Journal of Primary Care and Community Health最新文献

Objectives: The COVID-19 pandemic presented significant challenges, particularly the psychological impact of prolonged preventive measures. This study aimed to explore the longitudinal relationships among adherence, anti-pandemic fatigue, and depression, focusing on how these dynamics evolved.

Methods: A prospective longitudinal survey was conducted among 627 adults in Hong Kong during the pandemic across 3 waves. Repeated measures ANOVA, cross-lagged path modeling, and mediation model were employed to assess temporal relationships among adherence, anti-pandemic fatigue, and depression.

Results: Adherence at T3 significantly predicted T4's anti-pandemic fatigue (B = 0.196, SE = 0.055) and depression (B = 1.690, SE = 0.247), and anti-pandemic fatigue significantly predicted T4's depression (B = 0.684, SE = 0.260). These effects diminished at later waves, reflecting psychological relief as restrictions eased. Notably, adherence was found to increase anti-pandemic fatigue, which in turn exacerbated depressive symptoms.

Conclusion: While relationships varied over the 3 time points, the longitudinal design has clarified the causal inference. The study highlights the mental toll of prolonged restrictions and emphasizes the importance of designing integrative strategies that support adherence while addressing fatigue and depression. These findings offer actionable insights for primary care and community health programs in managing future public health emergencies.

Introduction: Treatment of cutaneous warts with intralesional vitamin D3 has demonstrated promising results in over 35 studies with methodological limitations.

Methods: We conducted a randomized, double-blind, placebo-controlled trial in our primary care procedure clinic of intralesional vitamin D3 12 000 IU vs placebo in cutaneous warts every 4 weeks up to 3 times. Warts were assessed 4, 8, 12, and 24 weeks after the initial injection. The primary outcome was complete wart resolution. Reduction in wart size was a secondary outcome.

Results: Between October 2020 and April 2023, we enrolled 77 participants with 1 or more cutaneous warts (41 and 36 in vitamin D3 and placebo groups, respectively) with untreated (32%) and recalcitrant (69%) warts. At 24 weeks, the index wart had resolved in 12 (30%) of vitamin D3 and 10 (31%) placebo participants. Treatment with vitamin D3 had no effect on wart surface area in an adjusted model nor wart resolution in analysis adjusted for baseline wart size, multiple warts, and the vehicle (OR 0.31 [95% CI] 0.01-10.3; P = 0.51).

Conclusions: These results demonstrate a lack of benefit of intralesional vitamin D3 in cutaneous warts.(ClinicalTrials.gov number NCT04278573).

Objective: This study aimed to examine the intrinsic capacity in Chinese older adults and its determinants (sociodemographic, lifestyle-related, environmental, and health-related factors) based on the WHO Integrated Care for Older People (ICOPE) framework.

Methods: A cross-sectional community-based study was conducted among 485 community-dwelling older adults recruited from 4 community health service centers in Xinxiang City, Henan Province between August 2024 and February 2025. Intrinsic capacity was assessed across 5 domains: locomotion, cognition, vitality, psychology, and sensory capacity (hearing and vision). Structural equation model (SEM) was used to examine relationships among intrinsic capacity, sociodemographic factors, lifestyle, family support, social participation, healthcare access, and health conditions.

Results: More than a half of subjects were female (61.2%), married (84.7%), having less than high school education (52%), with a mean age of 73.7 years (SD = 5.5). About 55.9% showed intrinsic capacity impairment, with most impairment of cognition (49.9%), followed by vision (44.9%), hearing (23.7%), locomotion (22.5%), vitality (18.1%), and psychological capacity (13%). The SEM demonstrated good fit and explained 83% of the variance in intrinsic capacity. Significant determinants, ranked by effect size, included dietary habits (β = .544), age (β = -.303), pain (β = -.240), handgrip strength (β = .205), social participation (β = .181), access to healthcare services (β = .138), hospitalization (β = -.10), and physical exercise (β = .089). All paths in the model were statistically significant ( p ' 0.05).

Conclusions: The SEM analysis demonstrated that dietary habits, handgrip strength, social participation, access to healthcare services, and physical exercise were positively associated with intrinsic capacity, while age, pain, and hospitalization showed negative associations. These findings suggest that primary care approaches focusing on multi-domain interventions, particularly health promotion, self-care, and early screening, may be promising areas for future public health initiatives. Community-based programs integrating these modifiable factors should be prioritized to promote intrinsic capacity and functional independence among Chinese community-dwelling older adults.

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.