Primary health care research & development最新文献

Background and objective: Early and collaborative interventions are desirable to prevent long-term sick leave and promote sustainable return-to-work (RTW). The aim of this study was to evaluate if the use of the Capacity Note - a brief intervention promoting early and structured communication between general practitioners (GPs), patients, and employers - had an impact on length of sick leave in patients with common mental disorders (CMDs) in primary healthcare.

Method: In a pragmatic trial, GPs at eight primary healthcare centres were randomized to provide the intervention or control and recruited eligible patients: employed women and men, 18-64 years, who visited a GP due to CMD and became or were (<4 months) full- or part-time sick-listed. Patients in the intervention group (n=28) used the Capacity Note in addition to usual care. Patients in the control group (n=28) received usual care. Outcomes of interest were time until full RTW, sick leave status at end of follow-up (17 months), number of sick leave episodes during follow-up, and number of sick leave days at 6, 12, and 17 months of follow-up.

Results: The proportion of patients with full RTW at the end of follow-up was 79.2% in the intervention group and 84.6% in the control group. Time until full RTW was 102 and 90 days (median) in intervention and control group, respectively. We found no statistically significant differences between the groups for any of the outcomes.

Discussion: Despite efforts to increase the number of participants, the study ended up with a small sample. This prohibited us from drawing any final conclusions about the effect of the intervention. Obstacles to recruitment of patients and use of the intervention are discussed.

Background: The COVID-19 pandemic has impacted patient's visits to general practitioners (GPs). However, it is unclear what the impact of COVID-19 has been on the interaction among the local primary care clinics, the GP Department within the hospital and specialists.

Methods: The interaction among GPs referring to hospital-based specialists and specialists to local doctors was determined, comparing pre-pandemic 2019 and 2020 during the pandemic.

Results: Reduced referrals from GPs to specialists were consistent with the reduction in specialist referrals back to the local doctors, which dropped by approximately 50% in 2020, particularly in the two most common chronic conditions (hypertension and diabetes mellitus).

Discussion: Reduced referral of patients from local clinics to Tongren Hospital is probably due to the extensive online training provided to the local GPs to become more competent in handling local patients via telehealth. Our data provide some insight to assist in combatting the pandemic of COVID-19, offering objective evidence of the impact of COVID-19 on patient management by GPs.

Aim: This review aims to identify the mechanistic relationships related to periodontal diseases and its possible association with changes in human milk composition and the composition and function of infants' gut microbiome.

Background: Maternal health conditions, especially inflammatory, are associated with altered human milk composition. It is not known whether maternal oral inflammatory diseases, including periodontal diseases, deleteriously affect human milk composition.

Methods: A narrative review was conducted according to SANRA, the Scale for the Assessment of Narrative Review Articles, guidelines. PubMed, Google Scholar, and Cochrane database of systematic reviews were searched from September 2019 up to December 2023 using keywords such as breast/human milk, maternal health/infections, and periodontal diseases. Reference lists of relevant articles were also screened. Our primary outcome of interest was human milk composition (i.e., any changes in macronutrients, immunological components, etc.). Secondary outcomes included changes in human milk microbiome and subsequent changes in the infant gut microbiome. Outcomes were synthesized using a narrative approach where the existing evidence and current literature were summarized. No risk of bias assessment of the studies was performed in this review.

Findings: The search yielded no studies investigating the relationship between periodontal diseases in nursing mothers and changes in human milk composition. However, a dose-response relationship exists between the severity of periodontal diseases and the risk of adverse pregnancy outcomes such as preterm birth. Mastitis and diabetes affected milk lipids. Immunoglobulin A (sIgA) was increased in mastitis, whereas reduced concentrations were reported in diabetes. Potential biological pathways through which periodontal diseases can negatively affect human milk composition include the systemic dissemination of inflammatory cytokines like IL-6, PGE2, and tumor necrosis factor (TNF)-β that can be up-regulated by bacterial by-products. This biological plausibility needs to be investigated, given the potentially negative impact on the quality of human milk that could be caused by periodontal inflammation.

Aim: This paper presents the development of the METRIC toolkit, aimed at enhancing primary healthcare interventions in the context of hepatitis C control, thus contributing to the World Health Organization's global strategy to achieve the elimination of the disease by 2030.

Background: At the global level, most people living with hepatitis C are unaware of their condition. As such, the eradication of hepatitis C necessitates comprehensive strategies within primary healthcare settings, as it provides an opportunity to reach the general population, facilitates the identification of potential patients who may be unfamiliar with hepatitis C, and guides them toward adequate care. Herein, we propose the METRIC toolkit as a means to optimize the efficiency and efficacy of healthcare services dedicated to hepatitis C control.

Methods: The development of the METRIC toolkit was guided by a thorough review of pertinent literature, focusing on primary healthcare interventions in hepatitis C control. Key components were identified, encompassing systematic problem identification, solution formulation, outcome evaluation, and feedback integration.

Findings: The METRIC toolkit represents a valuable resource for strengthening primary healthcare interventions in hepatitis C control. By fostering a culture of continuous improvement and data-driven decision-making, this framework holds promise in advancing the global agenda towards hepatitis C elimination. However, its successful application requires careful consideration of contextual factors and ongoing adaptation to local needs and circumstances.

Background: Primary healthcare (PHC) plays a crucial role in improving health outcomes and reducing healthcare burden, especially in low-to-middle-income countries (LMICs). However, PHC has not received adequate attention in Pakistan despite its recognized importance. This study aims to examine the current state of PHC in Pakistan, identifying factors compromising its quality and effectiveness.

Methods: To find relevant data, the authors conducted a thorough literature search on PubMed, Google Scholar, and Cochrane Library from inception till 2 July 2022, without any language restriction. The following keywords were employed during the literature search, separated by Boolean operators AND, OR: "Primary Healthcare", "PHC", "Healthcare primary", "Primary Health", and "Pakistan".

Results: Pakistan's PHC infrastructure shows promise, with a considerable number of healthcare facilities in place. However, various factors hinder its effectiveness and compromise the quality of care provided. Insufficient investment, resource constraints, inadequate training of healthcare providers, lack of oversight, and limited access to essential medicines and equipment are some of the key challenges observed. Improving PHC in Pakistan is vital for addressing the population's healthcare needs, particularly in rural areas. Adequate investment, enhanced training programs, improved oversight mechanisms, and increased availability of essential resources are necessary to strengthen the PHC system. By prioritizing PHC and addressing the identified challenges, Pakistan can enhance healthcare access, reduce healthcare burden, and improve overall health outcomes for its population.

Conclusion: It is high time LMICs like Pakistan recognize PHC as the most economically feasible pathway toward accomplishing healthcare targets and adopt adequate measures to elevate its standards.

Objective: Developing an appropriate context-based school-age obesity prevention programme, understanding the root causes of obesity in real-life situations is vital. The objectives of this study were to explore the risk factors of school-age obesity based on Ecological System Theory (EST) and develop mutual problem-solving guidelines for school-age obesity prevention.

Methods: Participation Action Research (PAR) was used as the study design. The data collection employed focus group discussions, in-depth interviews, participant's observations, together with the procedures of Appreciation, Influence, and Control (AIC) with 55 school key informants.

Results: Risk factors supported by EST at all level included high-calorie intake; sedentary lifestyles; perceptions of 'Chubby are cute'; indulgent parenting, including limited exercise area in school. PAR process guarantees the sustained context-based prevention guidelines.

Conclusions: The results could be used as a policy-driven for school-based participation and environmental support in order to promote health-promoting school.

Aims: We will examine the processes of change in psychological practice that have been altered by the lockdown.

Background: During the COVID-19 pandemic, low-income populations, notably residents of social homes or shelters, were shown to be particularly susceptible to contagion. During lockdown, telephone-based psychological consultations became the norm.

Methods: In this qualitative research, we carried out semi-structured interviews with 10 psychologists working in social homes or shelters. Interviews were transcribed verbatim. Data were studied using consensus qualitative research.

Findings: During lockdown, participants felt that isolation increased while medical and social support decreased. Psychologists had to adapt their work methods and work more closely with on-site staffs. After lockdown, there was an increase in mental health issues. Participants perceived that telephone consulting seemed to facilitate access to psychological help. Although psychologists have quickly adapted, a decrease in the quality of clinical work was a general assessment. Results stress the necessity to train French psychologists in telemental health practices.

Aims: This study aimed to assess the operational efficiency of Sub-District or Tambon Health Promoting Hospitals (THPHs) in Thailand's Eastern Economic Corridor (EEC) and to propose management guidelines for future improvements.

Background: The current state of Thailand's public health demonstrates that government policy has prioritized equal access to public health services in all areas. This increases the need for primary public health services, yet resources are limited and cannot be increased to meet the growing demand. The only effective way to address this issue is to develop the efficiency of public health operations.

Methods: The sample consisted of 104 THPHs in Chachoengsao, a province in Thailand's EEC. Data for five input and seven output variables were collected between September 18 and November 15, 2023. An online survey was conducted to gather the required data for fiscal year 2022. Data envelopment analysis was used to measure the efficiency of THPHs.

Findings: The average efficiency index of the 104 THPHs was 0.9066, with about 60% having an efficiency index of 1.00. When classified by size, it was found that the efficiency levels of the THPHs grew with size, considering that the average efficiency index of the small, medium, and large THPHs was 0.8642, 0.9140, and 0.9417, respectively. The proportion of efficient THPHs also increased with size, at 58.14%, 60.00%, and 66.67%, respectively. Regarding efficiency improvement targets, small THPHs had the highest output targets (28.40%), followed by medium THPHs (15.31%) and large THPHs (9.91%). For the inefficient THPHs, some management guidelines were made to improve their future performances.

Rationale: From education to healthcare and management processes, it is important to address the experience in health within its own complexity, context, and uniqueness. At this point, qualitative studies come to the fore and this increases the need for practical guides and models for qualitative studies. Qualitative studies have a paradigm that is different from quantitative research and its paradigm ontologically, epistemologically, and methodologically. These differences are reflected in the design of the research as well as the analysis, interpretation, and reporting of qualitative data. From such a point of view, this paper first briefly outlines the design process of qualitative studies and then proposes a model for the analysis, interpretation, and reporting of qualitative data.

Conceptual/theoretical framework: The three core concepts of the model are 'contextuality', 'reflectivity', and 'narrativity'. Such a conceptual/theoretical framework transforms qualitative data analysis, interpretation, and reporting processes into processes that are carried out with a reflective approach within their specific contexts.

Model: Taking this into account, by considering a contextual, reflective, and narrative approach, two frameworks, namely, the 'Contextual (Multiple) Reading and Analysis Framework' consisting of three stages and seven steps, and the 'Contextual Understanding, Interpretation and Reporting Framework' consisting of four stages, were developed. This provides a practical guide to contextual and reflective data analysis, interpretation, and reporting for the use of those conducting qualitative studies.