Family Healthcare

<title>Abstract</title> Background Telemedicine has gained prominence in primary care, but evidence comparing its modalities is scarce. Methods We conducted a cross-sectional study of 184,308 video and phone consultations from a telemedicine platform in Portugal, comparing quality indicators based on the Institute of Medicine (IOM) domains. Results Video consultations were associated with lower recurrence rates, higher patient-reported helpfulness (95.4% vs. 92.3%), and greater satisfaction. Time to appointment was shorter for phone consultations, but video had a longer duration and higher resolution rates. Conclusions Our findings suggest that video consultations offer higher perceived quality and lower reaccess rates in primary care telemedicine. These insights can inform digital health strategies in primary care settings.

Background:The potential risk of neuropsychiatric adverse events (NPAEs) associated with oseltamivir has been controversial since its market launch, with inconsistent conclusions across different studies, and the product label does not clearly describe the role of oseltamivir in these adverse events.Methods: This article integrates multisource evidence through evidence-based methods, critically evaluates and analyzes key evidence based on the hierarchy of evidence pyramid, and clarifies the specific association between oseltamivir and psychiatric adverse events, the strength of the association, and high-risk factors, providing a scientific basis for clinical decision-making and regulatory measures.Results: Based on current evidence, oseltamivir is unlikely to increase the risk of psychiatric adverse events under the standard dosage and administration guidelines and label instructions, irrespective of its use for the treatment or prevention of influenza.However, prolonged exposure (for 6 weeks, number needed to harm of 94), high-dose regimen (150 mg, twice daily, number needed to harm of 150), and adolescents aged 10-19 years (adjusted HR 2.69, 95% CI 1.05-6.93)may be high-risk factors for psychiatric adverse events. Conclusion:Clinical applications should extensively consider the indications, weigh the benefits and risks, and use the drug rationally; psychiatric-related adverse events should not be solely attributed to oseltamivir.

People who experience musculoskeletal symptoms during COVID-19 infection usually have long COVID-19. If a patient has symptoms after 30 days of COVID-19 infection, it is considered long COVID-19. Symptoms like pain, tenderness, and stiffness are common in the neck, back, and shoulders. Symptoms can be related to the body's immune response to the virus. During complicated COVID-19 infection, patients may experience muscle weakness and decreased bone density, leading to osteoporosis attributed to prolonged bed rest and reduced physical activity. Several disorders can cause bilateral lower limb weakness. Spinal disorders like cord compression caused by a tumor, herniated disc, infarction, cauda equina syndrome, and transverse myelitis can cause bilateral lower limb weakness. Inflammatory conditions like Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy (CIDP), inflammatory myopathy, and other conditions such as amyotrophic lateral sclerosis (ALS), multiple sclerosis, Parkinson's disease, myasthenia gravis, or a pinched nerve can also cause bilateral lower limb weakness. In addition, potassium deficiency, tick paralysis, and leg weakness as a side effect of medication can present with bilateral lower limb weakness. This case report presents a 59-year-old ambulatory patient with multiple underlying medical conditions who contracted COVID-19 and developed bilateral lower limb weakness, which did not improve even with vigorous physical therapy sessions, creating a challenge to find the underlying cause of weakness.

Abstract Background Hybrid effectiveness-implementation designs evaluate the effectiveness and implementation of interventions. We retrospectively evaluated the implementation of a stepped-wedge cluster randomized controlled trial (RCT) of a facilitated telemedicine model (experimental) integrated into opioid treatment programs (OTPs) compared to offsite referral (control) for hepatitis C virus (HCV) treatment. We compared organizational and implementation characteristics associated with an HCV cure and with high healthcare delivery satisfaction. Methods We used the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM)-QuEST framework to guide data collection and evaluation. We evaluated the clinical effectiveness outcome (HCV cure) and patient centered outcomes (changes between in-person and telemedicine patient satisfaction questionnaire subscales: time spent with doctor, interpersonal manner, accessibility and convenience, and general satisfaction). We combined patient and organization-level information to conduct a configurational comparative method of coincidence analysis (CNA) to identify strategy configurations associated with each outcome. We also utilized the random forest method to identify the most important variables and reran the CNA analysis. For contextual interpretation, we discussed stakeholders’ perceptions of the findings through focus group discussions. Results Using RE-AIM-QuEST, in terms of reach, the RCT enrolled 96.5% of the original projected sample. We found that low patient load per provider or counselor, site liaison presence, and approaches that promoted case manager integration into site workflows, were associated with increased clinical effectiveness. When evaluating organization factors associated with high satisfaction with healthcare delivery, we found that approaches that promote communication, patient and staff education, and site liaison presence were important in the facilitated telemedicine arm. In the referral arm, additional important factors identified included the ability of the case manager to explain the referral process and OTP affiliation with a university. In terms of telemedicine implementation, free-standing sites and low patient volume were associated with high satisfaction. In the referral arm, university affiliation was an important factor. Conclusions Factors associated with communication, addressing participants’ concerns, and case manager integration within OTP workflows are important for successful implementation of facilitated telemedicine. Using these combinations may be important for expanding and evaluating HCV treatment uptake and for understanding successful implementation of telemedicine-based interventions in underserved populations. Trial registration Clintrials.gov registration number NCT02933970; Comparison of Telemedicine to Usual Care for HCV Management for Methadone-maintained Individuals - Full Text View - ClinicalTrials.gov

Background The coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges worldwide, particularly in developing countries with limited healthcare resources. Among the various demographics, adolescents represent a crucial group in understanding and curbing the spread of the virus. Aim This research aims to assess the level of knowledge and practice of COVID-19 prevention measures among adolescents in a developing country. Methodology This study's descriptive cross-sectional study design was appropriate for capturing a snapshot of adolescents' understanding of COVID-19 in Umuahia, Abia State, Nigeria, a developing country. The study's participants were secondary school students in Umuahia's urban and rural secondary schools, aged 10-19. Fisher's formula was used to calculate the sample size. A multistage systematic sampling method was used to select 424 participants. Data were gathered using a self-administered questionnaire. The Statistical Package for the Social Sciences (SPSS) softwareversion 25 (IBM SPSS Statistics, Armonk, NY) was used to handle and evaluate the data that had been obtained. Results All the respondents were aware of COVID-19, primarily informed through social media and television (TV). It is concerning that less than half correctly identify the disease as caused by a virus (46.9%), with some falsely attributing it to bacteria (31.1%) or fungi (15.6%). While the majority of respondents knew about the existence of COVID-19 vaccines, only 63.4% were aware that there was no definitive cure for the disease. The most worrying finding was the limited awareness and practice of recommended precautions to prevent the spread of COVID-19. Handwashing with soap and water, social distancing, and using hand sanitizers were the most frequently recognized precautions. However, even these were poorly practiced, with less than 30% of the respondents following them regularly. It was also noted that misconceptions about precautions exist, including unusual practices such as regularly drinking hot water or eating bitter kola/pepperfruit. Also, the most prominent reason for refusal among the respondents for COVID-19 vaccines was parental refusal, accounting for 57.5% of negative responses. Conclusion The study's findings underscore the urgent need for tailored, accessible, and effective health education strategies to improve adolescents' understanding and adoption of COVID-19 preventive measures in the region.

The high prevalence of precancerous pathologies and cervical cancer indicates their relevance. Cervical cancer ranks fourth among the causes of mortality of women with cancer worldwide and second in women aged 15–44 years. According to the World Health Organization, approximately 500 thousand new cases of cervical cancer are diagnosed annually worldwide. In Russia, more than 15 thousand new cases are registered annually, and nearly half of them (47.8%) end in death. The increase in the frequency of advanced stages and the increase in mortality among women of reproductive age are of particular concern. According to statistical data from the oncology database of the Moscow Hertzen Cancer Research Institute, the incidence of cervical cancer over 10 years increased by 2.12% annually. This article presents the results of the statistical analysis of data for assessing the incidence of precancer pathologies and cervical cancer and discusses trends in the spread and juvenation of this pathology as well as its causes. The results of the analysis of errors in diagnosing intraepithelial lesions and modern possibilities for its optimization are also presented.

ABSTRACT Gastroesophageal reflux disease (GERD) and Helicobacter pylori (H. pylori) infection are different disease states that are united by the core role of acid suppression in their management. In GERD, proton pump inhibitors (PPIs) have long been standard therapy based on abundant positive clinical trial data supporting their efficacy and safety. In H. pylori, PPIs are also a critical element of therapy in combination with 1 or more antibiotics to achieve and maintain a pH that maximizes the efficacy of therapy. Despite the considerable clinical success and widespread use of PPIs, room remains for agents with differentiated pharmacokinetic and pharmacodynamic profiles. The potassium-competitive acid blockers (PCABs) are mechanistically distinct from PPIs but are acid-stable and do not require activation of the proton pump by coadministration of food. In pharmacodynamic studies, these agents have shown greater durations of acid suppression above the critical threshold of pH 4 (for GERD) and pH 6 (for H. pylori), which have been shown to optimize therapeutic efficacy in these settings. These results have translated in clinical studies to similar and, in some cases, improved outcomes relative to PPIs in these disease states. This review summarizes current knowledge on the physiology of acid secretion, pathophysiology and management of GERD and H. pylori, and key characteristics and clinical trial data for PPIs and PCABs.

Trigeminal schwannomas, rare tumors originating from Schwann cells of the trigeminal nerve, present unique diagnostic challenges due to their infrequent occurrence. The clinical manifestation of facial numbness and tingling necessitates a comprehensive approach for accurate diagnosis and optimal management. We present the case of a 45-year-old female who presented with a six-month history of progressive facial numbness localized to the left maxillary and mandibular regions. Intermittent sharp, shooting pain exacerbated by chewing and cold stimuli was reported. Physical examination revealed sensory deficits inleft trigeminal nerve distribution. Magnetic resonance imaging confirmed a well-circumscribed, enhancing lesion along the left trigeminal nerve. Surgical excision of the tumor confirmed the diagnosis of schwannoma. This case underscores the significance of a detailed clinical history, advanced imaging, and collaboration between neurologists and neurosurgeons in achieving an accurate diagnosis and favorable outcome for trigeminal schwannomas. The successful surgical intervention, coupled with histopathological confirmation, contributes to the understanding of these rare tumors.

Aim: While the mental health burden of the COVID-19 pandemic is turning into a public health problem, the global dimension of the problem makes it necessary to address the issue in the context of planetary health for a solution. The goal of this study was to examine the contents and challenges of managing mental health issues at the planetary health level during COVID-19. &#x0D; Method: The bibliographic method was used. Theses were searched by searching YOKSIS and PubMed for reviews with the keywords "mental health, planetary health, and COVID-19."&#x0D; Results: In the search made in June 2021, from 2018 till 27.02.2022; 19 related articles have been found. The most proportion of published reviews was about patients’ mental health via telehealth; only three of the reviews were about healthcare workers. Two of the researches were excluded because they were not reviewed. The same keywords are used for searching among the thesis of YOKSIS, only one research was found about fuzzy cognition maps and decision making. &#x0D; Conclusions: Research on managing mental health problems and planetary health during pandemics in the family medicine discipline is far from providing sufficient literature diversity. Advances in data analytics and information technologies are opening up new medical clinical problem-solving methods. In order to measure the effects of the COVID-19 pandemics and to establish global well-being and higher planetary mood in the future, research at the level of the individual, society and planet are required.