Center Visits Research Articles

Modified Textbook Outcome was a Predictor for Early Mortality After Oral Cancer Surgery.

To explore prognostic factors for early mortality among patients undergoing surgery for oral cavity cancer (OCC) and identify valuable strategies to improve patient outcomes. A total of 397 patients treated by primary tumor resection and neck dissection between 2017 and 2021 were retrospectively analyzed. Univariate and multivariate Cox regression analysis were used to explore the relationships between the study factors and early death (within 12months). Predictors were further incorporated into a nomogram for estimation of 1-year overall survival (OS). The mean age was 57.2 (SD, 9.8)years and 92.9% patients were male. The early death rate was 12.6% overall, 35.6% in patients with pN2-3, 22.3% in patients with tumor size > 3 cm, and 36.2% in patients with lymphovascular invasion. A non-modified textbook outcome (mTO), pN2-3, tumor size > 3 cm, and lymphovascular permeation were independent prognosticators for early mortality. A nomogram with the above-mentioned four factors were created with good discrimination and calibration. Among the pN2-3 or tumor size > 3 cm subgroup, a non-mTO, cancer resource center (CRC) visits, perineural invasion, and lymphovascular permeation were independent prognostic factors for early death. In addition to traditional clinicopathological features, a non-mTO and CRC visits could serve as prognostic factors for early death in OCC. A novel nomogram had good discrimination and calibration. Quality improvements in terms of mTO and patients demanding resource support could improve survival outcomes in OCC.

Statistical methods for clinical trials interrupted by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic: A review.

Cancellation or delay of non-essential medical interventions, limitation of face-to-face assessments or outpatient attendance due to lockdown restrictions, illness or fear of hospital or healthcare centre visits, and halting of research to allow diversion of healthcare resources to focus on the pandemic led to the interruption of many clinical trials during the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic. Appropriate analysis approaches are now required for these interrupted trials. In trials with long follow-up and longitudinal outcomes, data may be available on early outcomes for many patients for whom final, primary outcome data were not observed. A natural question is then how these early data can best be used in the trial analysis. Although recommendations are available from regulators, funders, and methodologists, there is a lack of a review of recent work addressing this problem. This article reports a review of recent methods that can be used in the setting of the analysis of interrupted clinical trials with longitudinal outcomes with monotone missingness. A search for methodological papers published during the period 2020-2023 identified 43 relevant publications. We categorised these articles under the four broad themes of missing value imputation, modelling and covariate adjustment, simulation and estimands. Although motivated by the interruption due to SARS-CoV-2 and the resulting disease, the papers reviewed and methods discussed are also relevant to clinical trials interrupted for other reasons, with follow-up discontinued.

Visits to Health Centers Among Adults, by Selected Characteristics: United States, 2022.

This report describes care received at health centers in the United States in 2022. Estimates are presented for selected characteristics. The data presented in this report are from the 2022 National Ambulatory Medical Care Survey Health Center Component. Data were collected from federally qualified health centers and federally qualified health center look-alikes and weighted to produce nationally representative estimates of visits to health centers from all 50 U.S. states and the District of Columbia. During 2022, an estimated 89.5 million visits were made by adults to health centers in the United States, an overall rate of 349.4 visits per 1,000 adults. The visit rate among women was higher than for men. Differences in visit rates by age were not significant. Adults who were not married accounted for 48.2% of visits, and adults who were married accounted for 37.6% of visits. More than one-half of health center visits were disease-related (61.4%). Symptoms-related diagnoses accounted for 22.0% of visits. Screenings (12.6%) and examinations (10.2%) were also frequent reasons for health center visits. Social determinants of health were listed as a reason for the visit at 2.0% of health center visits. Endocrine diseases represented the most frequently mentioned disease category (29.1%), overall and among adults age 45 and older. Mental disorders represented the most common disease category among adults ages 18-44. Women visited health centers at a higher rate than men. In addition, patient and visit characteristics, including marital status and diagnoses, differed by age.

Cross-sectional study for profiling health status, health-related demographics, and health-seeking behaviour of the Scheduled Caste Population in selected areas of Chennai and Chengalpet Districts of Tamil Nadu

Background: Scheduled Caste (SC) population forms a large section of the Indian population who are often marginalised and deprived of social, economic and health benefits due to ignorance and socio-cultural milieu. Though various studies have been conducted on the socio-economic and political conditions of the SC population in Tamil Nadu, limited data is available on the status and determinants of their health. Objectives: The study's objectives were to estimate the health status of the SC population, health-related socio-demographic conditions and the population's health-seeking behaviour. Method: The observational, cross-sectional study was conducted in five SC-predominant areas of Chennai and Chengalpet districts of Tamil Nadu. Their health status, socio- demographic conditions, including household conditions, and health-seeking behaviour were estimated. Result: A total of 1452 households and 6072 participants of the SC community were studied, mostly belonging to the Adidravida community. Most households were of Upper-lower socioeconomic class with basic household amenities. A total of 11.54% of the adult population had a history of diagnosed chronic illnesses. Nearly one-fifth of reproductive-age women had menstrual irregularities. Non-communicable and infectious diseases were the most frequent reason for health care centre visits. Conclusion: Extensive and continuous screening of health status and chronic diseases is essential for early diagnosis and intervention. Focused interventions on improving socio- demographic status can further strengthen the health condition of the SC community. Integrating all systems of medicine in public health can help cater to the health requirements of all sections of the community. Concerted efforts can cut down the burden of chronic diseases.

Functional integration of services during the antenatal period can potentially improve childhood growth parameters beyond infancy: findings from a post-interventional follow-up study in West Bengal, India

BackgroundDespite progress, the prevalence of childhood undernutrition in India remains amongst the highest globally.ObjectiveWe aimed to evaluate the impact of a functional integration interventional package during the antenatal period on childhood growth parameters.MethodsThis is a post-interventional follow-up study of a maternal nutrition interventional study conducted between 2018 and 2019 among women in their first trimester of pregnancy from three districts in West Bengal, India. Pregnant women received a package of augmented interventions from study staff which supplemented those provided to them under the state-run programmes, that included body-mass-index measurement at pregnancy registration, monthly weight monitoring, targeted dietary counselling, supervised supplementary nutrition intake and iron-folic acid supplementation during daily anganwadi center visits. In the current follow-up study conducted in 2021, age-matched pregnant women from the same areas who were pregnant during the same period as in the original study and had received standard-of-care under the state-run programmes were recruited into a comparison group. Study staff collected data regarding maternal height and serial weights that were recorded at antenatal visits in 2018-19, and birth and infant characteristics. Child height and weight were measured during the follow-up visit in 2021, which were used to calculate the relative risks of stunting, wasting and underweight using generalized linear models, to understand the sustained impact of the intervention beyond infancy. Eight-hundred-nine mother-child dyads (406 intervention; 403 comparison) were followed.ResultsMedian age of women in the intervention and comparison group was 23 (IQR 20–25) and 25 (IQR 24–27) years respectively. Median gestational-weight-gain was higher amongst intervention group women (9 vs. 8 kg, p = 0.04). Low-birth-weight prevalence was 29.3% (119/406) and 32.0% (129/403) in the intervention and comparison group. At 12–35 months of age, children born to women in the intervention group had significantly reduced risk of stunting (RR = 0.65, 95% CI 0.44–0.94), wasting (RR = 0.57, 95% CI 0.33–0.97) and underweight (RR = 0.61, 95% CI 0.42–0.88).ConclusionsThese results indicate that functional integration and strengthening of routine antenatal care services including targeted nutritional counselling to expectant mothers can have distal beneficial effects on childhood undernutrition beyond the immediate post-natal period.

Willingness to participate in a personalized health cohort – insights from the swiss health study pilot phase

BackgroundThis paper explores the feasibility of establishing a large-scale population-based cohort and biobank in Switzerland by assessing potential participants’ needs, expectations, and concerns about such an infrastructure providing information on health, lifestyle, and exposure trajectories, the development of disease, and risk factors over time.MethodsWe utilized a scenario-based questionnaire in the Swiss Health Study pilot phase (2020–2021), involving 1349 adults aged 20–69 from the cantons Vaud and Bern. We conducted descriptive statistics supported by R and qualitative content analysis of n = 374 open responses related to attitudes towards research.ResultsWe highlight the benefits and challenges of the scenario-based approach, discuss the sample represented in the pilot phase, and present implications for building a full cohort. We also report on participants’ attitudes towards and previous experience with health research. We analyze references regarding informed consent and feedback, attitudes towards the Swiss Health Study, and recommendations on improving its scope, design, and instruments. Results indicate a high interest (90%) in participating in a national health study, with 85% of a random population sample willing to join a long-term cohort. Only 43% were familiar with biobanks, and 44% preferred general consent. Trust was high for Swiss-based public research but lower for researchers from other countries or private sector. Over 95% expressed willingness to complete online questionnaires, undergo physical examination, and donate biosamples. Almost all participants wanted to know the outcomes of the medical tests (99.5%) and the exposure to environmental stressors (95%) from their study center visit. Preferred tools for monitoring sleep, physical activity, and diet were known smartphone apps with automatic data management.ConclusionOverall, the study reveals a positive attitude towards personalized health research, with a strong willingness to share data and samples. Key insights focus the meaning of informed consent for participation, the relevance of sampling and representativeness, as well as the significance and challenges of personalized feedback, especially regarding environmental health concerns. Findings emphasize participants’ supportive yet reflexive stances, underscoring the importance of aligning research values with individual values in personalized health research. These insights contribute valuable considerations for refining the scope, design, and instruments of future cohort studies.

Antibiotic use by clinical presentation across all healthcare providers in rural Burkina Faso: a healthcare visit exit survey.

To guide antibiotic stewardship interventions, understanding for what indications antibiotics are used is essential. In rural Burkina Faso, we measured antibiotic dispensing across all healthcare providers. From October 2021 to February 2022, we surveyed patients in Nanoro district, Burkina Faso, following visits to health centres (3), pharmacies (2), informal medicine vendors (5) and inpatients in health centres. We estimated prevalence of antibiotic use and the proportion of Watch group antibiotics by provider type and by clinical presentation, assessing compliance with WHO's AWaRe Antibiotic Book. We estimated per capita antibiotic use by multiplying prevalence of antibiotic use, mean DDD per adult treatment course, and the rate of healthcare visits per 1000 inhabitants per day, estimated from a prior household survey. Outpatient antibiotic use was more frequent after health centre visits (54.8%, of which 16.5% Watch, n = 1249) than after visits to pharmacies (26.2%, 16.3% Watch, n = 328) and informal medicine vendors (26.9%, 50.0% Watch, n = 349). The frequency of antibiotic use was highest for bronchitis (79.9% antibiotic use, of which 12.6% Watch), malaria (31.9%, 23.1% Watch), gastroenteritis (76.0%, 31.7% Watch), rhinopharyngitis (40.4%, 8.3% Watch) and undifferentiated fever (77.0%, 44.8% Watch). Compliance with WHO AWaRe guidance could have averted at least 68.4% of all Watch antibiotic use in outpatients at health centres. Community-wide, 2.9 DDD (95% CI 1.9-3.9) were used per 1000 adult inhabitants per day. Most Watch antibiotic use at community level or primary care deviated from WHO guidance. Antibiotic stewardship should focus on key clinical presentations and include primary care and self-medication.

Quality of the digital gp visits and characteristics of the users: retrospective observational study

Objectives This study compares the demographics, diagnoses, re-admission rates, sick leaves, and prescribed medications of patients accessing digital general practitioner (GP) visits with those of patients opting for traditional face-to-face appointments in a primary health care setting. Design The study adopted a retrospective analysis of patient record data collected in 2019, comparing visits to a digital primary health center with traditional health center visits. Setting Primary health care. Participants The data encompassed patients who utilized the digital clinic and those who visited public health centers for primary health care services. Main Outcome Measures The study assessed demographics, health diagnoses, prescribed medications, sick leave recommendations, re-admission rates, and differences in costs between digital clinic and face-to-face visits. Secondary outcomes included a comparative analysis of medication categories, resolution rates for health problems, and potential impacts on health care utilization. Results Digital clinic users were typically younger, more educated, and predominantly female compared with health centre users. Digital visits were well-suited for uncomplicated infections, while health centre appointments were associated with a higher prevalence of chronic conditions. Medication patterns differed between the two modalities, with digital clinic users receiving generic over-the-counter drugs and antibiotics, whereas health centre visits commonly involved cardiac and antihypertensive medications. Sick leave recommendations were slightly higher in the digital clinic, but the difference was not significant. Approximately 70% of health problems addressed in the digital clinic were successfully resolved, and the cost of digital visits was about 50,3% of face-to-face appointments. Conclusion Digital health care services offer a cost-efficient alternative for specific health problems, appealing to younger, educated individuals, when compared to the users of public health center, and may enable improvement of cost-effectiveness combined with acceptable demand management and patient segmentation practices. The results highlight the potential benefits of digital clinics, particularly for uncomplicated cases, while also emphasizing the importance of suitable referral mechanisms for in-person consultations.

Feasibility of Home Collection for Urogenital Microbiome Samples.

Feasibility of home urogenital microbiome specimen collection is unknown. This study aimed to evaluate successful sample collection rates from home and clinical research centers. Adult women participants enrolled in a multicentered cohort study were recruited to an in-person research center evaluation, including self-collected urogenital samples. A nested feasibility substudy evaluated home biospecimen collection prior to the scheduled in-person evaluation using a home collection kit with written instructions, sample collection supplies, and a Peezy™ urine collection device. Participants self-collected samples at home and shipped them to a central laboratory 1 day prior to and the day of the in-person evaluation. We defined successful collection as receipt of at least one urine specimen that was visibly viable for sequencing. Of 156 participants invited to the feasibility substudy, 134 were enrolled and sent collection kits with 89% (119/134) returning at least 1 home urine specimen; the laboratory determined that 79% (106/134) of these urine samples were visually viable for analysis. The laboratory received self-collected urine from the research center visit in 97% (115/119); 76% (91/119) were visually viable for sequencing. Among 401 women who did not participate in the feasibility home collection substudy, 98% (394/401) self-collected urine at the research center with 80% (321/401) returned and visibly viable for sequencing. Home collection of urogenital microbiome samples for research is feasible, with comparable success to clinical research center collection. Sample size adjustment should plan for technical and logistical difficulties, regardless of specimen collection site.

통합교육형 순회교육 담당 교사의 역량 탐색

The purpose of this study was to identify educational competencies (competency group - competency element - competency indicator) that itinerant teachers perceive as necessary and important according to the characteristics of inclusive itinerant education in which special education teachers from the Gyeonggi-do Special Education Support Center visit general schools to support students with special needs placed in general classrooms. This study aims to derive implications for future professional development programs to enhance the expertise of itinerant teachers at the Gyeonggi-do Special Education Support Center. To achieve this aim, a draft of the competencies for itinerant teachers was developed by analyzing papers on the competencies of special education teachers and inclusive itinerant education. The validity of these competencies was then verified through two rounds of Delphi expert surveys. Through this process, the necessary competencies for itinerant teachers at the Special Education Support Center were finalized into three competency groups, nine competency elements, and 20 competency indicators. Based on the research results, the structure and components of the final competencies required for itinerant teachers at the Gyeonggi-do Special Education Support Center were discussed; moreover, the differences from the competencies of general special education teachers and the characteristics of inclusive itinerant education conducted by the Gyeonggi-do Special Education Support Center were also considered.

Wealth and education-related inequalities in the utilisation of reproductive, maternal, newborn, and child health interventions within scheduled tribes in India: an analysis of Odisha and Jharkhand

BackgroundThe utilisation of Reproductive, Maternal, Newborn and Child Health (RMNCH) services remains lower among the Scheduled Tribes (ST) in India than among the rest of the country’s population. The tribal population’s poorest and least-educated households are further denied access to RMNCH care due to the intersection of their social status, wealth, and education levels. The study analyses the wealth- and education-related inequalities in the utilisation of RMNCH services within the ST population in Odisha and Jharkhand.MethodologyWe have constructed two summary measures, namely, the Co-coverage indicator and a modified Composite Coverage Index (CC), to determine wealth- and education-related inequalities in the utilisation of RMNCH indicators within the ST population in Odisha and Jharkhand. The absolute and relative inequalities with respect to wealth and education within the ST population are estimated by employing the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).ResultsThe results of the study highlight that access to RMNCH services is easier for women who are better educated and belong to wealthier households. The SII and RII values in the co-coverage indicator and modified CCI exhibit an increase in wealth-related inequalities in Odisha between NFHS-4 (2015-16) and NFHS-5 (2019-21) whereas in Jharkhand, the wealth- and education-related absolute and relative inequalities present a reduction between 2016 and 2021. Among the indicators, utilisation of vaccination was high, while the uptake of Antenatal Care Centre Visits and Vitamin A supplementation should be improved.InterpretationThe study results underscore the urgent need of targeted policies and interventions to address the inequalities in accessing RMNCH services among ST communities. A multi-dimensional approach that considers the socioeconomic, cultural and geographical factors affecting healthcare should be adopted while formulating health policies to reduce inequalities in access to healthcare.

Gut microbial diversity and functional characterization in people with alcohol use disorder: A case-control study.

Individuals with Alcohol Use Disorder (AUD) typically have comorbid chronic health conditions, including anxiety and depression disorders, increased sleep disruption, and poor nutrition status, along with gut microbial dysbiosis. To better understand the effects of gut dysbiosis previously shown in individuals with AUD, gut microbiome and metabolome were investigated between three cohorts. Two groups of individuals with AUD included treatment-seeking newly abstinent for at least six weeks (AB: N = 10) and non-treatment-seeking currently drinking (CD: N = 9) individuals. The third group was age, gender, and BMI-matched healthy controls (HC: N = 12). Deep phenotyping during two weeks of outpatient National Institutes of Health Clinical Center visits was performed, including clinical, psychological, medical, metabolic, dietary, and experimental assessments. Alpha and beta diversity and differential microbial taxa and metabolite abundance of the gut microbiome were examined across the three groups. Metabolites derived from the lipid super-pathway were identified to be more abundant in the AB group compared to CD and HC groups. The AB individuals appeared to be most clinically different from CD and HC individuals with respect to their gut microbiome and metabolome. These findings highlight the potential long-term effects of chronic alcohol use in individuals with AUD, even during short-term abstinence.

Hubungan Motivasi dan Dukungan Keluarga dalam Pengendalian Hipertensi dengan Tekanan Darah pada Pasien Hipertensi

Hypertension is a non-communicable disease which is the main factor causing various diseases such as stroke, heart and kidney. Based on data from the Andalas Health Center, it was found that there were 203 hypertension patients in April 2023. A survey conducted on hypertensive patients aged 40-60 years found 4 people with uncontrolled blood pressure (> 140/80 mmHg) and 2 people with controlled blood pressure (≤140/80 mmHg), 4 people who still consume fatty foods regularly excessive daily and 2 respondents who have reduced consumption of fatty foods, 4 people who consume excessive sodium and 2 people who have reduced sodium consumption, 4 people who diligently eat vegetables 4-5 times a week and 2 people who rarely eat vegetables in a week , 5 people who have no desire to exercise in a week and 1 respondent who has a desire to exercise every week. Furthermore, 3 hypertensive patients who are always reminded by their families in controlling hypertension and 3 people who are rarely reminded to control their hypertension, such as taking regular medication and managing their diet. The research objective was to determine the relationship between motivation and family support in controlling hypertension and blood pressure in hypertensive patients in the Andalas sub-district, the Andalas Health Center in 2023. The research design was a cross-sectional study. The study was conducted from October 2022 to July 2023. The study population was all hypertension patients who were registered at the Andalas Health Center visit in the Andalas sub-district, consisting of 68 people. All populations are used as research subjects. Data collection was carried out by interviewing questionnaires and direct measurements. Univariate data analysis using descriptive statistics in the form of frequency and percentage distributions, bivariate analysis using the chi-square test.

DOMINANT RISK FACTORS FOR THE INCIDENCE OF “ACUTE RESPIRATORY INFECTION” “ARI” IN TODDLERS

Background: Acute Respiratory Infection (ARI) is a contagious illness affecting diverse age groups, including toddlers, and is among the top ten reasons for Community Health Center visits. Purpose: This study aims to analyze the influence of dominant risk factors on the incidence of ARI in toddlers. Methods: This study used an observational, analytic-cross sectional approach, at Puskesmas Kampung Lalang, Medan, in 2023. The total population was 394 toddlers (aged 0-59 months). In the determination of the number of samples using the sample size estimation formula, 198 samples were obtained by purposive sampling. Data analysis used Chi-Square test and Multiple Logistic Regression Enter Methods, with a significance level of 95%. Results: The results showed that the variables of Vitamin A administration (OR = 0.27, 95% CI: 0.10-0.77) and immunization status (OR = 0.36, 95% CI: 0.14-0.93) were associated with a decreased risk of ARI in toddlers. In contrast, exclusive breastfeeding (OR = 2.35, 95% CI: 1.11-5.01) was associated with increased risk, while the physical environment of the house (OR = 2.92, 95% CI: 1.28-6.64) was associated with increased risk of ARI. Conclusion: Vitamin A administration and immunization reduce the risk of respiratory tract infection among under-fives at Puskesmas Kampung Lalang. Exclusive breastfeeding and home conditions increased the same risk. Improving these risk factors is essential to reduce the prevalence of childhood respiratory infections in the area.

EXPRESS: Spring Forward = Fall Back? the Effect of Daylight Saving Time Change on Consumers’ Unhealthy Behavior

Prior research documents deleterious consequences of the annual clock change to daylight saving time in many contexts, but little is known about the effect the policy has on consumer behavior. While policy debates around ending seasonal clock changes continue, millions of consumers worldwide are potentially adversely affected by the time change. Drawing on the notions of sleepiness and self-control, the authors propose a framework of how the onset of daylight saving time increases unhealthy behavior. The hypotheses are tested via two studies cast in the difference-in-differences modeling framework capturing consumption before and after the time change and across consumers who experience the transition versus who do not. Results of the first study suggest that the onset of daylight saving time increases calorie consumption from packaged snacks that are largely unhealthy, specifically in the evening and on cloudy days. The effect of the end of daylight saving time is not significant, suggesting an overall asymmetric effect of the time change on unhealthy behavior. Study 2 reveals that the onset of daylight saving time decreases fitness center visits, particularly for consumers without healthy consumption habits and with high transaction costs. Analysis of social media data suggests that consumers find the time change disruptive. Overall, the findings imply that public policy makers and businesses should find ways to support consumers around the onset of daylight saving time.

Access to Mental Health and Substance Use Treatment in Comprehensive Primary Care Plus

To meet increasing demand for mental health and substance use services, the Centers for Medicare & Medicaid Services launched the 5-year Comprehensive Primary Care Plus (CPC+) demonstration in 2017, requiring primary care practices to integrate behavioral health services. To examine the association of CPC+ with access to mental health and substance use treatment before and during the COVID-19 pandemic. Using difference-in-differences analyses, this retrospective cohort study compared adults attributed to CPC+ and non-CPC+ practices, from January 1, 2018, to June 30, 2022. The study included adults aged 19 to 64 years who had depression, anxiety, or opioid use disorder (OUD) and were enrolled with a private health insurer in Pennsylvania. Data were analyzed from January to June 2023. Receipt of care at a practice participating in CPC+. Total cost of care and the number of primary care visits for evaluation and management, community mental health center visits, psychiatric hospitalizations, substance use treatment visits (residential and nonresidential), and prescriptions filled for antidepressants, anxiolytics, buprenorphine, naltrexone, or methadone. The 188 770 individuals in the sample included 102 733 adults (mean [SD] age, 49.5 [5.6] years; 57 531 women [56.4%]) attributed to 152 CPC+ practices and 86 037 adults (mean [SD] age, 51.6 [6.6] years; 47 321 women [54.9%]) attributed to 317 non-CPC+ practices. Among patients diagnosed with OUD, compared with patients attributed to non-CPC+ practices, attribution to a CPC+ practice was associated with filling more prescriptions for buprenorphine (0.117 [95% CI, 0.037 to 0.196] prescriptions per patient per quarter) and anxiolytics (0.162 [95% CI, 0.005 to 0.319] prescriptions per patient per quarter). Among patients diagnosed with depression or anxiety, attribution to a CPC+ practice was associated with more prescriptions for buprenorphine (0.024 [95% CI, 0.006 to 0.041] prescriptions per patient per quarter). Findings of this cohort study suggest that individuals with an OUD who received care at a CPC+ practice filled more buprenorphine and anxiolytics prescriptions compared with patients who received care at a non-CPC+ practice. As the Centers for Medicare & Medicaid Innovation invests in advanced primary care demonstrations, it is critical to understand whether these models are associated with indicators of high-quality primary care.

Temporal and spatial patterns in the prescriptions of disease-modifying therapies for multiple sclerosis. Results from the Italian Multiple Sclerosis and Related Disorders Register

BackgroundThe therapeutic scenario in multiple sclerosis (MS) has evolved over recent years with the progressive introduction of new drugs focused to better balance efficacy, safety and management requirements. The objective of this study was to examine the prescribing patterns of disease-modifying therapies (DMT) over time and across different geographic areas, and the latency between disease onset, first Register center visit, disease diagnosis, and the start of treatment in a large cohort of persons with MS from the Italian Multiple Sclerosis and Related Disorders Register. MethodsUp to 2022, the Register collected data from 124 centers on more than 78,000 persons, of whom 56,872 received at least one DMT prescription. Beside baseline demographic and clinical characteristics, we focused on DMT according to their efficacy distinguishing between moderate-efficacy (ME), or high-efficacy (HE). ResultsThere was a higher probability of prescribing HE-DMT for increasing calendar years (multivariable odds ratio, OR=11.51 in 2021 or thereafter vs before 2000), in males (OR=1.08 vs females), patients with primary progressive with or without relapse (OR=3.00 vs clinically isolated syndrome), those with a higher Expanded Disability Status Scale score (OR=3.85 for >4 versus 0–1), and those from larger referral centers (OR=1.89 vs smaller ones). Conversely, higher age at onset was associated to a lower probability of prescribing HE-DMT (OR=0.74 at 40 or more vs <20 years). A trend to shorter times was observed in subsequent calendar years for disease onset, first center visit, diagnosis and first DMT prescription. No trend was detected based on the location of the geographic referral centers. The times between disease onset, first center visit, and diagnosis and the first DMT prescription showed significant decreases according to the year, while differences were less evident for the geographic areas. ConclusionThis study highlights some factors influencing the choice of HE-DMT, including aspects of both healthcare and clinical phenotype. The absence of a geographic pattern may indicate some homogeneity in DMT prescriptions across different Italian MS centers.

The comparison of spatial patterns and factors associated with healthcare provider knowledge in palliative care in various regions of China

As an integral part of the overall life cycle, it is crucial to ensure equity and accessibility to palliative care services at the end of life. The knowledge of healthcare providers has a significant beneficial impact on the quality of palliative care services. This study aimed to compare the nationwide geographic distribution of healthcare providers’ knowledge of palliative care at the provincial level in China and identify the possible factors associated with its geographic disparities. A descriptive cross-sectional study was conducted in all provinces (n = 29) that implemented palliative care pilot programs in China. Data were collected online using a structured questionnaire. The possible factors associated with healthcare providers’ knowledge including economy, demographics, and health, were explored by using exploratory regression and ordinary least squares. In addition, spatial autocorrelation was also examined with Moran’s I, LISA, and Geographically Weighted Regression. A total of 18,272 participants from 903 health institutions in 87 palliative care pilot cities were included across 29 out of 31 provinces in China. The average knowledge score (mean ± standard deviation [SD]) was 8.61 ± 2.85. A positive spatial correlation was observed in healthcare providers’ palliative care knowledge level in China. The high level of knowledge was significantly associated with fewer hospitals per 10,000 population (β = −0.384, 95% CI: −0.601 to −0.168, p = 0.001), more primary healthcare institutions per 10,000 population (β = 0.220, 95% CI: 0.032–0.407, p = 0.024), and more community health center visits (β = 0.259, 95% CI: 0.054–0.465, p = 0.016), with higher coefficients being observed in the northwest and northeast regions. This study suggested that the knowledge level of palliative care among healthcare providers nationwide was relatively low, indicating the existence of a disparity between the supply and demand of palliative care services. There may be regional disparities in palliative care services based on the substantial geographical variation in healthcare provider knowledge, emphasizing the necessity of tailored interventions targeting areas with the greatest need.

Faktor Risiko Katarak di Wilayah Kerja Puskesmas Astambul, Kabupaten Banjar, Kalimantan Selatan, Indonesia

Background. Indonesia has the highest prevalence of blindness in Southeast Asia; 81.2% are caused by cataracts. The prevalence of cataract blindness in South Kalimantan was 87.9%. Risk factors for cataracts include age, sex, comorbidities, such as diabetes mellitus and hypertension, steroid use, history of smoking, and exposure to ultraviolet radiation. This study aims to determine the risk factors and incidence of cataracts in the area of Astambul Community Health Center. Method. An observational analytical study with a cross-sectional approach. Primary data from January-February 2023 was collected from health center, posbindu and elderly posyandu visits. The data was analyzed with a chi square test. Results. p-value for age was p=0,046, gender p=0,251, occupation p=0,027, diabetes mellitus p=0,028, and hypertension p=0,023. Conclusion. A significant relationship between cataract incidence and age, diabetes mellitus, hypertension, and occupation. There is no significant relationship between cataract incidence and gender.

Teaching stress reduction techniques including biofeedback for managing stress in medical students

IntroductionMedical students have been under immense pressure throughout their studies, impacting their mental health and academic performance. Stress reduction is a fundamental skill that all students require to manage their studies and lives efficiently. Biofeedback devices providing information about physiological states have been shown to aid stress reduction. Methods to reduce stress should be taught to medical students to help them tackle the challenges of medical school.ObjectivesOur goal was to teach stress reduction methods such as extracurricular activities and paced breathing aided by biofeedback training and its application in simulated healthcare situations to medical students.Methods15 medical students who completed medical physiology were recruited for an elective course of 7 sessions on practical techniques in stress management. One credit was offered to those who completed the course requirements consisting of participation in sessions and individual biofeedback training. Sessions (classes) consisted of presentations on good sleeping and eating patterns, group simulations of stressful hospital environments, visiting a science centre with interactive displays, an orchestra performance, and nature walks. Before biofeedback training, heart and respiration rates were taken individually by a biofeedback device during the first week of the course. Data was processed using a code created in statistical software. Heartbeats per minute and heart rate variability (HRV) for every 10 seconds were calculated and plotted on a graph. Two measurements were taken with each student: a baseline measurement for 10 minutes and another measurement during controlled breathing paced at 6 breaths per minute for 15 minutes, of which the first 10 minutes were used for calculation and plotting. Students provided narrative feedback in an essay submitted after the course was completed.Results5 males and 10 females from years 2-5 registered for the elective, and 12 participated in individually scheduled sessions. Heart beats per minute decreased, whereas HRV increased during paced breathing sessions in 83% of them. Most students reported feeling calm and drowsy during the sessions, and 2 students fell asleep by the end.Feedback from 11 students showed that the music session and the science centre visit were the highlights throughout the elective. Improvements recommended were to have a consistent time slot for all sessions and fewer simulations.Conclusions In concert with the literature, biofeedback training seems to be a feasible and effective method for relaxation in medical students. This method could be offered as part of mental health services for students. Data could be used to follow students’ progress and identify those requiring extra support. Providing them with avenues to de-stress while emphasizing activities outside medicine could boost their confidence and improve their coping skills.Disclosure of InterestNone Declared