Search Results (238)

Background/Objectives: In many parts of the world, pharmacists hold the primary responsibility for providing safe and effective pharmacotherapy. A key aspect is the availability of appropriate medicines for each individual patient. When industrially manufactured medicines are unsuitable or unavailable, pharmacists can prepare tailor-made medicines. While this principle applies globally, practices vary between countries. In the Netherlands, the preparation of medicines in pharmacies is well-established and integrated into routine healthcare. This narrative review explores the role and significance of extemporaneous compounding, pharmacy preparations and related product care in the Netherlands. Methods: Pharmacists involved in pharmacy preparations across various professional sectors, including community and hospital pharmacies, central compounding facilities, academia, and the professional pharmacists’ organisation, provided detailed and expert insights based on the literature and policy documents while also sharing their critical perspectives. Results: We present arguments supporting the need for pharmacy preparations and examine their position and role in community and hospital pharmacies in the Netherlands. Additional topics are discussed, including the regulatory and legal framework, outsourcing, quality assurance, standardisation, education, and international context. Specific pharmacy preparation topics, often with a research component and a strong focus on product care, are highlighted, including paediatric dosage forms, swallowing difficulties and feeding tubes, hospital-at-home care, reconstitution of oncolytic drugs and biologicals, total parenteral nutrition (TPN), advanced therapy medicinal products (ATMPs), radiopharmaceuticals and optical tracers, clinical trial medication, robotisation in reconstitution, and patient-centric solid oral dosage forms. Conclusions: The widespread acceptance of pharmacy preparations in the Netherlands is the result of a unique combination of strict adherence to tailored regulations that ensure quality and safety, and patient-oriented flexibility in design, formulation, and production. This approach is further reinforced by the standardisation of a broad range of formulations and procedures across primary, secondary and tertiary care, as well as by continuous research-driven innovation to develop new medicines, formulations, and production methods. Full article

Chronic diseases are a leading cause of death worldwide and have a significant negative impact on public health, overall well-being, national economies, and the long-term sustainability of already burdened health systems. In addressing some of the current health challenges, the contribution of pharmacists and community pharmacies is of particular significance. Pharmacists play a vital role in the medication use process, enhancing the efficacy of pharmacological interventions and facilitating the delivery of health services. Community pharmacies occupy a key position within the healthcare system, acting as a primary point of contact with the public and frequently representing the most accessible healthcare facility for patients. In recent times, community pharmacies have undergone a process of adaptation, shifting from a narrow focus on the dispensing of medications towards a more comprehensive approach that is patient-centered and incorporates a range of healthcare services, while also prioritizing the quality of the services provided. This work aims to explore the role of pharmacists in the provision of pharmaceutical services in three countries with distinct healthcare systems, examining how these services operate, the requirements for their delivery, the associated remuneration structures, and the extent of out-of-pocket costs for patients—ultimately analyzing their impact on health outcomes. Full article

The colonization of Legionella spp. in engineered water systems constitutes a major public health threat. In this study, a six-year environmental surveillance (2020–2025) of Legionella colonization in five different types of facilities in Crete, Greece is presented, including hotels, passenger ships, primary healthcare facilities, public hospitals, and private clinics. A total of 1081 water samples were collected and analyzed, and the overall positivity was calculated using culture-based methods. Only 16.46% of the samples exceeded the regulatory limit (>10³ CFU/L) in the total sample, with 44.59% overall Legionella positivity. Colonization by facility category showed the highest rates in primary healthcare facilities with 85.96%, followed by public hospitals (46.36%), passenger ships with 36.93%, hotels with 38.08%, and finally private clinics (21.42%). The association of environmental risk factors with Legionella positivity revealed a strong effect at hot water temperatures < 50 °C (RR = 2.05) and free chlorine residuals < 0.2 mg/L (RR = 2.22) (p < 0.0001). Serotyping analysis revealed the overall dominance of Serogroups 2–15 of L. pneumophila; nevertheless, Serogroup 1 was particularly prevalent in hospitals, passenger ships, and hotels. Based on these findings, the requirement for continuous environmental monitoring and risk management plans with preventive thermochemical controls tailored to each facility is highlighted. Finally, operational disruptions, such as those experienced during the COVID-19 pandemic, especially in primary care facilities and marine systems, require special attention. Full article

Background/Objectives: Despite ongoing national interventions, pockets of acute malnutrition persist in rural settings of South Africa, contributing to disproportionate rates of child morbidity and mortality. This study aimed to identify risk factors associated with acute malnutrition among under-five children attending primary healthcare facilities in Msinga, KwaZulu-Natal Province, with a specific focus on dietary diversity and selected infant and young child feeding indicators. Methods: A cross-sectional, facility-based study was conducted among 415 mother–child pairs attending five randomly selected PHC facilities in the Msinga sub-district. Participants were selected using a multistage sampling design from a sampling frame of 18,797 under-five children. Of the 551 mother–child pairs approached; the final analytic sample comprised 415 observations. Data were collected through structured interviews, anthropometric assessments, and dietary diversity scores (DDS). Data were analyzed using Stata 18, and Poisson regression was applied to identify risk factors. Results: The prevalence of acute malnutrition was 29% based on weight-for-height/length z-scores (WHZ/WLZ) and 27% based on mid–upper-arm circumference z-scores (MUACZ). Children aged ≥36 months had significantly higher prevalence of acute malnutrition (aPR = 1.62; 95% CI: 1.15–2.10). Children from households with five or more members had reduced risk (aPR = 0.66; 95% CI: 0.45–0.74), and those born full-term showed a strong protective association (aPR = 0.39; 95% CI: 0.23–0.64). Maternal age was associated with reduced risk, with children of mothers aged 25–34 years (aPR = 0.67; 95% CI: 0.48–0.93) and ≥35 years (aPR = 0.58; 95% CI: 0.35–0.84) experiencing significantly lower prevalence. Mixed feeding was significantly associated with reduced risk (aPR = 0.86; 95% CI: 0.55–1.17), while a DDS ≥4 was protective (aPR = 0.41; 95% CI: 0.04–0.84). Consumption of protein-rich foods was notably low, with only 21% consuming flesh foods and 10% consuming eggs. Conclusions: Acute malnutrition in under-five children was significantly associated with poor diet quality, older age, low household income, and mixed feeding practices. Protective factors included full-term pregnancy, larger households, older maternal age, and adequate dietary diversity, highlighting the importance of targeted, multisectoral interventions. Full article

Occupational injuries among nurses impact their well-being and health service delivery. This study aimed to determine the prevalence of occupational injuries and their contributing factors among nurses in selected public health facilities. A descriptive cross-sectional study was conducted among 295 randomly selected nurses. Primary data were collected using self-administered questionnaires, while secondary data were abstracted from the occupational injuries register. Data were analysed using statistical software. The 12-month prevalence of occupational injuries was 28.8% (95% confidence interval [CI] = 24.3–33.3%), with needlestick injuries being the most common (63.5%). Significant associations were observed between occupational injuries and education level (p = 0.027), employment status (p = 0.012), and years of experience (p = 0.029). Nurses with a bachelor’s degree had 3.30 times higher odds of injury (Adjusted OR [AOR] = 3.30, 95% CI = 1.11–9.81, p = 0.03), while the lack of proper training increased the odds by 3.27 times (AOR = 3.27, 95% CI = 1.62–6.61, p < 0.001). Being a registered nurse reduced the odds by 70% (AOR = 0.30, 95% CI = 0.12–0.74, p = 0.01). Addressing these factors is essential for reducing occupational injuries and improving healthcare outcomes. Full article

Objective: The purpose of this study is to explore the factors influencing access to healthcare services among Type 2 Diabetes Mellitus (T2DM) patients enrolled in the PEKA B40 programme at a public health clinic in Melaka, Malaysia. It aims to examine how key dimensions—availability, accessibility, accommodation, and acceptance—affect patients’ experiences and the utilisation of diabetes-related healthcare services. This study also seeks to identify gaps and challenges within the current healthcare delivery system, particularly for low-income populations, to inform strategies for improving equitable and sustainable access to care. Methods: This study was conducted in a public health clinic in Melaka, Malaysia. Purposive sampling was used among T2DM patients under the “Health Care Scheme for Group B40” programme in a public health clinic in Melaka, Malaysia. The study included participants with at least a 6-month history of T2DM to ensure substantial experience in accessing healthcare services. Results: Fifteen patients participated in this study. Elderly individuals, retirees, and those with average incomes demonstrated higher healthcare service utilisation. Ethnic diversity was crucial, revealing its impact on health behaviours and healthcare-seeking patterns. Primary or secondary education levels among participants highlighted the necessity for targeted health literacy efforts. Conclusions: This study highlighted notable awareness and satisfaction among patients concerning the availability, accessibility, and accommodation of services, particularly emphasising the importance of geographical proximity in healthcare services. However, challenges faced by elderly individuals in accessing social support are also highlighted. The potential of enhancing the amenities of healthcare facilities to improve patient experiences is also reflected in our results. These insights provide evidence for the effectiveness of the Malaysian healthcare system in catering to a diverse demographic and can also be helpful in refining healthcare strategies and further optimising patient-centred care in Malaysia. Full article

Background: This study aimed to assess patient satisfaction with the quality of healthcare services at selected public primary healthcare facilities in Almaty during the COVID-19 pandemic and to identify associated demographic and facility-related factors. Methods: A cross-sectional, quantitative study was conducted over a period of 6 months, from 30 June to 31 December 2021, through a web-based survey. An adapted questionnaire was employed to survey the respondents. In total, 1035 respondents participated in the study. To examine the relationship between demographic and facility characteristics and patient satisfaction, we utilized the proportional odds model for ordinal logistic regression. Results: A total of eight primary healthcare organizations from the public sector in Almaty participated in the survey. The analysis identified significant demographic predictors of patient satisfaction, such as marital status, social status, self-perceived health, and the use of online consultations. Among the facility-related factors, only the availability of a cross-ventilation system emerged as a significant predictor. Conclusions: This study provides evidence for the factors influencing patient satisfaction with primary healthcare services in Almaty during the COVID-19 pandemic. Both demographic characteristics and facility-level attributes were found to significantly affect satisfaction levels. These findings underscore the need for targeted structural and organizational improvements in primary healthcare settings, especially during public health emergencies. Addressing these gaps through infrastructural upgrades, enhanced preparedness, and the integration of patient-centered care models can help to bolster trust and resilience within Kazakhstan’s healthcare system. Full article

In modern engineering applications, localization and orientation play an increasingly crucial role in ensuring the successful execution of assigned tasks. Industrial robots, smart home systems, healthcare environments, nuclear facilities, agriculture, and autonomous vehicles are just a few examples of fields where localization technologies are applied. Over the years, these technologies have evolved significantly, with numerous methods being developed, proposed, and refined. This paper aims to provide a comprehensive review of the primary localization and orientation technologies available in the literature, detailing the fundamental principles on which they are based and the key algorithms used to implement them. To achieve accurate and reliable localization, fusion-based approaches are often necessary, integrating data from multiple sensors and systems or estimating hidden states. For this purpose, algorithms such as Kalman Filters, Particle Filters, or Neural Networks are usually adopted. The first part of this article presents an extensive review of localization technologies, including radio frequency, RFID, laser-based systems, vision-based techniques, light-based positioning, IMU-based methods, odometry, and ultrasound-based solutions. The second part focuses on the most widely used algorithms for localization. Finally, summary tables provide an overview of the best and most consistent accuracies reported in the literature for the investigated technologies and systems. Full article

Introduction: Sub-Saharan Africa in general, and the Democratic Republic of the Congo (DRC) in particular, is undergoing an epidemiological transition characterized by a more rapid increase in the number of non-communicable diseases (NCDs). However, the level of readiness of the DRC’s healthcare facilities (HFs) to manage these diseases is unknown. Thus, our study aimed to assess these HFs’ level of readiness to manage cardiovascular disease (CVD) and diabetes. Methodology: This cross-sectional study involved 1412 HFs in the DRC, selected by stratified random sampling. They are representative of the country’s 26 provinces. The World Health Organization (WHO) Service Availability and Readiness Survey (SARA) was used. The “readiness” outcome was a composite measure of the capacity of HFs to manage CVD and diabetes. The readiness indicator comprised four domains, and a score of ≥70% indicated “readiness” to manage CVD and diabetes. Informed consent was obtained from the stakeholders, and the ethics committee held a positive opinion. Statistical analyses were performed using STATA 17 software. Results: The average readiness scores of the DRC’s HFs to manage CVD and diabetes are less than 50%, being 38.3% (37.3–39.3) and 39.8% (38.7–40.9), respectively. These scores were less than 40% for CVD and diabetes in rural HFs. They were less than 30% for CVD and diabetes in primary-level HF. No province possesses over 50% of health facilities equipped to address cardiovascular illnesses, and only four provinces (Haut Uele, Kinshasa, Nord Kivu, and Sud Kivu) possess over 50% of health facilities equipped to address diabetes. The provinces with health facilities exhibiting the least preparedness in managing cardiovascular illnesses and diabetes are Nord Ubangi and Sankuru. Only 0.07% (0.01–0.5) of HFs obtained a score ≥ 70% for CVD management, and 5.9% (4.8–7.3) obtained this score for diabetes management. Conclusions: Significant deficiencies must be rectified to enhance service delivery in the management of cardiovascular disease (CVD) and diabetes. Most primary-level and rural facilities demonstrated inadequate preparedness for CVD and diabetes screening and management, exhibiting low readiness scores and limited-service availability in the assessed domains. While secondary-level services are relatively accessible, critical gaps persist that must be addressed to improve readiness for CVD and diabetes care. Healthcare facilities should possess the capacity to deliver recommended services across various tiers, ensuring both service readiness and availability. Full article

Multimorbidity poses significant challenges for resource-constrained healthcare systems, particularly in low and middle income countries where specific combinations of chronic conditions may differentially impact function. This cross-sectional study examined multimorbidity patterns and associations with functioning among 165 adults attending semi-rural primary healthcare facilities in South Africa. Participants completed performance-based measures (handgrip strength, five-times sit-to-stand test, step test and exercise prescription tool [STEP] maximum oxygen consumption) and self-reported function (12-item WHODAS 2.0). Exploratory factor analysis identified three multimorbidity patterns: HIV-hypercholesterolaemia-obesity (Pattern 1), hypertension-anaemia-lung disease (Pattern 2), and stroke-heart disease-hypercholesterolaemia (Pattern 3). Pattern 1 was associated with reduced aerobic capacity (β = −6.41, 95% CI: −9.45, −3.36) and grip strength (β = −0.11, 95% CI: −0.14, −0.07). Pattern 2 showed associations with mild (β = 1.12, 95% CI: 0.28, 1.97) and moderate (β = 1.48, 95% CI: 0.53, 2.43) self-reported functional problems and reduced grip strength (β = −0.05, 95% CI: −0.09, −0.003). Pattern 3 was associated with all self-reported impairment levels, with the strongest association for severe impairment (β = 2.16, 95% CI: 0.32, 4.01). These findings highlight the convergence of infectious and non-communicable diseases in this setting. Simple clinical measures like grip strength and self-reported function may hold potential as screening or monitoring tools in the presence of disease patterns, warranting further research. Full article

Adolescents living with HIV (ALHIV) (10–19 years) make up approximately 4.2% (320,000) of people living with HIV in South Africa. Adolescence is a developmental period characterized by pervasive biological, social and psychological changes, which challenges adherence and retention in care for ALHIV on antiretroviral therapy (ART). Further, as ALHIV grow “older”, they are expected to transition to the adult HIV treatment programme, where they should assume greater responsibility for managing their chronic condition and healthcare pathway. Whereas it is imperative that ALHIV are transitioned when they are ready, little is known about the challenges and experiences of ALHIV before and during transition. The aim of this paper was to report on the experiences and challenges of transition for ALHIV who received ART at an adolescent-friendly service that is adjunct to a public primary healthcare facility in the Western Cape province of South Africa. Methods: Photovoice methods were employed to explore the transition experiences of ALHIV on ART at a “supportive transition” public health facility in the Cape Town Metro in South Africa. Participants took pictures that depict their experience pre- and during transition to adult care and discussed these in groups with peers. Audio data were digitally recorded and transcribed verbatim and subjected to thematic analysis using Atlas.Ti version 24. Results: The emergent themes described their apprehension to transitioning to adult care; self-management; challenges to adherence; the need for psychosocial support; and how adolescent-friendly services were filling the gap. Conclusions: We illuminate the “I-We-I” configuration, to reflect (the first “I”) individual ALHIV experiences as isolated before being transferred to the supportive facility; how they experience a sense of belonging and family (“we”) in the supportive facility; but face apprehension about transitioning to adult care in the local clinic, where they have to self-manage (final “I”). Full article

Background and Objectives: Sleep disorders are highly prevalent in society and require focused attention within healthcare systems. While patient history, reported complaints, and subjective sleep questionnaires can provide initial insights into potential sleep issues, polysomnography (PSG) remains the gold standard for diagnosing various sleep disorders. However, long waiting times for PSG appointments in many healthcare facilities pose challenges for timely diagnosis and treatment. This study aimed to evaluate the diagnostic value of subjective measures, including patient-reported parameters, in comparison to the objective findings of PSG. Materials and Methods: In this study, we retrospectively analysed the data from 562 patients who underwent clinical evaluation and PSG testing at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics between 2018 and 2024. We report the diagnostic accuracy of different sleep questionnaires to detect various sleep disorders in our population. Results: We report the corresponding sensitivity and specificity values: the Epworth Sleepiness Scale (ESS)—73.2% and 44.1% for detecting severe obstructive sleep apnoea and 87.1% and 76.8% for detecting hypersomnia; the Insomnia Severity Index (ISI)—77.2% and 63.3% for detecting insomnia; the Berlin Questionnaire (BQ)—67.8% and 68.8% for detecting obstructive sleep apnoea; the Ullanlina Narcolepsy Scale (UNS)—84.4% and 58.9% for detecting hypersomnia; the Innsbruck REM Sleep Behaviour Disorder Inventory (RBD-I)—93.3% and 52.5% for detecting RBD; the REM Sleep Behaviour Disorder Single-Question Screen (RBD1Q)—73.3% and 81.0% for detecting RBD; and the Paris Arousal Disorder Severity Scale (PADSS)—57.5% and 90.5% for detecting parasomnia. Conclusions: When comparing our findings with the previous literature, we found that the screening tools generally demonstrated a slightly poorer performance in our population. However, our results suggest that certain individual questions from the comprehensive questionnaires may provide comparable diagnostic values, while reducing the patient burden. We propose a targeted screening approach that integrates fundamental clinical parameters, key screening questions, and selected validated questionnaires, enabling primary care and outpatient clinicians to more efficiently identify patients who may require referral for specialised sleep evaluation and treatment. Full article

Background: Sharing substance use disorder (SUD) data is essential for advancing equitable healthcare and improving outcomes for marginalized populations. However, concerns about privacy, stigma, and adherence to data privacy regulations often hinder effective data sharing. This study explores patient preferences and considerations related to sharing SUD-related medical records, with a focus on the sociocultural and systemic factors that shape their willingness to share. Methods: A total of 357 adult patients from four community-based clinics in Arizona participated in a cross-sectional electronic survey. The survey assessed sociodemographic factors, experiences of stigma (self-directed, anticipated, and provider-based), trust in healthcare providers, satisfaction with care, and willingness to share SUD data across various scenarios. Data were analyzed using descriptive statistics, Pearson correlations, and one-way ANOVA to uncover key associations. Results: Patients identified SUD history, diagnoses, and treatment information as particularly sensitive. Stigma was significantly correlated with increased sensitivity and reduced willingness to share data, especially with providers outside their primary facility (p < 0.001). In contrast, trust in providers and higher satisfaction with care were linked to greater willingness to share data with all providers (p < 0.01). Patients were more inclined to share SUD data during emergencies or for direct treatment purposes than for administrative or research applications (p < 0.001). Discussion: These findings underscore the ethical imperative to address stigma and foster trust to promote equitable SUD data sharing. Policies must empower patients with control over sensitive health information while ensuring cultural competence and fairness in care delivery. Ensuring that patients feel confident in how their data are used may encourage greater participation in health information exchange, ultimately supporting more effective and individualized SUD care. Full article

Intersectoral collaboration is an instrument that enables better productivity by filling in for possible gaps in knowledge, skills, and competencies in a given department by leveraging them from other departments. In Kenya, there is a paucity of information on intersectoral collaboration in healthcare. This article explores the possibilities of intersectoral collaboration, specifically in maternal healthcare, and what can be done to realize such collaborations to drive universal health coverage (UHC) in Kenya. Free maternity services (FMSs) are among the primary healthcare services that push Kenya towards UHC. In light of the centrality of UHC in driving current health policy, there are still several challenges which must be faced before this goal can be achieved. Moreover, competing priorities in health systems necessitate difficult choices regarding which health actions and investments to fund; these are complex, value-based, and highly political decisions. Therefore, the primary objective of this article is to explore health facility administrators’ views on whether intersectoral collaboration could help with the realization of UHC in Kenya. The study area was Kilifi County, Kenya. The article is based on follow-up qualitative research conducted between March and July 2016 and from January to July 2017, and follow-up interviews conducted during COVID-19 in 2020 and 2021. The data are analyzed through a thematic analysis approach. The findings indicate that through Linda Mama, the expanded free maternity services program is one of the possible pathways to UHC. However, participants noted fair representation of stakeholders, distributed leadership, and local participation, considering bargaining power as a key issue that could enhance the realization of UHC in intersectoral collaboration through Linda Mama. These techniques require a bottom–up strategy to establish accountability, a sense of ownership, and trust, which are essential for UHC. Full article

Background/Objectives: Primary healthcare (PHC) plays a central role in the promotion of universal healthcare coverage within the Brazilian health system. Nevertheless, inequalities across municipalities represent substantial barriers to achieving equity in access to health, particularly due to disparities in the quality of healthcare delivered to patients. Thus, the study aimed to investigate factors associated with perception of PHC quality among adult individuals using private and public facilities within the Brazilian health system. Methods: The empirical approach was based on quantitative analysis of cross-sectional data from five nationally representative surveys conducted by the Brazilian Institute for Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE) in 1998, 2003, 2008, 2013, and 2019. Pairwise comparisons and marginal analyses allowed for the assessment of differences in patients’ perception of healthcare quality according to source of funding and type of healthcare quality. A logistic regression model was estimated to identify factors associated with the perception of good quality of care. Model discrimination, calibration, and goodness-of-fit were assessed to ensure the robustness of analyses. Results: The results indicate that patients’ satisfaction was positively associated with level of implementation of the national program based on payment for performance in public healthcare facilities, PMAQ-AB (OR = 3.376; p < 0.001), self-assessment of good health status (OR = 3.209; p < 0.001), and healthcare financed through health insurance (OR = 2.344; p < 0.001). Contrarily, receiving healthcare in a public facility (OR = 0.358; p < 0.001) was negatively associated with the evaluation of good quality. Conclusions: The findings showed that patients’ perception of quality of care presents significant associations with patients’ health characteristics, healthcare funding source, and implementation of the PMAQ-AB. Furthermore, patients generally perceived lower healthcare quality in public facilities. The study indicates the need for evidence-based decision-making in public policies of health, particularly regarding further advances in payment for performance programs designed to foster improvements in quality of care within public PHC facilities in Brazil. Full article