Family Medicine and Community Health最新文献

This is a short communication to reflect on experiences at North American Primary Care Research Group (NAPCRG) conference from the perspective of Asian family physicians. They feel that NAPCRG can play an important role to level up the skills and talents in countries with less-established primary care research capacity and capability. NAPCRG should not be restricted to networking functions for only North America, Europe and Oceania but should include Asia, South America and Africa. These international academic networks will strengthen primary care research in the world.

Objective: To examine the relevance of existing chronic care models to the integration of chronic disease care into primary care services in sub-Saharan Africa and determine whether additional context-specific model elements should be considered.

Design: 'Best fit' framework synthesis comprising two systematic reviews. First systematic review of existing chronic care conceptual models with construction of a priori framework. Second systematic review of literature on integrated HIV and diabetes care at a primary care level in sub-Saharan Africa, with thematic analysis carried out against the a priori framework. New conceptual model constructed from a priori themes and new themes. Risk of bias of included studies was assessed using CASP and MMAT.

Eligibility criteria: Conceptual models eligible for inclusion in construction of a priori framework if developed for a primary care context and described a framework for long-term management of chronic disease care. Articles eligible for inclusion in second systematic review described implementation and evaluation of an intervention or programme to integrate HIV and diabetes care into primary care services in SSA.

Information sources: PubMed, Embase, CINAHL Plus, Global Health and Global Index Medicus databases searched in April 2020 and September 2022.

Results: Two conceptual models of chronic disease care, comprising six themes, were used to develop the a priori framework. The systematic review of primary research identified 16 articles, within which all 6 of the a priori framework themes, along with 5 new themes: Improving patient access, stigma and confidentiality, patient-provider partnerships, task-shifting, and clinical mentoring. A new conceptual model was constructed from the a priori and new themes.

Conclusion: The a priori framework themes confirm a need for co-ordinated, longitudinal chronic disease care integration into primary care services in sub-Saharan Africa. Analysis of the primary research suggests integrated care for HIV and diabetes at a primary care level is feasible and new themes identified a need for a contextualised chronic disease care model for sub-Saharan Africa.

Objectives: The objective of this study is to describe the clustering of medical, behavioural and social preconception and interconception health risk factors and determine demographic factors associated with these risk clusters among Canadian women.

Design: Cross-sectional data were collected via an online questionnaire assessing a range of preconception risk factors. Prevalence of each risk factor and the total number of risk factors present was calculated. Multivariable logistic regression models determined which demographic factors were associated with having greater than the mean number of risk factors. Exploratory factor analysis determined how risk factors clustered, and Spearman's r determined how demographic characteristics related to risk factors within each cluster.

Setting: Canada.

Participants: Participants were recruited via advertisements on public health websites, social media, parenting webpages and referrals from ongoing studies or existing research datasets. Women were eligible to participate if they could read and understand English, were able to access a telephone or the internet, and were either planning a first pregnancy (preconception) or had ≥1 child in the past 5 years and were thus in the interconception period.

Results: Most women (n=1080) were 34 or older, and were in the interconception period (98%). Most reported risks in only one of the 12 possible risk factor categories (55%), but women reported on average 4 risks each. Common risks were a history of caesarean section (33.1%), miscarriage (27.2%) and high birth weight (13.5%). Just over 40% had fair or poor eating habits, and nearly half were not getting enough physical activity. Three-quarters had a body mass index indicating overweight or obesity. Those without a postsecondary degree (OR 2.35; 95% CI 1.74 to 3.17) and single women (OR 2.22, 95% CI 1.25 to 3.96) had over twice the odds of having more risk factors. Those with two children or more had 60% lower odds of having more risk factors (OR 0.68, 95% CI 0.52 to 0.86). Low education and being born outside Canada were correlated with the greatest number of risk clusters.

Conclusions: Many of the common risk factors were behavioural and thus preventable. Understanding which groups of women are prone to certain risk behaviours provides opportunities for researchers and policy-makers to target interventions more efficiently and effectively.

Objective: To identify complex multimorbid conditions, including chronic conditions, functional limitations and geriatric syndromes, associated with the presence and severity of periodontal disease (PD), after accounting for a series of demographic and behavioural characteristics.

Design: This cross-sectional study used secondary data from a nationally representative sample, classification and regression tree analysis and random forest identified combinations of specific conditions constituting complex multimorbidity associated with the presence and severity of PD.

Setting: US National Health and Nutritional Examination Survey (2013-2014).

Participants: Individuals 60 years of age or older who completed a periodontal examination.

Results: Among 937 participants aged 60 and over, the prevalence of PD was 72.6%. PD was associated with sociodemographic factors and limitations in instrumental activities of daily living. Male sex and non-white race were the two most critical predictors of stage III/IV PD. Other important factors included age, education level and the federal poverty level.

Conclusions: Rather than chronic conditions or geriatric syndromes, PD was associated with sociodemographic factors and functional limitations. Accounting for the co-occurrence of sociodemographic and functional limitations will help recognise older adults who are at an increased vulnerability to the severity of PD.

Objective: Because of their increased interaction with patients, healthcare workers (HCWs) face greater vulnerability to COVID-19 exposure than the general population. We examined prevalence and correlates of ever COVID-19 diagnosis and vaccine uncertainty among HCWs.

Design: Cross-sectional data from the Household Pulse Survey (HPS) conducted during July to October 2021.

Setting: HPS is designed to yield representative estimates of the US population aged ≥18 years nationally, by state and across selected metropolitan areas.

Participants: Our primary analytical sample was adult HCWs in the New York Metropolitan area (n=555), with HCWs defined as individuals who reported working in a 'Hospital'; 'Nursing and residential healthcare facility'; 'Pharmacy' or 'Ambulatory healthcare setting'. In the entire national sample, n=25 909 HCWs completed the survey. Descriptive analyses were performed with HCW data from the New York Metropolitan area, the original epicentre of the pandemic. Multivariable logistic regression analyses were performed on pooled national HCW data to explore how HCW COVID-19-related experiences, perceptions and behaviours varied as a function of broader geographic, clinical and sociodemographic characteristics.

Results: Of HCWs surveyed in the New York Metropolitan area, 92.3% reported being fully vaccinated, and 20.9% had ever been diagnosed of COVID-19. Of the subset of HCWs in the New York Metropolitan area not yet fully vaccinated, 41.8% were vaccine unsure, 4.5% planned to get vaccinated for the first time soon, 1.6% had got their first dose but were not planning to receive the remaining dose, while 52.1% had got their first dose and planned to receive the remaining dose. Within pooled multivariable analysis of the national HCW sample, personnel in nursing/residential facilities were less likely to be fully vaccinated (adjusted OR, AOR 0.79, 95% CI 0.63 to 0.98) and more likely to report ever COVID-19 diagnosis (AOR 1.35, 95% CI 1.13 to 1.62), than those working in hospitals. Of HCWs not yet vaccinated nationally, vaccine-unsure individuals were more likely to be White and work in pharmacies, whereas vaccine-accepting individuals were more likely to be employed by non-profit organisations and work in ambulatory care facilities. Virtually no HCW was outrightly vaccine-averse, only unsure.

Conclusions: Differences in vaccination coverage existed by individual HCW characteristics and healthcare operational settings. Targeted efforts are needed to increase vaccination coverage.

As a social determinant of health, poverty has been medicalised in such a way that interventions to address it have fallen on the shoulders of healthcare systems and healthcare professionals to reduce health inequities as opposed to creating and investing in a strong social safety net. In our current fee-for-service model of healthcare delivery, the cost of delivering secondary or even tertiary interventions to mitigate the poor health effects of poverty in the clinic is much more costly than preventive measures taken by communities. In addition, this leads to increasing burnout among the healthcare workforce, which may ultimately result in a healthcare worker shortage. To mitigate, physicians and other healthcare workers with power and privilege in communities systematically disenfranchised may take action by being outspoken on the development and implementation of policies known to result in health inequities. Developing strong advocacy skills is essential to being an effective patient advocate in and outside of the exam room.