Objective:To determine the degree of client satisfaction with immunisation services at Primary Health facilities in Calabar,Cross River State,Nigeria.Method:A semi-structured questionnaire was administered on 402 care...Objective:To determine the degree of client satisfaction with immunisation services at Primary Health facilities in Calabar,Cross River State,Nigeria.Method:A semi-structured questionnaire was administered on 402 caregivers who were selected using systematic random sampling from four primary health centres.The four centres were randomly selected from the 19 health centres using the table of random numbers.Data obtained were analysed using Epi-Info s of tware version 2002.Results:The majority of clients were dissatisfied with most aspects of care given at the Health Care Centres including long waiting time,accessibility of immunisation services,poor respect for clients’ rights,especially to their dignity,health information and counseling on their medical needs.Conclusions:The study concludes that client satisfaction with immunization service in Calabar was low due to poor attitude of health care providers,long waiting time and lack of respect for clients’ rights.展开更多
Nature reserves play a significant role in providing ecosystem services and are key sites for biodiversity conservation.The Tianchi Bogda Peak Natural Reserve(TBPNR),located in Xinjiang Uygur Autonomous Region,China,i...Nature reserves play a significant role in providing ecosystem services and are key sites for biodiversity conservation.The Tianchi Bogda Peak Natural Reserve(TBPNR),located in Xinjiang Uygur Autonomous Region,China,is an important ecological barrier area in the temperate arid zone.The evaluation of its important ecosystem services is of great significance to improve the management level and ecological protection efficiency of the reserve.In the present study,we assessed the spatiotemporal variations of four ecosystem services(including net primary productivity(NPP),water yield,soil conservation,and habitat quality)in the TBPNR from 2000 to 2020 based on the environmental and social data using the Integrated Valuation of Ecosystem Services and Trade-offs(InVEST)model.In addition,the coldspot and hotspot areas of ecosystem services were identified by hotspot analysis,and the trade-off and synergistic relationships between ecosystem services were analyzed using factor analysis in a geographic detector.During the study period,NPP and soil conservation values in the reserve increased by 48.20%and 25.56%,respectively;conversely,water yield decreased by 16.56%,and there was no significant change in habitat quality.Spatially,both NPP and habitat quality values were higher in the northern part and lower in the southern part,whereas water yield showed an opposite trend.Correlation analysis revealed that NPP showed a synergistic relationship with habitat quality and soil conservation,and exhibited a trade-off relationship with water yield.Water yield and habitat quality also had a trade-off relationship.NPP and habitat quality were affected by annual average temperature and Normalized Difference Vegetation Index(NDVI),respectively,while water yield and soil conservation were more affected by digital elevation model(DEM).Therefore,attention should be paid to the spatial distribution and dynamics of trade-off and synergistic relationships between ecosystem services in future ecological management.The findings of the present study provide a reference that could facilitate the sustainable utilization of ecosystem services in the typical fragile areas of Northwest China.展开更多
Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to est...Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.展开更多
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 serv...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.展开更多
Net Primary Productivity (NPP) is the basis of the material and energy transport calculation in ecosystem studies. NPP directly reflects the production capacity of plant communities under natural conditions. Ecosystem...Net Primary Productivity (NPP) is the basis of the material and energy transport calculation in ecosystem studies. NPP directly reflects the production capacity of plant communities under natural conditions. Ecosystem services are hot topics in the field of ecology. Many studies calculate ecosystem service value based on NPP. Taking Guanshanhu District of Guiyang City, Guizhou Province as the research object, using TM, ETM<sup>+</sup>, Gaofen2 and MOD17A3HGF.006 as data sources, this paper analyzed the change of ecosystem service value based on NPP in 2000, 2010 and 2020. The results showed that the area of forest ecosystem increased during 2000-2010 and decreased during 2010-2020. The artificial surface grew rapidly from 1146.82 hm<sup>2</sup> to 7544.29 hm<sup>2</sup> during 2000-2020. The farmland ecosystem decreased from 13308.29 hm<sup>2</sup> to 6342.33 hm<sup>2</sup> during 2000-2020. With the dynamic changes in ecosystem spatial distribution and component structure, the total NPP in 2000, 2010 and 2020 was 12.58 × 10<sup>4</sup> t, 11.90 × 10<sup>4</sup> t and 11.78 × 10<sup>4</sup> t, respectively, showing a decreasing trend. The total value of natural and semi-natural ecosystems services based on NPP showed an increasing trend, which was ¥ 6.938 × 10<sup>8</sup> in 2000, ¥ 8.052 × 10<sup>8</sup> in 2010 and ¥ 10.306 × 10<sup>8</sup> in 2020 respectively. The ecosystem contributed the most to the ecological service value in 2000 was farmland, but in 2010 and 2020, it was the forest ecosystem. The ecological service value of grassland and wetland was relatively small, while the ratio of the wetland ecological service value displayed a decreasing trend. In the future, it is necessary to establish a strict pretrial system for land use, so as to effectively protect the natural and semi-natural ecosystems and fulfill the growing ecological demands of residents.展开更多
Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies....Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies.Methods Multi-stage stratified random sampling was used to collect questionnaires from primary medical and health institutions in 5 provinces,and 102 questionnaires were distributed.Then Excel 2016 and IBM SPSS 21.0 software were applied for descriptive statistical analysis,chi-square test and multiple response analysis.Results and Conclusion A total of 92 primary medical and health institutions participated in the survey,and 92 valid questionnaires were recovered.The survey shows that 54.1%of the institutions have established more than 8 pharmaceutical administration regulations.63.5%and 31.8%of the institutions have formulated pharmaceutical administration and pharmacotherapy team charters(or management systems).29.7%of institutions have pharmacy personnel in accordance with relevant regulations.The higher proportion of pharmacy services are prescription review and adjustment,medication guidance,collecting and reporting adverse reactions,medication errors and medication hazard information.Primary medical and health institutions still need to further improve their pharmaceutical administration system,organizational structure,pharmacy professional training and clinical pharmacy service.展开更多
Land use/land cover(LULC)change and climate change are two major factors affecting the provision of ecosystem services which are closely related to human well-being.However,a clear understanding of the relationships b...Land use/land cover(LULC)change and climate change are two major factors affecting the provision of ecosystem services which are closely related to human well-being.However,a clear understanding of the relationships between these two factors and ecosystem services in Central Asia is still lacking.This study aimed to comprehensively assess ecosystem services in Central Asia and analyze how they are impacted by changes in LULC and climate.The spatiotemporal patterns of three ecosystem services during the period of 2000-2015,namely the net primary productivity(NPP),water yield,and soil retention,were quantified and mapped by the Carnegie-Ames-Stanford Approach(CASA)model,Integrated Valuation of Ecosystem Services and Tradeoffs(InVEST)model,and Revised Universal Soil Loss Equation(RUSLE).Scenarios were used to determine the relative importance and combined effect of LULC change and climate change on ecosystem services.Then,the relationships between climate factors(precipitation and temperature)and ecosystem services,as well as between LULC change and ecosystem services,were further discussed.The results showed that the high values of ecosystem services appeared in the southeast of Central Asia.Among the six biomes(alpine forest region(AFR),alpine meadow region(AMR),typical steppe region(TSR),desert steppe region(DSR),desert region(DR),and lake region(LR)),the values of ecosystem services followed the order of AFR>AMR>TSR>DSR>DR>LR.In addition,the values of ecosystem services fluctuated during the period of 2000-2015,with the most significant decreases observed in the southeast mountainous area and northwest of Central Asia.LULC change had a greater impact on the NPP,while climate change had a stronger influence on the water yield and soil retention.The combined LULC change and climate change exhibited a significant synergistic effect on ecosystem services in most of Central Asia.Moreover,ecosystem services were more strongly and positively correlated with precipitation than with temperature.The greening of desert areas and forest land expansion could improve ecosystem services,but unreasonable development of cropland and urbanization have had an adverse impact on ecosystem services.According to the results,ecological stability in Central Asia can be achieved through the natural vegetation protection,reasonable urbanization,and ecological agriculture development.展开更多
This study examined regional differences in ecosystem services for the Da Hinggan Mountains(DHM),China.A correction index was constructed based on ten-year average net primary productivity(NPP)data.A new equivalent fa...This study examined regional differences in ecosystem services for the Da Hinggan Mountains(DHM),China.A correction index was constructed based on ten-year average net primary productivity(NPP)data.A new equivalent factor table that was suitable for the assessment of wetlands in the DHM was formed by using the expert weight determination method(EWDM).An evaluation model was established for evaluating the ecosystem service value(ESV)of wetlands in the DHM.The results show that in 2020,the total ESV of wetlands reached 93361×10^(6) USD,with the forest swamp and marsh ecosystems contributing the most.From the perspective of value composition,regulating services and supporting services are the main service functions of wetlands in the DHM.From 2010 to2020,ESV provided by wetlands increased by 4337×10^(6) USD/yr in the DHM.The value of forest swamp and peatland ecosystems increased by 18.6%and 12.7%,respectively,whereas the value of swamp,shrub swamp,and marsh decreased.The research results are of significance for contributing to local government performance evaluation and determining financial compensation for the provision of wetland ecosystem services.展开更多
Rationale: Medical treatment on short-term primary care medical service trips (MSTs) is generally symptom-based and supplemented by point-of-care testing. This pilot study contributes to the effective planning for suc...Rationale: Medical treatment on short-term primary care medical service trips (MSTs) is generally symptom-based and supplemented by point-of-care testing. This pilot study contributes to the effective planning for such austere settings based on predicted symptomology. Objective: We aimed to prospectively document the epidemiology of patients seen during two low-resource clinics on a MST in Honduras and apply predefined case definitions adapted from guidelines used by international healthcare organizations (e.g. World Health Organization). Methods: An observational design was used to track the epidemiology during two clinics on an MST in Limon, Honduras in March 2015. The QuickChart mobile electronic medical record (EMR) application was piloted to document diagnoses according to predefined case definitions. Results: The most commonly diagnosed syndromes were upper respiratory complaints (20.19%), nonspecific abdominal complaints (20.19%), general pain (15.38%), hypertension (9.62%), pruritus (6.73%), and asthma/ COPD (4.81%). The case definitions accounted for 94% of all complaints and diagnoses on the brigade. Discussion: The distribution of common patient diagnoses on this MST was similar to that which had been reported elsewhere. The use of broader symptom-based case definitions for epidemiologic surveillance could also facilitate the syndromic management of patients seen on MSTs, and improve the consistency of treatment offered. Conclusion: Case definitions for common syndromes on primary care MSTs may be a feasible method of standardizing patient management. Preliminary use of the QuickChart EMR was acceptable for documentation of epidemiology in the field. Further study is necessary to investigate the reliability of syndromic diagnostic criteria between different clinicians and in a variety of MST settings.展开更多
The Pharmaceutical Care(PC)service is a growing sector.The continuous development of the role of the professional pharmacist in the sector of health services within the pharmacy leads to having an active role in the p...The Pharmaceutical Care(PC)service is a growing sector.The continuous development of the role of the professional pharmacist in the sector of health services within the pharmacy leads to having an active role in the primary care.The PC service has been in operation for years in other western countries such as Spain,the United Kingdom and the United States.Several studies have been carried out,which confirm the benefits of the service in reducing morbidity,hospital admissions and the cost of the health care system.This article sets out the concept of PC and the financial benefit to health expenditure.It also analyzes the Drug Therapy Problem(DTP)and the Patient Care Process.To conclude,a patient case is presented to understand the practical implementation of the theory of the PC and to show how the professional pharmacist reports the pharmacotherapeutic case.展开更多
This study proposes to discuss the experience lived by Pró-Saúde and PET-Saúde team of FACISA/ UFRN together with the Municipal Health Department of Santa Cruz/RN from a critical-reflexive perspective a...This study proposes to discuss the experience lived by Pró-Saúde and PET-Saúde team of FACISA/ UFRN together with the Municipal Health Department of Santa Cruz/RN from a critical-reflexive perspective about the interaction between education, service and community as well as advances in approach and the strengthening between the school and Primary Health Care. This is an exploratory study with an experience report approach of the Pró-Saúde and PET-Saúde team from 2012 to 2014. The integration of these programs in experimental scenarios of the Unified Health System and the strengthening of the proposed training of human resources capable of the current healthcare system were observed. Thus, contributions in health in undergraduate courses and practices of health services are important, since the approach to the reality of the population and their social needs contribute to the vocational training quality.展开更多
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 presen...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.展开更多
Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in P...Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in Primary Health Care (PHC), and have recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with challenges in achieving the desired results in the PHC system. Thus, the study aimed to explore the factors that influence PCC utilization in the PHC facilities in Nigeria. A qualitative exploratory-descriptive design was used for this study. Data collection was conducted with the nurses from PHC facilities through individual interviews. Data saturation was achieved with 35 participants from 30 PHC facilities in Osun State, Nigeria, using a purposive sampling technique. All interviews were audio-recorded, later transcribed verbatim, and analyzed using the thematic analysis approach. NVivo 12 software was used for data management. The results from this study were categorized into two factors: Organizational factors and individual factors. Six themes that emerged from the study include inadequate management support, insufficient opportunities for further training, work overload and time constraints, health personnel readiness to use PCC, dearth enthusiasm for change, and poor nurses’ Accountability. The study shows that nurses encountered diverse challenges in providing patient-centered care. To improve the quality of healthcare delivery in the PHC facilities, there is a need to reinforce adequate management support, education, continued training, and the internal motivation of nurses to achieve transformative health outcomes in the community.展开更多
Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthc...Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthcare and services to the patient is the nurses’ ability to create a friendly rapport with the patients. Yet, the majority in the rural Primary Health Care facilities are still facing many challenges in demonstrating patient-centeredness services to the community. Thus, the objective of this study is to explore and describe the factors influencing patient-centered care provision and nurses’ experience in Primary Health Care facilities. An exploratory qualitative approach with purposive sampling was used to gather data. Individual interviews with 35 nurses were conducted using a semi-structure interview guide question in the Primary Health Care settings in Nigeria. Each of the interviews with the nurses lasted for 25 minutes to one hour. All interviews were audio-taped, and transcribed verbatim using Microsoft Word. The transcripts were read and re-read, coded using NVivo version 12 software to organize the relevant information and categorized them into themes and sub-themes. Thematic analysis guided this study. The findings revealed three themes and sub-themes. The impact of environmental factors with two subthemes—suitable working environment and coordinated care;resources—shortage of staff and inadequate resources as sub-themes, and lastly, cultural sensitivity and religious influence—communication. Poor implementation of PCC strategies in most of the PHC facilities could lead to poor patient care and a lack of job satisfaction among nurses. This study identified that nurses have both negative and positive experience in providing patient-centered care health services. Providing patient-centered care in the Primary Health Care setting promotes the goal of achieving universal health coverage in Nigeria if the government would prioritize nurses’ pay, employ more staff, provide a conducive working environment, and opportunities for further training programs for nurses to enable and empower them with the necessary knowledge and skills. This, in turn, will translate into a range of outcomes that are socially valued, such as health responsiveness, health coverage and fairness.展开更多
Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will prop...Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will propose improvement in the offered assistance. Methods: This is a quantitative and evaluative study made in the municipality of Santa Cruz, State of Rio Grande do Norte, Brazil, with a sample of 180 people. The study was approved by the Ethics and Research Committee of the Federal University of Rio Grande do Norte under Opinion number 152/2012. Results: It was found that the adult population classified the quality of care from regular to good, showing an association with the waiting time, time spent from the unit to one’s house and the reception. Conclusions: It could be concluded that this study contributes to the development of strategies able to provide a full and equitable care to the adult population in the primary health care network, since this is the gateway to other levels of care, because it aims to promote adult health and prevent diseases.展开更多
<strong>Background:</strong> Anxiety disorders are the most common mental disorders, typically treated with psychotherapy and medication. These treatments are not suitable for, acceptable to, or effective ...<strong>Background:</strong> Anxiety disorders are the most common mental disorders, typically treated with psychotherapy and medication. These treatments are not suitable for, acceptable to, or effective for everyone. Alpha-Stim AID is a Cranial Electrotherapy Stimulation (CES) treatment with evidence of effectiveness in treating anxiety disorders. <strong>Objective:</strong> The aim of this paper is to present outcomes on anxiety, depression, and quality of life of Alpha-Stim use in primary care patients in the United Kingdom’s (UK) National Health Service (NHS) who reported symptoms of anxiety. <strong>Methods: </strong>Open label patient cohort design. Self-report measures: PHQ-9 (depression), GAD-7 (anxiety) and EQ-5D-5L (health related quality of life). Twenty-three patients with symptoms of anxiety completed a six-week course of Alpha-Stim intervention. <strong>Results:</strong> Reliable improvement and remission rates respectively were 60.9% and 17.4% for the GAD-7;42.9% and 22.7% for the PHQ-9. Significant improvement and medium/large effect sizes (n2 = 0.59 and 0.56 respectively). EQ-5D-5L results showed significant improvements in quality of life. Perceived quality of life doubled with an improvement of 0.36 on the health index score, this intervention adds 3.64 Quality Adjusted Life Years (QALYs). <strong>Limitations:</strong> The study was not an RCT, there was no control group. <strong>Conclusions:</strong> Alpha-Stim AID CES can be delivered through a UK primary care practice, and can have a significant impact on symptoms of anxiety and depression, and improve quality of life in primary care patients with anxiety symptoms. Further feasibility studies in primary care and sufficiently powered RCT are required.展开更多
文摘Objective:To determine the degree of client satisfaction with immunisation services at Primary Health facilities in Calabar,Cross River State,Nigeria.Method:A semi-structured questionnaire was administered on 402 caregivers who were selected using systematic random sampling from four primary health centres.The four centres were randomly selected from the 19 health centres using the table of random numbers.Data obtained were analysed using Epi-Info s of tware version 2002.Results:The majority of clients were dissatisfied with most aspects of care given at the Health Care Centres including long waiting time,accessibility of immunisation services,poor respect for clients’ rights,especially to their dignity,health information and counseling on their medical needs.Conclusions:The study concludes that client satisfaction with immunization service in Calabar was low due to poor attitude of health care providers,long waiting time and lack of respect for clients’ rights.
基金This research was funded by the Key Laboratory for Sustainable Development of Xinjiang's Historical and Cultural Tourism,Xinjiang University,China(LY2022-06)the Tianchi Talent Project.
文摘Nature reserves play a significant role in providing ecosystem services and are key sites for biodiversity conservation.The Tianchi Bogda Peak Natural Reserve(TBPNR),located in Xinjiang Uygur Autonomous Region,China,is an important ecological barrier area in the temperate arid zone.The evaluation of its important ecosystem services is of great significance to improve the management level and ecological protection efficiency of the reserve.In the present study,we assessed the spatiotemporal variations of four ecosystem services(including net primary productivity(NPP),water yield,soil conservation,and habitat quality)in the TBPNR from 2000 to 2020 based on the environmental and social data using the Integrated Valuation of Ecosystem Services and Trade-offs(InVEST)model.In addition,the coldspot and hotspot areas of ecosystem services were identified by hotspot analysis,and the trade-off and synergistic relationships between ecosystem services were analyzed using factor analysis in a geographic detector.During the study period,NPP and soil conservation values in the reserve increased by 48.20%and 25.56%,respectively;conversely,water yield decreased by 16.56%,and there was no significant change in habitat quality.Spatially,both NPP and habitat quality values were higher in the northern part and lower in the southern part,whereas water yield showed an opposite trend.Correlation analysis revealed that NPP showed a synergistic relationship with habitat quality and soil conservation,and exhibited a trade-off relationship with water yield.Water yield and habitat quality also had a trade-off relationship.NPP and habitat quality were affected by annual average temperature and Normalized Difference Vegetation Index(NDVI),respectively,while water yield and soil conservation were more affected by digital elevation model(DEM).Therefore,attention should be paid to the spatial distribution and dynamics of trade-off and synergistic relationships between ecosystem services in future ecological management.The findings of the present study provide a reference that could facilitate the sustainable utilization of ecosystem services in the typical fragile areas of Northwest China.
文摘Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.
文摘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.
文摘Net Primary Productivity (NPP) is the basis of the material and energy transport calculation in ecosystem studies. NPP directly reflects the production capacity of plant communities under natural conditions. Ecosystem services are hot topics in the field of ecology. Many studies calculate ecosystem service value based on NPP. Taking Guanshanhu District of Guiyang City, Guizhou Province as the research object, using TM, ETM<sup>+</sup>, Gaofen2 and MOD17A3HGF.006 as data sources, this paper analyzed the change of ecosystem service value based on NPP in 2000, 2010 and 2020. The results showed that the area of forest ecosystem increased during 2000-2010 and decreased during 2010-2020. The artificial surface grew rapidly from 1146.82 hm<sup>2</sup> to 7544.29 hm<sup>2</sup> during 2000-2020. The farmland ecosystem decreased from 13308.29 hm<sup>2</sup> to 6342.33 hm<sup>2</sup> during 2000-2020. With the dynamic changes in ecosystem spatial distribution and component structure, the total NPP in 2000, 2010 and 2020 was 12.58 × 10<sup>4</sup> t, 11.90 × 10<sup>4</sup> t and 11.78 × 10<sup>4</sup> t, respectively, showing a decreasing trend. The total value of natural and semi-natural ecosystems services based on NPP showed an increasing trend, which was ¥ 6.938 × 10<sup>8</sup> in 2000, ¥ 8.052 × 10<sup>8</sup> in 2010 and ¥ 10.306 × 10<sup>8</sup> in 2020 respectively. The ecosystem contributed the most to the ecological service value in 2000 was farmland, but in 2010 and 2020, it was the forest ecosystem. The ecological service value of grassland and wetland was relatively small, while the ratio of the wetland ecological service value displayed a decreasing trend. In the future, it is necessary to establish a strict pretrial system for land use, so as to effectively protect the natural and semi-natural ecosystems and fulfill the growing ecological demands of residents.
文摘Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies.Methods Multi-stage stratified random sampling was used to collect questionnaires from primary medical and health institutions in 5 provinces,and 102 questionnaires were distributed.Then Excel 2016 and IBM SPSS 21.0 software were applied for descriptive statistical analysis,chi-square test and multiple response analysis.Results and Conclusion A total of 92 primary medical and health institutions participated in the survey,and 92 valid questionnaires were recovered.The survey shows that 54.1%of the institutions have established more than 8 pharmaceutical administration regulations.63.5%and 31.8%of the institutions have formulated pharmaceutical administration and pharmacotherapy team charters(or management systems).29.7%of institutions have pharmacy personnel in accordance with relevant regulations.The higher proportion of pharmacy services are prescription review and adjustment,medication guidance,collecting and reporting adverse reactions,medication errors and medication hazard information.Primary medical and health institutions still need to further improve their pharmaceutical administration system,organizational structure,pharmacy professional training and clinical pharmacy service.
基金This study was supported by the Strategic Priority Research Program of Chinese Academy of Sciences,the Pan-Third Pole Environment Study for a Green Silk Road(Pan-TPE)(XDA2004030202).
文摘Land use/land cover(LULC)change and climate change are two major factors affecting the provision of ecosystem services which are closely related to human well-being.However,a clear understanding of the relationships between these two factors and ecosystem services in Central Asia is still lacking.This study aimed to comprehensively assess ecosystem services in Central Asia and analyze how they are impacted by changes in LULC and climate.The spatiotemporal patterns of three ecosystem services during the period of 2000-2015,namely the net primary productivity(NPP),water yield,and soil retention,were quantified and mapped by the Carnegie-Ames-Stanford Approach(CASA)model,Integrated Valuation of Ecosystem Services and Tradeoffs(InVEST)model,and Revised Universal Soil Loss Equation(RUSLE).Scenarios were used to determine the relative importance and combined effect of LULC change and climate change on ecosystem services.Then,the relationships between climate factors(precipitation and temperature)and ecosystem services,as well as between LULC change and ecosystem services,were further discussed.The results showed that the high values of ecosystem services appeared in the southeast of Central Asia.Among the six biomes(alpine forest region(AFR),alpine meadow region(AMR),typical steppe region(TSR),desert steppe region(DSR),desert region(DR),and lake region(LR)),the values of ecosystem services followed the order of AFR>AMR>TSR>DSR>DR>LR.In addition,the values of ecosystem services fluctuated during the period of 2000-2015,with the most significant decreases observed in the southeast mountainous area and northwest of Central Asia.LULC change had a greater impact on the NPP,while climate change had a stronger influence on the water yield and soil retention.The combined LULC change and climate change exhibited a significant synergistic effect on ecosystem services in most of Central Asia.Moreover,ecosystem services were more strongly and positively correlated with precipitation than with temperature.The greening of desert areas and forest land expansion could improve ecosystem services,but unreasonable development of cropland and urbanization have had an adverse impact on ecosystem services.According to the results,ecological stability in Central Asia can be achieved through the natural vegetation protection,reasonable urbanization,and ecological agriculture development.
基金Under the auspices of the National Natural Science Foundation of China(No.U19A2042,U20A2083,42001112)。
文摘This study examined regional differences in ecosystem services for the Da Hinggan Mountains(DHM),China.A correction index was constructed based on ten-year average net primary productivity(NPP)data.A new equivalent factor table that was suitable for the assessment of wetlands in the DHM was formed by using the expert weight determination method(EWDM).An evaluation model was established for evaluating the ecosystem service value(ESV)of wetlands in the DHM.The results show that in 2020,the total ESV of wetlands reached 93361×10^(6) USD,with the forest swamp and marsh ecosystems contributing the most.From the perspective of value composition,regulating services and supporting services are the main service functions of wetlands in the DHM.From 2010 to2020,ESV provided by wetlands increased by 4337×10^(6) USD/yr in the DHM.The value of forest swamp and peatland ecosystems increased by 18.6%and 12.7%,respectively,whereas the value of swamp,shrub swamp,and marsh decreased.The research results are of significance for contributing to local government performance evaluation and determining financial compensation for the provision of wetland ecosystem services.
文摘Rationale: Medical treatment on short-term primary care medical service trips (MSTs) is generally symptom-based and supplemented by point-of-care testing. This pilot study contributes to the effective planning for such austere settings based on predicted symptomology. Objective: We aimed to prospectively document the epidemiology of patients seen during two low-resource clinics on a MST in Honduras and apply predefined case definitions adapted from guidelines used by international healthcare organizations (e.g. World Health Organization). Methods: An observational design was used to track the epidemiology during two clinics on an MST in Limon, Honduras in March 2015. The QuickChart mobile electronic medical record (EMR) application was piloted to document diagnoses according to predefined case definitions. Results: The most commonly diagnosed syndromes were upper respiratory complaints (20.19%), nonspecific abdominal complaints (20.19%), general pain (15.38%), hypertension (9.62%), pruritus (6.73%), and asthma/ COPD (4.81%). The case definitions accounted for 94% of all complaints and diagnoses on the brigade. Discussion: The distribution of common patient diagnoses on this MST was similar to that which had been reported elsewhere. The use of broader symptom-based case definitions for epidemiologic surveillance could also facilitate the syndromic management of patients seen on MSTs, and improve the consistency of treatment offered. Conclusion: Case definitions for common syndromes on primary care MSTs may be a feasible method of standardizing patient management. Preliminary use of the QuickChart EMR was acceptable for documentation of epidemiology in the field. Further study is necessary to investigate the reliability of syndromic diagnostic criteria between different clinicians and in a variety of MST settings.
文摘The Pharmaceutical Care(PC)service is a growing sector.The continuous development of the role of the professional pharmacist in the sector of health services within the pharmacy leads to having an active role in the primary care.The PC service has been in operation for years in other western countries such as Spain,the United Kingdom and the United States.Several studies have been carried out,which confirm the benefits of the service in reducing morbidity,hospital admissions and the cost of the health care system.This article sets out the concept of PC and the financial benefit to health expenditure.It also analyzes the Drug Therapy Problem(DTP)and the Patient Care Process.To conclude,a patient case is presented to understand the practical implementation of the theory of the PC and to show how the professional pharmacist reports the pharmacotherapeutic case.
文摘This study proposes to discuss the experience lived by Pró-Saúde and PET-Saúde team of FACISA/ UFRN together with the Municipal Health Department of Santa Cruz/RN from a critical-reflexive perspective about the interaction between education, service and community as well as advances in approach and the strengthening between the school and Primary Health Care. This is an exploratory study with an experience report approach of the Pró-Saúde and PET-Saúde team from 2012 to 2014. The integration of these programs in experimental scenarios of the Unified Health System and the strengthening of the proposed training of human resources capable of the current healthcare system were observed. Thus, contributions in health in undergraduate courses and practices of health services are important, since the approach to the reality of the population and their social needs contribute to the vocational training quality.
基金supported through funding from the Australian Government Department of Health.
文摘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.
文摘Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in Primary Health Care (PHC), and have recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with challenges in achieving the desired results in the PHC system. Thus, the study aimed to explore the factors that influence PCC utilization in the PHC facilities in Nigeria. A qualitative exploratory-descriptive design was used for this study. Data collection was conducted with the nurses from PHC facilities through individual interviews. Data saturation was achieved with 35 participants from 30 PHC facilities in Osun State, Nigeria, using a purposive sampling technique. All interviews were audio-recorded, later transcribed verbatim, and analyzed using the thematic analysis approach. NVivo 12 software was used for data management. The results from this study were categorized into two factors: Organizational factors and individual factors. Six themes that emerged from the study include inadequate management support, insufficient opportunities for further training, work overload and time constraints, health personnel readiness to use PCC, dearth enthusiasm for change, and poor nurses’ Accountability. The study shows that nurses encountered diverse challenges in providing patient-centered care. To improve the quality of healthcare delivery in the PHC facilities, there is a need to reinforce adequate management support, education, continued training, and the internal motivation of nurses to achieve transformative health outcomes in the community.
文摘Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthcare and services to the patient is the nurses’ ability to create a friendly rapport with the patients. Yet, the majority in the rural Primary Health Care facilities are still facing many challenges in demonstrating patient-centeredness services to the community. Thus, the objective of this study is to explore and describe the factors influencing patient-centered care provision and nurses’ experience in Primary Health Care facilities. An exploratory qualitative approach with purposive sampling was used to gather data. Individual interviews with 35 nurses were conducted using a semi-structure interview guide question in the Primary Health Care settings in Nigeria. Each of the interviews with the nurses lasted for 25 minutes to one hour. All interviews were audio-taped, and transcribed verbatim using Microsoft Word. The transcripts were read and re-read, coded using NVivo version 12 software to organize the relevant information and categorized them into themes and sub-themes. Thematic analysis guided this study. The findings revealed three themes and sub-themes. The impact of environmental factors with two subthemes—suitable working environment and coordinated care;resources—shortage of staff and inadequate resources as sub-themes, and lastly, cultural sensitivity and religious influence—communication. Poor implementation of PCC strategies in most of the PHC facilities could lead to poor patient care and a lack of job satisfaction among nurses. This study identified that nurses have both negative and positive experience in providing patient-centered care health services. Providing patient-centered care in the Primary Health Care setting promotes the goal of achieving universal health coverage in Nigeria if the government would prioritize nurses’ pay, employ more staff, provide a conducive working environment, and opportunities for further training programs for nurses to enable and empower them with the necessary knowledge and skills. This, in turn, will translate into a range of outcomes that are socially valued, such as health responsiveness, health coverage and fairness.
文摘Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will propose improvement in the offered assistance. Methods: This is a quantitative and evaluative study made in the municipality of Santa Cruz, State of Rio Grande do Norte, Brazil, with a sample of 180 people. The study was approved by the Ethics and Research Committee of the Federal University of Rio Grande do Norte under Opinion number 152/2012. Results: It was found that the adult population classified the quality of care from regular to good, showing an association with the waiting time, time spent from the unit to one’s house and the reception. Conclusions: It could be concluded that this study contributes to the development of strategies able to provide a full and equitable care to the adult population in the primary health care network, since this is the gateway to other levels of care, because it aims to promote adult health and prevent diseases.
文摘<strong>Background:</strong> Anxiety disorders are the most common mental disorders, typically treated with psychotherapy and medication. These treatments are not suitable for, acceptable to, or effective for everyone. Alpha-Stim AID is a Cranial Electrotherapy Stimulation (CES) treatment with evidence of effectiveness in treating anxiety disorders. <strong>Objective:</strong> The aim of this paper is to present outcomes on anxiety, depression, and quality of life of Alpha-Stim use in primary care patients in the United Kingdom’s (UK) National Health Service (NHS) who reported symptoms of anxiety. <strong>Methods: </strong>Open label patient cohort design. Self-report measures: PHQ-9 (depression), GAD-7 (anxiety) and EQ-5D-5L (health related quality of life). Twenty-three patients with symptoms of anxiety completed a six-week course of Alpha-Stim intervention. <strong>Results:</strong> Reliable improvement and remission rates respectively were 60.9% and 17.4% for the GAD-7;42.9% and 22.7% for the PHQ-9. Significant improvement and medium/large effect sizes (n2 = 0.59 and 0.56 respectively). EQ-5D-5L results showed significant improvements in quality of life. Perceived quality of life doubled with an improvement of 0.36 on the health index score, this intervention adds 3.64 Quality Adjusted Life Years (QALYs). <strong>Limitations:</strong> The study was not an RCT, there was no control group. <strong>Conclusions:</strong> Alpha-Stim AID CES can be delivered through a UK primary care practice, and can have a significant impact on symptoms of anxiety and depression, and improve quality of life in primary care patients with anxiety symptoms. Further feasibility studies in primary care and sufficiently powered RCT are required.