scholarly journals THE IMPACT OF TREATING REVERSIBLE CAUSES OF COGNITIVE DECLINE: A LONGITUDINAL STUDY IN PRIMARY HEALTH CARE

2021 ◽  
Author(s):  
Marcos Pereira ◽  
Vannessa Sá ◽  
Paulo Henrique Rocha ◽  
João Pedro Oliveira ◽  
Rafael Amorim ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Cognitive Decline ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Subjective Cognitive Decline ◽  
Primary Health ◽  
Increased Risk ◽  
The Impact

Background: Evidence from longitudinal studies points to the syndromic continuum of dementia. Individuals with mild cognitive impairment (MCI) are at increased risk of progressing to dementia over time, as well as older adults with subjective cognitive decline (SCD). Objective: To assess the impact of treating reversible causes of dementia on the outcome of patients with cognitive decline. Methods: Data were collected between 2017 and 2020 (mean follow-up = 44.52 ±6.85 months) in primary health care in Patos de Minas, MG. Subjects were screened using the MMSE, Figure Memory Test, Verbal Fluency, Clock Drawing Test, Geriatric Depression Scale, Geriatric Anxiety Inventory, and the Functional Activities Questionnaire. Results: Of 15 patients with SCD, 26.7% progressed to MCI. Of 45 patients with MCI, 13.4% progressed to dementia, 4.4% died and 26.7% regressed to SCD. Of 31 individuals with dementia, 6.5% regressed to SCD, 22.6% regressed to MCI and 19.4% died. Clinical improvement can be explained by the treatment of reversible causes, such as hypothyroidism, hypovitaminosis B12, and mood and anxiety disorders. Conclusion: Two-thirds of people who meet the criteria for MCI do not convert to dementia during the follow-up. These results reinforce the need of adequate screening and treatment of reversible causes of dementia in the primary care.

scholarly journals Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine Thumé ◽  
Marciane Kessler ◽  
Karla P. Machado ◽  
Bruno P. Nunes ◽  
Pamela M. Volz ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Rio Grande ◽  
Cognitive Testing ◽  
Rio Grande Do Sul ◽  
Primary Health ◽  
The Impact

Abstract Background The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. Methods/design The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). Results Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.

scholarly journals Depression in older adults: prevalence and risk factors in a primary health care sample

2017 ◽  
Vol 59 (2) ◽  
pp. 33
Author(s):  
Uschenka Padayachey ◽  
S Ramlall ◽  
J Chipps
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Depression Scale ◽  
Subjective Health ◽  
High Rate ◽  
Geriatric Depression ◽  
Care Clinic ◽  
Primary Health Care Clinic ◽  
Primary Health ◽  
Increased Risk

Background: Depression in the geriatric population has been identified as a significant problem in view of the associated negative outcomes regarding poor functioning, increased perception of poor health and increased utilisation of medical services. Significantly associated with increased morbidity and mortality, depression has been found to be an independent cause of disability as well as adding to disability due to primary physical illnesses. Early identification and treatment of depression reduces medical costs and lessens caregiver burden. Epidemiological data and prevalence rates of geriatric depression in Africa are limited, although such data are vital to mobilise and plan government mental health initiatives aimed at screening and early intervention. Objective: To determine the prevalence of depression and associated clinical and socio-demographic factors amongst older adult patients attending a primary health care clinic in the Ethekwini District in Kwa-Zulu Natal, South Africa. Methods: The 15-item Geriatric Depression Scale and a socio-demographic questionnaire were administered in English to 255 geriatric outpatients, randomly selected, at a local community clinic in Durban. Data analysis: Data were analysed using SPSS version 23®. Descriptive statistics were used to summarise the sample demographics and response rate and non-parametric statistics were used to test for associations and differences. Results: A Cronbach’s alpha for the GDS was calculated (p = 0.793). Some 40% of participants screened positive for depression. Female gender, widowhood and a negative subjective health status rating were significantly associated with depression and marriage appeared to be protective (p < 0.001). Participants with a poor subjective health rating were 21 times more likely to be depressed and widowhood conferred an almost fourfold increased risk of being depressed, with widows at greater risk than widowers. No association between depression and specific medical conditions was identified. Conclusion: There is a high rate of undetected depression among the elderly attending a local primary health care clinic with widowhood and poor subjective health being strong predictors of mood disorders. The findings warrant replication in bigger samples. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1272250

scholarly journals Πρόγραμμα εκτίμησης αναγκών υγείας στους ηλικιωμένους κατοίκους της περιοχής ευθύνης του Κέντρου Υγείας Βιάννου, Ηρακλείου, Κρήτης

2018 ◽  
Author(s):  
Ιωάννα Στεφανάκη
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Mental State ◽  
Barthel Index ◽  
Mini Mental State Examination ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Geriatric Depression ◽  
Primary Health ◽  
State Examination

Σκοπός: Σκοπός της παρούσας διδακτορικής διατριβής ήταν η εκτίμηση της κατάστασης υγείας των κατοίκων της τρίτης ηλικίας σε μια αγροτική περιοχή της Κρήτης και ο σχεδιασμός παρέμβασης σε θέματα πρόληψης και προαγωγής της υγείας, με τη χρήση σταθμισμένων εργαλείων στη Γενική Ιατρική. Ανάμεσα στους αντικειμενικούς στόχους περιλαμβάνονταν (α) η εκτίμηση της κινητικότητας και της ικανότητας αυτονομίας και της ποιότητας ζωής των ηλικιωμένων, (β) η εκτίμηση της ψυχικής τους υγείας και της γνωστικής τους κατάστασης καθώς και η ανάλυση της ικανότητας τους να διαχειρίζονται το stress και η συσχέτιση της με χρόνια νοσήματα, (γ) η ανάλυση της κατάστασης υγείας των ηλικιωμένων με αναφορά σε δεδομένα νοσηρότητας με ιδιαίτερη έμφαση στους παράγοντες κινδύνου (προσδιοριστές/determinants) των συχνότερων νοσημάτων, (δ) η αξιολόγηση της θρησκευτικότητας/πνευματικότητας και άλλων τοπικών κοινωνικο-οικονομικών παραγόντων και του ρόλου τους ως προσδιοριστές της υγείας και (ε) η σύγκριση της κατάστασης υγείας των ηλικιωμένων κατοίκων της περιοχής αυτής με άλλους πληθυσμούς της Ευρώπης. Η μελέτη έχει ενταχθεί σε ένα Ευρωπαϊκό δίκτυο (Tipping the Balance Towards Primary Health Care/TTB) που εστιάζει στην έρευνα και στην ανάπτυξη της ΠΦΥ. Πληθυσμός μελέτης και μέθοδοι: Πρόκειται για συγχρονική μελέτη με πληθυσμό αναφοράς όλα τα άτομα ηλικίας άνω των 65 ετών που διαβιούσαν σε 4 επιλεγμένα χωριά του δήμου Βιάννου (Ν=600 άτομα). Οι πληροφορίες για τη δομή του πληθυσμού (σύνθεση κατά φύλο και ηλικία) δόθηκαν με βάση την απογραφή του 2001 από τον Δήμο Βιάννου. Οι επαφές με τα άτομα αυτά πραγματοποιήθηκαν μετά από πρόσκληση στο Κέντρο Υγείας Βιάννου και στο Περιφερειακό Ιατρείο Εμπάρου ή κυρίως με κατ’ οίκον επίσκεψη δύο ιατρών Γενικής Ιατρικής, κατά τη χρονική περίοδο 2007-2009. Το σύνολο εκείνων που ολοκλήρωσαν τον έλεγχο υγείας ανήλθε σε 411 άτομα (179 άνδρες, 232 γυναίκες). Ο έλεγχος περιλάμβανε λεπτομερή λήψη ιατρικού ιστορικού, κλινική εξέταση και λήψη σωματομετρήσεων, ανίχνευση των γνωστικών/συναισθηματικών διαταραχών με την χρήση των Mini Mental State Examination (MMSE) και Geriatric Depression Scale (GDS), της ικανότητας διαχείρισης του stress, της ακράτειας ούρων, των διαταραχών κινητικότητας/ποιότητας ζωής με σταθμισμένες κλίμακες (SOC scale, Barthel index, QWB-SA scale) καθώς και εργαστηριακό έλεγχο. Τέλος μελετήθηκε ο βαθμός θρησκευτικότητας/πνευματικότητας με τη χρήση ειδικού ερωτηματολόγιου σταθμισμένο στα Ελληνικά (RFI-SRB). Αποτελέσματα: Από τους 411 συμμετέχοντες στη μελέτη, το 43,6% (Ν=179) ήταν άνδρες και 56,4% (Ν=232) γυναίκες. Το 42,7% (175 άτομα) ανήκε στην ηλικιακή ομάδα άνω των 75 ετών. Η πλειοψηφία των ατόμων ήταν έγγαμοι (71,5%), απόφοιτοι δημοτικού (61,3%) και συνταξιούχοι (70,7%). Βρέθηκε να έχουν υιοθετήσει συμπεριφορικούς παράγοντες κινδύνου για χρόνια νοσήματα, όπως η συνήθεια καπνίσματος (18,8%), η χαμηλή κατανάλωση φρούτων & λαχανικών (22,8%) και η σωματική αδράνεια (73,2%). Τα κυριότερα χρόνια νοσήματα όπως αυτά καταγράφηκαν από το ιστορικό τους διαπιστώθηκαν να είναι η αρτηριακή υπέρταση (55,8%), τα μυοσκελετικά νοσήματα (28,2%), ο σακχαρώδης διαβήτης (21,2%), η χρόνια αποφρακτική πνευμονοπάθεια (14,4%) και η θυρεοειδοπάθεια (9,2%). Επίσης διαπιστώθηκε υψηλή βαθμολογία της κλίμακας Βarthel (μέση τιμή 96,9) και χαμηλά επίπεδα έκπτωσης γνωστικών διαταραχών (μέση βαθμολογία κλίμακας MMSE25.2±4.3, p<0.001) και συναισθηματικών διαταραχών (μέση βαθμολογία κλίμακας GDS 3,9). Ένα από τα κύρια ευρήματα της μελέτης ήταν ότι οι συμμετέχοντες εμφάνιζαν υψηλή ικανότητα διαχείρισης του stress της καθημερινότητας και συγχρόνως υψηλή πνευματικότητα (θρησκευτικότητα) (p=0,039). Οι γυναίκες εμφάνιζαν έναντι των ανδρών σημαντικά μεγαλύτερη μέση βαθμολογία συναισθηματικών διαταραχών – GDS (4,6 έναντι 3,2, p=0,001) και χαμηλότερη γνωσιακών διαταραχών - MMSE (24,6 έναντι 26,0, p=0,001) ή αίσθησης της συνεκτικότητας - SOC (117,9 έναντι 128,4, p=0,032). Πάνω από το 1/3 των ατόμων (37,3%) θεωρούσε ότι έχει καλό επίπεδο γενικής υγείας και μόλις το 7,5% ανέφερε κακή υγεία ενώ σημαντικά υψηλότερο ποσοστό των γυναικών έναντι των ανδρών θεωρούσαν ότι έχουν κακή υγεία (9,5% έναντι 4,5%, p=0,002). Μεγαλύτερη χρήση των υπηρεσιών υγείας αναφορικά με τις επισκέψεις στον Γενικό Ιατρό και τις παραπομπές για νοσηλεία, φαίνεται να έκαναν οι άνδρες που διαβιούσαν μόνοι. Συμπέρασμα: Το παρόν διδακτορικό πόνημα παρουσιάζει ένα μέρος των αναγκών υγείας και του επιπέδου υγείας ηλικιωμένων κατοίκων σε μια αγροτική περιοχή της Κρήτης. Περαιτέρω μελέτη θεωρείται απαραίτητη για την διερεύνηση της αλληλεπίδρασης ψυχοκοινωνικών, βιολογικών ή άλλων παραγόντων στη διατήρηση της καλής γενικής υγείας του πληθυσμού, παρά την ύπαρξη πολλαπλών παραγόντων κινδύνου. Η μελέτη αυτή μπορεί να χρησιμοποιηθεί από τους σχεδιαστές των υπηρεσιών υγείας ως αναφορά για την υιοθέτηση μέτρων και εργαλείων στην καθημερινή πρακτική.

scholarly journals Schistosomiasis reinfection and community compliance in a primary health care participatory research project in Menoufia, Egypt

2021 ◽  
Vol 1 (2) ◽  
pp. 215-222
Author(s):  
Amal A. M. Khairy ◽  
Hassan Farag
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Laboratory Testing ◽  
Local Community ◽  
Case Finding ◽  
Health Care Teams ◽  
Community Members ◽  
Primary Health ◽  
The Impact

Thistudy aimed to train local primary health care teams on sound scientific techniques for schistosomiasis case-finding, recording, treatment and follow-up in the context of primary health care; involve local community members in designing and conducting epidemiological research on schistosomiasis and follow-up of positive cases in collaboration with primary health care teams; and assess the impact of this methodology on community compliance to laboratory testing and treatment, besides the impact on rates of prevalence, intensity, incidence and reinfection

scholarly journals 456 - Viability of RUDAS as a screening tool for cognitive decline in primary health care settings

2020 ◽  
Vol 32 (S1) ◽  
pp. 176-177
Author(s):  
Natacha Coello de Cunha Guimaraes ◽  
J. Antonio Garcia-Casal ◽  
Sofía Díaz Mosquera ◽  
María Alvarez Ariza ◽  
Raimundo Mateos Álvarez
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Cognitive Test ◽  
Clinical Dementia Rating ◽  
Dementia Screening ◽  
Primary Health ◽  
Valid Instrument ◽  
Sensitivity Specificity

IntroductionPrimary Health Care (PHC) has an essential role in the early detection of people with cognitive impairment (CI). Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive test, appropriate for people with minimum completed level of education and easily adaptable to multicultural contexts. For these reasons it could be a good instrument for dementia screening in PHC. It comprises the following areas: recent memory, body orientation, praxis, executive functions and language.ObjectivesThe objective of this study was to analyse the viability of RUDAS, as an instrument for the screening of CI in PHC. RUDAS viability in PHC was checked, and it's psychometric properties assessed: Reliability, Sensitivity, Specificity, Positive and Negative Predictive Value were studied. RUDAS was compared to Mini Mental State Exam (MMSE) as a “gold standard”.Patients and MethodsRUDAS was administered to 150 participants older than 65 years, randomly selected from seven PHC physicians’ consultations in O Grove Health Center. The test battery also included Katz, Barthel and Lawton Indexes, MMSE and the Geriatric Depression Scale. For each instrument administration time, difficulties perceived while administration and participant's collaboration were recorded. RUDAS was administered again within one month to assess test-retest reliability. For dementia clinical diagnosis, patients were classified following the Clinical Dementia Rating (CDR) scale based on clinicians’ criteria and health records.ResultsRUDAS application was brief (7,58±2,10 minutes) and well accepted. RUDAS’ area under Receiver Operating Characteristic (ROC) curve was 0.965 (95% Confidence Interval (CI) = 0.91-1.00) for an optimal cut-off point of 21.5, with sensitivity of 90.0%, and a specificity of 94.1%. RUDAS did not correlate with depression. Education, socioeconomic status and urban or rural context did not contribute any variance to RUDAS total score.ConclusionsRUDAS is a valid instrument to assess CI in PHC. It is easily applicable and appears to be culturally fair and free from educational level and language interference in bilingual contexts. However, longitudinal studies to determine its sensitivity to change in cognitive function over time are needed.

The Roots of Global Health Inequity

2017 ◽  
Author(s):  
Joia S. Mukherjee
Keyword(s):  
Health Care ◽  
World War Ii ◽  
Primary Health Care ◽  
Economic Policies ◽  
World War ◽  
The Public ◽  
The World Bank ◽  
Primary Health ◽  
The Cold War ◽  
The Impact

This chapter outlines the historical roots of health inequities. It focuses on the African continent, where life expectancy is the shortest and health systems are weakest. The chapter describes the impoverishment of countries by colonial powers, the development of the global human rights framework in the post-World War II era, the impact of the Cold War on African liberation struggles, and the challenges faced by newly liberated African governments to deliver health care through the public sector. The influence of the World Bank and the International Monetary Fund’s neoliberal economic policies is also discussed. The chapter highlights the shift from the aspiration of “health for all” voiced at the Alma Ata Conference on Primary Health Care in 1978, to the more narrowly defined “selective primary health care.” Finally, the chapter explains the challenges inherent in financing health in impoverished countries and how user fees became standard practice.

Impact of community participation in primary health care: what is the evidence?

2015 ◽  
Vol 21 (1) ◽  
pp. 2 ◽  
Author(s):  
Jessamy Bath ◽  
John Wakerman
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Outcomes ◽  
Community Participation ◽  
Service Providers ◽  
Developmental Process ◽  
Service Access ◽  
Primary Health ◽  
Intermediate Outcomes ◽  
The Impact

Community participation is a foundational principle of primary health care, with widely reputed benefits including improved health outcomes, equity, service access, relevance, acceptability, quality and responsiveness. Despite considerable rhetoric surrounding community participation, evidence of the tangible impact of community participation is unclear. A comprehensive literature review was conducted to locate and evaluate evidence of the impact of community participation in primary health care on health outcomes. The findings reveal a small but substantial body of evidence that community participation is associated with improved health outcomes. There is a limited body of evidence that community participation is associated with intermediate outcomes such as service access, utilisation, quality and responsiveness that ultimately contribute to health outcomes. Policy makers should strengthen policy and funding support for participatory mechanisms in primary health care, an important component of which is ongoing support for Aboriginal Community Controlled Health Services as exemplars of community participation in Australia. Primary health-care organisations and service providers are encouraged to consider participatory mechanisms where participation is an engaged and developmental process and people are actively involved in determining priorities and implementing solutions.

The Use of and Attitude Towards Telehealth in Rural Communities

2007 ◽  
Vol 13 (3) ◽  
pp. 29 ◽  
Author(s):  
Emily Mauldon
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Routine Practice ◽  
Care Providers ◽  
Urban Hospital ◽  
Primary Health ◽  
The Impact ◽  
Rural Patients

This paper reports on the attitudes of a sample of health care providers towards the use of telehealth to support rural patients and integrate rural primary health and urban hospital care. Telehealth and other information technologies hold the promise of improving the quality of care for people in rural and remote areas and for supporting rural primary health care providers. While seemingly beneficial for rural patients, study participants believed that telehealth remains underused and poorly integrated into their practice. In general, participants thought that telehealth is potentially beneficial but places constraints on their activities, and few actually used it. Published literature usually reports either on the success of telehealth pilot projects or initiatives that are well resourced and do not reflect the constraints of routine practice, or has an international focus limiting its relevance to the Australian context. Because of the paucity of systematic and generalisable research into the effects of the routine use of telehealth to support rural patients, it is unclear why health care professionals choose to provide such services or the costs and benefits they incur in doing so. Research and policy initiatives continue to be needed to identify the impact of telehealth within the context of Australian primary health care and to develop strategies to support its use.

scholarly journals Difficulties in nutritional counseling and child growth follow-up: from a professional perspective

2017 ◽  
Vol 70 (5) ◽  
pp. 949-957 ◽  
Author(s):  
Claudia Nery Teixeira Palombo ◽  
Elizabeth Fujimori ◽  
Áurea Tamami Minagawa Toriyama ◽  
Luciane Simões Duarte ◽  
Ana Luiza Vilela Borges
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Medical Model ◽  
Child Growth ◽  
Nutritional Counseling ◽  
Child Feeding ◽  
Professional Experiences ◽  
Primary Health ◽  
Professional Perspective

ABSTRACT Introduction: Nutritional counseling and growth follow-up are priorities when providing care to children; however, these have not been completely incorporated into primary health care. Objective: To know the difficulties for providing nutritional counseling and child growth follow-up, from a professional healthcare perspective. Method: Qualitative study, using Donabedian as theoretical framework, developed by 53 professionals in the field of primary health care. Data was obtained from focal groups and submitted to content analysis. Results: The main difficulties for nutritional counseling were clustered in the category of ‘perceptions and beliefs related to child feeding’. The ‘problems of infrastructure and healthcare’ and ‘maintenance of the hegemonic medical model’ are the main difficulties for following-up growth. Final considerations: Besides investments in infrastructure, healthcare training is indispensable considering beliefs and professional experiences, so in fact, nutritional counseling and child growth follow-up are incorporated in primary health care.

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