The diagnostic accuracy of spirometry versus peak expiratory flow test for follow-up of adult asthma patients at primary care level.

Background: The asthma burden is growing worldwide, and this is predisposed by environmental and occupational exposures as well as individual risk factors. This study was aimed at a comparison of diagnostic accuracy of spirometry and peak expiratory flow rate (PEFR) in asthma screening of adult patients with lung function abnormalities that present at the level of primary care. Methods: This study was conducted in Shymkent city, South Kazakhstan, the third most populous city of the country with developed industries and high rates of pulmonary diseases. Four hundred and ninety-five adult patients with lung function abnormalities were enrolled in the study and underwent two screening tests (spirometry and PEFR). The diagnosis of asthma was verified by a qualified pulmonologist after performance of screening tests and was based on symptoms, medical history, and laboratory and lung function tests. Results: The sensitivity of spirometry was 0.97 and that of PEFR was 0.95 (p = 0.721), whereas the specificity of spirometry was 0.37 and that of PEFR was 0.28 (p = 0.227). Both tests yielded the same results for the positive predictive value (0.98). The negative predictive value was significantly higher for spirometry versus PEFR (0.23 versus 0.08; p = 0.006). The positive and negative likelihood ratios of the two tests also differed significantly (p = 0.001 and p = 0.006, respectively), whereas the overall accuracy was comparable between the two tests (0.96 for spirometry and 0.94 for PEFR; p = 0.748). Conclusion: Ambulatory PEFR monitoring is non-inferior to the monitoring of the forced expiratory volume in 1 second and could be used for screening purposes on equal grounds with spirometry.

Comparative analysis of primary health care indicators security standing in Belgium and Norway: Lessons from readiness to COVID-19.

The research aims to suggest the most enabling indicator of COVID-19 resistance in Belgium and Norway by studying the dynamics of staff and bed security indicators of the primary health care sector. The research methodology comprises Organization for Economic Cooperation and Development (OECD) statistical analysis of staff and bed security indicators. The reason for choosing Belgium and Norway for comparative analysis regarding the readiness to face the COVID-19 pandemic in terms of staff and bed security is because Belgium is leading by the highest level and Norway is leading by the lowest level of morbidity and mortality per 1 million population. The study revealed that the greatest enabler of the primary health care system efficiency in terms of resistance to COVID-19 is primary health care staff security. The analysis clearly shows that the number of beds is not paramount for the effectiveness of the healthcare system and primary health care. The COVID-19 pandemic has exposed the deficiencies and weaknesses of primary health care systems of all countries of the world. The research results suggest that Belgium and other countries focus on the education of nurses and therapists. The significance of the research results is that they prove that the main factor of the effectiveness of the primary health care system is its human resources. This information is useful for improving health systems in many countries around the world.