Clinic Clients Research Articles

Current tobacco use and COVID-19 diagnoses in a cohort of adult clients of public dental clinics in Sweden

Smoking has been linked with both increased and decreased risk of COVID-19, prompting the hypothesis of a protective role of nicotine in the pathogenesis of the disease. Studies of the association between use of smokeless tobacco and COVID-19 would help refining this hypothesis. We analysed data from 424,386 residents in the Stockholm Region, Sweden, with information on smoking and smokeless tobacco (snus) use prior to the pandemic obtained from dental records. Diagnoses of COVID-19 between February and October 2020 were obtained from health-care registers. We estimated the risk of receiving a diagnosis of COVID-19 for current smokers and for current snus users relative to non-users of tobacco, adjusting for potential confounders (aRR). The aRR of COVID -19 was elevated for current snus users (1.09 ;95%CI = 0.99–1.21 among men and 1.15; 95%CI = 1.00–1.33 among women). The risk for women consuming more than 1 can/day was twice as high as among non-users of tobacco. Current smoking was negatively associated with risk of COVID-19 (aRR = 0.68; 95% CI = 0.61–0.75); including hospital admission (aRR = 0.60; 95% CI = 0.47–0.76) and intensive care (aRR = 0.43; 95% CI = 0.21–0.89). The hypothesis of a protective effect of tobacco nicotine on COVID-19 was not supported by the findings. The negative association between smoking and COVID-19 remains unexplained.

The effectiveness of mindfulness group therapy based on cognition in reducing anxiety and increasing the quality of life of couples with delinquent husbands

Aim: The present study was conducted to investigate the effectiveness of cognitive-based mindfulness group therapy on reducing anxiety and increasing the quality of life of couples with delinquent husbands. Method: The current research design was a quasi-experimental pre-test-post-test and follow-up with a control group. The statistical population included all criminals and their spouses who refer to Wasal Psychological and Counseling Clinic during the year 2021. For sampling, the available sampling method is used, 20 couples are selected from the clients of Vesal Psychological and Counseling Clinic and are randomly replaced in the experimental group and the control group. Received the cognitive-based intervention and no intervention was provided to the members of the control group. Before and after the implementation of the intervention, Beck's anxiety questionnaire (Beck et al., 1990) and quality of life (World Health Organization group, 1998) were completed by the sample group. Result: The results of repeated measurement variance analysis showed that in the post-test and follow-up stages, the anxiety of women with delinquent husbands in the experimental group compared to the control group showed a significant decrease (F = 89.74, P = 0.001) and the quality of life of the experimental group compared to the control group. The evidence of increase (F = 110.31, P = 0.001) was found significant. Conclusion: The findings of the research confirm that it is important that mindfulness group therapy based on reducing anxiety reduces the marital conflicts of couples with delinquent spouses.

The burden of TB/HIV co-infection among clients attending DOTs clinic in a tertiary centre in Southwestern, Nigeria: A 5-year retrospective study.

Tuberculosis (TB) and human immunodeficiency virus (HIV) are closely correlated and continue to cause deleterious effects in co-infected patients. This study aimed to determine the prevalence and associated factors of TB/HIV co-infection among directly observed treatment short-course (DOTs) clinic clients in Ogun State, Nigeria. The TB register and treatment cards of patients that visited the DOTs centre in Federal Medical Centre Abeokuta between January 2015 and December 2019 were reviewed. A total of 726 TB patients' records were reviewed, among which 186 (22.5%) were co-infected with HIV. TB/HIV co-infection was significantly associated with the ⩽19 years age group 54 (37.2%), females 85 (26.7%), divorced and separated 8 (34.8%), rural residents 18 (34.0%), those who had no formal education 53 (39.8%) and the unemployed 63 (31.7%). Gender and educational status remained significant predictors of TB/HIV co-infection after adjustment for confounding factors. Gender-sensitive programming and interventions geared towards improving knowledge of TB and HIV using a wide array of approaches should be considered.

Treatment and Partner Notification Outcomes for Clients Diagnosed With Chlamydia and Gonorrhea Through GetCheckedOnline Compared With Sexually Transmitted Infection Clinics in British Columbia, Canada.

ABSTRACT Background Whether treatment, engagement in partner notification (PN), and PN outcomes differ between clients of internet-based and clinic-based testing services is poorly understood. We compared these outcomes between people diagnosed with chlamydia and/or gonorrhea (CT/GC) through a sexually transmitted infection (STI) clinic service and GetCheckedOnline GCO), an internet based testing service in British Columbia (BC). Methods We conducted a retrospective matched cohort study among CT/GC cases where each case diagnosed through GCO in 2016-2017 was matched to two STI clinic cases by diagnosis, gender, age group, and specimen collection date. Data was collected through chart review with outcomes compared using appropriate statistical tests. Results Of 257 GCO and 514 matched clinic cases, case treatment was high and did not differ between GCO (254/257, 98.9%) and clinic (513/514, 99.8%) cases, as was engagement in partner notification (250/257 (97.2%) vs. 496/514 (96.5%)). There was no difference in the proportion of notified partners between GCO (159/270, 58.9%) and clinic cases (253/435, 58.2%) although a greater proportion of partners reported by clinic cases were notified by STI nurses (43/435, 9.9%) vs. GCO cases (6/270, 2.2%). Conclusions GCO clients diagnosed with CT/GC demonstrated similar treatment uptake and engagement in PN to clinic clients, and PN outcomes did not differ. The greater reliance on STI clinic nurses for partner notification among clinic clients may be related to having had an initial in-person testing visit.

Assessing the sustainability of the Systems Analysis and Improvement Approach to increase HIV testing in family planning clinics in Mombasa, Kenya: results of a cluster randomized trial

BackgroundIn Kenya, HIV incidence is highest among reproductive-age women. A key HIV mitigation strategy is the integration of HIV testing and counseling (HTC) into family planning services, but successful integration remains problematic. We conducted a cluster-randomized trial using the Systems Analysis and Improvement Approach (SAIA) to identify and address bottlenecks in HTC integration in family planning clinics in Mombasa County, Kenya. This trial (1) assessed the efficacy of this approach and (2) examined if SAIA could be sustainably incorporated into the Department of Health Services (DOHS) programmatic activities. In Stage 1, SAIA was effective at increasing HTC uptake. Here, we present Stage 2, which assessed if SAIA delivery would be sustained when implemented by the Mombasa County DOHS and if high HTC performance would continue to be observed.MethodsTwenty-four family planning clinics in Mombasa County were randomized to either the SAIA implementation strategy or standard care. In Stage 1, the study staff conducted all study activities. In Stage 2, we transitioned SAIA implementation to DOHS staff and compared HTC in the intervention versus control clinics 1-year post-transition. Study staff provided training and minimal support to DOHS implementers and collected quarterly HTC outcome data. Interviews were conducted with family planning clinic staff to assess barriers and facilitators to sustaining HTC delivery.ResultsOnly 39% (56/144) of planned SAIA visits were completed, largely due to the COVID-19 pandemic and a prolonged healthcare worker strike. In the final study quarter, 81.6% (160/196) of new clients at intervention facilities received HIV counseling, compared to 22.4% (55/245) in control facilities (prevalence rate ratio [PRR]=3.64, 95% confidence interval [CI]=2.68–4.94). HIV testing was conducted with 60.5% (118/195) of new family planning clients in intervention clinics, compared to 18.8% (45/240) in control clinics (PRR=3.23, 95% CI=2.29–4.55). Interviews with family planning clinic staff suggested institutionalization contributed to sustained HTC delivery, facilitated by low implementation strategy complexity and continued oversight.ConclusionsIntervention clinics demonstrated sustained improvement in HTC after SAIA was transitioned to DOHS leadership despite wide-scale healthcare disruptions and incomplete delivery of the implementation strategy. These findings suggest that system interventions may be sustained when integrated into DOHS programmatic activities.Trial registrationClinicalTrials.gov (NCT02994355) registered on 16 December 2016.

Brief Adjustment Scale-6 for Measurement-Based Care: Psychometric Properties, Measurement Invariance, and Clinical Utility.

The Brief Adjustment Scale-6 (BASE-6) was recently developed for measuring general psychological functioning within measurement-based care (MBC). The present study further evaluated psychometric properties, generalizability to race/ethnic populations, and clinical utility of the BASE-6. Three adult samples, Sample 1: online community participants (n = 394); Sample 2: college students (n = 249); Sample 3: outpatient clinic clients (n = 80), were included. The results demonstrated a high level of internal consistency, good test-retest reliability, and convergent validity in all samples. The unidimensional structure of BASE-6 was confirmed and factorial invariance was established across groups. Finally, the BASE-6 captured change over time by demonstrating a large effect size of pre-post treatment changes and significant linear change in multilevel growth modeling. These results support the BASE-6 as a reliable and valid measure regardless of race/ethnicity and can sensitively detect clinical change over the course of the treatment. Thus, the BASE-6 appears to accurately monitor overall psychological adjustment.

Barriers to Accessing Video-Based Telehealth Appointments at a Community Veterinary Clinic During the COVID-19 Pandemic.

ObjectiveTo assess veterinary needs of clients with low socioeconomic status during the COVID-19 pandemic, to explore the impact of the pandemic on marginalized communities, and to understand perceptions regarding barriers and incentives of telehealth appointments as a method to increase care access.Sample205 active Community Veterinary Medicine Clinic clients at Tufts at Tech Community Veterinary Clinic in Worcester, MA.ProceduresThis cross-sectional study used a survey-based method to assess veterinary needs of clients with low socioeconomic status during the COVID-19 pandemic. The survey measured client perceptions regarding potential barriers and incentives of telehealth appointments. Participants were randomly sampled from a list of active clients and completed the survey either by email or over the phone. The survey was available in both English and Spanish. Clients who completed the questionnaire received credit for a free examination.ResultsA total of 205 clients submitted survey responses. Factors affecting access to veterinary care were impacted by the COVID-19 pandemic. Access to reliable internet in the home was reported by 87% (n = 177) of participants. Digital access was correlated with education when controlling for race, income, age, and gender. Education was predictive of comfort with using video-chat (χ2 = 65, df = 24, p ≤ 0.01) and of whether or not clients reported need for assistance for using video-chat (χ2 = 52, df = 18, p ≤ 0.01). Patient education level was significantly predictive of wanting to use telehealth for at least one type of appointment (p ≤ 0.05).Conclusions and Clinical RelevanceThe findings indicate that implementing telehealth services at this Community Medicine Clinic is feasible for much of the active clientele and offers a new avenue to provide veterinary care during times of social distancing restrictions and beyond.

Self-stigma among clients of outpatient psychiatric clinics: A cross-sectional survey.

Self-stigma is common among people with mental disorders. A large body of research has examined associations between self-stigma and sociodemographic, clinical and psychosocial factors but the results are still conflicting. The aim of this study was to describe self-stigma among persons with affective and psychotic disorders and identify sociodemographic and clinical factors associated with experiences of self-stigma. A cross-sectional survey was performed with Finnish clients (N = 898) at 16 psychiatric clinics using self-reported questionnaires. The data were analyzed using descriptive statistics and with one-way and multi-way analysis of variance (ANOVA). The results showed that clients in community settings experience self-stigma (a total mean SSMIS-SF score of 74.8 [SD 22.3]). Having a diagnosis of an affective disorder, having a long history of mental disorder (>16 years) and the severity of depressive symptoms were the key factors associated with experiences of self-stigma. Clients living in community settings should be assessed regularly for depressive symptoms of mental disorders, and interventions should be conducted, especially at an early stage of the illness, to reduce self-stigma. Factors associated with self-stigma should be taken into account in the future development of interventions to reduce stigma.

Development of an Implementation Facilitation Strategy to Link Mental Health Screening and eHealth Intervention for Clients in Ryan White-Funded Clinics in Chicago.

To reduce the impact of depression on people living with HIV, we are implementing a clinic-based behavioral health screener and referral to Optimizing Resilience and Coping with HIV through Internet Delivery, an evidenced-based intervention. We used the Consolidated Framework for Implementation Research to identify contextual barriers and facilitators in advance of implementation. Sixteen Chicagoland area Ryan White Medical Case Management sites. We conducted a sequential mixed-methods study with medical case managers and supervisors. Participants completed an online survey assessing Consolidated Framework for Implementation Research domains, scored on a 1 (strongly disagree) to 5 (strongly agree) scale. Survey results informed a purposive sampling frame and interview protocol. Interviews were analyzed by rapid qualitative analysis. On average, survey respondents (n = 58) slightly agreed with positive views of team culture, learning climate, and implementation readiness (mean = 3.80-3.87). Potential barriers included intervention complexity (mean = 3.47), needed human resources (mean = 2.71-3.33), and only slight agreement with relative advantage over existing screening/referral systems (mean = 3.09-3.71). Qualitative results (n = 15) identified low advantage for clinics with robust behavioral health systems but strong advantage in clinics without these services. Respondents identified system-wide training and monitoring strategies to facilitate implementation. Ryan White Medical Case Management sites are a generally favorable context for the implementation of the interventions. As illustrated in an implementation research logic model, barriers will be addressed through deploying strategies proposed to impact clinic- and individual-level outcomes, including electronic prompts (reduce complexity), training on Optimizing Resilience and Coping with HIV through Internet Delivery as a complement to other behavioral health services (increase relative advantage), and feedback during implementation (strengthen rewards/incentives).

Quality of care in a differentiated HIV service delivery intervention in Tanzania: A mixed-methods study

Differentiated service delivery (DSD) offers benefits to people living with HIV (improved access, peer support), and the health system (clinic decongestion, efficient service delivery). ART clubs, 15-30 clients who usually meet within the community, are one of the most common DSD options. However, evidence about the quality of care (QoC) delivered in ART clubs is still limited. We conducted a concurrent triangulation mixed-methods study as part of the Test & Treat project in northwest Tanzania. We surveyed QoC among stable clients and health care workers (HCW) comparing between clinics and clubs. Using a Donabedian framework we structured the analysis into three levels of assessment: structure (staff, equipment, supplies, venue), processes (time-spent, screenings, information, HCW-attitude), and outcomes (viral load, CD4 count, retention, self-worth). We surveyed 629 clients (40% in club) and conducted eight focus group discussions, while 24 HCW (25% in club) were surveyed and 22 individual interviews were conducted. Quantitative results revealed that in terms of structure, clubs fared better than clinics except for perceived adequacy of service delivery venue (94.4% vs 50.0%, p = 0.013). For processes, time spent receiving care was significantly more in clinics than clubs (119.9 vs 49.9 minutes). Regarding outcomes, retention was higher in the clubs (97.6% vs 100%), while the proportion of clients with recent viral load <50 copies/ml was higher in clinics (100% vs 94.4%). Qualitative results indicated that quality care was perceived similarly among clients in clinics and clubs but for different reasons. Clinics were generally perceived as places with expertise and clubs as efficient places with peer support and empathy. In describing QoC, HCW emphasized structure-related attributes while clients focused on processes. Outcomes-related themes such as improved client health status, self-worth, and confidentiality were similarly perceived across clients and HCW. We found better structure and process of care in clubs than clinics with comparable outcomes. While QoC was perceived similarly in clinics and clubs, its meaning was understood differently between clients. DSD catered to the individual needs of clients, either technical care in the clinic or proximate and social care in the club. Our findings highlight that both clinic and DSD care are required as many elements of QoC were individually perceived.

Comorbid psychiatric disorders in children and adolescents with attention deficit hyperactivity disorder: A descriptive analytic study

Background. Psychiatric studies are influenced by geographical conditions and research methods. Among them, the use of diagnostic tools may cause controversy over the results of studies on psychiatric disorders as such ADHD. The aim of this study was to investigate comorbid psychiatric disorders in children and adolescents with attention deficit hyperactivity disorder. Methods. In this study, 400 children and adolescents with ADHD were selected from the clients of Razi and Sharif Hospital Psychiatric Clinic. For sample selection, a demographic questionnaire and semi-structured diagnostic interview (K-SADS-PL) were utilized to evaluate the presence of psychiatric disorders. The duration of the project was 4 months. Results. The mean age of the patients was 9.16±2.46 years and the highest frequency was in the age group of 6 to 9 years (63%). Of the 400 patients studied, 73.3% were boys. The highest frequency of education was related to preschool (61.5%). A history of ADHD was positive in 10.8% in the father, 2.3% in the mother and 3.8% in both parents. Also, 9.5% of patients had a history of ADHD in their brother and 4% had a positive history of ADHD in their sister. The most common psychiatric disorder in the present study was oppositional defiant disorder (92%). One comorbid disorder was identifiable in more than 54% of participants. Conclusion. The most common psychiatric disorder in children with ADHD includes oppositional defiant disorder, which is more common in boys, although no significant differences was founded in terms of sex and age. Practical Implications. Findings of this study suggest that the clinicians, child psychologists and psychiatrists ought to take into consideration the probability of comorbid disorders with ADHD, since failing to consider them might directly influence the quality and quantity of treatments utilized.

Willingness to consider and to pay for a variety of telehealth services amongst adult hearing clinic clients

Objective To examine willingness to consider and to pay for various one-to-one telehealth appointments and online group training/information sessions amongst hearing service clients interested in future telehealth. Design Online survey exploring telehealth usage and attitudes more broadly. Study sample One-hundred-and-sixty-eight (39.8%) of the 422 survey respondents who answered the question were interested in future hearing-related telehealth. Data were analysed for the 148 providing demographic information. Results At least some respondents were interested in each type of one-to-one appointment (∼30–60% for most types) and group training/information session (∼30–50% for most types). Some inconsistent associations were found between willingness to consider individual appointment types and a metropolitan location, younger age, and female gender. Associations with having a hearing device fitted may have been influenced by the different needs of those without devices. Younger respondents were more likely to consider a wide range of appointment types. Being younger was associated with an interest in 7 of the 9 different group session types. The acceptable price range was AUD$30–$86 (USD$22–$62) (n = 129) for one-to-one appointments and AUD$47–$103 (USD$34–$73) for three group sessions (n = 99). Conclusions Despite additional communication needs, hearing service clients have a strong interest in a range of individual and group telehealth services.

Satisfaction with HIV care: Comparative assessment between HIV clients in community pharmacies and specialty clinics in Rivers State Nigeria

Background: Decentralization is a major HIV care strategy that was implemented in 2016 with the aim of improving the availability and accessibility of HIV care by devolving HIV care services from tertiary health facilities to peripheral centres such as HIV community pharmacies (CP). Aim: This study assessed and compared the satisfaction of stable HIV clients receiving services at community pharmacy and specialist HIV clinic. Patients, Materials and Methods: Comparative cross-sectional study design involving 174 clients in CP and 174 clients in specialty clinics (SCs) in Rivers State, Nigeria was used. Clients’ satisfaction was measured using patient satisfaction questionnaire and dichotomized into satisfied and not satisfied. Chi-square test was used for the analysis of “strongly agree” and “agree” responses while Mann–Whitney U test was used to compare client’s satisfaction between facilities. Results: Clients attending CP showed higher mean ranks compared to SCs in the general satisfaction (P < 0.001) and financial aspect (P < 0.001) domains while the SCs clients demonstrated higher mean in the interpersonal manners (P = 0.012) and time spent with providers (P < 0.001). Overall, 65.5% and 72.3% of participants were satisfied with HIV care in SCs and CP respectively with a gap of 6.8% in favour of CP (P = 0.117). Conclusion: The study found a higher level of overall client satisfaction for HIV care services received at CP compared to the SCs. These findings emphasize the need for confirmation of this hypothesis using analytic design to inform further decentralization to the remaining Local Government Areas in Rivers State.

Veterinary care deserts: what is the capacity and where is it?

Introduction: Access to veterinary care is a complex issue that lies at the intersection of socioeconomics, culture, and space. Although there has been substantial research that has explored factors that impede access to care, the issue has not been well addressed from a geographic perspective. Access deserts is a familiar concept that has been applied to human health care, access to nutritious foods, etc. Thus, there is value in conceptualizinsg access to veterinary care through the same lens. This research aims to advance the effort of identifying veterinary care deserts by specifying normative values for two fundamental parameters: the ratio of care providers to measures of the population and the catchment of clinics. Methods: Total employees at veterinary clinics were aggregated at the county level and normalized by different measures of human and companion animal population. All clinic employees are included under the assumption that increased support staff increases the overall care capacity. Weighted means were generated and reported for each approach. The number of veterinary clinic employees needed in each county in order to reach the weighted mean for the overall country is also reported both at the county level and state level. Clinic catchment was measured by evaluating the mean distance traveled using data from a large number of clinics and clinic clients. The data were further analyzed using Rural Urban Commuting Areas (RUCA) classifications. Results: Veterinary employee shortages were observed ranging from 20,000 to 60,000 employees depending on how the data are viewed. Parameters for the weighted mean number of employees were reported in a detailed chart. Results of the distance analysis indicate that most people travel between 2 and 6 miles to reach clinics. Conclusion: This research indicates spatial disparities in the distribution of veterinary staff. The parameters of the ratio of employees to population measures and distance traveled can both be used in future research that aims to identify local and regional veterinary care deserts. This analysis could be further enhanced by the addition of factors such as socioeconomic data or social determinants of health to further define and identify care deserts.

OBESIDAD INFANTIL, CONOCIMIENTOS Y ACTITUDES MATERNAS EN UN CENTRO DE ATENCION PRIMARIA DE SALUD DE LA PROVINCIA DE JUJUY

Introduction: worldwide, obesity is a prominent manifestation of malnutrition among children. Objectives: to determine the nutritional status of children and to evaluate maternal knowledge and attitudes regarding childhood obesity, among clients of a Primary Health Care Clinic (PHC) in a locality of the lowland regions of the province of Jujuy. Methods: a questionnaire was administered to 100 mothers of children 2 to 5 years of age, attending the healthy children control program in a PHC. During October-November 2014 we obtained information regarding sociodemographic factors, maternal knowledge and attitudes regarding childhood obesity and measures of children's weight and height. We calculated children's body mass index (BMI) with the World Health Organization's standards. Results: 83% of the children had normal nutritional status, 6% had overweight and 8% had obesity. Among mothers, 60% did not acknowledge that excess weight can cause diabetes, only 1% perceived that their children were "fat" and 72% reported that their children were 'active"; 85% of the mothers considered important for their children to be active, 89% agreed with the statement "if a child eats normally, it is not important to be physically activite in order to be healthy", and 64% agreed with the statement "a fat child is a health child". Conclusions: Our results indicate a high prevalence of excess weight among children and a considerable level of inadequate maternal knowledge and attitudes regarding childhood obesity. There is a need to implement health education interventions to strengthen maternal abilities. Key words: childhood obesity; maternal knowledge and attitudes; primary health care setting; Argentina.

Застосування інструментів цифрового маркетингу для підвищення ефективності підприємницької діяльності

Abstract. Introduction. The advantages of digital marketing include better audience coverage, the ability to collect clear and detailed data, flexible approach, interactivity, lack of territorial restrictions in the implementation of marketing ideas, easy access to resources, real-time marketing management. Purpose. The purpose of the study is to substantiate and develop theoretical and practical principles of using digital marketing tools to improve business efficiency. Results. Based on the analysis of the definitions of "digital marketing", our own definition is proposed: it is the marketing of goods and services through digital channels and tools in virtual and real environments for effective interaction with existing and potential consumers. The main trends in digital marketing include the growing popularity of video content, social networks and messengers such as promotion channels, multi-channel marketing, working with "big data", mobile content and more. Based on the review of trends in educational content and requests of the generation of "millennials" for information, it was found that the medical center "Gold Clinic" should develop its digital information platforms in the direction of filling with relevant content, providing different formats of content, providing it in real time time. Conclusions. Gold Clinic lags behind in terms of number of views, number of pages viewed and time spent on the site, as well as in terms of visibility on the Internet. Therefore, now content marketing and search engine optimization should become strategic priorities to improve the efficiency of digital marketing of the enterprise. Thus, in order to personalize the content for clients of the Gold Clinic, it is advisable to use modern technologies such as artificial intelligence, machine learning, decisionmaking based on the analysis of "big data", augmented reality and more.

Smartphone-based active vaccine safety surveillance (SmartVax) at a Swiss adult vaccination clinic - a pilot study.

Post-licensure surveillance of adverse events following immunisation (AEFI) is critical for detecting rare but severe AEFI. SmartVax software, using smartphone technology, actively solicits reports of AEFI via automated, opt-out SMS surveys to vaccine recipients in the days following immunisation. We report on a pilot study to test the feasibility and acceptance of SmartVax in Switzerland. Between February and September 2020, consecutive subjects immunised at an adult immunisation clinic and the employee health service at the University Hospital of Basel were screened. Participants included three subgroups: healthcare workers (HCW), subjects with immune-mediated inflammatory diseases (IMID) and clients of the regular adult immunisation clinic. Three days after vaccination, participants received an SMS inquiring if they had any AEFI. In the case of an AEFI, subjects received an automated SMS with a link to an online survey assessing the type and temporal evolution of the AEFI. Descriptive statistics of response rate, time-to-response, frequency and type of AEFI by vaccine and clinical subgroup were performed. Of 293 subjects screened, 276 were included (46.6% routine vaccination check-up visits, 33.3% HCW, 20.1% IMID patients) receiving 625 vaccinations during 360 immunisation visits. The SMS response rate was high (90.3%), with a median time-to-respond of 47 minutes (interquartile range11-205). After 29.8% of immunisation visits at least one AEFI was reported. There were no differences in frequency or type of AEFI between the three clinical subgroups. The recombinant, adjuvanted zoster vaccine Shingrix® was associated with the highest rate of local and systemic reactions. Monitoring post-licensure vaccine safety using the active SMS-based surveillance system SmartVax is feasible in Switzerland. We observed a high acceptance in the diverse study population, including healthcare workers and IMID patients. High response rates in the elderly and reliable monitoring almost in real-time make SmartVax a promising tool for COVID-19 vaccine safety monitoring.

The impact of COVID-19 lockdown on the well-being of clients of a specialist personality disorder service.

ObjectiveThe aim of this study was to investigate the well-being of people with severe borderline personality disorder (BPD) during the first wave of COVID-19 social restrictions.MethodClients of an outpatient specialist personality disorder clinic (n = 77) were invited to the study. An online survey was conducted including a range of open-ended questions exploring well-being and the Coronavirus Anxiety Scale (CAS) which assesses ‘coronaphobia’. Qualitative data were analysed using inductive content analysis with NVivo software. CAS data were analysed descriptively using SPSS version 25.ResultsThirty-six surveys were completed (48% response rate). Many participants experienced significant challenges to their overall well-being during lockdown although some reported improvements in psychosocial functioning. Three participants (8.3%) experienced clinically significant ‘coronaphobia’.ConclusionThe self-reported physical and mental health of participants with BPD demonstrated resilience, suggesting that the capacity to maintain treatment via telehealth helped to mitigate many of the adverse aspects of social restrictions. This study was conducted during the first wave of social restrictions; subsequent studies will reveal longer-term effects of extended community lockdowns.

Simulation of the effect of low-cost companion animal clinics on the market for veterinary services.

To understand the market dynamics of companion animal veterinary services through the simulation of willingness to pay and willingness to wait as consumer behavior attributes. Numerical distributions for the willingness to pay and willingness to wait of simulated potential clients of companion animal clinics. Simulations were run by use of numerical distributions to create demand curves and analyze market dynamics across 2 market segments (price sensitive and price insensitive) and different price dispersion between clinics. The simulations suggested that the profit-maximizing price of a full-service clinic created a natural segmentation of the companion animal veterinary market, with a majority of clients coming from the price-insensitive segment. The simulation of 2 clinics (full-service and low-cost) with 2 market segments showed an increase in the overall market for veterinary services when a low-cost clinic was present. In addition, the lower the price charged at the low-cost clinic, the greater the profits for the full-service clinic. The presence of multiple prices for the same services, or price dispersion, in a market increases the overall market value and services more clients. Discouraging low-cost companion animal practices from entering the market decreases efficiency by leaving a population of pet owners unserved and ultimately reduces the overall market for veterinary services and the economic viability of veterinary practices.

Health and Lifestyle, Safety, Relationship and Personality Factors Influence Gender, Sex and Sexuality Issues among Youth—A Case Record Analysis from Youth Mental Health Promotion Clinics in Karnataka, India

Promoting positive identity and seeking early support for gender, sex and sexuality (GSS) issues among youth is vital. Understanding and addressing factors associated withGSS among them is critical. We assessed four-year case records (January 2017–December 2020) of all first visit youth mental health promotion clinic (YMHPC) clients (15–35 years) for factors associated with GSS issues in Karnataka. Overall, prevalence of GSS issues was 1.8% (189/10,340). Increased risk of GSS issues was observed among clients reporting suicidality (AOR = 4.27, 95% CI = 2.70–6.74) and relationship issues (AOR = 3.63, 95% CI = 2.36–5.57), followed by issues of safety (AOR = 2.56, 95% CI = 1.72–3.81), personality (AOR = 2.48, 95% CI = 1.60–3.85), health and lifestyle (AOR = 2.27, 95% CI = 1.77–4.19), smokers (AOR = 2.30, 95% CI = 1.24–4.27), and those who felt depressed (AOR = 2.10, 95% CI = 1.43–3.09) and worthless (AOR = 2.08, 95% CI = 1.28–3.39). Clients aged 21–25 years (AOR = 1.80,95% CI = 1.27–2.54), male (AOR = 1.72, 95% CI = 1.20–2.46) and who had been married (AOR = 2.32, 95% CI = 1.51–3.57) had a higher risk of GSS issues than those aged 15–20 years and other counterparts, respectively. Clients who drank alcohol (AOR = 0.49, 95% CI = 0.30–0.81) had reduced risk of GSS issues. The findings re-iterate the importance of early recognition of factors (essential precursors) of GSS issues among youth. The study highlights the importance of promoting awareness and improving primordial prevention of possible GSS issues in later life. This study has important implications on youth mental health promotion programs, especially in countries like India.