Journal of Family Medicine and Primary Care最新文献

Background: Out-of-office blood pressure (BP) measurement devices, such as ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM), enhance the accuracy and reliability of BP readings, detecting white-coat and masked hypertension. The American Heart Association (AHA) advises confirming hypertension diagnoses with ABPM to prevent overdiagnosis, emphasizing the importance of precise out-of-office diagnostic tools. This study aimed to 1) explore the prevalence of ABPM and HBPM use prior to hypertension diagnosis; 2) assess the adherence to AHA recommendations regarding ABPM utilization; and 3) investigate the association between patient characteristics and out-of-office BP monitoring practices.

Methods: A retrospective cross-sectional study analyzed a random sample of adult patients newly diagnosed with essential hypertension at a tertiary hospital primary care center in Riyadh, Saudi Arabia, between 2016 and 2022.

Results: This study evaluated the use of ABPM and HBPM in a sample of 268 newly diagnosed hypertensive patients, with a mean age of 49.17 ± 12.69 years. Although ABPM orders were placed for 57.8% of patients, only 48.5% completed the procedure. Notably, 42.2% of hypertension diagnoses were solely based on ABPM, while 7.1% and 1.1% utilized HBPM alone or in combination with ABPM, respectively. This analysis revealed a lower utilization of ABPM among older adults, individuals with diabetes or chronic kidney disease, and married patients (P < 0.05). However, this association with marital status, diabetes, and chronic kidney disease was no longer statistically significant in a fully adjusted model (P > 0.05).

Conclusion: Out-of-office BP monitoring, particularly ABPM, was underutilized in newly diagnosed hypertensive patients, especially in older age groups and patients with specific comorbidities, who may benefit the most from this method. These results underscore the need for increasing physician knowledge and compliance with the existing guidelines.

Purpose/background: To identify the proportion of patients with prediabetes who have prescribed metformin and factors related to doing so as a preventive measure for diabetes in primary care at a Family Medicine Unit in northeastern Mexico.

Methods: This retrospective observational study included 372 adults who met the criteria for prediabetes diagnosis according to the American Diabetes Association. Data was collected from medical records from January 2020 to December 2021. Possible associations between the variables of interest and the prescription of metformin were tested via hypothesis tests, furthermore, binary logistic regression was performed.

Results: Nearly 85% of the patients met at least one criterion for receiving metformin according to ADA recommendations, but only 60% of them were prescribed this medication. Patients with metformin prescriptions differed from those without in aspects such as having a documented diagnosis of prediabetes in their medical records, a higher BMI, and higher glucose levels.

Conclusions: Almost one out of two patients with a high risk of type 2 diabetes are not treated with metformin as a preventive measure. Factors associated with metformin prescription included a high BMI, elevated baseline glucose levels, and a prediabetes diagnosis in the medical record. These findings suggest the need for studies to evaluate physicians' reasons for different treatments and implementation of recommendations for type 2 diabetes prevention in patients with prediabetes in primary health care.

Background: Gestational diabetes mellitus in pregnancy is associated with polyhydramnios, macrosomia, and shoulder dystocia, and it also increases maternal and perinatal mortality.

Methods: This sequential explanatory mixed-method study was conducted for six months. All the pregnant women attending the outpatient department of the Obstetrics and Gynaecology Department at 24-28 weeks of gestation were subjected to universal screening with 75 gms of glucose and 2 hours of plasma glucose >140 mgs% is taken for diagnosis (according to DIPSI guidelines). After diagnosis, they were subjected to an HbA1c test. Women with HbA1c is >6.5% were excluded from the study. If pregnant women are screened negative by the DIPSI test, the test was repeated in the third trimester (32-34 weeks of gestation). Chi-square tests were used to find out the test of association for quantitative data and manual content analysis was performed for qualitative data.

Results: DIPSI test was found to decrease the adverse maternal and neonatal outcome by early screening and management. The stakeholders' perspectives identified by key informant interview were improper knowledge and awareness about the testing and others were anxiety and fear associated with the testing procedure.

Conclusions: As DIPSI test is an effective single step in screening and diagnostic test, hence all pregnant mothers should undergo this glucose challenge test in their antenatal visits.

Introduction: Adolescent females in India particularly from rural areas indicate sparse sexual and reproductive health (SRH) information and are at risk of unfavourable sexual and reproductive health outcomes.

Objectives: The study was primarily intended to assess the effect of structured interventional education on awareness and practices of school-going adolescent girls about sexual and reproductive health.

Methods: This was an interventional study comprising of interactive strategies, namely peer-led approach, flipped learning, skit, scenario-based discussion and puppetry. The pre- and post-test was conducted among 1232 girls in selected schools at rural block in Kumbakonam rural region of Tamil Nadu State of India.

Results: The participants reported statistically significant gain in knowledge, attitudes and practices about reproductive health due to educational intervention (P < 0.001). Nearly 50% of participants were aware about various contraceptive methods before intervention. The prevalence of self-reported symptoms of RTIs/STIs was 23.7%. Nearly more than half of participants were aware about various contraceptive methods.

Conclusions: Peer-led education can be a potential health promotion strategy among adolescent population.

Aims: Among persons with hypertension and diabetes on treatment for at least 1 year at the Rural Health Centre (RHC) noncommunicable disease (NCD) clinic, 1. To determine the control status for hypertension and diabetes. 2. To assess the relationship between proxy behavior for collection of medications and the control status.

Settings and design: Rural Health Centre, Ramanathapuram, Puducherry, India; record-based retrospective observational study.

Methods and material: The study employed a universal sampling of 396 eligible persons with diabetes and hypertension who had been on medication for over a year at the RHC NCD clinic and had recorded blood pressure and glucose values within the last 4 months. Case sheets of these patients were retrieved from the Medical Registration Department, and data from the past 12 months were collected and analyzed to assess proxy behaviors and absenteeism.

Statistical analysis used: Data were entered from the case sheets in Epicollect5 and analyzed using Stata v17.

Results: Among hypertensive patients, 48.01% were aged 60 and above, with 55.63% being female. Fifty-six percent of hypertensive patients had their condition controlled. For diabetic patients, 40.88% were aged 45-59 years, with 59.75% being female. Only 18.24% of diabetic patients had their condition controlled. The multivariable analysis examined factors associated with the control status of hypertension and diabetes. Those aged 30-44 (aRR: 1.47, 95% CI: 1.01-2.15) and 45-59 (aRR: 1.37, 95% CI: 1.03-1.82) had a higher risk of uncontrolled hypertension compared to those aged 60 and above. Gender did not show significant associations with hypertension control status. Regarding attendance status, patients who had both proxy and missed visits (RR: 1.46, 95% CI: 1.02-2.07) had a higher risk of uncontrolled hypertension. There was also a significant association with patients having more than three proxies (aRR: 1.51, 95% CI: 1.10-2.17) exhibiting a higher risk of uncontrolled hypertension. Absenteeism status showed that those absent for 1-3 visits had a higher relative risk (RR: 1.37, 95% CI: 1.03-1.82) of uncontrolled hypertension compared to those with no absenteeism.

Conclusion: Proxy behavior affects the control status of persons with hypertension and diabetes. A longitudinal study is warranted to assess the relationship between proxy visits and control status.

Centipede envenomation is usually not life-threatening. They usually present with local symptoms of swelling and pain. Centipede venoms contain large amounts of allergenic proteins that can pose a risk of allergic complications following the bite. Here, we report a rare but important case of systemic anaphylaxis in the form of abdominal pain immediately following a centipede bite that subsided after adrenaline administration. Knowledge of this systemic anaphylaxis is essential for timely management of centipede envenomation.

Background: Coronavirus was first officially reported in Wuhan city of China in December 2019. As this novel coronavirus spread rapidly throughout the world, health care workers faced many difficulties addressing the pandemic. In the present study, we explored the challenges faced by front-line health managers on human resource management, execution of the central policies, and training and in formulating innovative approaches during the coronavirus disease 2019 (COVID-19) pandemic in India.

Methods: A qualitative study was conducted using framework analysis among front-line health managers concerning COVID-19 management at the district level. We conducted 120 in-depth interviews among eight states with the use of an interview guide.

Results: The results are described under five sections: 'challenges of front-line managers in policymaking and its execution', 'human resource management', 'gaps in local execution of central policies', 'challenges in training workforce and data management', and 'innovative approaches adopted during COVID 19'.

Conclusions: We observed that a centre-down approach was not appreciated much. Many participants felt that there was a need to understand the local context and appropriate amendment. The private system is a part of the Indian health system and can never be ignored; thus, all guidelines should include the private system.

Background: Paramedics are continuously exposed to stressful events, making them liable to mental disorders. This study assesses the health of paramedics in Jeddah, focusing on their mental, emotional, and physical well-being.

Methods: This cross-sectional study included fieldwork paramedics in Jeddah through an online survey distributed on social media. With a response rate of 86.09%, 192 complete responses were analyzed. Outcomes included mental health, mood and somatic effect, self-esteem, and sleep.

Results: Most participants were males (83.85%), married (50%), non-heavy smokers (51.04%), and non-alcohol drinkers (51.04%). A significant number reported health-related work or daily life difficulties, with 62.5%-67.18% attributing these to physical and emotional issues, respectively. Over half rated their mental health as poor or somewhat poor, impacting their relationships significantly. Additionally, 70.31% frequently felt anger, and many faced limitations in physical activities. About 14.58% had a prior mental illness diagnosis, with nearly a quarter on medication, and 61.98% had recently sought psychiatric help. Sleep deprivation affected 61.98%, with 38.53% reporting poor sleep quality.

Conclusions: The findings highlight the negative impact on paramedics' mental health, showing a substantial diagnosis rate of mental disorders, activity limitations, negative mood, and relationship issues. Despite significant sleep problems, a positive aspect is their proactive psychiatric help-seeking behavior.

Context/background: The COVID-19 pandemic affected the health care services worldwide, with the target of END TB 2025; it was important to make sure that the TB notification and linkage services were not hampered. The current study aims to document the overall impact of COVID-19 on TB notification and treatment services.

Aims/objectives: To document the impact of COVID-19 on notification and comparison of their outcome between pre-COVID-19 and COVID-19 era.

Methodology: Programmatic data of 9893 notified TB cases reported from Surat rural between 2019 and 2021 were collected from Nikshay portal through DTO Surat. Detailed comparison of pre- and COVID-19 era was performed using stratified analysis.

Results: There was a significant (P = 0.02) 29% decline in cases reported in 2020 as compared to the cases reported in the previous year. The impact of COVID-19 was also seen on mortality of the reported cases (18% increase). The overall proportion of treatment failure was increased (28%), whereas difference of 20% was seen in cases where treatment regimen was required to be changed.

Conclusions: Despite the overall impact of COVID-19 on TB services (2020), the health department has proactively countered and bounce back in 2021 with an overall increase in notification and treatment services.