Secondary Health Care Research Articles

Prevalence and associated factors of non-adherence to antihyperlipidemic medication: a nationwide cross sectional survey in Pakistan

Hyperlipidemia significantly contributes to the risk of developing cardiovascular diseases. However, about half of the patients do not adhere to their antihyperlipidemic medications, leading to healthcare costs and premature mortality. This study's objective was to determine the prevalence and associated factors of non-adherence to antihyperlipidemic medications. The study covered hypertensive patients (21,451) aged 21–75 years, presenting to the primary and secondary healthcare facilities across Pakistan (covering 21 divisions) from January 2022 to April 2023. The outcome intended was non-adherence to antihyperlipidemic medication, which was assessed by SEAMS and pill-counting methods (non-adherence < 80%). The study found overall non-adherence to antihyperlipidemic medication of 60.6% across Pakistan, with the highest non-adherence rates found in Azad Jammu and Kashmir (71.9%) and the lowest in Islamabad (47.7%). Multivariable logistic regression analysis revealed that female, no health card (Sehat Sahulat Program government insurance), < 5 years of illness, < 5 daily medications, and dose frequency of twice daily revealed a positively significant association with non-adherence. While monthly income 51,000–100,000, graduation level of education, Muhajir, and hyperlipidemia with one comorbid condition had a significant negative association with the non-adherence. Antihyperlipidemic non-adherence is a multifaceted, multifactorial, profound problem requiring a multipronged approach.

Health-related quality of life in Indonesian hypertension outpatients in Western, Central, and Eastern Indonesia measured with the Bahasa Indonesia version of EQ-5D-5L

ObjectiveTo report EuroQol-5D (EQ-5D) index scores in Indonesian hypertensive (HT) outpatients and to determine the association between index scores and socio-demographic characteristics and clinical conditions.MethodSociodemographic data was obtained through interviews, and clinical data were obtained from healthcare databases and physicians. Participants from healthcare facilities in the Western, Central, and Eastern parts of Indonesia (primary and secondary healthcare). Chi-square and forest plots were used to calculate index scores and multiple ordinal regression to investigate sociodemographic and clinical variables that significantly affect the index score.Results1239 participants (Western: 358; Central: 451; and Eastern: 430), and the index score was 0.83. Participants in primary care (Western and Eastern) had the best scores, at 0.85 and 0.90 compared to those in the Central (0.83). These factors were shown to be significantly associated with lower EQ-5D index scores: (i) lived in the Central part of Indonesia, (ii) treated in a secondary care, (iii) older than 60, (iv) had only completed junior high school, (v) unemployed, (vi) three or more comorbidities, (vii) took more than one type of HT medication, (viii) ate very little or no vegetables in daily lives, and (ix) accompanied by a caregiver.ConclusionThe EQ-5D index score can be used in health and economic assessment. According to index scores by participants in Central Indonesia, it would be beneficial to investigate and carry out more appropriate intervention strategies together with health promotion campaigns focused on healthy living. Overall, participants were more likely to report problems in the pain dimension.

Sickness absence after work accidents and post-traumatic stress among white-collar workers in the retail and wholesale industry; a longitudinal Swedish cohort study

BackgroundMost studies about accidents and about PTSD, respectively, have been conducted either on blue-collar workers, or on the entire working population. There are very few such studies on white-collar workers.AimTo examine diagnosis-specific sickness absence (SA) and disability pension (DP) after a work accident or PTSD, respectively, among white-collar workers in the private retail and wholesale industry.MethodsA prospective population-based cohort study of all 192,077 such workers aged 18–67 (44% women) in Sweden in 2012, using linked microdata from nationwide registers. We identified individuals who had secondary healthcare due to work-related accidents (n = 1114; 31% women) or to PTSD (n = 216; 79% women) in 2012–2016. Their average number of net days of diagnosis-specific SA (in SA spells > 14 days) and DP were calculated for 365 days before and 365 days after the healthcare visit.Results35% of the women and 24% of the men had at least one new SA spell during the 365 days after healthcare due to work accidents. Among women, the average number of SA/DP days increased from 14 in the year before the visit to 31 days the year after; among men from 9 to 21 days. SA days due to fractures and other injuries increased most, while SA days due to mental diagnoses increased somewhat. 73% of women and 64% of men who had healthcare due to PTSD had at least one new SA spell in the next year. Women increased from 121 to 157 SA/DP days and men from 112 to 174. SA due to stress-related disorders and other mental diagnoses increased the most, while DP due to stress-related diagnoses and SA due to musculoskeletal diagnoses increased slightly.ConclusionsAbout a quarter of those who had secondary healthcare due to work accidents, and the majority of those with such healthcare due PTSD, had new SA in the following year. SA due to injury and mental diagnoses, respectively, increased most, however, SA/DP due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP in different diagnoses after work accidents and among people with PTSD.

Perception and Attitude of First-Time Mothers Towards Caesarean Section in Secondary Health Care Facility (A Mixed-Method Study)

Abstract Background: Despite the global rise in caesarean section (CS), Nigeria has a CS rate of 2.8%, which is far below the World Health Organisation recommendation of 10%–15%. Primigravida and/or first-time mothers constitute a cohort of women who are prone to obstetric emergencies such as cephalo–pelvic disproportion and obstructed labour. Objectives: To evaluate the first-time mothers’ knowledge, perceptions, and attitudes towards CS. Materials and Methods: This was a mixed-methods study conducted among first-time mothers (primigravids &gt;28weeks and first-time CS-delivered) at Adeoyo Maternity Teaching Hospital, Ibadan, using questionnaires that assessed knowledge and attitude for the quantitative aspect and in-depth interviews for the qualitative aspect using a structured topic guide. Responses from the quantitative aspect were analysed using STATA 15, and each participant’s level of knowledge was scored and categorised as: Good knowledge &gt;70%, fair knowledge 50%–70% and poor knowledge &lt;50%. Content analysis was done for the qualitative aspect, and emerging themes on perception and interpretation in CS were summarised and presented as results for interpretation. Results: About 275 mothers (178 pregnant and 97 CS-delivered) were sampled. Only a few (13.45%) of the participants had good knowledge with an equivocal attitude towards CS. The majority (84%) believed that CS helped in saving lives. Also, there was a statistically significant difference between their knowledge and their educational level, occupation, religion, ethnicity, and family income (P &lt; 0.05). The multinomial regression showed that gainfully employed Christian women significantly had more fair and good knowledge than Muslims (RR = 2.01, 95% CI = 1.13–3.57, P = 0.017) (RR = 2.71, 95% CI = 1.23–5.95, P = 0.013). Conclusion: Only a small number of the participants had good knowledge, and their perceptions about CS varied. The attitudes of participants towards CS appeared mixed, as nearly equal proportions of participants had positive and negative attitudes. Hence, there is a need to increase advocacy, antenatal education, and counselling during antenatal clinic visits. Also, first-time mothers need to be put on insurance to reduce the burden of costs.

Clinical and cost-effectiveness of spironolactone in treating persistent facial acne in women: SAFA double-blinded RCT.

Acne is common, can cause significant impact on quality of life and is a frequent reason for long-term antibiotic use. Spironolactone has been prescribed for acne in women for many years, but robust evidence is lacking. To evaluate whether spironolactone is clinically effective and cost-effective in treating acne in women. Pragmatic, parallel, double-blind, randomised superiority trial. Primary and secondary healthcare and community settings (community and social media advertising). Women aged 18 years and older with facial acne persisting for at least 6 months, judged to potentially warrant oral antibiotic treatment. Participants were randomised 1:1, using an independent web-based procedure, to either 50 mg/day spironolactone or matched placebo until week 6, increasing to 100 mg/day spironolactone or matched placebo until week 24. Participants continued usual topical treatment. Primary outcome was the adjusted mean difference in Acne-Specific Quality of Life symptom subscale score at 12 weeks. Secondary outcomes included Acne-Specific Quality of Life total and subscales; participant self-assessed improvement; Investigator's Global Assessment; Participant's Global Assessment; satisfaction; adverse effects and cost-effectiveness. Of 1267 women assessed for eligibility, 410 were randomised (201 intervention, 209 control), 342 in the primary analysis (176 intervention, 166 control). Mean age was 29.2 years (standard deviation 7.2) and 7.9% (28/356) were from non-white backgrounds. At baseline, Investigator's Global Assessment classified acne as mild in 46%, moderate in 40% and severe in 13%. At baseline, 82.9% were using topical treatments. Over 95% of participants in both groups tolerated the treatment and increased their dose. Mean baseline Acne-Specific Quality of Life symptom subscale was 13.0 (standard deviation 4.7) across both groups. Mean scores at week 12 were 19.2 (standard deviation 6.1) for spironolactone and 17.8 (standard deviation 5.6) for placebo [difference favouring spironolactone 1.27 (95% confidence interval 0.07 to 2.46) adjusting for baseline variables]. Mean scores at week 24 were 21.2 (standard deviation 5.9) in spironolactone group and 17.4 (standard deviation 5.8) in placebo group [adjusted difference 3.77 (95% confidence interval 2.50 to 5.03) adjusted]. Secondary outcomes also favoured spironolactone at 12 weeks with greater differences at 24 weeks. Participants taking spironolactone were more likely than those taking placebo to report overall acne improvement at 12 weeks {72.2% vs. 67.9% [adjusted odds ratio 1.16 (95% confidence interval 0.70 to 1.91)]} and at 24 weeks {81.9% vs. 63.3% [adjusted odds ratio 2.72 (95% confidence interval1.50 to 4.93)]}. Investigator'sGlobalAssessment was judged successful at week 12 for 31/201 (18.5%) taking spironolactone and 9/209 (5.6%) taking placebo [adjusted odds ratio 5.18 (95% confidence interval 2.18 to 12.28)]. Satisfaction with treatment improved in 70.6% of participants taking spironolactone compared with 43.1% taking placebo [adjusted odds ratio 3.12 (95% confidence interval 1.80 to 5.41)]. Adverse reactions were similar between groups, but headaches were reported more commonly on spironolactone (20.4% vs. 12.0%). No serious adverse reactions were reported. Taking account for missing data through multiple imputation gave an incremental cost per quality-adjusted life-year of £27,879 (adjusted) compared to placebo or £2683 per quality-adjusted life-year compared to oral antibiotics. Spironolactone resulted in better participant-reported and investigator-reported outcomes than placebo, with greater differences at week 24 than week 12. This trial is registered as ISRCTN12892056 and EudraCT (2018-003630-33). This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/13/02) and is published in full in Health Technology Assessment; Vol. 28, No. 56. See the NIHR Funding and Awards website for further award information.

The use of locum doctors in the NHS: understanding and improving the quality and safety of care.

The use of locum doctors in the National Health Service is widely believed to have increased, and there have been widespread and sustained concerns among policy-makers, healthcare providers, professional associations and professional regulators about the quality/safety, cost and effective use of locum doctors. To provide evidence on the extent, quality and safety of medical locum practice and the implications of medical locum working for health service organisation and delivery in primary and secondary care in the English National Health Service, to support policy and practice. Four interlinked work packages involving surveys of National Health Service trusts and of general practices in England; semistructured interviews and focus groups across 11 healthcare organisations in England; analysis of existing routine data sets on the medical workforce in primary care and in National Health Service trusts in England from National Health Service Digital and National Health Service Improvement; and analysis of data from the Clinical Practice Research Datalink in primary care and of electronic patient record data from two National Health Service hospitals in secondary care. In primary care, about 6% of general practice medical consultations were undertaken by locums in 2010 and this had risen slightly to about 7.1% in 2021. In National Health Service trusts (mostly secondary care and mental health), about 4.4% of medical staff full-time equivalent was provided by locum doctors. But those overall national rates of locum use hide a great deal of variation. In primary care, we found the National Health Service Digital workforce returns showed the rate of locum use by Clinical Commissioning Group varied from 1% to almost 31%. Among National Health Service trusts, the reported rate of locum use varied from < 1% to almost 16%. We found that there was poor awareness of and adherence to national guidance on locum working arrangements produced by National Health Service England. Our research showed that locum working can have adverse consequences for the quality and safety of care, but that such consequences were probably more likely to result from the organisational setting and the working arrangements than they were from the locum doctors themselves and their competence, clinical practice or behaviours. Our research was hampered in some respects by the COVID pandemic which both resulted in some delays and other challenges. Our efforts to use electronic patient record data in secondary care to explore locum doctor working were stymied by the problems of data access and quality. Locum doctors are a key component of the medical workforce in the National Health Service, and provide necessary flexibility and additional capacity for healthcare organisations and services. We found that the extent of reliance on locum doctors varied considerably, but that an over-reliance on locums for service provision was undesirable. Some differences in practice and performance between locum and permanent doctors were found, but these seemed often to arise from organisational characteristics. We found that patients were more concerned with the clinical expertise and skills of the doctor they saw than whether they were a locum or not. Organisational arrangements for locum working could be improved in many respects. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128349) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 37. See the NIHR Funding and Awards website for further award information.

Infection prophylaxis among patients with antineutrophil cytoplasmic antibody (ANCA) vasculitis: a scoping review.

Severe infections associated with the use of strong immunosuppressive medication are a leading cause of morbidity and mortality in patients with ANCA vasculitis (AV). While guidelines conditionally recommend trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis for Pneumocystis jirovecii pneumonia in AV patients, robust evidence on prophylaxis strategies is lacking. This scoping review aimed to assess the existing evidence on infection prophylaxis in AV patients, identify knowledge gaps, and guide future study design. A comprehensive search of six databases and relevant references identified original studies in English from January 1, 2000, to July 31, 2020. Inclusion criteria encompassed studies evaluating the impact of any antimicrobial prophylaxis strategy on infection-related outcomes in AV patients receiving immunosuppressive treatment. Studies were screened by four researchers using a blinded approach. Data was extracted by two reviewers, with differences resolved via consensus in consultation with a third reviewer. Nineteen studies met inclusion criteria, including two randomized trials and 17 cohort studies, with TMP-SMX being the most commonly assessed prophylactic strategy. The studies varied in sample sizes, outcomes measured, prophylactic strategies employed, and proportion of patients who received the regimen. Most cohort studies included no or limited control of potential confounding factors. This scoping review suggests significant variation in AV patients' receipt of TMP-SMX and alternative infection prophylaxis approaches. Observational studies using large secondary healthcare databases with rigorous designs are needed to provide high-quality evidence of the real-world effectiveness of antimicrobial prophylactic regimens, to improve clinical decision-making and quality of care for AV patients receiving immunosuppressive treatment.

Factors predicting the level of vaccine protection against hepatitis B virus infection among physicians and nurses in Šabac, Serbia.

As healthcare workers run a high and constant occupational risk of hepatitis B virus (HBV) infection through exposure to biological material, vaccination is mandatory as well as the monitoring of antibody levels one to two months after complete immunisation. The aim of this descriptive cross-sectional study was to determine HBV vaccine coverage of 200 primary and secondary healthcare workers (100 each) from Šabac, Serbia and their blood anti-HBs titre. We also wanted to identify factors that could predict the titre. Anti-HBV vaccination covered all participants, of whom 89.5 % were fully vaccinated, and 85 % had a protective antibody titre. We found a statistically significant association between antibody titre and the number of received vaccine doses, chronic jaundice, autoimmune disease, and cancer in our participants. The fact that 15 % did not achieve the protective antibody titre confirms the necessity of its control after immunisation, which is not routinely carried out in most countries, Serbia included. It is, therefore, necessary to develop a detailed strategy for monitoring vaccination and serological status of healthcare workers in order to improve their safety at work. An important role should also be given to continuous education of healthcare workers from the beginning of schooling to the end of their professional career.

Incidence of Methicillin Resistant Staphylococcus Aureus in Mother-Neonates Pair in the Delivery Units of Three Secondary Healthcare Facilities in Zaria, Kaduna State, Nigeria

Incidence of Methicillin Resistant Staphylococcus Aureus in Mother-Neonates Pair in the Delivery Units of Three Secondary Healthcare Facilities in Zaria, Kaduna State, Nigeria

Budget Implementation and Socio-Economic Development in Akwa Ibom State

This study examined the influence of the implementation of the annual budget on the socio-economic sector of the state with emphasis on education &amp; health. It was observed that in most states of the federation, the factors responsible for budget failures included but were not limited to budget indiscipline, lack of accountability, inadequate oversight functions on the side of lawmakers, and untimely release of funds, amongst others. It was the objective of this study to establish how the implementation of annual budgets in Akwa Ibom State has impacted the level of secondary and primary healthcare delivery in the State as well as the educational facilities in Akwa Ibom State. To achieve the above objectives, the survey research design was employed to gather data from a large population through the instrumentality of the research questionnaire. Hard data were also obtained from the state’s budget office. To explain this study, the Elite Preference Model which is a variant of the Elite Theory was employed. The findings of this study revealed that the implementation of the budget had a significant negative relationship with secondary and primary healthcare delivery and the attainment of educational services/facilities in Akwa Ibom State. Given the above findings, it was recommended amongst others that, as a matter of policy, budget discipline should be enforced in all its three dimensions, namely, numerical discipline, timing discipline and policy discipline. It was also recommended that a target budgeting strategy should be adopted by the Akwa Ibom State government.

ISOLATION AND CHARACTERIZATION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN SELECTED HOSPITALS OF DUTSE METROPOLIS, JIGAWA STATE, NIGERIA

The purpose of this study was to examine the equipment used in five hospitals located in Jigawa state. Finding Methicillin-Resistant Staphylococcus aureus (MRSA) on hospital equipment in a few Dutse metropolitan hospitals was the main goal. Three hundred and fifty hospital instruments in all were swabbed and then examined. Tests for antibiotic susceptibility were conducted after S. aureus was isolated and identified. The isolates were most effectively treated by gentamicin and ciprofloxacin, according to the results. Primary healthcare facilities contained 31 S. aureus isolates and 16.67% MRSA isolates, whereas secondary healthcare hospitals had 48 S. aureus isolates and 55.56% MRSA isolates. There were 25 S. aureus isolates and 27.78% MRSA isolates from tertiary healthcare facilities. The mecA and blaZ genes' polymerase chain reaction (PCR) analyses revealed amplicons of 336 bp and 400 bp, respectively, which were in line with control samples. Six of the 11 isolates that were tested tested positive for mecA, suggesting resistance to methicillin, and nine tested positive for blaZ, indicating the synthesis of B-lactamase. In conclusion, patients, medical staff, and the general public are seriously threatened by the MRSA infection that exists in these facilities.

Evaluation of Glaskow-Blatchford, Rockall Scores and Shock Index of Patients Admitted from the Emergency Department with A Diagnosis of Upper Gastrointestinal System Bleeding

Background: Risk scores and shock index used in upper gastrointestinal system (GSB) bleeding have an important place in determining the treatment and clinical course of the patient. The aim of this study is to evaluate the predicted success in mortality by analyzing shock indices together with Glasgow Blatchford Scoring (GBS) and Rockall Scoring (RS), whichare used in upper GI bleeding. Methods: This study was conducted with a retrospective analysis of patients who were hospitalized with a diagnosis of upper GI bleeding from the emergency department of a single-center secondary care health institution. For each patient, age, gender, treatment procedures performed in the emergency department or clinic, and endoscopy results were evaluated. Mortality and discharge status of the patients were compared with the scoring values. Result: 86 patients were evaluated in the study. The average age was 69.09±19.07 and the most applications were in the 61-79 age range (48.8%). The most common presenting complaints of the patients were bloody vomiting and black stools. On physical examination, melena was positive in 64% of the patients. 89.5% of the patients were treated in intensive care. The mortality rate was 10.5%. In patients with death, the shock index value was ≥0.75 in all patients and the average was 1.07. As a result of the study, it was seen that GBS, RS and shock index were successful in predicting mortality. Conclusion: Current scoring systems need to be developed in order to manage patients with upper GI bleeding, which is frequently seen in emergency departments today, more quickly and to reduce patient costs.

Latent profile analysis of biopsychosocial measures in older patients with (un)explained persistent somatic symptoms

Patients with persistent somatic symptoms (PSS) often receive either somatic or psychiatric care, depending on whether symptoms are respectively medically explained (MES) or unexplained (MUS). This separation may not be as clinically relevant as previously assumed; however, research on data-driven subgroups within cohorts of older patients with PSS is not available. Our goal is to identify more clinically relevant homogeneous subgroups beyond the distinction of MUS and MES among older patients with PSS by using a data-driven approach. We performed two Latent Profile Analyses (LPAs), one focused on 6 somatic health measures, the other on 6 psychosocial measures, using data from a case-control study with participants (>60 years) with MUS (N = 118) or MES (N = 154), recruited from the general public, general practices and secondary healthcare. We identified two somatic-health based (strong, vulnerable) and four mental-health based (strong, vulnerable, lonely, non-acceptance) profiles. We found no statistically significant overlap between the somatic – and mental health profiles (κ = 0.019). Health related quality of life negatively associated with the mentally – and somatically vulnerable profiles. We conclude that singular focus on MUS/MES distinction in the care for older PSS patients may lead to undertreatment of the most vulnerable patients. Integrated care is recommended when treating persistent somatic symptoms in later life, regardless of the (un)explained origin of the symptoms.

Health care service utilization and drug overdose death:A national nested case-control registry study.

More knowledge is needed to identify and reach those at overdose risk with preventive measures. We examined past 12-month health service utilization, identified the most frequently utilized service, explored this utilization in more detail, and examined correlates of overdose death. A population-based nested case-control registry study including all drug overdose deaths (1 January 2010 to 31 December 2018) in Norway through the Cause of Death Registry (n = 2388). The year-, age- and gender-matched controls included through a population registry (n = 21,465). Data cross-linked with population and patient registries. Multivariable conditional logistic regression analyses estimated the likelihood of overdose death. The cases (vs. controls) attended a higher median number of services (3 vs. 1). The General Practitioner (GP) was the most utilized service. The majority (55.7%) of cases had 11-50 encounters, while the majority (60.7%) of the controls had 1-5 encounters. No high school diploma, no employment, urban living, social welfare benefits/disability pension, single-person household, recent incarceration, multiple health service utilizationand frequent GP encounters, as well psychological and certain physical diagnoses were correlates of overdose death among the GP attenders. The cases had utilized more services than the controls and the GP was the most frequently utilized service. In addition to lowsocioeconomic status, psychological and certain physical diagnoses were correlates of overdose death. This is the first national case-control registry study to document the high utilization of multiple primary and secondary health care services before drug overdose death, as well as reasons for attendance and correlates of overdose death.

Analysis of patients with acute surgical abdomen due to trauma and evaluation of factors affecting mortality and the impact of COVID-19 pandemic process on patient admissions

Objective: To analyze the patients who developed acute surgical abdomen due to trauma, to evaluate the factors affecting mortality and to examine the impact of the COVID-19 pandemic process on patient admissions. Materials and Methods: The study was conducted retrospectively by analyzing the patients who applied to the emergency department of a secondary healthcare institution between 01.01.2019-31.12.2023 (5 years) and developed an emergency surgical abdomen secondary to trauma and were hospitalized and treated. All age groups were included in the study. Demographic data, type of trauma, type of treatment, site of injury, laboratory data, length of hospitalization and mortality status were analyzed. Comparative analysis of the injured regions according to the type of trauma was performed. Data of patients who were discharged and those who died were compared. Data collection was performed through hospital electronic data. Results: 123 patients were evaluated in the study. 78.9% (n=97) of the patients were male. The mean age was 36.43±14.81 years and the most common age range was 21-40 years (60.2%, n=74). At the time of presentation to the emergency department, the most common Glasgow Coma Score was 11-15 (83%, n=102). The most common reason for presentation was traffic accident (40.7%, n=50). Post-traumatic injuries to more than one organ or region in the abdomen were most common (28.5%, n=35). Surgical procedures were performed in 65.9% (n=81) of the patients. The mean duration of hospitalization was 7.14±5.40 days. Hemoglobin and platelet levels were found to be significantly lower at the time of admission in the patients who died (p

Exploring The Implementation Challenges Faced By Healthcare Providers In Delivering Services Under Ayushman Bharat -Arogya Karnataka Health Scheme In Bengaluru, Karnataka-A Qualitative Study

Background: Ayushman Bharat-Arogya Karnataka (AB-ArK) is a flagship health insurance scheme of Karnataka started in Oct-2018. The integrated health assurance scheme of Ayushman Bharat-Arogya Karnataka is implemented by the State of Karnataka on an assurance/trust mode through the State Health Agency-Suvarna Arogya Suraksha Trust (SAST). AB-Ark is a Universal Health coverage scheme that provides a comprehensive healthcare to both Below Poverty Line (BPL) and Above Poverty Line (APL) families, covering a wide range of secondary and tertiary healthcare services. This scheme, part of the broader Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), seeks to offer financial protection against catastrophic health expenditures and improve access to quality healthcare services. Learning the experiences and insights from the scheme's implementers can enhance our understanding of how contextual factors impact a program's success. Therefore, it is crucial to examine the different contextual elements that can either support or obstruct the effective execution of a scheme. Objective: To understand the specific obstacles and barriers in effectively implementing the Ayushman Bharat Arogya Karnataka health scheme from a healthcare provider perspective. Methods: The study employed a qualitative approach involving 8 in-depth interviews. Interviews were audio recorded and were transcribed as per the reported verbatim. The transcripts were then analysed in Microsoft excel using thematic analysis for emerging patterns and insights leading to conclusions drawn from the analysis results. Results: Findings were depicted in broad themes and subthemes under individual, community, health system and policy levels. In brief, factors like infrastructure, patient load, awareness, affordability, quality of care and operational challenges were discussed. Conclusion: Study finding revealed various challenges faced by the health care provider, which needs to be addressed for the scheme’s long-term success and sustainability. Continuous monitoring, policy adjustments, and stakeholder engagement are essential to overcoming these hurdles and achieving the scheme's objectives.

Pregnant Women’s Perception of Gestational Anemia and Iron Supplements in Oman

Background: Gestational anemia is one of the most confronted problems during gestation. Nevertheless, the number of pregnant women with gestational anemia is growing in Oman. This study aimed to explore the perception of pregnant women regarding gestational anemia and iron supplements. This study would help us to comprehend pregnant women’s perceptions, attitudes, and factors regarding gestational anemia and iron supplements, as well as to understand the factors behind iron-deficiency anemia among pregnant women. Method: This study utilized a qualitative method directed by a grounded theory (constructivist) approach. The researchers conducted semi-structured (in-depth) interviews with 36 pregnant women with gestational anemia in the North Batinah Governorate in Oman. The researchers selected three primary healthcare institutions and one secondary healthcare institution, intending to reach pregnant women with gestational anemia. Both purposive sampling and theoretical sampling were used in this study. Results: From constant comparative analysis, four categories were developed: “Knowing the Problem”, “Believing in Treatment”, “Influencing Factors”, and “Trying To Manage”. Conclusion: Understanding pregnant women’s perception of gestational anemia and iron supplements could assist the Ministry of Health in developing ways to provide proper education and service for expectant mothers in Oman.

Bridging the gap: enhancing TBI care in Pakistan's primary and secondary healthcare settings.

Traumatic Brain Injury (TBI) in Pakistan is predominantly caused by road traffic accidents, falls, and violence, resulting in approximately 300,000 new cases annually. Significant gaps exist in awareness, resources, and accessibility for effective TBI management, especially in primary care settings. To improve care, strategies include training healthcare providers, nationwide awareness campaigns, strengthening healthcare infrastructure, and establishing referral systems. Collaboration between government, NGOs, and international partners is crucial for enhancing TBI management.

Healthcare utilisation and associated costs for methadone versus buprenorphine recipients: Examination of interlinked primary and secondary care electronic health records in England.

More evidence for patterns of healthcare utilisation and associated costs among people receiving opioid agonist therapy (OAT) is needed. We investigated primary and secondary healthcare usage and costs among methadone and buprenorphine recipients in England. We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases of patients who were prescribed OAT between 1 January 2007 and 31 July 2019. The cohort was linked to Hospital Episode Statistics admitted patient care, outpatient and emergency department data, neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records. Negative binomial regression models were applied to estimate weighted rate ratios (wRR) of healthcare utilisation. Total and mean costs were calculated using Unit Costs of Health and Social Care and the National Healthcare Service Payment by Results National Tariffs. Among 12,639 patients observed over 39,016 person-years, we found higher rate of hospital admissions (wRR 1.18; 1.08-1.28) among methadone compared with buprenorphine recipients. The commonest hospital discharge diagnoses among methadone patients were infectious diseases (19.2%), mental and behavioural disorders (17.0%) and drug-related poisoning (16.5%); the three commonest among buprenorphine patients were mental and behavioural diseases (21.5%), endocrine (13.8%) and genitourinary system diseases (13.1%). Methadone patients had similar mean costs compared with buprenorphine patients (cost difference: £539.01; 432.11-1006.69). Differences in healthcare utilisation frequency for methadone versus buprenorphine recipients were observed. The differences in associated costs were mainly driven by hospital admissions. These findings offer valuable insights for optimising care strategies and resource allocation for OAT recipients.

Investigation of the Attitudes of Healthcare Professionals towards Disabled Women in Terms of Gender Perceptions

Background: Gender inequality causes women to be exposed to discrimination in many fields. Gender discrimination against women affects disabled women more deeply. Prejudiced and negative attitudes of healthcare professionals may prevent disabled women from receiving adequate health services. Objective: This study aimed to examine the attitudes of healthcare professionals towards women with disabilities in terms of gender perception. Methods: The sample of this descriptive, cross-sectional study consisted of 234 healthcare professionals. Research data were collected using the Descriptive Information Form, Gender Role Attitudes Scale (GRAS), and Disabled Women Attitude Scale (ADWS). Results: The mean age of the participants was 36.60±8.27, and the average professional working time was 172.23±94.59 months. Of them, 60.7% were women, 34.2% were nurses, 40.6% worked in secondary healthcare institutions, and 31.6% had a disabled relative. The mean total score of GRAS was 54.06±9.61, and ADWS was 62.42±13.79. GRAS and ADWS mean scores were higher in women. The mean GRAS score was higher in university graduates and those working 21 years or more. The mean ADWS score was higher in individuals who do not have a disabled relative. Additionally, there was a low positive correlation between GRAS and ADWS mean scores (p