ANALYSIS OF MOTIVATION PHASE OF THE HAPA THEORY (HEALTH ACTION PROCESS APPROACH) AND INTENTION TO EXCLUSIVE BREASTFEEDING IN THE SIDOSERMO PRIMARY HEALTHCARE CENTER, SURABAYA

ABSTRACTExclusive breastfeeding can encourage optimal growth and development, especially during the child’s critical period which spans from when the baby is born until 2 years old. The objective of this study was to analyze the motivational phase of the Health Action Process Approach (HAPA) theory with the intention of exclusive breastfeeding in the work area of the Sidosermo Primary Healthcare Center. This study was a quantitative cross-sectional study with an observational research design. The sampling technique was conducted through the systematic random sampling technique with a total sample of 32 people. The study showed that risk perception has a significant influence on the intention of exclusive breastfeeding with a significance value of 0.014 < α (0.05) and an odds ratio of 0.101. This suggests that respondents who had the right perception about exclusive breastfeeding are 0.101 times more likely to exclusively breasfeed their child than respondents who had a wrong perception. This study also showed that there was a significant influence between self-efficacy towards the intention of exclusive breastfeeding, with a significance value of 0.006 < α (0.05). Respondents who felt that they were able to give exclusive breastfeeding were 17 times more likely to provide exclusive breastfeed than those who felt they were less able. The results of this study indicated that there was an influence between the outcome expectancies with the intention of exclusive breastfeeding with a significance value of 0.004 < α (0.05) and an odds ratio of 28.8. It means that respondents who had high expectations had 28.8 times more intention to provide exclusive breastfeeding than respondents who had low expectations. Keywords: exclusive breastfeeding, intention, Health Action Process Approach (HAPA)

Effectiveness of Telephone Monitoring in Primary Care to Detect Pneumonia and Associated Risk Factors in Patients with SARS-CoV-2

Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis; patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.

Abstract P119: Cardiovascular Risk And Subclinical Target Organ Damage In A Young Adult Population Provided By A Primary Healthcare Center In Brazil (Laparc Study)

Background: In this young and apparently healthy population, it is important to identify early CV risk factors and subclinical target organ damage (TOD) with low complexity procedures, aiming regression, control and primary prevention with future reduction of CV morbidity and mortality. Objectives: To evaluate subclinical TOD using Ankle-Brachial Index (ABI), Office and Home Pulse Pressure (PP), identifying arterial stiffness. Methods: A cross-sectional population study for CV risk assessment in adults aged 20-50 years old provided by a Primary Healthcare Center in Brazil. A total of 632 individuals were evaluated (40% male; mean age 36 ± 9 years). Socio-demographic, anthropometric data, and lifestyle evaluation were recorded. All underwent Office Blood Pressure (OBP) measurements in the 4 limbs to calculate the ABI and office PP. All received the Home Blood Pressure Monitoring (HBPM) device (7 days protocol) and the mean of the general BP and the calculation of the PP were evaluated. They also performed an ECG to calculate Sokolow-Lyon Index (SLI) and Cornell Voltage Index (CVI). Results: The prevalence of hypertension according to OBP was 16% and 18% according to HBPM, but with a low agreement between diagnoses (kappa = 0.385). HBPM identified 4 phenotypes: normotension (74%), sustained hypertension (8%), masked hypertension (10%), and white coat hypertension (8%). The median of office PP was 46 [39-52] mmHg and of Home PP was 45 [41-50] mmHg. Elevated Office PP and Home PP (> 60 mmHg) were identified in 64 and 28 participants, respectively. High office PP was more frequent in men, obese, with increased neck circumference and lower ABI. It was also associated with higher SLI and CVI. High Home PP was also more frequent in men, obese, with increased neck circumference and higher CVI. The median of the ABI was 1.14 [1.08-1.22], which is the cutoff point we used to define early changes in the ABI. Individuals with decreased ABI are more obese, with smaller neck circumference and lower OBP control. They also had higher systolic BP values and office PP (49 vs 43 mmHg, p<0.001). Conclusion: In this young population, early changes in subclinical TOD already identify a higher CV risk profile, indicating the importance of implementing prevention measures to reduce this risk.

QUALITY OF PRESCRIPTIONS IN PRIMARY CARE: WE NEED TO TARGET THAT

Aim: To identify errors in drug prescriptions and its causes in a primary healthcare center. Method: Cross-sectional study carried out in a primary healthcare center in northeastern Brazil. A total of 707 drug prescriptions were analyzed using an instrument with pre-established criteria, according to the country's legal provisions regarding drug prescription. An Ishikawa diagram was created to identify the possible causes for the identified errors. Results: A total of 138 drug prescriptions (19.5%) presented information failure or inadequacy. From the errors found, 116 (16.41%) were related to information on dosage. The Ishikawa diagram showed opportunity for improvement in management, training, and technical/professional qualification. Conclusion: The errors seen on drug prescriptions at a primary healthcare center were related to illegibility, absence of dosage, and absence of mandatory patient information. Organizational, technical, scientific, and political factors were identified as the roots of the identified errors.

Type D Personality and Essential Hypertension in Semarang City, Indonesia: A Primary Healthcare Center-based Case-Control Study

Type D personality is defined as the interaction between negative affectivity (NA) and social inhibition (SI). Hypertension has the highest cases in primary healthcare center (PHC) in Semarang City compared to other non-communicable diseases. This study aims to determine type D personality role on essential hypertension. It was a case-control study conducted at the PHC in Semarang City from January 2020 to March 2021 with 139 cases and 139 controls among 18-60 years old patients. Sample collection was performed by stratified random sampling. The instruments used were the DS-14 scale, structured questionnaire IPAQ-SF, food frequency questionnaire, and the Holmes and Rahe Stress Scale, while data were analyzed using logistic regression. The prevalence of type D personality in the case group (64%; 95%CI: 55.9%-72.1%) was higher than in the control (36.7%; 95%CI: 28.7%-44.7%). Type D personality was discovered to be significantly associated with essential hypertension (OR: 3.07; 95%CI: 1.83-5.16). After other covariates adjustment, the association was still statistically significant (AdjOR: 2.41; 95%CI: 1.32-4.41).

Analysis of Implementation of Maternity Planning and Prevention of Complication (P4K) Program with Stickers in Purwakarta Regency 2017

Pregnant women are one of the risk groups that should be considered to receive particular attention. Maternal mortality is caused by direct and indirect causes, which generally can be identified in early pregnancy. The Ministry of Health has launched various programs to reduce maternal mortality. At the community level, since 2007, there has been a birth planning and prevention of complications (P4K) program as a screening tool for pregnant women at risk by using stickers. The main point of this program is the active participation of families and communities to care for pregnant women in their environment. Purwakarta Regency, a region with uncomplicated geographical conditions, is supported by Health Human Resources (SDMKes) and Health facilities to do various programs in reducing the number of maternal deaths; one of them is P4K with stickers. In 2017, there were still 21 maternal deaths that should have been identified and referred to the hospital if the program was running well. The study aims to analyze the implementation of the P4K Sticker at the District Level. This research is qualitative research with in-depth interviewing techniques involving 12 informants and related documents, according to the theory of Van Meter and Van Horn policy implementation based on 6 (six) variables. This study found that the standard and policy objectives have not been fully achieved. There is still insufficient funding to support the program optimally. In terms of communication, there still a different understanding between the Health Office and Primary Healthcare Center. Despite there are still constraints on the number of human resources, the program's attitude is supportive. Economic and political situations are good, but social conditions are not supportive. The conclusion is that the program's implementation still has constraints in each variable. Existing program barriers can be overcome by optimizing inter-organizational communication, in this case, the District Health Office with Primary Healthcare Center, to have a common understanding regarding the implementation of Sticker P4K.

Comparison of Lab based Device and Cuff-less based Device for Efficient Heart Rate Monitoring in Normal Individuals and Heart Diseased Individuals for Extended Duration

Aim: This study was performed to validate and compare our designed cuff less device with standard heart rate monitors used in Hospitals. Materials and Methods: The Heart patient data were collected in Government PHC (Primary Healthcare Center), Navalpakkam hospital and the normal individual data were collected in Saveetha School of Engineering (SSE), Saveetha University (CLAB 404/425). Results: The means of the BPM also was found to be very similar with a minor deviation in heart rate of heart patients monitored by our cuff less device. The high insignificance assures that our device has given reading at par with commercial monitors used in the market Conclusion: Within the limits of our study our cuff-less device is as efficient as a vital sign monitor (lab based device) used in hospitals or Laboratories (one way ANOVA, P >0.05, insignificant).

Abstract P026: Cardiovascular Risk Factors, Lifestyle And Social Determinants: Results From A Population-based Cross-sectional Study In Brazil (laparc Study)

Objective: To evaluate the relationship between the main cardiovascular (CV) risk factors and socioeconomic indicators in a population of young adults provided by a Primary Healthcare Center in a large urban area of Brazil. Methods: Cross-sectional population study that included adults aged between 20- and 50-years old provided by a Primary Healthcare Center in Rio de Janeiro, Brazil. Demographic data (gender and age), socioeconomic data (education level, occupation, employment), CV risk factors (smoking, sedentary lifestyle, obesity, hypertension, diabetes, dyslipidemia) were recorded. The metabolic profile was evaluated through laboratory tests. Those who studied up to high school were considered poorly educated. Results: A total of 604 individuals were enrolled [39% male, mean age: 38.8 ± 8,9 years]. The median of schooling was 12 years. In addition, 288 individuals had high schooling, of which 44.5% were male. A total of 130 individuals did not study or work. Women with low education had a higher risk of smoking, hypertension, and obesity, with no difference regarding labor or study activities. Otherwise, men with low education had higher risk of sedentary lifestyle and hypertension. Among men, not working or studying increased the risk of smoking and hypertension. Conclusions: We found an inverse association between socioeconomic status and the prevalence of CV risk factors. Women are more affected by low schooling, while men are more affected by their working occupation. The study suggests that socioeconomic factors influence the CV risk, affecting men and women differently, pointing to the need for public policies to reverse this situation.

Abstract P142: Metabolically Healthy Obesity In A Young Adult Population Provided By A Primary Healthcare Center In Brazil (LAPARC Study)

Background: Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease. Objective: To evaluate the prevalence and CV risk factors associated with MHO in a young adult population provided by a Primary Healthcare Center in a large urban area of Brazil. Methods: A cross-sectional population study for CV risk assessment in adults aged 20-50 years old provided by a Primary Healthcare Center in Rio de Janeiro, Brazil. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (OBP) measurements, laboratory evaluation (lipid and glycemic profile). Obesity was defined as a BMI ≥ 30 kg/m2 and MHO are those who have less than 3 of the following criteria: hypertension, diabetes, total cholesterol ≥ 200 mg/dL, HDL<40 mg/dL (men) and 50 mg/dL (women), triglycerides>150 mg/dL and increased waist circumference. Results: A total of 632 individuals were evaluated (60% female; mean age 37 ± 9 years). The prevalence of obesity was 25% (161 of 632 individuals), of which 73% (117 of 161 individuals) were classified as MHO. Obese individuals are older, with a higher prevalence of physical inactivity (51% vs 41%, p=0.03), hypertension (44% vs 19%, p<0.001), dyslipidemia (50% vs 36%, p=0.002) and diabetes (7% vs 2%, p=0.001) with higher systolic OBP. MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p=0.02) and abdominal circumference (102 vs 110 cm, p=0.03), with lower diastolic BP. Conclusions: MHO was more prevalent in this young adult population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention.