Parents report that around 20% of infants cry a lot without apparent reason during the first four postnatal months. This crying can trigger parental depression, breastfeeding cessation, overfeeding, impaired parent–child relationships and child development, and infant abuse. The Surviving Crying (SC) cognitive behaviour therapy (CBT)-based materials were developed in earlier research to improve the coping, wellbeing and mental health of parents who judge their infant to be crying excessively.

This study set out to:

• develop a health visitor (HV) training module based on the SC materials, tailored to fit health visiting;

• assess whether HVs could deliver a SC-based service successfully;

• confirm whether parents gained similar benefits to those in the earlier study;

• prepare for a controlled trial of the SC-based service.

A training module was developed to enable HVs to deliver the SC materials, much of it provided online. Ten HVs took the training module (‘SC HVs’). They and the Institute of Health Visiting provided feedback to refine it. SC HV delivery of the CBT sessions to parents with excessively crying babies was assessed using a standardised test. Parental wellbeing was measured using validated questionnaires. Parents and SC HVs evaluated the effectiveness of the SC service using questionnaires or interviews.

The study produced the intended training module. Most SC HVs completed the training, and 50% delivered the SC-based service successfully. Both training and delivery were disrupted by the Covid-19 pandemic, illness and work pressures. Replicating earlier findings: most parents’ anxiety and depression scores declined substantially after receiving the SC service; improvements in parents’ confidence, frustration and sleep were found; and all parents and the SC HVs interviewed found the SC service useful and agreed it should be included in the National Health Service. A controlled trial of the resulting SC service is underway.

As part of a replication study after the randomized controlled trial (RCTs) in the Netherlands, the impact was assessed on health services utilization and expenditure of two self-management programmes for older adults with osteoarthritis (OA) of the knee and hip.

Evidence-based patient education and exercise programmes, developed and tested in RCTs, are often insufficiently diffused among practitioners and primary healthcare providers and tend to have a modest reach in the population. Large-scale adoption in primary healthcare can be improved if programmes are feasible and effective in real life.

The programmes were conducted in real-life conditions by primary healthcare providers (local health centres, home-care providers, physical therapy centres). Pre-test/post-test data were collected for consultation of the general practitioner (GP), medical specialist, physical therapist, and for the use of OA medication, as well as for the expenditure for physical therapy and OA medication.

In total, 20 Knee and 20 Hip programmes were carried out by 18 providers. The Knee programmes were attended by 204 participants and the Hip programmes by 169 participants. Physical therapy and use of OA medication for both programmes and consultation of the medical specialist for the Hip programme decreased. No effect was observed for consultations of the GP. Expenditure for physical therapy and use of OA medication could not be assessed, due to difficulties to obtain sufficient reliable data from participating health insurers. Both programmes produced similar outcomes in real-life conditions compared to their RCTs. The implications are discussed as to accurate data collection on OA expenditure, future cost-utility and cost-effectiveness studies, and the large-scale implementation of the programmes in the Dutch primary healthcare system.

Sufficient knowledge required to deal with emergencies at the accident site may not be found in most medical students due to the lack of effective first-aid training in most medical education curricula. This study aims to assess and evaluate medical students’ knowledge level in providing first-aid care, especially first-year students.

An electronic questionnaire was distributed via social media to 1,855 medical students in October 2020. The knowledge level was assessed based on scores obtained for each clinical scenario requiring first aid and classified as good, intermediate, or weak. Statistical analysis was performed using SPSS software.

The study found that academic year and specialization significantly influence medical students’ first-aid knowledge level. However, demographic factors such as gender, university, marital status, housing status, work status, financial condition, and previous first-aid training did not show any significant effect.

The level of knowledge among Syrian medical students in providing first-aid care is somewhat limited. Therefore, first-aid courses should be made more accessible to these students, and their effectiveness should be ensured and maintained through frequent updates. Moreover, more attention should be placed on publicizing first-aid knowledge to make life-saving procedures attainable to anyone, anytime and anywhere.

Tuberculosis (TB) is still a major public health problem in many countries, including Brazil. Primary health care (PHC) services are a set of important services with infrastructure and resources to diagnose, treat, and cure several diseases, including the TB.

The aim of this study is to analyse aspects of the facility infrastructure of Brazilian PHC, regarding the control and treatment of TB from a countrywide perspective.

This is a cross-sectional study based on PHC services. Data were collected from 38,812 health centres and were assessed by means of the National Program for Improving Access and Quality Primary Care. The outcome was obtained by the presence and availability of the following infrastructure items: air circulation in the consultation room, refrigerator, individual protective equipment, plastic jar for sputum examination, and TB notification form of the primary care information system. Poisson regression was used to calculate the prevalence ratio.

Of the 38,812 evaluated centres, only 1628 (4.2%) presented a positive result regarding the outcome. Primary health centres, among all types of centres, presented the highest quality of facility infrastructure for TB control. Centres with large workloads, as well as those that presented a list of offered services and a welcoming consulting room, also presented the highest quality infrastructure. The present study shows that major improvements should be made to the infrastructure to reach a satisfactory TB control in Brazil.

Aim of cross-sectional study was to survey the risk of diabetes mellitus in a severely disadvantaged Hungarian community and then to use laboratory tests to screen for potential carbohydrate metabolism disorders among those in the moderate- and high-risk groups.

The prevalence of diabetes mellitus shows a worrisome trend worldwide. Low socio-economic status significantly affects the development of diabetes, healthy life years and life expectancy.

Diabetes risk of the population was surveyed with the FINDRISC (Finnish Diabetes Risk Score) questionnaire, followed by oral glucose tolerance test (OGTT) and glycated haemoglobin test of moderate- and high-risk patients.

In sample of 551 subjects, moderate or high risk for diabetes was confirmed in 147 patients (26.68%). There was significant correlation between increased risk and age (P < 0.001) and between increased risk and body mass index (P < 0.001). Significant difference was confirmed between incidences for disease based on the results of OGTT and glycated haemoglobin test when two different criteria systems were used. Age was the strongest predictor of pre-diabetes/diabetes (P = 0.016). The presence of metabolic syndrome increased the level of glycated haemoglobin by an average of 0.2% in normal glycemic status.

As communication skills are essential for medical practice, many medical schools have added communication skills training to their curricula in recent years. The aim of this study was to determine and compare the attitudes to communication skills of family medicine, internal medicine and general surgery residents.

Family medicine, internal medicine and general surgery residents of three training and research hospitals and one university hospital in Ankara were included in this cross-sectional study. A questionnaire was used for obtaining information about age, gender, marital status, graduation date and whether receiving any training for communication skills. The Turkish version of the Communication Skills Attitude Scale was used.

In all, 58 (50%) family medicine, 30 (25.9%) internal medicine, and 28 (24.1%) general surgery residents were accepted to participate in the study. Of the 116 residents, 58 (50%) were female and 58 (50%) were male, with a mean age of 29.47±4.63 years, and 68 (58.6%) of them were married; 59.5% of the participants received training about communication skills and 56.5% of them received it at medical school. The mean positive attitude scale (PAS) score was 3.85±0.58, and the mean negative attitude scale (NAS) score was 2.42±0.52. The PAS scores of female residents were higher than those of males (P=0.01). The PAS scores of residents who received communication skills training were higher than the scores of those who had not (P=0.01). The PAS scores of family medicine residents were higher and the NAS scores were lower than those of internal medicine and general surgery residents.

The communication skill attitudes of family medicine residents were better than those of internal medicine and general surgery residents.

To determine what diagnostic terms are utilized by general practitioners (GPs) when seeing patients with mixed emotional and physical symptoms.

Prototype cases of depression, anxiety, hypochondriasis, somatization and undifferentiated somatoform disorders were sourced from the psychiatric literature and the author’s clinical practice. These were presented, in paper form, to a sample of GPs and GP registrars who were asked to provide a written diagnosis.

Fifty-two questionnaires were returned (30% response rate). The depression and anxiety cases were identified correctly by most participants. There was moderate identification of the hypochondriasis and somatization disorder cases, and poor identification of the undifferentiated somatoform case.

Somatization and undifferentiated somatoform disorders were infrequently recognized as diagnostic categories by the GPs in this study. Future research into the language and diagnostic reasoning utilized by GPs may help develop better diagnostic classification systems for use in primary care in this important area of practice.

Community health committees (CHCs) are a mechanism for communities to voluntarily participate in making decisions and providing oversight of the delivery of community health services. For CHCs to succeed, governments need to implement policies that promote community participation. Our research aimed to analyze factors influencing the implementation of CHC-related policies in Kenya.

Using a qualitative study design, we extracted data from policy documents and conducted 12 key informant interviews with health workers and health managers in two counties (rural and urban) and the national Ministry of Health. We applied content analysis for both the policy documents and interview transcripts and summarized the factors that influenced the implementation of CHC-related policies.

Since the inception of the community health strategy, the roles of CHCs in community participation have been consistently vague. Primary health workers found the policy content related to CHCs challenging to translate into practice. They also had an inadequate understanding of the roles of CHCs, partly because policy content was not adequately disseminated at the primary healthcare level. It emerged that actors involved in organizing and providing community health services did not perceive CHCs as valuable mechanisms for community participation. County governments did not allocate funds to support CHC activities, and policies focused more on incentivizing community health volunteers (CHVs) who, unlike CHCs, provide health services at the household level. CHVs are incorporated in CHCs.

Kenya’s community health policy inadvertently created role conflict and competition for resources and recognition between community health workers involved in service delivery and those involved in overseeing community health services. Community health policies and related bills need to clearly define the roles of CHCs. County governments can promote the implementation of CHC policies by including CHCs in the agenda during the annual review of performance in the health sector.

Family medicine practitioners (FMP) take care of a varied range of patients with undifferentiated conditions over a lifetime. Although it was incepted in Saudi Arabia in 1980, limited data exists on FMP. This paper explores what family physicians deem relevant.

A cross-sectional survey was conducted among FMP in Saudi Arabia in 2018–2019 who responded to an online questionnaire that listed 20 activities usually done by FMP asking them to rate their meaningfulness on a 5-point Likert Scale, and select the top 3 they would like to spend the most and the least time on. Chi-square statistics were used to compare preference for time spent on these six activities by participant characteristics

Of the 415 survey participants, the majority were male (246) and had a Bachelor’s degree (176). The management of risk conditions, follow-up of chronic illnesses and running preventive health clinics were listed as most meaningful. The majority wished to spend more time on managing health risks, handling daily common complaints and follow-up of chronic illnesses and less time on terminal care activities (46.8%), emergency care (32.3%) and addiction medicine (23.4%). Bachelor’s degree holders wished to spend more time on emergency care compared to Diploma, Board-certified and Fellowship holders (63%, 21%, 10% and 5%, respectively; P = 0.01).

The activities preferred by FMP align with prevailing disease epidemiology. Variations in preferences of ‘managing emergencies’ reflect the varied format of training. Training of FMP should be standardized and further studies investigate reasons for specific preferences.

To assess and improve the quality of Secondary to Primary Care communication on discharge with a focus on post-surgical wound care.

Hospital discharge summaries are the principle means of relaying accurate information back to primary care healthcare providers regarding a patient’s hospital attendance and any ongoing care that is required. The quality of these summaries can be quiet varied both nationally and local to our Trust. Subsequently the Surgical Directorate were seeing an increased level of additional emergency communication from Primary Care providers especially in relation to post-operative wound care.

A survey was distributed to local Primary Care practitioners to assess satisfaction with the General Surgical Department wound care information located on the discharge summary. Using these results, a wound closure information document was developed and distributed to general practice surgeries, and a patient-held ‘wound care’ card was piloted for two months. The survey was then repeated to determine the success of the intervention.

Post discharge communication was on the whole felt to be of poor quality and lacked a large amount of essential and desirable information. There was a particular absence of relevant information regarding surgical wound closure techniques utilised and their ongoing management. Many Primary Care practitioners acknowledge that their knowledge on this subject can be low. A Trust specific information leaflet combined with a dedicated patient held discharge information card can solve a number of these issues improving Primary and Secondary Care satisfaction and reducing the use of emergency resources and appointments.

Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses.

To identify the factors that affect European GPs’ empowerment in making an early diagnosis of cancer.

This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale.

The final list of statements indicated those that were considered by consensus to be the most relevant.

In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs’ working conditions. Statements relating to training, skills and working efficiency were not considered priority areas.

GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.

To gain insights into what business model-building and model-changing aspects make physiotherapy primary healthcare organisations (PTPHOs) attain and sustain superior performance in a changing environment, according to their managers.

Since 2006, the transition towards managed competition in the Dutch healthcare market has been intended to improve the performance of primary healthcare organisations like PTPHOs. In such a market, competition on efficiency with reimbursement system has been introduced. Consequently, performance entails achieving and sustaining quality, efficiency, and financial outcomes. Superior performance requires that PTPHOs continuously align their external environment and internal organisation. The business model literature suggests that business model-building and model-changing support this alignment process.

This qualitative study had an explorative design. A pre-defined interview guide based on business model theory was applied. Semi-structured interviews were conducted with physiotherapy primary healthcare organisation managers and transcribed verbally. The transcripts were analysed using directed content analysis.

The study results show, both verbally and graphically, that PTPHOs generate superior performance in a changing environment through business model-building and model-changing. Participating managers (n = 25) confirmed extant findings that business model-building consists of strategy and business model configuration. In addition, business model-building entails establishing interfaces to exploit external environment and internal organisation information. Also, these interfaces are evaluative techniques and tools, action, and process – make sense of knowledge and information. To sustain superior performance, it is essential to change the business model. This can be achieved through three change cycles: business model change, short-term change, and long-term change.

Managers of both superior and lower performance organisations independently stress the importance of the same business model-building and model-changing aspects related to attainment and sustainment of superior performance. However, superior performance PTPHOs address building and changing business models in a more diversified and integrated way than their lower performance counterparts.

To analyze how people cope with suicide loss and the implications for primary health care.

Previous studies have shown that primary health care will often be an initial source of support for those bereaved by suicide.

We included adult persons who were ready to talk about a suicide completed by a person they knew well (family member or close friend). Participants were recruited via mixed media (television, radio, print, social media, etc.). Altogether, we conducted 37 individual interviews, which were recorded using a dictaphone and lasted from 46 to 158 min. The interviews were transcribed verbatim and analyzed using a content analysis method. The interviewees were mostly women (n = 27) and family members (n = 28) of a person who had died by suicide during the years 2012–2018.

We identified two main themes in the data: supporters and barriers in support. Coping with suicide takes time, and support was mostly found among friends and family. Support from GPs was mentioned in the context of diagnosing medical problems and prescribing medicines. Respondents indicated that feeling ashamed and a lack of trust impeded their willingness to seek help from their GP. Unmet needs among the bereaved may increase their risk of diminished mental health outcomes. Thus, primary health care practitioners may have a substantial opportunity to support those who are bereaved by suicide.

Primary care providers have an opportunity to provide bereavement support among their patients. Continuing medical education regarding the needs of the bereaved and a coordinated approach among primary care practitioners may be useful to proactively identifying and supporting those in need.