Healthcare Consultations Research Articles

The Ten-Point Treatment Programme: developing and evaluating an easy-read version for people with intellectual disabilities

Purpose People with intellectual disabilities (IDs) typically present with co-occurring communication difficulties. Research indicates that cognitive-linguistic impairment is predictive of poor health literacy, which can preclude individuals from developing a comprehensive understanding of their health, care and treatment needs. People accessing forensic intellectual and developmental disability (FIDD) services are more likely to engage meaningfully in treatment and rehabilitation only if they feel empowered to play active roles in their own care. Delivering proposed treatment programmes in an accessible format, which meets their language needs, is likely to promote this. Design/methodology/approach This paper aims to describe the development and evaluation of an easy read version of the “Ten point treatment programme” within an inpatient FIDD service. An expert panel comprising speech and language therapists and education professionals utilised a quality improvement method to develop this. Patients and staff evaluated this resource and gave feedback through surveys or meetings. The resource was refined based on responses, and a final version produced. Findings The easy-read Ten-Point Treatment programme resource was considered valuable by patients and staff from this service. Research limitations/implications Future research should seek to pilot this resource, to explore alternative multi-modal means of accessible information provision coproduced at every level and to examine ways in which this resource could be incorporated within health-care consultations. Another research direction will be to assess the impact of this resource on comprehension, drawing upon objective, previously validated measures. Practical implications Provision of an easy-read version of the Ten-Point Treatment Programme may support individuals with communication difficulties to understand health and care information relevant to their inpatient admission and may empower them to take more active roles in their treatment pathway. It is important to acknowledge, however, that easy read is not an accessible means of information provision for all individuals with ID and that the empirical evidence for its impact is limited. Originality/value This is the first published attempt to evaluate the acceptability of an easy-read version of the Ten-Point Treatment Programme within an inpatient FIDD service in the UK.

Patterns of psychiatric healthcare use during pandemic times among boys and girls with pre-existing diagnoses: a Norwegian nationwide primary and specialist healthcare registry study

BackgroundThe COVID-19 pandemic introduced complexities that were likely more demanding for some groups, such as children and adolescents, and especially those with pre-existing mental health diagnoses. This study examines long-term patterns of psychiatric healthcare use among this vulnerable group, providing insights into shifts in psychiatric healthcare use during a global health crisis.MethodsWe use data from the primary and specialist healthcare registries available from the Norwegian emergency preparedness register for COVID-19 (Beredt C19) to estimate patterns of psychiatric healthcare use. The data spans 2017 to 2022, covering children and adolescents aged 6–19. We identified young people with recent diagnoses of mental health conditions and compared weekly consultation volumes before and during the pandemic for mental health conditions overall and the following diagnostic or symptom categories separately: anxiety/depression and Attention-Deficit Hyperactivity Disorders (ADHD). Analyses were stratified by gender.ResultsThere was a consistent trend of lower-than-predicted weekly healthcare consultations among young people with pre-existing mental health diagnoses in both primary and specialist healthcare during the pandemic. The reduction was more pronounced in later follow-up periods. The study highlights gender disparities, with boys experiencing more notable declines in healthcare consultations, especially in specialist care. Additionally, the time trends varied across different diagnostic groups. While consultations for anxiety/depression were consistently below the predicted levels, declines in ADHD occurred later in the pandemic. The data suggests an overall decline in healthcare use rather than a shift between sectors.ConclusionThe findings offer insights into healthcare use during pandemic times among children and adolescents with pre-existing mental health diagnoses. The study underscores the importance of continuous monitoring and support for this group, ensuring accessible and responsive healthcare during public health emergencies.

Video classes for adolescent nursing consultations: development and validation.

Create and validate the content of video lessons to support nurses when carrying out adolescent consultations in Primary Health Care. Methodological research carried out in four stages: 1) Exploration, with 83 nurses and two literature narrative reviews; 2) Construction of scripts and storyboards; 3) scripts and storyboards' content validation; 4) Video classes production. Data analysis was conducted using the Content Validity Index. The exploratory stage revealed that 85.5% of nurses carry out consultations with adolescents and 44.6% face difficulties. The most cited topics of interest were legal aspects of care, adolescent consultation, pregnancy and risk assessment in adolescence. In the review carried out with the objective of identifying a script for producing the video lessons, no one was found that met the needs of the study. The other narrative reviews showed that nursing training for adolescent consultations is incipient. 14 expert nurses validated the content with a Content Validity Index above 0.9. Afterwards, a series of four video lessons entitled "Teen talk" was produced. content was validated in terms of objective, structure/presentation and relevance, allowing the video classes to assist in the professional qualification of nurses to carry out consultations for adolescents.

Sources of Information on and Perceptions Related to Infant and Young Child Feeding among Fathers: A Cross-Sectional Study from Southern India

ABSTRACT Introduction: The infant and young child feeding (IYCF) practices determine the well-being of the child. Reliable and updated information is essential to have adequate feeding practices for young children. This also applies to the fathers of children. The sources of information and related factors are crucial in improving paternal IYCF practices. Methodology: This study assessed the perceptions, preferred sources of information of the fathers regarding IYCF, and associated factors. This paper includes a part of the community-based cross-sectional phase from a larger multiphase study carried out among 450 fathers of young children (aged <2 years) in a rapidly developing coastal district of the South Indian State of Karnataka. Data were analyzed using Jamovi software version 2.3.26. Results: The age of the participants ranged from 23 to 56 (mean: 34.6 years +/- 5.4); 46.7% of participants preferred relatives and friends, and 38.9% preferred healthcare providers as sources of information on IYCF. Those residing in predominantly rural areas were more likely to consult health care providers for information on IYCF (OR 3.50 (95% CI 1.98–6.53; P < 0.001)). Also, 77.3% of participants felt weaning must be started after 6 months of age. Nearly half of the participants were aware of the exact nature of food items to be introduced during weaning of their child. Conclusions: A high proportion of the participants felt the need to update their knowledge of IYCF. Nearly one-third of them preferred healthcare providers as a source of information. Participants from predominantly rural areas preferred healthcare providers as compared to those from urban areas.

Suicidal Communication Prior to Suicide in Children and Young Adults-A Medical Records Review in Health Care Services in Sweden.

Suicide among children and young adults is a leading cause of mortality, highlighting the importance of the development of life-saving interventions. This study is part of the nationwide study Retrospective investigation of health care utilization of individuals who died by suicide in Sweden in 2015, Lund University, Sweden. The aim was to gain a better understanding of verbal suicidal communication and suicidal behaviour in children and young adults who die by suicide, to analyse gender and age differences, and to discuss the findings in relation to the prevailing psychological theories of suicidality. The study sample consisted of medical records from final health care consultations of 114 individuals up to 25 years, who died by suicide in Sweden a single year. Suicidal plans were documented in 13 percent of children and young adults. Females were more likely to have a notation of suicidal communication than males. Twenty-seven percent had made previous suicide attempts. Approximately 90 percent of the study cohort had contact with health care settings within 24 months prior to suicide. Questioning about suicidal plans appears to be an insufficient tool to assess suicidality in children and young adults. Clinical implications regarding alternative assessment methods and preventive measures are discussed.

Transparency and Authority Concerns with Using AI to Make Ethical Recommendations in Clinical Settings.

In response to recent proposals to utilize artificial intelligence (AI) to automate ethics consultations in healthcare, we raise two main problems for the prospect of having healthcare professionals rely on AI-driven programs to provide ethical guidance in clinical matters. The first cause for concern is that, because these programs would effectively function like black boxes, this approach seems to preclude the kind of transparency that would allow clinical staff to explain and justify treatment decisions to patients, fellow caregivers, and those tasked with providing oversight. The other main problem is that the kind of authority that would need to be given to the guidance issuing from these programs in order to do the work set out for them would mean that clinical staff would not be empowered to provide meaningful safeguards against it in those cases when its recommendations are morally problematic.

The temporal alignment of mental health consultations across family members: a study of Norwegian adolescents, their parents, and siblings.

Mental health problems among adolescents have become more prevalent in recent years. Parents' and siblings' mental health might be affected by living with a depressed adolescent. This study examines how the mental health of family members develops in the years before and after an adolescent seeks help for depression. Unique Norwegian register data that cover the full population are used to estimate models with individual fixed effects. The development in the probability of mental health consultations for parents and older siblings in families with a second-born adolescent seeking help for depression from a GP for the first time is compared to the respective development in families where the second-born adolescent has not had such health care consultation. Results indicate that adolescents' depression consultations are associated with a simultaneous increase in mental health consultations in parents and siblings. Mothers and fathers are affected similarly, although the effect seems to be short-lived. Siblings experience a short-term increase in mental health consultations, in addition to a steeper long-term increase across the observation period, compared to peers in families where the second-born adolescent does not seek help for depression. Events that might affect the mental health of multiple family members simultaneously, specifically parental breakup and unemployment, did not explain the observed patterns. Help-seeking for mental health problems is temporally aligned across family members. Intra- and intergenerational spillovers might contribute to this.

Enhancing anemia detection through multimodal data fusion: a non-invasive approach using EHRs and conjunctiva images

Anemia detection using multimodal approaches leverages the integration of multiple data sources, such as imaging, clinical records, and hematological parameters, to improve diagnostic accuracy. Such methods can capture the complex interplay of factors contributing to anemia, providing a more comprehensive assessment than traditional single-modality techniques. In this research, a novel deep learning multi-modal feature fusion approach is proposed for the automated detection of anemia using EHRs (Electronic Health Records), and Conjunctiva image dataset. First, EHR records are preporcessed by selecting the most appropriate features using Random Forest. The features from the conjunctiva images are extracted using RCBAM (Reverse Convolution Block Attention Mechanism). After that, GRAD-Cam algorithm is applied to calculate the pixel percentages of all the features. The output of Random Forest and GRAD-Cam algorithms is concatenated to form a multimodal fusion. The important information from the concatenated features is selected with the help of a professional healthcare consultant. The different experiments are performed on textual and image datasets individually and after concatenating. The results show that the proposed model outperforms from state-of-the-art methods with an accuracy of 95%. Despite challenges such as class imbalance and computational demands, our findings reveal substantial clinical potential, offering a patient-friendly and accessible diagnostic solution.

Perception, Usability, and Satisfaction with Telemedicine in the United Arab Emirates.

Background: Telemedicine has become a global tool for enhancing health care accessibility. However, its widespread adoption is still limited by technological illiteracy, lack of appropriate devices, slow internet services, and privacy concerns. In the Middle East and North Africa, including the United Arab Emirates (UAE), there is a dearth of telemedicine research. This study aimed to understand the perceptions and satisfaction levels of the UAE population regarding telemedicine. Methods: Between June and September 2023, a cross-sectional study was undertaken, using an online questionnaire distributed among UAE citizens and residents aged 18 years and above. The survey aimed to gauge the perceptions, usability, and satisfaction levels of telemedicine users, alongside identifying barriers hindering its acceptance. Data analysis was performed using Python 3, using Matplotlib v3.3.4 and Pandas v1.2. Results: The data analysis encompassed 1,013 participants, among whom 66.9% (678/1,013) were familiar with telemedicine. From this group, 29.8% (202/678) had previously utilized it. Of these users, 92.3% (186/202) found it to be useful or highly useful, whereas 83.1% (168/202) expressed overall satisfaction with their telemedicine experience. Among those who had not used telemedicine (47%, 476/1,013), the predominant concerns were a preference for in-person health care consultations for better care (77%, 367/476) and uncertainty about the quality of care offered through telemedicine (62%, 296/476). Conclusions: Despite high awareness of telemedicine in the UAE, its actual usage remains limited, highlighting the necessity for increased promotional efforts. Nevertheless, positive feedback suggests considerable potential for broad adoption. Future studies should address participants' concerns to enhance telemedicine utilization in the region.

Autoencoder-Based Neural Network Model for Anomaly Detection in Wireless Body Area Networks

In medical healthcare services, Wireless Body Area Networks (WBANs) are enabler tools for tracking healthcare conditions by monitoring some critical vital signs of the human body. Healthcare providers and consultants use such collected data to assess the status of patients in intensive care units (ICU) at hospitals or elderly care facilities. However, the collected data are subject to anomalies caused by faulty sensor readings, malicious attacks, or severe health degradation situations that healthcare professionals should investigate further. As a result, anomaly detection plays a crucial role in maintaining data quality across various real-world applications, including healthcare, where it is vital for the early detection of abnormal health conditions. Numerous techniques for anomaly detection have been proposed in the literature, employing methods like statistical analysis and machine learning to identify anomalies in WBANs. However, the lack of normal datasets makes training supervised machine learning models difficult, highlighting the need for unsupervised approaches. In this paper, a novel, efficient, and effective unsupervised anomaly detection model for WBANs is developed using the autoencoder convolutional neural network (CNN) technique. Due to their ability to reconstruct data in a completely unsupervised manner using reconstruction error, autoencoders hold great potential. Real-world physiological data from the PhysioNet dataset evaluated the suggested model’s performance. The experimental findings demonstrate the model’s efficacy, which provides high detection accuracy, as reported F1-Score is 0.96 with a batch size of 256 along with a mean squared logarithmic error (MSLE) below 0.002. Compared to existing unsupervised models, the proposed model outperforms them in effectiveness and efficiency.

An Educational Framework for Healthcare Ethics Consultation to Approach Structural Stigma in Mental Health and Substance Use Health.

This paper addresses the need for, and ultimately proposes, an educational framework to develop competencies in attending to ethical issues in mental health and substance use health (MHSUH) in healthcare ethics consultation (HCEC). Given the prevalence and stigma associated with MHSUH, it is crucial for healthcare ethicists to approach such matters skillfully. A literature review was conducted in the areas of bioethics, health professions education, and stigma studies, followed by quality improvement interviews with content experts to gather feedback on the framework's strengths, limitations, and anticipated utility. The proposed framework describes three key concepts: first, integrating self-reflexive practices into formal, informal, and hidden curricula; second, embedding structural humility into teaching methods and contexts of learning; and third, striking a balance between critical consciousness and compassion in dialogue. The proposed educational framework has the potential to help HCEC learners enhance their understanding and awareness of ethical issues related to structural stigma and MHSUH. Moreover, context-specific learning, particularly in MHSUH, can play a significant role in promoting competency-building among healthcare ethicists, allowing them to address issues of social justice effectively in their practice. Further dialogue is encouraged within the healthcare ethics community to further develop the concepts described in this framework.

How often are patients recording their healthcare consultations in Australia and why? An online survey

PurposeRecording important healthcare consultations can benefit patients. Technological developments enable recordings by patients and health professionals, as well as real-time ‘listening’ by AI scribes. Not enough is known about whether and why patients record their consultations. ObjectiveTo investigate people's experiences and preferences regarding consultation recording in Australia. MethodsA 21-item online survey available for all Australians aged 18+ was distributed via social media and professional networks in 2022. Items explored recording behaviour (past and planned), and reasons for recording and sharing. Quantitative data were analysed descriptively; qualitative content analysis was used to analyse open-text items. ResultsA total of 486 responses were received, of which 236 responses were analysed. Of these, 26 % had openly recorded a healthcare consultation, and 15 % had recorded covertly. The majority (71 %) of participants would consider recording a visit and would like their clinic to allow this (56 %). Participants strongly opposed the idea of sharing a recording on social media (84 %). Open-text responses indicated participants valued the health professional's consent, and protecting their own privacy by not oversharing recordings. ConclusionRecording of consultations in Australia is common, usually to enhance patients' knowledge, understanding, and participation in their care. Patients value the possibility of recording, especially when they are experiencing vulnerability. Recording can help people navigate the impacts of disability and barriers to information access. Privacy and fairness remain paramount. InnovationThis is the first survey of recording practices in Australia and is highly-relevant given recent technological developments. The findings indicate that changes in policy, law and technologies themselves are needed, to clarify parties' rights and responsibilities and to ensure the benefits of consultation recording are realised.

Approach to skin problems in travellers: clinical and epidemiological clues.

Travel-related skin problems are a common reason for healthcare consultations. We present a clinical approach to diagnosing skin diseases in travellers, emphasizing clinical examination and epidemiological clues such as travel history, incubation time and at-risk behaviours. Skin problems or manifestations of systemic infections are the third most common health issue encountered by travellers, though their causes and frequency may vary based on the season and destination. The four most frequent skin conditions affecting travellers include arthropod bites, sunburns, hookworm-related cutaneous larva migrans (CLM) and bacterial skin and soft tissue infections. Dengue fever is the leading cause of febrile exanthema in travellers returning from Asia, Latin America and the Caribbean, while hookworm-related CLM is the most common cause of creeping dermatitis. Notable travel-related infections associated with pruritus include cercarial dermatitis, scabies, creeping dermatitis and urticaria. Acute schistosomiasis is the most common parasitic cause of acute urticaria in travellers. African tick-bite fever is the most frequently encountered rickettsiosis, typically presenting with single or multiple eschars. Diagnostic approaches emphasize the importance of travel history, at-risk activities during travel and lesion distribution. At-risk activities include sun exposure, walking barefoot, exposure to sea and fresh water, hiking in forested or jungle areas, exposure frequency to mosquitoes and sandflies, poor hygiene and food intake, drug history and sexual behaviour. Morphological characteristics (vesicula, bullae, pustule, papule, nodule, plaque, oedema and ulcer), distinguishing between single and multiple skin lesions, localized or generalized, and whether mucosa, scalp, palmar or plantar surfaces are affected, provide further clinical clues. Systemic signs and symptoms such as fever and pruritus will aid in the differential diagnosis algorithms. With a thorough clinical assessment and knowledge of geographic and exposure-related risk factors, the differential diagnosis of travel-associated skin conditions can be narrowed down allowing for timely clinical management.

Uncontrolled chronic pain: can a pain consultation in primary care be a solution?

Chronic pain is one of the most frequent medical problems in Portuguese primary health care. These patients significantly show poorer functioning capabilities and quality of life than the general population. The importance of improving the quality of life in patients suffering from chronic pain is paramount, and a holistic approach must be implemented. However, proper pain evaluation and management may be time-consuming in a routine primary health care consultation. Given the significant impact of this disease, we initiated a dedicated consultation for patients with chronic pain in our primary health care unit. A complete evaluation is performed, and, among other questionaries, the Brief Pain Inventory is applied to evaluate pain impact on functioning at the first appointment and re-evaluated after six months of follow-up. In the first six months, 31 patients with uncontrolled pain were referred by their family physicians to this consultation. Non-pharmacological strategies were strongly recommended alongside pharmacological therapies. Although this consultation is relatively recent, our patients with longer follow-ups showed improvement in both maximum and minimum pain levels and substantial improvement in all the measured interferences in the Brief Pain Inventory. Even though there is literature that thoroughly describes the impact of pain on patients’ quality of life, there is much to be done to change this problem. Since family physicians know their patients and their contexts well, they are in a privileged position to manage this problem, and a specific pain consultation in primary health care can be one of the best services for managing pain.

Lifestyle Recommendations for Patients Before and After Thoracic Aortic Surgery: A Framework Analysis.

Patients receive many different recommendations after thoracic aortic surgery. Unfortunately, there is much variation in recommendations between different surgical centers. This variation in recommendations creates uncertainty and anxiety in patients. Therefore, we aimed to provide an overview with clear lifestyle recommendations for patients before and after thoracic aortic surgery. Documentary research and a framework analysis were used to analyze brochures, website texts, and health care protocols. These documents consisted of lifestyle recommendations for patients before and after thoracic aortic surgery (direct information) or cardiac surgery (indirect information). An analytical framework was constructed and all lifestyle recommendations for patients before and after thoracic aortic surgery were coded through indexing, charting, and mapping by two researchers (N.K. and H.v.Z.). The first draft with lifestyle recommendations was prepared by two researchers (N.K. and H.v.Z.). Feedback from all authors involved patients and consulted health care professionals was processed in the final draft. In total, 170 documents were analyzed. Indexing revealed 414 lifestyle recommendations, which were included in the first draft. Charting, mapping, removal of duplicates, and processing of feedback resulted in a final draft with 52 lifestyle recommendations about behavioral change, body weight, nutrition, cessation of alcohol and drug use, cessation of smoking, wound healing, sedentary behavior and physical activity, mental well-being, and family and close relatives. This study provides an overview of clear lifestyle recommendations for patients before and after thoracic aortic surgery. This overview is the first step because follow-up research is needed on which lifestyle recommendations are necessary and evidence-based. The overview of lifestyle recommendations serves as a foundation, after which individual customization can be provided.

Revolutionising patient care: the role of AI-generated avatars in healthcare consultations

Abstract Background/Introduction The healthcare sector faces an unprecedented challenge with the surging demand in both public and private settings, pushing them towards the brink of overload. This scenario underscores a critical knowledge gap in leveraging technology to alleviate the burden on healthcare services. Our study introduces an innovative solution through the development of avatars generated with artificial intelligence (AI) technologies, that replicate the likeness and expertise of healthcare professionals. These AI-generated avatars aim to bridge the gap in patient consultations, offering a scalable and efficient alternative to traditional care models. Purpose The primary objective of our study was to design and implement a virtual assistant capable of conducting patient consultations with the same reliability and personal touch as a trusted human medical professional. This was carried out through the integration of diverse AI technologies including generative models, large language models (LLMs), speech-to-text, and text-to-speech algorithms. Methods Our methodology encompassed the creation of three-components, the visual and auditory representation of the healthcare professional (avatar), the capability to process and generate speech (brain functions), and a database of information sourced from medical repositories as well as expert inputs (compiled knowledge). The development process involved capturing and generating the likeness and voice of a medical expert, training LLMs with the compiled knowledge, and engineering the system to function in real-time. This multifaceted approach ensured the AI-generated avatars were not only personalised but also intelligent and interactive. Results The successful execution of each component confirmed its feasibility, with the AI-generated avatars resembling their human counterparts in appearance and voice, effectively processing spoken inputs, and providing medical advice based on the compiled knowledge. The primary challenge identified was the integration of these components to operate seamlessly in real-time, indicating the need for further refinement in synchronisation and response speed. Conclusion This study has laid a foundational step towards revolutionising patient care through AI technologies. Our results demonstrate the potential of AI-generated avatars to alleviate workloads by providing personalised and efficient patient consultation services. Future work will focus on enhancing the real-time integration of system components, improving the scalability of the solution, and further personalising the patient experience. This direction not only intends to expand the capabilities of healthcare providers but also opens new avenues for patient engagement and care delivery.

Forecasting cognitive functioning: an artificial intelligence approach with Dynamic Bayesian Networks

Abstract Background Several potentially modifiable risk factors are associated with subjective cognitive decline (SCD). However, developmental patterns of these risk factors have not been used before to forecast later SCD. Practical tools for the prevention of cognitive decline are needed. We examined multifactorial trajectories of risk factors, and their associations with SCD using an artificial intelligence approach to build a score that forecasts later SCD. Methods Five repeated surveys (2000-2022) of the Helsinki Health Study (n = 8960, 79% women, aged 40-60 at Phase 1) were used to build dynamic Bayesian networks (DBN) for estimating the odds of SCD. A score-based approach was implemented for learning DBN using the quotient normalized maximum likelihood criterion. The model was used to predict SCD based on the history of consumption of fruit and vegetables, smoking, alcohol consumption, leisure-time physical activity, body mass index, and insomnia symptoms, adjusting for sociodemographic covariates. Results Of the participants, 31-48% reported decline in memory, learning, and concentration in 2022. Physical activity was the strongest predictor of SCD in a 5-year interval, with an odds ratio of 0.76 (95% Bayesian credible interval 0.59-0.99) for physically active compared to inactive participants. Alcohol consumption showed a U-shaped relationship with SCD. Other risk factors had minor effects. Conclusions A new online risk score tool was developed that enables individuals to inspect their own risk profiles, as well as explore potential targets for interventions and their estimated contributions to later SCD. Dynamic decision heatmap was presented as a communication tool to be used at healthcare consultations. Key messages • Potentially modifiable health-related behaviours such as physical activity can contribute to subjective cognitive decline. • Artificial intelligence can be applied to discover the complex interactions between risk factors and subjective cognitive decline, to support preventive healthcare at individual and population levels.

Aberrations in medically certified sick leave and primary healthcare consultations in Norway in 2023 compared to pre-COVID-19-pandemic trends

BackgroundSince 2022, Norway has employed a vaccine-only COVID-19 strategy. Primary healthcare in Norway uses International Classification of Primary Care version 2 (ICPC-2) codes. This study aims to systematically compare medically certified sick leave and primary healthcare consultations in 2023 with the pre-pandemic 2010–2019 trends, and subsequently estimate the magnitude of these changes.MethodsFor the respective outcomes of (A) working person-years lost to medically certified sick leave (WYLSL) and (B) number of primary healthcare consultations, 556 and 85 ICPC-2 code combinations were extracted from the Norwegian Labour and Welfare Administration’s sick leave registry and the Norwegian Syndromic Surveillance System. For each ICPC-2 code combination, a Bayesian linear regression was performed using data between 2010 and 2019 to estimate an expected baseline for 2023, which was then used to calculate the deviation from the pre-pandemic trend. A false discovery rate of 5% was used to account for multiple testing.ResultsAll years from 2020 to 2023 had excess WYLSL, corresponding to 14,491 (90% PI: 8,935 to 20,016) in 2020, 12,911 (90% PI: 5,916 to 19,996) in 2021, 21,263 (90% PI: 12,627 to 29,864) in 2022, and 24,466 (90% PI: 14,023 to 34,705) in 2023. This corresponded to an economic loss of approximately 1.5 billion USD in 2023. Excess WYLSL due to A* (General and unspecified) increased from 2020 to 2023, with an estimated excess of 4,136 WYLSL in 2023 (69% higher than expected). More than half of this increase was explained by A04 (Weakness/tiredness general), whose excess WYLSL in 2023 were estimated at 2,640 (80% higher than expected). The excess in A04 (Weakness/tiredness general) corresponded to an economic loss of 161 million USD and accounted for 11% of the total excess WYLSL in 2023. The excess WYLSL in R* (Respiratory) in 2023 was 3,408, which correspond to an economic loss of 207 million USD and accounted for 14% of the total excess in 2023.ConclusionsSignificant excesses in working person-years lost to medically certified sick leave and primary healthcare consultations in 2023. A sizable proportion of the excesses were due to diseases/symptoms associated with acute and post-acute sequelae of COVID-19.

A qualitative exploration of Gestalt therapy and systemic pedagogy paediatric primary healthcare consultations in Agramunt (Spain).

Gestalt therapy (GT) and systemic pedagogy (SP) are useful tools to approach emotional difficulties and mental health problems among children and adolescents. The main objective of this study was to explore the perceptions on GT and SP techniques in paediatric mental health-related consultations in a primary healthcare (PHC) centre in Catalonia in 2018-2019, among families, healthcare, and education professionals. Qualitative study, combining semi-structured interviews with families (N = 42) and professionals (N = 15), conducted after a series paediatric PHC consultations including GT and SP techniques. Interviews lasted between 15 and 90min and were conducted at the PHC centre where GT/SP consultations took place, and at professionals' workplaces. Socio-demographics, reasons for consultation, and quantitative ratings on the perceived effectiveness of GT/SP consultations were also collected to combine these data with the qualitative interviews. Qualitative data were analyzed descriptively using thematic analysis. Quantitative data were analyzed by calculating frequencies (percentages) for categorical variables, and means, medians, and ranges for continuous variables. Narratives from families and healthcare professionals indicate that GT/SP consultations might have been effective in improving children and adolescents' symptomatology and emotional health. Improved well-being within the family context was another main finding, based on families' perceptions and experiences. Besides, GT/SP were considered acceptable for approaching emotional and mental health in PHC services, although barriers for implementation were identified. This study presents data on the potential usefulness of GT/SP to design and implement services that promote emotional and mental health among children and adolescents in PHC. Also, for the development of health policies and future research in this area.

An Agent-Based "Virtual Clinical Trial" for the Analysis and Evaluation of COPD Patients Cohorts Behavior

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to symptoms such as shortness of breath, coughing, and chest tightness. Treatment typically involves lifestyle adjustments, medication, and pulmonary rehabilitation to improve lung function and quality of life. This study presents a model examining COPD patient behavior within cohort-based strategies, focusing on how environmental factors impact vital signs across the entire cohort. We developed a comprehensive virtual clinical trial model that encompasses study protocol design, participant recruitment, virtual data collection, outcome analysis, and conclusions. This includes remote symptom monitoring, virtual healthcare consultations, treatment adherence assessments, and research data collection. Additionally, we explore the influence of external variables such as environmental conditions, comorbidities, and lifestyle factors on chronic disease symptoms and disease stability. We used an Agent-Based Model(ABM) to incorporate these factors to assess COPD progression and treatment efficacy. Individual agents represent COPD patients, each characterized by attributes such as age, smoking history, lung function, comorbidities, and treatment plans.