Journal of Primary Care and Community Health最新文献

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.

Cervical cancer mortality among Hispanic immigrant women remains disproportionately high in Tarrant County, Texas, despite national improvements. In this region, restrictive healthcare eligibility criteria and fragmented safety net systems limit access to preventive and life-saving care. A reactionary political environment further compounds these barriers. Drawing on the findings of a multi-year mixed-methods study and a subsequent academic-community partnership in Tarrant County, this article examines how governance decisions, fiscal priorities, and institutional policies shape immigrant health access. Using a political economy of health framework, we show how these structural conditions produce and sustain cervical cancer disparities. Qualitative research is essential for documenting how political and structural forces shape health outcomes. However, scholars working in restrictive policy environments within reactionary governance contexts face distinct methodological and ethical pressures. These include scrutiny of research framing, limitations on community collaboration, and risks associated with publicly naming policy-level drivers of inequity. Based on insights from conducting research in a politically contested setting, we identify strategies for maintaining rigor while minimizing harm to both research participants and community partners. These strategies include ethical community-engaged research practices, capacity-building efforts that strengthen local health infrastructures, and strategic framing techniques that communicate findings accurately without increasing political resistance. By pairing empirical analysis with pragmatic guidance for research in reactionary governance contexts, this article demonstrates how qualitative scholarship can contribute to public understanding, institutional reflection, and incremental system change even when direct policy reform is constrained. We ground these insights in cervical cancer survivorship among Hispanic immigrant women in Tarrant County to keep methodological guidance anchored in disease-specific realities.

Background: The increasing prevalence of opioid use coupled with the emergence of the Coronavirus Disease-19 (COVID-19) pandemic impacted opioid overdoses and death rates. People with opioid use disorder (OUD) are particularly vulnerable to the pandemic's consequences. Although Medications for Opioid Use Disorder (MOUD) are the most well supported treatment for OUD, they remain underutilized by clinicians, particularly in the primary care setting, emphasizing the importance of examining factors that impact prescribing.

Objective: To assess clinicians' prescribing practices for MOUD and assess the pandemic's effect on MOUD prescription. To determine whether there is an association between patient-specific factors, such as mental health diagnoses and substance use disorder (SUD), and MOUD prescription practices prior to and during the COVID-19 pandemic.

Methods: A retrospective chart review assessed 500 patient charts with a diagnosis of OUD to assess demographics, MOUD prescribing, substance use, and co-morbid mental health conditions.

Results: 312 charts met inclusion criteria. There was no significant difference in the percentage of new MOUD prescriptions among the selected cohort between the 2 selected timeframes, nor was there a significant difference in the prescriber/setting of new prescriptions. Cumulative analysis revealed that greater than 2/3 of the selected patients had concurrent mental health diagnoses. Greater than 50% of patients reported active non-opioid substance use. The odds of having a co-occurring SUD were significantly higher among patients treated in the emergency department and various treatment settings-including urgent care and non-primary care clinics-as compared to the primary care outpatient setting.

Conclusions: Strong evidence supports the efficacy of using MOUD in primary care, yet it is underutilized in the mid-Michigan region. Overall prevalence of mental health diagnoses, SUD, MOUD prescriber practices were similar prior to and during the COVID-19 pandemic. There was a high occurrence of co-occurring SUD especially among patients treated outside of the primary care setting. Future initiatives to increase clinician education around MOUD and address patient barriers to treatment are warranted.

Objective: Multicancer Detection (MCD) tests, such as the GRAIL Galleri, offer a novel approach to cancer screening by detecting cancer-specific methylation patterns in cell-free DNA through a single blood sample. This study evaluated an 18-month implementation of MCD testing in a tertiary ambulatory internal medicine clinic.

Patients and methods: Between June 2022 and November 2023, 2244 asymptomatic (without symptoms attributed to cancer) patients underwent MCD testing. The study focused on operational workflows, patient and physician education, and diagnostic follow-up of positive results. Standardized materials, including electronic health record (EHR) workflows, FAQs, and diagnostic pathways, were developed to facilitate implementation. Challenges included managing false positives, patient anxiety, costs, and ethical considerations.

Results: Of the 2244 patients tested, 17 (0.76%) had positive results, and 15 underwent further diagnostic evaluation. Cancer was confirmed in 11 (73.3%) patients, including cases of breast, colon, esophageal, lymphoma, ovarian, and pancreatic cancers. Four patients had no identifiable malignancy despite comprehensive work-up.

Conclusions: MCD testing is feasible in routine clinical workflows, with 73% of positive cases yielding cancer diagnoses. While promising, further research is required to assess long-term outcomes, cost-effectiveness, and optimal implementation strategies of cancer interception in broader healthcare settings.

Introduction: One of the most effective measures for the reduction and prevention of healthcare-associated infections (HAI) is hand hygiene (HH). Covert direct observation of HH is difficult to realize in general practice office (GPO). The World Health Organization recognizes electronic monitoring as a form of measuring product use and estimating compliance. This is the first study to monitor HH performance electronically in Dutch GPOs.

Objectives: The main aim of this study was to evaluate HH compliance in general practice offices.

Methods: An observational study was conducted at 4 Dutch GPOs between 2019 and 2021. We measured HH compliance using data on HH events (HHE) from alcohol-based hand rub (ABHR) dispensers with a built-in electronic counter. Daily HH opportunities were calculated according to the 'Five Moments for Hand Hygiene' based on the continuously documented activities using general practitioners (GPs) patient electronic dossier systems.

Results: In total, hand hygiene was performed during 1786 of the estimated 4322 opportunities (41%). HH compliance for the general practitioners, practice assistants, and nurse practitioners was 38%, 51%, and 43%, respectively. The overall HH compliance within the same GPOs was 42% pre-pandemic and rose to 56% during the pandemic. The overall mean volume of ABHR was 2.44 ml, varying per HHE between 1.91 to 2.55 ml. The mean volume of ABHR measured before and during the pandemic rose from 2.55 ml to 2.81 ml. The overall self-reported compliance was 86% and was highest among nurse practitioners.

Conclusions: Hand hygiene compliance among HCWs in Dutch GPOs was found to be 41%, with general practitioners having the lowest compliance and practice assistants the highest compliance. While the mean volume of ABHR used per HHE seems appropriate, directed observations would be needed to ensure that an adequate hand-rub technique was used to cover the whole hand. Multi-modal interventions are needed to improve HH-compliance and stimulate the switch to ABHR with in the Dutch general practice office.