Urban Health Care Centers Research Articles

Trends in head and neck cancer incidence in Ho Chi Minh City, Vietnam between 1996 and 2015

IntroductionThis study provides an analysis of head and neck cancer (HNC) cases over a 20-year period in Ho Chi Minh City, Vietnam. It aims to shed light on HNC's characteristics and trends in this highly populated urban region. MethodsThe analysis encompasses 8974 HNC cases, emphasising incidence rates, gender distribution, and the prevalence of different subtypes, including oral cavity, nasopharyngeal, oropharyngeal, and laryngeal/pharyngeal cancers. Ho Chi Minh City was chosen due to its extensive cancer reporting systems and its role as a major urban healthcare centre attracting a wide range of patients. ResultsThe study reveals an increasing incidence of HNC in Ho Chi Minh City, with a notable predominance of male patients (73 %). The breakdown of HNC cases shows oral cavity cancer at 34 %, nasopharyngeal at 33 %, oropharyngeal at 12 %, and laryngeal/pharyngeal at 21 %. Compared to global averages, Vietnamese patients are diagnosed at an earlier age, with a noticeable trend of decreasing mean age of diagnosis over the study period. ConclusionThis comprehensive study provides valuable insights into the HNC landscape in Ho Chi Minh City, revealing a slightly lower overall incidence but an earlier age of diagnosis compared to global trends. These findings suggest the need for region-specific public health initiatives and further research to clarify the epidemiological features of HNC in Vietnam.

Perception towards electronic health records & uptake of digital health IDs among the urban residents in northern India: A mixed methods study.

Background & objectives Ayushman Bharat Digital Mission (ABDM) envisages a unique digital health ID for all citizens of India, to create electronic health records (EHR) of individuals. The present study assessed the uptake of Digital Health IDs by the patient and general population, their attitude toward EHR, and explored the barriers to digital ID and utilizing electronic health records services. Methods A concurrent explanatory mixed methods study was undertaken in Chandigarh, India, with an analytical cross-sectional design as a quantitative part and a qualitative descriptive study. The study participants were 419 individuals aged ≥18 yr who attended the urban primary healthcare centre (n=399) and the community-based screening camps (n=20) between July 2021 and January 2022. Latent Class Analysis (LCA) was undertaken to identify hidden sub-population characteristics. In-depth interviews were done to identify the barriers to health ID uptake. Results The digital health ID uptake rate was 78 per cent (n=327). Among the study participants, those who were aware of EHR, those who wanted a national EHR system, those who were confident with the government on EHR security, and those who were willing to make national EHR accessible for research showed significantly higher digital health ID uptake than their counterparts. The themes identified under barriers of uptake from the qualitative interviews were lack of awareness, technology-related (including digital literacy) and utility-related. Interpretation & conclusions Increasing EHR awareness, digital health literacy, and enacting data protection laws may improve the acceptance of the digital health ecosystem in India.

Comorbidities and use of health services in people with diabetes mellitus according to risk levels by adjusted morbidity groups

BackgroundPeople with diabetes mellitus frequently have other comorbidities and involve greater use of primary and hospital care services. The aim of this study was to describe the comorbidities and use of primary and hospital care services of people with diabetes according to their risk level by adjusted morbidity groups (AMG) and to analyse the factors associated with the utilisation of these services.MethodsCross-sectional study. People with diabetes were identified within the population of patients with chronic conditions of an urban health care centre by the AMG stratification tool integrated into the primary health care electronic clinical record of the Community of Madrid. Sociodemographic, functional, clinical characteristics and annual health care services utilisation variables were collected. Univariate, bivariate and Poisson regression analyses were performed.ResultsA total of 1,063 people with diabetes were identified, representing 10.8% of patients with chronic conditions within the health centre. A total of 51.4% were female, the mean age was 70 years, 94.4% had multimorbidity. According to their risk level, 17.8% were high-risk, 40.6% were medium-risk and 41.6% were low-risk. The most prevalent comorbidities were hypertension (70%), dyslipidaemia (67%) and obesity (32.4%). Almost 50% were polymedicated. Regarding health services utilisation, 94% were users of primary care, and 59.3% were users of hospital care. Among the main factors associated with the utilisation of both primary and hospital care services were AMG risk level and complexity index. In primary care, utilisation was also associated with the need for primary caregivers, palliative care and comorbidities such as chronic heart failure and polymedication, while in hospital care, utilisation was also associated with comorbidities such as cancer, chronic obstructive pulmonary disease or depression.ConclusionsPeople with diabetes were older, with important needs for care, many associated comorbidities and polypharmacy that increased in parallel with the patient’s risk level and complexity. The utilisation of primary and hospital care services was very high, being more frequent in primary care. Health services utilization were principally associated with functional factors related to the need of care and with clinical factors such as AMG medium and high-risk level, more complexity index, some serious comorbidities and polymedication.

Association of Household Food Insecurity with Stunting and Underweight Among Iranian Children Aged 2 - 5 Years old

Background: Although previous literature has assessed the association of household food insecurity with nutritional outcomes among children, the findings are inconsistent across different study populations. Objectives: We aimed to evaluate the association of household food insecurity with nutritional outcomes among children residing in Khalkhal city, Iran. Methods: The present cross-sectional study was conducted on 300 Iranian children aged 2 - 5 years who visited urban and rural health care centers between November 2021 and March 2022. Subjects were included in the survey using multi-stage cluster sampling. Household food security status was assessed using the United States Department of Agriculture (USDA) 18-item food security questionnaire. Odds ratios (95% confidence interval) for stunting according to the food insecurity score were estimated using multivariable logistic regression in three models. Results: In the present study, 39% of participants had food security, while the prevalence of food insecurity without hunger, food insecurity with moderate hunger, and food insecurity with severe hunger were 22.3%, 23%, and 15.7%, respectively. In all models, both categorized and continuous food insecurity scores correlated negatively with weight (P for all < 0.001). Food insecurity did not predict the risk of stunting in all subjects before and after adjustment (Model 1: OR (CI) = 1.008 (0.96-1.05), P = 0.72; Model 2: OR (CI) = 1.01 (0.96 - 1.05), P = 0.65; Model 3: OR (CI) = 0.98 (0.92-1.04), P = 0.53). Conclusions: In the current study, we found that Iranian families with the lowest income had the highest food insecurity scores. Household food insecurity was negatively correlated with weight status among children aged 2 - 5 years.

Assisted reproductive technology (ART) patient information-seeking behavior: a qualitative study

BackgroundApproximately 13% of women in the United States of reproductive age seek infertility services. Assisted reproductive technology (ART), including in vitro fertilization, is used to help patients achieve pregnancy. Many people are not familiar with these treatments prior to becoming patients and possess knowledge gaps about care.MethodsThis study employed qualitative methods to investigate how patients interact with information sources during care. Patients who underwent ART including embryo transfer between January 2017 and April 2022 at a large urban healthcare center were eligible. Semi-structured, in-depth interviews were conducted between August and October 2022. Fifteen females with an average age of 39 years participated. Reflexive thematic analysis was performed.ResultsTwo main themes emerged. Participants (1) utilized clinic-provided information and then turned to outside sources to fill knowledge gaps; (2) struggled to learn about costs, insurance, and mental health resources to support care. Participants preferred clinic-provided resources and then utilized academic sources, the internet, and social media when they had unfulfilled information needs. Knowledge gaps related to cost, insurance, and mental health support were reported.ConclusionART clinics can consider providing more information about cost, insurance, and mental health support to patients.Trial registrationThe Massachusetts General Hospital Institutional Review Board approved this study (#2022P000474) and informed consent was obtained from each participant.

Service quality: perspective of people with type 2 diabetes mellitus and hypertension in rural and urban public primary healthcare centers in Iran

ObjectiveThis study aimed to assess the service quality (SQ) for Type 2 diabetes mellitus (T2DM) and hypertension in primary healthcare settings from the perspective of service users in Iran.MethodsThe Cross-sectional study was conducted from January to March 2020 in urban and rural public health centers in the East Azerbaijan province of Iran. A total of 561 individuals aged 18 or above with either or both conditions of T2DM and hypertension were eligible to participate in the study. The study employed a two-step stratified sampling method in East Azerbaijan province, Iran. A validated questionnaire assessed SQ. Data were analyzed using One-way ANOVA and multiple linear regression statistical models in STATA-17.ResultsAmong the 561 individuals who participated in the study 176 (31.3%) were individuals with hypertension, 165 (29.4%) with T2DM, and 220 (39.2%) with both hypertension and T2DM mutually. The participants’ anthropometric indicators and biochemical characteristics showed that the mean Fasting Blood Glucose (FBG) in individuals with T2DM was 174.4 (Standard deviation (SD) = 73.57) in patients with T2DM without hypertension and 159.4 (SD = 65.46) in patients with both T2DM and hypertension. The total SQ scores were 82.37 (SD = 12.19), 82.48 (SD = 12.45), and 81.69 (SD = 11.75) for hypertension, T2DM, and both conditions, respectively. Among people with hypertension and without diabetes, those who had specific service providers had higher SQ scores (b = 7.03; p = 0.001) compared to their peers who did not have specific service providers. Those who resided in rural areas had lower SQ scores (b = -6.07; p = 0.020) compared to their counterparts in urban areas. In the group of patients with T2DM and without hypertension, those who were living in non-metropolitan cities reported greater SQ scores compared to patients in metropolitan areas (b = 5.09; p = 0.038). Additionally, a one-point increase in self-management total score was related with a 0.13-point decrease in SQ score (P = 0.018). In the group of people with both hypertension and T2DM, those who had specific service providers had higher SQ scores (b = 8.32; p < 0.001) compared to the group without specific service providers.ConclusionStudy reveals gaps in T2DM and hypertension care quality despite routine check-ups. Higher SQ correlates with better self-care. Improving service quality in primary healthcare settings necessitates a comprehensive approach that prioritizes patient empowerment, continuity of care, and equitable access to services, particularly for vulnerable populations in rural areas.

Development and Validation of a Resilience Skills Questionnaire for Health Sector Professionals Based on Social Cognitive Theory.

Good resilience skills support effective and timely adjustment to demanding situations in the workplace. Existing tools are insufficient to develop and evaluate workplace interventions to improve employee's resilience skills. The aim of this study was to develop and validate a Resilience Skills Questionnaire (RSQ) using the key constructs of social cognitive theory-self-efficacy, self-regulation, and social support-as a theoretical framework. Following DeVellis' guidelines for scale development, first an expert panel of thirteen professors was recruited to support the item development stages and determine content validity. At this stage, the initial pool of 38 items was reduced to 25 items and CVR and CVI were calculated as 0.92 and 0.93, respectively, indicating good content validity. A second panel of ten health professionals confirmed face validity. An online survey comprised of the 25 developed items was then completed by 336 health professionals working in urban healthcare centers in Shiraz, Iran, in November 2021. The data were used to assess the psychometrics of the questionnaire according to its hypothesized three-dimensional structure. Confirmatory factor analysis yielded a final model of seventeen items in three dimensions, self-efficacy (six items), social support (six items), and self-regulation (five items), with good psychometric properties (χ2/df = 2.44 (p < 0.001), RMSEA = 0.06, GFI = 0.92, AGFI = 0.90, IFI = 0.93, CFI = 0.93). All standardized factor loadings were significant (p < 0.001). Internal consistency, as measured by Cronbach's alpha, was very good: RSQ (0.90), self-efficacy (0.86), social support (0.83), and self-regulation (0.86). Based on these results, the RSQ can be used as a standard and valid measure to develop and evaluate the effect of educational intervention programs to improve resilience skills and reduce job stress.

Self-care Ability and Demographic Characteristics among Older Adults in the Urban and Rural Areas of Miandoab, Iran

Objectives: Self-care helps older adults manage their health and stay independent by delaying disability. This study aimed to study the self-care ability and demographic characteristics of older adults in urban and rural areas of Miandoab. Design: This cross-sectional study was conducted in 2017, encompassing a total of 620 older adults aged 60 years and above. Participants: Eligible older adults were selected using stratified random sampling method from both urban and rural healthcare centers located in Miandoab, Iran. The data collection instruments comprised a demographic questionnaire and self-care ability. Data analysis was conducted using SPSS version 18 software employing t-tests and one-way analysis of variance. Results: The mean ± standard deviation of self-care was higher in the physical dimension of the older adults living in rural areas (80.64±0.81), males (90.69±1.00), married elderly (90.87±0.75), illiterate elderly (94.67±1.08), employed individuals (91.78±0.98), those with less than 65 years old (95.18±0.69), and old adults with an income level of more than 2 million (93.36±1.56). Moreover, a statistically significant difference was observed (P&lt;0.05). Conclusions: Demographic factors such as the place of residence, marriage, economic sufficiency, and lifestyle influenced the level of self-care. The findings suggest providing measures to improve the quality of life of older adults. The members of the rural family physicians’ health team and healthcare providers in urban areas should play a more substantial role in training and improving self-care

Evaluation of Uric Acid to Albumin Ratio as a Marker of Coronary Artery Disease Severity in Acute Coronary Syndrome: A Cross-Sectional Study.

Coronary artery disease (CAD) is a widespread cause of morbidity and mortality. Serum uric acid, a mediator of endothelial dysfunction and inflammation in vascular disease, can increase the risk of atherosclerosis, contributing to CAD. As serum albumin inhibits platelet activation and aggregation, low levels of it can contribute to platelet-induced coronary artery stenosis. Limited studies have been conducted worldwide in evaluating the role of uric acid to albumin ratio (UAR) in predicting severity or poor outcomes in acute coronary syndrome (ACS) patients. This study was undertaken to assess the role of UAR as a predictor of CAD severity, which can facilitate the identification of high-risk patients. A hospital-based analytical cross-sectional study was conducted in an urban tertiary healthcare center for a period of two months between June and August of 2022. A total of 100 ACS patients were included in the study. The study population included patients above the age of 18 years diagnosed with ACS who underwent a coronary angiography. Coronary angiograms were used to diagnose the presence of CAD, and its severity was assessed using Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores (SS). The correlation of UAR with CAD severity using SS was studied and compared between three varieties of ACS: ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). Chi-squared tests were used to determine statistical significance for qualitative data.Independent t-tests were used to identify the mean difference between two quantitative variables. Receiver operating characteristic (ROC) curves were constructed for UAR and high SS. A comparison between UAR and neutrophil to lymphocyte ratio (NLR) as a predictor of disease severity was done.ROC and optimal cutoff points were chosen to calculate sensitivity, specificity, and positive and negative predictive values. Microsoft Excel (Microsoft, Redmond, WA, USA) and SPSS V22.0(IBM Corp., Armonk, NY, USA) were used to analyze the data. A total of 100 ACS patients were included in the study and divided into two groups on the basis of SS, with 74% showing low severity and 26% showing intermediate-high severity. There was a statistically significant difference found between older age and SS (p=0.017). Our study showed 74% (n=74) of the patients were male and 26% (n=26) were female. It also revealed that 75.7% (n=56) of the male patients were in the low-severity group, and 24.3% (n=18) of males were in the intermediate-high severity group. 69.2% (n=18) of the female patients were in the low-severity group, and 30.8% (n=8) were in the intermediate-high severity group. Of the 100 patients, 55% were diagnosed with STEMI, of which 69.1% were in the low-severity group, and 30.9% were in the intermediate-high severity group. Among all the patients 33% of the patients were diagnosed as NSTEMI, of which 72.7% were in the low-severity group, and 27.3% were in the intermediate-high severity group. Twelve percent of the patients were diagnosed with UA, and 100% of these patients were in the low-severity group. The mean UAR was 1.40 ± 0.38 in the low-severity group and 1.29 ± 0.46 in the intermediate-high severity group (p=0.22). Our study yielded no statistically significant difference in UAR among varying severities of CAD.

Prevalence of COVID-19 anxiety, geriatric anxiety, and related factors among the elderly in Quchan, Iran during the COVID-19 pandemic: a cross-sectional study.

Anxiety is a prevalent mental disorder among the elderly, leading to discomfort, disability, increased expenses, reduced quality of life, and dysfunction. Consequently, this study was conducted to determine the prevalence of COVID-19 anxiety and geriatric anxiety, along with the factors influencing anxiety, in the elderly population served by urban healthcare centres in Quchan. This cross-sectional study involved 650 elderly individuals aged 60-95 years. The participants were selected using a two-stage cluster sampling method. Data were collected through three questionnaires: the Geriatric Anxiety Inventory (GAI), the Corona Disease Anxiety Scale (CDAS), and a questionnaire on factors contributing to anxiety. Data analysis was performed using simple and multiple regression with IBM SPSS 24. The prevalence of geriatric anxiety among the elderly was 40.3%, while the prevalence of COVID-19 anxiety (moderate and severe) was 22.8%. Significant relationships were observed between geriatric anxiety and substance abuse, stressful life events, comorbidities, COVID-19 anxiety, financial support, loneliness, walking habits, and sleep patterns (P < 0.05). COVID-19 anxiety and geriatric anxiety are prevalent concerns among the elderly. Factors like substance abuse, stressful life events, COVID-19-related anxiety, comorbidity, living alone, lack of financial support, and poor walking and sleeping habits, which affect anxiety in the elderly, it is essential to address these factors in life planning and provide services through relevant organisations, healthcare teams, and initiatives by the elderly themselves.

Patterns of tobacco use among patients visiting primary health centers in India: An exploratory study

Abstract Background: Tobacco is a public health concern at global and national levels. The state of Gujarat has 28.6% prevalence of tobacco use, 22% in males and 8% in females. Rajkot, the fourth largest and fastest growing city in Gujarat, is not free from the burden of tobacco use. Aim: The aim of this study was to assess the patterns of tobacco use and utilization of tobacco cessation services in the city of Rajkot. Methodology: This was a cross-sectional observational study conducted on adult tobacco users attending rural and urban primary healthcare centers (PHCs) in Rajkot. At least 16 participants were recruited from all 75 PHCs (a total of 1152) using probability sampling. Study instruments comprised semi-structured proforma, Fagerstrom Test for Nicotine Dependence, and readiness to change questionnaire. Responses were analyzed using SPSS version 26.0. Results: A total of 1161 participants were included. Smokeless tobacco (n = 967, 83.3%) was preferred over smoking. Mava was the most common smokeless tobacco preparation consumed. The median age of onset was 28 years (interquartile range [IQR]: 22–37), and the median duration of use was 5 years (IQR: 4–10). Males had a significantly greater duration of abstinence (U = 1218.6, P = 0.002), greater readiness to quit (χ 2 [df] = 35.66 [8], P = 0.001), and anticipated success (χ 2 [df] = 28.71 [8], P = 0.004) in abstaining. While utilization of tobacco cessation services was poor overall, counseling (32.5%) and nicotine replacement therapy (19%) were the most commonly used. Conclusion: There is a need for in-depth research on tobacco use among smaller communities, upscaling harm reduction services for tobacco use. Prevention and IEC initiatives need to be revamped considering the special needs of female tobacco users.

Investigating the effect of mindfulness counselling on sexual functioning of women with premenstrual syndrome

Mindfulness exercises can improve a wide range of the psychological and interpersonal consequences of premenstrual syndrome. Nevertheless, there is sparse information about the effect of mindfulness counselling on sexual dysfunction in women with this condition. This study aimed to determine the effect of mindfulness counselling on the sexual functioning of women with premenstrual syndrome. In this controlled randomized study, 112 women diagnosed with premenstrual syndrome referred to selected urban healthcare centers in Isfahan, Iran, were randomly allocated to two groups (intervention and control), each with 56 participants. The intervention group underwent mindfulness counselling in eight 60-minute sessions online via Google Meet. The control group did not receive any kind of intervention. The principal measure was score on the Rosen Female Sexual Functioning Index (FSFI) before, immediately, and one month after the intervention. The data were analyzed by SPSS 23, through descriptive and analytical statistical tests (chi-square, Mann-Whitney, independent t-test, ANOVA, and repeated measure) with a significance level of 0.05. There was no statistically significant difference in the mean FSFI score (or the subscores) between the intervention and control groups (p greater than 0.05) at baseline. In the intervention group, there were significant increases (relative to both baseline and in comparison with the control group) in the mean subscores for sexual desire (P < 0.0001), orgasm (P = 0.01), satisfaction (P = 0.0001), sexual pain (P = 0.003), and general sexual functioning (P < 0.0001) immediately after and one month after the intervention, but the score for sexual arousal was significantly greater only at the one-month evaluation (P < 0.0001) and there were no differences in the scores for vaginal lubrication. On the other hand. Mindfulness counselling was effective in improving the sexual functioning of women suffering from premenstrual syndrome, and should be used for this purpose in healthcare centers.

Patient Waiting Time at Primary Healthcare Centers in Riyadh Region, Saudi Arabia: A Cross-sectional Study

BackgroundPatient waiting time can adversely affect health services utilization and continuity of care, impacting patient satisfaction. In Saudi Arabia, there is limited information about the average waiting time at primary healthcare centers. Therefore, this study quantifies patient waiting time for services offered in Ministry of Health primary healthcare centers in Saudi Arabia.Materials and methodsA cross-sectional study utilizing secondary data from the Health Information System at primary healthcare centers in Riyadh was conducted in December 2020. Ten primary healthcare centers were selected. All patients visiting the selected centers during the study period were included, except those who needed emergency care or came for services without seeing the physician. Data regarding patient waiting time in minutes for different stages of primary healthcare services were collected.ResultsThe median total waiting time was 23 min. The median waiting time for pre-consultation and consultation were 6.00 and 6.78 min, respectively. The waiting time for pharmacies in rural primary healthcare centers was 22.1 min, while there was no recorded information regarding pharmacy waiting time in urban primary healthcare centers. The total waiting time at urban primary healthcare centers was longer than at rural primary healthcare centers, with a significant difference between both groups (t = − 15.5, P < 0.001). Patient age, marital status, educational level, occupation, and weekdays were significant factors influencing waiting time (P < 0.05).ConclusionThis study reveals positive outcomes regarding the average waiting time in primary healthcare centers in the Riyadh region. Further primary research is recommended.

Reproductive Health Literacy and its Related Factors in Women of Reproductive Age Referring to Comprehensive Healthcare Centers in Chabahar in 2021

Background: Reproductive health literacy plays a vital role in the health of women as one of the vulnerable groups in the community. Therefore, the present study aimed to investigate reproductive health literacy and its related factors in women of reproductive age referring to comprehensive healthcare centers in Chabahar in 2021. Methods: This cross-sectional study was conducted on women of reproductive age referring to comprehensive urban and rural healthcare centers in Chabahar. The participants were 220 women who were selected using convenience sampling. The data were collected using the Reproductive Health Literacy Scale and analyzed via SPSS software (version 22). Results: The mean score of reproductive health literacy was significantly lower in the women aged 15-24 years, those with lower education, women in rural areas, and housewives. The mean score of reproductive health literacy was significantly different among the women in terms of socioeconomic status (P=0.12). The results of multiple linear regression analysis indicated that the age group and education could significantly predict the women’s overall reproductive health literacy. Conclusion: Following the findings of this study, effective interventions need to be incorporated into national women’s health programs to improve reproductive health literacy in women with lower age and primary education, women living in villages, and housewives

Diet adherence and factors associated with nonadherence among Type 2 diabetics at an urban health center in Tamil Nadu, India

Introduction: Diabetes is a slow epidemic causing threat to public health worldwide. Several studies have been done to assess the medication adherence among patients with diabetes. The present study has focused on dietary adherence and attempted to identify factors associated with nonadherence to a diabetic diet. Materials and Methods: A cross-sectional study was conducted among 284 patients with type 2 diabetes visiting the outpatient department of an urban health-care center in Tamil Nadu, India. A semi-structured questionnaire was used for data collection. Summary of Diabetes Self-Care Activities tool was used to assess adherence for medication and physical activity while Perceived Dietary Adherence Questionnaire tool was used to assess the adherence to diabetic diet. Results: The dietary adherence was high in only 4.2% (95% confidence interval [CI]: 2.20–7.26) of the patients with diabetes while 73.2% (95% CI: 67.69–73.30) and 22.5% (95% CI: 17.81–27.84) had medium and low adherence to diabetic diet, respectively. Adherence to medication and exercise were 91.5% and 63.4%, respectively. The duration of diabetes, higher body mass index, presence of comorbidity, history of diabetic complication, and adherence to exercise were associated with better compliance to diet while socioeconomic status was not. Conclusion: The present study has identified poor adherence to diabetic diet in spite of good medication adherence. The practice of spacing of carbohydrate food and intake of Omega-3 fats needs to be improved while the consumption of food rich in other fats should be decreased. Dietary fiber intake can also be better. The findings can help plan future study to identify barriers to diet adherence and also effective methods to improve dietary practices among the patients with diabetes. The following core competencies are addressed in this article: Medical knowledge, Patient care, Systems-based practice, Practice-based learning and improvement.

Assessing Structural and Non-structural Safety and Readiness of Healthcare Centers in Bojnord in Dealing with Functional, Non-structural and Structural Dimensions of Disasters in 1400

Introduction: Natural and man-made disasters will have harmful impacts. Given the important role of healthcare centers in time of crisis, they need to be regularly assessed in terms of structural and non-structural readiness.&#x0D; Methods: This was a descriptive and cross-sectional study conducted on 22 urban and rural healthcare centers in Bojnord, a city in North Khorasan province, Iran. The relevant forms and checklists were completed through interviews with doctors, experts, and direct observation regarding functional, structural and non-structural documentation. After collecting data and completing the desired forms and checklists, the information obtained in all the centers was generally compared and evaluated.&#x0D; Results: Based on the results obtained from comprehensive urban and rural health service centers of Bojnoord Health Center, the level of functional readiness is 52.56, the safety of structural elements is 60%, the safety of non-structural elements is 57.32%, and the total safety is 57.71%. The disaster safety index is also 6 out of 10.&#x0D; Conclusion: According to the current research, the readiness of healthcare centers for disasters is far from the desired level. This situation could be due to the lack of an integrated disaster risk management, insufficient budget and knowledge on this issue. In the field of disaster risk management, it is necessary to plan to increase the understanding of disaster risk at the level of officials and society.&#x0D;

Stochastic Simulation Modelling and Analysis of Out-Patient flow: A Case Study of General Hospital Hadejia, North-western Nigeria

Increasing demand for health care coupled with resource constraints may lead to overcrowding in health care center. Generally, patient flow into health care center is characterized by variability due to its stochastic behavior. In recent years, there has been increasing interest in Discrete Event Simulation (DES) technique in healthcare systems due to its sensitivity to systems’ variability. Discrete Event Simulation (DES) technique is used in this study to examine patient flow in an urban health care center, the General Hospital Hadejia (GHH), with a view to analyzing resource utilization, minimizing waiting time, and improving efficiency and effectiveness. Data relating to waiting time, service time, and movements of patients between departments within the health center were collected and analyzed. The influence of operational policies on the efficient movement of patients during peak and off-peak demand periods is studied. Results of the discrete event simulation experiment show an average increase of 41% of patients’ visits to the hospital when the existing layout of the hospital is modified.

Socio-epidemiological factors and comorbidities associated with Chagas disease manifestations in two urban reference health care centres in Rio de Janeiro, Brazil.

Chagas disease (CD) is still an important public health issue in Latin America. This study aims to analyse the association between socio-epidemiological factors and comorbidities with clinical manifestations of CD. We performed a cross-sectional study of 985 adult patients (65±11y; 59.5% women) with CD. Data collection was based on questionnaires and medical records review. CD clinical forms (indeterminate, digestive, cardiac and cardiodigestive) and the stages of the cardiac form were classified according to the II Brazilian Consensus on CD. Statistical analyses were based on univariate and multivariate logistic regression. Older age and Brazilian birth state (Minas Gerais and Bahia) were associated with a greater likelihood of the cardiac form of CD. A greater likelihood of the digestive form was seen in men and those of older age. Patients with arterial hypertension and diabetes were less likely to have the digestive form. Men had a greater likelihood of having a more severe cardiac presentation. Those from Minas Gerais and Bahia states had a greater likelihood of having stage B1 or B2. The results reinforce the aging of the CD population living in urban areas in Brazil, the high prevalence of comorbidities and that epidemiology, sex and the presence of comorbidities may be related to the clinical form of CD.

The relationship of caregiver strain with resilience and hardiness in family caregivers of older adults with chronic disease: a cross-sectional study

BackgroundProviding long-term home care to older adults with chronic diseases may endanger the physical, mental, social, and spiritual health of caregivers and lead to care strain.ObjectiveThis study aimed to assess the relationship of caregiver strain with resilience and hardiness in family caregivers of older adults with chronic disease.MethodologyThis cross-sectional correlational study was conducted in 2020–2021 in Tehran. Participants were 230 family caregivers randomly recruited from 8 urban health care centers. Data were collected using a personal characteristics questionnaire, the Modified Caregiver Strain Index, Connor-Davidson Resilience Scale, Family Hardiness Index, and the data were analyzed by using SPSS 22 version. Pearson’s correlation coefficient was applied for data analysis. P-values ≤0.05 were considered significant.ResultsA total of 230 caregivers participated in the study. The mean age of participants was (46.65 ± 13.63) years and most of them were female (73.9%). Mean scores of caregiver strain, resilience, and hardiness in family caregivers were 16.23 ± 4.5, 39.89 ± 10.9, and 31.21 ± 7.79, respectively. Pearson correlation showed a significant and inverse correlation between caregiver strain and resilience (r = -0.310, P = 0.002), and also a significant and inverse relationship between caregiver strain and hardiness (r = -0.276, P = 0.001).ConclusionIn this study, family caregivers had moderate caregiver strain, low resilience, and high hardness. Caregiver strain in family caregivers of older adults with chronic disease is an important health issue associated with resilience and hardiness. To promote health, effective adaptation to long-term care, and reduce caregiver strain, designing effective interventions to increase resilience and hardiness in family caregivers seems necessary.

Connecting Healthcare with Income Maximisation Services: A Systematic Review on the Health, Wellbeing and Financial Impacts for Families with Young Children.

Financial counselling and income-maximisation services have the potential to reduce financial hardship and its associated burdens on health and wellbeing in High Income Countries. However, referrals to financial counselling services are not systematically integrated into existing health service platforms, thus limiting our ability to identify and link families who might be experiencing financial hardship. Review evidence on this is scarce. The purpose of this study is to review “healthcare-income maximisation” models of care in high-income countries for families of children aged between 0 and 5 years experiencing financial difficulties, and their impacts on family finances and the health and wellbeing of parent(s)/caregiver(s) or children. A systematic review of the MEDLINE, EMBase, PsycInfo, CINAHL, ProQuest, Family & Society Studies Worldwide, Cochrane Library, and Informit Online databases was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) statement. A total of six studies (five unique samples) met inclusion criteria, which reported a total of 11,603 families exposed to a healthcare-income maximisation model. An average annual gain per person of £1661 and £1919 was reported in two studies reporting one Scottish before–after study, whereby health visitors/midwives referred 4805 clients to money advice services. In another UK before–after study, financial counsellors were attached to urban primary healthcare centres and reported an average annual gain per person of £1058. The randomized controlled trial included in the review reported no evidence of impacts on financial or non-financial outcomes, or maternal health outcomes, but did observe small to moderate effects on child health and well-being. Small to moderate benefits were seen in areas relating to child health, preschool education, parenting, child abuse, and early behavioral adjustment. There was a high level of bias in most studies, and insufficient evidence to evaluate the effectiveness of healthcare-income maximisation models of care. Rigorous (RCT-level) studies with clear evaluations are needed to assess efficacy and effectiveness.