary approach to asylum seekers health assessment: a 5-year experience in Modena, Italy

Abstract Background Asylum seekers’ well-being represents a global health issue. They face significant challenges to their physical and mental health due to their migratory path. In the Modena province (Northern Italy), a multidisciplinary approach has been applied to the care of asylum seekers by Department of Public Health (DPH), with a team of specialists in infectious diseases, dermatology, gynaecology, obstetrics, psychology and preventive medicine. Asylum seekers receive a first visit, including medical and psychological assessment and screening for infectious diseases. Ad hoc pathways are also active for asylum seekers who need secondary-level care. This study aims to investigate the health status of asylum seekers referred to Modena Centre. Methods This cohort study enrolled asylum seekers hosted in Modena between November 2018 and May 2023. During the first visit, personal and anamnestic data were collected aided by cultural mediators, along with clinical assessment. Furthermore, Tuberculin-Skin-Test (TST) and blood tests for HBV-HCV-HIV-Syphilis were performed. Results A total of 646 migrants were included, 94% were males with a median age of 26 years (range: 15-50), the majority from Bangladesh (39%). Females were mostly from Ivory Coast (36%), median age of 30 years (range: 17-45). Most conditions were treated at the primary care level and were related to cutaneous disease (22%), only 11% of subjects required second-level diagnostics. Positive TSTs were 41% (N = 265). Of them, 55.5% (N = 147) also tested positive for QuantiFERON-TB. Screening for infectious diseases revealed positivity rates of 4% for HBsAg, 1% for HCVAb, 0.8% for HIV and 1.4% for TPPA+RPR. Conclusions The multidisciplinary approach is the innovative and strength point of this protocol for asylum seekers’ health ensuring prompt management of pathologies after their arrival. Moreover, data collection is useful for improving intake services and implementing public health programs for vulnerable individuals. Key messages • The innovation of this protocol for asylum seekers’ health lies in its multidisciplinary approach. • Clinical data collection will support health policies’ choices to protect vulnerable individuals.

First experience of endovascular balloon occlusion of the aorta in the wounded with hemorrhagic shock during the war in Ukraine

Background. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used worldwide to stop bleeding in trauma and wounds in patients with hemorrhagic shock. REBOA allows for the hemodynamic stabilization, patient transportation and final bleeding control. The study aims to demonstrate the capabilities of REBOA as a method of bleeding control in the wounded with hemorrhagic shock in the context of war in Ukraine. Materials and methods. Five AFU servicemen who sustained mine-blast wounds in the Eastern Ukraine as a result of shelling by Russian troops were delivered with signs of internal bleeding and hemorrhagic shock to the primary and secondary levels of medical care (Role 1, 2). The REBOA balloon catheter was inserted and inflated by surgeons working in stabilization centers or advanced surgical teams. Upon admission, all patients underwent chest and abdominal ultrasound according to the FAST protocol. We used COBRA-OS 4 Fr and ER-REBOA 7 Fr balloon catheters. The positioning of the balloon in the aorta was performed according to external anatomical landmarks (3 cases) and ultrasound (2 cases). In all clinical cases, the balloon catheter was placed in zone I. In one case, the balloon was moved from zone I to zone III (control of the source of bleeding). The duration of aortic occlusion ranged from 15 to 50 minutes. Immediately after removal of the introducer, manual compression of the puncture site was used (3 cases) or suturing of the arteriotomy (2 cases). Results. The sources of bleeding in our clinical cases were injuries of the iliac vessels (2 cases), the renal artery (1 case), and injuries of the inferior vena cava and liver (2 cases). Four patients were evacuated to a higher level of medical care after the REBOA was installed. In one case, there were complications from vascular access (femoral artery thrombosis). We were unable to save one wounded soldier, most likely due to the delay in evacuation from the previous stage, the severity of injury, and massive blood loss. Conclusions. As our observations have shown, the use of REBOA in combat conditions allows not only to stabilize hemodynamics in the wounded with severe combined trauma and bleeding but also to conduct a successful evacuation to a higher level of medical care to stop bleeding ultimately. REBOA can be successfully used at the prehospital stage. This requires clearly defined indications for the technique’s use, training of medical personnel, and provision of balloon catheters to medical units of the Armed Forces of Ukraine.

Psoriasis: a disease beyond the skin.

Psoriasis is a chronic, immune-mediated inflammatory dermatosis with a multifactorial etiology, affecting approximately 3% of the Italian population. This condition not only imposes a substantial burden on physical health but also significantly diminishes the personal and social quality of life of affected individuals. This study aims to assess the critical role of integrated management approaches in psoriasis, focusing specifically on the role of primary care physicians in coordinating multidisciplinary care and addressing comorbidities. A comprehensive review of current therapeutic guidelines, classification systems, and available treatment strategies was conducted. This was supplemented with real-world clinical case studies. The study evaluated intervention approaches at both primary and secondary care levels, involving collaborations between general practitioners and specialists. Special emphasis was placed on the use of clinical assessment tools such as the Psoriasis Area and Severity Index (PASI) to categorize disease severity and guide therapeutic decisions. Our findings underscore the effectiveness of a multidisciplinary and personalized approach in managing psoriasis, particularly in moderate-to-severe cases. The pivotal role of primary care physicians in the early diagnosis, ongoing monitoring, and coordination of care pathways was highlighted, leading to significant improvements in comorbidity management. The clinical cases presented illustrate how tailored therapeutic regimens, supported by close collaboration between general practitioners and dermatologists, can result in the effective resolution of psoriatic lesions and markedly enhance patients’ quality of life. This study reinforces the necessity of a comprehensive, integrated, and multidisciplinary approach in the management of psoriasis, with primary care physicians serving as crucial intermediaries between community-based and specialist care. Depending on disease severity, treatment response, and recurrence patterns, primary care physicians play a central role in directing patients to appropriate secondary care services. The integration of specialist dermatological care with ongoing community-based monitoring optimizes clinical outcomes and mitigates the overall disease burden. We advocate for the establishment of clinical networks that facilitate seamless communication between different levels of care, ensuring holistic and targeted management of both psoriasis and its associated comorbidities. Keywords: Psoriasis, primary care physician, multidisciplinary care, integrated therapy, quality of life, comorbidities.

Matrix Support: interface between Specialty Dental Centers and primary oral health care in Brazil

BackgroundMatrix Support (MS) is a strategy that can be used to improve integration between Primary Health Care (PHC) and other levels of care.ObjectiveThe aim of this study was to investigate the association between MS carried out in Brazilian Dental Specialty Centers (CEOs) (secondary level of oral health care) and aspects of the integrated work process with PHC, as well as contextual variables.MethodsA quantitative cross-sectional study was conducted using data from the Program for Quality Improvement and Access to CEOs (PMAQ-CEO). Secondary data from the External Evaluation of the second cycle of PMAQ-CEO were analyzed, including contextual variables obtained from sources such as the Unified Health System (SUS) and official research institutions. Descriptive analyses were performed, and four multiple models were adjusted to investigate the association between the variables.ResultsThe results showed that about half of the CEOs did not carry out therapeutic projects developed with the oral health teams of PHC. It was found that the lack of therapeutic projects developed with the teams was associated with the lack of discussion of complex cases by the team, lack of discussion of individual therapeutic project, absence of joint continuing education activities, lack of construction and discussion of clinical protocols, and lack of belief in the importance of planning and periodic evaluation. The results suggest that the articulation between PHC and secondary oral health care still presents weaknesses within the scope of SUS. Comprehensive care needs to be strengthened, requiring greater intervention from management.ConclusionIt was concluded that the individual factors of CEOs, related to the work process, have a greater influence on the lack of integration with oral health teams of PHC, compared to the contextual variables of municipalities.

Case Report: Delorme Technique for the Treatment of Giant Non-Reducible Rectal Prolapse at the Second Level of Care

Rectal prolapse is an invagination of the rectum that causes it to protrude through the anus. Irreducible rectal prolapse is an unusual condition; in most cases, the prolapse reduces spontaneously. Non-surgical treatment alternatives have been noted, such as the use of sugar, which reduces rectal prolapse. The results have not yet been compared against surgical treatment, so they cannot yet be considered the preferred option. Given the many techniques and procedures, it should be considered that the best procedure must be chosen not only to correct the prolapse but also to restore defecatory function and to improve fecal incontinence throughout the patient's lifetime. The Delorme procedure is a transanal technique that addresses complete rectal prolapse with a low surgical risk and minimal morbidity (less damage to pelvic and hypogastric nerves compared to abdominal procedures). It is associated with a significant improvement in anal continence, low recurrence rates, short hospital stays, and patient comfort.

Rehabilitation with removable dentures in adults and older people with partial or total edentulism: Chilean Public Health System Experience, 2017–2019

Statement of problemTooth loss is frequent among the Chilean population, particularly the poor and elderly. The Public's response is mostly via removable dentures (RDs), however there is limited evidence regarding its results. PurposeThe objective of this descriptive ecological study is to monitor and characterize the production of RDs within Chile's Public Health System. Material and methodsPublic records were obtained from the Department of Statistics and Health Information of Chile (DEIS) website. All records regarding RDs activities within the Public Health System for years 2017 to 2019 were retrieved and included in the analysis. ResultsBetween 2017 and 2019, the Public Health sector delivered an average of 342,261 RDs annually, which corresponds to 2.4 RD per 100 individuals. Overall, 70.3 % of beneficiaries were female, 63.2 % were for people between the ages of 20 to 64, and 35.3 % were for people aged 65 or older. Among RDs provided, 57 % were made at the primary level and 43 % at the secondary level of care. The program “More Smiles”, accounted for 52.3 % of primary healthcare RD delivery. At the secondary level, 14.9 % of RDs had metallic framework, while 85.1 % were acrylic. Older persons and males were more likely to receive acrylic RDs than their counterparts. ConclusionsRDs are regularly supplied in Chile's Public Healthcare System, mainly through primary care. The characterization regarding programs, type of RDs, gender and age of the recipients, may guide future hypothesis regarding the adequateness of the response to address tooth loss at a population level. Further investigation into the impact on patient satisfaction and RD quality is recommended to enhance understanding in this domain. Clinical implicationsThe study explores the scale and characteristics of removable prosthetic provision within Chile's Public Health System. This comprehensive overview enables the identification of areas requiring further attention to ensure the delivery of high-quality treatments and the efficient allocation of public resources.

The economic burden of bipolar disorder: a case study in Southern Iran

BackgroundBipolar Disorder (BD) imposes considerable economic and social burdens on the community. Therefore, the present study aimed to determine the economic burden of bipolar disorder in patients referred to single-specialty psychiatric hospitals at the secondary and tertiary care level in 2022.MethodsThis partial economic evaluation was conducted as a cross-sectional study in the south of Iran in 2022, and 916 patients were selected through the census method. The prevalence-based and bottom-up approaches were used to collect cost information and calculate the costs, respectively. The data on Direct Medical Costs (DMC), Direct Non-Medical Costs (DNMC), and Indirect costs (IC) were obtained using the information from the patients’ medical records and bills as well as the self-reports by the patients or their companions. The human capital approach was also used to calculate IC.Findings: The results showed that in 2022, the annual cost of bipolar disorder was $4,227 per patient. The largest share of the costs was that of DMC (77.66%), with hoteling and ordinary beds accounting for the highest expenses (55.40%). The shares of DNMC and IC were 6.37% and 15.97%, respectively, and the economic burden of the disease in the country was estimated at $2,799,787,266 as well.ConclusionIn general, the costs of bipolar disorder treatment could impose a heavy economic burden on the community, the health system, the insurance system, and the patients themselves. Considering the high costs of hoteling and ordinary beds, it is suggested that hospitalization of BD patients be reduced by managing treatment solutions along with prevention methods to reduce the economic burden of this disease. Furthermore, in order to reduce the costs, proper and fair distribution of psychiatrists and psychiatric beds as well as expansion of home care services and use of the Internet and virtual technologies to follow up the treatment of these patients are recommended.

Transforming Lives Through Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY): A Review

Background: The Pradhan Mantri Jan Arogya Yojana (PMJAY) program was created in line with the global goal of Universal Health Coverage (UHC), and aims to ensure everyone has access to quality healthcare services without suffering financial difficulties. In India, over 60% of healthcare spending is still borne by households, and a significant portion of the population lacks any form of health protection coverage. Discussion: The High-Level Expert Group (HLEG) recommended a shift from supply-side healthcare financing to demand-side financing, leading to the introduction of government-sponsored health insurance schemes. To achieve Universal Health Coverage (UHC), the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched following the recommendations of the National Health Policy 2017. The PMJAY program is the world's largest publicly sponsored social health insurance program, delivering comprehensive healthcare services covering primary, secondary, and tertiary care levels. The scheme covers approximately 12 crore households, including more than 50 crore beneficiaries, offering healthcare coverage of up to Rs. 5 lakh per family annually. PMJAY operates nationwide in India, covering all states and union territories except for a few.. Conclusion: To move forward, PMJAY can play a transformative role in the healthcare landscape, integrate with primary healthcare, contribute to economic development, and expand its scope to include more healthcare services.

Post-COVID conditions response: a collaborative approach to -establishing multidisciplinary clinics in Ecuador.

Worldwide, 3.7% (144.7 million) of people diagnosed with COVID-19 developed Post-COVID Conditions (PCC). Therefore, creating and implementing multidisciplinary rehabilitation clinics is important to address the needs of patients and improve overall recovery. This study was made possible with support from the United States Agency for International Development funded RISE program, under the terms of the cooperative agreement 7200AA19CA00003. This case study was conducted in Ecuador and describes the creation and implementation of 21 PCC rehabilitation clinics in primary healthcare centers and secondary level hospitals in 7 provinces across the country. Data was gathered for the identification of partnering health facilities and needs, for the evaluation of knowledge enhancement in health professionals after a specific training program, and for the measurement of key performance indicators. This article emphasizes the organization, educational strategies, and implementation of rehabilitation programs tailored specifically for the management of Post-COVID Conditions in Ecuador. The implementation of PCC rehabilitation clinics involved a collaborative effort between the Ministry of Public Health (MOPH), the private sector and a non-governmental organization (Jhpiego). Twenty-one health facilities from the primary and secondary level of care were selected, and PCC rehabilitation implemented in 7 provinces of Ecuador. Additionally, 133 health providers were trained and a total of 13,846 patients treated, among whom 859 had a diagnosis of PCC. Medical doctors outperformed nurses in both pre- and post-tests scores. However, all healthcare professionals demonstrated comparable improvement in knowledge acquisition. Rehabilitation manuals were developed and adopted by the MOPH, rehabilitation equipment was donated and a mobile application, "RESPIRA", was developed and disseminated free of charge. The establishment of PCC rehabilitation clinics in Ecuador was successful in identifying patients in need of early rehabilitation. The insights of this study can serve as a guide for the development of similar initiatives in other countries. Tailored courses are essential to address disparities and ensure comprehensive skill development and promote equitable healthcare delivery.

Contextualizing risk, pathways, and solutions for the relationship between adverse childhood experiences (ACEs) and type 2 diabetes among inner-city African Americans: A qualitative analysis and development of a theoretical framework

PurposeAdverse childhood experiences (ACEs) confer significant risk for diabetes in adulthood. The purpose of this study was to explore perceptions about risk, potential pathways leading to diabetes, and solutions based on the lived experience. MethodsThree focus groups were conducted. A semi-structured interview guide was used to explore prevalence and causes of ACEs, pathways to diabetes, and possible solutions. Grounded theory was used for analysis. Constant comparisons resulted in emergent themes that were indexed and compared with the rest of the data to establish analytical categories. Analytical categories were further refined as additional data was collected until groups of key themes or categories were identified and used to construct a theoretical framework. ResultsParticipants totaled 23 across 3 groups. All participants were African American. Average age was 49, average number of years living with diabetes was 13 years. Participants included both men and women. Participants experienced one or more occasions of sexual abuse, physical and verbal abuse, and neglect. The major themes can be classified as A. Cause, B. Pathway, and C. Treatment/solution. LimitationsFindings may not generalize to the overall population with ACEs and diabetes. ConclusionsThree major themes were identified: family instability and financial hardship as risks for ACEs, maladaptive coping leading to diabetes, and social structure as a potential solution. Future research is needed to examine quantitatively, pathways to inform prevention at the primary, secondary, and tertiary levels of care for both the prevention of ACEs, mitigating risk for diabetes, and improving overall health.