Clinic Attendance Research Articles

Maintaining Normal Serum Ferritin Levels During Pregnancy: A Randomized Controlled Trial of Daily versus Weekly Ferrous Sulfate

Background: Serum ferritin is the most reliable indication of stored iron in pregnancy, offering a noninvasive way to detect iron deficiency anemia before it occurs. Therefore, this study aimed to determine serum ferritin levels among women receiving daily versus weekly iron supplementation, with a secondary focus on comparing the proportion developing iron deficiency anemia and compli-ance rates between the two groups.Methods: This non-blinded randomized control trial involved non-anaemic pregnant women attend-ing antenatal clinics at two Teaching Hospitals in Osun State. One hundred twenty-five subjects were recruited to receive 65mg in the control group, while another 125 subjects in the active group re-ceived three tablets (195mg) of ferrous sulfate (Fesulf) once weekly for 17 weeks from the 20th to 37th weeks of gestation. The primary outcome measure was comparing mean serum ferritin levels in both groups at 37 weeks.Results: Among the 240 subjects analyzed, the 37-week serum ferritin level was higher in the daily group (73.26±26.67μg/L) compared to the weekly group (63.04±30.71 μg/L), p value=0.006. Four (3.36%) and 10 (8.26%) of our subjects had Iron deficiency anaemia. Nine subjects (3.75%) reported dyspepsia as a side effect. Daily 65 mg of Felsulf proved more effective than weekly 195mg in main-taining normal blood ferritin levels during pregnancy.Conclusions: Daily iron supplementation with 65mg ferrous sulfate was more effective at main-taining adequate maternal iron concentration in this group of non-anaemic pregnant women. This dosage is recommended for routine iron supplementation in our environment.

Dietary diversity, undernutrition, and predictors among pregnant adolescents and young women attending Gulu University teaching hospitals in northern Uganda.

Undernutrition has deleterious consequences to both the mother and the unborn child, significantly contributing to maternal and neonatal morbidity and mortality. We assessed dietary diversity, the prevalence, and predictors of undernutrition among pregnant adolescents and young women (PAYW) attending antenatal clinic (ANC) at two large teaching hospitals in northern Uganda. Between 12th June 2023 to 27th October 2023, we conducted a facility-based, cross-sectional study at Gulu Regional Referral Hospital (GRRH) and St Mary's Hospital Lacor (SMHL), both in Gulu district, Uganda. We recruited PAYW aged 15-24 years attending ANCs. Sociodemographic and clinical characteristics of the study participants were collected using a pre-tested, semi-structured questionnaire. Undernutrition was defined as a mid-upper arm circumference (MUAC) of < 23 cm. Modified Poisson regression analysis was performed to determine factors independently associated with undernutrition. Data analyses was performed using STATA version 17.0. A p<0.05 was considered statistically significant. A total of 324 participants, with a mean age of 21.2±2.2 years were enrolled. About 62.0% (n = 201) of the participants dewormed during pregnancy. The prevalence of undernutrition was 12.7% [n = 41]. Prevalence was higher among participants who maintained pre-pregnancy diet (adjusted prevalence ratio [aPR] = 2.27, 95% Confidence Interval [CI]: 1.26-4.05, p = 0.006), those who did not receive nutritional education (aPR = 2.25, 95% CI: 1.21-4.20, p = 0.011) and consumption of non-green leafy vegetables (aPR = 4.62 95% CI: 1.64-13.01, p = 0.004). The prevalence of undernutrition was lower among participants who consumed milk and milk products (aPR = 0.44 95% CI: 0.24-0.81, p = 0.009) and among those who consumed fish and seafood compared to those who did not (aPR = 0.45 95% CI: 0.20-1.00, p = 0.050). About 1 in 8 of PAYW attending GRRH or SMHL had undernutrition, particularly those who lacked education about feeding habits during pregnancy and limited access to milk and milk products, fish and seafoods. We recommend health workers to offer timely education of pregnant adolescent and young women mothers about good feeding habits during pregnancy, appropriate monitoring of weight gain and physiological changes during pregnancy.

Cervical cancer screening practices of antenatal clinic attendees in Garki Hospital Abuja, Nigeria

Cervical cancer screening practices of antenatal clinic attendees in Garki Hospital Abuja, Nigeria

Educational Intervention Effects on Bilateral Tubal Ligation Knowledge among Women Attending Antenatal and Family Planning Clinics in Bomet County

Bilateral Tubal Ligation (BTL) is a highly effective contraceptive method with more than 99% effectiveness at preventing pregnancy. Its uptake remains low in Sub-Saharan Africa, at 1.6%. The Kenya Health and Demographics Survey 2014, indicated that almost half of the married women did not desire further childbearing. The low acceptance of BTL as a method of contraception in this region has been attributed to a lack of knowledge and cultural and religious misconceptions. This study aimed to determine the level of knowledge about BTL at baseline and the impact of an educational intervention among women attending ANC/Family planning clinics at Tenwek and Longisa Hospitals in Bomet County. A quasi-experimental study design was used. Demographic characteristics, knowledge of BTL, perceived risks, and benefits were assessed at baseline and post-intervention. A difference measure was used to assess the impact of the intervention at 95% CI, with a p-value of 0.05 considered significant. The data was analyzed using STATA version 18. The mean age of the participants at baseline and post-intervention was 29.0±5.8 years and 29.2±5.6 years, respectively. Overall, 62% of participants said they would choose BTL, with 52% in the post-intervention arm. When asked if their religion allowed BTL, 80.6% said yes and were supported by their husband (92%), However, 62% said they couldn't have it if their spouse was against it. In general, lower knowledge scores were obtained in the post-intervention arm, implying that the educational intervention provided did not influence participants' knowledge of BTL. There was no statistically significant difference in the participants' knowledge levels at baseline and post-intervention [3.3 (-3.2 to 9.9); p-value=0.3]. Educating families, particularly women of childbearing age, about alternative family planning methods would increase uptake, allowing families to achieve desired family sizes while limiting the impact of unwanted pregnancies and maintaining a healthy population.

Differences in burn injury knowledge among reproductive-age women attending an urban and a semi-rural hospital in Northwest Nigeria: A cross-sectional study

ObjectivesTo assess burn injury knowledge and its predictors among reproductive-age women attending an urban and a semi-rural hospital in Northwest Nigeria DesignA descriptive cross-sectional study SettingIt was conducted in the general and paediatric outpatient clinics of Aminu Kano Teaching Hospital in Kano (urban setting) and the general outpatient, paediatric outpatient and antenatal clinics of Federal Medical Centre Birnin Kudu (semi-rural setting). ParticipantIn 2021, 362 women aged 18–44 years were randomly selected from clinic attendees over six weeks. Of them, 217 were from the urban hospital. Data regarding their sociodemographic characteristics and knowledge of burn injuries was collected using a pretested, semi-structured interviewer-administered questionnaire. Outcome measureKnowledge of burn injuries ResultsAbout 83.4 %, 77.1 % and 77.6 % of respondents had adequate general, primary prevention and overall knowledge of burn injuries, respectively. Their mean overall knowledge score was 18.6 out of 24, but only 55.5 % had adequate first-aid knowledge. The study sites did not significantly differ in burns first-aid, prevention and overall knowledge scores. However, urban respondents were more ignorant about the cause of burns and knew that burn injuries could be fatal. More semi-rural respondents knew that flames and chemicals cause burn injuries. Predictors of overall knowledge were age, educational level, number of children in their household, previously seeing a burn-injured child, and primary source of burns-related information. ConclusionsThe proportion of respondents with adequate overall burn injury knowledge was high; however, knowledge gaps exist among them. Overall, their first-aid knowledge was relatively low. The urban and semi-rural respondents had no significant differences in first-aid, prevention, or overall knowledge of burn injuries. However, knowledge of the causes of burns and burn complications differed between the urban and semi-rural study locations. Therefore, the clinical settings of this study present opportunities for similar burn-related educational interventions.

Epidemiology of Trichomonas vaginalis infection in the Middle East and North Africa: systematic review, meta-analyses, and meta-regressions

Trichomoniasis, caused by the parasite Trichomonas vaginalis (TV), remains an underappreciated sexually transmitted infection (STI), primarily due to inadequate understanding of its epidemiology and public health implications. This study aimed to characterize TV epidemiology in the Middle East and North Africa (MENA). Systematic review and analysis of evidence sourced from international, regional, and national databases were conducted. Findings were reported following PRISMA guidelines. Random-effects meta-analyses and meta-regressions were performed to determine pooled mean prevalence, investigate associations with prevalence, and identify sources of between-study heterogeneity. The review identified 263 relevant publications, encompassing 462TV prevalence measures. The pooled mean TV prevalence was estimated as follows: 4.7% (95% CI: 3.9-5.6%) in the general population of women, 17.2%(95% CI: 5.4-33.6%) among intermediate-risk populations, 10.3% (95% CI: 6.2-15.3%) among female sex workers, 13.9% (95% CI: 12.3-15.6%) among symptomatic women, 7.4% (95% CI: 1.9-15.5%) among infertility clinic attendees, 2.3% (95% CI: 0.1-6.3%) among women with miscarriages or ectopic pregnancies, and 1.6%(95% CI: 0.8-2.7%) among STI clinic attendees. Limited data were found for men. Multivariable meta-regressions explained >40% of the prevalence variation, unveiling a hierarchical prevalence pattern by population type, an inverse correlation with national income, and a prevalence decline at a rate of 1% per calendar year. Despite conservative sexual norms, MENA has a substantial TV prevalence, comparable to the global TV prevalence. The unexpectedly high prevalence of this curable infection may, in part, be attributed to limited access to and underutilization of STI screening and treatment services. This work was supported by the Qatar Research, Development, and Innovation Council [ARG01-0522-230273] and by the Biomedical Research Program at Weill Cornell Medicine-Qatar.

Health markers, depressive symptoms, and community deprivation in a type 2 diabetes multidisciplinary care clinic for youth

IntroductionType 2 diabetes disproportionately affects non-Hispanic/Latino Black and Hispanic/Latino youth. The purpose of this study was to examine whether differences in metabolic risk factors and depressive symptoms exist by race/ethnicity and socioeconomic deprivation and whether these impact clinic attendance and health markers over 1 year in a multidisciplinary type 2 diabetes clinic for youth.MethodsThis study was a retrospective chart review of 54 youth with type 2 diabetes who had both an initial and follow-up visit. Demographic information, metabolic health markers [body mass index (BMI), hemoglobin A1C, liver enzymes, lipid panel, and urine microalbumin], depressive symptoms, and clinic attendance data were obtained from the medical record. Patient address was geocoded to the census tract level to calculate community socioeconomic deprivation.ResultsLiver enzymes (ALT and AST) were significantly higher in patients identifying as Hispanic/Latino (ALT M = 97.0 ± 40.6, AST M = 53.6 ± 21.4) and lowest in patients identifying as non-Hispanic/Latino Black (ALT M = 23.1 ± 11.3, F = 10.6 p < .001; AST M = 23.1 ± 11.4, F = 8.1; p < .001) at initial visit. From initial visit to follow-up, there were significant improvements in ALT (F = 13.43, p < .001), AST (F = 6.58, p < .05), and BMIz (F = 18.39, p < .001). Patients identifying as Black or Hispanic showed an increase in depressive symptoms over time, while patients identifying as non-Hispanic White showed a decrease (F = 11.08; p < .05). Unexpectedly, patients living in areas with higher socioeconomic deprivation showed a decrease in hemoglobin A1C over time, while patients living in lower socioeconomic deprivation showed an increase (F = 5.15, p < .05).ConclusionsDifferences exist in metabolic health parameters by race/ethnicity and by socioeconomic deprivation. Multidisciplinary care for youth with type 2 diabetes needs to consider and work to address the systems of inequity experienced by patients that drive disparities in health outcomes.

Malaria Prevalence and its Associated Factors Among Pregnant Women Attending Antenatal Clinic at General Hospital Dutse, Jigawa State, Nigeria

Malaria Prevalence and its Associated Factors Among Pregnant Women Attending Antenatal Clinic at General Hospital Dutse, Jigawa State, Nigeria

Neighborhood Poverty and Clinic Attendance in the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program.

Higher neighborhood-level poverty is associated with greater odds of missing a free eye disease screening appointment, underscoring the importance of community-based interventions to address upstream social determinants of health. To investigate the association between neighborhood-level characteristics and attendance for a free eye disease screening. The MI-SIGHT program is conducted in two community clinics in Southeastern Michigan. Participant-level demographics were extracted from electronic health records. Neighborhood level-characteristics including Area Deprivation Index (ADI), median household income (HHI), percent of households with >30% rent burden, percent of households without vehicles, percent of households in subsidized housing, and energy burden were obtained from the Wisconsin Neighborhood Atlas and the United States census. Logistic regression was used to model the probability of clinic visit attendance, which was the main outcome measure. 1431 participants were scheduled for screening appointments between July 2020 to November 2021, with a no-show rate of 23%. Individuals lived an average of 7.7 miles from each clinic (SD=8.1) and in neighborhoods with a mean ADI of 6.8 (SD=3.2, 1-10 scale where 10 is the most deprived). After adjusting for age, sex, race, and ethnicity, participants from neighborhoods with higher deprivation were more likely to have missed clinic visits. For example, there was an 8% higher odds of missed clinic visits for every 1-point increase in ADI (odds ratio, OR=1.08, P=0.020) and an 18% higher odds of a missed visit with every 10% increase in households without a vehicle (OR=1.18, P=0.013). Higher neighborhood-level poverty was associated with greater odds of missing a free eye disease screening appointment after adjusting for individual characteristics. Increased neighborhood-level resources are likely needed to bolster engagement in preventive eye care.

Factors Associated with Time to Initial Antiretroviral Therapy Discontinuation in the DC Cohort.

When an initial antiretroviral therapy (ART) regimen is effective and well-tolerated, it can be maintained for years as long as the patient adheres. Prior research has revealed that shorter initial ART duration is associated with regimen type, female sex, injection drug use as the HIV transmission category, and lower baseline CD4 count. We examined potential factors associated with initial regimen discontinuation among a subset of newly diagnosed virally unsuppressed PWH in the DC Cohort, an ongoing prospective observation study that uses electronic health record data from clinic sites to collect relevant information, including demographic and clinical information. Participants were excluded from the analysis if they had less than 6 months of follow-up and were virally suppressed at enrollment. There were 479 individuals included in the study. The median age of participants was 33.9 years [interquartile range (IQR) 26-43.9]. The sample was predominantly male (79.1%) and of Black race (70.8%). Over half of the study participants (56.4%) attended community-based clinic sites. The median time to the discontinuation of initial ART was 2.7 years [95% confidence interval (CI): 2.3, 3.4]. Females had a shorter time to ART discontinuation [adjusted hazard ratio (aHR) 1.55, 95% CI: 1.14, 2.11] as did individuals who started on a protease inhibitor-based regimen versus integrase strand transfer inhibitors (aHR 1.87, 95% CI: 1.34, 2.61) and those receiving HIV care at a community-based site (aHR 1.46, 95% CI: 1.11,1.93). Although limited by lack of reason for discontinuation, we demonstrated that ART-naïve women, community clinic attendees, and patients starting on PIs had a shorter duration of initial ART. More anticipatory guidance may be needed to help patients stay on their initial therapy and manage the side effects or to be flexible in trying different regimens.

278 Outpatient "Did Not Attend" Episodes: A Cohort Study Investigating Influencing Factors

Abstract Aim Outpatient "Did Not Attend" (DNA) episodes represent a significant financial burden to healthcare systems, with an estimated cost of £1 billion for the NHS. Understanding factors that contribute to DNA episodes is crucial for optimizing healthcare resource utilization. We examined a cohort of outpatient clinics within the general surgery department at South Tees Hospitals NHS Foundation Trust to identify factors associated with DNA episodes. Method A prospectively collected database of all outpatient clinics was interrogated from 01/01/2021, to 31/03/2023. Information on patient age, gender, appointment type (new vs. follow-up, face-to-face vs. remote), index of multiple deprivation (IMD) decile, and driving distance was recorded for each clinic attendance. Results Of 19,769 clinic appointments, 1,509 (8%) resulted in DNAs. Disproportionate number of patients with DNAs resided in the lowest IMD decile (19%), compared to other deciles (range: 6.4%-10%). Driving distance did not differ between attended (median: 16 km, IQR: 6-30 km) and DNA groups (median: 15 km, IQR: 5-30 km). DNA rates did not vary between remote (8%) and face-to-face (7%) clinics. Multivariable binary logistic regression found older age, IMD, and hospital site as predictors of outpatient DNA. Individuals who were younger and from the lowest IMD decile were more likely to DNA. Conclusions Outpatient DNA is multifactorial. Travel distance/duration and remote consultations did not influence attendance in our cohort. Working-age patients and those residing in lower IMD deciles were more likely to DNA. Solely relying on remote consultations may not be sufficient to effectively address DNA episodes.

Health Promotion Practices among Pregnant Women Attending Antenatal Clinics at a Tertiary Hospital in Nigeria.

A cross-sectional study conducted in a semi-urban tertiary healthcare hospital in South western Nigeria to assess health promotion practices and associated sociodemographic factors among pregnant women attending antenatal clinics. A total of 220 pregnant women were studied. Results showed that 95.0% of the participants had good health promotion practices with physical activities having the lowest while spiritual values had the highest score. Moreover, age, religion, education, and occupation were significantly associated with health promotion practices among the pregnant women.

Does clinical experience influence the effects of team simulation training in stroke thrombolysis? A prospective cohort study

ObjectivesAfter introducing a team simulation training programme at our hospital, we saw a reduction in door-to-needle times (DNT) for stroke thrombolysis but persisting variability prompting further investigation. Our objective is...

Assessment of Medication Compliance and Follow-Up Clinic Attendance Among Patients With Cardiovascular Diseases in the Jazan Region.

Cardiovascular diseases are common causes of mortality in Saudi Arabia and the world. This study aims to assess medication compliance and regularity of follow-up for cardiovascular patients in the Jazan region. An analytical cross-sectional approach was used to target all registered cardiovascular patients attending the cardio clinic in a Jazan region hospital. Data were collected using an interview questionnaire developed by the researchers with the help of experts. The questionnaire included the patients' sociodemographic data, clinical characteristics, disease-related data, drugs, and appointments. The study included 259 patients diagnosed with cardiac disease. About 53.7% of the patients were males. All the cases had the disease for one year or more. About 56% of the patients hadno difficulty remembering their medications, while 44% had problems remembering to take them. More than half of the patients had good medication adherence, and 79.6% had good appointment adherence. Only 20.4% of patients had a poor adherence rate. The adherence rate for the patients' medication and appointments was satisfactory due to high patient awareness. On the other hand, poor adherence was related more to non-Saudi patients.

Effect of Anterior Uveitis on Corneal Endothelial Cells

Objective: Investigating the impact of anterior uveitis on changes occurring in corneal endothelial cells. Methods: In this prospective cross-sectional study (cases and controls), the research sample included 43 patients (86 eyes) from the ophthalmic clinic attendees at Tishreen University Hospital in Latakia during the period 2023-2024. Results: The average corneal endothelial cell count was lower in the anterior uveitis group, both granulomatous (2074.16±173.70 cells/mm²) and nongranulomatous (2188.38±165.7 cells/mm²) types, compared to the control group (2696.1±136.60 cells/mm²) with a (p-value &lt;0.01) in all age groups studied. The average percentage of hexagonal cells was lower in the both granulomatous (42.41±2.6%) and non- granulomatous (47.0±2.2%) types, compared to the control group (61.4±2.0%) with a (p-value &lt;0.01) in all age groups studied. The average cell volume change coefficient was higher in the anterior uveitis group, both granulomatous (40.16±2.1) and non-granulomatous (34.70±1.08) types, compared to the control group (29.8±1.36) with a (p-value &lt;0.01) in all age groups studied. Host and disease-related characteristics had no effect on the measured results) p-value=0.184(. ECC was negatively correlated to the duration of uveitis (a=-0.513; p-value&lt;0.001), maximum intraocular pressure during the course of disease (a=-0.472; p-value = 0.0001), and the number of attacks (a=-0.515; p-value&lt;0.001). Conclusion: Corneal endothelial cells are affectd in patients with anterior uveitis, and this negative impact increases with the duration of the disease, the number of attacks, and the presence of elevated intraocular pressure. This negative impact is more pronounced in granulomatous uveitis.

Prevalence of Multi Drug Resistant Coagulase Negative Staphylococci among some Pregnant Women Attending Antenatal Clinic in Yola, Nigeria

Study’s Novelty/Excerpt This study presents findings on the prevalence and characterization of coagulase-negative staphylococci (CoNS) among pregnant women in public health facilities in Yola, revealing a significant prevalence rate of 26.97%. The research highlights the high susceptibility of CoNS to certain antibiotics and the alarming presence of multi-drug resistant and extended spectrum beta-lactamase (ESBL) producing strains. This underscores the necessity for routine screening of pregnant women for CoNS to prevent potential gestational complications, providing crucial data for public health interventions and antibiotic stewardship programs. Full Abstract Coagulase negative staphylococci have been reported to be a frequent agent of uncomplicated UTI in young sexually active women which can also lead to symptomatic infection, low birth weight (LBW) babies and preterm delivery. This study was undertaken to determine the prevalence and characterize coagulase negative staphylococci among pregnant women in public health facilities in Yola. A total of 250 urine samples were collected from pregnant women attending antenatal clinic at Specialist Hospital and Boshang Clinic and Maternity both in Yola. The samples were cultured on cysteine lactose electrolyte deficient medium and isolates characterized using phenotypic methods. The prevalence of coagulase negative staphylococci from this study was 26.97%, Staphylococcus aureus 16.29% and Escherichia coli 36.51%. The frequency of CoNS was highest among age group of 36-40 years and least among 16-20 years (12.5%). CONS isolated from this study demonstrated high susceptibility to pefloxacin, ciprofloxacin, erythromycin, ceftriaxone and streptomycin. Some isolates showed high resistance to ampiclox, cefuroxime and amoxicillin. About 83% of the isolates had multiple antibiotic resistant indexes greater than 0.2 with about 25% of the antibiotic resistance being plasmid mediated. Furthermore, phenotypic screening using the double disk synergy test showed that 20 (40%) of the isolates were extended spectrum beta lactamase (ESBL) producing. This study revealed the presence of multi-drug resistant and ESBL producing coagulase negative staphylococci among pregnant women in the study area. There is therefore the need for pregnant women to be screened for coagulase negative staphylococci to avoid complications during gestation period.

Sex Differences in Outcomes of an Intensive Risk Factor Modification Program in Patients With Atrial Fibrillation.

The outcomes of atrial fibrillation (AF) seem to be variable between males and females. We therefore aimed to determine sex differences in weight loss, cardiorespiratory fitness gain, and recurrence and progression of AF following risk factor management. Of 1415 consecutive patients referred for electrophysiology management of AF, 825 had a body mass index of ≥27 kg/m2; after exclusions, 355 (males, 234; females, 121) were offered risk factor management and participation in a tailored exercise program. Females were older than males (65.5±10.4 versus 62.5±10.6 years; P=0.013) with a higher body mass index (34.1±5.4 versus 32.6±4.1 kg/m2; P=0.003) and more commonly paroxysmal AF (67.8% versus 48.3%; P<0.001). There was no sex difference in clinic attendance (58.7% versus 60%; P=0.82), weight loss (P=0.86), fitness gain (P=0.44), or improvement in AF symptoms (P=0.35). Weight loss (≥10% compared with <10%) was associated with lower total AF recurrence in males (hazard ratio, 0.41 [95% CI, 0.23-0.73]) and females (hazard ratio, 0.41 [95% CI, 0.20-0.83]). Fitness gain (≥2 metabolic equivalents compared with <2 metabolic equivalents) was associated with lower total AF recurrence in females (hazard ratio, 0.13 [95% CI, 0.05-0.30]) but not in males (hazard ratio, 0.63 [95% CI, 0.38-1.04]; P=0.002). There was a trend toward more reversal from persistent to paroxysmal AF in males compared with females (21.8% versus 14.0%; P=0.079). Males and females with AF demonstrate a similar degree of weight loss and fitness gain through structured risk factor management. However, fitness had a much greater benefit for total arrhythmia recurrence in females compared with males, whereas there was a trend toward more AF reversal in males. URL: https://anzctr.org.au; Unique identifier: ACTRN12614001123639.

Attitudes toward an HPV vaccine for condyloma acuminata and willingness to undergo vaccination among STD clinic attendees in China: Focus on STI prevention with HPV vaccine

BackgroundCondyloma acuminata (CA) is a common, and recurrent sexually transmitted disease (STD) that greatly contributes to direct health care costs and has a substantial psychosocial impact. Human papillomavirus (HPV) vaccination (containing L1 protein for HPV types 6 and 11) effectively controls CA.ObjectivesWe investigated attitudes toward the HPV vaccine for CA and willingness to undergo vaccination among STD clinic attendees in China.MethodsAttendees at STD clinics at two selected hospitals in Guangdong and Jiangsu Provinces from May to September 2017 were requested to complete a self-administered questionnaire for this cross-sectional study.ResultsThe participants’ median age was 28 years (IQR: 24.0–34.0), and the sex ratio was balanced; 63.5% were from Guangdong, 36.5% were from Jiangsu, and 44.5% had a history of CA. The vaccine acceptance rate was high among the participants (85.8%,235/274) to whom the HPV vaccine for CA was available, especially among those who had heard of CA (89.0%, AOR = 3.14, 95% CI: 1.29–7.63, p = 0.0114). 95 (34.7%) of 274 participants had a positive attitude toward the HPV vaccine for CA. STD clinic attendees who had heard of the connection between HPV and CA (AOR = 2.56, 95% CI: 1.31-5.00, p = 0.0060), had heard of the HPV vaccines or cervical cancer vaccines (AOR = 1.90, 95% CI: 1.02–3.54, p = 0.0444) and had ever proactively discussed CA or the vaccine with others (AOR = 1.95, 95% CI:1.00-3.79, p = 0.0488) had better attitudes toward the HPV vaccine for CA. Over half of the participants (52.5%) expected the price of the HPV vaccine for CA to be under $90.ConclusionThe acceptance of the HPV vaccine for CA was high among STD clinic attendees in China, and the participants’ self-perceived knowledge of CA and HPV was associated with better attitudes toward the HPV vaccine for CA. Education to improve knowledge is vital for reducing vaccine hesitancy.

Low-dose ondansetron: A candidate prospective precision medicine to treat alcohol use disorder endophenotypes

BackgroundAlcohol use disorder (AUD) is among the leading causes of morbidity and mortality worldwide, and over 95 million people live with alcohol dependence globally. The estimated heritability of AUD is 50–60 %, and multiple genes are thought to contribute to various endophenotypes of the disease. Previous clinical trials support a precision medicine approach using ondansetron (AD04, a 5-HT3 antagonist) by segregating AUD populations by the bio-genetic endophenotype of specific serotonergic genotypes and the bio-psychosocial endophenotype of the severity of drinking or both. By targeting the modulation of biogenetic signaling within the biopsychosocial context of AUD, low-dose AD04 holds promise in reducing alcohol consumption among affected individuals while minimizing adverse effects. MethodsThis was a phase III, 6-month, 25-site, randomized, placebo-controlled clinical trial using AD04 to treat DSM-V–categorized AUD individuals who were pre-stratified into the endophenotypes of heavy or very heavy drinking individuals and possessed a pre-defined profile of genetic variants related to the serotonin transporter and serotonin-3AB receptor. Participants (N = 303) presented moderate to severe AUD, >80 % were men, mostly in their fifties, and >95 % were of European descent. Low-dose AD04 (approx. 033 mg twice daily) or a matching placebo was administered twice daily for 6 months. Brief Behavioral Compliance Enhancement Treatment (BBCET [53]) was administered every two weeks to enhance medication compliance and clinic attendance. ResultsThere was a significant reduction in the monthly percentage of heavy drinking days, PHDD (-46·7 % (2·7 %), 95 %CI: -52·1 % to -41·2 % vs. -38·1 % (2·9 %), 95 %CI: -43·8 % to -32·5 %, respectively; LS mean difference=-8·5 %; p = 0.03) among AD04-treated vs. placebo-receiving heavy drinking individuals at month 6. Heavy drinking individuals were also less likely to be diagnosed with AUD [Month 1: -32·0 % (2·8 %), 95 %CI: -37·5 % to -26·5 % vs. -23·2 % (2·9 %), 95 %CI: -28·9 to -17·5 %; LS mean difference= -8·8 %; p = 0·026)], and improved on the WHO quality of life BREF scale with a significant effect for at least a 1-level downward shift (OR = 3.4; 95 % CI: 1·03–11·45, p = 0·044). Importantly, heavy drinking individuals, as distinct from very heavy drinking individuals, were the bio-psychosocial endophenotype more predictive of therapeutic response to AD04. AD04 had an exceptional safety and tolerability profile, like the placebo's. ConclusionsIn this Phase 3 clinical trial, AD04 was shown to be a promising treatment for currently drinking heavy drinking individuals with AUD who also possess a specific genotypic profile in the serotonin transporter and serotonin-3AB receptor complex. Using AD04 to reduce the harm of AUD in heavy drinking individuals who are currently drinking, without the necessity of abstinence or detoxification from alcohol use, is an important advance in the field of precision medicine. AD04’s adverse events profile, which was like placebo, should enhance accessibility and acceptance of modern medical treatment for AUD by lowering the incorrect but commonly perceived stigma of personal failure.

Remote symptom monitoring with patient-reported outcome measures in outpatients with chronic kidney disease (PROKID): a multicentre randomised controlled non-inferiority study.

The increasing incidence of chronic kidney disease (CKD) is straining the capacity of outpatient clinics. Remote healthcare delivery might improve CKD follow-up compared with conventional face-to-face follow-up. Patient-reported outcomes (PROs) are used to empower remote follow-up and patient engagement. The consequences of shifting from face-to-face follow-up to remote outpatient follow-up on kidney function, health resource utilisation and quality of life remain unknown. We conducted a multicentre pragmatic non-inferiority trial at three outpatient clinics in the Central Denmark Region. A total of 152 incident outpatients with CKD were randomised (1:1:1) to either PRO-based, PRO-telephone follow-up or standard of care (SoC). The primary outcome was the annual change in kidney function measured by the slope of the estimated glomerular filtration rate (eGFR). The non-inferiority margin was an eGFR of 2.85ml/min/1.73m2/year. Mean differences were estimated using intention-to-treat (ITT), per protocol and random coefficient models. Mean eGFR slope differences between PRO-based and SoC were -0.97ml/min/1.73m2/year [95% confidence interval (CI) -3.00-1.07] and -1.06ml/min/1.73m2/year (95% CI -3.02-0.89) between PRO-telephone and SoC. Non-inferiority was only established in the per-protocol analysis due to CIs exceeding the margin in the ITT group. Both intervention groups had fewer outpatient visits: -4.95 (95% CI -5.82 to -4.08) for the PRO-based group and -5.21 (95% CI -5.95 to -4.46) for the PRO-telephone group. We found no significant differences in quality of life, illness perception or satisfaction. Differences in the eGFR slope between groups were non-significant and results on non-inferiority were inconclusive. Thus, transitioning to remote PRO-based follow-up requires close monitoring of kidney function. Reducing patients' attendance in the outpatient clinic was possible without decreasing either quality of life or illness perception.ClinicalTrials.gov identifier: NCT03847766.