Care Contacts Research Articles

Reduced healthcare costs for patients with screen-detected colorectal cancer: A Danish nationwide cohort study.

This Danish nationwide retrospective register-based cohort study investigated healthcare costs for patients with screen-detected colorectal cancer (SD-CRC) compared to non-screen-detected CRC (NSD-CRC). Nationwide cohort study. Quarterly healthcare costs including costs of hospital care, out-of-hospital medication, and primary sector contacts were compared between the two groups from two years before diagnosis of CRC until two years after. A quasi-experimental difference-in-differences analysis was performed to estimate the differences per patient in total quarterly healthcare costs between the groups. A total of 13,852 patients were included, 4703 with SD-CRC, 7420 with NSD-CRC, and 1,729 with interval- or post-colonoscopy CRC (I-PC-CRC). The total quarterly healthcare costs per patient were significantly higher in the NSD-CRC group than in SD-CRC. This was consistent across the total period and in 6-month analyses, accruing additional €16,600 of costs for patients with NSD-CRC over two years after diagnosis. Total healthcare costs were significantly higher for patients with NSD-CRC as compared to patients with SD-CRC across all Union for International Cancer Control (UICC) stages, except for UICC stage I. Correspondingly, total costs associated with I-PC-CRC were significantly higher than for SD-CRC. Apart from improving post-treatment outcomes, higher participation rates in the CRC screening programmes present an opportunity for reducing healthcare costs related to patients diagnosed with CRC.

The impact of palliative care contact on the use of hospital resources at the end of life for brain tumor patients; a nationwide register-based cohort study.

The aim of this nationwide retrospective cohort study was to evaluate the timing of the first specialist palliative care (SPC) contact and its impact on the use of hospital resources at the end of life in patients with brain tumors. The analysis comprised 373 brain tumor patients who died during 2019 in Finland. Patients were divided into two groups according to the time of first SPC contact: early, i.e. first SPC contact more than 30 days before death, and late, i.e. no SPC contact or 30 days or less before death. 216 (58%) were male, with a mean age of 67 years (range 18-94). SPC contact was established for 102 (27%) patients and the median time of first SPC contact before death was 76 days. Patients with an early SPC contact had fewer outpatient clinic contacts (28% vs. 53%; p-value < 0.001) and fewer hospitalization (10% vs. 37%; p-value < 0.001) in secondary care compared with patients with late SPC contact. Early SPC contact had no impact on emergency department contacts. Patients with early SPC contact were more likely to die at long term care facility or in SPC wards instead of hospital (p-value < 0.001) compared to patients with late SPC contact (hospital deaths 51% vs. 80%, respectively). Early SPC contact reduced the burden on secondary care for brain tumor patients in the last months of life. Palliative care contact should be offered early to all brain tumor patients.

Consensus on Symptom Selection for Endometriosis Questionnaires: A Modified e-Delphi Study.

To build consensus on most important symptoms and related consequences for use in questionnaires to characterise individuals with suspected and confirmed endometriosis in the general population. A questionnaire of 107 symptoms and related consequences of endometriosis was collaboratively developed by patients, medical doctors and researchers and further assessed in a two-round e-Delphi study. Participants assessed the relevance of the symptoms, and a priori it was decided that 70% was the threshold for inclusion of a symptom. Participants represented 7 countries, including Australia, Denmark, France, Hungary, the United Kingdom, the United States, and Turkey. Individuals with endometriosis, medical doctors and researchers with expertise in endometriosis. A modified e-Delphi study. Consensus-based selection of symptoms for endometriosis questionnaires. Seventy-six participants completed the first Delphi round and 65 completed the second round. Four symptoms met consensus in the first round (menstrual pain, pain during sexual intercourse, cyclic pain during defecation, and infertility), with two additional symptoms reaching consensus in the second round (cyclic pain and increased doctor/health care contacts for abdominal/pelvic pain). This study highlighted six symptoms relevant for inclusion in endometriosis research questionnaires: menstrual pain, pain during sexual intercourse, cyclic pain during defecation, cyclic pain, infertility, and a high number of doctor/health care visits due to abdominal/pelvic pain. Recognising a broad range of potential symptoms is essential for raising awareness and supporting early detection efforts.

The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK.

This study evaluated the impact of 2015/2016 prescribing guidance on antidepressant prescribing choices in children. A retrospective e-cohort study of whole population routine electronic healthcare records was conducted. Poisson regression was undertaken to explore trends over time for depression, antidepressant prescribing, indications and secondary care contacts. Time trend analysis was conducted to assess the impact of guidance. A total of 643 322 primary care patients in Wales UK, aged 6-17 years from 2010-2019 contributed 3 215 584 person-years of follow-up. Adjusted incidence of depression more than doubled (IRR for 2019 = 2.8 [2.5-3.2]) with similar trends seen for antidepressants. Fluoxetine was the most frequently prescribed first-line antidepressant. Citalopram comprised less than 5% of first prescriptions in younger children but 22.9% (95% CI 22.0-23.8; 95% CI 2533) in 16-17-year-olds. Approximately half of new antidepressant prescribing was associated with depression. Segmented regression analysis showed that prescriptions of 'all' antidepressants, Fluoxetine and Sertraline were increasing before the guidance. This upward trend flattened for both 'all' antidepressants and Fluoxetine and steepened for Sertraline. Citalopram prescribing was decreasing significantly pre guidance being issued with no significant change afterward. Targeted intervention is needed to address rising rates of depression in children. Practitioners are partially adhering to local and national guidance. The decision-making process behind prescribing choices is likely to be multi-factorial. Activities to support implementation of guidance should be adopted in relation to safety in prescribing of antidepressants in children including timely availability of talking therapies and specialist mental health services.

The effect of a team-based service model on treatment processes and outcomes and healthcare usage among people with type 2 diabetes in North Karelia, Finland.

In North Karelia, Finland, a team-based service model was implemented in primary healthcare (PHC) during 2020. In this model, a healthcare customer contacts a nurse who initiates the service process immediately, possibly consulting or directing customers to other professionals. The effect of this new service model among patients with type 2 diabetes (T2D) was assessed. Data from T2D patients diagnosed by 2016 and still residing in North Karelia in 2023 (N = 6312) were extracted from electronic health records. Diabetes-related contacts with nurses or physicians in PHC and specialised healthcare (SHC) were considered, along with emergency care contacts, measurement activity and levels of glycated haemoglobin (HbA1c) and low-density lipoproteins (LDL) between 2017 and 2022. Annual differences between areas were analysed using logistic and Poisson mixed models. The team-based service model increased T2D-related PHC remote contacts with nurses for a couple of years, but eventually they decreased to a lower level than before. Additionally, the number of other contacts reduced. It had no effect on measurement activity or treatment levels of HbA1c and LDL. The team-based service model might reduce the number of healthcare contacts among T2D patients, but more evidence is needed on its effectiveness and cost-effectiveness.

Specialized palliative outpatient clinic care involvement associated with decreased end-of-life hospital costs in cancer patients, a single center study

BackgroundStudies show that hospital deaths bring significant health care costs, and the involvement of specialized palliative care can help to reduce these costs. The aim of this retrospective registry-based study was to evaluate end-of-life hospital costs in patients dying in a university hospital oncology ward, with or without specialized palliative outpatient clinic contact at any timepoint.MethodsThe study population consists of all patients who died in the Kuopio University Hospital oncology ward in the years 2012–2018 (n = 457). Hospital costs in the last 30 days of life and data on treatment decisions and background factors were gathered. Costs for patients with and without palliative care contact were compared. Effects of various variables on the costs were analyzed using gamma regression model.ResultsBoth the last 14 days’ and 30 days’ hospital costs before death were significantly lower among those 65 patients [14.2%] who had had a specialist palliative care contact. This was seen in inpatient day costs, microbiology, radiation therapy, laboratory, drug, radiology, and total costs. In a multivariate analysis including age, gender, year of death, time from diagnosis to death, and cancer type, the costs for 30 days prior to death were 33% lower in those patients who had had palliative care contact.ConclusionsOur results provide first indications that a contact to specialist palliative care in an outpatient clinic may reduce end-of-life hospital care costs in hospital-deceased cancer patients.

Time Toxicity of Systemic Anticancer Therapy for Metastatic Lung Cancer in Routine Clinical Practice: A Nationwide Cohort Study.

The concept of time toxicity of cancer treatment, defined as proportion of days from physical contact with the health care system, has been suggested as simple, patient-centered measure useful for shared decision making, particularly in incurable cancer. We investigated the extent of health care contacts in clinical practice in Danish patients with stage IV lung cancer starting first-line systemic anticancer therapies. This is a nationwide cohort study of newly diagnosed patients with stage IV lung cancer in Denmark who initiated treatment during 2019-2021 and followed for up to 1 year. The time toxicity after treatment initiation was calculated as the proportion and mean cumulative number of days with physical health care system contacts recorded in Danish registries. The remaining days without any physical contact were defined as home days. One-year cumulative mortality was also assessed. We included 4,384 patients with stage IV lung cancer. One year survival was 45% after treatment initiation. Of days alive, the mean cumulative number of days with physical health care contacts was 56 days within 1 year. The corresponding number of home days was 198. Overall, 22% of days alive involved physical contact with the health care system, broadly similar for patients with non-small cell lung cancer (22%) and small cell lung cancer (24%). For specific regimens, the corresponding proportions were chemotherapy (24%), immunotherapy (21%), immunochemotherapy (21%), and targeted therapy (16%). More than 1 in 5 days after initiation of systemic treatment for metastatic lung cancer was spent in physical contact with the health care system. This information may aid shared decision making by informing about expected burdens in relation to cancer therapy.

Placental malaria and adverse pregnancy outcomes in Majang Zone of Gambella Region, Southwest Ethiopia: a histopathological and molecular study

BackgroundPlacental malaria (PM) is characterized by Plasmodium parasite sequestration in the placenta. It is responsible for various adverse pregnancy outcomes, including maternal anaemia and low birth weight (LBW). This study aimed to assess prevalence and risk factors of PM, and gestational malaria (GM), together with the prevalence of congenital malaria (CM), maternal anaemia, and LBW among parturient women attending delivery ward of Metti Health Centre (Metti HC) in Majang Zone of Gambella Region, Southwest Ethiopia.MethodsA cross-sectional study involving 180 parturient women attending delivery ward of Metti HC was conducted from November 2022-March 2023. Sociodemographic, obstetric, and anti-malarial intervention data were collected. Capillary, placental and cord blood, and placental biopsy were collected to diagnose malaria using rapid diagnostic test (RDT), microscopy, quantitative polymerase chain reaction (qPCR), and histopathology. Haemoglobin concentration and blood group of the mother and weight of the newborn were determined. Statistical analyses were done by SPSS Version 26.0. Multivariable logistic regression analysis and Chi-square test were done to identify risk factors. Results were presented in text, tables and graphs.ResultsThe prevalence of GM, PM, CM, maternal anaemia, and LBW was 24.4% (95% CI 18.1–30.1), 34.4% (95% CI 27.4–41.4), 5.0% (95% CI 2.4–8.8), 41.7% (95% CI 34.6–49.0) and 27.8% (95% CI 21.6–34.6), respectively. Risk factors of GM were: presence of malaria history within the previous year (AOR: 5.10; 95% CI 1.64–15.83), lack of indoor residual spray (IRS) within the previous year (AOR: 2.98; 95% CI 1.05–8.45), and lack of antenatal care (ANC) contact during the index pregnancy (AOR: 3.96; 95% CI 1.44–10.87). Risk factors of PM were: presence of malaria history within the previous year (AOR: 2.98; 95% CI 1.05–8.45), and lack of ANC contact during the index pregnancy (AOR: 4.83; 95% CI 1.91–12.18). The risk of CM (p < 0.001), maternal anaemia (p < 0.001) and LBW (p < 0.001) increased with GM and PM.ConclusionThere is high prevalence of GM, PM, maternal anaemia, and LBW in the study area. The presence of GM and PM increased the risk of maternal anaemia, CM, and LBW. The identified risk factors should be considered to mitigate malaria among parturient women and its adverse outcomes.

Design and analysis of a telemonitoring system for high-risk pregnant women in need of special care or attention

BackgroundHigh-risk pregnancies, characterized by underlying health issues or unusual circumstances, pose increased risks to both maternal and neonatal health during pregnancy and childbirth. Global guidelines emphasize the importance of early identification, monitoring, and intervention to mitigate these risks.MethodWe decided to design and implement a telemonitoring system for remotely monitoring and managing pregnancies in women with conditions such as hypertension, diabetes, or high-risk pregnancy. When a high-risk pregnant mom is discharged from the hospital, the Healthcare Center or Integrated Healthcare Services Center in her area is immediately notified via SMS to ensure her condition is monitored remotely. In addition to sending notifications, the patient’s medical record, post-discharge care recommendations, drug prescription, re-visit time, and contact details are also sent to them via the application. The high-risk pregnant mom is followed up and all her information is recorded in the application for further use. To evaluate the usability of the proposed telemonitoring system, we conducted a laboratory study involving 92 participants, including pregnant mothers’ care experts at hospitals, healthcare center experts, midwives at integrated healthcare services centers, and midwifery department experts with varying levels of digital skills. Participants performed activities related to the application’s services, while their satisfaction was measured using the QUIS 7.0 questionnaires covering multiple aspects of usability, including user interface, system capabilities, and online help, with ratings on a Likert scale.ResultThe usability evaluation revealed that the average satisfaction score across all usability dimensions was above 8, demonstrating a satisfactory level of system usage from all user perspectives. Additionally, the close alignment of mean and median scores, along with standard deviations below 1 for several dimensions, indicated consistent positive feedback among users.ConclusionOur telemonitoring system demonstrates promise for enhancing the management of high-risk pregnancies, facilitating better health outcomes for mothers and infants through effective remote monitoring and support. The usability test results underscore the platform’s effectiveness and user satisfaction, contributing valuable insights for future improvements in high-risk pregnancy care.

Redesigning paramedicine systems in Canada with “IMPACC”

In this perspective, the authors argue that paramedicine's core structure and mandate (i.e., the 9-1-1 system) can innovate to better align with the needs of the public and address the evolving healthcare landscape. Examining Canada as a case, paramedic services are increasingly utilized by the public as a first point of contact for health and social care and often for nonemergent events. Existing emergency-focused paradigms leave the health profession poorly aligned or underprepared to meet the needs of the public and isolated from other healthcare providers and systems. While advances in healthcare policy, infrastructure, and best practices have been proposed to address Canada's healthcare challenges, these advances have yet to sufficiently translate into core paramedicine systems. To illustrate these points, the authors critically examine the alignment of paramedicine models of care with public need, paramedicine's response to government and scholarly advances in healthcare policy and practice, and contemporary public healthcare issues in Canada. Paramedicine's changing landscape is also examined as context for innovation and change. The authors argue that core paramedicine systems be augmented with (not replaced by) an integrated interprofessional primary care paradigm and introduce a novel conceptual strategy, approach, and model of care referred to as IMPACC—Improving Patient Access to Care in the Community, including its guiding principles, conceptual framing, intended outcomes and domains for education. The authors conclude that paramedicine in Canada stands at a pivotal juncture and that the traditional emergency-focused model is increasingly misaligned with contemporary health and social care needs, necessitating a shift toward a more integrated, interprofessional primary care approach. The IMPACC concept offers a viable conceptual blueprint for this transformation, proposing a redesigned 9-1-1 system that incorporates timely primary care services and fosters interprofessional collaboration and integration for differentiated and undifferentiated patients in the community within core paramedicine systems.

Hypertonic saline nasal irrigation and gargling for suspected or confirmed COVID-19: Pragmatic randomised controlled trial (ELVIS COVID-19).

In a previous pilot randomised controlled trial conducted on UK adults, we found that hypertonic saline nasal irrigation and gargling (HSNIG) reduced common cold symptoms, the need for over-the-counter medications, viral shedding, and the duration and transmission of the illness. It is unclear whether HSNIG improves outcomes of the coronavirus disease 2019 (COVID-19). Hypertonic saline can be prepared and HSNIG performed at home, making it a safe and scalable intervention, particularly well-suited for low- and middle-income countries. We conducted a pragmatic randomised controlled trial in Pakistan on adults with suspected or confirmed COVID-19, initially within 48 hours of symptom onset, later extended to within five days due to recruitment challenges. Participants were randomised to one of two groups: the intervention group received instructions on preparing a 2.6% hypertonic saline solution for HSNIG, while the control group was instructed on performing ablution for Muslim prayers (wudu), which involves nasal washing and gargling with tap water. Our primary outcome was the time to symptom resolution, measured by two consecutive days of scoring zero on relevant questions from the validated, self-reported, adapted short form of the Wisconsin Upper Respiratory Symptom Survey (WURSS-24). Secondary outcomes included the severity of all symptoms, the severity and time to resolution of individual symptoms, health care contacts (GP/physician, emergency contacts), hospital attendance (and length of stay if admitted), over-the-counter (OTC) medication (frequency and cost), and transmission to household contacts. The analysis was conducted on an intention-to-treat basis. Logistic regression was used to calculate adjusted odds ratios (aORs) of improvement and Cox regression to calculate adjusted hazard ratios (aHRs) for the time to improvement with accompanying 95% confidence intervals (CIs). We randomised 576 people: 279 to the HSNIG group and 297 to the control group. Among those, 10 out of 279 (3.6%) in the HSNIG had symptom resolution, compared with 11 out of 297 (3.7%) in the control group (aOR = 1.20, 95% CI = 0.46- 3.22). The time-to-event analysis also showed no significant benefit (aHR = 1.23, 95% CI = 0.51-2.97). Excluding the 127 participants with no data on the primary outcome (who did not complete the study), 10 out of 222 (4.5%) in the HSNIG group had symptom resolution, compared to 11 out of 227 (4.8%) in the control group. HSNIG was not effective for individuals with suspected or confirmed COVID-19 who began the intervention within five days of symptoms onset and therefore cannot be recommended for use. Further investigation is needed for interventions started within 48 hours of illness onset. ClinicalTrials.gov (NCT05104372).

Compliance with the WHO recommended 8+ antenatal care contacts schedule among postpartum mothers in eastern Uganda: A cross-sectional study.

The World Health Organization (WHO) recommends at least 8 antenatal care (ANC) contacts during pregnancy, but many women in low and middle-income countries do not adhere to this schedule, which may contribute to high rates of maternal and neonatal mortality. This study assessed compliance to the WHO recommended 8+ ANC contacts schedule and associated factors among postpartum mothers in eastern Uganda. This was a cross-sectional multicenter study conducted between July and August 2022 at four selected hospitals in Eastern Uganda using quantitative techniques. We recruited postnatal mothers who had given birth within 48 hours with records of their ANC contacts. Compliance to the WHO recommended 8+ ANC contacts schedule was defined as having received the recommended ANC contacts as per the gestational age at childbirth following the current ANC for a positive pregnancy experience WHO guidelines. We conducted multivariable logistic regression analysis to assess the association between compliance to the WHO recommended 8+ ANC contacts schedule and selected independent variables. A total of 1104 postpartum mothers participated in the study with a mean age (± standard deviation) of 26 ± 6.4 years, and a majority had given birth from a referral hospital (n = 624 56.5%). Compliance to the WHO recommended 8+ ANC contacts schedule was low (n = 258, 23.4%), and only 23.2% (196) of the women had attended their first antenatal care contact within the first trimester. Factors associated with compliance to the WHO recommended 8+ ANC contacts were: attending the first antenatal care contact within 12 weeks of gestation [AOR: 6.42; 95% CI: (4.43 to 9.33)], having 2 to 4 children [AOR: 0.65; 95% CI: (0.44 to 0.94)], having a spouse who is unemployed [AOR: 1.71; 95% CI: (0.53 to1.08)] and having insurance coverage [AOR: 2.31; 95% CI: (1.17 to 4.57)]. Compliance with the 8+ ANC contacts schedule remains very low. Efforts should focus on increasing health education, particularly for multiparous women, and encouraging mothers to begin ANC in their first trimester. Exploring the dynamics of partner support, especially with employment status, may offer insights into improving ANC attendance.

Family support among young adults: The role of childhood maltreatment

BackgroundSuccess in young adulthood marked by independence and exploration is not universal. Parentification, when young people acquire adult roles before they are developmentally ready, and family support patterns suggest potential differences based on childhood maltreatment history hence widening inequalities. ObjectiveThis study aimed to describe family-of-origin support patterns among young adults with various levels of exposure to child maltreatment and child protective services (CPS). Participants & settingThe study leveraged Year 22 data of the Future of Families and Child Wellbeing dataset; a national, longitudinal, birth-cohort study of U.S. children born in 1998–2000. MethodsWe used bivariate statistics and logistic regressions to examine maltreatment exposure, socioeconomic conditions, and family-of-origin relationships. ResultsThose with out-of-home care and CPS contact without out-of-home care had lower odds of contact and feeling “extra” close to their caregiver compared to those without reported maltreatment, and those with out-of-home care had lower odds of receiving financial support from family for bills (OR = 0.62, 95 % CI [0.42, 0.92]). Those with out-of-home care had higher odds of providing dependent care to family members (OR = 1.67, 95 % CI [1.02, 2.72]); and those with CPS contact only had higher odds of supporting family members financially (OR = 1.79, 95 % CI [1.29, 2.47]). ConclusionFindings suggest the importance of public support programs to assist those with maltreatment histories susceptible to the absence of parental support and additional demands of support provision. Understanding young adult-parent relationships within the context of childhood maltreatment is critical to promote well-being.

Brief Outpatient Rehabilitation Program for Post-COVID-19 Condition: A Randomized Clinical Trial.

Post-COVID-19 condition (PCC) is emerging as a common and debilitating condition with few treatment options. To assess the effectiveness of a brief outpatient rehabilitation program based on a cognitive and behavioral approach for patients with PCC. Patients with mild to moderate PCC were randomized 1:1 to an established transdiagnostic rehabilitation program or care as usual at a single referral center recruiting from the region of the South-Eastern Norway Regional Health Authority. Participants were followed up after treatment completion and 12 months after enrollment using participant-reported outcome measures. Data were collected from February 22, 2022, until April 15, 2024. Intention-to-treat analysis was performed. The program consisted of 2 to 8 outpatient encounters with approximately 2 to 6 weeks between each encounter. The intervention was theoretically grounded in the cognitive activation theory of stress, and physicians and physiotherapists were trained in cognitive and behavioral approaches with targeted negative stimuli and response outcome expectancies being particularly important. Participant-reported physical function assessed by the Short-Form Health Survey 36 Physical Function Subscale (SF-36-PFS) served as the primary outcome. Secondary outcome measures were the remaining subscales of the SF-36, return to work self-efficacy and symptom scores on fatigue, postexertional malaise, breathlessness, cognitive difficulties, sleep problems, anxiety and depression symptoms, and smell and taste abnormalities. Safety measures included primary health care contacts; hospital admissions; initiation of pharmacologic and/or nonpharmacologic therapy; occurrence of novel disease, illness, or other health problems; worsening of selected key symptoms; working abilities; and thoughts of suicide. A total of 473 patients with mild to moderate PCC were assessed for eligibility (n = 364 physician referred; n = 109 self-referred); 314 were included (225 females [72%]; mean [SD] age, 43 [12] years) and 231 completed the primary end point evaluation. The SF-36-PFS scores improved statistically and clinically significantly in the intervention group (score difference between groups, 9.2; 95% CI, 4.3-14.2; P < .001; Cohen d = 0.43; intention-to-treat analysis). The effect was sustained over time. Most secondary and safety measures favored the intervention. In this randomized clinical trial, a brief outpatient rehabilitation program with a cognitive and behavioral approach in patients with PCC was effective and safe. This trial adds to the evidence supporting such interventions in routine clinical care. Future research should investigate which elements of this approach are the most effective and identify subgroups for which the current treatment is most relevant. ClinicalTrials.gov Identifier: NCT05196451.

Chest pain in a multi-ethnic population: A community-based study on sex differences in chest pain prevalence and care contacts.

While chest pain is a common symptom, its prevalence among women and men across ethnic groups is unknown. Moreover, how chest pain is associated with general practitioner (GP) and cardiologist visits in women and men across ethnic groups, remains to be determined. We used baseline data on 12423 women and 9071 men from the multi-ethnic HELIUS cohort (Amsterdam, the Netherlands; 2011-2015). Using logistic regressions, we studied sex differences in chest pain prevalence across ethnic groups. Next, in those who reported chest pain in the past two years (henceforth; recent chest pain), we studied sex differences in GP, cardiologist, and any specialists visits, in total and by ethnicity. Analyses were adjusted for age, ethnicity (in the total population), socioeconomic factors, associated symptoms, clinical parameters, and lifestyle factors. Across most ethnic groups, women were more likely than men to report lifetime (33% vs 29%, p<.001) and recent chest pain (4.5% vs 2.7%, p=.001). In those with recent chest pain, women were more likely to have visited a GP, yet less likely to have visited a cardiologist, but not any specialist, compared to men. These differences were also observed in several sensitivity analyses, including in those with symptoms suggestive of typical Angina Pectoris. Chest pain is more commonly reported in women than men across most ethnic groups. While men were less likely to have visited a GP than women, women were less likely to have visited a cardiologist. Combined, this suggests delays in care may occur at different points in the care trajectory for women and men.

Processes of obstetrical care and outcomes among Ontario physicians versus non-physicians: a population-based study

ObjectiveWe compared processes of antepartum, intrapartum and postpartum care and obstetrical outcomes between physicians and non-physicians.DesignThis is a population-based retrospective matched cohort study.SettingThe study was conducted in Ontario, Canada.ParticipantsPhysicians and...

Prevalence, Incidence, and Age at Diagnosis of Boys With Hypospadias: A Nationwide Population-Based Epidemiological Study.

The aim of this study was to assess the diagnostic prevalence, incidence, diagnostic age, and surgical volume of hypospadias in Denmark. Males with a hypospadias diagnosis in the Danish National Patient Registry (n = 10,276) were identified (1977-2019). A diagnostic algorithm, validated by medical file review (n = 1710), confirmed diagnoses and severity (distal/proximal). The yearly prevalence (live-born hypospadias boys/100,000 newborn boys) and incidence (first hypospadias registration in the Danish National Patient Registry/100,000 boys in background population) were calculated. Age at diagnosis and number of health care contacts were calculated. Poisson regression was used to analyze temporal trends. Hypospadias was verified in 9189 males (89.4%; distal 8404 [91.5%]; proximal 785 [8.5%]). From 1977 to 2006, the prevalence rose significantly to a mean of 503 (95% CI: 440-565) and peaked at 847 (distal 768, proximal 79) in 2007. From 2008 to 2018, the prevalence stabilized (mean 774, 95% CI: 738-810). A significant rise in incidence was observed. Age at diagnosis decreased from 1977 to 2019. Proximal hypospadias was diagnosed earlier (median 0 years, IQR, 0-0.5) than distal (median 0.2 years, IQR, 0-1.9) and had more (P < 10-4) nonsurgical hospital contacts (median = 5, IQR, 3-7 vs median = 2, IQR, 1-3). At least 1 surgical admission was recorded for 4550 (58.4%). Boys without surgical admissions (n = 3244, 41.6%) were primarily distal cases (97.7%). Since 1977, the prevalence of diagnosed hypospadias cases significantly increased and peaked around 800 per 100,000 live boys in 2007. The diagnostic age decreased, proximal cases were diagnosed earlier, and there were more surgical admissions than distal cases. A significant proportion were never operated.

Satisfaction With Home Care Services and Its Related Factors for Persons With Spinal Cord Injury: A National Community Survey

In order to live independently at home, persons with spinal cord injury (SCI) often require professional home care. The role of the care coordinator remains unclear, as it can be fulfilled by the general practitioner or an SCI specialist, as well as by informal caregivers. We aimed to quantify satisfaction with professional home care among persons with SCI living in Switzerland and the association between first contact for care and having an informal caregiver with satisfaction with home care. Measurements were obtained from the national community survey of the Swiss Spinal Cord Injury Cohort Study. Logistic regression was used to determine the association between first contact for care, having an informal caregiver, and satisfaction with home care, adjusted for sociodemographic factors, SCI characteristics, and functional level. Overall satisfaction with professional home care was high, with 84% of participants reporting being either very satisfied or satisfied. Neither first contact for care nor availability of an informal caregiver was statistically significantly associated with satisfaction. The results showed that women (odds ratio 0.56, 95% CI 0.31-1.00) were statistically significantly less satisfied with home care than men. There was also variation by language region. These findings highlight the importance of providing personalized and culturally sensitive home care that takes into account the diverse preferences and expectations of persons with SCI, especially regarding gender and language region.

Use of eight or more antenatal care contacts and determinants among healthcare providers in Ethiopia: systematic review and meta-analysis

Eight or more antenatal care contact sessions are recommended as part of antenatal care to prevent pregnancy-related complications. However, studies across Ethiopia have shown discrepancies and inconsistent results. The goal of this study was to determine the pooled compliance to ≥8 antenatal care contact sessions and associated factors among Ethiopian healthcare providers. Studies were systematically searched from March 1, 2024, to April 2, 2024, using Embase, Web of Science, PubMed/MEDLINE, Science Direct, African Journal Online, and the Wiley Online Library. The data were subsequently transferred to Stata software, version 11, for further data analysis. Pooled effect sizes were calculated based on the prevalence of ≥8 antenatal care contact sessions, and the odds ratios and 95% confidence intervals to indicate statistical significance were determined for the associated factors. To evaluate statistical heterogeneity, the Cochrane Q test and I2 statistic were used. In this systematic review and meta-analysis, a total of 492,000 articles were retrieved from various databases and registers. Finally, 16 studies with 7781 participants were included. The overall compliance to the guidelines that recommend ≥8 antenatal care contact sessions was 18.35% (95% confidence interval, 10.98-25.73). Healthcare providers who worked at hospital health facilities (adjusted odds ratio, 5.09; 95% confidence interval, 2.26-11.47) had knowledge of the importance of ≥8 antenatal care contact sessions for pregnant women (adjusted odds ratio 2.04; 95% confidence interval, 1.10-3.78). Those who were able to clearly differentiate between the guidelines recommending 8 antenatal care contact sessions and those recommending 4 antenatal care visits (adjusted odds ratio, 3.95; 95% confidence interval, 2.10-7.33) were more likely to record ≥8 antenatal care contact sessions, which was significantly associated with the outcome variable. In this study, more than 80% of antenatal care healthcare providers did not comply with the modern and World Health Organization-recommended antenatal care contact guidelines for a variety of reasons. It is very important to address factors that prevent healthcare providers from complying with the recommended ≥8 antenatal care contact sessions. To improve compliance to the World Health Organization guidelines of ≥8 antenatal care contact sessions, training on these guidelines is recommended.

Antimicrobial stewardship implementation in primary and secondary tier hospitals in India: interim findings from a need assessment study using mixed method design

Anti-microbial stewardship program (AMSP) is practiced only in tertiary hospitals in India, though, the lower tier hospitals remain the first point of contact in patient care. This study was conducted in lower tier hospitals to calculate antibiotic and multiple antibiotic prescription rate (APR, MPR) for common infections and finding existing strength of health system for optimizing antibiotic prescription. We conducted a cross sectional convergent parallel mix-method study in eight lower tier hospitals of three districts of West Bengal, India. Six hundred OPD prescriptions of UTI, ARI, AUFI, ADD were evaluated. Qualitative data collected through in-depth interviews of medical officers/officers in administrative positions, infection control nurses were analyzed using content analysis method. APR was 63.8% in primary tier hospitals and 60.8% in secondary tier hospitals. The MPR was higher in secondary tier hospital (23.8%). Presence of infection control committee, designated nursing staff, initiation of prescription audit, increased monitoring were identified as few facilitators for future implementation of AMSP in lower tier hospitals. The routine infection control activities of lower tier hospitals are currently delinked from AMR containment measures and thus, customized AMSP needs to be established in these hospitals catering two third of the population of India.