Journal of Primary Care and Community Health最新文献

Background: Adult immunisation is a critical yet underutilised public health strategy in India, despite the growing burden of vaccine-preventable diseases (VPDs) among adults. However, previous studies have explored awareness, knowledge, and acceptance of selected adult vaccines, a comprehensive understanding of utilisation patterns and vaccine-seeking behaviour remains limited.

Methodology: A prospective observational study was conducted from April 2023 to February 2024 (10 months) at the Adult Immunisation and Travel Medicine Centre of a tertiary hospital. Adults aged ≥16 years who received at least 1 recommended vaccine were included, focusing on those outside the age group covered by the national immunisation programme. Data on demographics, immunisation status, comorbidities, and adverse events following immunisation (AEFIs) were collected. Statistical associations were analysed using the chi-square test (P < .05) and logistical regression.

Results: A total of 1021 vaccine doses were utilised by 819 individuals. The most commonly utilised vaccines were Hepatitis B (62.03%), Influenza (10.99%), and Pneumococcal Conjugate Vaccine (PCV; 6.72%). The majority of recipients were female (58.97%), young adults (70.7%), healthcare workers (HCWs; 70.69%), and individuals from higher socio-economic classes (61.91%). Vaccine utilisation was 2.4 times higher among HCWs than non-HCWs. Partial immunisation was more common among young males (P < .0001) from non-HCWs (47.92%, 0.03) populations and those from lower-middle (67.93%, P < .0001) socio-economic classes. Only 1 serious Adverse Event (AE) was reported, later found to be unrelated with vaccination. Chi-square analysis revealed statistically significant associations between vaccine utilisation and variables such as gender, age, population type, socio-economic status, and comorbidities (P < .05).

Conclusion: Similar to global and national trends, adult vaccine coverage remained sub-optimal. However, among the limited users, only the economically advantaged sections of the community were able to afford and access immunisation, while vaccine-seeking behaviour was largely absent across wider segments of society.

Introduction and objectives: Pesticide exposure during pregnancy is associated with adverse outcomes, and farmworkers face disproportionate risk. In California, healthcare providers can help mitigate exposure through work accommodation notes and State Disability Insurance (SDI) certification. However, little is known about provider knowledge and practices in this area. This study explores how healthcare providers support pregnant farmworking patients in reducing occupational pesticide exposure and identifies key barriers, facilitators, and recommendations for healthcare systems.

Methods: We conducted 3 virtual focus groups and 6 interviews (July 2024-March 2025) with California healthcare providers and state agency staff. Discussions explored knowledge, attitudes, and practices around screening, counseling, and SDI certification for pregnant farmworkers. Transcripts were thematically analyzed using grounded theory with inductive and deductive coding.

Results: Key barriers included limited prenatal care access, inadequate provider training, limited culturally and linguistically appropriate resources, inconsistent screening and counseling practices, and uncertainty around SDI eligibility and certification. These contributed to variable practices: some providers facilitated early disability leave and others hesitated due to unclear guidance or perceived administrative burden. Facilitators included early prenatal care, staff support, knowledgeable providers, and exposure screening workflows.

Conclusions: Standardized guidelines, improved provider education, and coordinated policy and clinic-level changes are urgently needed to ensure equitable care for pregnant farmworkers.

Objectives: Optimal hypertension (HTN) control is critical for reducing cardiovascular risk. National quality measures and clinical guidelines for HTN define the most recent BP reading of ≥140/90 mmHg during the performance year as uncontrolled. In the current study, we aim to improve and standardize HTN management and control through process improvement cycles in an Academic outpatient primary care setting.

Methods: Using our outpatient database, we first identified a sample of Medicare beneficiaries with HTN determined to be uncontrolled during performance years 2023 and 2024, and performing root-case analyses to find any contributing factors, and develop a strategy for improving HTN control and quality metrics.

Results: A lack of repeat BP measurement and inadequate follow-up were found to be the major factors contributing to uncontrolled BP. Home Blood Pressure Monitoring (HBPM) with timely follow-up was tested as a potential opportunity for improving HTN quality metrics in these patients. Device validation showed that 40 of 42 home BP monitors provided accurate readings. Subsequently, 38 BP uncontrolled patients were engaged through home or office BP assessments. After 2 weeks, 25 of 38 (66%) patients achieved Medicare-defined BP controlled, including 10 through HBPM alone, 8 with follow up during an office visit. Thirteen patients were still BP uncontrolled with a relative risk (RR) of 0.34 (95% CI: 0.22-0.52, P < .001).

Conclusion: These results support HBPM together with close follow-up as an effective approach to reduce the risk of uncontrolled hypertension and associated noncompliance in value-based care reporting.

Introduction/objectives: Social determinants of health (SDOH) have the potential to differentially impact child developmental outcomes. This study examined whether scores on the Environmental Screening Questionnaire (ESQ), a newly developed SDOH screening tool, were associated with scores on the Brigance and Ages & Stages Questionnaires-Social-Emotional (ASQ:SE-2) child development assessments.

Methods: Brigance, ASQ:SE-2, and ESQ scores from children enrolled in a Head Start Program in Northeast Iowa were collected during the 2021 to 2022 and 2022 to 2023 school years. Associations between scores in each ESQ domain and Brigance and ASQ:SE-2 scores were assessed.

Results: Education-Employment and Community concerns on the ESQ were associated with reduced Brigance scores (r = -.21, P < .001; r = -.17, P = .001). Concerns related to Housing, Child and Family Health, and Community were associated with more concerning ASQ:SE-2 scores (r = .14, P = .005; r = .18, P < .001; r = 0.27, P < .001). In multivariable models controlling for sex and ethnicity, Education-Employment concerns were significant predictors of lower Brigance scores, while Child and Family Health and Community concerns were significant predictors of ASQ:SE-2 scores.

Conclusions: ESQ scores in certain SDOH domains correlate significantly with child developmental outcomes. The ESQ domains of Child and Family Health and Community appear to be particularly important for appropriate child socio-emotional development. Interventions should focus on addressing critical SDOH domains to promote child resilience and counteract the non-medical factors that can interfere with child developmental outcomes.

Background: Timely developmental assessment is essential for children with neurodevelopmental concerns, particularly before starting school. In public health systems, long wait times for multidisciplinary assessments disproportionately affect vulnerable populations, especially those from culturally and linguistically diverse (CALD) backgrounds. To address this, the South Western Sydney (SWS) Local Health District introduced 'School Starter Blitz' clinics-targeted initiatives prioritising school-entry-age children for diagnostic assessment.

Methods: This retrospective cohort study analysed data from October 2022 to September 2024 for children aged 1 to 16 years referred to the Child Development Assessment Service (CDAS) with the objective of assessing impact of Blitz intervention on waiting times. Blitz clinics were held during 4 targeted months. Structured phone screening prioritised children nearing school age, particularly those without previous diagnoses. Demographic, clinical, and service-use data were analysed using descriptive and inferential statistics.

Results: Of 1957 eligible children, 23.5% were assessed during Blitz months. These children were more likely to be younger (≤5.5 years), first-time patients, without prior diagnoses and classified as high priority at the time of referral triage (39% vs 22%, P < .001). Waiting times were significantly shorter reduced by 89 days on average (223 vs 312 days, P < .001) during blitz months. Regression analysis identified CALD background and children with diagnosis other than autism as additional factors associated with shorter wait times. Despite the Blitz months having generally shorter waiting times for various clinical factors, overall, there was no significant difference according to socioeconomic place of residence.

Conclusion: The 'School Starter Blitz' effectively prioritised younger, first-time children from CALD backgrounds for developmental assessment. It represents a feasible and scalable service redesign that improves access and reduces delays in assessment. However, successful implementation requires investment in administrative support and staff satisfaction. The findings also underscore the persistent influence of the Inverse Care Law in public health access. Broader adoption of this model has the potential to enhance both equity and efficiency across public health systems.

Background: Diabetes remains a major public health concern in the United States, particularly in Tennessee, where prevalence rates exceed national averages. Traditional statistical approaches may not fully capture the non-linear interactions among predictors. This study applied both traditional approaches and machine learning (ML) techniques to predict and identify key contributing factors associated with self-reported diabetes using the 2023 Behavioral Risk Factor Surveillance System (BRFSS) dataset.

Methods: A cross-sectional analysis was conducted on 5634 (weighted population 5 614 486) adults from the Tennessee BRFSS dataset. Sociodemographic, behavioral, and health-related variables were analyzed. Data processing, exploratory analysis, and modeling were performed in Python using Pandas, NumPy, Scikit-learn, and SHAP. Seven algorithms were tested: Logistic Regression, Support Vector Machine, K-Nearest Neighbors, Decision Tree, Random Forest, Gradient Boosting, and XGBoost, with stratified 5-fold cross-validation. Models were evaluated using accuracy, precision, recall, balanced accuracy, F1-score, AUROC, and PR-AUC.

Results: The Gradient Boosting model demonstrated the best overall performance, achieving an accuracy of 82%, precision of 48%, recall of 32%, F1-score of 37%, AUROC of 0.80, and PR-AUC of 0.45. Key predictors included high blood pressure, high cholesterol, body mass index, comorbidity burden, and physical inactivity. SHAP analysis revealed that both clinical factors and social determinants substantially influenced diabetes risk.

Conclusion: This study highlights the strong potential of machine learning, particularly Gradient Boosting, in predicting self-reported diabetes. Integrating SHAP analysis enhanced interpretability by revealing how the above factors interact to influence diabetes risk, underscoring the value of explainable AI for precision public health and targeted prevention strategies.

Introduction: Language development during the first 2 years is crucial for cognitive and social growth. The purpose of this study was to assess receptive language (RL) and expressive language (EL) development and associated factors in 18-month-old Thai children.

Methods: This cross-sectional study was conducted from September 2024 to February 2025. Multistage sampling was applied to recruit 1150 participants who were parents or primary caregivers of 18-month-old children. Data were collected using structured questionnaires and the Developmental Surveillance and Promotion Manual, a standardized national tool. Binary logistic regression was used to analyze associations between child, parental, and healthcare access factors and language development.

Results: Overall, 88.7% and 85.6% of children had age-appropriate RL and EL development, respectively. After adjusting for covariates, high parental knowledge and high parental behaviors in language development were significantly associated with both age-appropriate RL development (AOR = 2.122, 95% CI = 1.338-3.364 and AOR = 2.251, 95% CI = 1.396-3.628, respectively) and age-appropriate EL development (AOR = 2.452, 95% CI = 1.618-3.718 and AOR = 1.892, 95% CI = 1.210-2.960, respectively). Access to anemia screening services at 6 to 12 months was also significantly associated with both age-appropriate RL development (AOR = 1.700; 95% CI = 1.104-2.617) and age-appropriate EL development (AOR = 2.026; 95% CI = 1.384-2.967).

Conclusion: Parental and healthcare access factors were significant determinants of language development. Improving parental competencies and integrating language development surveillance and preventive healthcare at primary care settings could be valuable strategies for promoting language development in early childhood.

In response to persistently low enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) across Tennessee, the WIC Champions group conducted a statewide survey to evaluate healthcare providers' practices and barriers in screening for food insecurity and referring patients to WIC. The survey, conducted from November 2023 to February 2024, included 70 diverse healthcare professionals across 28 Tennessee counties. Findings revealed that 88% of providers screen for food insecurity and 95% believe it is vital to patient health. However, only 67% felt familiar with local resources for referrals, and significant barriers including limited staff, time, and resource availability were reported. Despite 90% of respondents being familiar with WIC, only 39% made direct referrals, with many relying on less structured methods such as verbal encouragement or providing contact information. Surveyed providers identified the need for improved outreach materials, better integration with electronic health records, and dedicated referral staff. The findings highlight the critical role of healthcare settings in addressing food insecurity but underscore systemic barriers that impede effective WIC referrals. Enhanced support, training, and infrastructure are necessary to empower providers and expand WIC access, aligning with key national strategies to combat hunger and improve public health outcomes.

Objectives: Primary care clinicians are mostly the initial point of contact in providing patient care; however, many clinicians report inadequate training and a lack of confidence in promoting brain health among their patients from a nutrition perspective. This participatory mixed-methods study evaluated the impact of a Project ECHO® pilot program on clinicians' perceived self-efficacy in promoting brain health through nutrition among Latino older adults in South Texas.

Methods: Employing an explanatory sequential design, a training curriculum was designed for primary care clinicians using the Project ECHO® model. Four virtual sessions were provided once a week on nutrition-related topics through the videoconferencing platform Zoom. Quantitative data were collected via pre- and post-program surveys (N = 13) and analyzed using the Wilcoxon signed-rank test in GraphPad Prism Version 10.6.0 to inform subsequent qualitative interviews. Thematic analysis was conducted to examine the transcripts from individual interviews with 4 of the 13 participating clinicians using Taguette (Version 1.3, Open-Source Software).

Results: Data indicated a statistically significant increase in mean self-efficacy scores among clinicians following program participation (P < .005). Participant satisfaction with the program exceeded 90%, and clinicians intended to integrate nutrition into brain health counseling with patients. Thematic analysis of individual interviews identified 3 key themes, including perceived training outcomes, evaluation of the study design, and suggested areas for program improvement.

Conclusions: Findings suggest that the Project ECHO^® Nutrition and Brain Health program is a feasible intervention for improving clinician self-efficacy in delivering nutrition-based brain health care to Latino older adult populations. Future research should examine whether enhanced self-efficacy translates into practice change and improved patient outcomes.