Health Care Centers Research Articles

Co-designing the Family Wellbeing Program to Address Mental Health Disparities in a Latino Community: Lessons Learned

Abstract: Background: Latino caregivers caring for children under 5 years old who are under resourced, and underserved may be most vulnerable for experiencing mental health problems. Furthermore, Latino families with young children—during the COVID-19 pandemic—were at particular risk for multiple and concurrent stressors and acute adversities. Objectives: The Family Wellbeing Program (FWP) was designed to strengthen Latino caregivers’ mental health and mental well-being, and facilitate their access to mental health supports and service providers. Methods: Using the principles of community-based participatory research, a university research team and staff from a federally qualified health care center co-developed and implemented the FWP. Pre- and post-implementation focus groups with six staff were conducted and data analysis was guided by the RE-AIM framework. Results: Staff identified implementation challenges related to the pandemic and socioenvironmental factors affecting the reach and participation of Latino families. Staff perceived the program improved caregivers’ help-seeking behaviors, yet suggestions for improving the FWP for Latino caregivers were noted. Staff also discussed implementation strategies to sustain future programming. Conclusions: Implementation strategies along the RE-AIM dimensions were identified to improve the participation of Latino caregivers in future adaptations of the FWP. The implications of this work could show promise for sustaining programs designed to address disparities in mental health among Latino caregivers.

Primary care physicians' knowledge and attitudes about obesity, adherence to treatment guidelines and its' association with confidence to treat obesity at the Saudi Ministry of Interior primary health care centers.

Many primary care physicians (PCPs) believed that managing overweight and obesity is essential to their jobs, however, many believe that they were doing it ineffectively, unsatisfying, and had negative attitudes. We conducted this study to explore the knowledge, attitudes and adherence to obesity management guidelines, identify potential barriers that may prevent adherence of PCPs to obesity treatment guidelines. We conducted this cross-sectional study and conducted a questionnaire sent via email to all PCPs in the Ministry of Interior centers in Riyadh, Al-Kharj, AlQassim, Wadi Ad Dawasir, Hail and Tabuk in Saudi Arabia. A total of 119 PCPs participated in the survey, 61 (51.3%) males and 58 (48.7%) females. All respondents (n = 119, 100%) answered correctly that obesity is a disease. Of PCPs surveyed, genetics accounted for 75.6% of the responses as the cause of obesity. 79.8% believed that the best way for patients with obesity to lose weight was to engage in regular physical activity. The majority of PCPs (87.4%) thought that treating obesity should be a top priority, and 88.2% would typically recommend obesity therapy to their patients. Around 68.9% of PCPs thought that it's their patients' responsibility to lose weight. The majority will recommend obesity treatment and 75.6% would talk to their patients about weight concerns, while 60.5% would refer their patients to obesity surgery. There was a positive significant association between higher knowledge and better attitude and better adherence to treatment guidelines. More experienced PCPs were more confident. The most common perceived barrier was the patients' lack of desire to follow obesity treatment. Primary care clinics and PCPs play a crucial role in diagnosing and treating patients with obesity, according to Ministry of Health guidelines on the prevention and management of obesity. PCPs must not only acknowledge obesity as a chronic illness and the possible long-term consequences it may cause, but also provide comprehensive, multi-component interventions that include lifestyle changes, medication, and appropriate referrals for bariatric surgery when needed. Healthcare professionals must form a cooperative relationship with obese patients to ensure that the patients follow treatment protocols.

P040 STRENGTHENING PRIMARY HEALTH SYSTEMS FOR HYPERTENSION: THE CASE OF HEARTS IMPLEMENTATION IN GUATEMALA

Hypertension is considered the leading cause of death and disability worldwide due to the multiple complications it entails. Hypertension contributes to 40% of the total cardiovascular diseases worldwide. In Guatemala, the burden of hypertension is increasing, with a prevalence of 32.2%. Hypertension alone is responsible for 12% of deaths in the country. The World Health Organization's (WHO) HEARTS is global to local initiative that consists in a technical package represents a public health approach to hypertension control, with a strong foundation in the effective and sustainable delivery of care for chronic diseases in primary care centers and their communities. Since 2017, Resolve to Save Lives, WHO, and other partners have supported the implementation of the HEARTS hypertension control program in public health care centers in LMICs (Low- and Middle-Income Countries). The goal was to establish a model for hypertension control suitable for broader expansion. By December 2022, 12.2 million hypertensive patients had been treated in the program across 33 participating LMICs. A pilot study integrating the diabetes module (HEARTS-D) into the implementation of the hypertension care model has been conducted in two health areas (Sololá and Chiquimula) since 2023. Starting in 2024, the execution of a project funded by the World Diabetes Foundation (WDF) will be carried out to expand these strategies by implementing a national comprehensive care model for diabetes and hypertension in the country. In 2021, a pilot study focused on the implementation of the model was conducted, resulting in a fourfold increase in the treatment rate of patients and a 14% increase in the proportion achieving blood pressure control. These results support the feasibility of implementing the HEARTS model for blood pressure control in the healthcare system of LMICs. The integration of the model in Guatemala since November 2022 enhances previous efforts and solidifies the country's commitment to integrating timely responses in the management of these conditions and the implementation of standardized treatment.

Assessment of the risk of falls among elderly persons in primary care settings

<p><strong>Aim </strong>To investigate the risk for falls in elderly patients treated in the Primary Health Care Centre Gradiška, Bosnia and Herzegovina.<br /><strong>Methods </strong>This study included 500 patients aged 65 and older. They were chosen randomly by 10 family physicians. Data collection took place every Wednesday and Friday, between January 2022 and July 2022. The patients' gait and balance assessments were performed using the Tinetti Gait and Balance Tool to assess the risk of falls. A supplementary questionnaire was created to record data about the patients' age, sex, chronic diseases, and drugs they take.<br /><strong>Results </strong>Among the included patients there were 266 females (53.2%) and 234 (46.8%) males, with the mean age of 75.25 years. The Tinetti test showed that the risk of falls was high for patients older than 75 years, 111 patients (69.8%), and 48 patients (30.2%) aged 65 to 74 (p=0.000). The risk of falling was higher for female, 93 (35%), than male patients, 66 (28.2%) (p=0.018). Considering chronic diseases, a high risk of falls was found in 32 (2.1%) patients with heart failure (p=0.029) and 19 (11.9%) patients with osteoporosis (p=0.000). Patients who used antihypertensive drugs had the highest risk for falls, 124 (78.0%) (p=0.757).<br /><strong>Conclusion </strong>About two-thirds of the examinees over the age of 75 had a high risk of falls, which indicates that family doctors should be more involved in fall prevention of elderly patients and consistently educate older patients and their families about it.</p>

P116 ANTHROPOMETRIC INDICES AND DYSLIPIDAEMIA IN A SEMI-URBAN NIGERIAN POPULATION

Background/Objective: Obesity and dyslipidaemia are cardiovascular/metabolic risk factors. Dyslipidaemia's intricacy with obesity is dependent on several individual factors and hyperinsulinaemia is a major drive for obesity induced dyslipidaemia. Cost remains a challenge for lipid assay in our locality as majority pay out of pocket for healthcare. Hence, aim of the study- to correlate anthropometric indices with dyslipidaemia and determine which amongst six anthropometric indices best predicts dyslipidaemia. Methods: Consents were obtained from two hundred and sixteen subjects recruited consecutively, from three primary health care centres in a semi-urban Nigerian population. Biodata and cardiovascular risk factors’ history were obtained using interviewer administered questionnaire. Bodyweight, height, waist and hip circumferences were obtained using standard methods. Oscilliometric method was used for blood pressure check while body mass index (BMI), ratios of waist to hip (WHR) circumference and waist to height(WHtR), a body shape index (ABSI) and body roundness index (BRI) were calculated using online calculators. Fasting blood glucose (FBG) was performed using hexokinase method while enzymatic method was used for serum total cholesterol (TC), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and triglyceride (TGD) assays after a 12hr overnight fast. Correlation, ROC curve and multivariate analysis using binary logistic regression analysis were used in the analysis. Results: Mean age of participants was 54.8±15.0years. Majority, (71.8%) were females. The prevalence of dyslipidaemia was 94.9%. A weak positive correlation exists between BRI and TC (r =0.134, p=0.049) and with LDL (r =0.182, p=0.007). The AUC was 0.686 (0.516-0.856) for ABSI, cut-off of -1.479, (sensitivity 81.0%; specificity 54.5%). Predictors of dyslipidaemia included age <60years (AOR=15.94, 95%CI: 1.8-143.2) and male gender(AOR=0.08, 95%CI: 0.02-0.50). Conclusions: There is a high prevalence of dyslipidaemia. Lipid levels increases as anthropometric readings rise. ABSI best predicted dyslipidaemia though moderately specific therefore, can be used to screen individuals and identify those in whom lipid assay must be done at all cost during management of cardiovascular/metabolic risk factors. Table: Area under ROC curve (AUC), optimal cut-off points, sensitivities and specificities of anthropometric indices in predicting dyslipidaemia.

Pathways of Care in the Hospital Visiting Patients Having Mental Health Problems in Central India

Background: There is a high community prevalence of mental health problems in India. Psychiatric patients often consult nonspecialist or unqualified health providers which results in significant treatment delays and poor mental health outcomes. Knowledge of existing treatment-seeking practices may be useful to design specific and effective awareness programs. Objectives: The objectives were to study the types of health-care providers contacted by patients suffering from different mental illnesses as well as assess the treatment delays and associated factors. Methodology: A cross-sectional observational descriptive study was done in a psychiatry clinic of a tertiary health care center and teaching hospital in Central India. The information was collected from consecutive newly visiting patients on two predefined weekdays through face-to-face interviews. A predesigned sociodemographic format and World Health Organization pathways interview schedule were used to assess pathways of care. Results: Data were collected from 157 participants. Majority of participants were males (58%). Mood disorders were the most common diagnostic category (28%), followed by substance-related disorders (23%) and anxiety disorders (21%). Eighty (51%) among the total participants consulted psychiatrist in the first visit. Allopathic practitioners were the second commonly consulted health provider category. The median delay in treatment was maximum in substance-related disorders (7 years). Conclusion: Significant delay in treatment was observed across all diagnostic categories. Training general practitioners in the diagnosis and treatment of mental illnesses and a structured health-care referral system to enhance appropriate psychiatry consultations may be desirable to improve mental health outcomes in India.

The evaluation of neurologists’ awareness on hepatitis B virus reactivation before launching immunosuppressive treatment

Background: Individuals encountering hepatitis B virus (HBV) are at risk of hepatitis B virus reactivation (HBVr) when exposed to immunosuppressive (IS) therapy. Here, we aimed to evaluate neurologists’ knowledge on HBVr in patients receiving IS treatment and draw attention to importance of the issue. Methods: Eighty-six physicians from neurology departments throughout Turkey between 1st March- 30th April 2020 were enrolled. Results: Of 86 physicians (average age 37.2±7.6 years), 34 (39.5%) were affiliated with university hospitals, 23 (26.7%) in training and research hospitals, and 29 (33.6%) in secondary healthcare centers. While 28 (32.5%) stated following a guideline, 58 (67.4%) declared following no guidelines. Physicians receiving postgraduate training on HBVr administered prophylaxis before IS treatment at a higher rate (p=0.04), and 69 (80.2%) considered all patients receiving any IS treatment should be screened for HBVr. To all participants, patients selected for screening should be tested for HBsAg; 83 (96.6%) and 29 (33.3%) stated patients should be tested for anti-HBs and anti-HBc IgG, respectively. Conclusion: Given our study findings, rate of screening performed by neurologists to give IS treatment for HBVr and their awareness level on the situation were not found to be sufficient. In addition, two more important factors required to be raised awareness were detected in our study: First, the rate of using anti-HBc in screening is low, and the awareness should be increased in this direction. Secondly, the risk of HBVr should be categorized in terms of IS treatment and host in our country where HBV infection is seen at a high rate, and determining the prophylactic approach is insufficient.

Improving health behaviours and attitudes around podoconiosis in Northern Western Ethiopia: Implementation and intervention effectiveness.

Assessing how interventions are implemented is essential to understanding why interventions may or may not achieve their intended outcomes. There is little evidence about how interventions against Neglected Tropical Diseases (NTDs) are being implemented. Guided by the Context and Implementation of Complex Intervention (CICI) framework, we evaluated an ongoing intervention against the NTD podoconiosis to examine the implementation process and its effectiveness in terms of improving shoe wearing practices, increasing knowledge and reducing stigmatizing attitudes towards podoconiosis in rural Ethiopia. We employed an exploratory mixed methods approach, qualitative followed by quantitative, between April and July 2022 to assess implementation agents, theory, strategy, process and outcomes of the intervention. We conducted document analysis, observations, focus group discussions, in-depth interviews and key informant interviews for the qualitative phase. We administered a survey to 369 rural residents, of whom 42 were affected by podoconiosis. The implementers utilized government healthcare centers in a bid to mainstream podoconiosis services within local healthcare structures. The implementers provided training for health professionals and the public and distributed supplies to patients over a three-month period. The intervention reached 62% of patients, but female patients were less likely to participate than male patients. Only 18% of community members had participated in health education campaigns linked to the intervention. Involvement in the intervention resulted in improved shoe wearing practice and holding fewer stigmatizing attitudes. However, internalized stigma among patients was still rife; and the plan to utilize community assets to extend the intervention activities was not effective. Implementers must monitor the fidelity and progression of programs on a constant basis to make corrections. They also need to expand health education, provide psychosocial support and design economic empowerment programs for patients to reduce stigma. They must also collaborate with policy makers and international partners to sustain program activities at intervention delivery points.

Once-weekly insulin efsitora alfa versus once-daily insulin degludec in adults with type 1 diabetes (QWINT-5): a phase 3 randomised non-inferiority trial

Insulin efsitora alfa (efsitora) is a once-weekly basal insulin. This phase 3 study aimed to assess the efficacy and safety of efsitora compared with insulin degludec (degludec) in adults with type 1 diabetes. This randomised, 52-week, parallel-design, open-label, treat-to-target non-inferiority study conducted at 82 global health-care centres, randomly assigned (1:1) adults (ie, those aged ≥18 years) with type 1 diabetes glycated haemoglobin A1c (HbA1c) 7·0-10·0% (53·0-85·8 mmol/mol) to efsitora (n=343) or, degludec (n=349), both in combination with insulin lispro. The primary endpoint was the change in HbA1c from baseline to week-26 (non-inferiority margin=0·4%). The trial was registered at ClinicalTrials.gov (NCT05463744) and is completed. Between Aug 12, 2022, and May 7, 2024, of 893 participants enrolled, 692 (77%) participants were randomly assigned to once-weekly efsitora or once-daily degludec, and 623 (90%) participants completed the study. Mean HbA1c decreased from 7·88% (62·66 mmol/mol) at baseline to 7·41% (57·5 mmol/mol) at week 26 with efsitora and from 7·94% (63·3 mmol/mol) at baseline to 7·36% (56·9 mmol/mol) at week 26 with degludec. Mean HbA1c change from baseline to week 26 was -0·51% with efsitora and -0·56% with degludec (estimated treatment difference 0·052%, 95% CI -0·077 to 0·181; p=0·43), confirming a non-inferiority margin of 0·4% for efsitora compared with degludec. Rates of combined level 2 (<54 mg/dL [3·0 mmol/L]) or level 3 severe hypoglycaemia were higher with efsitora compared with degludec (14·03 vs 11·59 events per patient year of exposure; estimated rate ratio 1·21, 95% CI 1·04 to 1·41; p=0·016) during weeks 0-52, with the highest rates during weeks 0-12. Severe hypoglycaemia incidence was higher with efsitora (35 [10%] of 343) versus degludec (11 [3%] of 349) during weeks 0-52. Overall incidence of treatment-emergent adverse events was similar across treatment groups. One death not related to the study treatment occurred in the degludec group. In adults with type 1 diabetes, once-weekly efsitora showed non-inferior HbA1c reduction compared with daily insulin degludec. Higher rates of combined level 2 or level 3 hypoglycaemia and greater incidence of severe hypoglycaemia in participants treated with efsitora compared with participants treated with degludec might suggest the need for additional evaluation of efsitora dose initiation and optimisation in people with type 1 diabetes. Eli Lilly and Company.

Serum retinol binding protein 4 in individuals with essential hypertension and type 2 diabetes: A cross-sectional study.

Cardiometabolic disorders, notably primary hypertension and type 2 diabetes, present substantial global health challenges. The intricate interplay between metabolic and cardiovascular pathways has prompted extensive research into molecular mechanisms linking these conditions. The adipokine Retinol Binding Protein 4 (RBP4), initially recognized for retinol transport, has emerged as a potential biomarker in the network of metabolic and cardiovascular dysfunction. Recent studies implicate RBP4 in insulin resistance and its complications, including hypertension. This study explores RBP4 dynamics in patients with primary hypertension and type 2 diabetes, aiming to contribute valuable insights into diagnostic and therapeutic advancements in managing these interconnected disorders. This cross-sectional study, conducted over 2 years in a tertiary healthcare centre of North India, aimed to investigate the serum concentration of Retinol Binding Protein 4 (RBP4) in 119 participants diagnosed with primary hypertension and type 2 diabetes. Ethical guidelines were strictly followed, and comprehensive clinical assessments, including blood pressure measurements, were performed. RBP4 levels were quantified using an ELISA kit, alongside markers of insulin resistance. Statistical analyses, involving t-tests and correlation assessments, sought to unravel potential associations between RBP4, insulin resistance, and blood pressure parameters using SPSS 20.0. The study comprised 61 healthy control (HC) participants and 58 individuals diagnosed with both essential hypertension and type 2 diabetes (EH+T2D). EH+T2D participants were on average older (45.71 ± 9.29 years vs. 40.34 ± 9.47 years, P = 0.002). Dyslipidemia prevalence was markedly higher in EH+T2D (72.4% vs. 11.4%, P < 0.0001), accompanied by disrupted lipid profiles. Serum RBP4 concentration was significantly elevated in EH+T2D (49.17 ± 19.37 mg/L, P < 0.0001), suggesting its potential role in the shared pathophysiology of primary hypertension and type 2 diabetes. Pearson's correlation analysis revealed associations between RBP4 levels, metabolic, and cardiovascular parameters, underscoring its potential as a link between these conditions. Elevated serum RBP4 levels suggest its potential as a novel biomarker in the shared pathophysiology of primary hypertension and type 2 diabetes. The correlation analysis highlights the intricate interplay between metabolic, lipid, and cardiovascular parameters, emphasizing the need for holistic interventions.

Eculizumab as Salvage Treatment for Thrombotic Microangiopathy After Lung Transplantation.

Thrombotic microangiopathy (TMA) is a rare complication after lung transplantation (LT) that has seldom been characterized in detail. Recent evidence has linked TMA other than primary atypical hemolytic uremic syndrome (aHUS) with hyperactivation of the complement alternative pathway. The focus of this investigation was to analyze the treatment response with eculizumab in TMA after LT. Case series where we have studied 11 patients with TMA after LT from 2 Spanish tertiary healthcare centers. Clinical data and response rates to eculizumab are provided. The main indication for lung transplant was chronic obstructive pulmonary disease (COPD) (36%) and most cases (82%) received bilateral LT. The median time to TMA diagnosis was 11.6 months (4.7-28.9) and the TMA trigger in the majority of cases (73%) was immunosuppressive drugs. Platelet and hemoglobin nadir were 58×103/µL (24-108) and 7.7g/dL (7.1-7.9), respectively. All cases presented acute kidney injury (AKI) with a median creatinine of 4mg/dL (3.2-4.8) and 54.5% required acute dialysis. Eculizumab was started after a median time of 8 days (6-14) with a median duration of 3 weeks (2-8). Complete TMA response was observed in 7 (63.6%) cases and hematologic response in 10 (90.9%). The time to hematologic and renal response was 23 days (13-29) and 28 days (14-46), respectively. TMA after LT is infrequent but potentially devastating. Our findings suggest that short cycles of eculizumab may be effective for severe TMA after LT.

Novel Metabolic Indicators and the Risk of Cardiovascular Disease in Patients with Hypertension: A Primary-care Cohort Study

Background and AimsData are limited on whether several easily measured indices serve as effective tools for Cardiovascular disease (CVD) risk assessment in hypertensive patients. This study aimed to assess the associations of metabolic score for insulin resistance (METS-IR), lipid accumulation product (LAP), and visceral adiposity index (VAI) with CVD risk in hypertensive patients. Methods and ResultsOur data were drawn from the medical records of primary-care institutions in China. The present study included 306,680 individuals with hypertension attending primary healthcare centers. Cox regression analyses were applied to assess the associations of novel metabolic indicators with the risk of CVD. During a median follow-up of 1.98 years, 5820 participants developed CVD. When comparing with the lowest quartile of the indices, the highest quartile of METS-IR, LAP, and VAI was associated with 1.25-fold (95% CI: 1.16-1.35), 1.15-fold (95% CI: 1.05-1.25), and 1.19-fold (95% CI: 1.10-1.28) risk of CVD after adjusting for potential confounders. ConclusionThis study provided additional evidence that novel metabolic indicators like METS-IR, LAP, and VAI were associated with the risk of CVD. These results suggest that proactive assessment of visceral adiposity and insulin resistance could be helpful for the effective clinical management of the hypertensive population.

Pattern of Utilization of Antenatal Care Services and Adherence Among Females Following Up at Primary Healthcare Centers in Al-Ahsa.

Background Antenatal care (ANC) is a crucial component of maternal and child health, yet disparities in utilization persist globally. This study aimed to assess the patterns of ANC service utilization and adherence among pregnant women attending primary healthcare centers (PHCCs) in Al-Ahsa, Saudi Arabia. Methodology A quantitative, cross-sectional study was conducted among 277 women attending PHCCs in Al-Ahsa. Data were collected through structured questionnaires, assessing demographic characteristics, ANC follow-up patterns, structural and personal barriers, and mental health conditions using the Depression, Anxiety, and Stress Scale. Results Significant regional variations in ANC follow-up patterns were observed, with higher proportions of pregnant women attending ANC in the Middle and Eastern regions. Prominent structural barriers included transportation challenges (structural barrier 3, 61.0%) and limited service availability (structural barrier 6, 56.0%), while personal barriers encompassed transportation problems (personal barrier 6, 36.8%) and forgetfulness regarding appointments (personal barrier 4, 19.9%). Mental health assessments revealed predominantly normal levels of depression, anxiety, and stress, with some regional variations in distress levels. Conclusions The study highlights regional disparities in ANC service utilization and adherence, influenced by structural barriers, personal barriers, and mental health conditions. Tailored interventions addressing these barriers, improving access to care, and providing targeted support are crucial for enhancing ANC service utilization and promoting maternal and child health in Al-Ahsa.

Depression and Anxiety Screening of Patients With Type II Diabetes Mellitus Attending Primary Healthcare Centers in Saudi Arabia.

Diabetes mellitus is a chronic condition affecting both physical and mental health. High blood sugar levels can lead to serious complications if not managed properly. Individuals with diabetes are also at a higher risk of developing mental health disorders like depression and anxiety. The objective was to assess the prevalence of depression and anxiety among patients with type II diabetes attending primary healthcare centers in Makkah, Saudi Arabia. An analytical cross-sectional study design was employed, targeting adults with type II diabetes attending primary healthcare centers in Makkah. A total sample size of 412 participants was selected through systematic random sampling. Data were collected using validated Arabic versions of the patient health questionnaire (PHQ-9) and the general anxiety disorder (GAD-7) questionnaire, along with demographic information. Statistical analysis was conducted with non-parametric tests used to evaluate the significance of outcome variables. The median age of participants was 47 years, with 237 (57.5%) being male and 373 (90.5%) Saudi nationals. Neuropathy was the most prevalent complication, affecting 181 (43.9%) of participants. The median GAD-7 score was 5, and the median PHQ-9 score was 7. Mild to moderate depression was observed in 224 (54.4%), and 194 (47%) had mild-to-moderate anxiety. Significant associations were found between mental health outcomes and several factors: nationality (non-Saudis showed higher depression and anxiety scores, p = 0.010 and p = 0.020, respectively), marital status (divorced participants had the highest mean ranks for both conditions, p = 0.003 for depression and p < 0.001 for anxiety), and monthly income (p = 0.007 for depression and p = 0.008 for anxiety). Additionally, the presence of diabetes complications was strongly associated with higher depression and anxiety scores (p < 0.001 for both). The findings indicate a high prevalence of depression and anxiety among patients with type II diabetes in Makkah. These mental health issues are significantly associated with socio-demographic factors and diabetes complications. Integrated medical and psychological care is needed to improve the quality of life and treatment outcomes for diabetic patients.

Comparative analysis of clinical profile, laboratory profile and outcome in COVID-19 patients with and without hypothyroidism.

Previous studies suggest that patients' thyroid status might directly impact the course of Coronavirus disease 2019 (COVID-19). The objective of the study was to determine the clinical profile of COVID-19 patients with hypothyroidism and compare it with that of COVID-19 patients without hypothyroidism. Retrospective observational study. The study was conducted in a tertiary healthcare centre in Tamil Nadu between May and June 2021. The study included 117 patients admitted with hypothyroidism and COVID-19 as well as 117 age and Gender matched COVID-19 patients without hypothyroidism. Data regarding the demography, comorbidities, presenting symptoms, method of diagnosis of COVID-19, computed tomography (CT) severity score, Interleukin 6 (IL-6), D-dimer, oxygen requirement, number of days in hospital and outcome were collected for both groups. Data analysis was conducted, and p<0.05 was considered statistically significant. The study comprised 234 patients over two months, from May to June 2021. Distribution of presenting symptoms showed that the hypothyroidism group presented with a higher incidence of fever (66.67%), loose stool (18.80%) and myalgia (7.69%). Results show that RTPCR+, O2 Requirement, death, D-dimer, IL-6, number of days admitted as well as CT-severity did not show any statistically significant differences (p>0.05) between both groups. The outcomes also showed that both groups reported four mortalities. The results of the study help conclude that the hypothyroidism status of a COVID-19 patient is not associated with higher severity of clinical symptoms, deranged laboratory values as well as mortality. None declared.

P207 MAY MEASURE MONTH 2022 AND 2019: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS PRE COVID-19 AND POST COVID-19 FROM ULAANBAATAR, MONGOLIA

Background: Mongolia has experienced high mortality rates from ischaemic heart disease and haemorrhagic stroke, with hypertension as a major risk factor. Two separate hypertension screening campaigns were conducted: the May Measurement Month (MMM) campaign in May 2019 and a follow-up campaign after the COVID-19 pandemic between July and September 2022. Methods: The 2019 MMM campaign involved screening at 80 sites, primarily workplaces, using trained health volunteers. Blood pressure was measured using clinically verified digital devices. In contrast, the 2022 campaign was conducted at five primary healthcare centers in Ulaanbaatar, with participants voluntarily attending the screening, where blood pressure was measured over three sessions. Results: In 2019, 6522 individuals were screened, with a hypertension prevalence of 32.5%, where 62.2% were aware of their condition and 50.1% were on medication. The control rate among those treated was 27.1%. In 2022, 1774 individuals were screened, showing a higher prevalence of 56.1%, with 95.4% awareness and 52.7% receiving treatment. The control rate for treated individuals was significantly higher at 48.5%. Conclusion: Both campaigns highlight the critical public health issue of hypertension in Mongolia. The increase in hypertension awareness and control rates in 2022 may be due to smaller sample size and participants are already patients who came to visit primary healthcare centers.However, the persistent high prevalence of hypertension underscores the need for continued prioritization and enhanced strategies in hypertension management.

P208 MAY MEASURE MONTH 2023: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS FROM ULAANBAATAR, MONGOLIA

Background and Objectives: In Mongolia, 1 in 3 people have high blood pressure and mortalities due to ischaemic heart disease and haemorraghic stroke has hit record high in the past years. Since 2019, Mongolia has been participating in the world's largest hypertension screening campaign, May Measure Month. After skipping the screening campaign for 2 years, we aimed to screen people for hypertension after the COVID-19 pandemic. Method Screening sites were set up in 14 primary healthcare centers (PHC) of 4 districts in Ulaanbaatar, Mongolia between June and September 2023. Screenees came into the PHC and participated voluntarily and they were aged 18 and above. Questionnaire was completed with three sittings BP measured. Definition was hypertension was as a systolic BP at least 140 mmHg and/or a diastolic BP at least 90 mmHg (using the mean of the second and third readings) or taking antihypertensive medication. We used SPSS version 29.0.2.0 and RStudio for data analysis. Result Total of 5036 respondents were participated. Of which, 44.8% were male and female were 55.2% with mean age 46.8 (±15.8). Hypertensive adult proportion was 42.6% (2143), of whom 85.1% (1823) were aware and 84.0% (1800) were on hypertension treatment. Of those on medication, control rate 53.8% had controlled blood pressure (&lt;140/90). Noncommunicable disease factors including smoking was 26.6%, current vaper 7.6%, alcohol consumption 28.8%, diabetes 7.2%, previously diagnosed heart attack was 3.7% while stroke was 3.5%. Overweight and obese were 36.8% and 14.6% respectively. Conclusion The high hypertension prevalence and inadequately treated hypertension demonstrates that hypertension treatment management is needed to be prioritized.

P183 PERIPARTUM CARDIOMYOPATHY: MONOCENTRIC DESCRIPTION AT THE NORTHERN REGIONAL MATERNITY HOSPITAL OF THE DOMINICAN REPUBLIC

Background: Peripartum cardiomyopathy (PPCM) is a pathology in which the woman's heart dilates and displays signs and symptoms of heart failure. It is a rare pathology, with a high mortality rate, and predominance in black patients. Its diagnosis and management are not standardized, nor adapted to low income countries. This leads to barriers in identifying and treating the disease in higher-risk countries such as Haiti, making it a relevant issue in the Dominican Republic due to high immigration of haitians to the country. Therefore we aimed to evaluate the association of risk factors and the pharmacological regimen of patients in a public healthcare center in the Dominican Republic. Methods: An observational, retrospective, cross-sectional study was carried out with convenience sampling. This included patients who had been admitted to the Presidente Estrella Ureña Regional Hospital with suspected PPCM during the last 3 years. Variables studied include: sociodemographic factors, toxic habits, pathological and gynecological-obstetric history, cardiovascular, pulmonary and general signs and symptoms. Results: A sample of 19 patients with a median age of 27 years was obtained, 73.4% of them were black. All of the patients who had illness onset in the peripartum period (first 28 days after labor) presented adverse events, infectious comorbidities and “other comorbidities” while 75% of them presented cardiac and pulmonary comorbidities. Regarding treatment, only 77.8% of patients with antepartum onset received treatment in this period. Additionally, 66.7% of patients with antepartum onset developed adverse events that required oxygen-supplementation, versus only 33% of those without adverse events. Conclusions: It is relevant to design tools for calculating the risk of developing PPCM and standardize its disparate diagnosis and treatment, particularly aimed at countries with limited resources. This aims to improve the prognosis in patients with risk factors such as: black race, age over 30 years and living in low/middle-resource countries.

Iron Deficiency Anemia among Sanitation Workers in a Tertiary Care Hospital: A Cross-sectional Study

ABSTRACT Background: Iron deficiency anemia (IDA) has been the main cause of the health burden in India over the past decade. The aim of the present study was to examine the iron status and prevalence of iron deficiency anemia using biochemical markers among sanitation workers working at a tertiary healthcare center. Methodology: This hospital-based cross-sectional observational study was conducted on 80 sanitation workers for a period of 18 months (age 31–40 years). Dietary intake patterns were collected through the structured questionnaires. Blood samples were analyzed for complete blood count, serum iron level and unsaturated iron binding capacity, and ferritin. Total iron binding capacity and percentage transferrin saturation were calculated. Stool samples were screened for intestinal helminthic ova and cysts of intestinal protozoa. Results: Of the 80 sanitation workers, IDA was found in 38.7%; out of this, mild anemia was found in 16 (20%) participants, while 11.3% and 7.5% participants had moderate and severe anemia, respectively. Higher plasma sTfR levels were observed in women with severe iron depletion than in those with iron sufficiency (median 17.6 versus 15.5 nmol/L; P = 0.001). A statistically significant positive correlation between hemoglobin and serum iron, serum ferritin, and transferrin saturation was found. Hemoglobin was positively correlated with white blood cells, red blood cells, hematocrit, and mean corpuscular hemoglobin. Conclusion: This study highlights the presence of mild IDA among sanitary workers and lower levels of iron intake than the recommended dietary allowance.

Physician practices in referring rheumatoid hand and thumb carpometacarpal arthritis cases to hand surgeons.

To investigate the referral practices across different medical specialties and identify possible barriers to hand surgery referral. Rheumatoid hand deformities (RHDs) and thumb carpometacarpal (CMC) arthritis may require surgery once deformities occur. However, in Saudi Arabia, the rate of referrals to hand surgeons remains low. This was a cross-sectional study that included 102 consultants of family medicine, rheumatology, and orthopedics across various regions of Saudi Arabia. A total of 30 institutions were contacted and requested to distribute a survey questionnaire to their physicians; these institutions included 8 private hospitals, 16 government hospitals, and 6 primary healthcare centers. The survey included questions on the incidence, rate, management, knowledge, and referral of patients with RHD and CMC arthritis using a 5-point Likert scale. The Kruskal-Wallis H test was utilized in our analysis to evaluate the differences in responses among the 3 specialties. For RHD and thumb CMC arthritis, the referral rate was higher among orthopedic surgeons compared to rheumatologists and family medicine physicians. The main barriers to referral were patient refusal, medical treatment alone being deemed adequate, and a lack of awareness of surgical options for management. Our findings highlight discrepancies in patterns of physician referral of RHD and thumb CMC arthritis cases to hand surgeons, indicating the need for targeted interventions to improve referral rates and enhance patient outcomes.