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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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”.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

Training can improve healthcare providers’ cultural competence and increase their awareness of bias and discrimination in medical decision-making. Cultural competences training is lacking in the education of dieticians in the Netherlands. The aim of this study was to describe the pilot-implementation of a cultural competence training for dieticians and preliminary evaluation of the training.

A training was developed based on Seeleman’s cultural competence framework and previously held interviews with migrants, dieticians, and experts. The training consisted of a mixture of didactic and experiential methods, alternating knowledge transfer with exercises to increase awareness, reflection, and feed-back on recorded consultations, and communication training with migrant training actors. The training was piloted in 8 participating dieticians and preliminary mixed-method evaluation was done using a Cultural Competence Questionnaire, Experience Evaluation Questionnaire, and consultation observations.

The questionnaires showed that dieticians were positive about the training. They found it valuable and educational. Participants reported an increase in self-perceived cultural competence and attitudes. Knowledge and skills remained approximately the same. The observations showed that dieticians applied the teach-back method and discussed treatment options more often after training. There was no increase in the use of visual materials.

The training was well appreciated and, although a small-scale pilot, this mixed-method study suggests an ability to change cultural competence. The combination of a self-assessment instrument and consultation observations to evaluate cultural competence was highly valuable and feasible. These encouraging results justify a broader implementation of the training.

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.

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.

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.

Although psychological interventions can be used to improve chronic pain management, underserved individuals (i.e., racially minoritized and socioeconomically disadvantaged) may be less likely to engage in such services. The purpose of this study was to examine whether offering a psychological intervention for chronic pain in a primary care clinic could be a method in which to successfully engage underserved patients.

There were 220 patients with chronic pain in a primary care clinic located in a socioeconomically and racially diverse city who were approached to discuss enrolment in a pilot randomized controlled trial of a five-session psychological intervention for chronic pain. Patients were introduced to the study by their primary care provider using the warm handoff model. We compared whether there were sociodemographic differences between those who enrolled in the study and those who declined to enrol.

There were no differences between those who enrolled and those who declined enrolment with regard to race, age, insurance type, and household income. However, females were more likely to enrol in the study compared to males.

Recruiting patients to participate in a trial of a psychological intervention for chronic pain in a primary care clinic appeared to be effective for engaging Black patients, patients with lower income, and those with government insurance. Thus, offering a psychological intervention for chronic pain in a primary care clinic may encourage engagement among racially minoritized individuals and those with lower socioeconomic status.

The goals of this investigation were to 1) identify and measure exposures inside homes of individuals with chemical intolerance (CI), 2) provide guidance for reducing these exposures, and 3) determine whether our environmental house calls (EHCs) intervention could reduce both symptoms and measured levels of indoor air contaminants.

CI is an international public health and clinical concern, but few resources are available to address patients’ often disabling symptoms. Numerous studies show that levels of indoor air pollutants can be two to five (or more) times higher than outdoor levels. Fragranced consumer products, including cleaning supplies, air fresheners, and personal care products, are symptom triggers commonly reported by susceptible individuals.

A team of professionals trained and led by a physician/industrial hygienist and a certified indoor air quality specialist conducted a series of 5 structured EHCs in 37 homes of patients reporting CI.

We report three case studies demonstrating that an appropriately structured home intervention can teach occupants how to reduce indoor air exposures and associated symptoms. Symptom improvement, documented using the Quick Environmental Exposure and Sensitivity Inventory Symptom Star, corresponded with the reduction of indoor air volatile organic compounds, most notably fragrances. These results provide a deeper dive into 3 of the 37 cases described previously in Perales et al. (2022).

We address the long-standing dilemma that worldwide reports of fragrance sensitivity have not previously been confirmed by human or animal challenge studies. Our ancient immune systems’ ‘first responders’, mast cells, which evolved 500 million years ago, can be sensitized by synthetic organic chemicals whose production and use have grown exponentially since World War II. We propose that these chemicals, which include now-ubiquitous fragrances, trigger mast cell degranulation and inflammatory mediator release in the olfactory-limbic tract, thus altering cerebral blood flow and impairing mood, memory, and concentration (often referred to as ‘brain fog’). The time has come to translate these research findings into clinical and public health practice.

The current study aims at describing sexually transmitted infections (STI) surveillance data collected from 2015 to 2020 as well as investigating patients’ characteristics and risk factors in the sample population.

Reported STI cases are continuously increasing in Europe. In Belgium, 94.1% of citizens have a regular general practitioner (GP) or are affiliated to a general practice. By using GPs for surveillance, STIs can be monitored in the general population. Between January 2015 and December 2020, the Sentinel General Practitioners (SGP) network retrospectively reported five STIs: chlamydia, gonorrhoea, genital warts, herpes, and syphilis.

In the SGP network database on STIs, participating GPs report on case-by-case basis through paper or online registration forms. We performed descriptive statistics, X2 test and logistic regression using SAS® 9.4. Multivariate multiple logistic regression was performed to investigate the relationship between STIs and patients’ characteristics.

During the study period, 1009 cases were reported, corresponding to an episode-based incidence estimated at 121 per 100,000 inhabitants. The majority of patients (59.8%) were men, and 83.6% were under age 30. Among female patients 92.7% had heterosexual contacts whereas 64.4% of male patients did. Women were more likely to be diagnosed with chlamydia (odds ratio [OR] 1.56; 95% confidence interval [CI] 1.12–2.17) and herpes (OR 1.72, 95% CI 1.04–2.86) than men.

In this study, STI surveillance data were in agreement with literature. Continuous surveillance through the SGP network remains an important tool to obtain information about populations at risk and STI incidence in the general population.

The concept of lifestyle-based risk scores is known but not evaluated in most rural communities of low- to mid-income countries. This study investigated the correlation of lifestyle scores with health indices.

This was a descriptive cross-sectional investigation. A total of 203 participants (141 females and 62 males), 18–90 years, had anthropometric assessments and lifestyle scores determined from a 12-item framework. Data analysis included average age in different health conditions, lifestyle scores in age groups, and correlations with age.

Average age of healthy subpopulation was 39 years while diabetes, hypertension, and obesity subpopulations were 58, 64, and 56 years, respectively. The percentage of participants whose activities of daily living (ADL) were unaffected by ill-health decreased with age (P < 0.0001), and lifestyle scores also decreased with age (P < 0.01) and negatively correlated with physical activities.

This report contributes to diabetes cardiovascular complications management. Sedentary ADL factors need integration in healthy lifestyle education especially among the elderly.

To understand young women’s views of cervical screening, what obstacles they face, and what encourages them when considering attending their cervical screening.

Cervical screening figures have been steadily decreasing in the United Kingdom (UK). There is limited research on this trend, especially around views and knowledge of young women, aged 20–24 years, have before they are eligible for cervical screening.

This qualitative study conducted 15 semi-structured Zoom in-depth interviews to discuss young women’s knowledge and perceptions of cervical screening in 2022. Participants were based in the UK. Thematic analysis was used to systematically manage, analyse, and identify themes including cervical screening knowledge; perceptions of cervical screening; barriers to cervical screening; and facilitators of cervical screening.

The findings demonstrate significant gaps in knowledge and negative perceptions of cervical screening. Barriers to attending cervical screening were perceived pain and embarrassment. Facilitators suggested to promote attendance were ensuring access to appointments, creating pop-up clinics, and utilising incentives. The level of knowledge demonstrated by the participants, their negatively framed perceptions; and the vast number of barriers identified present substantial factors that could affect future attendance to cervical screening. Overall, action needs to be taken to prevent decreasing cervical screening attendance rates and eradicate any barriers women may experience.

Gestalt therapy (GT) and systemic pedagogy (SP) are useful tools to approach emotional difficulties and mental health problems among children and adolescents. The main objective of this study was to explore the perceptions on GT and SP techniques in paediatric mental health-related consultations in a primary healthcare (PHC) centre in Catalonia in 2018–2019, among families, healthcare, and education professionals.

Qualitative study, combining semi-structured interviews with families (N = 42) and professionals (N = 15), conducted after a series paediatric PHC consultations including GT and SP techniques. Interviews lasted between 15 and 90 min and were conducted at the PHC centre where GT/SP consultations took place, and at professionals’ workplaces. Socio-demographics, reasons for consultation, and quantitative ratings on the perceived effectiveness of GT/SP consultations were also collected to combine these data with the qualitative interviews. Qualitative data were analyzed descriptively using thematic analysis. Quantitative data were analyzed by calculating frequencies (percentages) for categorical variables, and means, medians, and ranges for continuous variables.

Narratives from families and healthcare professionals indicate that GT/SP consultations might have been effective in improving children and adolescents’ symptomatology and emotional health. Improved well-being within the family context was another main finding, based on families’ perceptions and experiences. Besides, GT/SP were considered acceptable for approaching emotional and mental health in PHC services, although barriers for implementation were identified.

This study presents data on the potential usefulness of GT/SP to design and implement services that promote emotional and mental health among children and adolescents in PHC. Also, for the development of health policies and future research in this area.

It is essential to increase the rates of early diagnosis in cancer control, and the diagnostic process needs to be improved to achieve this goal. Previous studies showed that in countries where there is a gatekeeping system, there might be a delay in cancer diagnosis. Our aim is to examine the process of cancer diagnosis in a healthcare system without gatekeeping.

A quantitative descriptive study has been conducted in various outpatient clinics of Pendik Training and Research Hospital, between 1 February and 31 May 2019, with individuals aged over 18 and diagnosed with cancer in the last six months. The data was collected through a questionnaire filled in by face-to-face interview method. Patient’s socio-economic characteristics, their symptoms at the time of the diagnosis and the diagnosis process were questioned.

The median diagnostic interval was 30 days (min–max 1–365), and the median patient interval was 60 (1–600) days. Patients pointed out that the diagnostic tests, especially the pathology reporting process, caused the diagnostic interval to be prolonged. Of the patients, 84% (n 135) stated that they did not consider their symptoms as a sign of serious illness. The patient interval was shortest with symptoms of haematuria and haematochezia and longest with dysuria and change in bladder habit.

The study examined the diagnosis process in our health system, where patients can apply for health services at any stage. The results showed that there were no superior outcomes to those observed in primary care-led health systems. Patients reported that waiting times for medical tests led to prolongation of the diagnosis time. Cancer awareness of patients should also be increased to shorten patient admission times.

This scoping review aimed to identify the social prescription activities that exist for the elderly in a community context.

The increase in population ageing imposes the need to implement specific actions that guarantee elderly people the possibility of experiencing this phase with quality. The pandemic significantly exacerbated the needs of the elderly, leading to, regarding the loss of functional capacity, quality of life, well-being, mental health, and increased loneliness. Social prescription emerges as an innovative and non-clinical strategy, being a personalized approach that focuses on individual needs and objectives (Islam, 2020). By referring primary health care users to resources available in the community, obtaining non-medical support that can be used in conjunction with, or instead of, existing medical treatments (Chng et al., 2021).

A scoping review was conducted based on preferred reporting items for systematic reviews and meta-analyses, extension for scoping reviews (PRISMA-ScR). Searches were performed in electronic databases for potential studies: Scopus, PubMed, Medline, and Psychology and Behavioral Sciences Collection. Studies were included if they: (1) addressed social prescription interventions; (2) were community based; and (3) included elderly participants. Data extraction followed predefined criteria.

Of a total of 865 articles identified, nine were selected. The social prescription activities identified fall into eight main domains: arts, personal development, social interaction, physical activity, gardening, cultural activities, religious activities, and technological activities. The interventions resulted in improved well-being, enhanced quality of life, health promotion, and reduced isolation and loneliness. Social prescription, while innovative, is still an evolving intervention, which can respond to the needs of the elderly population, given the range of activities that may exist in the community. Primary care professionals must develop these interventions, establish a link between health and the community, respond to these needs, and promote healthy ageing.

Referral system is among the key elements of primary health care that leads to enhanced efficiency, reduced costs, reduced waiting time, and patients’ enhanced access to more specialized services. The present study was aimed at analysing the policies of the electronic referral (e-Referral) system in Iran.

This qualitative study was conducted based on Walt and Gilson’s policy triangle and Kingdon’s models. Data were collected through document analysis and 51 semi-structured interviews with managers at various levels, experts, family physicians, specialist physicians, and patients. Document analysis was performed by content analysis method, and interview analysis was performed through framework analysis method in Atlas.ti 8.

The e-Referral system was launched with the aim of equitable access to services and to benefit from better management of health resources. Valid scientific evidences were used to formulate policies. Numerous meetings were held with domestic and foreign stakeholders at the provincial, city, and rural levels. The implementation of the programme followed a bottom-up approach, and the main obstacles to the implementation of the programme included the change of senior managers of the health system and their not being fully aware of the importance of the programme, inadequate allocation of financial resources, and unwillingness of some patients to follow the referral system.

The policy triangle framework, while explaining the components of the e-Referral system programme, revealed the obstacles to the proper implementation of the programme. In order to ensure that the programme goes on continuously and successfully, it is essential to create the necessary determination and commitment on the part of the minister of health and medical education and senior managers of the health system, earmark resources for the programme, improve resource allocation with insurance management, reform the payment system, plan to raise public awareness, and attract community participation.

This study aims to assess the health worker absenteeism and factors associated with it in a high-focus district in Chhattisgarh, India.

Human resources for health are among the key foundations to build resilient healthcare systems. Chhattisgarh is a high-focus Indian state with a severe shortage of health care workers, and absenteeism further aggravates the shortage.

This study was conducted as a mixed-methods study employing sequential explanatory design. Absenteeism was defined as the absence of health worker in the designated position without a formal leave or official reason in two different unannounced visits. A facility survey across all the public healthcare facilities in Jashpur district, Chhattisgarh, was conducted through random, unannounced visits employing a checklist developed based on Indian Public Health Standards. Twelve participants were purposively sampled and interviewed from healthcare facilities to explore factors associated with absenteeism. Survey data were analysed descriptively, and thematic analysis was employed to analyse qualitative interviews.

Among all the positions filled at primary health centre level (n = 339), close to 8% (n = 27) were absent, whereas among the positions filled at community health centre level (n = 285), only 1.14% (n = 4) were absent. Absenteeism was not found in the district hospital. Qualitative interviews reveal that macro-level (geographical location and lack of connectivity), meso-level (lack of equipment and amenities, makeshift health facilities, doctor shortage, and poor patient turnover), and micro-level (unmet expectations) factors contribute to health worker absenteeism.

Health worker absenteeism was more at PHC level. Systemic challenges, human resource shortages, and infrastructural shortcomings contributed to health worker absenteeism.