Promoting Healthy Food Access and Nutrition in Primary Care: A Systematic Scoping Review of Food Prescription Programs

Objective To conduct a scoping review to synthesize evidence on food prescription programs. Data Source A systematic search of PubMed, CINAHL, Web of Science, Embase, and the Cochrane Library was conducted using key words related to setting, interventions, and outcomes. Study Inclusion and Exclusion Criteria Publications were eligible if they reported food prescription administered by a health care practitioner (HCP) with the explicit aim of improving healthy food access and consumption, food security (FS), or health. Data Extraction A data charting form was used to extract relevant details on intervention characteristics, study methodology, and key findings. Data Synthesis Study and intervention characteristics were summarized. We undertook a thematic analysis to identify and report on themes. A critical appraisal of study quality was conducted using the Mixed Methods Appraisal Tool (MMAT). Results A total of 6145 abstracts were screened and 23 manuscripts were included in the review. Food prescriptions may improve fruit and vegetable consumption and reduce food insecurity (FI). Evidence for impacts on diet-related health outcomes is limited and mixed. The overall quality of included studies was weak. Addressing barriers such as stigma, transportation, and poor nutrition literacy may increase utilization of food prescriptions. Conclusion Food prescriptions are a promising health care intervention. There is a need for rigorous studies that incorporate larger sample sizes, control groups, and validated assessments of dietary intake, food security, and health.

What do knee OA patients perceive about their disorder? A qualitative study

Purpose The purpose of this study was to explore patient’s perception of their disorder. Design/methodology/approach This study used a phenomenographical approach within a qualitative research paradigm. A total of 21 patients with knee osteoarthritis (OA) were recruited for the study, and data were collected through open-ended face-to-face interviews. The interviews were transcribed and thematically analyzed. The transcribed verbatim was analyzed for themes. Findings The themes developed reflected the patients’ perceptions about the disease process. Thematic analysis revealed three themes: Knee OA is a degenerative disease, Knee OA is an age-related disease and Knee OA is caused by certain activities of daily living. The patient’s information varied and was limited to what had been provided by the health-care practitioner. The knowledge was more biomedical in orientation and was limited and not supported by the evidence. Research limitations/implications There is a need to provide evidence-based information that the patient must understand. Health-care providers must use a biopsychosocial framework to discuss the disease knowledge with patients. Practical implications This study helps us in identifying disease perceptions that can be used to design education programs for knee OA patients. It also highlights the need for delivering educational programs to knee OA patients. Originality/value This study lays a foundation for further research. To the author’s best knowledge, this is the first study to explore disease perceptions using a qualitative approach conducted among patients from a lower middle-income country.

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.

The caring perspective during a COVID pandemic

Work as a private primary health care practitioner with a special interest in older persons has been a rollercoaster ride over the course of the pandemic with the need to improvise, provide a wider form of care and an inordinate amount of role changing. The initial recommendation was to stay away from any possible cases which may have remotely resembled COVID with a view to keeping physicians and their practice safe. This message was unheard after the start of the second wave as the health services struggled to cope, testing became ever more accessible and patients who did develop COVID-19 needed someone to care for them when state services were overstretched. Meanwhile, the availability of all forms of specialist care grew ever scarcer in the community and increasingly caregivers such as myself realised that boundaries were now blurred under such circumstances. As hospital wards became taken up with exclusively COVID-19 patients, other hospital care delivery became on an urgent only basis and this had an effect on care in the community for patients living with chronic diseases. Physicians such as myself became ever more involved in caring for persons with mental illness and with the plethora of anxiety prevalent in a community burdened with a pandemic, an overabundance of morbid media coverage and social media feeding on fear and doubt.

The utilisation of public and private health care among Australian women with diabetes: Findings from the 45 and Up Study

Aim To describe the prevalence of health care utilisation and out-of-pocket expenditure associated with the management of diabetes among Australian women aged 45 years and older. Design Cross-sectional survey design. Methods The questionnaire was administered to 392 women (a cohort of the 45 and Up Study) reporting a diagnosis of diabetes between August and November 2016. It asked about the use of conventional medicine, complementary medicine (CM) and self-prescribed treatments for diabetes and associated out-of-pocket spending. Results Most women (88.3%; n = 346) consulted at least one health care practitioner in the previous 12 months for their diabetes; 84.6% (n = 332) consulted a doctor, 44.4% (n = 174) consulted an allied health practitioner, and 20.4% (n = 80) consulted a CM practitioner. On average, the combined annual out-of-pocket health care expenditure was AU$492.6 per woman, which extrapolated to approximately AU$252 million per annum. Of this total figure, approximately AU$70 million was spent on CM per annum. Conclusions Women with diabetes use a diverse range of health services and incur significant out-of-pocket expense to manage their health. The degree to which the health care services women received were coordinated, or addressed their needs and preferences, warrants further exploration. Limitations of this study include the use of self-report and inability to generalise findings to other populations.

The characteristics of women aged 59-64 years who consult health care practitioners for back pain from the Australian Longitudinal Study on Women's Health (ALSWH).

Background: Back pain affects a substantial proportion of the adult population, and back pain sufferers tend to explore a wide range of health care options. This study investigates the use of medical and physiotherapy services by Australian women with back pain. Method: This is a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), designed to investigate multiple factors affecting the health and well-being of women over a 20-year period. The study focuses on 1,851 women aged 59-64 years, who had indicated that they had previously sought help from a health care practitioner for back pain. Results: Half of the women (56.5%) with back pain had consulted a general practitioner (GP), 16.2% had consulted a medical specialist, and 37.3% had consulted a physiotherapist for their back pain. Women with regular or continuous back pain were more likely to consult a GP (OR=3.98), medical specialist (OR=5.66) and a physiotherapist (OR=1.63). Conclusion: Australian women with back pain were more likely to consult a GP, medical specialist or physiotherapist if they had more regular/continuous back pain. Future research needs to investigate further the consultation and referral patterns identified in this study.

Case Report on Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disorder that inhibits the body's immune system that induces inflammation in the injured areas of the body. It is commonly caused the joints of the palms, wrists, and knees. An inflaming rheumatoid arthritis joint contributes to joint tissue damage. This condition may cause chronic or long term discomfort, instability, and deformation. Symptoms include exhaustion, pain, and depression. If the patient does not undergo early diagnosis and care for symptoms, a series of symptoms can arise including Osteoporosis, rheumatoid nodules, dry eye and mouth, carpal tunnel syndrome Case Report: The female patient name is Yogita Shinde 65-year-old religion Hindu lived in the kandhali. She was admitted to AVBR Hospital with the chief complaint of pain in her shoulder and hands, joints pain, swelling on both the hands. She started taking ibuprofen 800 mg 3 times per day to relieve discomfort and rigidity. Three months earlier, as she was doing her job, she had pain on her right and left shoulders. She still started to feel very sleepy and short-tempered. Tab ibuprofen was not an effective very long time for pain. One morning, Yogita couldn't lift her arms without the intense pain of her back. She was conscious that it was time for help. She had spoken to her parents, and they advised her to see a physician. The primary healthcare practitioner (PHP), who tested and carried out a variety of blood test. Positive-rheumatoid factors, CCP antibiotics, higher ESR, and C-reactive protein were seen via the blood samples. These findings were communicated to Yogita and the Rheumatologist was directed at her PCP to see her as soon as possible. The primary health care practitioner inquired about the medical records of Yogita parents and grandparents, family conditions, medical and operative records of yogita, and details on their family and working lives. And after that, the physician started the treatment, after which Yogita feels better for some days. After a few weeks she having recurrent pain in her hand and foot, this is intolerable to her. And then she is admitted to AVBR Hospital on date 20th Sept 2020

People with physical disabilities in Sri Lanka are in need for the service of community physiotherapists

Background: Physiotherapists have long been recognized as important providers of services for people with disability. In Sri Lanka the concept of community physiotherapy has not emerged yet. The present study aimed to identify the need for ‘community physiotherapy service’ in Kandy district, Sri Lanka. Methods: A community service projection community based rehabilitation, of three years was conducted by the department of physiotherapy, faculty of allied health sciences, University of Peradeniya, Sri Lanka in 2017-2019 in collaboration with department of social service and social welfare of Kandy district secretariat, Sri Lanka.Results: One hundred and seventy participants with physical disabilities were included in the study 94 (55.29%) were males (mean age; 33.57 (SD ±23.17) and 76 (44.71%) were females (mean age; 33.14 (SD ±24.98). The pediatric population was 41.76% (N=71) followed by 38.82% of adults (N=66) and 19.41% of elderly patients (N=33) of the total population. The highest number of PWD had pediatric conditions (39.41%), followed by musculoskeletal (31.76%), neurological (15.88%), geriatric (8.82%) and cardio-respiratory (4.12%) conditions. The majority (55.88%) of all the people with disabilities who visited the clinics were in need for further physiotherapy consultation and follow up.Conclusions: In Kandy district of Sri Lanka alone, number of people with physical disabilities who are in need of continuous physiotherapy follow ups is high compared to services already available. Conducting a successful community-based rehabilitation program in Sri Lanka as a whole, require having a specialized health care practitioner to the primary health care team; ‘a community physiotherapist’.

Systemic reactions to subcutaneous allergen immunotherapy: real-world cause and effect modelling

Background Subcutaneous immunotherapy (SCIT) is an effective treatment for allergic rhinoconjunctivitis. However, adverse events, including life-threatening systemic reactions, may occur. The purpose of this project is to identify risk factors for systemic reactions to SCIT and to provide practice-based solutions using a quality improvement (QI) framework. Methods A QI initiative was performed in a hospital-based, Canadian Allergy clinic administering SCIT in a 12-month period. Results A total of 4242 injections of SCIT were performed over a period of 12 months. Of these, 10 injections resulted in a systemic reaction requiring epinephrine administration (i.e., an incidence of 1 in 424 injections, or 0.24%). Eight patients had at least one documented risk factor for a systemic reaction, and six had multiple risk factors. Major risk factors included seasonal exacerbation of allergic rhinitis, uncontrolled asthma, and an error in route of administration. All reactions occurred with the highest allergen extract concentration. Conclusion This QI initiative highlights the need for improved patient and health care practitioner education and pre-administration screening. We suggest several considerations for SCIT administration: provide patients with written information on safety; screen patients before injections, including a review of treatment plan adherence and asthma control; adjust dosing to slow down buildup of the most concentrated immunotherapy extract, particularly in high risk patients; and apply additional safety measures in patients with multiple risk factors.

Exploring Cancer Pain Self-Management Needs and Preferences: A Meta-Ethnography

Self-management of chronic disease and related symptoms provides a framework for understanding the contextual factors that influence self-management knowledge and skills that patients and families require to manage their condition on a day-to-day basis. The management of cancer pain is a significant issue for patients and families, and their experience can provide insight on cancer pain self-management support needs and preferences. A meta-synthesis of 20 qualitative research articles on self-management of cancer pain was conducted to gain a deeper understanding of the self-management support needs of patients with cancer pain. Noblit and Hare’s meta-ethnographic model was used. The meta-synthesis resulted in increased understanding of the needs and preferences for self-management support of cancer pain and the role of the health care practitioner. Practical implications are presented.