Care Center Research Articles

Confidence on COVID-19 vaccine and its associated factors among people living with HIV: a cross-sectional survey in selected regions of Tanzania

BackgroundSeveral vaccines were introduced in Tanzania to combat the COVID-19 pandemic. While studies have explored the acceptability and hesitancy of COVID-19 vaccines within the general population, there is limited research focusing on the confidence and associated factors among People Living with HIV (PLHIV). This study aims to fill that gap by investigating vaccine confidence and its determinants in this demographic group.MethodsA cross-sectional study was conducted in centres for care and treatment in four regions of mainland Tanzania using structured questionnaires. A generalized linear mixed model was fitted to determine the factors associated with confidence in the COVID-19 vaccine.ResultsA total of 1,100 participants were interviewed; 761 (69.2%) were female. The mean age and standard deviation were 41.6 ±12.1 years. The overall level of confidence in COVID-19 vaccines was 55.3%. Females were less likely to express confidence compared to males (aOR = 0.77; 95% CI: 0.72–0.84). Participants with primary (aOR = 1.79; 95% CI: 1.65–1.94), secondary (aOR = 1.81; 95% CI: 1.57–2.09), and university-level education (aOR = 2.14; 95% CI: 0.17–26.54) were more likely to report confidence in COVID-19 vaccines. Attending a dispensary-level health facility (aOR = 1.32; 95% CI: 1.27–1.38) and living in rural areas (aOR = 1.43; 95% CI: 1.23–1.66) were significantly associated with confidence in COVID-19 vaccines.ConclusionAlthough COVID-19 is no longer a global public threat, these findings highlight the significance of being prepared in public health and the necessity of continuous efforts to comprehend and enhance vaccine acceptance and confidence among people living with HIV. By tackling the factors that impact vaccine attitudes in this group, we can improve our preparedness for future public health challenges where vaccine uptake may once again become crucial.

Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care center

Current guidelines recommend reflex testing for hepatitis D virus (HDV) coinfection in hepatitis B surface antigen (HBsAg)-positive patients over risk-factor based screening. We aimed to evaluate the feasibility and diagnostic yield of reflex anti-HDV testing at a Central European tertiary care center. We retrospectively included 560 consecutive patients who had a recorded (first) positive HBsAg test result at the Vienna General Hospital between 2018 and 2022. While reflex anti-HDV testing had been implemented in our hepatitis outpatient clinic (n = 153, ‘reflex testing cohort’), HDV screening needed to be manually ordered in the remaining patients (n = 407, ‘standard testing cohort’). Overall, 98.0% and 65.1% of patients in the reflex and standard testing cohort were screened for anti-HDV, respectively, and the overall seroprevalence of anti-HDV among screened patients was 6.7% (n = 28, reflex testing cohort: 9.3%, standard testing cohort: 5.3%). Risk factors for HDV were present in 49.1% of all included and in 89.3% of anti-HDV positive patients, respectively. Anti-HDV positive patients showed higher ALT (54 [33–83] vs. 29 [19–49] U/L; p = 0.005) and a higher proportion of low-to-undetectable HBV-DNA (61.5% vs. 33.2%; p < 0.001), as compared to anti-HDV negative patients. HDV-RNA PCR was ordered in n = 21/28 (75.0%) of anti-HDV positive patients, and 76.2% had detectable HDV-RNA. Among viremic patients, 75% and 37.5% had significant fibrosis (≥ F2) or cirrhosis (F4), respectively. The prevalence of anti-HDV among HBsAg-positive patients is considerable in a large hospital located in Central Europe. Double reflex testing, i.e., anti-HDV being triggered by the presence of HBsAg and HDV-PCR bring triggered by the presence of anti-HDV, seems warranted to increase the diagnostic yield.

Interactional space for agency: Discussing photography with preschoolers

According to the latest research in both arts education and childhood studies, young children's agency is relational, entangled and negotiated. However, in early childhood visual arts education, modernist practices emphasising the independent and self-expressive child–agent are still recognisable. In this article, early childhood artistic activities are seen as a shared venue for interaction, social exchange and joint meaning-making, thereby providing a specific forum for displaying agency. Informed by conversation analysis, we explore discussions between 14 preschoolers and a researcher on contemporary art and children's self-authored photographs in a workshop in an early childhood education and care centre. By examining our discussions as turn-by-turn procedures, we identify children's displays of agency. The findings illustrate children's agency as a multifaceted and complex interactional phenomenon based on verbal and non-verbal communication and demonstrating both imaginative, progressively oriented talk and modes of resistance. While a shared playful stance appeared as a suitable means to approach art/creative photographs, it simultaneously became an essential interactional resource for inviting and promoting children's agency. Collaborative play with photographs provided an interactional space in which the fixed child/children–adult binary could be questioned and different types of agency were available for both children and the adult.

Connect, care, create: practical framework for physical environment design for person-centred palliative care.

This article aims to explore architectural-rich insights derived from users' experiences within everyday practice in palliative environments and provides a practical framework for healthcare organisations, architects and researchers involved in (re)designing palliative environments for person-centred care. An ethnographic study involving participatory observation was undertaken to gain insight into the influence of palliative environments on the diverse users' subjective experiences. This immersive research took place across multiple palliative environments, encompassing a palliative care unit, a day care centre for palliative care and a hospice located in Belgium. Also, informal conversations and photo-elicitation interviews were conducted with residents, family members, healthcare professionals, volunteers and maintenance staff. Analysing the subjective experiences yielded a practical framework of four architectural atmospheres (proximity, support, engagement, comfort) intended to serve as guiding principles for designing palliative environments. To shape these atmospheres, this article elaborates on 17 spatial aspects and aligns them with real-life experiences of users within palliative environments, thereby enriching and contextualising these insights. This study presents a practical framework encompassing atmospheres, spatial aspects and overarching insights. It is augmented by supplemental material featuring real-life user experiences, all directed towards guiding the design of palliative environments in pursuit of person-centred palliative care. This article advocates for a collaborative, interdisciplinary, holistic design approach that acknowledges these considerations' interconnectedness and considers the users' multiple perspectives. Ultimately, this approach serves as a means of bridging design intentions and actual experiences encountered by users in their real-life contexts to assist healthcare organisations and architects in creating environments for person-centred palliative care.

Pregnancy Preparedness and Complication Preparedness of Pregnant Women in Prenatal Clinics of Tertiary Hospitals

This study assesses the level of Birth Preparedness and Complication Readiness (BPACR) among pregnant women attending antenatal clinics at a tertiary care center. Conducted through an analytical cross - sectional approach from August to October 2023 at Rajarajeswari Medical College Hospital, Bengaluru, it involved 194 participants who were 32 weeks gestation or more. The research utilized a questionnaire covering sociodemographic characteristics, knowledge of birth preparedness, and complication readiness, with data analyzed using descriptive statistics. Results indicated a low BPACR index with significant gaps in awareness and preparedness for childbirth and emergency situations. Only a fraction of participants had initiated antenatal care in the first trimester, and a majority were unaware of severe preeclampsia signs. The study underscores the need for enhanced education and awareness programs at both community and health center levels to improve birth preparedness and complication readiness among pregnant women.

Etiology of Acute Encephalitis Syndrome in Adults in a Tertiary Care Center in Eastern Uttar Pradesh

Seasonal outbreaks of acute encephalitis syndrome (AES) with high case fatality rates have been commonly reported among adults in India. With an increase in Japanese encephalitis virus (JEV) vaccination, the etiology of AES is also changing. However, most studies on AES in India have focused only on children and on JEV. This study was conducted in the Department of Medicine, Institute of Medical Sciences, Banaras Hindu University between 2020 and 2022 to determine the etiology of AES in adults. Blood and cerebrospinal fluid (CSF) were collected from patients 18 years or older with fever and altered sensorium for ≤15 days. We did IgM ELISA for dengue, chikungunya, West Nile virus, scrub typhus, leptospirosis from serum, CSF-IgM for JEV, and CSF–polymerase chain reaction for herpes simplex virus 1 and 2, varicella-zoster virus, enterovirus, and cartridge-based nucleic acid amplification test (CBNAAT) for tuberculous meningitis (TBM). The most common cause of AES identified in our study was TBM (16.7%), followed by leptospirosis (15.1%) and scrub typhus (11.9%). The high occurrence of TBM in our study highlights the importance of CSF-CBNAAT for all AES patients. As leptospirosis and scrub typhus are easily treatable, early detection and treatment of these infections should be recommended.

Cost analysis of oncological outpatient neurosurgery under general anesthesia with Hospital-at-Home based postoperative care.

This study evaluates the efficiency and cost-effectiveness of an oncological outpatient neurosurgery (OON) protocol using Enhanced Recovery After Surgery (ERAS) principles in a European healthcare setting. Additionally, it assesses the impact of incorporating Hospital at Home (HaH) for perioperative follow-up on program efficiency and costs. We analyzed a case cohort of patients who underwent OON with HaH-based postoperative follow-up for tumor removal or biopsy at a tertiary care center since 2019. A control cohort treated under standard inpatient care was also examined. Costs associated with surgery and postoperative care were meticulously calculated for both groups. The case (n=17) and control (n=38) cohorts had comparable demographics and clinical profiles. Surgical costs, including operating room, anesthesia, and surgeon fees, were similar across groups. However, post-operative monitoring was significantly shorter for the outpatient cohort, leading to reduced observation costs (p<0.001). While the duration of follow-up care was similar, outpatient follow-up via HaH was more cost-effective, reducing overall surgery costs by approximately €2958 per patient (p<0.001) compared to inpatient care. No significant differences were observed in costs related to treatment, radiology, or lab tests between groups. Outpatient neurosurgery with HaH follow-up offers substantial cost savings without compromising care quality in a public health setting. Inpatient care's higher costs are largely due to bed utilization, while the integration of HaH does not add significant costs, making it a viable alternative for postoperative management.

Perception of parents on barriers and facilitators of treatment outcomes among children and adolescents attending psychotherapy services in a primary health care centre in Belize

Background: The study assessed the perception of parents on barriers and facilitators treatment outcomes among children and adolescents attending psychotherapy services in a primary health care centre. Methods: A cross sectional descriptive study using both quantitative and qualitative methods. The quantitative method used retrospective review of records of 65 children and adolescent clients who accessed psychotherapy services between January 2022 and December 2023 at Port Loyola Health Centre in Belize city. The qualitative method used in-depth interviews of twenty parents of the patients randomly selected from the clinic registers. Univariate and bivariate analyses was used for the quantitative data while thematic analysis was used for the qualitative data. Results: 25 (38.5%) of the patients completed their treatment and 34 (52.3%) dropped out, with half dropped out after the first visit. The identified parental perceived barriers and facilitators are organized into four main themes. The first theme was related to knowledge and understanding of mental health problems by the parents which showed that respondents had good knowledge about mental health problems. The second theme identified attitudes towards treatment as a major factor to completion of treatment. The third theme was related to structural factors like transportation cost and parents’ work schedule identified as key barriers. The fourth theme was related to inconvenient appointment time and lack of flexibility in the scheduling of appointment at the clinic. Conclusions: The study highlights key areas of interventions to minimize barriers to completion of treatment among children accessing mental health services.

PHC visits trends effects on control of blood pressure for hypertensive patients following up in PHCs in Makkah, Saudi Arabia

Hypertension is a major risk factor for cardiovascular disease, stroke, and kidney disease. In Saudi Arabia, the prevalence of hypertension is estimated to be 14%. Primary health care centers (PHCCs) play a major role in the diagnosis, treatment, and follow-up of hypertensive patients in Saudi Arabia. This study employed a cross-sectional design to collect data from medical records of hypertension patients registered with primary health care centers (PHCCs) in Makkah, Saudi Arabia. The data was obtained through a comprehensive review of these medical records. Out of the 16,623 patients included in the study, the average annual visit frequency was 5.5 for females and 6 for males. 65.6% (10,910 patients) completed all four annual visits. There was no statistically significant difference in visit completion rates between males and females. The visit count was found to be negatively correlated with Systolic BP (-0.151, 95% CI [-0.195, -0.165]), Diastolic BP (-0.137, 95% CI [-0.147, -0.117]), and MAP (-0.176, 95% CI [-0.191, -0.161]), with a P-value &lt; 0.001 for all parameters. Our findings indicate that the number of visits to Makkah Primary Health Centers positively influences blood pressure control in hypertensive patients.

Studying the Diabetic Foot at Risk Using a 60-Second Foot Screening Tool and the Importance of the Categories of the Foot at Risk in Diabetes Patients at a Tertiary Care Center in East India

Studying the Diabetic Foot at Risk Using a 60-Second Foot Screening Tool and the Importance of the Categories of the Foot at Risk in Diabetes Patients at a Tertiary Care Center in East India

Quality of Life and Out-of-Pocket Expenditures for Sickle Cell Disease Patients in Saudi Arabia: A Single-Center Study

Background: Sickle cell anemia (SCD) is a relatively uncommon health condition in many countries, but it is prevalent in Saudi Arabia mainly due to the high incidence of consanguineous marriages. Regrettably, there are elevated rates of vaso-occlusive crises (VOCs) and blood transfusions, leading to poor quality of life and significant financial strain. Objective(s): This study aimed to assess the frequency of blood transfusions, out-of-pocket expenditures (OOPEs), and health-related quality of life (HRQoL) in SCD patients. Methods: This was a questionnaire-based cross-sectional study that involved SCD patients at a university-affiliated tertiary care center in Riyadh, Saudi Arabia. The patients’ medical and sociodemographic characteristics were obtained from the electronic medical records. Data on HRQoL and OOPEs were collected through a questionnaire-based interview. To present the baseline characteristics, descriptive statistics such as mean, standard deviation, frequency, and percentage were used. In addition, various statistical tests, including the Chi-Square test, Student t-test, one-way ANOVA, and multiple linear regression, were performed. Results: One hundred and eighteen patients consented to participate and were included in the analysis. Almost 53% of the patients were females. The mean age of the sample was 31 years, while the age-adjusted quality-adjusted life years (QALYs) was 24.33 years (p-value &lt; 0.0001). Most patients (83.05%) reside in Riyadh with a monthly family income of less than USD 2666.67 (75.42%). Monthly OOPEs were, on average, USD 650.69 ± 1853.96, and one-third of the adult patients reported income loss due to illness, further exacerbating their financial strain. High frequency of blood transfusion (β = −0.0564, p-value = 0.0066) and higher number of comorbidities (β = −0.10367, p-value = 0.0244) were negatively associated with the HRQoL among adult patients. On the other hand, adult patients with higher levels of education had better HRQoL (β = 0.05378, p-value = 0.0377). Conclusions: The findings of this study highlight the negative impact of SCD on patients’ HRQoL and financial well-being. This underscores the urgent need for comprehensive systemic approaches to address the challenges posed by SCD in Saudi Arabia.

Enhancing digital health competencies: insights from european human resources for health

Abstract Background Mixed-skills for digital health transformation are critical for human resources for health (HRH). This study aimed to inform the design of new training programmes that address soft, hard and digital health skills. Methods Using a mixed-methods design science approach, focus groups were conducted by invitation and with informed consent, online or in-person. A script was prepared with key questions for orientation and facilitation, addressing the topics of current situation, desired situation, desired skills, practical and organisational needs to implement continuous training in healthcare. The collected data were analysed using Nvivo. Results Focus groups (14) had 87 participants (Norway, Latvia, Belgium, Italy and Portugal): 26 healthcare professionals (nurses, midwives, nutritionists, pharmacists, assistants and doctors); 27 managers or directors of hospitals and care centres; 34 experts (digital health specialists, researchers, technical officers, members of professional societies and national authorities). Real needs were identified, with 2 direct sub-themes that were best related to each other (Pearson coefficient, p &amp;gt; 0.40 - cluster analysis): 1. ‘Current situation’: Cybersecurity (eg. privacy, law and ethics); Time (work time versus private time, p = 0.69); Type (informal versus formal training, p = 0.32); Programmes (graduation, continuing education and post-graduation levels). 2. ‘Desired situation: Desired skills (eg. digital - basic ICT, data analysis, soft - communication, emotional intelligence, and hard skills - medication administration, catheters, ECG, vital signs, telehealth - digital stethoscope); Learning design and objectives (eg. collective learning, simulations, location - peer-to-peer and hybrid); Emergency care and the link between primary and secondary levels of care were considered important. Conclusions These findings of convergence among HRH inform Program design process to support the training programs and course syllabus design. Key messages • The identified needs and priorities inform Program design further to support Digital Health Transformation training programs and course syllabus design. • Real needs points to Current and Desired situation, where HRH give important insights that need to be considered to engage people to perform training courses.

1.Q. Round table: Primary healthcare workforce crisis in Europe: global policy discourse and national implementation

Abstract Background Primary healthcare (PHC) has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. Recent WHO efforts have underscored the challenges in aligning the global PHC-oriented model with national health systems, highlighting the need for tailored approaches to fulfil diverse needs and contexts. Although significant progress has been made in advancing PHC, some gaps persist, particularly surrounding the integration of PHC and healthcare workforce debates and its prioritisation within national health agendas. These gaps lead to disconnects between PHC policy implementation and workforce considerations, exasperating the existing workforce crisis and obstructing effective service delivery. Objectives This workshop bridges the gap between PHC workforce policy and the ongoing healthcare workforce crisis, focusing on the European region and different types of health systems, socio-economic conditions, health labour markets and workforce compositions. We apply a health system and multi-level governance approach, arguing the need for greater attention to the implementation of global policy concepts and the diverse national and regional conditions, interests, and needs. The workshop begins with an overview of the PHC workforce situation, presenting novel results drawn from European comparative research and nine selected country case studies, followed by a panel discussion. The panellists provide in-depth evidence on various PHC workforce challenges and introduce illustrative examples of policy interventions and good-practice models coming from the case countries. Insights from the WHO Centre for Primary Health Care advance the debate by highlighting strategies and capacity for transformative PHC workforce policies, and the need for further investigation to critically align global and national approaches. The policy recommendations emerging from the panel will be critically reflected in a plenary discussion. The workshop will stimulate debate and improve knowledge exchange across countries, in particular in the WHO European region, as well as between research, policy and practice. It will strengthen both the PHC model and the healthcare workforce, and finally advance the building of resilient health systems. Key messages • Shift the primary healthcare debate from idealistic attributes to actionable implementation strategies, emphasising policy dynamics, political contexts, and diverse stakeholder interests. • Understand the various PHC-oriented models and their dynamics to determine the necessary quantity, competencies, and composition of HCWs and how they can be governed effectively to implement PHC.

The primary healthcare workforce crisis: a comparative assessment of the European region

Abstract Background The healthcare workforce crisis strongly affects the primary healthcare sector, worsening the work conditions of healthcare workers and hampering service delivery and health system resilience. This study introduces a health system and governance approach to identify transformative capacities in health system contexts. Methods A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England. Results Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark and the Netherlands, and to a lesser extent also Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation. The WHO primary healthcare model only marginally informs policy decisions, but it may receive some more attention in Kazakhstan. Conclusions We conclude that aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas. Speakers/Panelists Tiago Correia NOVA IHMT, Lisbon, Portugal Viola Burau Aarhus University, Aarhus C, Denmark Marius-Ionuț Ungureanu Babeș-Bolyai University, Cluj-Napoca, Romania Anna Sagan WHO European Centre for Primary Health Care, Almaty, Kazakhstan

Prognosis of Zero Coronary Artery Calcium Score in Symptomatic Patients of South Asian Descent - an Experience from a Tertiary Care Center in Pakistan.

The absence of CAC in asymptomatic individuals is associated with a very low incidence of cardiovascular events. Of symptomatic patients, 1-2% with zero CAC score have non-calcified coronary artery atherosclerosis, and at least one third of cardiovascular events occur in individuals with zero CAC. South Asians (SA) have proportionally higher case fatality rates for CVD, relatively younger age of presentation, and accelerated rate of atherosclerosis when compared with other ethnic groups. All consecutive patients who underwent a CTCA to evaluate angina or angina-equivalent symptoms during the study duration were enrolled retrospectively. Patients with prior myocardial infarction, history of revascularization, and congenital heart disease were excluded. MACE was defined as the total of cardiac death, non-fatal myocardial infarction, and/or non-elective revascularization. A total of 534 patients were enrolled after final exclusion. The mean age was 53 years ± 11. Males constituted 68.4% of the study population. Dyslipidemia was the most common co-morbid condition identified (50%), followed by diabetes (18.4%) and hypertension (3.6%). At least 28.8% of patients with zero CAC scores had the presence of coronary artery disease (soft plaque) of any degree. Obstructive CAD (>50%) was present in 5.8% of patients. Follow-up was available for 61.4% of patients. On a mean follow-up of 96.6 months ± 49.8 (range 21-194 months), all-cause MACE was observed in 8.8% of patients. The most common MACE was angina (3.96%) and all-cause mortality (3%). The baseline characteristics and MACE did not differ in patients with and without obstructive CAD. The baseline characteristics did not differ significantly between patients with and without MACE. The incidence of soft plaque in this SA cohort is higher than that reported in international studies. However, in symptomatic SA, a CAC score of zero carries a good long-term prognosis, irrespective of the degree of CAD.

Association between a new healthcare access index and life expectancy in Japan: A nationwide study

Abstract Background Access to medical institutions is crucial to healthcare systems. Japan has universal health coverage and unrestricted access to medical institutions; patients can visit any medical institution without requiring referral letters. We developed the Japan- Spatial Accessibility Scale for Medical Institutions (J-AMI) to provide integrated spatial accessibility to multiple sized healthcare institutions. We also examined the association between the J-AMI and life expectancy. Methods This study included 220,621 administrative census mesh blocks defined by address; 89,248 clinics and 8,181 hospitals across 47 provinces in Japan, with a total population of approximately 126 million. The road distance between the centre of each block and the nearest clinic was calculated and scored every 1 km. Hospitals were classified as secondary and tertiary hospitals based on the availability of emergency and critical care centres. Secondary and tertiary hospitals were scored every 2 and 4 km, respectively. The scores for clinics and secondary and tertiary hospitals (1-8 points each) were aggregated and scored using a mesh. The population-weighted municipal J-AMI (PWM-J-AMI) scores were calculated for each municipality. Correlations between the PWM-J-AMI scores and life expectancy by municipality were examined. Geographic information was analysed using ArcGIS Pro. Results Median life expectancies for male and female individuals were 81.4 years (interquartile range [IQR]: 80.9-81.9 years) and 87.5 years (IQR: 87.2-88.0 years), respectively. The median PWM-J-AMI score was 9.5 (IQR: 5.4-14.5). The PWM-J-AMI scores were negatively correlated with male and female individual’s life expectancy by municipality (r=-0.29, p &amp;lt; 0.01 and r = 0.18, p &amp;lt; 0.01, respectively). Conclusions The results suggest that the better a region’s access to medical care, the longer its life expectancy. Efficient medical institution allocation and telemedicine promotion may be essential to improving access. Key messages • We developed the Japan- Spatial Accessibility Scale for Medical Institutions (J-AMI) to provide integrated spatial accessibility to multiple sized healthcare institutions, using ArcGIS Pro. • The PWM-J-AMI scores were negatively correlated with male and female individual’s life expectancy by municipality, which suggest that the better a region’s access, the longer its life expectancy.

PD-L1 Expression Varies in Thyroid Cancer Types and Is Associated with Decreased Progression Free Survival (PFS) in Patients with Anaplastic Thyroid Cancer

Background: Thyroid cancer (TC) remains a significant clinical challenge worldwide, with a subset of patients facing aggressive disease progression and therapeutic resistance. Immune checkpoint inhibitors targeting programmed death-ligand 1 (PD-L1) have emerged as promising therapeutic approaches for various malignancies, yet their efficacy in TC remains uncertain. The objective of this study was to investigate PD-L1 expression in aggressive TC and its association with histological subtypes, molecular mutation, and progression-free survival. Methods: This is a retrospective study of patients with advanced TC seen in two tertiary health care centers. Included in this study were patients with advanced TC with recurrence or progression on therapy for whom tumor molecular profiling and PD-L1 status were available. Kaplan–Meier estimators were utilized to analyze the progression-free survival (PFS) between patients with PD-L1 positive and negative status in Anaplastic TC (ATC) subgroup. Results: A total of 176 patients with advanced thyroid cancer were included (48.9% female). Of the patients, 13 had ATC, 11 Medullary TC (MTC), 81 Papillary TC Classic Variant (PTCCV), 20 Follicular TC (FTC), 8 Oncocytic TC (OTC), 10 Poorly Differentiated TC (PDTC), and 30 had the Papillary TC Follicular Variant (PTCFV). BRAF mutation was present in 41%, TERT in 30%, RAS in 19%, TP53 in 10%, and RET in 8.6% of patients. PD-L1 positivity was significantly different across different TC types and histological subtypes (p &lt; 0.01): Patients with OTC had the highest frequency of PD-L1 positivity (71%), followed by ATC (69%), PTCCV (28.5%), and FTC (11%). Patients with MTC and PTCFV did not exhibit any PD-L1 positivity. TP53 mutation was positively associated with PD-L1 expression (21.6% vs. 7.5%, p = 0.03), and RAS mutation was negatively associated with PD-L1 expression (8.1% vs. 24.2% p = 0.04). Among patients with ATC, positive PD-L1 expression was associated with lower PFS (p = 0.002). Conclusions: PD-L1 expression varies across different TC types and histological subtypes and may be modulated by the mutational landscape. PD-L1 expression in ATC is associated with shorter PFS. Follow up studies are warranted to elucidate the molecular mechanism driving the observed differences in immune pathways, potentially paving the way for the development of more effective and personalized immune therapies for patients with aggressive TC.

Left atrial reservoir strain differentiates cardiac amyloidosis and hypertrophic cardiomyopathy

Abstract Aims Availability of mortality-reducing therapies for cardiac amyloidosis (CA) has led to an increase in referral rates to tertiary care centers. Investigations to improve diagnosis rates are urgently needed, as diagnosis of CA requires a multimodal approach and its early diagnosis is crucial due to high mortality in untreated patients. The aim of this study is to evaluate the accuracy of the left atrial reservoir strain (LASr) in differentiating CA patients from patients with hypertrophic cardiomyopathy (HCM). Methods This is a cross-sectional analysis from the Graz HCM Registry, a prospective single-center cohort study enrolling consecutive patients with a HCM phenotype. This analysis included HCM and CA patients with valid standardized transthoracic echocardiographic examinations. Blinded investigators performed post-processing echocardiographic analyses in 100 HCM and 95 CA patients. Results Compared to HCM patients, CA patients were more frequently male [79 (83%) vs. 54 (54%); p&amp;lt;0.001] and older [78 (73-81) vs. 58 (47-70) years; p&amp;lt;0.001]. Moreover, CA patients had a lower BMI [25.0 (22.8-26.9) vs. 26.5 (24.3-29.7) kg/m²; p=0.002] as well as lower systolic [134±20 vs. 142±25 mmHg; p=0.018] and diastolic blood pressure [78±12 vs. 84±12 mmHg; p&amp;lt;0.001]. Additionally, CA patients had higher NT-proBNP [2533.0 (1146.0-5016.0) vs. 543.0 (195.0-1381.0) pg/ml; p&amp;lt;0.001] and lower eGFR [58.4±19.1 vs. 80.1±22.2 ml/min/1.73m²; p&amp;lt;0.001]. LASr was significantly worse in CA patients compared to HCM patients [9.2 (5.6-13.0) vs. 21.7 (14.8-27.6) %; p&amp;lt;0.001]. Multivariable logistic regression analysis revealed LASr as an independent predictor of CA [OR=0.936 (95% CI 0.877-0.998)], adjusting for covariates. ROC analysis showed an AUC of 0.80 (95% CI 0.73-0.86) for LASr to discriminate CA from HCM. LASr ≤14.3% demonstrated a 80% sensitivity and 79% specificity for the identification of CA patients. Sensitivity analyses involving 74 sex- and age-matched patients yielded materially unchanged results. Conclusion Compared to HCM patients, LASr was diminished in CA patients and an independent predictor of CA. Moreover, LASr showed high diagnostic accuracy in differentiating CA and HCM patients. Prospective studies are needed to evaluate the added value of left atrial strain in the diagnostic work-up of CA patients.ROC curve of LASr

An intersectional approach on menstrual inequity as lived by women in circumstances of socioeconomic vulnerability in an urban and rural setting in Spain: a qualitative study

Since menstrual health and menstrual inequity are determined by social power structures, this study proposes to analyse, from an intersectional perspective, the experiences of menstrual inequity of women and people who menstruate (PWM) (≥18 years) under circumstances of socioeconomic vulnerability in an urban and rural setting in Catalonia (Spain), focusing on menstrual poverty, menstrual management and access to health care for menstrual health. An exploratory and interpretative qualitative study was conducted. Venue-based convenience sampling was carried out, recruiting women from a non-governmental organisation and a primary health care centre. Eighteen individual semi-structured interviews were conducted between October 2022 and February 2023. Data were analysed through reflexive thematic analysis. Analysis revealed that menstrual care was generally a distant preoccupation that revolved around circumstances of socioeconomic vulnerability, housing, and productive/reproductive work. Menstrual poverty, menstrual management and menstrual self-care challenges, barriers to accessing health care for menstrual health, and menstrual taboo, stigma and discrimination were commonplace and deepened by socioeconomic vulnerability. In this way, women’s menstrual experiences were rooted in intersecting axes of inequity, based on gender, race and class. Intersectional and critical participatory research, policy and practice are imperative to develop counter mechanisms that confront systems of privilege-oppression to modulate menstrual experience, health and equity.

Smaller intrinsic QRS area and smaller reduction of QRS area during cardiac resynchronisation therapy are associated with higher risk of ventricular arrhythmias and appropriate ICD therapy

Abstract Background Cardiac resynchronisation therapy (CRT) patients are at high risk for ventricular arrhythmias (VAs), and little is known about which characteristics are associated with an increased risk for arrhythmic events. Purpose To investigate the association between QRS area parameters and the risk for VAs in patients with heart failure undergoing primary preventive CRT with defibrillator (CRT-D) implantation. Methods All patients receiving CRT-D between 2015 and 2020 at a large-volume tertiary care center were retrospectively evaluated. Digital 12-lead electrocardiograms (ECGs) were collected before and after CRT implantation. Patients were included if they had native LBBB and were implanted with a primary preventive CRT-D. Kors’ regression transformation was used to derive vectorcardiographic QRS area from the 12-lead ECGs. QRS area parameters were analysed in relation to a primary endpoint of first appropriate ICD therapy, i.e., ATP or shock therapy. Results 177 patients with LBBB (68.9 years [60.7–73.8]; 21.5% female; 52.9% New York Heart Association (NYHA) class III-IV; LVEF 25.9±6.3%) were followed over a median follow-up time of 2.5 years [1.6–3.0] after CRT-D implantation. 27 patients reached the primary endpoint. The median pre-CRT QRS area was 134.5 μVs [102.3–163.8]. Multivariable Cox regression identified a small pre-CRT QRS area (HR, per 10 μVs decrease, 1.30; [1.12–1.51]; p=&amp;lt;.001) and a small post-CRT reduction in QRS area (HR, per 10 μVs decrease, 1.30; [1.13–1.49]; p=&amp;lt;.001) as independent predictors of an increased risk of appropriate ICD therapy. In analyses with a scoring variable combining pre-CRT QRS area and QRS area reduction both above or below median, the combination of a small pre-CRT QRS area and a small QRS area reduction was strongly associated with an increased risk of reaching the endpoint (HR, per point increase, 2.47; [1.2–4.9]; p=0.01). Conclusion A small intrinsic QRS area, by itself or in combination with a small reduction of post-CRT QRS area, was strongly associated with a higher risk of ventricular arrhythmias in this cohort of CRT-D treated patients. In conjunction with other parameters, further risk stratification for arrhythmic events could be achieved by assessing QRS area data pre- and post-CRT.Figure 1.K-M pre-CRT QRS area quartilesFigure 2.K-M QRS area score