Urban Primary Health Care Research Articles

Effectiveness of a new one-hour blood pressure monitoring method to diagnose hypertension: a diagnostic accuracy clinical trial protocol

Introduction24-hour ambulatory blood pressure monitoring (ABPM) is the gold standard diagnostic method for hypertension, but has some shortcomings in clinical practice while clinical settings often lack sufficient devices to accommodate...

Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa.

PurposeTo quantify costs to patients of accessing HIV care prior to ART initiation.Materials and methodsUsing a cross-sectional study design, costs incurred by HIV-positive patients prior to ART initiation were estimated at urban primary healthcare facilities in South Africa. Costs included direct costs, indirect (productivity) costs, carer and coping costs (value of assets sold and money borrowed). The percentage of individual income spent on healthcare was calculated and compared by patient income tertiles and CD4 count strata.Results289 patients (69% female, mean age 37 (SD: 10) years, median CD4 317 (IQR: 138–494) cells/mm3) were interviewed. The total mean monthly cost of pre-ART care was US$15.71. Indirect costs accounted for $2.59 (16.49%) of this when time was valued using the patient’s reported income. The mean monthly patient costs were $31.61, $12.78, $12.65 and $11.93 for those with a CD4 count <100, 101–350, 351–500 and >500 cells/mm3 respectively. The percentage of individual income spent on healthcare was 7.25% for those with a CD4 count <100 cells/mm3 and 4.05% for those with a CD4 count >500 cells/mm3.ConclusionsDespite the provision of charge-free services at public clinics, care prior to ART initiation can be costly, particularly for the poor and unemployed. Our study adds to the growing body of evidence that highlights the need to consider policies to reduce the economic barriers to HIV service access, particularly for low income or unwell patient groups, such as improving access to disability grants.

Theory of Nurse Practitioner Job Satisfaction

Nurse practitioner (NP) job satisfaction was evaluated qualitatively to enhance understanding of relevant processes and concepts. A constructivist grounded theory study was undertaken. The study population included NPs working in rural and urban primary health care in Northern Ontario, Canada. An original theory to explain NP job satisfaction and intent to leave was developed. This report focuses on the concept of NP job satisfaction within the broader theory and explores all relevant findings.

Patient safety attitude in primary health care settings in Giza, Egypt: Cross-sectional study.

Although there is increasing interest in patient safety, yet there is a general lack of awareness of the problem. This study aims to investigate patient safety attitudes among health care providers in primary health care (PHC) facilities in Egypt through employing the Safety Attitudes Questionnaire in order to explore the areas of deficiency and opportunities for improvement concerning patients' safety. A cross-sectional study was conducted in an urban PHC and one rural unit where 130 working team at the time of the study was interviewed with response rate of 63.7%, SPSS 18 was used for data analysis. Descriptive analyses, independent samples t tests, and/or analysis of variance (ANOVA) were performed to examine the relationship between patient's safety culture and independent variables, namely, profession, gender, or age groups. Highest positivity percentage was found for job satisfaction dimension (23%), while it was the least for the ambulatory care (2.3%). Participants belonging to age group older than or equal to 50 scored statistically significant mean values in both job satisfaction and working conditions dimensions (P=0.03 and 0.02, respectively). Health care managers scored statistically significant mean in the ambulatory care dimension 68.1±15.3, (P=0.03). Managers had more positive attitudes regarding patient safety issues in the practices they are responsible for, compared with the employees. This could be an opportunity to enhance safety attitudes within PHC centers and gain their commitment to guarantee safer and higher quality patient care.

Opportunistic Screening for Alcohol and Tobacco Use Among Male Patients Seeking Care From an Urban Primary Health Center

Opportunistic Screening for Alcohol and Tobacco Use Among Male Patients Seeking Care From an Urban Primary Health Center

High prevalence of anemia among postnatal mothers in Urban Puducherry: A community-based study.

Background:Anemia is a common problem across all life stages and ages with a higher burden among women. The postnatal period is an often-neglected period for the provision of effective care to the mothers. Anemia burden is also high during this period, which leads to many morbidities and poor quality of life.Methods:A community-based cross-sectional study was done in the field practice area of two Urban Primary Health Centres (PHCs) in Puducherry between March 2015 and February 2016. A total of 227 postnatal mothers were selected by simple random sampling from the list of mothers delivered from the field practice area. House visit was done within 4 weeks of completion of their postnatal period. Socio-demographic details and third-trimester hemoglobin levels were collected using a pretested questionnaire. Hemoglobin level during post-partum was measured using Sahli's Hemoglobinometer. Paired t-test is done to assess the difference in hemoglobin antepartum and post-partum. Multiple Logistic Regression is done to identify factors associated with postpartum anemia.Results:The mean (SD) hemoglobin during postpartum was 10.95 (1.1) gm% ranging from 7.4 gm% to 13.8 gm%. The prevalence of anemia among postnatal mothers is 76.2% (n = 173, 95% CI: 70.4%-81.4%). Around 26% (59) had mild anemia, 49.8% (113) had moderate anemia and 0.4% (1) had severe anemia. One-fourth of the mothers who had a normal hemoglobin level in their third trimester had developed anemia in the postnatal period. There was a significant difference in mean hemoglobin during postpartum and that of third trimester (10.95 vs 10.69 gm%, t = 3.4, df 226, P = 0.001). Birth order of two or more is significantly associated with postpartum anemia (aOR 2.2, 95% CI: 1.07-4.39).Conclusions:The prevalence of anemia among postnatal mothers is high. Routine hemoglobin estimation, advice on consumption of iron-rich foods and Iron and Folic Acid (IFA) supplementation have to be provided to postnatal mothers to improve this situation.

Effectiveness of daily directly observed treatment, short-course regimen among patients registered for treatment at an urban primary health center in Bengaluru

Background: Tuberculosis (TB) is a major public health problem in India with high morbidity and mortality. As per the World Health Organization guidelines, the Revised National Tuberculosis Control Program introduced daily directly observed treatment, short-course (DOTS) regimen with a fixed-dose combination with weight bands. This study was undertaken to compare the effectiveness of daily DOTS regimen with intermittent regimen and to assess the proportion of adverse drug reactions in both groups. Materials and Methods: A descriptive study was conducted at a peripheral health institute under one of the TB Units in South Bengaluru. Participants registered for treatment during the third and fourth quarter of 2017 were selected using continuous sampling. Data were collected by case record analysis, structured interviews, and telephonic follow-up. Results: The study included 81 participants, with the mean age of 40 ± 16.1 years. Majority of the study participants 55 (67.9%) were male, and majority (38 [46.9%]) belonged to the upper-lower class. Forty-two (51.8%) of the study participants were on intermittent regimen, and 39 (48.1%) were on daily DOTS regimen. There was 100% sputum conversion at the end of treatment under both treatment regimens. A total of 36 (85.7%) participants under intermittent regimen and nine (23%) under daily regimen developed one or the other adverse drug reactions. The treatment success for participants under intermittent regimen was 38 (90.47%) and that for daily regimen was 35 (89.74%). However, there was no statistically significant difference between the two groups. Conclusion: Both daily and intermittent DOTS regimens are equally effective in TB treatment, but adverse drug reactions were more common with the intermittent regimen.

Structured Diabetes Education Program for Improving Self-care Behavior in Primary Care Settings of Puducherry: Evidence from a Randomized Controlled Trial.

Context:Diabetes self-management education plays a critical role in improving patients’ clinical outcome and quality of life.Aims:This study aims to study the effectiveness of a structured diabetes educational program on improvement of self-care behavior among type 2 diabetics in urban Primary Health Centres (PHCs) of Puducherry.Settings and Design:A community-based open-label parallel-arm randomized controlled trial was conducted in two randomly selected urban PHCs of Puducherry during December 2015–February 2017.Subjects and Methods:Using systematic random sampling, 157 eligible participants were recruited in intervention and control PHCs each. Sociodemographic, disease characteristics, and anthropometric measures were captured using a pretested questionnaire at baseline. Self-care behavior was recorded with Summary of Diabetes Self-Care Activities scale. Intervention consisted of structured diabetes education sessions with distribution of information leaflets and self-care kits to the intervention-arm participants, while control arm received standard care. At the end of 6 months, endline assessment was done for both groups. Data were analyzed by intention-to-treat, per-protocol, and difference-in-difference analysis using STATA.Results:Footcare increased significantly by 1.95 days/week compared to control arm, while a moderate change of 0.49 days/week in diet compliance and a minimal change of 0.10 days/week in physical activity were observed. Medication adherence, regular blood sugar testing, and smoking behavior also showed improvement in intervention arm.Conclusions:A structured education program that is culturally tailored showed an overall improvement in self-care behavior. This research supports the need for structured education program for diabetics to empower them and improve self-care practices.Trial registration:CTRI/2017/06/008772

Awareness and client satisfaction of the services providedunder National Urban Health Mission in an Urban PrimaryHealth Center coming under Bruhath Bengaluru MahanagaraPalike - A cross sectional study

Background Though there has been health care facilities at reachable distance due to various reasons people have not been utilizing the services to the full extent. Thus Government of India launched National Urban Health Mission NUHM as a sub-mission of National Health Mission on 1st May 2013. It provided the necessary Human Resources on contractual basis for betterment of health-care services. As it has been 5 years since implementation of NUHM this study is done to assess the awareness and client satisfaction of general public about the services provided and also to recognize the key areas which needs improvement.Objectives To assess the awareness and client satisfaction of the services provided by the Urban Primary Health Centre under NUHM. Methodology Study Design Community based Crosssectional study. Study area Urban field practice area of BMCRI Bengaluru Study Units Households coming under selected Urban Primary Health Center of BBMP. Study period was from 01092018 to 30112018. Sampling method used was systematic Random sampling. Sample size Based on the study conducted by Suresh Kumar Ray at al the sample size calculated as 345. Data collection and Analysis A face validated semi-structured questionnaire administered by interview method and Statistical analysis was done using SPSS version 20.0.Results Out of 347 households surveyed 48 167 were availing the services from UPHC. Public were aware of individual components of NUHM services to different extent. Among those availing facilities 70 118 of the households were satisfied about the health care services provided by UPHC. Among the remaining 30 49 they were unhappy about waiting time for OPD consultation 46 23 and also about distance at which health-care facilities are available 29 14. The households wanted to have more information about availability of various schemes and services provided.Conclusion Though it has been five years since the implementation of NUHM only 48 were availing the service from UPHC Sidhaiah Road and only 36 were aware of all the facilities provided under NUHM.nbsp

Depression, anxiety, and bodily pain independently predict poor sleep quality among adult women attending a primary health center of Puducherry, India.

Background:Sleep disorders and mental health problems are common diagnoses in primary care settings. The objective of this study was to estimate the magnitude of poor sleep, depression, and anxiety through opportunistic screening and to find out the independent predictors of poor sleep quality among female participants.Materials and Methods:A hospital-based study was conducted in the outpatient department (OPD) of an urban primary health center of Puducherry. Patients and accompanying healthy attendants ≥ 18 years of age who visited the OPD for any reason were included. Those with serious acute illness, previously diagnosed mental illness, pregnant women, and women in postpartum period (upto 6 weeks) were excluded. Systematic random sampling was used to select the participants. A semi-structured questionnaire was used to collect sociodemographic and clinical details along with the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale. Height and weight were also measured.Results:A total of 301 participants were recruited. Mean age of the participants was 49.4 (standard deviation 15.2) years. Magnitude of poor sleep (PSQI score > 5), abnormal anxiety, and abnormal depression were 118 (39.2%), 60 (19.9%), and 28 (9.3%) respectively. Multivariate logistic regression analysis showed that history of pain [odds ratio (OR) 3.2 (1.6–6.5), P = 0.001], abnormal anxiety [OR 2.5 (1.2–5.6), P = 0.021], and abnormal depression [OR 4.3 (1.4–13.2), P = 0.01] independently predicted poor sleep quality among females.Conclusion:OPD-based opportunistic screening for sleep and mental health problems should be routinely conducted by primary care and family physicians.

Young, obese, and underweight patients show up inadequately at scheduled appointments: Findings from a record-based study on diabetic, hypertensive diabetic, and hypertensive patients attending a primary care clinic of Puducherry.

Background:One key barrier to proper management of common cardio-metabolic conditions such as diabetes and hypertension in primary care is inadequate adherence to treatment, which, in many cases, results from inadequate follow-up at scheduled appointments. In addition to provider and health system level factors, individual patient level factors are also associated with attendance at follow-up appointments.Objective:To document the association of diabetic, hypertensive diabetic, and hypertensive patient's demographic and clinical factors with showing up inadequately at scheduled appointments.Methods:A record-based retrospective follow-up study was conducted in an urban primary health center of Puducherry from January to March 2015. Registered diabetic, hypertensive diabetic, and hypertensive patients who made at least one visit between July and December 2014 were included. Data on demographic factors, clinical factors, and dates of visits to the clinic were collected from case records of patients and were entered in EpiData entry version 3.1. Analysis was performed using R statistical package.Results:Out of 366 patients, 79% were females and 70.2% were aged >50 years. It was found that 183 (50%) were diabetic, 266 (72.7%) were hypertensive, and 115 (31.4%) were hypertensive diabetic. Out of 366 patients, all the five follow-up visits were attended by 185 (50.6%) patients, and “adequate follow-up” was found in 123 (33.6%) patients. Young, underweight, and obese patients were more likely to have inadequate follow-up.Conclusion:Family physicians should give special attention to these groups in their routine practice along with providing targeted health education and implementing full proof mechanisms to track them.

Strengthening growth monitoring among under-5-year children to fight childhood undernutrition in India.

Introduction:Growth monitoring of children in India is usually done by Anganwadi workers using weight-for-age growth charts. We wanted to assess the magnitude of various types of undernutrition among under-5 children using multiple growth charts and risk factors of undernutrition. We also wanted to assess if prevalence of undernutrition improves following sensitization of various stakeholders.Methodology:This is a single-arm prospective study conducted at a selected urban primary health center area in Puducherry. All the eligible 366 under-5 children and their mothers were included. Data were collected using pretested structured questionnaire. Assessment of nutritional status was done using three types of growth charts. Three home visits were made, at an interval of around 6 months, for monitoring the nutrition status of children.Results:The prevalence of undernutrition at baseline was 15.8% (95% CI 12–19.6). The prevalence of underweight, wasting, and stunting were 9.6%, 7.6%, and 7.3%, respectively. Weight-for-age growth chart could identify only 67% with stunting and 50% of children with wasting. The decrease in prevalence of wasting, underweight, and stunting were 63.6%, 44.8%, and 31.5%, respectively, over 1-year follow-up. Nutrition status could improve by prevention of low birth weight, ensuring gaps between births and promotion of breastfeeding and hand hygiene.Conclusion:It is important to use multiple growth charts for assessing nutritional status of children, instead of relying only on weight-for-age growth chart. Overreliance on use of weight-for-age growth chart will fail to identify more children with wasting. Under-5 undernutrition status can be decreased following intensive growth monitoring and planning appropriate actions involving various stakeholders.

Basthi Dawakhana of Hyderabad: The first Urban Local Body led community clinics in India.

Basthi Dawakhana initiative was launched by the Greater Hyderabad Municipal Corporation (GHMC) in Telangana state of India, in April 2018. This article documents, reviews, and analyzes the key design aspects of Basthi Dawakhana, delve into why such clinics are important for strengthening primary health care in Indian cities and urban settings, and proposes a few strategies for implementation effectiveness. In the main text of the article, evolution of urban health services, national urban health mission in India, and Mohalla clinics of Delhi has been provided. The implementation challenges and potetnial solutions for scaling up Basthi Dawakhana have been discussed. The author argues that Basthi Dawakhana initiative is aligned with the 73rd and 74th amendments in the Constitution of India, which transferred the responsibilities for primary care and public health to the Urban Local Bodies (ULBs). The article concludes that Basthi Dawakhana are arguably the first ULB-led community clinics initiative and an opportunities for ULBs in India to lead efforts to strengthen primary healthcare. These Dawakahna along with Mohalla Clinics, can serve platform to reform urban primary healthcare services and advance universal health coverage (UHC) in the country.

A comparative study on vaccination default rates among children aged 9-24 months attending a static immunization clinic in urban and rural area of Bangalore

Background: Immunization contributes significantly to the achievement of millennium development goal number 4 and is one of the eight elements of primary health care. Effective utilization of immunization services is associated with reduced infections in young children with immature immune system and improved child health outcome. The objectives of the study were to compare the default rates for vaccine doses in immunization schedule; to study the factors responsible for default; to describe the socio-demographic profile of study subjects.Methods: An observational study was conducted in the urban and rural Primary health centre on immunization days for 3 months. The study subjects were children aged (9-24) months attending immunization clinics. Their care givers were interviewed regarding socio-demographic profile and causes for default. Sample size calculated was 184 (92) each from urban and rural clinic).Results: Among 184 care givers interviewed, mean age of study subjects was 14.9±4.6 months in urban &amp; 14.6±4.9 months in rural clinic. Default rates for vaccination were 5.4% (birth dose), 7.6% (6th wk.) both in urban &amp; rural clinic. However, for further doses i.e., 10th week, 14th week, 9 months and 18 months the default rates were slightly higher in rural compared to urban clinic. Commonest reason for default was mother not aware that child had missed dose (urban 52.2% and rural 42.3%) followed by child being sick (urban 26.6% and rural 30.4%).Conclusions: The overall default rate was found to be very high which is a serious concern and need to be addressed in order to prevent eventual dropouts.

Beliefs about hypertension among primary health care workers and clients in Nigeria: A qualitative study.

ObjectiveThe main objective of the study was to elicit beliefs about hypertension among Nigerian Primary Health Care clients and workers.BackgroundIn many regions of Nigeria, the primary health care facility is usually the only source of formal health care available. Since hypertension is a chronic condition that requires lifelong life style modification and drug treatment, it is important to understand the context and background to the condition through the beliefs and perceptions among both lay persons and health care providers who manage the condition.SettingRural and urban primary health care facilities in the Federal Capital Territory Nigeria.ParticipantsA total of Eighty-one (81) primary health care clients and workers participated in the study.Methods and outcome measureA qualitative research using interviews, focus group discussions and reflective work as sources of data collection. The outcome measures were emerging themes from thematic framework analysis.ResultsThere were four themes that summarize beliefs of both PHC workers and clients namely: (1) Meaning of hypertension (2) causes of hypertension, (3) Consequences of hypertension (4) Perceptions of treatment, one additional distinct theme was elicited among PHC workers “contextual explanation”. However, under each of the shared four themes, there were both similarities and differences in beliefs expressed between PHC workers and clients.ConclusionsThis study highlights important similarities and differences in beliefs about hypertension among primary health care clients and primary health care workers that have significant implications for management of hypertension in primary care settings in Nigeria.

The Cost of Acute Respiratory Infections With Cough Among Urban Aboriginal and Torres Strait Islander Children.

Introduction: Acute respiratory infections with cough (ARIwC) contribute considerably to childhood morbidity, yet few studies have examined the cost of these illnesses among Australian children. Moreover, of the few studies that have, none are inclusive of Aboriginal and/or Torres Strait Islander children, despite this population experiencing a greater burden of respiratory illnesses. This study aimed to determine the costs of ARIwC among urban Aboriginal and/or Torres Strait Islander children from the perspective of caretakers, the public healthcare system, and employers.Methods: This cost of illness study used data collected from Aboriginal and/or Torres Strait Islander children aged <5 years enrolled in a 12 month prospective cohort study conducted through an urban primary healthcare clinic in Queensland, Australia. Illness-related resource use was collected for each episode of ARIwC reported, and costed at market rates. Linear regression was used to (a) examine cost per episode by season of illness onset and cough duration and (b) examine cost per month of observation by baseline child and family characteristics.Results: During the study period, a total of 264 episodes of ARIwC were reported among 138 children. The total mean cost was estimated to be $AU252 per non-hospitalized episode (95%CI 169–334). Caretakers, the public healthcare system and employers incurred 44, 39, and 17% of costs per episode, respectively. After accounting for months of completed follow-ups, the total mean cost per child per year was estimated to be $991 (95%CI 514–1468). Winter episodes and episodes resulting in chronic cough were associated with significantly higher costs per episode. A prior history of wheezing, connections to traditional lands and parent/guardian belief that antibiotics should be given until symptoms resolved were associated with significantly higher cost per child month of observation.Conclusion: The cost of ARIwC in this predominantly disadvantaged population is substantial, particularly for caretakers and this needs to be considered in both clinical management and public health initiatives. The importance of cultural factors on health and burden of illness should not be overlooked. Further research into the prevention of chronic cough may play an important role in reducing the economic burden of pediatric respiratory infections.

Subgroups of lifestyle patterns among hypertension patients: a latent-class analysis

BackgroundHypertension remains one of the most important preventable risk factors for diseases and death. Identifying clustered patterns of modifiable lifestyle risk factors for hypertension and demographics factors related to these clustered patterns allows for targeting health prevention interventions. Therefore, this study aims to identify latent classes of hypertensive patients’ lifestyle risk factors based on the clustering of four modifiable lifestyle risk factors: eating, physical activity patterns, smoking habits, and blood pressure control.MethodsA total of 750 patients (Mage = 65.38 years, SDage = 9.2 years) with diagnosed hypertension in urban and rural primary health care centers in Takab (Iran) were recruited randomly from August 2016 to February 2017. Latent class analysis was performed by using proc. LCA in SAS 9.2.ResultsThree classes of lifestyle patterns were identified. About 14.4% of hypertensive patients were categorized in a low-risk class (I), 54.6% in an intermediate-risk class (II), and 31% in a high-risk class (III) of lifestyle. A one-year increase in age significantly increases the risk of membership in classes II and III. Similarly, being widowed or divorced increases the risk of membership in classes II and III. Also, having a higher education level decreases the risk of membership in classes II and III.ConclusionsThis study contributes to the literature on lifestyle behaviors among older adults and provides evidence that there are considerable differences in lifestyle behaviors between subgroups of older adult patients. The three profiles of hypertensive patients’ conditions suggest that because behaviors often occur simultaneously within an individual level, a latent-class approach helps cluster co-occurrence risk behaviors and focuses on interventions targeted to several healthy behaviors among high-risk patients.

Contracting-out urban primary health care in Bangladesh: a qualitative exploration of implementation processes and experience

BackgroundContracting-out (CO) to non-state providers is used widely to increase access to health care, but it entails many implementation challenges. Using Bangladesh’s two decades of experience with contracting out Urban Primary Health Care (UPHC), this paper identifies contextual, contractual, and actor-related factors that require consideration when implementing CO in Low- and Middle- Income Countries.MethodsThis qualitative case-study is based on 42 in-depth interviews with past and present stakeholders working with the government and the UPHC project, as well as a desk review of key project documents. The Health Policy Triangle framework is utilized to differentiate among multiple intersecting contextual, contractual and actor-related factors that characterize and influence complex implementation processes.ResultsIn Bangladesh, the contextual factors, both intrinsic and extrinsic to the health system, deeply impacted the CO process. These included competition with other health projects, public sector reforms, and the broader national level political and bureaucratic environment. Providing free services to the poor and a target to recover cost were two contradictory conditions set out in the contract and were difficult for providers to achieve. In relation to actors, the choice of the executing body led to complications, functionally disempowering local government institutions (cities and municipalities) from managing CO processes, and discouraging integration of CO arrangements into the broader national health system. Politics and power dynamics undermined the ethical selection of project areas. Ultimately, these and other factors weakened the project’s ability to achieve one of its original objectives: to decentralize management responsibilities and develop municipal capacity in managing contracts.ConclusionsThis study calls attention to factors that need to be addressed to successfully implement CO projects, both in Bangladesh and similar countries. Country ownership is crucial for adapting and integrating CO in national health systems. Concurrent processes must be ensured to develop local CO capacity. CO modalities must be adaptable and responsive to changing context, while operating within an agreed-upon and appropriate legal framework with a strong ethical foundation.

Relationship Between Opioid Analgesic Prescription and Unemployment in Patients Seeking Acupuncture for Chronic Pain in Urban Primary Care.

The widespread use of opioid analgesics to treat chronic nonmalignant pain has contributed to the ongoing epidemic of opioid-related morbidity and mortality. Previous studies have also demonstrated a relationship between opioid analgesic use and unemployment due to disability. These studies have been limited to mainly white European and North American populations. The objective of this study is to explore the relationship between opioid analgesic use for chronic nonmalignant pain in an urban, mainly black and Hispanic, low-income population. This is a cross-sectional observational study. Subjects were recruited from six urban primary care health centers. Adults with chronic neck, back, or osteoarthritis pain participating in an acupuncture trial were included. Survey data were collected as a part of the Acupuncture Approaches to Decrease Disparities in Pain Treatment two-arm (AADDOPT-2) comparative effectiveness trial. Participants completed a baseline survey including employment status, opioid analgesic use, the Brief Pain Inventory, the global Patient Reported Outcomes Measurement Information Systems quality of life measure, the Patient Health Questionnaire-9 (PHQ-9), and demographic information. A multivariable logistic regression model was built to examine the association between opioid analgesic use and unemployment. Opioid analgesic use was associated with three times the odds of unemployment due to disability while controlling for potential confounders, including depression, pain severity, pain interference, global physical and mental functioning, and demographic characteristics. This study adds to the growing body of evidence that opioid analgesics should be used with caution in chronic nonmalignant pain.

Impact of air pollution in paediatric consultations in Primary Health Care: Ecological study

Abstract Objective To study the correlation between the levels of environmental pollutants and the number of paediatric consultations related to respiratory disease in Primary Health Care. Patients and methods An ecological study is performed, in which the dependent variable analysed was the number of paediatric consultations in an urban Primary Health Care centre in Madrid over a 3 year period (2013–2015), and specifically the consultations related to bronchiolitis, recurrent bronchospasm, and upper respiratory diseases. The independent variables analysed were the levels of environmental pollutants. Coefficients of correlation and multiple lineal regressions were calculated. An analysis has been carried out comparing the average of paediatric consultations when the levels of nitrogen dioxide (NO2) were higher and lower than 40 μg/m3. Results During the period of the study, there were a total of 52,322 paediatric consultations in the health centre, of which 6,473 (12.37%) were related to respiratory diseases. A positive correlation was found between SO2, CO, NOx and NO2 and benzene levels and paediatric consultations related to respiratory diseases, and a negative correlation with temperature. The number of consultations was significantly higher when NO2 levels exceeded 40 μg/m3. In the multiple lineal regression (P = .0001), the correlation was only positive between consultations and NO2 levels (3.630, 95% CI: 0.691–6.570), and negative with temperature (−5.957, 95% CI: −8.665 to −3.248). Conclusions NO2 environmental pollution is related to an increase in respiratory diseases in children. Paediatricians should contribute to promote an improvement in urban air quality as a significant preventive measure.