Journal of Family Medicine and Primary Care最新文献

{"title":"Bias in obtaining broad consent in a German general practice? - Preliminary results from a cross-sectional study.","authors":"Konstantin Moser, Felix Bauch, Manon Richter, Christine Brütting, Alexander Bauer, Shlomo Vinker, Tobias Deutsch, Thomas Frese","doi":"10.4103/jfmpc.jfmpc_1957_23","DOIUrl":"10.4103/jfmpc.jfmpc_1957_23","url":null,"abstract":"<p><strong>Background: </strong>The growing importance of collecting Broad Consent (BC) for research utilizing electronic health records in Germany has brought attention to the need for a deeper understanding of potential selection bias in the process. Since 2020, the BeoNet-Halle outpatient database has been collecting anonymous and pseudonymous patient data from primary care and specialty practices throughout Germany, with the practice being an integral part of this data collection effort. The primary objective of the pilot study is to explore potential socioeconomic discrepancies between patients who provided BC and the general practice population.</p><p><strong>Method: </strong>This is a single-center, cross-sectional study. The study was performed with patients from one Medical Care Center including eight GPs. We categorized patients with at least one interaction with a general practitioner from March 2021 to January 2023 into two sets: patients who approved BC versus a randomly chosen representative sample (RS) of non-BC inquirers. We mailed a sociodemographic survey to both groups.</p><p><strong>Results: </strong>A total of 561 patients were analyzed, with the BC group responding more actively (60.7%) than the RS group (29.7%). Age and gender were similar between the BC group and RS group. Being widowed, divorced, or unmarried and being neither open nor hostile toward research was associated with an increased likelihood of giving consent. Analysis of personality traits did not show any impact on giving consent.</p><p><strong>Conclusions: </strong>Overall, this study outlines that there is some bias between BC and RS. Possible associations in BC decisions that offer insights into complex decisions to participate in medical research are marital status, immigrant background, income, and age. Findings emphasize the potential of BC for outpatient research, warranting further investigation to optimize its application in the general practice setting.</p>","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of urea, uric acid and creatinine levels in patients of primary hypothyroidism - A cross-sectional study.","authors":"Bhagyashree Gali, Vanishree S Bubanale","doi":"10.4103/jfmpc.jfmpc_403_24","DOIUrl":"10.4103/jfmpc.jfmpc_403_24","url":null,"abstract":"<p><strong>Background: </strong>The thyroid gland is one of the largest endocrine glands in the body, secreting thyroxine (T4) and triiodothyronine (T3). Mild hypothyroidism can have negative consequences for a variety of tissues, even though clinically the patients are euthyroid. Many research studies were conducted to evaluate the serum creatinine levels of people with hypothyroidism; however, relatively little research was conducted to evaluate serum urea and serum creatinine levels in subclinical hypothyroidism. As a result, the current study was carried out to investigate urea, uric acid, and creatinine levels in hypothyroidism.</p><p><strong>Objectives: </strong>Our study aimed to determine and correlate the levels of urea, uric acid and creatinine in newly diagnosed primary hypothyroidism cases.</p><p><strong>Materials and methods: </strong>In this cross-sectional study, 96 newly diagnosed cases of primary hypothyroidism were included. The findings were correlated with 20-60-year-old and sex-matched cases. Serum urea was determined by the kinetic method (Glutamate Dehydrogenase Method), serum uric acid by the uricase method and serum creatinine by Jaffe's method in Erba's Mannheim fully automated analyser.</p><p><strong>Result: </strong>This study showed a positive correlation between uric acid and thyroid stimulating hormone (TSH) and a negative correlation between urea and creatinine. There was no statistical significance in the mean values of urea, uric acid and creatinine but an increased level of urea, uric acid and creatinine was seen in the age group 20-30 years when compared with the other age groups.</p><p><strong>Conclusion: </strong>The study concludes that serum urea showed a positive correlation with TSH, whereas uric acid and creatinine showed a negative correlation with TSH, and there was no statistical significance in the mean values of urea, uric acid and creatinine in hypothyroid patients.</p>","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of malignancy in thyroid nodules with AUS cytopathology: A retrospective cross-sectional study.","authors":"Abdullah M Alshalaan, Waleed A D Elzain, Jaber Alfaifi, Jaber Alshahrani, Mohammed Mana M Al Qahtani, Hind A A Al Qahtani, Mohammed A AlFlan, Shubayli H H Alshehri, Ahmed A Al Asim, Afnan A S Abonukhaa, Ali Saleh R Alshamrani, Alam Eldin Musa Mustafa","doi":"10.4103/jfmpc.jfmpc_249_24","DOIUrl":"10.4103/jfmpc.jfmpc_249_24","url":null,"abstract":"<p><strong>Background: </strong>Category III (AUS; Atypia of Undetermined Significance) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was established to describe thyroid nodule features that are neither benign nor cancerous.</p><p><strong>Objectives: </strong>This study aims to evaluate the rate of thyroid malignancy in patients diagnosed with AUS at the Armed Forces Hospital Southern Region (AFHSR), Saudi Arabia.</p><p><strong>Method: </strong>The patients (508) diagnosed with AUS in their thyroid nodules underwent fine-needle aspiration cytology (FNAC). Data were collected through a chart-based approach, reviewing patients' medical records and relevant information.</p><p><strong>Results: </strong>Among the cases, the majority were females (84.6%). Among the different age groups, individuals between 40 and 50 years had the highest prevalence of thyroid nodules (32.5%). Approximately 27% of patients exhibited tumor sizes larger than 4 cm. FNAC results revealed 16.5% benign, 26% AUS, and 22.4% follicular neoplasm cases. Histopathology indicated 54.1% of benign and 37.2% of malignant cases. Papillary carcinoma accounts for 80.4% of all malignant cases. A significant correlation was observed between FNAC and postoperative histopathology (<i>P</i> value < 0.05). Hypoechoic nodules exhibited 33.9% of malignant cases, and calcification was observed in 25% of the cases. A significant association was found between malignancy and echogenicity and between malignancy and calcification (<i>P</i> value = 0.003 and 0.001, respectively).</p><p><strong>Conclusion: </strong>The findings of this study identify malignancy in thyroid nodules with AUS cytopathology, particularly in the Southern region of Saudi Arabia. The correlation between pre-surgery FNAC and postoperative histopathology supports FNAC's diagnostic value. Additionally, echogenicity and calcification can potentially contribute to predicting nodule malignancy.</p>","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High fiber diet versus polyethylene glycol in management of chronic constipation in children with cerebral palsy: A randomized controlled trial.","authors":"Vandana Arya, Sailesh Khyalia, Kapil Bhalla","doi":"10.4103/jfmpc.jfmpc_464_24","DOIUrl":"10.4103/jfmpc.jfmpc_464_24","url":null,"abstract":"<p><strong>Background: </strong>Constipation is one of the most common gastrointestinal symptoms in patients with cerebral palsy. This study was conducted with the aim to compare the efficacy of a high fiber diet and polyethylene glycol in the management of chronic constipation in children with cerebral palsy.</p><p><strong>Methodology: </strong>An open-label randomized controlled trial was conducted in the Department of Pediatrics of a tertiary care hospital in Northern India among cerebral palsy children aged 1-6 years having chronic constipation. Seventy children were enrolled in the study (35 in each group). Group A children received high fiber diet as per the diet chart prepared by the dietician. Group B received polyethylene glycol (0.5-1 g/kg/day) for a period of three months. At the end of four weeks and three months, all children were assessed for clinical improvement and both groups were compared in terms of stool frequency, consistency of stool, fecal incontinence, palpation of hard stool per abdomen, blood in stool, pain on defecation and overall satisfactory outcome. Satisfactory outcome was defined as defecation > two times weekly, soft stool, no pain on defecation, no palpation of hard stool on abdominal examination, no fecal incontinence, and no blood in stools. Children were also assessed for any adverse effects.</p><p><strong>Results: </strong>Baseline parameters and GMFCS were comparable in the two groups. Both group patients showed significant improvement in symptoms of constipation at the end of four weeks and three months compared to baseline. However, there was no significant difference between the two groups in terms of satisfactory outcome and parameters like frequency of stool, consistency of stool, palpation of hard stool, fecal incontinence, and blood in stools.</p><p><strong>Conclusion: </strong>A high fiber diet can be considered a good alternative to polyethylene glycol for the management of chronic constipation in children with cerebral palsy.</p>","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scrub typhus strikes: Menacing maternal and fetal health.","authors":"Pratap Bhan Kaushik, Ajaykumar C Sahu","doi":"10.4103/jfmpc.jfmpc_660_24","DOIUrl":"10.4103/jfmpc.jfmpc_660_24","url":null,"abstract":"","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low back pain among college students in a public Saudi university: A cross-sectional study.","authors":"Khalid A Bin Abdulrahman, Abdullah Talae S Al Askar, Abdulrhman Khalid A Alhamidi, Abdullah Hezam A Al Sharani, Ali Abdulelah S Alanazi, Abdullah Nasser H Alkatheeri, Maan Talal A Alhazmi, Abdulrahman Jahz Alharbi","doi":"10.4103/jfmpc.jfmpc_2021_23","DOIUrl":"10.4103/jfmpc.jfmpc_2021_23","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is the most prevalent orthopedic condition worldwide. University students are more likely to have this issue due to their demanding and time-consuming course load. This study aimed to investigate the prevalence of LBP and the factors that lead to it among students at the Imam Mohammad Ibn Saud Islamic University (IMSIU).</p><p><strong>Methods: </strong>This cross-sectional study targeted undergraduate students using an online self-administered questionnaire. A descriptive analysis method was conducted.</p><p><strong>Results: </strong>Of the 830 students who completed the survey, 71.4% were females. About two-thirds were aged between 18 and 22 years. Our study shows that 68.2% had complained of recent LBP. The most significant prevalent factor associated with LBP among IMAMU students, 94.2%, was prolonged sitting. Heavy object lifting is 93.2%, and unhealthy seating/body position is 90.2%, which comes in second and third place. Those who complained about the discomfort of their lecture hall seats were shown to be dramatically more likely (5.549 times more) to develop LBP than students who did not. Students with a positive history of depression were significantly more prone (2.565-fold) to LBP. A positive family history of LBP and smoking cigarettes were found to increase the chance of developing LBP.</p><p><strong>Conclusion: </strong>LBP among IMSIU students is high, mainly because of prolonged sitting, heavy object lifting, and unhealthy sitting and/or body position. There is a strong association between LBP and a positive family history of LBP, smoking, and uncomfortable seats. Prevenive measures, such as an intervention program for university students, are required.</p>","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Virtual care is a double-edged sword</i>: Adjusting preventive care service delivery in community health clinics during COVID-19.","authors":"Dea Papajorgji-Taylor, Christina R Sheppler, Carmit McMullen, Patrick J O'Connor, Rachel Gold","doi":"10.4103/jfmpc.jfmpc_1971_23","DOIUrl":"10.4103/jfmpc.jfmpc_1971_23","url":null,"abstract":"<p><strong>Purpose: </strong>Qualitatively examine how community health clinics delivered cardiovascular disease (CVD) preventive care during COVID-19 using virtual care and related adaptations.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted in 2021-2022 with nine clinician leaders from four clinics across the country that share an electronic health record. Interviews covered: (1) the pandemic's impact on preventive care delivery, (2) the adaptation and role of virtual care, and (3) management of CVD risk in this context. Collected data were analyzed using a thematic analysis approach.</p><p><strong>Results: </strong>Staff reported substantial pros and cons to virtual care for CVD risk management. It was seen as useful for general check-ins with patients. However, without current laboratory results and vital measurements, providers found it challenging to assess patient CVD risk and direct care accordingly.</p><p><strong>Conclusion: </strong>Findings add to the evolving evidence base that the necessary pivot to virtual care during the pandemic spurred innovations but also created limitations and delays in delivering appropriate preventive care.</p>","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142516439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of intravenous labetalol in severe pre-eclampsia and eclampsia at a teaching institution in Chhattisgarh.","authors":"Rachna Jain, Sangeeta Raman Jogi","doi":"10.4103/jfmpc.jfmpc_185_24","DOIUrl":"10.4103/jfmpc.jfmpc_185_24","url":null,"abstract":"<p><strong>Introduction: </strong>Severe hypertension in pregnancy deserves prompt recognition and urgent effective reduction in order to reduce the risk of complications such as eclampsia and HELLP syndrome and to achieve desirable neonatal outcomes. There is a need for effective and safe parenteral antihypertensive treatment.</p><p><strong>Subjects and methods: </strong>We studied the effectiveness and safety of intravenous labetalol use in severe hypertension in pregnancy and post-partum period in a teaching hospital in Chhattisgarh in 101 women. IV labetalol was given as bolus doses till the blood pressures were controlled. Neonatal outcomes were recorded, and adverse effects such as hypotension, hypoglycemia, and neonatal asphyxia were documented.</p><p><strong>Results: </strong>Intravenous labetalol given as a single bolus of 20 mg was efficacious in controlling blood pressures in 93 out of 101 (93%) women, and the rest were controlled with 1 or 2 additional doses in 1-3 hours. No neonatal deaths happened beyond the 13 intrauterine fetal deaths at presentation. No women developed any episodes of hypotension, tachycardia of more than 100, or nausea or vomiting on labetalol.</p><p><strong>Conclusion: </strong>Intravenous labetalol, even as a single bolus dose, is highly efficacious and is free of any major adverse effects.</p>","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a training program in improving knowledge and skills about selected common neurological disorders among primary healthcare doctors: The Karnataka Brain Health Initiative (KaBHI) in India.","authors":"Pooja Mailankody, Rajani Parthasarathy, D Randeep, Girish N Rao, Avanthi Paplikar, Annie Nithiya Vathani Johnson, Feba Varghese, Sarath Govindaraj, Rehan Shahed, Aparna Vasudev, Deenadayalan Boopalan, Girish B Kulkarni, Yogeshwar Kalkonde, Sanjib Sinha, Suvarna Alladi","doi":"10.4103/jfmpc.jfmpc_1984_23","DOIUrl":"10.4103/jfmpc.jfmpc_1984_23","url":null,"abstract":"<p><strong>Introduction: </strong>Neurological disorders are the leading causes of death and disability globally. In low-middle-income countries such as India, there is a wide treatment gap for neurological disorders. To address this gap, an initiative known as the Karnataka Brain Health Initiative (KaBHI) was developed in collaboration with the public health system of the state of Karnataka in India.</p><p><strong>Method: </strong>A structured hybrid training program was conducted for 120 medical doctors working in the Primary Health Centers (PHCs) in the public health system in three districts of Karnataka. Pre- and post-training evaluation was conducted to assess physicians' knowledge and skills for evaluating patients with common neurological conditions.</p><p><strong>Results: </strong>Of 120 PHC doctors, 111 (92%) scored below the passing score of 50 points out of 100 before the training program. After the training, all trainees scored above this cut-off. The study found a significant improvement in knowledge and skills after the training (before training: 40.48 ± 7.92, after training: 66.28 ± 8.98 (<i>P</i> < 0.001) mean difference = 25.81), and was comparable among the PHC doctors in all three districts.</p><p><strong>Conclusions: </strong>Our study shows the feasibility of training primary care doctors in the public health system to manage selected common neurological disorders. The training program can potentially help to reduce the treatment gap for neurological disorders in India.</p>","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of climate change on water-related physical events, consequent human migration, and burden of drowning in India: An evidence synthesis.","authors":"Deepti Beri, Jane Elkington, Sandeep Moola, Soumyadeep Bhaumik, Jagnoor Jagnoor","doi":"10.4103/jfmpc.jfmpc_958_23","DOIUrl":"10.4103/jfmpc.jfmpc_958_23","url":null,"abstract":"<p><strong>Introduction: </strong>Disrupted weather patterns are associated with climate change. Between 2001 and 2018, nearly 74% of disasters were water-related, including floods and cyclones. Such water-related cataclysmic events increase the risk of drowning. We aimed to map evidence on the impact of climate change on water-related physical events, associated human migration, and drowning burden in India.</p><p><strong>Materials and methods: </strong>We searched electronic databases, government reports, and relevant websites to map evidence on water-related physical events (including but not limited to sea-level rise, glacier bursts, lake bursts, floods, rainfall, cyclones, and droughts) and consequent human migration using narrative review approach, while drowning burden through scoping review approach. We summarized the results narratively.</p><p><strong>Results: </strong>Evidence from 48 studies and seven reports suggest that India will witness the greatest sea-level rise, significantly impacting poor coastal communities. An increase in droughts, cyclonic rainfall, storms, and floods, with increasing surface rainwater and streamflow water, due to melting glaciers is expected. Climate change-triggered migration is expected notably in northeast and south India, making farmers, drivers, street vendors, women, and youth most vulnerable. No direct evidence was identified on the impact of climate change, water-related disasters, meteorological events, or seasonal variations on drowning from India.</p><p><strong>Conclusion: </strong>Our study highlights a significant gap in the availability of context-specific and localized data to improve disaster response and strengthen public health systems, especially for areas most vulnerable to climate change. There is an urgent need to generate new knowledge and understanding of climate change, water-related or meteorological events, and seasonal variations' impact on drowning burden as the level of risk remains unknown.</p>","PeriodicalId":15856,"journal":{"name":"Journal of Family Medicine and Primary Care","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}