Exploration of preschool hearing screening at primary healthcare centers in Riyadh,Saudi Arabia:A cross-sectional study

The hearing status of children should be examined throughout early childhood,even if they have passed the newborn hearing loss because hearing loss can occur at any time and may affect their ability to learn.Preschool hearing screening(PHS)is vital to continue screening throughout early childhood.The current practice of PHS in the primary healthcare centers(PHCs)in Saudi Arabia is unknown.The purpose of this study was to investigate PHS in the PHCs.This cross-sectional descriptive study used an in-person-administered questionnaire to collect data.A total of 106 out of 120 participants(male=61;female=45)representing the PHCs in Riyadh were interviewed.Most of the participants were aged 31–40 years and held a bachelor’s degree as the highest academic qualification with limited years of experience.PHS was mostly performed through subjective measures by asking the parents(71.7%)and the child(65.1%).The audiometric evaluation was conducted for preschool children in only half of the PHCs.General practitioners and nurses usually perform PHS.Substantial gaps in the practice of PHS were identified.The lack of training and appropriate instruments and the need for audiological services were the main challenges.Incorporating robust and objective protocols for PHS into the educational system is a valuable strategy for identifying hearing loss early and reducing its impact through the establishment of effective intervention plans.

The Impact of COVID-19 on the Mental-Emotional Wellbeing of Primary Healthcare Professionals: A Descriptive Correlational Study

The present study aimed to examine work environment related factors and frontline primary healthcare profes-sionals’mental-emotional wellbeing during the COVID-19 pandemic in school communities of Hong Kong.A total of 61(20%)school health nurses(frontline primary healthcare professionals)participated in a cross-sec-tional online survey from March to June 2020.Outcomes of mental-emotional health were measured using the Mental Health Continuum-Short Form(14-item scale with three subscales related to emotional,social and psychological wellbeing);the Perceived Stress Scale(10-item scale with two subscales related to perceived help-lessness and lack of self-efficacy);and the Coping Orientation to Problems Experienced Inventory(Brief COPE),a 28-item inventory with two subscales related to adaptive and maladaptive strategies.Almost half(42.6%)of par-ticipants experienced mental health problems.Those employed in government subsidized schools had signifi-cantly lower scores in mental health wellbeing than those who worked in private schools.Factors relating to increased mental health problems included lack of emotional support,inadequate training relating to infection prevention and control measures,disengagement and self-blame.A variety of factors influencing school health nurses’social,emotional and psychological wellbeing in their work environment during the COVID-19 pandemic were also reported.The mental-emotional wellbeing of school nurses may relate to their subjective feeling of lone-liness as participants were the sole frontline primary healthcare professional working in the school community during the COVID-19 pandemic.Studyfindings provide relevant evidence for management teams to build a cul-ture of psychological and social support into workplace policies and procedures.Continuous staff development and adequate social support are important to promote the mental-emotional wellbeing of primary healthcare pro-fessionals in school communities as they play a significant role in safeguarding resources during pandemics.

Antibiotic Prescribing Patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia

Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely;Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. Results: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. Conclusion: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future.

Intensity of nursing work in a primary healthcare center:An observational study

Objectives:In the sphere of occupational intensity,nursing stands recognized for its inherently demanding nature,marked by a rapid succession of tasks.Our primary aim was to assess the level of job intensity within nursing by analyzing the frequency and duration of activities performed by nurses,instances of task overlap,and the distribution of break times within a primary healthcare center.Methods:This study was conducted using a descriptive working method.Nursing activities were recorded with the observation of six nurses,each monitored for 37.5 h.We used the Maribor System for measuring Quantity in Nursing Care in Primary Health Care Settings to measure the nursing care activities about direct patient care,indirect patient care,and other unproductive aspects through direct non-participant observations.Results:About 41.5%(n=1,640)of all nursing activities involving direct contact with patients,about 38.2%(n=1,508)was indirect patient care,where a large amount worked with paper files(n=666,16.9%).In addition,about 15.0%were other nursing activities(mostly computer work),and just 5.3%(n=210)of tasks were unproductive.The observational findings indicate a pronounced level of work intensity experienced by nurses in primary health clinics.Significantly,nurses were predominantly engaged in direct patient care tasks,often managing multiple activities simultaneously.Their transitions between tasks occurred approximately every 3 min,frequently without adequate intervals for breaks.Conclusions:This study highlights the need to shift nurses’focus from a task-centric approach to one centered on patient care.The prevailing emphasis on tasks may contribute to enduring fatigue and professional dissatisfaction.Consequently,there is an urgent need to redefine the scope of a nurse’s role and implement a comprehensive computer information system as an integral part of this redefined approach.

Chronic obstructive pulmonary disease in primary healthcare institutions in China: Challenges and solutions

Chronic obstructive pulmonary disease(COPD)is a preventable and treatable condition characterized by persistent respiratory symptoms and airflow limitation.It usually results from airway and/or alveolar abnormalities caused by exposure to noxious particles or gases.1 The burden of respiratory diseases,most commonly COPD,ranks third among all systemic diseases in China.2 In the latest epidemiological survey,the prevalence rate of COPD in rural areas was significantly higher than that in urban areas(9.6%vs.7.4%).3 Furthermore,most patients with COPD first visit primary healthcare institutions.However,the overall prevention and treatment standard for COPD at the primary level in China is not promising.4,5,6 This study aimed to introduce and present challenges in the prevention and treatment of COPD based on the relevant literature to improve the knowledge of and attention on healthcare-related treatment and prevention for COPD.

Health Workers’ Preparedness towards Integrating Mental Healthcare into Primary Health Settings: Evidence from Nigeria

Background: The global drive to scale up mental health services and eliminate the treatment gap requires incorporating mental health services into primary health care (PHC). Primary health care provides comprehensive, continuous, and coordinated care and if need be provides referrals to higher levels of care. However, for these services to meet the basic objective of PHC, it is necessary to determine healthcare workers’ preparedness for caring for the mentally ill. Therefore, this study aimed to examine health workers’ preparedness for integrating mental healthcare into primary settings in a rural community in Nigeria. Methodology: A descriptive research design was used to conduct the study among all 215 primary healthcare workers within Nkanu West Local Government Area (LGA). The instrument for data collection was a structured questionnaire constructed by the author. A pilot study was conducted on 10% of the sample population. Cronbach’s Alpha formula was used to estimate the reliability coefficient (0.85). The collected data were analysed with descriptive statistical frequencies and percentages. Results: Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Findings show that healthcare workers’ preparedness to care for the mentally ill at the primary healthcare centre is quite low. It was also found that mental illness is still shredded by stigma as a result of poor awareness. Consequently, there is still a persistent pervasive belief system that Mental illness is a form of retribution from the gods for one’s wrong deed in the study area. Conclusion: It was concluded that few of the respondents were prepared for the care of the mentally ill which might be a result of poor awareness about mental health and the negative stereotype given about mental health. From the analysis, it can be deduced that health workers exhibit some degree of positive attitude towards care of the mentally ill, though, mental illness is associated with stigmatization due to a lack of public understanding of mental disorders. There was strong support for integrating mental health into primary health care by health care providers. Therefore there is a need for community education and building of the capacity of healthcare workers for integration of the care of the mentally ill to be feasible in PHC centres.

Healthcare needs and access in a sample of Chinese young adults in Vancouver, British Columbia: A qualitative analysis

Objectives: Immigrants of Chinese ethnicity and young people (between 18 and 30 years of age) are known to access health services less frequently and may be at greater risk for experiencing unmet health needs. The purpose of this study was to examine the health beliefs, health behaviors, primary care access, and perceived unmet healthcare needs of Chinese young adults.Methods: Semi-structured in-depth interviews were carried out with eight Chinese young adults in Vancouver, Canada. Results: A content analysis revealed that these Chinese young adults experienced unmet healthcare needs, did not have a primary care provider, and did not access preventive services. Cultural factors such as strong family ties, filial piety, and the practice of Traditional Chinese Medicine influenced their health behaviors and healthcare access patterns. Conclusion: Chinese young adults share similar issues with other young adults in relation to not having a primary care provider and accessing preventive care but their health beliefs and practices make their needs for care unique from other young adults.

Patient Satisfaction with Primary Health Care Services in Riyadh City, Saudi Arabia

Patient satisfaction is a crucial measure of healthcare quality and plays a vital role in ensuring effective healthcare systems. This study aims to assess the level of patient satisfaction with primary healthcare services in Riyadh, Saudi Arabia, identify social factors affecting satisfaction, and determine the reasons behind dissatisfaction and how to improve satisfaction. The study employed a cross-sectional observational design and included a random sample of 400 patients from primary healthcare centers in Riyadh. Data were collected using an electronic questionnaire and analyzed using SPSS software. The study found that patients were generally satisfied with the primary healthcare services provided in Riyadh, with high levels of satisfaction reported for booking appointments, triage services, and emergency care. However, some aspects of the healthcare experience, such as long waiting times and the physical design of healthcare centers, need improvement. These findings can be used to inform the development of policies and interventions aimed at enhancing healthcare quality in Saudi Arabia.

Enhanced primary mental healthcare forIndigenous Australians: serviceimplementation strategies and perspectivesof providers

Background:Improving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations.We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program,the Access to Allied Psychological Services program,whilst specifically focusing on the implementation strategies and perspectives of service providers.Methods:We conducted semi-structured interviews with 31 service providers(primary care agency staff,referrers,and mental health professionals)that were analysed thematically and descriptively.Results:Agency-level implementation strategies to enhance service access and cultural appropriateness included:the conduct of local service needs assessments;Indigenous stakeholder consultation and partnership development;establishment of clinical governance frameworks;workforce recruitment,clinical/cultural training and supervision;stakeholder and referrer education;and service co-location at Indigenous health organisations.Dedicated provider-level strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery(involving,flexible referral pathways,suitable locations,adaptation of client engagement and service feedback processes)and,to a lesser extent,the nature and content of interventions(provision of culturally adapted therapy).Conclusions:This study offers insights into key factors underpinning the successful national service implementation approach.Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare for Indigenous people are critically dependent on effective local agency-and provider-level strategies to optimise the integration,adaptation and broader utility of these services within local Indigenous community and healthcare service contexts.Despite the explicit provider focus,this study was limited by a lack of Indigenous stakeholder perspectives.Key study findings are of direct relevance to inform the future implementation and delivery of culturally appropriate primary mental healthcare programs for Indigenous populations in Australia and internationally.

Quality of Service to Users of Primary Health Care:A Study of Evaluation

The quality of service to people in Primary Healthcare (PHC) is linked to the provision of quality service by professionals who integrate this service in the community. Accordingly, this study aims to evaluate the service given by health professionals in primary health care, from the user’s perception. This is an evaluative and quantitative study, conducted with people who use the PHC service. 180 adults are interviewed in the city of Santa Cruz, Rio Grande do Norte, Brazil. The results show that most respondents are women. The average age is of 36.65, median of 34.00 and standard deviation of 11,554. With regards to the quality of service, it ranges from fair to good. When performing correlation between the quality of service and time spent to reach the service, most people say that they spend between 0 and 15 minutes from their house to the healthcare service unit. About reception, respondents reported being satisfied and that the service has been responsible and quality for health monitoring. Thus, it is noted that the user classifies the quality of the service in primary healthcare as regular, showing weaknesses that need to be corrected to prevent damage in service provision in Primary Healthcare.

What Does Research Say for Improving the Efficiency of Lady Healthcare Workers in Pakistan? Review Article

Background: In Pakistan, the crucial role of Lady Health Workers (LHWs) cannot be over looked and must be supported. Their alliance position between the community and health system allows them to provide services to the most marginalised groups. However, LHWs face numerous challenges and issues resulting in reduced efficiency and effectiveness of LHW program. Aims: The study aims to identify the challenges highlighted in various studies that undermine the performance of LHWs and attempts to combine the recommendations of the studies for addressing these challenges. Methods: Literature search included articles from 2000 to 2024. PubMed and Google Scholar were the main search engines utilized. Initial search resulted in 1380 articles, out of which only those showing a link to the study title were included in the study. From the total articles searched, 55 were selected for writing this article. Results: Literature highlighted the importance of community selection, monitoring, monetary as well as non-financial incentives;trainings;availability of supervision, workload balance, monitoring;recognition, clarity on roles, resources and uninterrupted supply of logistics, support and embedment of LHWs in community and health system. Lack or poor quality of these aspects may lead to low performance of LHWs. Conclusions: This paper explores the extent of issues and challenges faced by LHWs in Pakistan. A number of interventions appear to be effective in improving the efficiency of LHWs in Pakistan. The review may serve as an essential resource for program planners and decision-makers in improving the effectiveness and efficiency of LHW programs.

Faecal immunochemical test outside colorectal cancer screening?

Faecal immunochemical tests(FITs)are the most widely colorectal cancer(CRC)diagnostic biomarker available.Many population screening programmes are based on this biomarker,with the goal of reducing CRC mortality.Moreover,in recent years,a large amount of evidence has been produced on the use of FIT to detect CRC in patients with abdominal symptoms in primary healthcare as well as in surveillance after adenoma resection.The aim of this review is to highlight the available evidence on these two topics.We will summarize the evidence on diagnostic yield in symptomatic patients with CRC and significant colonic lesion and the different options to use this(thresholds,brands,number of determinations,prediction models and combinations).We will include recommendations on FIT strategies in primary healthcare proposed by regulatory bodies and scientific societies and their potential effects on healthcare resources and CRC prognosis.Finally,we will show information regarding FIT-based surveillance as an alternative to endoscopic surveillance after high-risk polyp resection.To conclude,due to the coronavirus disease 2019 pandemic,FIT-based strategies have become extremely relevant since they enable a reduction of colonoscopy demand and access to the healthcare system by selecting individuals with the highest risk of CRC.

广州市花都区整合型医疗卫生服务体系构建

总结广州市花都区构建整合型医疗卫生服务体系的实践,基于“结构-过程-结果”模型分析政策效应,提出进一步完善基层整合型医疗卫生服务体系的建议,包括加大基层健康预防投入以实现可持续发展,实现健康信息互联互通和资源共享,医疗卫生服务模式从“层级型”向“整合型”转变。

Phytochemical and ethnopharmacological review of Elephantorrhiza goetzei(Harms)Harms

Elephantorrhiza goetzei(E.goetzei) commonly known as Goetze's elephantorrhiza,is traditionally used as a decoction in the treatment of a variety of conditions such as pain,sores,sexually transmitted infections(STIs),gastro-intestinal disorders,microbial infections and genito-urinary system disorders.On the basis of its wide distribution in south central Africa,E.goetzei has a long history of applications among the different ethnic groups.A total of 23 ethnomedicinal uses of E.goetzei are documented in this study from 62.5% of the countries where the species is indigenous.Multiple classes of phytochemicals including phenolic compounds,coumarins,flavonoids,saponins,stilbenoids,tannins and triterpenoids have been identified from E.goetzei bark,leaves and roots in different investigations.Scientific validation of its diverse uses in traditional medicine has been demonstrated through antibacterial,antifungal,antiviral,anthelmintic,antioxidant and cytotoxicity assays of crude extracts as well as isolated compounds from the species.E.goetzei has been widely used as a source of herbal medicine for several years without any adverse effects.In light of its long traditional use and the modern phytochemical and pharmacological evaluations summarized in this study,E.goetzei has been demonstrated to show a strong potential for therapeutic and health-maintaining uses.However,there is need for additional studies on the isolated compounds to validate the traditional uses in human models as well as evaluating the possible mechanisms of action.The present review focusing on the biology,traditional uses,phytochemistry and pharmacological properties of E.goetzei has provided preliminary information for further studies on the species.

Impact of a colorectal cancer screening program implantation on delays and prognosis of non-screening detected colorectal cancer

BACKGROUND The implementation of a colorectal cancer(CRC)screening programme may increase the awareness of Primary Care Physicians,reduce the diagnostic delay in CRC detected outside the scope of the screening programme and thus improve prognosis.AIM To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme.METHODS We performed a retrospective intervention study with a pre-post design.We identified 322 patients with incident and confirmed CRC in the pre-implantation cohort(June 2014–May 2015)and 285 in the post-implantation cohort(June 2017-May 2018)in the Cancer Registry detected outside the scope of a CRC screening programme.In each patient we calculated the different healthcare diagnostics delays:global,primary and secondary healthcare,referral and colonoscopyrelated delays.In addition,we collected the initial healthcare that evaluated the patient,the home location(urban/rural),and the CRC stage at diagnosis.We determined the two-year survival and we performed a multivariate proportional hazard regression analysis to determine the variables associated with survival.RESULTS We did not detect any differences in the patient or CRC baseline-related variables.A total of 20.1%of patients was detected with metastatic disease.There was a significant increase in direct referral to colonoscopy from primary healthcare(25.5%,35.8%;P=0.04)in the post-implantation cohort.Diagnostic delay was reduced by 24 d(106.64±148.84 days,82.84±109.31 d;P=0.02)due to the reduction in secondary healthcare delay(46.01±111.65 d;29.20±60.83 d;P=0.02).However,we did not find any differences in CRC stage at diagnosis or in two-year survival(70.3%;P=0.9).Variables independently associated with twoyear risk of death were age(Hazard Ratio-HR:1.06,95%CI:1.04-1.07),CRC stage(II HR:2.17,95%CI:1.07-4.40;III HR:3.07,95%CI:1.56-6.08;IV HR:19.22,95%CI:9.86-37.44;unknown HR:9.24,95%CI:4.27-19.99),initial healthcare consultation(secondary HR:2.93,95%CI:1.01-8.55;emergency department HR:2.06,95%CI:0.67-6.34),hospitalization during the diagnostic process(HR:1.67,95%CI:1.17-2.38)and urban residence(HR:1.44,95%CI:1.06-1.98).CONCLUSION Although implementation of a CRC screening programme can reduce diagnostic delays for CRC detected in symptomatic patients,this has no effect on CRC stage or survival.

Non-inclusion of certified herbal medicines in the National Health Insurance Scheme affects patient utilization of the integrated herbal medicine services in Ghana

Background:In 2011,Ghana piloted the integration of herbal medicine services into mainstream health care delivery in selected government hospitals across the country.To date,however,no single certified herbal drug is generally covered by the national health insurance scheme.This study evaluated the implications of out-of-pocket payment for prescriptions on the patronage of herbal medicine units in 3 selected government hospitals within Kumasi Metropolis.Methods:A cross-sectional study on 413 participants was performed using a semi-structured questionnaire.Results:The majority of study respondents were female(54%),and the median age was 35 years.Most participants(83.1%)were aware that herbal medicine was integrated in the mainstream health care system of the country.Regarding the costs of certified herbal drugs,51.5%of respondents considered them very expensive;72.1%of the respondents believed that the costs of certified herbal drugs adversely affected the utilization of herbal units at government hospitals,which produced a positive correlation(r=0.5498).A total of 99.5%of the respondents recommended the inclusion of certified herbal drugs on the national health insurance drug list.Conclusion:This study revealed that the costs of certified herbal medicines negatively affect utilization of herbal units at government hospitals.To improve the utilization of herbal units,certified herbal drugs dispensed at these units must thus be included in the national health insurance drug list.

A perspective on the development of family medicine in China

Family medicine is a medical specialty devoted to comprehensive primary care for people of all ages.It has been recognized and developed as the foundation of modern healthcare system in all other advanced countries(except USA),and has enjoyed great success in the improvement of national health status and constraint of healthcare expenditure.The new healthcare reform plan and the development of family medicine system in China with focus on the wellbeing of all people have been hailed as a historic milestone.Establishment of a new specialty from scratch into a massive work force,however,has proven to be a tremendous challenge.With strong momentum from central government and the support of favorable finance and policy,a great achievement could be made when the healthcare model has truly changed from specialty care into primary care in medical education institutions and the healthcare industry,and the creation of hundreds of family medicine residency training programs has been accomplished.This article elucidated some perspectives and strategies on the development of family medicine in China.

Identifying contextual determinants of problems in tuberculosis care provision in South Africa: a theory-generating case study

Background:Despite progress towards End TB Strategy targets for reducing tuberculosis(TB)incidence and deaths by 2035,South Africa remains among the top ten high-burden tuberculosis countries globally.A large challenge lies in how policies to improve detection,diagnosis and treatment completion interact with social and structural drivers ofTB.Detailed understanding and theoretical development of the contextual determinants of problems inTB care is required for developing effective interventions.This article reports findings from the pre-implementation phase of a study ofTB care in South Africa,contributing to HeAlth System StrEngThening in Sub-Saharan Africa(ASSET)-a five-year research programme developing and evaluating health system strengthening interventions in sub-Saharan Africa.The study aimed to develop hypothetical propositions regarding contextual determinants of problems inTB care to inform intervention development to reduce TB deaths and incidence whilst ensuring the delivery of quality integrated,person-centred care.Methods:Theory-building case study design using the Context and Implementation of Complex Interventions(CICI)framework to identify contextual determinants of problems in TB care.Between February and November 2019,we used mixed methods in six public-sector primary healthcare facilities and one public-sector hospital serving impoverished urban and rural communities in the Amajuba District of KwaZulu-Natal Province,South Africa.Qualitative data included stakeholder interviews,observations and documentary analysis.Quantitative data included routine data on sputum testing andTB deaths.Data were inductively analysed and mapped onto the seven CICI contextual domains.Results:Delayed diagnosis was caused by interactions between fragmented healthcare provision;limited resources;verticalised care;poorTB screening,sputum collection and record-keeping.One nurse responsible forTB care,with limited integration ofTB with other conditions,and policy focused on treatment adherence contributed to staff stress and limited consideration of patientsz psychosocial needs.Patients were lost to follow up due to discontinuity of information,poverty,employment restrictions and limited support for treatment side-effects.Infection control measures appeared to be compromised by efforts to integrate care.Conclusions:Delayed diagnosis,limited psychosocial support for patients and staff,patients lost to follow-up and inadequate infection control are caused by an interaction between multiple interacting contextual determinants.TB policy needs to resolve tensions between treating TB as epidemic and individually-experienced social problem supporting interventions which strengthen case detection,infection control and treatment,and also promote person-centred support for healthcare professionals and patients.