Initial Care Research Articles

Pain Following Obstetric Anal Sphincter Injuries: A Prospective Cohort Study.

Studies characterizing pain and pain management following obstetric anal sphincter injury (OASI) are limited. Our primary objective was to analyze time to pain resolution following OASI. Secondary objectives included analyzing pain severity, location, triggers, and patterns of pain medication use. This was a prospective cohort study of patients with OASIs seen in a postpartum care clinic at a tertiary referral center between 2017 and 2022. We analyzed data on pain resolution, visual analog scale pain scores, pain triggers, pain location, and pain medications. A total of 362 patients were included in this study. In the Kaplan-Meier estimator, 58.5% of patients showed resolution of pain by 3 months following their initial postpartum care clinic visit, and 73.3% showed resolution of pain by 6 months. The median months to pain resolution was 2.2 (95% confidence interval: 1.6-3.0) for patients with third-degree lacerations and 2.3 (95% confidence interval: 1.6-6.8) for patients with fourth-degree lacerations. Visual analog scale scores showed the most improvement in the first 2 months. Common pain triggers included sitting and bowel movements in the first few months, as well as intercourse during later recovery. Pain location varied over time; bilateral pain in the levator ani muscles and obturator internus were most prevalent at each time point. Pain appeared to be predominantly managed by acetaminophen and ibuprofen. Half of patients who experience OASI will have pain resolution by 2-3 months postpartum. Most patients will have resolution of their pain by 6 months postpartum.

Secondary Effects of the COVID-19 Pandemic on Pregnancy Intention.

The coronavirus disease 2019 (COVID-19) pandemic had many downstream effects, including, for some women, altering the wish to become pregnant. This study examines the effects on pregnancy intention and Edinburgh Postnatal Depression Scale (EPDS) score at the initiation of prenatal care in a low-income population during the COVID-19 pandemic. A retrospective review of cohorts of women initiating prenatal care at two large Medicaid clinics between May and November 2019 and May and November 2020 was performed. Women entering prenatal care before 20 weeks and carrying pregnancies to term were included. Charts were abstracted for pregnancy intention, demographics, medical history, and EPDS score. Multivariate logistical regression analysis was used to analyze pregnancy intention pre- and pandemic. EPDS scores were compared by unpaired t test in the unplanned pregnancies pre- and pandemic. There were 462 women in the prepandemic cohort and 477 patients in the COVID pandemic cohort. During the pandemic, 53.04% (253/477) of women reported unplanned pregnancies, a significant increase from a baseline of 42.86% (198/462) of pregnancies prepandemic (P < 0.01, odds ratio 1.62, 95% confidence interval 1.19-2.20) when controlling for all other factors. Analysis of unplanned pregnancies specifically showed no significant differences in the demographic makeup pre- and pandemic. There also was no significant change in EPDS scores in unplanned pregnancies between the two cohorts. There was a significant increase in the number of unplanned pregnancies during the COVID-19 pandemic in a large Medicaid patient population, although the demographics of those having unplanned pregnancies and the average EPDS score did not change significantly.

Patterns, delays, and associated factors of help-seeking behaviour for lifetime mood disorders and anxiety disorders: A national representative survey

BackgroundUtilisation of health services is low and delayed among individuals with mood mental disorders and anxiety disorders, despite high disease burdens and available effective treatments. This study aims to examine patterns and delays in help-seeking and associated factors among individuals with lifetime disorder of mood disorders and/or anxiety disorders. MethodsWe used data from the China Mental Health Survey (CMHS), a nationally representative multistage clustered-area probability sample study across 31 provinces. We assessed lifetime mental disorders and help-seeking behaviour using the Composite International Diagnostic Interview (CIDI). Logistic regression analyses were used to examine sociodemographic and clinical correlates of delay to seek health care. ResultsAmong 32,552 participants, we identified 3075 patients with lifetime mood and/or anxiety disorders; 486 (15.5 % [95 % CI: 13.6–17.5 %]) have sought health care. Of these, 163 (4.8 % [95 % CI: 3.7–6.3]) ever sought specialized mental health services. The delays to initial health care were 1.0 (IQR: 0–7.1), 1.9 (0–10.0), and 10.0 (1.0–22.1) years for depressive, bipolar, and anxiety disorders. Patients with comorbidities, later age of onset, and living in urban areas showed a higher propensity for help-seeking (all p < 0.05). Older cohort was associated with longer delays in seeking health care, while a later age of onset was associated with shorter delays (all p < 0.05). LimitationsThe cross-sectional retrospective design and self-assessment approach may add bias. ConclusionsFailure and delays in help-seeking are common in China. National strategies are needed to promote health care utilisation.

Unequal Uptake: Insurance-Related Disparities in Prenatal Genetic Counseling and Screening at a Quaternary Medical Center.

The purpose of this study was to evaluate the association between the type of insurance coverage and the uptake of prenatal genetic counseling and aneuploidy screening. This was a retrospective analysis of pregnant people who sought prenatal care at a quaternary medical system from August 1, 2017 to August 29, 2019. The primary exposure was insurance status, while the outcomes of interest were the uptake of genetic counseling and aneuploidy screening. Characteristics of the four insurance coverage groups were compared using simple comparisons and multivariable logistic regression models estimating odds of receiving genetic counseling and screening. A total of 8774 births were included. There were significant differences among insurance groups in race, ethnicity, language, parity, and gestational age at the first visit. Pregnant people differed significantly by payer status with regard to the uptake of both counseling and aneuploidy screening. In adjusted models, those without insurance or who were self-paid were significantly less likely to have genetic counseling and aneuploidy screening as compared to those with public or private insurance. In adjusted models, those who were older, spoke English, and were in their first pregnancy were significantly more likely to receive genetic counseling and aneuploidy screening. This analysis contributes to the understanding of how insurance mechanisms within the United States can contribute to the uptake of prenatal genetic counseling and screening. However, there is a complex interplay between payer status and other patient-level characteristics such as age, language, and timing of initiation of prenatal care. Future studies that assess both system-level and patient-level characteristics are crucial.

Patient pathways in primary health care – an interview study across various health care personnel in a Canadian and a Norwegian county

BackgroundDue to demographic changes in the Western world governments emphasize the need for viable solutions, e.g. through decentralization of specialist health care services and better coordination within and between health care services. Both Norway and Canada have been through health care reforms and initiatives aiming to improve continuity and coordination of services. Organizational change to primary care in both countries encompasses both team-based service delivery involving allied health professionals, and new blended payment models. The objective of this study was to explore patient pathways in primary healthcare from various health personnel’s perspectives, and across various primary care organizations in Norway and Canada.MethodsThe study had a qualitative design, including interviews with physicians, nurses and managers (n = 19) in primary care, from a county in Norway and a region in Canada. Data were analyzed with a thematic approach, in line with recommendations from Braun & Clarke.ResultsThree themes were identified: 1) Structural challenges, 2) Towards a more specialized primary health care and 3) Dedication could improve continuity. Findings indicate that coordinating health care services was assumed difficult due to different health care levels, funding systems, managements, electronic record systems and organizations. Hospitals were assumed more task oriented, while primary health care services were considered more care oriented, and this challenged the coordination across organizations. Primary care services were perceived to be more and more specialized, also representing a threat for coordination and continuity. Health care personnel in both countries perceived that dedicated personnel for each patient could improve information flow and continuity across services.ConclusionsAchieving continuity and coordination of health care services seems challenging. Integration strategies seem essential for reducing silo thinking and fragmentation of health care services.

Predicting place of delivery choice among childbearing women in East Africa: a comparative analysis of advanced machine learning techniques

BackgroundSub-Saharan Africa faces high neonatal and maternal mortality rates due to limited access to skilled healthcare during delivery. This study aims to improve the classification of health facilities and home deliveries using advanced machine learning techniques and to explore factors influencing women's choices of delivery locations in East Africa.MethodThe study focused on 86,009 childbearing women in East Africa. A comparative analysis of 12 advanced machine learning algorithms was conducted, utilizing various data balancing techniques and hyperparameter optimization methods to enhance model performance.ResultThe prevalence of health facility delivery in East Africa was found to be 83.71%. The findings showed that the support vector machine (SVM) algorithm and CatBoost performed best in predicting the place of delivery, in which both of those algorithms scored an accuracy of 95% and an AUC of 0.98 after optimized with Bayesian optimization tuning and insignificant difference between them in all comprehensive analysis of metrics performance. Factors associated with facility-based deliveries were identified using association rule mining, including parental education levels, timing of initial antenatal care (ANC) check-ups, wealth status, marital status, mobile phone ownership, religious affiliation, media accessibility, and birth order.ConclusionThis study underscores the vital role of machine learning algorithms in predicting health facility deliveries. A slight decline in facility deliveries from previous reports highlights the urgent need for targeted interventions to meet Sustainable Development Goals (SDGs), particularly in maternal health. The study recommends promoting facility-based deliveries. These include raising awareness about skilled birth attendance, encouraging early ANC check-up, addressing financial barriers through targeted support programs, implementing culturally sensitive interventions, utilizing media campaigns, and mobile health initiatives. Design specific interventions tailored to the birth order of the child, recognizing that mothers may have different informational needs depending on whether it is their first or subsequent delivery. Furthermore, we recommended researchers to explore a variety of techniques and validate findings using more recent data.

Evaluating pain management in older people after orthopaedic surgery - a study in Jordan.

Pain management in older people presents unique challenges due to age-related physiological changes, altered responses to medicines, comorbidities and polypharmacy. These challenges, which are exacerbated in those aged ≥75 years, can compromise the efficacy and safety of pharmacological treatment, including after discharge following orthopaedic surgery. To evaluate pain management and follow-up care provided in primary care settings in Jordan to older people who had undergone orthopaedic surgery. For this descriptive study, data were collected from the discharge summaries and electronic health records of older people who were receiving support from community nurses in rural primary care units in the Aqaba Governorate in Jordan after undergoing orthopaedic procedures in hospital. Of the 100 participants, 63 lived in a nursing home and 30 had been diagnosed with dementia. Hip fractures, diagnosed in 56 participants, were the most common reason for surgery. Thirty-two participants had a documented post-discharge follow-up plan regarding pain management in primary care. Of the 90 participants who were still being followed up 12 weeks after discharge, 51 (57%) were still being prescribed opioids for regular use or as required. Nurses have a crucial role in ensuring effective and safe pain management in older people, particularly when using opioids, due to the heightened risk of adverse effects and medicine interactions. Tailored pain management involves careful initiation of medicines; regular monitoring and assessment of pain levels, adherence to medicines and monitoring of potential side effects; and individualised follow-up plans.

The smell of sepsis: Electronic nose measurements improve early recognition of sepsis in the ED

ObjectiveEarly recognition of sepsis is essential for timely initiation of adequate care. However, this is challenging as signs and symptoms may be absent or nonspecific. The cascade of events leading to organ failure in sepsis is characterized by immune-metabolic alterations. Volatile organic compounds (VOCs) are metabolic byproducts released in expired air. We hypothesize that measuring the VOC profile using electronic nose technology (eNose) could improve early recognition of sepsis. Material and methodsIn this cohort study, bedside eNose measurements were collected prospectively from ED patients with suspected infections. Sepsis diagnosis was retrospectively defined based on Sepsis-3 criteria. eNose sensor data were used in a discriminant analysis to evaluate the predictive performance for early sepsis recognition. The dataset was randomly split into training (67 %) and validation (33 %) subsets. The derived discriminant function from the training subset was then applied to classify new observations in the validation subset. Model performance was evaluated using receiver operating characteristic (ROC) curves and predictive values. ResultsWe analyzed a total of 160 eNose measurements. The eNose measurements had an area under the ROC (AUROC) of 0.78 (95 % CI: 0.69–0.87) for diagnosing sepsis, with a sensitivity of 72 %, specificity of 73 %, and an overall accuracy of 73 %. The validation model showed an AUC of 0.83 (95 % CI: 0.71–0.94), sensitivity of 71 %, specificity of 83 %, and an accuracy of 80 %. ConclusioneNose measurements can identify sepsis among patients with a suspected infection at the ED. Clinical trial registrationThe study is embedded in the Acutelines data-biobank (www.acutelines.nl), registered in Clinicaltrials.gov (NCT04615065).

Perinatal presentation of Klinefelter syndrome and variants: take-home lessons for the urologist

BackgroundKlinefelter syndrome (KS) is a sex chromosome disorder usually diagnosed in adulthood during work-up for infertility or hypogonadism. Perinatal diagnoses are uncommon.Case presentationWe report two newborn cases of KS with associated hypospadias and bilateral cryptorchidism suspected on prenatal genetic testing triggered by ambiguous genital appearance on prenatal ultrasound. Management is presented and the relevant literature on the prenatal and prepubertal presentation and management of KS is summarized.ConclusionsKlinefelter syndrome can be suspected prenatally in patients with increased nuchal translucency or ambiguous genitalia. Cell-free DNA can establish prenatal diagnosis with good sensitivity and specificity. Early diagnosis allows for early initiation of multidisciplinary care, focused counseling, lifestyle modification, early androgen replacement, and cryopreservation during late puberty or early adulthood. Testosterone treatment during infancy was linked to improved phenotypic features of KS and better cognitive and behavioral outcomes.

Preventative care in student-run free clinics: a narrative review on feasibility, ethics, and recommendations

BackgroundStudent-run free clinics are critical for medical education and medical care of underserved populations. This paper explores the feasibility of establishing ethical preventative health services at student-run free clinics such as the Rochester Education and Advocacy for Community Health (REACH) Clinic, affiliated with the Mayo Clinic Alix School of Medicine. Our analysis discusses the challenges and ethical considerations of providing preventative healthcare in student-run clinics. This paper also provides recommendations for implementing preventative care at REACH and other student-run clinics.MethodsA literature search was conducted by an experienced librarian across four databases using keywords “student-run clinics” and “preventative healthcare.” Additionally, contributing authors identified and gathered data about community service organizations that provide preventative healthcare services to residents of Rochester, MN and surrounding areas.ResultsThe literature search yielded 50 articles, 20 of which were included in the narrative review. Vaccinations and cancer screenings were the two preventative care initiatives most commonly undertaken by student-run clinics. The benefits of student-run clinic initiatives for both patients and students were an emerging theme. Clinics often achieved high vaccination and screening rates, and integration of preventative care topics into medical curricula was valued by students. However, the limitations of student-run clinics also emerged as a theme, particularly limitations to resources and comprehensive follow-up. 15 community health organizations in/around Rochester, MN were identified; of these, five provide preventative healthcare services.ConclusionStudent-run clinics like REACH play a key role in delivering preventative care to underserved populations, bridging critical gaps in our healthcare system, and benefiting patients and students alike. However, the ethical principles of beneficence and non-maleficence should be considered when student-run clinics decide what services to offer. Preventative care has been successfully implemented at other student-run clinics but requires careful arrangement of adequate follow-up care, especially when it comes to cancer screening. Vaccinations are a low-cost, high-impact initiative that can be feasibly implemented at most student-run clinics.

Determinants of immediate uptake of Post-Partum Intrauterine Device among women delivered in hospitals in West Wolegga Zone, Ethiopia

BackgroundThe use of immediate postpartum intrauterine contraceptive devices during the postpartum period supports women’s need for spacing births and prevents them from unplanned pregnancies. However, in developing countries, utilization of immediate postpartum contraceptives is low. This increases the risk of maternal morbidity, maternal mortality, preterm birth, child mortality, low birth weight, and small gestational age in subsequent pregnancy with interpregnancy interval.ObjectiveTo assess immediate postpartum intrauterine contraceptive device utilization and the associated factors among women who gave birth in Hospitals in West Wolegga Zone in 2020.Methods and materialsAn institutional-based cross-sectional study was conducted in public hospitals in the West Wolegga Zone from 1 April 2020 to 30 April 2020 among 290 postpartum women. The sample size was proportionally allocated to six hospitals by considering their monthly delivery. Study subjects were taken by systematic sampling technique (Kth=N/n =1025/290=3.53), thus every 4th woman who gave birth in the hospital was recruited in each hospital until the total sample size for this study was obtained.Bivariable and multivariable logistic regression was used to assess the association of independent variables with immediate postpartum intrauterine device utilization. A significance level of 0.05 was used to assess the statistical significance of the study’s associations.ResultsIn this study, the magnitude of the Immediate postpartum intrauterine contraceptive device utilization was 19.3%.factors like Early initiation of antenatal care [AOR=4.46 95% CI:1.84-10.78], Planning of future pregnancy [AOR=3.7(95% CI: 1.43-9.54)], Ever heard of the immediate postpartum intrauterine contraceptive device [AOR=2.67(95% CI: 1.08-6.58)] and Counseling about postpartum intrauterine contraceptive device [AOR=5.15(95% interval: 2.00-13.28] were associated with immediate postpartum intrauterine device utilizations.ConclusionThe use of immediate postpartum intrauterine contraceptive devices is low compared to other studies conducted in Ethiopia. Age, early antenatal care initiation, pregnancy planning, hearing of the immediate postpartum intrauterine device immediately inserted after delivery, and counselling on the immediate postpartum intrauterine device were significantly associated with mothers’ use of immediate postpartum intrauterine devices. Health Program directors should develop strategies to increase the use of immediate postpartum intrauterine contraceptive devices.

Increasing Access to Palliative Care in Cameroon: Progress, Gaps, and Recommendations.

Access to palliative care is an urgent global need. Countries with the greatest palliative care needs have limited access. In Cameroon, demand for palliative care is growing due to the rising incidence of life-limiting conditions. Identifying available palliative care services and programs could provide an understanding of access gaps and inform future roadmaps for palliative care development in the country. We aim to map available palliative care services, identify gaps and inform recommendations to promote early access to palliative care in Cameroon. We undertook a literature review of articles reporting any aspects of palliative care in Cameroon. We searched Embase, MEDLINE, Scopus, PsycINFO, CINAHL, PubMed and gray literature. Data were analyzed thematically using the World Health Organization model for the assessment of palliative care development. We identified 41 articles reporting 21 organizations with some form of palliative care services such as clinical services, education, advocacy and research. These were led mostly by individual health care providers or private and faith-based organizations. Major palliative care initiatives included training in the form of workshops, and adult and pediatric outpatient, in-patient and community-based palliative care. There were few reports of oral morphine production, community engagement, advocacy and palliative care research. Progress in palliative care development was reported in five regions of Cameroon over the last two decades. Findings suggest the need for an intersectoral approach including government, community, and health care stakeholders to achieve sustainable palliative care. This could potentially ensure equitable access to palliative care in Cameroon.

Enhancing Temporomandibular Disorders Education for Initial Care Clinicians Through Interprofessional Education.

Temporomandibular disorders (TMDs) are common musculoskeletal pain conditions that can significantly impact daily activities such as eating, talking, breathing, intimacy, and expressing emotion. TMDs are often complex and multifactorial, and many patients experience overlapping pain conditions, sleep difficulties, and mental health challenges. The National Academies of Sciences, Engineering and Medicine (NASEM) has called for improved TMD education and training for health professionals, as current training opportunities are limited. To prepare health professionals to care for patients who have a TMD, we designed a 5-hour, interactive, module-based curriculum aligned with the 2020 NASEM recommendations. The four-part module set addresses TMD physiology and pathophysiology, assessment, diagnosis, and management. Instructional methods are founded on the Cognitive Theory of Multimedia Learning and include engaging videos, clinical evaluation and education tools, and interactive digital simulation scenarios. Thirty learners from diverse health professional backgrounds (medicine, dentistry, physician assistant, nursing, physical therapy) participated. Multiple-choice question assessments and pre/post retrospective survey scores demonstrated enhanced knowledge (M = 2.9 vs. M = 4.2, p < .001) and perceived competence (M = 1.9 vs. M = 3.4, p < .001), respectively. Encouragingly, all participants indicated applicability to their clinical practice. Our modules offer educators and clinicians a valuable resource to improve TMD knowledge and facilitate best practices. Supplementary resources included in the curriculum are conducive to clinical implementation, fostering improved clinician assessment and patient education.

French consensus on the care pathway for children with suspected or diagnosed type 1 obstructive sleep disorder

Obstructive sleep-disordered breathing (OSDB) is the consequence of an anatomical and/or functional reduction in upper airway size during sleep. Young patients can also be affected. TROS type1 (TROS1 ) is most often found in young, non-obese children with no associated comorbidities, presenting with an otorhinolaryngological (ENT) obstacle, generally an enlargement of lymphoid tissue (tonsils and/or adenoids). The aim of this article was to outline the consensus. A collaborative work, realized on the request of the French Society of Sleep Research and Medicine, to provide recommendations for the management of obstructive sleep apnea syndrome type1 (OSA1 ) in children was published in 2023. This work brought together various experts in pediatric sleep disorders breathings (SDB). A sleep study for OSA1 is not mandatory when at least two nighttime symptoms are noted. A specialist otolaryngologist examination, including nasofibroscopy, is essential during diagnosis. The ENT specialist is the mainstay of initial care, but works as part of a multidisciplinary team that includes pediatricians, general practitioners, orthodontists and linguo-oro-maxillo-facial rehabilitation specialists. Whatever the treatment, follow-up must be continuous and multidisciplinary; it is essential to ensure the effectiveness of the treatments implemented, the absence of SDB recurrence and the recovery of nasal breathing.

Evolution of institutional long-term care costs based on health factors

As many developed countries face the challenges of an aging population, the need to efficiently plan and finance long-term care (LTC) becomes increasingly important. Understanding the dynamics of care requirements and their associated costs is essential for sustainable healthcare systems. In this study, we employ a multi-state Markov model to analyze the transitions between care states of elderly individuals within institutional LTC in the canton of Geneva, Switzerland. Utilizing a comprehensive dataset of 21494 elderly residents, we grouped care levels into four broader categories reflecting the range from quasi-autonomy to severe dependency. Our model considers fixed covariates at admission, such as demographic details, medical diagnoses, and levels of dependence, to forecast transitions and associated costs. The main results illustrate significant variations in care trajectories and LTC costs across different health profiles, notably influenced by gender and initial care state. Females generally require longer periods with less intensive care, while conditions like severe and nervous diseases show quicker progression to more intensive care and higher initial costs. These transitions and expected length of stay in each state directly impact LTC costs, highlighting the necessity of advanced strategies to manage the financial burden. Our findings offer insights that can be utilized to optimize LTC services in response to the specific needs of institutionalized elderly people. These findings can be applied to enhance healthcare planning, the preparedness of infrastructure, and the design of insurance products.

Examining whether method of suicide exposure and closeness to decedent relate to firearm storage practices

AbstractIntroductionOne factor that can influence whether someone will engage in secure firearm storage is having a suicide exposure (SE). Daruwala et al. (2018) examined this and found that individuals with an SE, without considering perceived closeness, did not significantly differ from those who did not have an SE in their firearm storage practices. Thus, the present study aimed to replicate and extend the research of Daruwala et al. (2018) by examining if the method of suicide (by firearm or other means) and closeness of suicide decedent relate to secure firearm storage practices.Methods308 male firearm owners completed self‐report measures assessing SE, perceived closeness to decedent, and current firearm storage practices. Chi square and logistic regression analyses were conducted.ResultsSuicide loss exposure, regardless of method used in suicide, did not relate to firearm storage practices in this sample. We also found that there was no association between perceived closeness to the decedent who died by suicide by firearm and secure storage, without considering age.ConclusionsResults underscore the difficulty in helping male firearm owners develop personally salient reasons to increase safety with firearms. Implications for clinical care, firearm safety, and public health initiatives are explored.

Physician Documentation of Social Determinants of Health: Results from Two National Surveys.

We measured physicians' (1) perceived importance of having access to social determinants of health (SDOH) data received from external providers in the electronic health record (EHR); (2) internal SDOH documentation practices in the EHR, including whether physicians document SDOH in a structured format that may facilitate use; and (3) use of EHR SDOH data to identify community resources and make referrals on behalf of patients. We conducted a secondary analysis of two national physician surveys. Respondents from the American Board of Family Medicine Recertification Survey (ABFM, n = 4040), a survey of family physicians fielded 2021-2022, and the National Physician Health IT Survey (NPHIT, n = 3006), a survey of outpatient physicians across specialty areas fielded in 2022. Under half of physicians felt that SDOH data were very important (ABFM: 44.8%, NPHIT: 30.8%). Although most physicians documented SDOH in the EHR (ABFM: 72%, NPHIT: 63.3%), fewer used structured documentation methods (ABFM: 56.3%, NPHIT: 33.2%). In both surveys, physicians who participated in value-based care initiatives, those for whom > 10% of their patient population was considered vulnerable, and those who felt that their clinic had the resources to address patients' social needs had higher likelihood of documenting SDOH. Sixty-two percent of family physicians reported using SDOH data for identifying resources and making referrals. In 2022, most physicians documented SDOH data in their EHR, yet fewer used structured methods, limiting data exchange opportunities to address patients' social needs. Under half of physicians considered access to external SDOH data to be "very" important, suggesting greater reliance on data collected internally and missed opportunities to identify patients who need support. Variation in perceived importance of SDOH data access and SDOH documentation by physician characteristics indicate opportunities to support adoption of structured documentation tools facilitating SDOH data capture and exchange to improve patient-centered care.

Evaluation of Peri Menopausal Syndrome at the Age Group of 43-48 Years. A Study from Tamilnadu, India

The perimenopause, sometimes referred to as the menopausal transition, is associated with significant changes in hormones and reproduction. Both these changes and the symptoms that go along with them have been well documented. The perimenopause is an ill- defined time frame that surrounds advancing years of a woman's reproductive life. The onset of irregular menstruation and its cessation after a year of amenorrhea constitute the final menstrual cycle. This study was conducted at the Sree Ramakrishna Medical College of Naturopathy and Yogic Sciences and Hospital in Kulasekharam, Tamil Nadu, India. The study's female participants were between the ages of 43 to 48. Following the description of the investigation's goals, vocal agreement was achieved. This survey had thirty responses. In this study the questionaire were consists of thirty questions such as hot flashes, thirst, pain, increased bleeding, and an unpleasant mood . Female participants who were unwilling or uncooperative were not included in the study. Many women find the menopausal transition to be a challenging time in their lives. If they lost any of their human potential, it would be catastrophic for both individuals and society. Therefore, it is essential to keep working to comprehend how perimenopause fits into women's lives and to predict and treat the common and uncommon symptoms that could lower their quality of life. Future health care initiatives should concentrate on these areas to enhance the general health and well-being of perimenopausal women.

Birth outcomes of individuals who have experienced incarceration during pregnancy.

Describe the prevalence, health, and birth outcomes of incarcerated pregnant individuals in California between 2011 and 2015. A population-based cohort study was performed using linked birth certificate and hospital discharge data. Associations between incarceration and birth outcomes were examined, including multivariable logistic regression to estimate odds ratios and 95% confidence intervals. Amongst 1401 incarcerated and 551,029 nonincarcerated pregnant people across 112 delivery hospitals, 33% of incarcerated individuals had late initiation of prenatal care; 2.4% experienced severe maternal morbidity, compared to 18.9% and 1.6% of controls, respectively (p < 0.05). Births to incarcerated individuals had higher adjusted likelihoods of prematurity (OR 1.42, 95% CI 1.21, 1.67), small for gestational age (OR 1.31, 95% CI 1.11, 1.56), and NICU admission (OR 1.64, 95% CI, 1.40, 1.93) relative to controls. Incarcerated individuals have greater likelihood of negative birth outcomes. Identification of approaches to reduce these harms is warranted.

The effect of interhospital transfer on pediatric burn injury mortality in a resource-limited setting.

The World Health Organization's burn mortality estimate is 180,000 annually. Ninety-five percent of all mortality caused by fire-related burns worldwide occurs in low- and middle-income countries (LMICs). Prior studies have shown that transfer status (direct transfer from an injury scene to a trauma center vs. indirect transfer from another health facility) affects patient outcomes. We evaluated the effect of interhospital transfer on burn mortality. We analyzed a burn database of pediatric patients admitted to the Kamuzu Central Hospital (KCH) burn unit in Lilongwe, Malawi. We performed a bivariate analysis based on their transfer status and mortality and a logistic regression analysis to determine the effect of transfer status on mortality after burn injury. A total of 2301 patients were analyzed, with 1095 (47.6%) being in the transfer cohort from referring hospitals. The median age was 3years (IQR 1-4). The transfer cohort had more patients presenting to the hospital more than 48h after injury. Upon multivariate logistic regression, controlling for pertinent variables, including time to presentation, burn-injured patients in the transfer cohort had increased odds of mortality (OR 2.26, 95% CI 1.22-4.19, and p=0.01) compared to patients who were not transferred. The predictive probabilities of burn mortality by TBSA showed significant differences in mortality based on transfer status at TBSA between 20% and 80%. Ensuring district hospitals and other primary health care centers in resource-limited settings are sufficiently equipped to provide initial burn resuscitation and care may decrease mortality rates associated with transferred patients.