As ações profissionais da/o assistente social na atenção primária em saúde no contexto da pandemia de Covid-19

O artigo sistematiza as ações das/os Assistentes Sociais vinculadas/os a um curso de residência multiprofissional em saúde da família cuja atuação ocorreu na Atenção Primária em Saúde (APS), durante a pandemia do novo coronavírus, num contexto de reorganização dos serviços de saúde e do trabalho das/os profissionais do setor. Pretende-se contribuir com as reflexões sobre a dimensão técnico-operativa da Profissão abordando aspectos do trabalho no Núcleo Ampliado em Saúde da Família (NASF) neste período de excepcionalidade. A sistematização foi realizada a partir dos registros em diários de campo elaborados pelas/os profissionais entre os meses de março a setembro de 2020. Os principais resultados indicam que a crise sanitária aprofundou as desigualdades sociais demandando ações profissionais predominantemente socioeducativas voltadas ao acesso da população aos serviços e direitos sociais que amparam e oferecem condições de vida diante das mudanças provocadas pela pandemia. A reorganização requerida no processo coletivo de trabalho nos serviços de saúde implicou em alterações dos fluxos de acesso aos serviços e direitos sociais. Significa que, no período analisado, predominaram demandas profissionais de gestão e planejamento seja envolvendo a elaboração de materiais informativos de suporte às ações educativas, divulgação de informações pertinentes à população usuária do SUS, bem como de instrução às equipes multiprofissionais quanto aos benefícios sociais disponibilizados para mitigar os efeitos da pandemia. As ações socioeducativas voltadas para mobilização e assessoria político-organizativas apresentaram-se imprescindíveis para concretizar o acesso às práticas coletivas de controle social atentas à universalidade do direito à saúde.Alternate :This article systematizes the actions of social assistants associated to a multi-professional residency course in family health, undertaken within the Primary Healthcare System, during the new coronavirus pandemic, in a context of reorganization of healthcare services and the labor of professionals in the sector. Its objective is to contribute to reflections about the technical-operative dimension of the profession, addressing aspects of work by the Expanded Family Healthcare Nucleus in this exceptional period. The systematization was conducted through registers in field diaries prepared by the professionals from March to September 2020. The main results indicate that the sanitary crisis deepened social inequalities, requiring predominantly educational professional actions aimed at the population's access to social rights and services that support better living conditions, considering changes provoked by the pandemic. The reorganization required in the collective work process in healthcare services involved alterations in the flows of access to social services and rights. This means that, in the period analyzed, there was a predominance of professional demands related to administration and planning, that involved the elaboration of informative materials to support educational actions, the promotion of pertinent information to the population that uses Brazil's federal public single healthcare system, and providing instructions to multi-professional teams about social benefits available to mitigate the effects of the pandemic. The socio-educational actions aimed at mobilization and political-organizational assistance were essential to realizing access to collective practices of social control focused on the universal right to healthcare.

Co-evolution of Pandemic, Human Security, and Technology

COVID-19 pandemic has placed a huge burden on the healthcare system, and mainly on healthcare workers who have faced the biggest challenges and concerns in their health profession toward the unprecedented outbreak of coronavirus worldwide. Science and technology for handling a pandemic has always been there in some form in different countries. This chapter presents key lessons from various community-based activities where technologies have been widely used and emphasizes the importance of interfacing science policy practice to sustainable development. Relative importance and emphasis of science and technology for human security gets mentioned as well. Further, case studies of a few nations illustrate the existence of a good partnership of science technology groups and different other stakeholders. However, the need to strengthen this partnership with a clearer direction and strategy for implementation as a mechanism to foster collaboration across global and regional mechanisms and institutions for the implementation and coherence of instruments and tools relevant to Human Security and Health for all. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer 2022.

The COVID-19 Pandemic Influence on Doctor's Service Performance Using Workload as a Mediation Variable

BACKGROUND: The COVID-19 pandemic greatly affected doctors' increasing workload, especially in Primary Health Care Facilities. If this is not addressed immediately, it will affect the performance or quality of a doctor's service. AIM: This research objective is to identify the role of Primary Healthcare Facility doctors' workload in moderating the impact of the COVID-19 Pandemic on their performance. METHOD(S): The explanatory-descriptive research was conducted using a quantitative approach. The research respondents were 103 general practitioners who worked at a Primary Healthcare Facility in Malang City (35.0% male and 65.0% female, the most extensive age range was 26-35 years (74.8%), with a working period of 1-5 years. 57 (55.3%) The research instrument was a questionnaire declared valid and reliable, distributed online, and analyzed using Partial Least Square. RESULT(S): The findings demonstrated that the COVID-19 pandemic significantly positively affected the performance of Primary Healthcare Facility doctors (beta = 0.455, t stat = 11.390). The pandemic also significantly impacted workload (beta = 0.283, t stat = 4.347). Workload impacted performance significantly and positively (beta = 0.224, t stat 4.157). Workload mediates the COVID-19 Pandemic influence on doctors' performance (beta = 0.063, t stat = 3.005). CONCLUSION(S): Doctors at Primary Health Care have not all experienced a decline in performance despite the increased workload due to the COVID-19 Pandemic. It forces doctors to juggle between completing their tasks, fighting against disease, and improving their performance.Copyright © 2023.

Exploring patient response towards hotline-based telemedicine service in Bangladesh

Background: Telemedicine system enables doctors and patients to communicate while staying afar which can be helpful for areas with lesser health facilities and at times of natural or health disasters. In developing countries like Bangladesh, telemedicine service offers the potential for wider health access and equity if effectively implemented. Therefore, the response and acceptance of care receivers who are the main beneficiaries of the service should be explored. As Dhaka University Telemedicine Programme (DUTP) is a non-profit University project-induced successful telemedicine service in Bangladesh, our study was conducted on the DUTP hotline-based telemedicine programme aimed to explore patients' prior knowledge and response (experience, satisfaction and acceptance) about the service. Method(s): The cross-sectional study was conducted by interviewing 200 participants over the phone with a structured questionnaire to analyze their knowledge and response. Participants were selected by randomization from the patient pool of hotline-based DUTP telemedicine service. The data was analyzed using SPSSv20. Results and discussion: Among the participants, 41% of total participants knew about telemedicine services before COVID-19. Average patient satisfaction was well above moderate level (p-value< 0.01;mean 3.88). 16.5% respondents mentioned about having any problem while availing the service where 'treatment or service related problem' was the most common. Significant association was found between people's 'occupation' and 'knowledge before COVID-19' (p = 0.002) indicating to the probable role of profession or occupation in molding people's health-service related knowledge. Patient-doctor communication ['perception about doctor's adequate evaluation (Q3)' and 'understanding doctor's advice properly (Q4)'] was found to be significantly associated with 'age' and 'location (division)' while most respondents (around 90%) perceived the communication as effective. 'Age' had also an association with 'treatment or service related problem'. 80.5% were willing to take the service in the future even by paying fees. All participants appreciated telemedicine service in general when they were asked about its possible inclusion in mainstream primary healthcare. Conclusion(s): The overall response of patients toward DUTP hotline-based telemedicine, in general, came out to be positive. Concerned authorities and policymakers may exploit this accepting attitude of people toward developing effective telemedicine services in order to ensure wider health and well-being of population.Copyright © 2023 The Authors

Parsonage-Turner syndrome: A case report of a rare side effect of COVID-19 booster vaccination.

The mass vaccination against COVID-19 has saved millions of lives globally. The majority of people experience short-term mild side effects; however, in rare cases, some develop long-term severe adverse events. This case report illustrates the case of a middle-aged man with Parsonage-Turner syndrome, a rare adverse event following COVID-19 immunisation. The patient presented with pain and weakness of the right upper arm for 2 months, which developed 5 days after he received his mRNA COVID-19 booster vaccine. He sought medical attention after 9 weeks of experiencing weakness with obvious muscle wasting. He reported his condition only via a phone application, as he thought that his condition was self-limiting and will improve with time. Herein, we discuss the syndrome and highlight the importance of patient education and early recognition of serious adverse events related to vaccinations in the primary care setting.

Nucleic Acid Point-of-Care Testing to Improve Diagnostic Preparedness.

Testing programs for severe acute respiratory syndrome coronavirus 2 have relied on high-throughput polymerase chain reaction laboratory tests and rapid antigen assays to meet diagnostic needs. Both technologies are essential; however, issues of cost, accessibility, manufacturing delays, and performance have limited their use in low-resource settings and contributed to the global inequity in coronavirus disease 2019 testing. Emerging low-cost, multidisease point-of-care nucleic acid tests may address these limitations and strengthen pandemic preparedness, especially within primary healthcare where most cases of disease first present. Widespread deployment of these novel technologies will also help close long-standing test access gaps for other diseases, including tuberculosis, human immunodeficiency virus, cervical cancer, viral hepatitis, and sexually transmitted infections. We propose a more optimized testing framework based on greater use of point-of-care nucleic acid tests together with rapid immunologic assays and high-throughput laboratory molecular tests to improve the diagnosis of priority endemic and epidemic diseases, as well as strengthen the overall delivery of primary healthcare services.

Examining the role of Indigenous primary healthcare across the globe in supporting populations during public health crises.

When health systems are overwhelmed during a public health crisis regular care is often delayed and deaths result from lapses in routine care. Indigenous primary healthcare (PHC) can include a range of programmes that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health (SDoH) and a focus on redressing health inequities. We examined how Indigenous PHC mobilises and innovates during a public health crisis to address patient needs and the broader SDoH. A rapid review methodology conducted from January 2021 - March 2021 was purposefully chosen given the urgency with COVID-19, to understand the role of Indigenous PHC during a public health crisis. Our review identified five main themes that highlight the role of Indigenous PHC during a public health crisis: (1) development of culturally appropriate communication and education materials about vaccinations, infection prevention, and safety; (2) Indigenous-led approaches for the prevention of infection and promotion of health; (3) strengthening intergovernmental and interagency collaboration; (4) maintaining care continuity; and (5) addressing the SDoH. The findings highlight important considerations for mobilising Indigenous PHC services to meet the needs of Indigenous patients during a public health crisis such as the COVID-19 pandemic.

Speech Recognition and Neural Networks based Talking Health Care Bot (THCB): Medibot

The COVID-19 pandemic has affected healthcare in several ways. Some patients were unable to make it to appointments due to curfews, transportation restrictions, and stay-at-home directives, while less urgent procedures were postponed or cancelled. Others steered clear of hospitals out of fear of contracting an infection. With the use of a conversational artificial intelligence-based program, the Talking Health Care Bot (THCB) could be useful during the pandemic by allowing patients to receive supportive care without physically visiting a hospital. Therefore, the THCB will drastically and quickly change in-person care to patient consultation through the internet. To give patients free primary healthcare and to narrow the supply-demand gap for human healthcare professionals, this work created a conversational bot based on artificial intelligence and machine learning. The study proposes a revolutionary computer program that serves as a patient's personal virtual doctor. The program was carefully created and thoroughly trained to communicate with patients as if they were real people. Based on a serverless architecture, this application predicts the disease based on the symptoms of the patients. A Talking Healthcare chatbot confronts several challenges, but the user's accent is by far the most challenging. This study has then evaluated the proposed model by using one hundred different voices and symptoms, achieving an accuracy rate of 77%. © 2023 IEEE.

Changes in Patient Visits and Associated Determinants in Primary Healthcare Settings in Guangdong: a Grey Relational Analysis

Background China has made some achievements in the construction of hierarchical medical system，but the development of its primary healthcare settings is still relatively slow. Objective To analyze the changes in patient visits and associated determinants in primary healthcare settings in Guangdong during 2013 to 2020，providing a basis for deepening the construction of hierarchical medical system. Methods In December 2021，this study extracted patient visits in primary healthcare institutions of Guangdong from Guangdong Health Statistics Yearbook（2013—2015），Guangdong Health and Family Planning Statistical Yearbook（2016—2017），and Guangdong's Hygiene and Health Statistical Yearbook（2018—2020） as the reference sequence，and extracted the population data and per capita disposable income from Guangdong Statistical Yearbook 2021，and the financial subsidy for primary healthcare institutions and the number of medical insurance participants from China Health and Family Planning Statistical Yearbook（2015—2017） and China's Hygiene and Health Statistical Yearbook（2018—2021） as the comparative sequence. Grey relational analysis was used to evaluate the strength of correlation between the number of patient visits and its potential associated determinants involving demographic and socioeconomic status，health resource allocation and medical insurance participation. Results The number of hospital visits in Guangdong increased from 334.592 million in 2013 to 401.317 million in 2019，with an average annual growth of 3.08%. The number of patient visits in primary healthcare settings in the province reached 437.317 million in 2019，and the average annual growth in these settings was 2.10% during 2013 to 2019. In 2020，the number of patient visits in hospitals and in primary healthcare settings both decreased significantly because of the COVID-19 pandemic. The number of patients visits in primary healthcare settings accounted for 50.7% of all patients visits in medical institutions in 2013，which declined to 48.1% in 2020. Grey relational analysis showed that both the number of residents（r=0.913） and the number of people aged over 65 years old（r=0.913） had the strongest correlation with the number of patient visits in primary healthcare settings，followed by the number of urban-rural resident basic medical insurance participants（r=0.899），the number of beds in primary healthcare settings（r=0.893），the number of primary healthcare settings（r=0.886） and the number of urban employee basic medical insurance participants（r=0.872）. Conclusion At present，many patients still choose to hospitals for medical services，which calls for actions to strengthen the first contact in primary care system. It is suggested to meet the needs of residents for nearby medical treatment by enriching the connotation of primary care services，widening the gap of healthcare expenses reimbursed by medical insurance among medical institutions and improving the service capacity of primary healthcare settings under the background of population aging. © 2023 Chinese General Practice. All rights reserved.

Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa.

BACKGROUND: Type 2 diabetes (T2DM) is a leading cause of mortality in South Africa and resistance to the use of insulin is common. This study aimed to explore factors that influence the initiation of insulin in patients with T2DM in primary care facilities in Cape Town, South Africa. METHODS: An exploratory descriptive qualitative study was conducted. Seventeen semi-structured interviews were held with patients eligible for insulin, on insulin and primary care providers. Participants were selected by maximum variation purposive sampling. Data were analysed using the framework method in Atlas-ti. RESULTS: Factors related to the health system, service delivery, clinical care and patients. Systemic issues related to the required inputs of workforce, educational materials, and supplies. Service delivery issues related to workload, poor continuity and parallel coordination of care. Clinical issues related to adequate counselling. Patient factors included a lack of trust, concerns about injections, impact on lifestyle and disposal of needles. CONCLUSION: Although resource constraints are likely to remain, district and facility managers can improve supplies, educational materials, continuity and coordination. Counselling must be improved and may require innovative alternative approaches to support clinicians who face high number of patients. Alternative approaches using group education, telehealth and digital solutions should be considered.Contribution: This study identified key factors influencing insulin initiation in patients with T2DM in primary care. These can be addressed by those responsible for clinical governance, service delivery and in further research.

Primary Care Physician's Perception and Satisfaction With Telehealth in the National Guard Primary Healthcare Centers in Jeddah, Saudi Arabia in 2022.

Background Telehealth is a tool to facilitate the connection between patients and their healthcare providers. With the recent emergence of telehealth, implementation of this service in primary healthcare centers (PHCs) has been accompanied by specific challenges despite the high levels of satisfaction reported. This study aimed to assess the factors that affect clinicians' perceptions and satisfaction with telehealth in National Guard PHCs to help explore and overcome any barriers and challenges. Methods A cross-sectional survey was distributed among primary healthcare physicians using virtual clinics in the National Guard PHCs in Jeddah, Saudi Arabia, in 2022. A validated questionnaire from previous literature was used to evaluate clinicians' perceptions and satisfaction with telehealth. Results The study included 53 primary healthcare physicians, with an overall response rate of 90%. Most physicians (77%) were satisfied with their overall experience with offering virtual visits. Nevertheless, 72% of physicians perceived patients' limited technical knowledge, and 70% considered limited access to technology a significant barrier against virtual visits. Higher satisfaction levels were significantly associated with those who did not consider the lack of integration of virtual visits with current workflow or electronic medical records (EMRs) a significant barrier to conducting virtual visits (p-value = 0.005). Conclusion Despite the undeniable advantages of telehealth, barriers, and challenges remain extant and can influence clinicians' satisfaction. Continuous monitoring for improvements is needed to enhance the telehealth experience.

Predictive factors for hospitalization in a cohort of primary healthcare patients with suspected COVID-19

Background: The objective of the study was to identify clinical and demographic factors predictive of hospitalization in primary healthcare patients diagnosed with suspected COVID-19 at the beginning of the pandemic. Method(s): A retrospective cohort study design was used. Patients attended in Casanova primary healthcare centre (CAP) (Barcelona, Spain) for symptoms compatible with possible or confirmed SARS-CoV-2 infection between February 24 and May 30, 2020, were included. Data was collected through the electronic medical record and by telephone interview. Result(s): 518 patients were included, of whom 283 (54.6%) were female. The median age was 50.2 years and 19.3% were aged >= 65 years: 79% were followed on an outpatient basis while the rest were hospitalized. Predictive factors for hospital admission were male sex, older age, a history of ischemic heart disease and the presence of dyspnoea, haemoptysis, nausea and vomiting, with a sensitivity of 48% and a specificity of 95.4%. Odynophagia and nasal congestion were predictors of a good prognosis. Mortality was 2.3% and 25% of deaths did not occur in hospital. Conclusion(s): Nearly 80% of primary healthcare patients received only outpatient care. Male sex, older age, a history of ischemic heart disease and symptoms like dyspnoea, haemoptysis, nausea and vomiting could lead to a greater risk of an unfavorable evolution during COVID-19. Patients with at least one of the above factors, which correlate with a higher hospital admission rate, should receive a closer follow-up to early detect when they can benefit from a hospital evaluation based on their clinical evolution.Copyright © 2023 The Authors

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 participants experienced mental health problems. Those employed in government subsidized schools had significantly 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 loneliness as participants were the sole frontline primary healthcare professional working in the school community during the COVID-19 pandemic. Study findings provide relevant evidence for management teams to build a culture 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 professionals in school communities as they play a significant role in safeguarding resources during pandemics. © 2023, Tech Science Press. All rights reserved.

Impact of the COVID-19 Pandemic on Outpatient Service in Primary Healthcare Institutions: An Inspiration From Yinchuan of China.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has posed a great challenge to the healthcare system. This study evaluated the impact of the pandemic on the utilization of primary healthcare (PHC). METHODS: The outpatient data from 158 PHC institutions in Yinchuan from May 1, 2017 to April 30, 2020 were used. The difference in difference (DID) model was used to analyze the difference in the number of outpatient visits per day, total outpatient expenditure per day, and outpatient expenditure per visit between December 2019 and February 2020 compared with the same periods in two previous years. The autoregressive integrated moving average (ARIMA) modelling was used to investigate the association between the outpatient volume and the number of the last week's new COVID-19 cases in Yinchuan, Ningxia, and China. RESULTS: From December 2019 to February 2020, the decline in the number of outpatient visits per day (DID: -367.21 times, P=.004) was larger than that in two previous years, and a similar trend can be seen in the outpatient expenditure per day. However, the rise in the outpatient expenditure per visit (DID: 19.06 thousand yuan, P=.003) was larger than that in two previous years. In 2020, the outpatient visits for most types of diseases decreased from week 3 and rebounded after week 5. The decline and rebound of outpatient visits in the population aged 45 years and older were steeper than in those younger. The outpatient volume was negatively associated with the number of the last week's new COVID-19 cases. CONCLUSION: This study indicated a significant impact of the pandemic on PHC service utilization. Since PHC service is the foundation of the healthcare system in most developing countries, measures should be taken to make PHC help cope with the crisis and relieve the burden of hospital care.

Analyzing the efficiency of Chinese primary healthcare institutions using the Malmquist-DEA approach: Evidence from urban and rural areas.

Background: China has been increasing the investment in Primary Health Care Institutions (PHCIs) since the launch of the New Health Care System Reform in 2009. It is a crucial concern whether the PHCIs can meet residents' need both in urban and rural with the limited government finance, especially encountering the challenge of the COVID-19. This study aimed to reveal the trend of the primary health service efficiency in the past decade, compare the urban-rural differences, and explore relevant factors. Methods: DEA and Malmquist models were applied to calculate the health service efficiency of PHCIs among 28 provinces in China, with the input variables including the number of institutions, number of beds, number of health technicians, and the outputs variables including the number of outpatients and emergency visits, number of discharged patients. And the Tobit model was used to analyze the factors on the efficiency in urban and rural. A sensitivity analysis for model validations was also carried out. Results: The average technical efficiency (TE) of urban PHCIs fluctuated from 63.3% to 67.1%, which was lower than that in rural (75.8-82.2%) from 2009 to 2019. In terms of dynamic efficiency, the urban PHCIs performed better than the rural, and the trends in the total factor productivity change were associated with favorable technology advancement. The population density and dependency ratio were the key factors on TE in both of the urban and rural PHCIs, and these two factors were positively correlated to TE. In terms of TE, it was negatively correlated with the proportion of total health expenditure as a percentage of GDP in urban PHCIs, while in rural it was positively correlated with the urbanization rate and negatively correlated with GDP per capita. Besides, the tests of Mann-Whitney U, and Kruskal-Wallis H indicated the internal validity and robustness of the chosen DEA and Malmquist models. Conclusions: It needs to reduce the health resource wastes and increase service provision in urban PHCIs. Meanwhile, it is necessary to strengthen medical technology and gaining greater efficiency in rural PHCIs by technology renovation.

Health Literacy among Japanese College Students: Association with Healthy Lifestyle and Subjective Health Status.

The improvement of health literacy (HL) is a critical issue for college students who are in the transitional period to adulthood and are establishing their subsequent lifestyles. The present study aimed to evaluate the current state of HL among college students and to explore the factors that influence HL. Moreover, it investigated the relationship between HL and health conditions. For this study, the researchers conducted an online survey of college students. The questionnaire consisted of the Japanese version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47), which is a self-assessment tool for HL that covers the major health issues of college students and health-related quality of life. The study analyzed 1049 valid responses. Based on the HLS-EU-Q47 total score, 85% of the participants exhibited problematic or unsatisfactory HL levels. Participants who reported high levels of healthy lifestyles obtained high HL scores. High levels of HL were associated with high levels of subjective health. Results from quantitative text analysis suggested that specific mindsets were correlated with high levels of competency in appraising health information among male students. In the future, educational intervention programs for college students need to be established to improve HL levels.

Occupational Risk Factors for Physical and Mental Health in Primary Healthcare Providers: A National Cross-Sectional Survey from 62 Urban Communities in China.

Purpose: To understand the physical and mental health status of primary healthcare providers (PHPs) including physicians, nurses and other staff and the workplace risk factors for depression, anxiety and intention-to-leave. Patients and Methods: In December 2021, a national cross-sectional survey was conducted from 62 urban communities in China, and all PHPs were invited to complete a standardized questionnaire. Information on demographic, health-related lifestyle, cardiovascular risk factors and physical health status, occupational stress and intention-to-leave was collected. Depression and anxiety were assessed using the Zung Self-Rating Anxiety/Depression Scale (SAS/SDS). Results: A total of 4901 PHPs were included. 67.0% males currently drank alcohol vs 25.3% in females; 36.0% males currently smoked cigarettes vs 1.4% in females. Notably, more than half males were overweight or obese, but this proportion was 24.2% in females. The prevalence of chronic diseases, including hypertension, diabetes, dyslipidemia, non-alcoholic fatty liver disease, gout, and disease clustering were higher in males than in females. The prevalence of depression and anxiety were high, 50% had depression, of whom 15.6% had moderate/severe depression. Over 15% participants had varied levels of anxiety, and approximately 4% had moderate/severe anxiety. PHPs who aged 18-29 (OR: 1.31, 95% CI: 1.05-1.64), were males (OR: 1.34, 95% CI: 1.14-1.57), with lower professional title (comparing with staff with senior title, the ORs of the intermedium, junior and none were 1.83, 2.18 and 2.49, respectively), took charge in nursing (OR: 1.41, 95% CI: 1.20-1.65), with higher perceived stress level (OR: 1.82, 95% CI: 1.41-2.34), and suffering from severe fatigue (OR: 2.55, 95% CI: 1.99-3.27) were more likely to have depression. Likewise, PHPs who were younger, with intermedium professional title, had higher perceived pressure level, and higher fatigue levels were more likely to have anxiety. Conclusion: The mental health of PHPs is worrisome, with a high burden of chronic diseases and occupational risk factors. Younger PHPs, nurses, and those with higher levels of work pressure and fatigue are more vulnerable to psychological problems. The high prevalence of intention-to-leave calls for strategies that relieve the workplace stress and enhance the human resource capability.

Antibiotic use in township hospitals during the COVID-19 pandemic in Shandong, China.

BACKGROUND: The overuse of antibiotics in primary healthcare settings (PHSs) has caused a serious public health problem in China. The outbreak of the Coronavirus Disease-19 (COVID-19) pandemic brought about dramatic changes in the supply of and demand for medical services in PHSs, possibly resulting in unprecedented changes in antibiotic use. OBJECTIVE: This study aims to assess the immediate and long-term impacts of the COVID-19 pandemic on the changes in antibiotic consumption in PHSs. METHOD: The data on antibiotic consumption were collected from selected township hospitals in Shandong, China from January 2019 to December 2021. Antibiotic consumption was quantified by using the defined daily doses (DDDs) and the WHO Access, Watch, Reserve category. A segmented regression model was established to analyze the immediate and long-term impacts of the COVID-19 pandemic on antibiotic use by using the interrupted time series analysis. RESULTS: The overall antibiotic consumption in all PHSs decreased by 32.04% and 16.69% in 2020 and 2021 respectively compared to the corresponding period in 2019. Over the entire study period, the use of penicillins (J01C) and cephalosporins (J01D) accounted for more than 50% of the total antibiotic consumption. The average annual consumption of Watch category antibiotics decreased by 42.02% and 33.47% in 2020 and 2021 respectively compared to that in 2019. According to the interrupted time series analysis, the total antibiotic consumption decreased significantly immediately after the COVID-19 pandemic outbreak (coef. = - 2.712, p = 0.045), but it then increased significantly over a long-term (coef. = 0.205, p = 0.005). Additionally, the consumption of Access category antibiotics increased significantly in PHSs in the long-term (coef. = 0.136, p = 0.018). However, the consumption of Watch category antibiotics declined sharply immediately after the pandemic (coef. = - 1.222, p < 0.001), but then it increased slightly over a long-term (coef. = 0.073, p < 0.001). CONCLUSION: The extensive use of penicillin and cephalosporins should be of great concern. After the outbreak of COVID-19 pandemic, the total antibiotic consumption decreased generally and the use pattern was improved to some extent in the PHSs in Shandong, China. This provides an opportunity for improving the misuse of antibiotics in PHSs in China.

Role of family physicians in providing primary healthcare during COVID-19 pandemic.

According to the World Health Organization, over 41 million cases of COVID-19 and 1 million deaths have been reported globally. More than 7 million cases of coronavirus have been reported in India alone. The growing number of cases of coronavirus worldwide poses numerous challenges to the country's current healthcare delivery system, especially in developing nations such as India. In such a situation, the task of maintaining continuity in the provision of comprehensive primary healthcare services in the community becomes a big challenge. This article discusses how family physicians can help to augment the healthcare system at the time of pandemic by providing easily accessible, holistic healthcare and by use of telemedicine. It also talks about the need to mainstream family medicine into the undergraduate and postgraduate medical curriculum and establish a robust network of family physicians trained in outbreak response and disease preparedness. For this study we looked for all papers with the terms 'Family physician', 'COVID-19', 'pandemic', and 'Primary health care'. Databases searched include PubMed, Google Scholar and DOAJ, using key words - family physician, family medicine, primary healthcare, COVID-19, and pandemic in different combinations.

Prognostic factors for persistent fatigue after COVID-19: a prospective matched cohort study in primary care.

BACKGROUND: Persistent fatigue after COVID-19 is common; however, the exact incidence and prognostic factors differ between studies. Evidence suggests that age, female sex, high body mass index, and comorbidities are risk factors for long COVID. AIM: To investigate the prevalence of persistent fatigue after COVID-19 in patients with a mild infection (managed in primary care) during the first wave of the pandemic and to determine prognostic factors for persistent fatigue. DESIGN AND SETTING: This was a prospective cohort study in Dutch general practice, combining online questionnaires with data from electronic health records. METHOD: Patients who contacted their GP between March and May 2020 and were diagnosed with COVID-19 during the first wave of the pandemic were included. Patients were matched to controls without COVID-19 based on age, sex, and GP practice. Fatigue was measured at 3, 6, and 15 months, using the Checklist of Individual Strength. RESULTS: All the participants were GP attendees and included 179 with suspected COVID-19, but who had mild COVID and who had not been admitted to hospital with COVID, and 122 without suspected COVID-19. Persistent fatigue was present in 35% (49/142) of the suspected COVID-19 group and 13% (14/109) of the non-COVID-19 group (odds ratio 3.65; 95% confidence interval = 1.82 to 7.32). Prognostic factors for persistent fatigue included low education level, absence of a partner, high neuroticism (using the Eysenck Personality Questionnaire Revised-Short Form), low resilience, high frequency of GP contact, medication use, and threatening experiences in the past. The latter three factors appeared to be prognostic factors for persistent fatigue specifically after COVID-19 infection. CONCLUSION: GP patients with COVID-19 (who were not admitted to hospital with COVID) have a fourfold higher chance of developing persistent fatigue than GP patients who had not had COVID-19. This risk is even higher in psychosocially vulnerable patients who had COVID-19.