Primary HealthCare

This study aimed to evaluate the effectiveness of instructional materials in promoting reading, writing, and arithmetic skills in standard one and two pupils in Misungwi District, Mwanza-Tanzania. The study employed mixed research approach and explanatory sequential design. Data was collected using questionnaires and interviews. Quantitative data were analyzed using SPSS version, while qualitative data were subjected to thematic analysis to identify recurring patterns. The study found that well-trained teachers, continuous professional development, and availability of age-appropriate instructional resources significantly enhance pupils’ mastery of reading, writing, and arithmetic in Standard One and Two. However, challenges such as overcrowded classrooms, limited parental involvement, inadequate teaching materials, and language barriers hinder effective learning of the 3Rs. The study concluded that instructional resources and skilled teaching are essential in promoting foundational literacy and numeracy skills, but must be supported by improved learning environments and home-school collaboration. It is recommended that the government and education stakeholders invest in teacher training, resource provision, and community engagement to strengthen 3Rs mastery among early grade pupils.

The article analyzes the theoretical and practical aspects of developing competitiveness and innovative abilities of modern teaching staff. It explores teachers’ skills in applying modern knowledge and technologies, their creative and innovative activities, and provides recommendations for their professional development.

Background: Cervical radiculopathy is a common cause of neck and upper-extremity pain, often resulting from degenerative cervical spine conditions. While many patients respond to conservative management, a substantial proportion experience persistent symptoms requiring interventional treatment. Cervical epidural corticosteroid injections have emerged as a widely used option for short-term pain relief in refractory cases. Aim: This article aims to review the indications, anatomical considerations, procedural techniques, complications, and nursing roles associated with cervical epidural corticosteroid injections in the management of cervical radiculopathy. Methods: A narrative review approach was used, integrating anatomical knowledge, clinical indications, injection techniques, imaging guidance, complication profiles, and interprofessional nursing responsibilities. Evidence from clinical studies and established procedural practices was synthesized to provide a comprehensive clinical overview. Results: Cervical epidural injections, particularly via the interlaminar approach, demonstrate effective short-term pain relief for selected patients, with approximately half achieving significant symptom reduction for up to three months. Fluoroscopic guidance enhances procedural accuracy and safety. Although generally safe, these injections are associated with potential complications, especially with transforaminal techniques, underscoring the importance of meticulous patient selection and skilled execution. Nursing involvement is critical in pre-procedural preparation, intra-procedural monitoring, and post-procedural care. Conclusion: Cervical epidural corticosteroid injections represent a valuable interventional modality for cervical radiculopathy when conservative therapies fail. Optimal outcomes depend on appropriate patient selection, precise technique, and coordinated interprofessional care.

ABSTRACTBackgroundDespite established guidelines recommending cardioprotective medications for patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD), prescribing practices often fall short of recommendations. In this study we aimed to assess the prescribing trends of guidelines-recommended cardioprotective medications, including sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), and high-intensity statins, among patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) in Qatar's primary health care corporation (PHCC).MethodsThis retrospective cross-sectional study analysed electronic medical records data from 29 PHCC centres in Qatar for the period January-December 2021. Prescription rates of SGLT2i/GLP-1RA, ACEi/ARB, and high-intensity statin were assessed based on documented medication usage. Logistic regression was used to identify factors associated with guideline-directed prescribing. The study received ethics approval from the PHCC in Qatar, with de-identified data accessible only to the Principal Investigator.ResultsAmong the 2,870 eligible subjects, only 10% (n = 292) were prescribed high-intensity statins, 12% (n = 357) received SGLT2i/GLP-1RA, and 56% (1,617)were prescribed ACEi/ARB. Male gender, higher HbA1c, and a diagnosis of dyslipidaemia were positively associated with increased likelihood of adherence to relevant clinical practice guidelines. However, these factors only explained only 16% of the observed variance.ConclusionThe majority of patients with T2DM and ASCVD did not receive the completed guideline-recommended regimens of cardioprotective medications, suggesting a significant gap in clinical practice. Urgent implementation of multifaceted strategies is warranted to address barriers and clinical inertia, thereby optimising cardiovascular risk reduction and secondary prevention therapies.

Primary health care is central to achieving Universal Health Coverage and better health outcomes; however, it requires adequate resources for effective implementation. To estimate the cost of implementing an integrated primary health care package in Sindh Province, Pakistan. We developed an integrated primary health care service package and standard treatment guidelines for each service provided at 12 basic health units across 4 districts of Sindh Province. We then collected and analysed cost and service volume data for the health units using the CORE Plus tool, under 3 service delivery scenarios. Standard costs per service in health units that provided round-the-clock maternal care services decreased in scenarios 2 and 3 as service volumes increased, while standard costs did not decrease in health units that provided services for only 6 hours per day for 6 days a week. The average annual standard costs per 10 000 population in round-the-clock health units were US$ 38 315 for scenario 1, US$ 47 139 for scenario 2 and US$ 56 719 for scenario 3. For health units that provided services for only 6 hours per day for 6 days, the annual standard cost was US$ 22 800. Medicines, supplies and laboratory tests accounted for the highest proportion of the total costs, followed by staff salaries and operating costs. Staffing requirements increased for multiple roles. Integrating services and analysing service costs regularly to align resources with care needs can help improve the cost-effectiveness of services at primary health centres.

Workplace violence (WPV) is a serious threat to healthcare workers (HCWs) worldwide. It affects their physical and mental health and impairs work performance. This study aimed to determine the prevalence of WPV against HCWs at the primary healthcare centers (PHCs) in Makkah city. The study assessed the WPV occurrence, types, causes, consequences, and perpetrators and aimed to explore HCWs' responses to violence and awareness of a reporting system. A cross-sectional study included 400 HCWs at PHCs in Makkah city recruited using cluster sampling. A structured self-reported questionnaire collected demographic and occupational characteristics, violence occurrence, and other characteristics of the violent acts, and finally described violence reporting. Pearson's chi-square analysis was used to test the differences in violence exposure according to respondents' characteristics. A multivariate logistic regression model was performed on all potential predictors of WPV. WPV prevalence was 32.5% (95% confidence interval [CI] = 0.2793-0.3733); 93.1% reported verbal violence, 40.8% intimidation, and 6.2% physical violence; 80% of violent events were initiated during morning shifts. Perpetrators were mostly men; 36.2% of WPV was initiated by patients. 40% of HCWs did not report violent incidents; the most common reason was perceived inefficacy. Only 46.3% of HCWs were aware of a violence reporting system. The lack of penalties was the most common cause of violence against HCWs, and 41.5% were dissatisfied with the consequences. A regression analysis revealed that pharmacists, working on different shifts and working in settings involving male patients, were more prone to WPV acts (adjusted odds ratio [AOR] = 1.8, 1.97, and 4.5, respectively). Married employees appeared more protected against WPV (AOR = 0.5) (overall model: chi-square χ² = 68.085, P = 0.000). Although HCWs in Makkah PHCs were frequently subjected to WPV, especially doctors and pharmacists, they frequently chose not to report. A dearth of WPV reporting knowledge suggests that HCWs should be given appropriate training. A national mechanism to monitor and stop violence against HCWs must be implemented.

Rationale:The success of tyrosine kinase inhibtors in the neoadjuvant and adjuvant setting provides a rationale for exploring selpercatinib in the perioperative setting to improve patient outcomes in early-stage lung cancer. However, selpercatinib is currently only approved as first-line treatment for advanced rearrangement during transfection (RET) fusion-positive non-small cell lung cancer (NSCLC), limiting its use and potential benefit for earlier stage patients. Hence, this case report explores selpercatinib’s potential use in early-stage disease to address this treatment gap and improve patient outcomes.Patient concerns:We report the case of a 75-year-old female with no history of smoking who was referred to our institute with a chest computed tomography scan revealing a mass in the right lower lung lobe.Diagnoses:The patient was diagnosed with RET fusion-positive lung adenocarcinoma based on findings from radiologic findings from computed tomography (CT) and positron emission tomography-CT scans, histopathological examination, and molecular profiling through next-generation sequencing.Interventions:The patient was treated with 4 cycles of carboplatin and pemetrexed. A follow-up CT scan revealed the progression of the mediastinal lymph node, leading to the decision to initiate selpercatinib treatment. Due to a major size reduction of the primary lesion and the absence of tumor cells in the lymph nodes, the patient underwent curative lobectomy and lymphadenectomy.Outcomes:Preoperative selpercatinib induced tumor regression, enabling surgical resection. Histopathological examination of the resected tumor revealed a major pathological response to preoperative selpercatinib treatment.Lessons:This case highlights the potential of selpercatinib in the perioperative setting, suggesting that it induces tumor regression and enabling of curative surgery in early-stage RET fusion-positive NSCLC. Our findings support the further investigation of selpercatinib in early stages and provide a rationale for future treatment strategies of early-stage RET fusion-positive NSCLC patients.

This article reflects on ethical stress as a shared feature of mental health social work and forensic psychology. Using a composite case, it explores the challenges of maintaining a values-based, systemic understanding of vulnerability within the power dynamics of the criminal justice system. The tension between care and control is examined, particularly in the context of court-ordered mental health treatment, alongside the therapeutic potential of holding relationships. Ultimately, the paper highlights the role of forensic psychology, through structured community provisions such as Mental Health Treatment Requirements, in supporting rehabilitation within imperfect systems.