Attendance Patterns Research Articles

Reproducing Hierarchies at the APSA Annual Meeting: Patterns of Panel Attendance by Gender, Race, and Ethnicity

ABSTRACTResearch on the political science profession has shown that homophilous research networks—that is, those organized along the lines of gender and race/ethnicity—reproduce hierarchies. Research networks composed of white men experience the most prestige and lead to the most opportunities. This study documents homophilous networks in a setting where they likely are nurtured: academic conferences. Drawing data from the 2019 Annual Meeting of the American Political Science Association, we examine the correspondence between the gender and the racial/ethnic composition of section members, panelists, and audience members for four research sections: Political Methodology; Political Psychology; Race, Ethnicity, and Politics; and Women and Politics. We find that attendees’ and panelists’ gender and racial/ethnic identity largely mirror the dominant gender and racial/ethnic group in their section. These findings indicate that homophily manifests at academic conferences and that efforts to diversify research networks should consider who listens to whom in these settings.

Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns

The burden of frequent attenders (FAs) of emergency departments (EDs) on healthcare resources is underestimated when single-centre analyses do not account for utilisation of multiple EDs by FAs. We aimed to quantify the extent of multiple ED use by FAs and to characterise FAs. We reviewed nationwide ED attendance in Singapore data from 1 January 2006 to 31 December 2018 (13 years). FAs were defined as patients with ≥4 ED visits in any calendar year. Single ED FAs and multiple ED FAs were patients who attended a single ED exclusively and ≥2 distinct EDs within the year, respectively. Mixed ED FAs were patients who attended a mix of a single ED and multiple EDs in different calendar years. We compared the characteristics of FAs using multivariable logistic regression. We identified 200,130 (6.3%) FAs who contributed to1,865,704 visits (19.6%) and 2,959,935 (93.7%) non-FAs who contributed to 7,671,097 visits (80.4%). After missing data were excluded, the study population consisted of 199,283 unique FAs. Nationwide-linked data identified an additional 15.5% FAs and 29.7% FA visits, in addition to data from single centres. Multiple ED FAs and mixed ED FAs were associated with male sex, younger age, Malay or Indian ethnicity, multiple comorbidities, median triage class of higher severity, and a higher frequency of ED use. A nationwide approach is needed to quantify the national FA burden. The multiple comorbidities and higher frequency of ED use associated with FAs who visited multiple EDs and mixed EDs, compared to those who visited a single ED, suggested a higher level of ED burden in these subgroups of patients. The distinct characteristics and needs of each FA subgroup should be considered in future healthcare interventions to reduce FA burden.

Latinx Community College Student Co-Enrollment

Co-enrollment, defined as simultaneous enrollment at more than one postsecondary institution, has become increasingly prevalent among college student attendance patterns. This descriptive study analyzes the characteristics and experiences of a nationally representative sample of co-enrolled Latinx community college students from the Beginning Postsecondary Longitudinal Study (BPS: 12/17). Results showed that certificate, associate’s degree, and bachelor’s degree completion was higher for co-enrolled Latinx community college students than for the entire sample of Latinx community college students. In addition, Latinx community college students co-enrolled at greater rates than the total sample of students in the dataset who co-enrolled.

Attendance in a national screening program for diabetic retinopathy: a population-based study of 205,970 patients

AimsA nationwide diabetic retinopathy (DR) screening program has been established in Denmark since 2013. We aimed to perform an evaluation of adherence to DR screenings and to examine whether non-adherence was correlated to DR progression.MethodsThe population consisted of a register-based cohort, who participated in the screening program from 2013 to 2018. We analyzed age, gender, marital status, DR level (International Clinical DR severity scale, none, mild-, moderate-, severe non-proliferative DR (NPDR) and proliferative DR (PDR)), comorbidities and socioeconomic factors. The attendance pattern of patients was grouped as either timely (no delays > 33%), delayed (delays > 33%) or one-time attendance (unexplained).ResultsWe included 205,970 patients with 591,136 screenings. Rates of timely, delayed and one-time attendance were 53.0%, 35.5% and 11.5%, respectively. DR level at baseline was associated with delays (mild-, moderate-, severe NPDR and PDR) and one-time attendance (moderate-, severe NPDR and PDR) with relative risk ratios (RRR) of 1.68, 2.27, 3.14, 2.44 and 1.18, 2.07, 1.26, respectively (P < 0.05). Delays at previous screenings were associated with progression to severe NPDR or PDR (hazard ratio (HR) 2.27, 6.25 and 12.84 for 1, 2 and 3+ delays, respectively). Any given delay doubled the risk of progression (HR 2.28).ConclusionsIn a national cohort of 205,970 patients, almost half of the patients attended DR screening later than scheduled or dropped out after first screening episode. This was, in particular, true for patients with any levels of DR at baseline. DR progression in patients with delayed attendance, increased with the number of missed appointments.

Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in Australian primary care patients: only part of the story?

BackgroundME/CFS is a disorder characterized by recurrent fatigue and intolerance to exertion which manifests as profound post-exertional malaise. Prevalence studies internationally have reported highly variable results due to the 20 + diagnostic criteria. For Australia, the prevalence of ME/CFS based on current case definitions is unknown.ObjectivesTo report prevalence of ME/CFS in patients aged ≥ 13 years attending Australian primary care settings for years 2015–2019, and provide context for patterns of primary care attendance by people living with ME/CFS.MethodologyConducted in partnership with the Patient Advisory Group, this study adopted a mixed methods approach. De-identified primary care data from the national MedicineInsight program were analyzed. The cohort were regularly attending patients, i.e. 3 visits in the preceding 2 years. Crude prevalence rates were calculated for years 2015–2019, by sex, 10-year age groups, remoteness and socioeconomic status. Rates are presented per 100,000population (95% confidence intervals (CI)). Qualitative data was collected through focus groups and in-depth 1:1 interview.ResultsQualitative evidence identified barriers to reaching diagnosis, and limited interactions with primary care due to a lack of available treatments/interventions, stigma and disbelief in ME/CFS as a condition.In each year of interest, crude prevalence in the primary care setting ranged between 94.9/100,000 (95% CI: 91.5–98.5) and 103.9/100,000 population (95%CI: 100.3–107.7), equating to between 20,140 and 22,050 people living with ME/CFS in Australia in 2020. Higher rates were observed for age groups 50-59 years and 40-49 years. Rates were substantially higher in females (130.0–141.4/100,000) compared to males (50.9–57.5/100,000). In the context of the qualitative evidence, our prevalence rates likely represent an underestimate of the true prevalence of ME/CFS in the Australian primary care setting.ConclusionME/CFS affects a substantial number of Australians. Whilst this study provides prevalence estimates for the Australian primary care setting, the qualitative evidence highlights the limitations of these. Future research should focus on using robust case ascertainment criteria in a community setting. Quantification of the burden of disease can be used to inform health policy and planning, for this understudied condition.

Virtual Tumor Board Increases Provider Attendance and Case Presentations.

Many cancer centers engage in multidisciplinary tumor board meetings to determine the optimal approach to complex cancer care. With the onset of the COVID-19 pandemic, many institutions changed the format of these meetings from in-person to virtual. The aim of this study was to determine if the change to a virtual meeting format had an impact on attendance and cases presented. Tumor board records were analyzed to obtain attendance and case presentation information at a National Cancer Institute-designated Comprehensive Cancer Center. Twelve-month in-person tumor board data were compared with 12-month virtual tumor board data to assess for difference in attendance and case presentation patterns. Seven separate weekly tumor board meetings at the beginning of the study (breast, GI, gynecology, liver, lung, melanoma, and urology) were expanded to nine meetings on the virtual platform (+endocrine and pancreas). Overall attendance increased by 46% on the virtual platform compared with in-person meetings (4,030 virtual attendances v 2,753 in-person, P < .001). Increased attendance was present across all specialties on the virtual platform. In addition, the number of patient cases discussed increased from 2,127 in in-person meeting to 2,656 on the virtual platform (a 20% increase, P < .001). A significant increase was observed in overall tumor board attendance and in case presentations per meeting, requiring the expansion of additional weekly meetings. Furthermore, in a major cancer center with multiple community affiliates, virtual tumor boards may encourage increased participation from remote sites with the benefit of obtaining expert specialist advice as compared with geographically challenging in-person meetings.

The Impact of COVID-19 on Dental Treatment in Kuwait-A Retrospective Analysis from the Nation's Largest Hospital.

Background: The COVID-19 pandemic has changed the way dentistry has been practiced the world over. This study sought to assess the impact of the COVID-19 pandemic on the patterns of attendance for dental treatment in a large hospital in Kuwait through comparisons with data from the year prior to the pandemic. Methods: A total of 176,690 appointment records from 34,250 patients presenting to the AlJahra specialist hospital in Kuwait for dental treatment from April 2019 to March 2021 were analyzed. The types of procedures and the departments in which they presented were analyzed, and the patterns of attendance before and during the pandemic were compared. Results: While there was a significant reduction in the number of orthodontic, endodontic, and periodontal procedures, there were no impacts on oral surgery, restorative procedures, or pediatric dentistry. Conclusions: There has been a return in the number of patients obtaining dental treatment; however, there has been a definite shift in the use of certain dental procedures.

코로나19 상황의 지속과 초등학교 저학년 자녀 어머니의 교육지원 경험

The purpose of this study was to explore educational support experiences of mothers raising low grade elementary school children during the COVID-19 pandemic situation. More specifically, this study took a closer look at the mothers􍾨 difficulties while they were supporting their children􍾨s school adjustment, their own coping strategies and expectations from related educational fields. For this, 7 mothers having first or second grade children participated in the in-depth interviews and transcribed interview data were analyzed based on a phenomenological method. The results were categorized with three themes. First of all, when COVID-19 pandemic broke out, mothers experienced difficulties including support for online class participation, lack of child care support system, adjustment of unstable school attendance, friend relationships and stress from unsafe daily routines. Next, under the continuing COVID-19 situation, coping strategies for the mothers􍾨 educational supports were adjusting the changing school attendance patterns, improved online class participation, and quitting jobs for care-giving their children, More realistic coping method adopted by the mothers was emphasizing rules and practices of disease prevention. Finally, mothers have expectations for teachers more communication with each family and role of helper developing each child􍾨s voluntary study habits. They also have expectations for school open even during the pandemic period maintaining class size small and for the government and related public sectors preparing systemic schooling and after school cares which can operate well even during the risky pandemic situation. Based on such results, this study discussed several implications in the educational fields.

Influential factors on oral health status of the elderly Iranians: A Path analysis

Objectives: This study aimed at assessing the influential factors on oral health status of the elderly Iranian population (65 to 74 years of age) by using Path analysis. Methods: This study was conducted on 7,521 elderly individuals participating in the Iranian National Oral Health Survey in 2012. After data collection process, initially decayed, missing, and filled teeth (DMFT) index as well as functional health (FH) index were evaluated in this study by using clinical data. The socio-economic status (SES), insurance type (IT), dental attendance pattern (DAP), reason of attendance (R of A), tooth cleaning (TC), and nutritional pattern (NP) were evaluated according to responses provided to the questions in the questionnaire by participant. Path analysis was applied to analyze the patterns between these variables and DMFT and FH index. Results: The participants’ mean DMFT was 26.6±8.03, and the median FH was 0 (0.10). Path analysis revealed that seniors with higher SES, and having a dental insurance with greater coverage had a direct effect on more regular DAP, and indirect effect on improvement of FH and reduction in DMFT index. More regular DAP had a direct effect on improvement of FH, and reduction of DMFT index. Also, NP with lower risk of caries had a direct effect on improvement of FH and reduction of DMFT index. Conclusion: Out of all the evaluated factors, IT, SES, DAP, and NP demonstrated to be particularly important and significantly affecting DMFT and FH indices in the elderly population. Out of all aforementioned factors, IT in low SES individuals was more important for obtaining required oral healthcare services. Apparently, seniors’ oral health is absolutely in need of special attention with particular focus on providing access to early prevention and care.

Association between disability status and dental attendance patterns in Australian children: A national survey.

This study investigated the dental attendance patterns of Australian children with and without disabilities using data from Growing up in Australia: The Longitudinal Study of Australian Children. Data on 6470 participants within two groups (B cohort [aged 12-13]: n=3381; K cohort [aged 16-17]: n=3089) were used for the study. Binomial regression models were fitted to examine the association between disability status and dental attendance. The models were adjusted for gender, parent's country of birth, region of residence, highest parental education and household weekly income, and multiple imputations was used for handling missing data. Children with disabilities constituted 2.4% and 3.8% of the study sample in the B and K cohort, respectively. The unadjusted risk ratio of irregular (vs. regular) dental attendance between children with and without disabilities was 1.07 (95% CI 0.78-1.46) in the B cohort and 1.15 (95% CI 0.93-1.42) in the K cohort. After adjustment and imputation, the risk ratios were 1.03 (95% CI 0.76-1.41) and 1.10 (95% CI 0.89-1.36) in the B and K cohort, respectively. Dental attendance pattern was positively, but minimally, associated with disabilities in older children, and factors including region of residence, parental education and household income were related to disability status and dental attendance. Further studies are required to clarify the association and ascertain key factors that affect the health and wellbeing of children with disabilities.

Diagnostic Pathway of Head &amp; Neck Cancer Patients in Ireland: Audit of patterns of first attendance 1983-2019.

##Objectives: This audit explores patterns of HNC patient presentation in primary care in Ireland over four decades and reflects on the possible impact of a 10-year national HNC awareness campaign. ##Materials and Methods: Trends in patient presentation and diagnosis are presented for 920 HNC patients across three time periods: 1983-1990, 2010 and 2018-2019. Descriptive analysis was undertaken using SPSS-v27 on basic demographic details, tumour-related details and primary care referral patterns. ##Results: Patients were generally male (71%), aged 54+ (71%), and 84% were diagnosed with squamous cell carcinoma (SCC). Larynx, tongue and tonsil were the most common sub-sites. General Medical Practitioners (GPs) were the first healthcare contact for 75% cases, with only13% referred by General Dental Practitioners (GDPs). This pattern remained consistent across four decades. GDP role was higher for tongue, floor of mouth and intra-oral tumours (30-47%), with some increase seen in recent years. While symptomology varied by site, symptom burden remained high across the decades with 99.9% exhibiting 1+ NICE ‘red flag signs’ of HNC, suggesting considerable diagnostic delay, despite a 10-year national campaign to raise public and professional awareness. ##Conclusions: This audit highlights the role of GPs in HNC diagnosis, but reveals sub-optimal use of the dental pathway. The high symptom burden reported suggests considerable diagnostic delay. Increased and sustained efforts are required to raise public and professional awareness, encourage regular dental attendance, upskill HCP in opportunistic screening and ensure appropriate responses to symptomatic patients.

Dental fear and anxiety in Asian youths: response components and inducing stimuli.

This study estimated the prevalence of dental fear/anxiety (DFA) and phobia in Asian youths and investigated the fear/anxiety response components and triggers for those with DFA. A convenience sample of youths, aged 17 to 24years old, was recruited from a local polytechnic. The Index of Dental Anxiety and Fear-4C + (IDAF-4C +) was employed to assess the occurrence of DFA (IDAF-4C) and phobia (IDAF-P) as well as to ascertain fear/anxiety-inducing stimuli (IDAF-S). Psychological distress was determined with the Patient Health Questionnaire-4 (PHQ-4). Sociodemographic, IDAF-4C + , dental attendance patterns, and PHQ-4 data were gathered electronically. Statistical analyses were conducted with chi-square, Kruskal-Wallis, and relevant post hoc tests (α = 0.05). A total of 215 participants were enrolled (mean age of 18.9 ± 2.0years; 87.4% women). Of these, 12.6/6.0% had moderate-to-high (MH)/high-to-extreme (HE) DFA and 0.9% experienced dental phobia. Significant differences in scores were observed between the HE/MH and no-to-moderate (NM) groups for all IDAF-4C components. Apart from the cost of dental treatment, IDAF-4S scores varied significantly among the three DFA groups. The two most highly rated DFA stimuli were painful/uncomfortable procedures and needles/injections for the HE group, while they were needles/injections and the cost of dental treatment for the MH and NM groups. Moderate-to-extreme DFA existed in 18.6% of the Asian youths examined. The emotional and physiological components of the IDAF-4C appear to contribute more to the DFA response. Dental pain including needles/injections and the cost of dental treatment troubled Asian youths the most. DFA is a common problem among Asian youths, and understanding its extent, nature, and triggers is central for effective interventions.

Modeling Classroom Occupancy Using Data of WiFi Infrastructure in a University Campus

Universities worldwide are experiencing a surge in enrollments, therefore campus estate managers are seeking continuous data on attendance patterns to optimize the usage of classroom space. As a result, there is an increasing trend to measure classrooms attendance by employing various sensing technologies, among which pervasive WiFi infrastructure is seen as a low cost method. In a dense campus environment, the number of connected WiFi users does not well estimate room occupancy since connection counts are polluted by adjoining rooms, outdoor walkways, and network load balancing. In this paper, we develop machine learning based models to infer classroom occupancy from WiFi sensing infrastructure. Our contributions are three-fold: (1) We analyze metadata from a dense and dynamic wireless network comprising of thousands of access points (APs) to draw insights into coverage of APs, behavior of WiFi connected users, and challenges of estimating room occupancy; (2) We propose a method to automatically map APs to classrooms using unsupervised clustering algorithms; and (3) We model classroom occupancy using a combination of classification and regression methods of varying algorithms. We achieve 84.6% accuracy in mapping APs to classrooms while the accuracy of our estimation for room occupancy is comparable to beam counter sensors with a symmetric Mean Absolute Percentage Error (sMAPE) of 13.10%.

Creating a Real-World Linked Research Platform for Analyzing the Urgent and Emergency Care System.

BackgroundThis article describes the development of a system-based data platform for research developed to provide a detailed picture of the characteristics of the Urgent and Emergency Care system in 1 region of the United Kingdom.Data Set DevelopmentCUREd is an integrated research data platform that describes the urgent and emergency care system in 1 region of the United Kingdom on almost 30 million patient contacts within the system. We describe regulatory approvals required, data acquisition, cleaning, and linkage.Data Set AnalysesThe data platform covers 2011 to 2017 for 14 acute National Health Service (NHS) Hospital Trusts, 1 ambulance service, the national telephone advice service (NHS 111), and 19 emergency departments. We describe 3 analyses undertaken: 1) Analyzing triage patterns from the NHS 111 telephone helpline using routine data linked to other urgent care services, we found that the current triage algorithms have high rates of misclassifying calls. 2) Applying an algorithm to consistently identify avoidable attendances for pediatric patients, we identified 21% of pediatric attendances to the emergency department as avoidable. 3) Using complex systems analysis to examine patterns of frequent attendance in urgent care, we found that frequent attendance is stable over time but varies by individual patient. This implies that frequent attendance is more likely to be a function of the system overall.DiscussionWe describe the processes necessary to produce research-ready data that link care across the components of the urgent and emergency care system. Making the use of routine data commonplace will require partnership between the collectors, owners, and guardians of the data and researchers and technical teams.HighlightsThis article describes the development of a system-level data platform for research using routine patient-level data from the urgent and emergency care system in 1 region of the United Kingdom.The article describes how the data were acquired, cleaned, and linked and the challenges faced when undertaking analysis with the data.The data set has been used to understand patient use of the system, journeys once in the system, and outcomes following its use, for example, patterns of frequent use within urgent care and accuracy of referral decisions within the system.

Workplace contact patterns in England during the COVID-19 pandemic: Analysis of the Virus Watch prospective cohort study.

SummaryBackgroundWorkplaces are an important potential source of SARS-CoV-2 exposure; however, investigation into workplace contact patterns is lacking. This study aimed to investigate how workplace attendance and features of contact varied between occupations across the COVID-19 pandemic in England.MethodsData were obtained from electronic contact diaries (November 2020-November 2021) submitted by employed/self-employed prospective cohort study participants (n=4,616). We used mixed models to investigate the effects of occupation and time for: workplace attendance, number of people sharing workspace, time spent sharing workspace, number of close contacts, and usage of face coverings.FindingsWorkplace attendance and contact patterns varied across occupations and time. The predicted probability of intense space sharing during the day was highest for healthcare (78% [95% CI: 75–81%]) and education workers (64% [59%–69%]), who also had the highest probabilities for larger numbers of close contacts (36% [32%–40%] and 38% [33%–43%] respectively). Education workers also demonstrated relatively low predicted probability (51% [44%–57%]) of wearing a face covering during close contact. Across all occupational groups, workspace sharing and close contact increased and usage of face coverings decreased during phases of less stringent restrictions.InterpretationMajor variations in workplace contact patterns and mask use likely contribute to differential COVID-19 risk. Patterns of variation by occupation and restriction phase may inform interventions for future waves of COVID-19 or other respiratory epidemics. Across occupations, increasing workplace contact and reduced face covering usage is concerning given ongoing high levels of community transmission and emergence of variants.FundingMedical Research Council; HM Government; Wellcome Trust

Programme and classroom factors affecting attendance patterns for Hispanic participants in adult ESL education

Absenteeism and attrition pose serious challenges in government-funded adult ESL programmes, inhibiting success rates, jeopardising funding, and potentially threatening programmes’ ability to continue to offer services. Because adult learners who enrol in programmes typically juggle numerous priorities and responsibilities beyond schooling, their engagement and attendance must be maintained. The research reported here aimed to identify key institutional factors that negatively affect adult Hispanic students’ attendance patterns in ESL classes. Specifically, it focussed on determining which aspects of the overall programme structure and which classroom factors had the greatest negative impact on students’ attendance patterns and engagement. Affective factors (e.g. social sensitivity, incongruence), ineffective or incomplete teaching methods, students’ perceptions of slow or no progress, and assessment issues were the most prominent factors that emerged from the analyses.

Evaluating Resource Utilization for In-Person and Virtual Joint Classes in Total Joint Arthroplasty: An Analysis of Attendance Patterns at a Large Metropolitan Health System

BackgroundProvider-run “joint classes” educate total joint arthroplasty (TJA) patients on how to best prepare for surgery and maximize recovery. There is no research on potential healthcare inequities in the context of joint classes or on the impact of the recent shift toward telehealth due to coronavirus disease 2019 (COVID-19). Using data from a large metropolitan health system, we aimed to (1) identify demographic patterns in prepandemic joint class attendance and (2) understand the impact of telehealth on attendance. MethodsWe included data on 3,090 TJA patients from three centers, each with a separately operated joint class. Attendance patterns were assessed prepandemic and after the resumption of elective surgeries when classes transitioned to telehealth. Statistical testing included standardized differences (SD > 0.1 indicates significance) and a multivariate linear regression. ResultsThe in-person and telehealth attendance rates were 69.9% and 69.2%, respectively. Joint class attendance was significantly higher for non-White, Hispanic, non-English primary language, Medicaid, and Medicare patients (all SD > 0.1). Age was a determinant of attendance for telehealth (SD > 0.1) but not for in-person (SD = 0.04). Contrastingly, physical distance from hospital was significant for in-person (SD > 0.1) but not for telehealth (SD = 0.06). On a multivariate analysis, distance from hospital (P < .05) and telehealth (P < .0001) were predictors of failed class attendance. ConclusionThis work highlights the relative importance of joint classes in specific subgroups of patients. Although telehealth attendance was lower, telehealth alleviated barriers to access related to physical distance but increased barriers for older patients. These results can guide providers on preoperative education and the implementation of telehealth.

Participant Characteristics and Attendance Patterns for a Multispecialty Veterans Affairs ECHO Program 2012-2018.

Introduction: The Veteran Integrated Service Network (VISN) 20 Veterans Affairs-Extension for Community Healthcare Outcomes (VA-ECHO) program connects specialty and primary care providers (PCPs) across large geographic areas, utilizing video-teleconferencing with the intention of increasing access to care among underserved and isolated populations. No previously published work describes participation patterns of a multispecialty ECHO program. We describe the development of VISN 20 VA-ECHO program to inform the design and evaluation of ECHO programs. Methods: The participant cohort included VA-affiliated licensed health care professionals, including trainees, who attended at least one VISN 20 VA-ECHO session between April 2012 and December 2018. Participant characteristics reported include gender, clinical location, clinical specialty, discipline, and rurality. Results: Over the 6-year time frame, VISN 20 VA-ECHO offered 945 sessions in 14 clinical specialties and recorded 17,893 hours of attendance. The cohort included 1,346 participants, 74.3% of whom were female, 85.2% employed in medical centers, and 40.7% affiliated with primary care. Most participants (62.3%) attended one specialty exclusively; among all participants, 40% attended five or more sessions. Discussion: Although VA-ECHO was implemented to develop single specialty expertise among PCPs, our participant cohort represented a more diverse audience from a range of disciplines and specialties. Our experience may be valuable to other teams implementing ECHO programs. Conclusions: Through adaptability and strategies that actively promoted inclusion of a diverse audience, VISN 20 VA-ECHO expanded to include multiple clinical specialties and successfully engaged an audience across a large geographic area and beyond PCPs.

The Impact of Covid-19 Pandemic on the Epidemiological Pattern of Fracture Clinic Attendances

Purpose: The Covid 19 pandemic has had enormous impacts on healthcare and orthopaedic services globally. The aim of our study was to assess the impact that the covid 19 pandemic has had on the epidemiological pattern of outpatient fractures clinic attendances. Methods: An observational retrospective study was performed looking at epidemiology of fractures seen at our fracture clinics during a three-month period of level 5 restrictions of the covid 19 pandemic and the equivalent period pre pandemic. Data pertaining to demographics, aetiology and fracture types are presented. Results: Patient attendances decreased from 117 in the ‘non-covid era’ to 77 in the ‘covid era’ with a total of 109 and 77 fractures identified respectively. Patients were mostly female with a median age of 55. National lockdown measures impacted the mechanism of injury with expected decreases in sporting injuries. The most common fracture types involved the carpus and hand, foot and ankle and malleoli with the proportion of distal forearm fractures increasing in the covid era. Conclusion: Fracture clinic presentations decreased during the covid era with a higher proportion of fragility fractures. This data may raise awareness regarding the effect of lockdown on an orthopaedic outpatient service for resource allocation for potential future waves.

The relationship between self-efficacy and oral health status of older adults

ObjectivesThe objectives of this study were to determine the relationship between reported self-efficacy and dental status in older adults, identify factors which might influence self-efficacy and, their willingness to pay (WTP) for preventive care. MethodsParticipants aged 60–90 years of age living in Singapore were recruited. All participants completed an oral health questionnaire and a clinical examination. Details of participants’ socio-economic status and educational attainment were collected, and participants also answered a range of questions related to self-efficacy, oral health attitudes, beliefs and dental attendance patterns. Participants were asked to indicate their willingness to pay for preventive care using contingent valuation. The clinical examination recorded decayed, missing and filled teeth [DMFT], root caries, periodontal attachment loss, bleeding on probing index, occlusal status and, denture wearing status. Associations between self-efficacy, self-report and clinical variables were assessed using Kendall's Tau B coefficient. Results614 participants [mean age 68.07 (5.99) years] were recruited. There was a high level of dental awareness and nearly 70% of the participants reported visiting a dentist once or twice a year. Self-efficacy was associated with levels of bleeding on probing and self-reported satisfaction with oral health. Nearly 60% of participants were not willing to pay for preventive advice from an oral healthcare professional. ConclusionOlder adults with a high level of self-efficacy had good gingival health, with low reported levels of bleeding on probing. Participants with low reported self-efficacy had higher disease levels and were less satisfied with their oral health. Clinical SignificanceSelf-efficacy in relation to oral hygiene practices is variable, and participants with low self-efficacy had higher gingival bleeding scores. However, willingness to pay for preventive advice is low, and further work is required to increase the value proposition of preventive care to older adults.