Journal of Primary Care and Community Health最新文献

Introduction: Under the mandate of supporting European immunisation cooperation and strategies, the specific aim of this work was about focusing on vaccine communication in order to raise awareness, increase confidence and strengthen the practice for vaccination in Italy.

Methods: The four-step Plan-Do-Check-Act cycle applied through a bundle of actions: (Plan) studying national vaccination scenarios and factors underlying vaccine hesitancy by developing a reference grid; (Do) creating a web platform-based toolbox with vaccine communication tools; (Check) engaging within national stakeholders within dedicated roundtables also associated to media trainings; (Act) co-developing, or co-selecting, tools to pilot amongst identified target communities.

Results: In 2021, we analysed evidence on vaccine hesitancy determinants in scientific (86%) and grey (14%) literature by applying contextual, individual, and vaccine-specific categories. A total of 42 out of 204 vaccine communication tools collected and evaluated in early 2022 referred to Italy. In mid-2022, participatory dialogue and engagement with national stakeholders, media included, addressed vaccine communication improvements in different target populations. In late 2022, co-creation/selection of vaccine communication tools and their piloting focused on specific vaccinations and communities, such as the school setting for Italy.

Conclusions: To address better vaccine communication outcomes, efforts on multistakeholder collaboration, training and advocacy are needed.

With the rise of people being affected with chronic illness, now the leading cause of mortality worldwide, primary care is overwhelmed with the demand for healthcare services. Primary healthcare is the first resource for patients living with chronic illness, but in 2019, COVID-19 brought healthcare professionals to increase services through virtual care for patients living with chronic illness. In the workplace, such professionals often need to be sufficiently resourced to collaborate, to address collaborative care barriers in telehealth and to keep patients engaged in their health. We performed a scoping review to identify how patients living with chronic diseases actively engage and describe their involvement in the process of interprofessional collaboration within the context of telehealth in primary care settings. We followed Arksey and O'Malley's and the Joanna Briggs Institute's methodological guidelines to conduct this scoping review. The analysis of the retained twelve studies showed little distinction between the experience of interprofessional collaboration from the patient's perspective in a telehealth context compared to a face-to-face context. However, we were able to identify gaps (eg, limited insight onto engagement dynamic, lack of patient-centric research, and insufficient research on patient engagement) relating to the experiences of patients, patient engagement, and professionals who have used telehealth. In an era of digital innovations, this lack of literature regarding the patient experience may jeopardize the quality of the interprofessional collaboration services offered to patients and patient engagement. This gap in patient engagement integrated into interprofessional collaboration in a telehealth context needs to be addressed.

Introduction: Nadezhda Clinic is a free student-run health clinic that provides culturally sensitive primary care services to the underserved Russian-speaking population of the greater Sacramento area. At the onset of the COVID-19 pandemic, the clinic suspended in-person services and solely offered telemedicine visits. Most patients were hesitant to utilize telemedicine due to poor technological literacy, privacy concerns, and a preference for in-person care.

Objective: This quality improvement project aimed to evaluate whether the implementation of culturally sensitive telemedicine services and outreach strategies would help address patient hesitancy and barriers to care.

Methods: Successful implementation of telemedicine was dependent on building trust with the community, providing multilingual technological assistance, and offering personalized support. Some measures that were reviewed in order to assess this included comparison of patient demographics, clinic attendance, and distance reached between in-person and telemedicine services.

Results: Telemedicine implementation was associated with increased clinic attendance rates with a no-show rate as low as 13% when compared to in-person services with a no-show rate of 20%. Telehealth services also enabled the clinic to reach patients in rural areas up to 120 miles away.

Conclusions: With the implementation of a culturally sensitive telemedicine protocol, Nadezhda Clinic achieved greater patient retention rates and reached patients at further distances, suggesting an overall reduction in hesitancy and barriers to care. Free clinics offering telemedicine are critical to further address healthcare disparities in marginalized communities.

Introduction: People in rural regions frequently lack resources for mental health support. Changing Our Mental and Emotional Trajectory (COMET) is a universal, community-based program designed to address mental and emotional health issues early and prevent crises. COMET Community Training is a short, interactive training that teaches people how to initiate a supportive and potentially emotional conversation using the simple, 7-item COMET Conversational Gravity Assist. This article describes and reports on the feasibility and acceptability of COMET and its Community Training.

Methods: COMET was developed using a participatory research approach by community members and health professionals living in a rural region and their research partners. COMET Community Trainings were conducted over a 22-month period. Surveys were administered to attendees before and after training to describe attendees' characteristics, view on content, and impact on intention to use COMET components. Field notes were completed by trainers to document the date and number of attendees.

Results: Over 700 people attended 60 Community Trainings. Questionnaires were completed by 644 trainees before and 580 after training. Of pre-survey respondents, 25% worked in education and 15% in farming/ranching. Post-survey respondents were 62% female, and 32% were between age 18 and 36. High levels of training satisfaction were reported. Average likelihood of using items in the COMET conversational guide increased significantly from pre to post training. On a scale of 1 to 10, nearly 80% of respondents rated their likelihood of using COMET in the next 3 months a 7 or higher.

Conclusions: COMET Community Training is a feasible program that effectively reaches a range of community members and improves the likelihood that they will initiate conversations when concerned about someone else's mental health. Results lay the groundwork for COMET as an intervention that promotes mental and emotional well-being to address inequality in mental health for people living in rural communities.

Background: Cryptocurrency trading seemingly mirrors the high-risk, high-reward nature of gambling, and may cause significant psychological challenges to traders. As cryptocurrency trading becomes mainstream, this scoping review aims to synthesize evidence from empirical studies to understand the emotional, cognitive, and social influences on cryptocurrency traders, and identify associated mental health traits/attributes influencing their behaviors.

Methods: This review adhered to PRISMA-ScR guidelines, pooling in 13 studies involving 11,177 participants across multiple countries. A detailed literature search was conducted up to August 4, 2024, and was rerun on October 9, 2024 using databases including PubMed/Medline, Web of Science, Embase, and Scopus. Keywords used included psychiatry, psychology, mental health, cryptocurrency, trading behavior, mental health, substance use, gambling, investment, and/or emotional impact. These terms were refined through iterative searches to retrieve the most relevant studies.

Results: The scoping review found several key psychological factors affecting cryptocurrency trading behaviors. Many traders exhibited addiction-like behaviors, compulsively trading even when it leads to financial losses. Social media was found to have a strong influence, encouraging herd behavior and impulsive decision-making to follow trends. High levels of psychological distress, including anxiety and depression, were found to be linked to the market's volatility and risks. Overconfidence bias was observed to make traders underestimate risks and overestimate their ability to predict the market. Cognitive biases like confirmation bias and the disposition effect caused traders to hold onto losing investments and sell winning ones too early.

Conclusion: Due to the shared psychological traits between cryptocurrency trading and gambling, it is imperative to implement targeted early interventions to mitigate the risk of its progression into a pathological condition. Tools like the Problematic Cryptocurrency Trading Scale may help identify and manage risky behaviors. Ongoing research is crucial to identify both positive and negative impact of cryptocurrency trading to develop effective support systems and regulatory policies to address traders' mental well-being.

Introduction: Homeless service workers play a key role in addressing the social and health needs of people experiencing homelessness, yet little is known about their own health status and behaviors.

Methods: A nationwide survey of Hungarian homeless service workers (n = 548) was conducted using a short version of the European Health Interview Survey. The results were compared with age- and sex-adjusted data from the general Hungarian population.

Results: Despite reporting good health, one-third of homeless service workers had long-standing health problems, with one-fourth experiencing activity limitations. Mild (29.1% vs 17.2%) and moderate (8.5% vs 4.7%) depressive symptoms were nearly twice as prevalent among service workers. They also reported lower daily consumption of fruits and vegetables (41.4% and 26.3% vs 57.0% and 45.4%) and a higher rate of daily smoking (35.4% vs 26.4%). Additionally, 59.3% were classified as overweight or obese. Participation in organized cancer screenings was higher among homeless service workers but stayed below 50% in both groups.

Conclusions: These findings can serve as a foundation for developing strategies to improve the health status of homeless service workers. Ultimately, this benefits both the workforce and the quality of services provided.

Introduction: Basal and intermediate insulin is available as U-100 (glargine, determir, NPH) or ultra-long-acting (ULA) U-200 (degludec) or U-300 (glargine). Insulins may be substituted with other insulin formulations based on financial factors, formulary preferences, patient preference, and patient response.

Objective: Evaluate the impact on total daily dose of insulin when switching from an intermediate or basal U-100 to a ULA insulin.

Methods: A single-center retrospective chart review was performed at a federally qualified health center. Patients switched from a U-100 intermediate or basal insulin to a U-200 degludec or U-300 glargine ULA insulin from 2019 to March 2024 were assessed. Clinical measures assessed were initial intermediate or basal insulin total daily dose, ULA insulin total daily dose at time of switch, at 1, 3, and 6 months, and change in HgbA1c, BMI, and weight.

Results: When switched from a U-100 to a U-200 or U-300 insulin (n = 53), basal insulin total daily dose decreased by 13.1 units at 6 months (P < .05). At the 6-month mark after ULA switch, HgbA1c decreased (P < .001), but BMI (P = .161) and weight (P = .076) were similar. HgbA1c, BMI, weight, and total daily insulin dose were not significantly different between patients assigned U-200 and U-300 insulins.

Conclusion: Patients switched from a U-100 basal insulin may utilize a lower total daily dose of a ULA insulin and experience reductions in HgbA1c, BMI, and weight.

Introduction: The main objective of this study was to assess whether socioeconomic factors were associated with the use of telehealth in primary care services in Portugal during the COVID-19.

Methods: A questionnaire was administered to patients in primary healthcare units during the pandemic. The set of variables used in this study was part of a larger patient satisfaction questionnaire. A descriptive statistical analysis was performed, and a multiple logistic regression analysis was estimated to assess factors associated with using remote consultation.ResultsThe use of a remote consultation was reported by 38.2% of respondents (N = 7008), and the main reason for telehealth use was prescription renewal. Among non-users of telehealth, 40% did not know they could contact their family doctor by email. Factors positively associated with telehealth use were: older age, women, married, filled questionnaire without help, consumption of OTC and prescribed drugs, unmet healthcare needs, and registered with family doctor. The evidence suggests a negative association between education and telehealth use.

Conclusions: No clear pattern emerged regarding the digital divide. The evidence shows a relevant lack of awareness regarding the possibility of using telehealth. If more complex forms of telehealth are adopted in primary care services, the digital divide might come to the surface.

Objectives: To determine the influence of cultural, including land-based, factors on the reported number of diagnosed chronic illnesses among Indigenous individuals living in Canada and the United States during SARS-CoV-2 (COVID-19).

Methods: 557 Indigenous individuals completed the Hearing Indigenous Voices survey (HIS) in 2021. Data from HIS respondents living with at least one chronic illness was used to conduct a Poisson regression. This equation estimated the effect of change in ancestral land use, participation in cultural activities, and demographic characteristics on the number of diagnosed chronic illnesses reported by Indigenous individuals.

Results: Results demonstrate that the number of chronic illnesses reported by Indigenous individuals during COVID-19 was positively correlated with 2 cultural factors. The first is spending a different amount of time on ancestral territories compared to before the pandemic (P < .01). Participating in beading, traditional arts and crafts, or Indigenous storytelling (P < .001) is the second. However, this relationship was moderated by age (P < .01) and socio-economic status (P < .001), with positive and negative associations respectively found for each demographic factor.

Discussion: Cultural practices, including accessing ancestral territories, often positively contribute to Indigenous Peoples' health. The increased number of diagnosed chronic illnesses among respondents who participate in cultural activities suggests that those living with chronic illness may not gain the same benefits from culture during pandemics because of the multitude of barriers they face during emergencies.

Introduction/objectives: Stable housing is a well-recognized health-related social need (HRSN) with little attention in medical training. This study examined the efficacy of a resident housing curriculum on referrals to a Community Health Worker (CHW) intervention to assist patients with unmet housing needs.

Methods: This was a retrospective cohort study conducted on Internal Medicine residents at a large urban residency program in Bronx, NY. We utilized multivariate mixed-effects logistic regression to determine whether clinician curriculum exposure increased CHW referrals among patients who self-reported housing needs in a HRSN screening tool between July 2021 and August 2024.

Results: Nine hundred six unique patients screened positive for unmet housing needs, and 303 (33.4%) patients were referred to CHWs by eligible clinicians (n = 118). Clinician exposure to the curriculum was not a significant predictor of CHW referrals (aOR = 1.03, 95% CI = 0.69-1.54), adjusting for covariates. Patient age (aOR = 0.98, 95% CI = 0.97-0.99), Spanish language (aOR = 1.65, 95% CI = 1.09-2.51), and Medicaid coverage (aOR = 1.61, 95% CI = 1.03-2.51) were associated with likelihood of referral.

Conclusions: Our findings demonstrate that the curriculum did not increase CHW referrals. Multimodal educational and systemic interventions that support the use of existing workflows may be needed to increase uptake of interventions to address HRSNs.