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Objective: The objective of this study is to assesses the preparedness of primary care centers (PHCs) in Aseer region, KSA, for the coronavirus disease 2019 (COVID-19) pandemic. Methods: This survey was conducted during April 2020 in PHCs. The questionnaire was developed by the investigators and sent via e-mail to health care providers of primary health care centers (PHCCs). The questionnaire consisted of five parts to assesses readiness of PHCs, knowledge, attitude, and practice of health care providers (HCPs) concerning the COVID-19 pandemic. Data entry and analysis were managed by SPSS version 20. Results: Three hundred and seventy-one HCPs participated in this study. Most of them were males (58%), doctors or nurses (81%). Almost all PHCCs have adequate infection control resources, with some shortage in sterilization rooms. Most of participants received on-job training (85%) and had good knowledge about COVID-19. Attitudes of participants showed variation toward COVID-19; 74% were afraid to be infected, 54% were afraid to care for infected patients, 58% were ready for vaccination, and 80% thought that COVID-19 has a huge negative impact on the health care system. Compliance with preventive measures ranged from 66% for keeping social distance to 90% for using personal protective equipment. Most of the participants had positive contributions regarding health education of individuals and communities using different methods including the new social media (80%). Conclusion: This study revealed that PHCCs in Aseer region were well equipped and HCPs were well prepared to deal with the COVID-19 pandemic. There are some shortage in a few items of infection control at PHCCs and gaps in knowledge and practice among HCPs which need continuous assessment and monitoring to overcome such barriers.

Objective: The objective of this study is to assesses the preparedness of primary care centers (PHCs) in Aseer region, KSA, for the coronavirus disease 2019 (COVID-19) pandemic. Methods: This survey was conducted during April 2020 in PHCs. The questionnaire was developed by the investigators and sent via e-mail to health care providers of primary health care centers (PHCCs). The questionnaire consisted of five parts to assesses readiness of PHCs, knowledge, attitude, and practice of health care providers (HCPs) concerning the COVID-19 pandemic. Data entry and analysis were managed by SPSS version 20. Results: Three hundred and seventy-one HCPs participated in this study. Most of them were males (58%), doctors or nurses (81%). Almost all PHCCs have adequate infection control resources, with some shortage in sterilization rooms. Most of participants received on-job training (85%) and had good knowledge about COVID-19. Attitudes of participants showed variation toward COVID-19; 74% were afraid to be infected, 54% were afraid to care for infected patients, 58% were ready for vaccination, and 80% thought that COVID-19 has a huge negative impact on the health care system. Compliance with preventive measures ranged from 66% for keeping social distance to 90% for using personal protective equipment. Most of the participants had positive contributions regarding health education of individuals and communities using different methods including the new social media (80%). Conclusion: This study revealed that PHCCs in Aseer region were well equipped and HCPs were well prepared to deal with the COVID-19 pandemic. There are some shortage in a few items of infection control at PHCCs and gaps in knowledge and practice among HCPs which need continuous assessment and monitoring to overcome such barriers. [ABSTRACT FROM AUTHOR]

Airborne bacteria pose a potential risk to human health upon inhalation in the indoor environments of health care facilities. Airborne bacteria may originate from various sources, including patients, workers, and daily visitors. Hence, this study investigates the quantity, size, and identification of airborne bacteria indoors and outdoors of four Primary Health Care Centers (PHCC) in Doha, Qatar. Air samples were collected from the lobby, triage room, and outside environment of the centers, including, Qatar University (QU-HC), Al-Rayyan (AR-HC), Umm-Ghuwailina (UG-HC), and Old Airport (OA-HC) between August 2020 and March 2021, throughout both the hot and the cold seasons. Samples were collected using an Anderson six-stage cascade impactor. The mean of the total colony-forming units was calculated per cubic meter of air (CFU/m3). QU-HC had the lowest mean of total bacterial count compared with other centers in the indoor and outdoor areas with 100.4 and 99.6 CFU/m3, respectively. In contrast, AR-HC had the highest level, with 459 CFU/m3 indoors, while OA-HC recorded the highest bacterial concentration of the outdoor areas with a total mean 377 CFU/m3. In addition, 16S rRNA sequencing was performed for genera identification. Staphylococcus, Acinetobacter, Bacillus, and Pseudomonas were the four most frequently identified bacterial genera in this study. The abundance of airborne bacteria in the four health centers was higher in the cold season. About 46% of the total airborne bacterial count for three PHCC centers exceeded 300 CFU/m3, making them uncompliant with the World Health Organization's (WHO) recommendation for indoor settings. Consequently, an IAQ standards should be shaped to establish a baseline for measuring air pollution in Qatar. Additionally, it is crucial to understand seasonal fluctuations better so that hospitals can avoid rising and spreading infection peaks. [ABSTRACT FROM AUTHOR]

Mohamed Ghaith Al-Kuwari,1 Samya Al Abdulla,2 Maha Abdulla,1 Azza Mustafa Mohammed,1 Ahmad Haj Bakri,1 Fahad Shaikhan,3 Hanan Buhaddoud1 1Strategy Planning and Health Intelligence, Primary Health Care Corporation, Doha, Qatar; 2Operations, Primary Health Care Corporation, Doha, Qatar; 3Preventative Health – Health Protection, Primary Health Care Corporation, Doha, QatarCorrespondence: Azza Mustafa Mohammed Tel +974 40270065Email ammohammed@phcc.gov.qaObjective: This study is a part of the Primary Health Care Corporation’s (PHCC) Health Needs Assessment (HNA) Initiative. It focuses on identifying perceptions of Arabic speaking primary care clients regarding community’s major health issues, their experiences in utilizing health services, and the barriers that limit their access to health care in the State of Qatar.Study Setting and Design: A total of 10 focus groups sessions were conducted at different PHCC’s health centers between October of 2019 and March of 2020. Sessions were distributed to cover all PHCC’s three geographical regions. Data were analyzed using thematic analysis.Participants: A total of 89 adult Arabic speaking individuals were recruited. Participants included were in the age groups (18– 69), native Arabic speaker, and registered at one of the PHCC’s health centers with a valid health card at time of recruitment.Results: Areas investigated included perceptions of the community’s health issues, needed health services, and perceived barriers to health care. Priority health issues identified were chronic non-communicable diseases, mental health, timely access to care, cultural competency of delivered services, and integration and coordination across health care settings and sectors. Participants were able to identify socioeconomic and environmental factors such as the need for health and wellness interventions at schools that affects the health of the individual and the community. The importance of raising the community’s awareness about health-related issues and availability of health services was highlighted by study participants.Conclusion: Collecting qualitative data provides an opportunity to examine people’s perceptions, and motivations and engage the whole community. This process is very important for strategic planning of health services. The study attempts to fill the knowledge gap and should be linked to health policy and the development of socially and culturally appropriate health programs.Keywords: primary care, qualitative research, PHCC, health needs assessment, Qatar

Manal Al-Zaidan,1 Mohamed Izham Mohamed Ibrahim,2 Mohamed Ghaith Al-Kuwari,3 Azza Mustafa Mohammed,3 Mansoor Nawaz Mohammed,4 Samya Al Abdulla5 1Pharmacy Department, Primary Health Care Corporation, Doha, Qatar; 2College of Pharmacy, QU Health, Qatar University, Doha, Qatar; 3Directorate of Strategy Planning and Health Intelligence, Primary Health Care Corporation, Doha, Qatar; 4Clinical Information Systems Department, Primary Health Care Corporation, Doha, Qatar; 5Directorate of Operations, Primary Health Care Corporation, Doha, QatarCorrespondence: Manal Al-ZaidanDirector of Pharmacy, P.O. Box 26555, Doha, QatarTel + 974 40271103Email malzaidan@phcc.gov.qaAbstract: The COVID-19 pandemic has strained health care systems around the world. Pharmacists have made substantial contributions to the health care operations during the COVID-19 response. The Pharmacy Department at Qatar Primary Health Care Corporation (PHCC) acted proactively to ensure that all patients received their medications and their refilled prescriptions in time and without any disruption. The Medication Home Delivery Service was introduced and implemented for all Qatar residents to prevent unnecessary visits to health centers, minimize the spread of COVID-19 to vulnerable populations, especially those with multiple comorbidities, and protect health care workers from exposure to the virus. Moreover, several other precautionary measures were taken by the PHCC to ensure uninterrupted access to health care, including moving to a virtual health care delivery model. As of September 2020, the service had served around 64,213 patients since its launch in March 2020. In total, 70,357 medications were delivered and 69,092 (98.2%) medication packages were delivered successfully to patients, with an average of 450.8 medication packages delivered per month. Despite various challenges, the PHCC is considering continuing the Medication Home Delivery Service in the long term to continue with a more effective and efficient service for patients during the coming months and years.Keywords: COVID-19, pandemic, pharmacy service, medication home delivery, PHCC, Qatar

Airborne bacteria pose a potential risk to human health upon inhalation in the indoor environments of health care facilities. Airborne bacteria may originate from various sources, including patients, workers, and daily visitors. Hence, this study investigates the quantity, size, and identification of airborne bacteria indoors and outdoors of four Primary Health Care Centers (PHCC) in Doha, Qatar. Air samples were collected from the lobby, triage room, and outside environment of the centers, including, Qatar University (QU-HC), Al-Rayyan (AR-HC), Umm-Ghuwailina (UG-HC), and Old Airport (OA-HC) between August 2020 and March 2021, throughout both the hot and the cold seasons. Samples were collected using an Anderson six-stage cascade impactor. The mean of the total colony-forming units was calculated per cubic meter of air (CFU/m3). QU-HC had the lowest mean of total bacterial count compared with other centers in the indoor and outdoor areas with 100.4 and 99.6 CFU/m3, respectively. In contrast, AR-HC had the highest level, with 459 CFU/m3 indoors, while OA-HC recorded the highest bacterial concentration of the outdoor areas with a total mean 377 CFU/m3. In addition, 16S rRNA sequencing was performed for genera identification. Staphylococcus, Acinetobacter, Bacillus, and Pseudomonas were the four most frequently identified bacterial genera in this study. The abundance of airborne bacteria in the four health centers was higher in the cold season. About 46% of the total airborne bacterial count for three PHCC centers exceeded 300 CFU/m3, making them uncompliant with the World Health Organization’s (WHO) recommendation for indoor settings. Consequently, an IAQ standards should be shaped to establish a baseline for measuring air pollution in Qatar. Additionally, it is crucial to understand seasonal fluctuations better so that hospitals can avoid rising and spreading infection peaks.

INTRODUCTION: The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response. METHODS: a community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations. RESULTS: integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p=0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p=0.05). CONCLUSION: this study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV).

Introduction: The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response. Methods: A community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations. Results: Integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36-0.55), p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p<0.05). Conclusion: This study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV). [ABSTRACT FROM AUTHOR]

Purpose: Prognostic prediction after curative resection of primary hepatocellular carcinoma (PHCC) remains an arduous task. The S-index calculated from γ-glutamyl transpeptidase, albumin, and platelets is reported to predict the severity of liver fibrosis. We constructed a nomogram for predicting the survival probability of PHCC based on a new indicator, the S-index, combined with other routine clinical parameters. Patients and methods: We selected 490 patients with PHCC postradical surgery at the First Affiliated Hospital of Wenzhou Medical University between January 2007 and January 2014. The subjects were randomly allocated into the training cohort and the validation cohort in the ratio 7:3 by the digital method. Important variables screened by univariate analysis were included in multivariate analysis to obtain independent risk factors for predicting the prognosis of PHCC. The construction of the nomogram was based on Cox proportional hazard regression models. The concordance index (C-index) was used in the nomogram for evaluating the model performance for prognosis. We drew time-dependent receiver operating characteristic curves to compare our model with other staging systems. Results: The nomogram based on six independent risk factors after multivariate analyses had good predictive power after radical surgery of PHCC. In the training and validation groups, the C-index of the nomogram was highly consistent for evaluating survival from PHCC. Compared with the traditional scoring system, the areas under time-dependent receiver operating characteristic curves were 0.7382, 0.7293, and 0.7520 for 1-, 3-, and 5-year overall survival, respectively. In summary, the nomogram showed excellent results in terms of prognosis of PHCC. Conclusion: Based on the S-index and the other clinical indicators, we developed a precise nomogram that predicts the survival probability of patients with PHCC after radical surgery. This tool can provide effective information for surgeons and patients. [ABSTRACT FROM AUTHOR]

Objective This study aimed to highlight on inappropriate antibiotic prescribing in upper respiratory tract infections (URTIs) in children in primary healthcare center (PHCC) in Kirkuk, Iraq. Methods This is a cross-sectional retrospective study conducted over 5-month period (November 1, 2018-March 31, 2019) for children ≤ 12 year old complaining from URTIs attending Azadi 2 PHCC, Kirkuk, Iraq. Information obtained from registry of the PHCC. Results Our study sample was 300 patients, there were n: 152, 51% females and n: 148, 49% males. The most common diagnosis was common cold (n: 120, 40%) followed by pharyngitis (n: 114, 38%), tonsillitis (n: 40, 13.3%), otitis media (n: 21, 7%), and the less common diagnosis was acute sinusitis (n: 5, 1.7%). Combined prescription of antibiotics with aduvants was the most common finding (n: 256, 85%) while prescription of adjuvants alone was in the second ranking (n: 42, 14%). Antibiotics was prescribed for 89.5% patients diagnosed with pharyngitis and 79.2% of patients diagnosed with common cold. Conclusion Antibiotics over prescription is high in a primary healthcare facility practice. Health authorities should enforce strict control or out rightly stop antibiotics over prescription to reduce chances of the emergence antibiotics resistance. [ABSTRACT FROM AUTHOR]

Background Treatment outcome of children with pediatric hepatocellular carcinoma (pHCC) is poor. Therefore, we evaluated the tyrosine kinase inhibitor sorafenib in a model of pHCC. Methods Cell viability after treatment with sorafenib was evaluated in HC-AFW1 cells (pHCC) using MTT assay and compared to an adult HCC (aHCC) and two hepatoblastoma (HB) cell lines. ERK, pERK, E-cadherin, and vimentin expression were investigated using Western Blot. Sorafenib (60 mg/kg) was administered orally to NOD.Cg-Prkdcscid-IL2rgtmWjl/Sz mice bearing subcutaneous HC-AFW1-derived tumors. Tumor progression, viability, and vascularization were monitored by tumor volume, AFP levels, and CD31 immunostaining, respectively. Sensitization to sorafenib was evaluated using the β-catenin inhibitor ICG001. Results Sorafenib reduced cell viability in HC-AFW1 (IC 50 : 8 µM), comparable to HB cells, however less pronounced in aHCC cells (IC 50 : 23 µM). Sorafenib inhibited ERK signaling in both, HC-AFW1 cells and -xenografts. In vivo, sorafenib treatment only led to a moderate tumor growth inhibition, although significant reduction of vascularization and tumor growth kinetics was observed. Long-term treatment with sorafenib decreased E-cadherin, but showed no induction of vimentin expression. Combining sorafenib with a β-catenin inhibitor led to an additional reduction of cell viability. Conclusion Sorafenib together with inhibitors of the β-catenin pathway might be an effective tool in the treatment of pediatric HCC. [ABSTRACT FROM AUTHOR]

Background: Primary hepatocellular carcinoma (PHCC) has a poor prognosis and high short-term mortality rate, even after resection. Thus, early diagnosis in PHCC cases can help improve quality of life via personalized management strategies., Results: The risk score system (RSS) were classified as low risk (<5 points), medium risk (5-10 points), or high risk (>10 points). The areas under the receiver operating characteristic curves were 0.80 in the training cohort and 0.69 in the validation cohort, which indicated satisfactory prognostic performance. The Hosmer-Lemeshow goodness of fit test ( P >0.05) revealed consistent performance in both groups. The concordance index (C-index: 0.663, 95% CI: 0.618-0.708) revealed excellent discrimination and good calibration in the validation cohort., Conclusions: This simple RSS, which is based on clinical and laboratory data from patients undergoing resection of PHCC, might allow clinicians and medical staff to better manage PHCC., Materials and Methods: A total of 672 PHCC cases were retrospectively obtained from the First Affiliated Hospital of Wenzhou Medical University between January 2007 and February 2015. Cox proportional hazard models were used to identify independent predictors of mortality. Kaplan-Meier curves and the log-rank test were used to examine the relationships between the prognostic factors and overall mortality.