Journal of Primary Care and Community Health最新文献

Objective: The COVID-19 vaccine is vital for protecting pregnant women and their babies, yet many foreign-born women face unique challenges in vaccine uptake. This study explores COVID-19-related fears and vaccine acceptance among from the Northern Triangle countries-El Salvador, Guatemala, and Honduras in the United States (U.S.).

Methods: This cross-sectional study aimed to identify factors influencing COVID-19 vaccination among foreign-born pregnant women from Central America, specifically El Salvador, Guatemala, and Honduras, living in the U.S.

Results: The study included 93 women (mean gestation: 23.3 weeks), most of whom had lived in the U.S. for at least 10 years and had low acculturation. Over two-thirds (66.7%) were fully vaccinated. Key factors driving vaccine acceptance included healthcare access, community health initiatives, and trusted provider recommendations. Cultural values emphasizing family protection and a heightened sense of vulnerability to COVID-19 also contributed to higher vaccination rates. However, 33.3% expressed hesitancy, particularly due to distrust in government, fear of needles, and concerns about the vaccine's rapid development, with Guatemalan participants showing the highest hesitancy.

Conclusions: Findings underscore the critical role of healthcare providers in vaccination decisions, and tailored communication strategies addressing cultural and emotional factors are essential to improving vaccine uptake, particularly in immigrant communities.

Introduction: Despite strong evidence supporting the benefits of water fluoridation in preventing dental caries, limited research exists on U.S. adults' knowledge, attitudes, and behaviors regarding fluoride and tap water intake. This study examined the knowledge, attitudes, and behaviors regarding fluoride and tap water intake of Green Hill, Alabama adults.

Methods: A convenience sample of 291 adults was surveyed concerning their knowledge, attitudes, and behaviors about fluoride in water and toothpaste, and water consumption preferences.

Results: There was a high level of knowledge about fluoride's role in cavity prevention, with 92.4% correctly identifying its benefits. However, 18.3% were unaware that fluoride does not help maintain healthy gums. Regarding attitudes, 14.5% strongly agreed and 28.3% agreed that fluoride in drinking water was beneficial, while 29.1% strongly supported and 53.5% supported its inclusion in toothpaste. A preference for bottled water over tap water was noted by 84.4% of participants, with 36.9% citing distrust of tap water quality as a primary reason. Bivariate analysis found a positive perception of fluoride in tap water correlated with better knowledge, while education level and fluoride awareness influenced attitudes.

Conclusion: Additional research is necessary to explore reasons underlying adults' water consumption habits and fluoride perceptions.

Introduction: Remote blood pressure monitoring (RBPM) programs are increasingly utilized to improve hypertension care. Rigorous analysis of program outcomes including clinical effectiveness and participant experience can inform future initiatives.

Methods: During year 1 of the COVID-19 pandemic, we implemented a RBPM program for patients who: (1) received primary care in a single academic medical network, (2) were part of an accountable care financial arrangement, and (3) had uncontrolled hypertension. Evaluation combined a 6-month prospective cohort observational study (assessing the program's association with hypertension control and remote blood pressure [RBP] reporting) with surveys (assessing patient and care team experience.)Results:A total of 150 patients (mean age 57 years, 65% male) enrolled across 10 clinics, of whom 121/150 contributed remote blood pressure data. Among the patients who contributed data, we observed an adjusted reduction in systolic blood pressure by 1.08 mm Hg/month (95% CI = -1.24 to -0.91) and diastolic blood pressure by 0.88 mm Hg/month (95% CI = -0.99 to -0.77) associated with our intervention. The number of patients contributing to RBPM data declined from 121 to 22 from inception to the end of the 6-month study. Among the 61 patient survey respondents (40% response rate), 80% reported high program satisfaction and likelihood to recommend. Survey respondents noted improvements in weight loss (14%), medication compliance (16%), diet (29%), and exercise (35%). Qualitative survey analysis identified themes of patient convenience and increased self-efficacy in blood pressure (BP) management. Quantitative and qualitative patient and care team survey analysis showed technology linkage challenges.

Conclusion: Overall, our primary care RPBM program was associated with improved blood pressure control among participants and favorable patient and care team experience but experienced challenges of significant decline in blood pressure reporting over time. For future institutional RBPM implementations, we aim to retain the high quality of blood pressure management guidance that participants received while increasing technology connectivity and longitudinal reporting support.

Background: In the state of Maharashtra in India, a pilgrimage called "Pandharpur Wari" attracts half a million pilgrims annually. Orthodox Hindu culture is generally resistant to allowing women to participate in religious functions during their menstruation. With a significant female presence, ensuring adequate Water Sanitation and Hygiene (WASH) facilities and Menstrual Health and Hygiene (MHH) is crucial. Due to scant reliable quantitative data, a qualitative study was conducted to investigate first-hand accounts of experiences of WASH facilities and MHH practices of women pilgrims during 2023 pilgrimage.

Methods: This study employed a qualitative design with convenience sampling, selecting 100 women pilgrims (aged 18-45 years) from the pilgrimage across 3 sites. Data were collected through semi-structured interviews. Descriptive and thematic analyses were conducted to examine experiences, challenges, and suggestions.

Results: Over half (53%) were aged 32 to 41 years while (18%) were between 22 and 31 years. Most had studied up to secondary level (77%) and were married (95%). Thirty-four percent were farmers and a few had some other day job (7%). A large majority (97%) faced difficulties accessing toilets and bathing facilities, with some resorting to open defecation (36%). About (2%) used oral contraceptive to delay periods and (7%) experienced menstruation during pilgrimage. Lack of facilities for bathing and toilets along the pilgrimage route was one prominent challenge. Other challenges were, needing to bathe in the open, lack of gender-segregated facilities, and scanty sanitary facilities along the route. Women were found to be resilient in managing menstruation amidst systemic gaps. It was also found that cultural beliefs shaped pilgrimage participation while in menses and how it was hard to manage menstruation during pilgrimage without adequate infrastructure.

Conclusion: The pilgrimage poses logistical, sanitation challenges for the pilgrims. Strategic planning, including mobile toilets, private bathing, menstrual hygiene support can improve the experience.

In this Commentary, we provide an in-depth look at the National Academies of Sciences, Engineering, and Medicine (NASEM) report, "Making Eye Health a Population Health Imperative Vision for Tomorrow (2016)," which emphasizes the need for the integration of vision and eye care into more holistic healthcare delivery approaches, since many individuals who are visually impaired have disproportionately high rates of chronic co-morbidities. We have highlighted current barriers as well as a coordinated approach and methodology to improve team-based care in the United States to reduce eye and vision health disparities, particularly through the delivery model of community health centers; however, the model might be applied in other countries.

Acquired angioedema due to C1-inhibitor deficiency (AAE-C1INH) is a rare condition characterized by the localized swelling of the deeper skin layers and mucous membranes, especially the face, lips, tongue, throat, and gastrointestinal tract. AAE-C1INH is strongly associated with lymphoproliferative disorders, although it can also be linked to autoimmune conditions, solid tumors, infections, or even occur without an identifiable cause. We present the case of a 45-year-old female patient with complaints of recurrent abdominal pain, bloating, and joint swelling. Laboratory testing showed decreased C1q and C4 complement levels, and C1 esterase inhibitor levels, indicative of AAE-C1INH. Further work up confirmed a diagnosis of extranodal marginal zone lymphoma with involvement of the bone marrow and spleen. Treatment with rituximab led to resolution of angioedema symptoms and almost complete remission of underlying lymphoma. This case underscores the importance of evaluating an underlying lymphoproliferative disorder in AAE-C1INH. Therefore, the early participation of a multidisciplinary team including specialists in immunology, hematology, and oncology is necessary for appropriate management.

Objective: Evaluate healthcare providers' and staffs' knowledge, self-reported abilities, activities, and barriers to providing preventive oral health services (POHS) at primary care medical visits before and after participation in the Rocky Mountain Network of Oral Health (RoMoNOH) project.

Methods: The RoMoNOH project integrated POHS into primary care medical visits of young children at 22 community health centers (CHCs) in Arizona, Colorado, Montana, and Wyoming by medical team members and/or by embedded dental hygienists (DHs). Twelve CHCs embedded DHs onto their teams. In an observational pre/post evaluation, a convenience sample of healthcare providers' characteristics were surveyed at baseline and 3 years across 4 oral health domains: knowledge, self-reported abilities, behaviors, and barriers. Each domain was scored from 0% to 100%, with 100% being optimal. Differences between pre- and post-project domain scores were assessed using chi-square, t-tests, and linear and logistic regression adjusting for providers' age.

Results: Embedding DHs into CHCs and staff turnover impacted pre/post survey participants. The final analytic cohort included 213 (pre-survey response rate: 71%) and 165 (post-survey response rate: 52%) healthcare providers who worked with children < age 3. Participants were female (pre: 81%, post: 81%) and aged >35 years (pre: 39%, post: 41%). Unadjusted mean differences across surveys improved across all oral health domains (pre/post): knowledge: 65%/81%, P < .001; self-reported ability: 52%/71%, P < .001; activities: 32%/57%, P < .001; barriers: 27%/21%, P = .011. After adjustment for age, these improvements remained significant (all P ≤ .011).

Conclusions: Healthcare providers' oral health practices improved over a multi-year oral health integration project aimed at increasing delivery of POHS at medical visits.

Objective: The objective of our retrospective study was to evaluate differences between screening methods (oral administration versus written self-report) for adolescent depression in an outpatient settingStudy Design:We analyzed data from 4075 well-child check (WCC) visits from adolescents (ages 12-18 years) at an academic medical center from January 2022 through December 2023. We evaluated the outcomes of depression screening questions from both those asked by staff (oral administration) and those filled out on paper by the patient (written self-report). A composite score of 3 or greater (out of 6) indicates a positive screen for depression. Logistic regression was used to assess for the likelihood of discrepancy between scores.

Results: Of the 4518 WCC visits analyzed, 3380 (75%) had completed data for both the orally administered and the written screenings. The scores were equal in 2563 (76%) visits; the written score was greater in 766 (22.6%) visits and the oral score was greater in 51 (1.5%) visits. The screen was positive for depression in 232 (6.8%) visits for the written self-report compared with 66 (2.0%) from the oral administration. Logistic regression analyses showed likelihood of score differences were higher in older age, female gender, Hispanic race/ethnicity, and those with public insurance.

Conclusion: This preliminary pilot study shows that there are score differences in depression screening when administered orally by staff versus self-reported in writing, and scores may be higher on the written self-report screening. Limitations of this study include slight differences in the wording of the questions and lack of rigorous protocol guidelines.

Introduction/objective: We qualitatively assessed current practices and perceived barriers surrounding the integration of tobacco dependence treatment (TDT) into lung cancer screening (LCS).

Methods: Informed by the Practical, Robust Implementation and Sustainability Model, we conducted semi-structured interviews with clinicians (n = 18) at 6 Veterans Affairs medical centers in the Midwest.

Results: TDT was usually addressed at an initial shared decision-making visit but often not with subsequent rounds of screening or nodule follow-up. No site was aware that any TDT-related outcomes were tracked within their program. While the LCS clinical reminders included some aspects of tobacco use (eg, tobacco pack-years), they did not support clinicians in offering TDT or capture outcomes and were perceived as "checkboxes to nowhere." This was contrasted with other clinical reminders linked to dashboards that provide rolling feedback for important clinical outcomes (eg, diabetes care). Interviewees reported competing demands and limited expertise in motivational interventions as additional barriers. A dedicated team for TDT and a "one-click referral" were perceived as key success factors.

Conclusions: TDT remains poorly integrated into LCS. Addressing identified barriers will require considerable investment in TDT resources and improvements to LCS tools to support the provision of cessation support.

Introduction: The COVID-19 pandemic accelerated telehealth adoption, but disparities in its utilization persist. This study examines primary care patient sociodemographic characteristics, telehealth utilization patterns, and provider adoptions before and during the pandemic.

Methods: A retrospective cohort study analyzed data from Mississippi Medicare beneficiaries continuously enrolled in Parts A, B, and D who accessed primary care services from 2019 to 2021.

Results: Among 201 677 Medicare beneficiaries accessing primary care, 1364 used telehealth before the pandemic, compared to 73 994 during the pandemic. Telehealth utilization shifted during the pandemic to younger, female, White beneficiaries, and those enrolled in Medicare due to disability or End Stage Renal Disease. During the pandemic, telehealth users exhibited higher Charlson Comorbidity Index and Social Vulnerability Index but lower Digital Divide Index scores compared to non-telehealth users. Telehealth was associated with more primary care visits, broader access, and higher continuity of care. Primary care physicians increased their share of telehealth services to 39%, while specialties such as neuropsychiatry and psychiatry showed the highest adoption rates, reaching 55% and 38%, respectively.

Conclusions: Telehealth demonstrated a growing role in primary care during the pandemic. Future efforts must address digital divides and advance health equity when integrating telehealth into primary care services.