An one-stop career platform detailing Schools & Universities offering English language, Bachelor, Master and PhD programs with course fee, living cost, scholarships, visa details, etc.
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Cyprus College
cycollege.ac.cy
The college was founded in 1961 with the purpose to provide a well rounded education of high calibre where students can acquire the necessary academic knowledge.
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Wroclaw University
international.uni.wroc.pl
Founded in 1702 by Leopold I Habsburg. Since the beginning of 20th century the university has produced 9 Nobel Prize winners.
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Volyn University
vdu.edu.ua
The history dates back to 1940. At present, the university includes 4 institutes, 14 faculties and 73 departments.
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Berkeley College
berkeleycollege.edu
Through the power of internet, Berkeley college online brings the classroom to you anywhere in the world with the same high level of support as On-Campus classes.
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AIS
ais.ac.nz
New Zealand's largest international degree provider. The programmes are focused on the global marketplace.
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<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The ability of bleeding risk scores to predict major bleeding (MB) or clinically relevant nonmajor bleeding (CRNMB) remains a topic of contention, particularly in nonselected patients in family practice. In addition, the capacity to predict bleeding risk using simple variables has yet to be established.<div class="boxTitle">Objectives</div>The main objective was to confirm that severe anemia was the most predictive factor for the estimation of bleeding risk in patients treated with vitamin K antagonists (VKAs). Secondary objectives were to test the capacity of different bleeding scores to detect high-risk patients. Subsequently, the impact of functional decline on bleeding incidence was explored.<div class="boxTitle">Methods</div>The CACAO study was a multicenter prospective cohort study of patients who, due to nonvalvular atrial fibrillation (NVAF) and/or venous thromboembolism (VTE), had been prescribed an oral anticoagulant by their general practitioner (GP) as a prophylactic measure. Patient characteristics were collected at the time of inclusion by GPs, who then monitored them in accordance with standard practice for one year. MB and CRNMB were the main outcomes for one year. By applying this approach, a total of 13 scores were analyzed.<div class="boxTitle">Results</div>Aaemia was found to be strongly associated with MB (HR: 2.77, 95% CI: 1.2–6.36), with a particularly pronounced association observed in cases of severe anemia (HR: 12.9, 95% CI: 2.76–60.35). Twelve out of 27 MB cases were not identified by at least half of the scores. By contrast, functional decline was identified as a novel factor associated with MB (HR: 2.45, 95% CI: 1.13–5.31).<div class="boxTitle">Conclusions</div>Preexisting anemia is a major prognostic factor associated with the occurrence of bleeding. It seems relevant to suggest that functional decline should be considered by GPs when assessing bleeding risk.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>To determine what effect maternal antenatal depression has on pregnancy and infant outcomes in the Lleida health region.<div class="boxTitle">Methods</div>Retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Variables included age, body mass index, caesarean section, pre-eclampsia, birth weight, and Apgar score. We performed multivariate analysis, with linear regression coefficients and 95% confidence interval (CI).<div class="boxTitle">Results</div>Antenatal depression was diagnosed in 2.54% pregnant women from a total sample of 17 177. Depression is significantly associated with a higher risk pregnancy and low birth weight. Pre-eclampsia, 1-minute Apgar score, and caesarean section were not significantly associated with depression.<div class="boxTitle">Conclusions</div>Antenatal depression increases the risk of pregnancy complications. In addition, depression in the mother increases the probability of low birth weight.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The complexities of diagnosing cancer in general practice has driven the development of quality improvement (QI) interventions, including clinical decision support (CDS) and auditing tools. Future Health Today (FHT) is a novel QI tool, consisting of CDS at the point-of-care, practice population-level auditing, recall, and the monitoring of QI activities.<div class="boxTitle">Objectives</div>Explore the acceptability and usability of the FHT cancer module, which flags patients with abnormal test results that may be indicative of undiagnosed cancer.<div class="boxTitle">Methods</div>Interviews were conducted with general practitioners (GPs) and general practice nurses (GPNs), from practices participating in a randomized trial evaluating the appropriate follow-up of patients. Clinical Performance Feedback Intervention Theory (CP-FIT) was used to analyse and interpret the data.<div class="boxTitle">Results</div>The majority of practices reported not using the auditing and QI components of the tool, only the CDS which was delivered at the point-of-care. The tool was used primarily by GPs; GPNs did not perceive the clinical recommendations to be within their role. For the CDS, facilitators for use included a good workflow fit, ease of use, low time cost, importance, and perceived knowledge gain. Barriers for use of the CDS included accuracy, competing priorities, and the patient population.<div class="boxTitle">Conclusions</div>The CDS aligned with the clinical workflow of GPs, was considered non-disruptive to the consultation and easy to implement into usual care. By applying the CP-FIT theory, we were able to demonstrate the key drivers for GPs using the tool, and what limited the use by GPNs.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Medication for opioid use disorder (MOUD) is the management of opioid use disorder (OUD) on an outpatient basis with buprenorphine or buprenorphine/naloxone (or methadone, which is limited to federally certified opioid treatment programs). Primary care practices are well poised to provide comprehensive care for patients with OUD, including provision of MOUD. The aim of this study was to assess provider and staff OUD attitudes and role perceptions before and after implementation of a MOUD clinical service line. A survey was distributed to evaluate attitudes and perceptions of patients with OUD and provision of MOUD among providers and staff in an academic family medicine clinic. Surveys were distributed in December 2020 (73% response rate), prior to a substance use disorder educational training and MOUD service line implementation, which provided patients with OUD both primary care services and management with buprenorphine/naloxone. A follow-up survey was distributed in February 2022 (69% response rate).Training and implementation of the MOUD service line demonstrated improvements in the domains of motivation (+0.63), attitudes (+0.32), satisfaction (+0.38), role support (+0.48), role adequacy (+0.39), and safety (+0.79) among surveyed participants. The change in satisfaction and safety domains was statistically significant (<span style="font-style:italic;">P</span> < .05). There was no change in the role legitimacy domain.Implementation of a primary care-based MOUD service line positively affected provider and staff motivation, attitudes, satisfaction, sense of safety, role support, and adequacy when working with patients with OUD. This highlights the benefits of MOUD-specific clinical support to optimize care delivery within primary care.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>During pregnancy, the requirements of essential nutrients for the mother and foetus increase. The changes in pregnant women’s eating behaviours may vary according to their sociodemographic characteristics. It is important to meet these increased requirements and understand the factors influencing eating habits during pregnancy.<div class="boxTitle">Objectives</div>This study aimed to determine the effects of changes in pregnant women’s eating attitudes and behaviours and their sociodemographic characteristics on their meeting status for nutrient recommendations.<div class="boxTitle">Methods</div>Sociodemographic information, eating behaviours, and attitudes of 656 pregnant women were obtained in face-to-face interviews between February and June 2020. Food consumption records were taken with a 24-hour recall method and evaluated according to the estimated average requirement value.<div class="boxTitle">Results</div>The average age of pregnant women was 29.0 ± 5.2 years, 28.0% were high school graduates, and 69.2% were non-working. The frequency of intakes below the estimated mean requirement value were iron, folic acid, vitamin B6, niacin, and calcium. It was demonstrated that there was a significant difference in snack consumption based on the working status and nutrition information obtained (<span style="font-style:italic;">P</span> < .05). Getting nutrition information, age, education level, working status, and pre-pregnancy body mass index significantly increased food consumption (<span style="font-style:italic;">P</span> < .05).<div class="boxTitle">Conclusion</div>Inadequate nutrient intake is a common public health problem in pregnant women. It is necessary to identify the sociodemographic characteristics that negatively impact pregnant women’s nutritional status and to develop nutrition and health education programs based on these features.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Context</div>The shortage of general practitioners (GPs) is a growing concern in Europe, especially in France. This problem is likely to continue until the end of the 2020s.<div class="boxTitle">Objectives</div>To study the GPs’ perceptions of access to care in medically underserved areas (i.e. with low physician density), its consequences on their working conditions, and how they cope with the resulting difficulties.<div class="boxTitle">Methods</div>Semi-structured individual interviews were conducted between May and August 2021 of 29 GPs practising in areas of southeastern France with a low physician density or at risk of a doctor shortage. Purposive sampling was used to include profiles of diverse physicians and diverse rural and urban areas. The interviews, conducted with an interview guide, were transcribed and analysed thematically.<div class="boxTitle">Results</div>The participants described a serious degradation of access to care in their areas. These issues also concerned urban areas, where they were, according to the participants, underrecognized. The participants’ workloads were rising, at a rate often perceived as unsustainable: many participants, including the youngest group, reported they were exhausted. Their principal source of dissatisfaction was their impression that they could not do their work correctly. Participants reported that these difficulties required them to improvise and adapt without any official or formal method to keep their practice manageable.<div class="boxTitle">Conclusion</div>These GPs were worried about the future of their profession and their patients. They expected strong measures by public policymakers and officials, but paradoxically seemed to have little interest in the solutions these officials are promoting.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The effects of integrated care with case management and nutritional counselling for frail patients with nutritional risk are unclear.<div class="boxTitle">Objectives</div>To assess the impact of the integrated care model for frail patients with nutritional risk in the primary care setting.<div class="boxTitle">Methods</div>This was a retrospective observational study. We enrolled 100 prefrail or frail patients according to Clinical Frailty Scale (CFS) aged ≥ 60 years with nutritional risk from the geriatric clinic. We implemented the frailty intervention model, including integrated care with comprehensive geriatric assessments (CGA), case management, and nutritional counselling by the dietitian. We obtained measures of CGA components, physical performance, body mass index (BMI), and daily caloric intake before and after the 2-month care program. We used the Wilcoxon signed-rank test to analyse differences after the care program and applied multiple linear regression to determine the predictive factors for CFS improvement.<div class="boxTitle">Results</div>Among the 100 patients (mean age, 75.0 ± 7.2 years; females, 71.0%; frail patients, 26%), 93% improved their CFS status, and 91% achieved > 80% of recommended daily caloric intake after the care program. The Mini Nutritional Assessment Short-Form significantly improved after the program. BMI and daily caloric intake increased significantly after nutritional counselling. The post-test short physical performance battery (SPPB) significantly increased with a faster 4 m gait speed. Baseline poor CFS was a significant predictor for CFS improvement.<div class="boxTitle">Conclusions</div>Integrated care with case management and nutritional counselling for prefrail and frail patients with nutritional risk in the primary care setting may improve physical performance and nutritional status.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Little is known about how variation in the scheduled length of primary care visits can impact patients’ patterns of health care utilization.<div class="boxTitle">Objective</div>To evaluate how the scheduled length of in-person visits with primary care physicians (PCPs) was associated with PCP and patient characteristics, outpatient utilization, and preventive care receipt.<div class="boxTitle">Methods</div>This retrospective cohort study examined data from a large American academic health system. PCP visit length template was defined as either 15- and 30-min scheduled appointments (i.e. 15/30), or 20- and 40-min scheduled appointments (i.e. 20/40).<div class="boxTitle">Results</div>Of 222 included PCPs, 85 (38.3%) used the 15/30 template and 137 (61.7%) used the 20/40 template. The 15/30 group had higher proportions of male (49.4%, vs. 35.8% in the 20/40 group) and family medicine (37.6% vs. 21.2%) physicians. In adjusted patient-level analysis (<span style="font-style:italic;">N</span> = 238,806), having a 15/30 PCP was associated with 9% more primary care visits (incidence rate ratio [IRR], 1.09; 95% confidence interval [CI], 1.03–1.14), and 8% fewer specialty care visits (IRR, 0.92; 95% CI, 0.86–0.98). PCP visit length template was not associated with significant differences in obstetrics/gynaecology visits, continuity of care, or preventive care receipt. In interaction analyses, having a 15/30 PCP was associated with additional primary care visits among non-Hispanic White patients (IRR, 1.10; 95% CI, 1.04–1.16) but not among non-Hispanic Black patients.<div class="boxTitle">Conclusion</div>PCPs’ choices about the scheduled length of in-person visits may impact their patients’ specialty care use, and have varying impacts across different racial/ethnic groups.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Opioids are commonly used both before and after total joint arthroplasty (TJA).<div class="boxTitle">Objective</div>The objective of this study was to estimate the long-term effects of pre- and perioperative opioid use in patients undergoing TJA.<div class="boxTitle">Methods</div>We used linked population datasets to identify all (<span style="font-style:italic;">n</span> =18,666) patients who had a publicly funded TJA in New Zealand between 2011 and 2013. We used propensity score matching to match individuals who used opioids either before surgery, during hospital stay, or immediately post-discharge with individuals who did not based on a comprehensive set of covariates. Regression analysis was used to estimate the effect of opioid use on health and socio-economic outcomes over 5 years.<div class="boxTitle">Results</div>Opioid use in the 3 months prior to surgery was associated with significant increases in healthcare utilization and costs (number of hospitalizations 6%, days spent in hospital 14.4%, opioid scripts dispensed 181%, and total healthcare costs 11%). Also increased were the rate of receiving social benefits (2 percentage points) and the rates of opioid overdose (0.5 percentage points) and mortality (3 percentage points). Opioid use during hospital stay or post-discharge was associated with increased long-term opioid use, but there was little evidence of other adverse effects.<div class="boxTitle">Conclusions</div>Opioid use before TJA is associated with significant negative health and economic consequences and should be limited. This has implications for opioid prescribing in primary care. There is little evidence that peri- or post-operative opioid use is associated with significant long-term detriments.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Multimorbidity management poses significant challenges for general practitioners (GPs). The aim of this study is to analyse the role of resilience and social support on the burden experienced by GPs in managing patients with multiple health conditions in Portugal.<div class="boxTitle">Methods</div>Cross-sectional quantitative study conducted among GPs in Portugal using an online questionnaire that included validated measurement tools: Questionnaire of Evaluation of Burden of Management of Multimorbidity in General and Family Medicine (SoGeMM-MGF), European Portuguese Version of the Resilience Scale (ER14), and the Oslo Social Support Scale-3 (OSSS-3) in Portuguese. A multiple linear regression analysis was conducted to examine the factors influencing the burden of managing multimorbidity.<div class="boxTitle">Results</div>Two hundred and thirty-nine GPs were included, with 76.6% being female and a median age of 35 years. Most participants were specialists (66.9%) and had less than a decade of experience managing multimorbidity. Over 70% had not received specific training in multimorbidity. Female GPs and those with a higher proportion of multimorbid patients in the registries experienced higher burden levels. A multivariate regression model with moderation revealed that the effect of resilience on burden varied depending on the level of social support. Higher resilience was associated with higher burden in the “Poor Social Support” category, while it was associated with lower burden in the “Moderate Social Support” and “Strong Social Support” categories, although not statistically significant.<div class="boxTitle">Conclusions</div>The study highlights the importance of GPs’ social support and resilience in managing the burden of multimorbidity, with poor social support potentially worsening the effects of high resilience.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Self-care is crucial in the prevention and treatment of chronic diseases. It is important to identify patients who need support with self-care.<div class="boxTitle">Objectives</div>This study introduces a self-care preparedness index (SCPI) and examines its associations with health-related quality of life (HRQoL) and other outcomes.<div class="boxTitle">Methods</div>A cross-sectional study of adults (<span style="font-style:italic;">n</span> = 301) with hypertension, coronary artery disease, or diabetes in primary health care. Based on the self-care questionnaire, SCPI was formed. A higher SCPI value indicated better self-care preparedness. We examined correlations and a hypothesis of linearity between SCPI and HRQoL (15D), depressive symptoms (BDI), patient activation (PAM), and health-related outcomes (self-rated health, life satisfaction, physical activity, body mass index [BMI], waist, low-density lipoprotein). Exploratory factor analysis was used to test the construct validity of SCPI.<div class="boxTitle">Results</div>A total of 293 patients with a mean age of 68 (54.3% women) were included in the analysis. BDI, BMI, and waist had a negative linear trend with SCPI. Self-rated health, physical activity, patient activity, and life satisfaction had a positive linear trend with SCPI. SCPI correlated with HRQoL (<span style="font-style:italic;">r</span> = 0.31 [95% CI: 0.20 to 0.41]). Exploratory factor analysis of the SCPI scores revealed 3 factors explaining 82% of the total variance.<div class="boxTitle">Conclusions</div>SCPI seems to identify individuals with different levels of preparedness in self-care. This provides means for health care providers to individualize the levels of support and counselling. SCPI seems to be a promising tool in primary health care but needs further validation before use in large scale trials or clinical practice.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Most anaemia studies focus on children and women of childbearing age. We assessed the frequency and main aetiologies of anaemia according to sociodemographic characteristics at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of middle-aged adults.<div class="boxTitle">Methods</div>The primary analyses included 15,051 participants aged 35–74 years with a valid blood cell count. We built logistic models to analyse the association between socioeconomic characteristics and anaemia diagnosis. We also described the main aetiologies in a subset (<span style="font-style:italic;">n</span> = 209) of participants with anaemia.<div class="boxTitle">Results</div>Anaemia was present in 3.0% (95% confidence interval [95%CI]: 2.6–3.4%) of men and 7.4% (95%CI: 6.9–8.0%) of women. The frequency of anaemia diagnosis was higher in women in all subgroups except for the oldest age stratum (65–74 years). The frequency of anaemia was particularly high in Blacks (6.0% and 15.5% in men and women, respectively). The most common causes of anaemia were iron deficiency (in women), chronic kidney disease, and chronic inflammation (in men). The frequency of unexplained anaemia was respectively 33.3% and 34.2% for men and women, and this condition was more frequent among participants of Black or Mixed races.<div class="boxTitle">Conclusions</div>Anaemia was associated with age, female sex, Black race, and low socioeconomic status. Unexplained anaemia was common and more frequent in individuals of Black and Mixed races. ELSA-Brasil follow-up data may provide further insight into the relevance of unexplained anaemia in this setting.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Multimorbidity is a growing problem. The number and complexity of (non-)pharmaceutical treatments create a great burden for patients. Treatment burden refers to the perception of the weight of these treatments, and is associated with multimorbidity. Measurement of treatment burden is of great value for optimizing treatment and health-related outcomes.<div class="boxTitle">Objective</div>We aim to translate and validate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for use in the Dutch population with multimorbidity and explore the level of treatment burden.<div class="boxTitle">Methods</div>Translating the MTBQ into Dutch included forward–backward translation, piloting, and cognitive interviewing (<span style="font-style:italic;">n</span> = 8). Psychometric properties of the questionnaire were assessed in a cross-sectional study of patients with multimorbidity recruited from a panel in the Netherlands (<span style="font-style:italic;">n</span> = 959). We examined item properties, dimensionality, internal consistency reliability, and construct validity. The level of treatment burden in the population was assessed.<div class="boxTitle">Results</div>The mean age among 959 participants with multimorbidity was 69.9 (17–96) years. Median global NL-MTBQ score was 3.85 (interquartile range 0–9.62), representing low treatment burden. Significant floor effects were found for all 13 items of the instrument. Factor analysis supported a single-factor structure. The NL-MTBQ had high internal consistency (<span style="font-style:italic;">α</span> = 0.845), and provided good evidence on the construct validity of the scale.<div class="boxTitle">Conclusion</div>The Dutch version of the 13-item MTBQ is a single-structured, valid, and compact patient-reported outcome measure to assess treatment burden in primary care patients with multimorbidity. It could identify patients experiencing high treatment burden, with great potential to enhance shared decision-making and offer additional support.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Multimorbidity is a global issue that presents complex challenges for physicians, patients, and health systems. However, there is a lack of research on the factors that influence physicians’ confidence in managing multimorbidity within primary care settings, particularly regarding physicians’ work conditions.<div class="boxTitle">Objectives</div>Drawing on the Job Demands–Resources Model, this study aims to investigate the level of confidence among Chinese primary care physicians in managing multimorbidity and examine the predictors related to their confidence.<div class="boxTitle">Methods</div>Data were collected from 224 physicians working in 38 Community Healthcare Centres (CHCs) in Shanghai, Shenzhen, Tianjin, and Jinan, China. Work-family conflict (WFC) perceived organizational support (POS), self-directed learning (SDL), and burnout were measured. Physicians’ confidence was assessed using a single item. Mediation effect analysis was conducted using the Baron and Kenny method.<div class="boxTitle">Results</div>The results showed that the mean confidence score for physicians managing multimorbidity was 3.63 out of 5, only 20.10% rating their confidence level as 5. WFC negatively related physicians’ confidence and POS positively related physicians’ confidence in multimorbid diagnosis and treatment. Burnout fully mediated the relationship between WFC and physicians’ confidence, and SDL partially mediated the relationship between POS and physicians’ confidence.<div class="boxTitle">Conclusions</div>The confidence level of Chinese primary care physicians in managing multimorbidity needs improvement. To enhance physicians’ confidence in managing multimorbid patients, CHCs in China should address WFC and burnout and promote POS and SDL.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>In a therapeutic partnership, physicians rely on patients to describe their health conditions, join in shared decision-making, and engage with supported self-management activities. In shared care, the patient, primary care, and specialist services partner together using agreed processes and outputs for the patient to be placed at the centre of their care. However, few empirical studies have explored physicians’ trust in patients and its implications for shared care models.<div class="boxTitle">Aim</div>To explore trust in patients amongst general practitioners (GPs), and the impacts of trust on GPs’ willingness to engage in new models of care, such as colorectal cancer shared care.<div class="boxTitle">Methods</div>GP participants were recruited through professional networks for semi-structured interviews. Transcripts were integrity checked, coded inductively, and themes developed iteratively.<div class="boxTitle">Results</div>Twenty-five interviews were analysed. Some GPs view trust as a responsibility of the physician and have a high propensity for trusting patients. For other GPs, trust in patients is developed over successive consultations based on patient characteristics such as honesty, reliability, and proactivity in self-care. GPs were more willing to engage in colorectal cancer shared care with patients with whom they have a developed, trusting relationship.<div class="boxTitle">Conclusions</div>Trust plays a significant role in the patient’s access to shared care. The implementation of shared care should consider the relational dynamics between the patient and health care providers.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>In Aotearoa New Zealand, co-payments to see a general practitioner (GP, family doctor) or collect a prescription are payable by virtually all adults.<div class="boxTitle">Objective</div>To examine the extent to which these user co-payments are a barrier to accessing health care, focussing on inequities for indigenous Māori.<div class="boxTitle">Methods</div>Pooled data from sequential waves (years) of the New Zealand Health Survey, 2011/12 to 2018/19 were analysed. Outcomes were self-reported cost barriers to seeing a GP or collecting a prescription in the previous year. Logistic regression was used to estimate odds ratios (ORs) of barriers to care for Māori compared with non-Māori, sequentially adjusting for additional explanatory variables.<div class="boxTitle">Results</div>Pooled data included 107,231 people, 22,292 (21%) were Māori. Across all years, 22% of Māori (13% non-Māori) experienced a cost barrier to seeing a GP, and 14% of Māori (5% non-Māori) reported a cost barrier to collecting a prescription. The age- and wave-adjusted OR comparing Māori/non-Māori was 1.71 (95% confidence interval [CI]: 1.61, 1.81) for the cost barrier to primary care and 2.97 (95% CI: 2.75, 3.20) for the cost barrier to collecting prescriptions. Sociodemographics accounted for about half the inequity for both outcomes; in a fully adjusted model, age, sex, low income, and poorer underlying health were determinants of both outcomes, and deprivation was additionally associated with the cost barrier to collecting a prescription but not to seeing a GP.<div class="boxTitle">Conclusions</div>Māori experience considerable inequity in access to primary health care; evidence supports an urgent need for change to system funding to eliminate financial barriers to care.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Effective and targeted endometrial cancer prevention strategies could reduce diagnoses by 60%. Whether this approach is acceptable to individuals and general practitioners (GPs) is currently unknown. This study sought to determine attitudes towards the provision of personalised endometrial cancer risk assessments and the acceptability of potential prevention strategies.<div class="boxTitle">Methods</div>Specific online questionnaires were developed for individuals aged 45–60 years with a uterus and UK-practising GPs, with social media, charity websites, and email used to advertise the study. Individuals completed the questionnaires between February and April 2022.<div class="boxTitle">Results</div>Of 660 lay questionnaire respondents, 90.3% (<span style="font-style:italic;">n</span> = 596) thought that undergoing an endometrial cancer risk assessment was a good or very good idea and 95.6% (<span style="font-style:italic;">n</span> = 631) would be willing to undergo such an assessment. The commonest reasons for wanting to participate were “to try and reduce my risk” (<span style="font-style:italic;">n</span> = 442, 67.0%), “to be informed” (<span style="font-style:italic;">n</span> = 354, 53.6%), and “it could save my life’ (<span style="font-style:italic;">n</span> = 315, 47.7%). Over 80% of respondents would make lifestyle changes to reduce their endometrial cancer risk (<span style="font-style:italic;">n</span> = 550), with half accepting a pill, Mirena, or hysterectomy for primary prevention. GPs were similarly engaged, with 93.0% (<span style="font-style:italic;">n</span> = 106) willing to offer an endometrial cancer risk assessment if a tool were available, potentially during a Well Woman screen.<div class="boxTitle">Conclusion</div>Personalised endometrial cancer risk assessments are acceptable to potentially eligible individuals and GPs and could be accommodated within routine practice. Clinical trials to determine the effectiveness of lifestyle modification and Mirena for endometrial protection are urgently required and should be targeted at those at greatest disease risk.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Earlier detection of children at risk for neurodevelopmental disorders is critical and has longstanding repercussions if not addressed early enough.<div class="boxTitle">Objectives</div>To explore the supporting or facilitating characteristics of paediatric primary care models of care for early detection in infants and toddlers at risk for neurodevelopmental disorders, identify practitioners involved, and describe how they align with occupational therapy’s scope of practice.<div class="boxTitle">Methods</div>A scoping review following the Joanna Briggs Institute framework was used. PubMed Central, Cumulative Index to Nursing & Allied Health Literature, and Scopus databases were searched. The search was conducted between January and February 2022. Inclusion criteria were: children aged 0–3 years old; neurodevelopmental disorders including cerebral palsy (CP) and autism spectrum disorder (ASD); models of care used in the paediatric primary care setting and addressing concepts of timing and plasticity; peer-reviewed literature written in English; published between 2010 and 2022. Study protocol registered at <a href="https://doi.org/10.17605/OSF.IO/MD4K5">https://doi.org/10.17605/OSF.IO/MD4K5</a><div class="boxTitle">Results</div>We identified 1,434 publications, yielding 22 studies that met inclusion criteria. Models of care characteristics included the use of technology, education to parents and staff, funding to utilize innovative models of care, assessment variability, organizational management changes, increased visit length, earlier timeline for neurodevelopmental screening, and collaboration with current office staff or nonphysician practitioners. The top 4 providers were paediatricians, general or family practitioners, nurse/nurse practitioners, and office staff. All studies aligned with occupational therapy health promotion scope of practice and intervention approach yet did not include occupational therapy within the paediatric primary care setting.<div class="boxTitle">Conclusions</div>No studies included occupational therapy as a healthcare provider that could be used within the paediatric primary care setting. However, all studies demonstrated models of care facilitating characteristics aligning with occupational therapy practice. Models of care facilitating characteristics identified interdisciplinary staff as a major contributor, which can include occupational therapy, to improve early detection within paediatric primary care.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Palatability is a key element of paediatric acceptability for medicines. Many patient and drug factors are considered when choosing an antibiotic for a child. Pharmacists report that they receive questions about the palatability of oral liquid antibiotics for children. This study aimed to explore the experiences of GPs and pharmacists concerning palatability of oral liquid antibiotics for children.<div class="boxTitle">Methods</div>A questionnaire about the impact of palatability on the choice of antibiotic formulation for children was emailed to all community pharmacists in Ireland and to GPs and trainee GPs in the Cork region and posted on social media. Survey items were not compulsory; therefore, percentage responses were calculated based on the number of responses to that item. GP and pharmacist responses were analysed independently.<div class="boxTitle">Results</div>Responses were received from 244 participants (59 GPs, 185 pharmacists). Clinical guidelines and availability of supply were the most important factors considered when choosing an oral liquid antibiotic formulation for children by GP (79.7%) and pharmacist (66.5%) respondents respectively. Forty GP respondents (76.9%) reported ensuring adherence was the most common palatability-related reason leading to deviation from guidelines. Pharmacist respondents (52%) reported advising a parent/caregiver to manipulate the required antibiotic dose to improve acceptability. The least palatable oral liquid antibiotics reported were flucloxacillin (16% GPs, 18% pharmacists) and clarithromycin (17% of each profession).<div class="boxTitle">Conclusion</div>This study identified palatability issues associated with oral liquid antibiotics for children reported by GPs and pharmacists. Pharmaceutical approaches to adapting oral liquid antibiotic formulations must be developed to improve palatability and thus paediatric acceptability.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Village doctors, as gatekeepers of the health system for rural residents in China, are often confronted with adversity in providing the basic public healthcare services.<div class="boxTitle">Objective</div>We sought to summarize the training contents, training method, training location, and training costs most preferred by village doctors in China and hope to provide evidence and support for the government to deliver better training in the future.<div class="boxTitle">Methods</div>Eight databases were searched to include studies that reported on the training needs of village doctors in China. We undertook a systematic review and a narrative synthesis of data.<div class="boxTitle">Results</div>A total of 38 cross-sectional studies including 35,545 participants were included. In China, village doctors have extensive training needs. “Clinical knowledge and skill” and “diagnosis and treatment of common disease” were the most preferred training content; “continuing medical education” was the most preferred delivery method; above county- and county-level hospitals were the most desirable training locations, and the training costs were expected to be low or even free.<div class="boxTitle">Conclusion</div>Village doctors in various regions of China have similar preferences for training. Thus, future training should focus more on the training needs and preferences of village doctors.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Pregnancy complications can impact the mother and child’s health in the short and longterm resulting in an increased risk of chronic disease later in life. Telomere length is a biomarker of future cardiometabolic diseases and may offer a novel way of identifying offspring most at risk for future chronic diseases.<div class="boxTitle">Objective(s)</div>To qualitatively explore General Practitioners’ (GPs) perspectives on the feasibility and uptake for recommending a telomere screening test in children who were born after a pregnancy complication.<div class="boxTitle">Methods</div>Twelve semi-structured interviews were conducted with GPs within metropolitan Adelaide, South Australia. Interviews were audio recorded, transcribed verbatim, and analysed for codes and themes.<div class="boxTitle">Results</div>Two themes were generated: ethical considerations and practical considerations. Ethically, the GP participants discussed barriers including consenting on behalf of a child, parental guilt, and the impact of health insurance, whereas viewing it for health promotion was a facilitator. For practical considerations, barriers included the difficulty in identifying people eligible for screening, maintaining medical communication between service providers, and time and financial constraints, whereas linking screening for telomere length with existing screening would facilitate uptake.<div class="boxTitle">Conclusions</div>GPs were generally supportive of potential telomere screening in infants, particularly via a saliva test that could be embedded in current antenatal care. However, several challenges, such as lack of knowledge, ethical considerations, and time and financial constraints, need to be overcome before such a test could be implemented into practice.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The coronavirus disease 2019 (COVID-19) pandemic and associated infodemic increased depression and anxiety. Proper information can help combat the infodemic and promotes mental health; however, rural residents have more difficulties in getting correct information than urban residents.<div class="boxTitle">Objective</div>To examine whether the information on COVID-19 provided by the local government maintained the mental health of rural residents in Japan.<div class="boxTitle">Methods</div>A self-administered questionnaire survey of Okura Village (northern district of Japan) residents aged ≥16 years was conducted in October 2021. The main outcomes, depressive symptoms, psychological distress, and anxiety were measured using the Center for Epidemiologic Studies Depression Scale, Kessler Psychological Distress Scale, and Generalized Anxiety Disorder scale 7-item. Exposure was defined as whether the resident read the leaflet on COVID-19 distributed by the local government. The targeted maximum likelihood estimation was used to analyse the effect of leaflet reading on the main outcomes.<div class="boxTitle">Results</div>A total of 974 respondents were analysed. Reading the leaflet was significantly lower risk for depressive symptoms relative risk (95% confidence interval): 0.64 (0.43–0.95). Meanwhile, no clear effects of leaflet reading were observed on mental distress and anxiety.<div class="boxTitle">Conclusions</div>In rural areas with local governments, analogue information may be effective to prevent depression.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The Mini Nutritional Assessment (MNA) is a validated questionnaire that estimates nutritional status. Given that this questionnaire uses stature measurement, which are unreliable in older adults, Mindex and Demiquet are alternatives to BMI for assessing malnutrition risk. However, the correlation of Mindex and Demiquet values with MNA scores has not been investigated.<div class="boxTitle">Objectives</div>This cross-sectional study examined the correlation of Mindex and Demiquet with nutritional status and blood parameters in older adults in Thailand.<div class="boxTitle">Methods</div>The correlation of Mindex and Demiquet with MNA scores and body mass index (BMI), as well as blood parameters, was evaluated. Sociodemographic characteristics, anthropometric measurements, and blood test results were collected from 347 participants aged 60 years and older (mean ± SD, 66.4 ± 5.3 years). Spearman’s rank correlation coefficient and multiple logistic regression analyses were used in statistical analyses.<div class="boxTitle">Results</div>MNA scores were significantly correlated with Mindex (<span style="font-style:italic;">P</span> < 0.001) and Demiquet (<span style="font-style:italic;">P</span> = 0.001), and BMI was related to Mindex and Demiquet (<span style="font-style:italic;">P</span> < 0.001). Low-density lipoprotein cholesterol (LDL-C) predicted MNA scores (<span style="font-style:italic;">P</span> = 0.048) in males but not females.<div class="boxTitle">Conclusions</div>Mindex and Demiquet values were positively correlated with MNA scores and BMI. In addition, LDL-C predicted MNA scores in male older adults.</span>
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