Delay In Seeking Care Research Articles

Time-trend analysis of tuberculosis diagnosis in Shenzhen, China between 2011 and 2020.

To describe the trend of tuberculosis (TB) diagnosis in the migrant city Shenzhen, China, and analyze the risk factors of diagnosis delays. Demographic and clinical information of TB patients from 2011 to 2020 in Shenzhen were extracted. A bundle of measures to enhance TB diagnosis had been implemented since late 2017. We calculated the proportions of patients who underwent a patient delay (>30 days from syndrome onset to first care-seeking) or a hospital delay (>4 days from first care-seeking to TB diagnosis). Multivariable logistic regression was used to analyze the risk factors of diagnosis delays. During the study period, 43,846 patients with active pulmonary TB were diagnosed and registered in Shenzhen. On average, the bacteriological positivity rate of the patients was 54.9%, and this increased from 38.6% in 2017 to 74.2% in 2020. Overall, 30.3 and 31.1% of patients had a patient delay or a hospital delay, respectively. Molecular testing significantly increased bacteriological positivity and decreased the risk of hospital delay. People >35 years old, the unemployed, and residents had a higher risk of delays in both patient care-seeking and hospital diagnosis than younger people, workers, or migrants. Compared with passive case-finding, active case-finding significantly decreased the risk of patient delay by 5.47 (4.85-6.19) times. The bacteriological positivity rate of TB patients in Shenzhen increased significantly but the diagnosis delays were still serious, which may need more attention when active case-finding in risk populations and optimization of molecular testing.

Delayed Medical Care of Underserved Middle-Aged and Older African Americans with Chronic Disease during COVID-19 Pandemic.

Background: While African American middle-aged and older adults with chronic disease are particularly vulnerable during the COVID-19 pandemic, it is unknown which subgroups of this population may delay seeking care. The aim of this study was to examine demographic, socioeconomic, COVID-19-related, and health-related factors that correlate with delayed care in African American middle-aged and older adults with chronic disease. Methods: In this cross-sectional study, 150 African American middle-aged and older adults who had at least one chronic disease were recruited from faith-based organizations. We measured the following exploratory variables: demographic factors (age and gender), socioeconomic status (education), marital status, number of chronic diseases, depressive symptoms, financial strain, health literacy, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 knowledge, and COVID-19 perceived threat. The outcome was delay in chronic disease care. Results: According to the Poisson log-linear regression, higher level of education, higher number of chronic diseases, and depressive symptoms were associated with a higher level of delayed care. Age, gender, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 perceived threat, COVID-19 knowledge, financial strain, marital status, and health literacy were not correlated with delayed care. Discussion: Given that higher healthcare needs in terms of multiple chronic medical diseases and depressive symptomatology but not COVID-19-related constructs (i.e., vaccination history, diagnosis history, and perceived threat) were associated with delayed care, there is a need for programs and interventions that assist African American middle-aged and older adults with chronic disease to seek the care that they need. More research is needed to understand why educational attainment is associated with more delayed care of chronic disease in African American middle-aged and older adults with chronic illness.

Development of the Red Flag Scorecard Screening Tool for Identification of Child Physical Abuse in the Emergency Department

BackgroundChild physical abuse (CPA) may have subtle presenting signs and can be challenging to identify, especially at emergency centers that do not treat many children. The purpose of this study is to determine the performance of a simple CPA screening tool to identify children most at risk. MethodsA screening tool (“Red Flag Scorecard”) was developed utilizing available evidence-based presenting findings and expert consensus. Retrospective chart review of children treated for injuries between 2014 and 2018 with suspected or confirmed CPA at a level I pediatric trauma center was then performed to validate the screening tool. Descriptive statistics and chi square tests were used to analyze the data. ResultsOf 408 cases, median age was 7 months and 60% were male. The majority (69%) were under 1 year of age. The most common history finding was delay in seeking care (58%, 236/408; p = <0.0001), the most common physical exam finding was bruising located away from bony prominences (45%, 182/408), and the most common imaging finding was unexplained brain injury (49%, 201/408). The majority, 84% (343/408), had at least 2 history findings. The combination score of at least 2 history findings and 1 physical/imaging finding was most sensitive (79%). The scorecard would have identified 94% of children who presented with no trauma history (198/211). ConclusionThe Red Flag Scorecard may serve as a quick and effective screening tool to raise suspicion for child physical abuse in emergency centers. Prospective study is planned to validate these results. Level of evidenceIV

Reproductive Health Knowledge and Care Seeking Behavior of Bangladeshi School Going Adolescent Girls: A Qualitative Study in A Demajani Village Area of Bogura District

The cultural context in Bangladesh generally discourages adolescent from giving opinions, speaking up or questioning adults. So their needs and vulnerabilities are often unaddressed and adolescent friendly services still unfamiliar concepts. In such cultural context, adolescent girls’ reproductive knowledge and healthcare seeking behaviour is important. Improper and delay in seeking care may also result in increased risk in the community. Understanding the pattern of healthcare-seeking behaviour could help public health practitioners and policy makers to improve the healthcare system and health promotion strategies. The objectives of the study were to unveil the adolescents’ girl knowledge on reproductive health. To elicit the types of care adolescent girl sought when they get ill and to identify determinates of the adolescent girl for seeking care. Focused group discussion and in-depth interview was conducted with adolescent unmarried school going girls at Demajani village under Bogura District on January 2023. The study followed by the health belief model. Respondents were going through the mental and physical changes as they were in adolescent stage. They leant about the reproductive health from their female family members. They share their physical problems with the peer group and tried to solve it by home remedies and then to the qualified doctor. Choice of treatment was dependent on their perceived susceptibility and severity. Respondents were depended on parent as they unmarried. Their family was motivated by the communities. Therefore their treatment seeking actives sometimes ignored the availability, affordability and accessibility of the health services.

Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma

BackgroundThe fear and lack of understanding of mental illness can lead to stigma. The stigma of mental illness affects not only individuals who suffer from it, but also the caregivers. Stigma among caregivers can lead to delay in seeking care, poor adherence to treatment and a high risk of relapse. Caregivers of patients with mental illness are at an increased risk of distress due to the burden to stigma and caregiving burden. An increase in caregivers’ burden can lead to a reduction in caregivers’ involvement. There is a relationship between caregivers’ involvement, burden, and affiliated stigma. The present study examined the mediating role of affiliated stigma in the relationship between caregivers’ burden and involvement among informal caregivers of hospital-admitted patients with mental illness in Uganda.MethodsA cross-sectional study was conducted among 428 informal caregivers (mean age: 39.6 years [SD±14.6]; females = 62.1%). Information was collected regarding sociodemographic characteristics, affiliated stigma, and the involvement and burden of informal caregivers. ResultsThe findings indicate that affiliated stigma serves as a full mediator between the caregiver’s roles and involvement (β=15.97, p<0.001). Being female increased the caregivers’ burden of caregiving (β= -0.23, p<0.001).ConclusionThe findings in the present study suggest that intervention to address affiliated stigma among caregivers of patients with mental illness should be incorporated into mainstream mental health care to reduce the caregiving burden.

Perceptions of stigma among pulmonary tuberculosis patients in Thailand, and the links to delays in accessing healthcare.

Delay in seeking care increases the morbidity and mortality in tuberculosis (TB) patients and leads to increased likelihood of transmission within the community. Stigmatisation is one of the influencing factors causing delay in accessing healthcare when experiencing symptoms of TB. This study aimed to explore the relationship between TB stigmatisation and patient delay among pulmonary tuberculosis (PTB) patients. A mixed methods study was undertaken among 300 randomly sampled participants who completed questionnaire surveys, supplemented by 25 in-depth interviews with purposively-sampled participants identified as delaying access to healthcare. Participants reporting higher perceived levels of TB stigmatisation demonstrated a longer duration of patient delay (p < 0.001). Qualitative data reinforced the view that perceptions of TB as being a disease carrying with it a stigma contributed to a delay in seeking healthcare. This was also exacerbated in patients with HIV-positive. Given that HIV-positive status is still subject to stigma in some parts of society, patients demonstrated additional reluctance to seek out healthcare if they were known to be HIV-positive whilst also experiencing symptoms of TB. The study highlights that accurate and objective information about TB is required to reduce societal stigmatisation related to the disease, thereby reducing the reluctance of patients to access healthcare.

Factors associated with delays in seeking treatment for acute bleeding among persons living with haemophilia in Uganda: a cross-sectional mixed methods study

Abstract Introduction Haemophilia is associated with a high tendency of acute bleeding episodes which can lead to severe morbidity and mortality in the absence of prompt care. Although delay in seeking care can lead to adverse outcomes, many people with haemophilia (PwH) in Uganda do not report to haemophilia treatment centres (HTCs) for treatment in the event of acute bleeding within the two hours recommended by the World Federation of Hemophilia (WFH). Information on factors associated with delays in seeking care is limited. A study among people with haemophilia presenting at five regional treatment centres across Uganda found transport costs is a major issue impacting treatment seeking for acute bleeds Aims This study aims to determine the extent and factors associated with delays in seeking treatment for acute bleeding among people with haemophilia (PwH) in Uganda to inform appropriate mitigating stratregies and hence improve health outcomes and quality and life. Methods The study was conducted in five haemophilia treatment centres (HTCs) across Uganda and used a cross-sectional design with mixed methods of data collection. PwH seeking care at the HTCs for acute bleeding episodes were consecutively sampled. A pre-tested questionnaire was used to collect data. Alongside this, qualitative interviews explored health workers’ perceptions of factors associated with delays in seeking treatment among patients. Health workers were purposively selected. The quantitative data were analysed using STATA version 16; qualitative data were analysed manually using inductive thematic analysis to generate codes, categories, sub-themes and themes. Multivariate modified Poisson regression analysis was used to determine factors associated with delay to seeking treatment at HTCs. Results 224 male PwH, aged 1 to 67 years (median 11 years) were included in the analysis. The time taken following an acute bleeding symptom to attending the HTC ranged between 1 and 65 hours, with a median of 9 hours. PwH were more likely to delay seeking treatment for acute bleeding episodes if they used public means of transport to the HTC (aPR 1.39; 95% CI 1.22-1.59). PwH who took immediate other actions on recognition of a sign of an acute bleeding episode were less likely to delay seeking treatment at the HTC (aPR 0.75; 95% CI 0.66-0.84). Conclusion Delays in seeking treatment among PwH in Uganda are the result of an interplay between individual and health system factors. Continued information and education programmes are needed to ensure PwH and caregivers understand the benefits of early treatment-seeking, alongside expanding HCP knowledge and capacity building. Mobile clinics and home therapy could reduce travel and waiting times for those needing to access treatment. Addressing these issues could help to provide a level of care for PwH that helps to ensure improved quality of life and better health outcomes.

Birth Preparedness and Complication Readiness among Women in Jugal Hospital, Harar, Ethiopia

Background: The majorities of maternal fatalities are avoidable and are generally blamed on patients delaying seeking care. Delays in deciding to seek treatment if a complication arises, delays in getting to care, and delays in obtaining care all have an impact on the availability and usage of obstetric services to avoid maternal mortality. So Birth preparedness and complication readiness is a crucial strategy for reducing maternal and newborn mortality. This study was aimed to assess the current status of birth preparedness and complication readiness in Harari regional state, Harar, Ethiopia from April 1st to 30th, 2023. Methods: An institution-based cross-sectional research was conducted at Jugal Hospital in Harar, Pregnant women who can hear and communicate and who were voluntary to participate were included. Systematic random sampling technique was used to select 233 pregnant women. The survey tool (questionnaire) used was developed by Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHIEGO). SPSS version 21 was used for analysis. Descriptive analysis was done and the results were presented in the form of narrative and table. Bivariable and multivariable logistic regression was done to identify factors associated with birth preparedness and complication readiness. All variables with p-value less than 0.25 in bivariable logistic regression model were entered to a multivariable logistic regression model for controlling possible confounding and odds ratios and their 95% CIs were computed. Result: Eighty-seven (37.83%), of the respondents mentioned at least two key obstetric danger signs during pregnancy, 92 (40.00%), of the respondents mentioned at least three key obstetric danger signs during childbirth and 66 (28.70%) of the respondents mentioned at least two key obstetric danger signs during postpartum period , 178 (77.39%), 199 (86.52%), 43 (18.70%), 67 (29.13%) and 7 (3.04%) of respondents indicated that they saved money, identified the place of delivery, identified skilled providers, identify means of transport and blood donors, respectively. Conclusion: This study revealed, age of the mother, Educational status, maternal occupation,. Residence, No. of pregnancy, Current ANC visit and History of stillbirth, were significantly associated with birth Preparedness and Complication readiness

Profile and determinants of delayed care-seeking and diagnosis among patients with imported malaria: a retrospective study in China, 2014–2021

BackgroundIn areas where malaria has been eliminated, delayed care-seeking and diagnosis of imported malaria are constant threats. This study aimed to describe the profile and determinants of delayed care-seeking and diagnosis among patients with imported malaria in China.MethodsThis retrospective study assessed surveillance data obtained from 2014 to 2021 in the Chinese provincial-level administrative divisions (PLADs) of Anhui, Henan, Hubei, and Zhejiang, and Guangxi. Epidemiological characteristics were analyzed using descriptive statistics. Furthermore, factors associated with delayed care-seeking and diagnosis among imported malaria cases were identified using multivariate logistic regression.ResultsOverall, 11.81% and 30.08% of imported malaria cases had delays in seeking care and diagnosis, respectively. During the study period, there was a decreasing trend in the proportion of imported malaria cases with delayed care-seeking (χ2 = 36.099, P < 0.001) and diagnosis (χ2 = 11.395, P = 0.001). In multivariate analysis, independent risk factors associated with delayed care-seeking include PLADs (Guangxi as reference), consultations in high-level facilities for the first medical visit, infections with non-Plasmodium falciparum species, and older age. However, PLADs (Guangxi as reference), the purpose of traveling (labour as reference), and infections with non-P. falciparum species increased the risk of delayed diagnosis. Delayed care-seeking (adjusted odds ratio: 1.79, P = 0.001) and diagnosis (adjusted odds ratio: 1.62, P = 0.004) were risk factors for severe disease development.ConclusionsBased on this study’s findings, we strongly advocate for improved access to quality healthcare to reduce the rate of misdiagnosis at the first visit. Infections caused by non-P. falciparum species should be highlighted, and more sensitive and specific point-of-care detection methods for non-P. falciparum species should be developed and implemented. In addition, education programs should be enhanced to reach target populations at risk of malaria infection. All these factors may reduce delayed care-seeking and diagnosis of imported malaria.Graphical

PATHWAYS OF CARE: THE EXPERIENCE AND COSTS OF CARING FOR FAMILY MEMBERS LIVING WITH DEMENTIA IN MEXICO

Abstract Introduction Formal health and social security institutions are not unequipped to respond to significant dementia prevalence, and currently, no publicly funded national level dementia care policies are in place. However, little is known about the economic, social and health consequences for those providing care. Methods This paper presents families’ health and social dementia care seeking trajectories and the structural factors that shape them. It is based on results of almost 2 years of highly inductive fieldwork, carried out before and during the ongoing COVID-19 pandemic, and includes 50 in-depth interviews with 23 unpaid family caregivers. Results Lack of awareness and knowledge about dementia and normalization of cognitive impairment as part of aging result in long delays in seeking care. When there is a diagnosis, health professionals concentrate on clinical aspects of illness, but seldom explain possible changes, behaviours, symptoms, or provide care strategies. For most carers, high opportunity costs are reported with high impact as they stop or change to more flexible employment, change living arrangements, in addition to the large economic impact of paying for most care inputs such as medicines or home adaptations. Conclusions In Mexico, these unpaid family carers struggle to navigate complicated care pathways, with little or no government or public support. Health system institutions should increase awareness and knowledge about dementia and prioritize developing and coordinating programs that provide timely diagnosis within primary care services and support strategies for people living with dementia and their carers, using person centred care.

1400. Emergency Department (ED) Use among Persons With HIV (PWH) before and during the COVID-19 Pandemic

Abstract Background Substantial changes in access and delivery of primary HIV care occurred during the COVID-19 pandemic. To assess how care access changed during the COVID-19 pandemic, we estimated ED use among PWH in care 2017-2021 in the southeastern US. Methods For each calendar year, among PWH in care in the UNC CFAR HIV Clinical Cohort (defined as having a clinic visit in the current or prior year), we estimated the percent of patients with ≥ 1 ED visit in a given year, overall and by age, gender, race/ethnicity, HIV viral load (VL), and CD4 count. We estimated risk ratios (RRs) comparing patient characteristics and years 2020-2021 vs. 2017-2019, using Poisson regression with generalized estimating equations to account for repeated measures. Results Among 2129 PWH in care 2017-2021 (N≈1700-1800 in each year), 57% identified as Black, 31% White, 8% Hispanic, 26% women, with median age of 47 years (IQR 35-55). During the study period, there were 3645 ED visits over 8813 person-years, a rate of 41.4 ED visits-per 100 person-years(95% CI 36.8-46.5) per 100 person-years. The 845 PWH with at least one ED visit during the study period contributed a median of 2 visits each (IQR 1-5). The unadjusted probability of having ≥1 ED visit in a given year was higher among women vs. men (RR=1.14, 95% CI 0.99-1.32), Black vs. White PWH (1.31, 1.13-1.52), with VL ≥ 40 copies/mL (1.40, 1.20-1.64), and with CD4 &amp;lt; 200 (1.66, 1.32-2.09) or 200-349 (1.50, 1.25-1.79) vs. ≥ 500 cells/μL; age was not associated with ED use. Compared with 2017-2019, the annual probability of having ≥ 1 ED visit was lower in 2020-2021, with RRs of 0.83 (95% CI 0.76-0.90) in unadjusted analyses and 0.80 (95% CI 0.71-0.90) after adjusting for demographics, VL, and CD4. There was also a significant unadjusted decrease for 2020-2021 vs. 2017-2019 among women, men, PWH who were Black, White, &amp;lt; 40 or 50-59 years old, and with CD4 &amp;gt;500 (Fig. B-F, all P&amp;lt; 0.05). Conclusion Among PWH in HIV care, ED use was higher among women, Black PWH, and PWH with poorly controlled HIV. ED use decreased 2020-2021 in most groups, indicating that PWH during the COVID-19 pandemic may be delaying seeking care for acute conditions, or accessing care in other ways. Work is ongoing to characterize reasons for ED visits across calendar years and examine the impact of reduced ED utilization among PWH. Disclosures Joseph J. Eron, MD, Adagio Therapeutics: data safety monitoring committee|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Glaxo Smith Kline: Advisor/Consultant|Merck: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support.

Exploration of pre-hospital patient delays in seeking care for symptoms of bacteremia and sepsis: A qualitative study.

We explored patient pre-hospital delays in seeking care for symptoms of bacteremia and sepsis. A qualitative descriptive study. In January 2021, we recruited a convenience sample of four men and six women who were former patients diagnosed with bacteremia. We conducted semi-structured interviews by telephone. The tape-recorded interviews were transcribed, coded and analysed using the Common-Sense Model of Self-Regulation. Data analysis continued until May 2021. The three main themes included: gathering threads of information, weaving together the threads of information and impact and outcome of the illness. The main finding revealed was that an inability to recognize symptoms of bacteremia resulted in delayed help-seeking. Participants had difficulty recognizing their symptoms as being related to bacteremia when they lacked experience with infection or could not differentiate them from symptoms of other chronic co-morbid conditions. Recognizing symptoms and searching for their meaning was an early step in developing an action plan for seeking care. Patient-reported physical and psychological outcomes of the infection on their quality of life (QOL) varied widely, from none to major impact.

Challenge of gastro-intestinal stromal tumor management in low-income countries: example of Benin

BackgroundGISTs are rare tumors but the most frequent mesenchymal tumors of the digestive tract. Diagnosis and treatment are challenging in low-income countries due to relatively poor access to immunohistochemistry and targeted therapy. In Africa, there are few studies about it. Imatinib, an oral targeted therapy, has been available in Benin since 2010 and free since 2016. This study describes the diagnosis and therapeutic management of GIST in Cotonou, Benin.MethodsThis is a descriptive cross-sectional study, with retrospective data collection over a 10-year period from 2010 to 2020, focused on patients with histological confirmed gastro-intestinal stromal tumor (GIST). Cases were identified using the registry database and the archival files of the Hubert Koutoukou Maga National University Hospital of Cotonou (CNHU-HKM).ResultsFifteen GISTs were identified during the study period. The median age was 52 and the sex ratio was 2:1 (10 males and 5 females). The most frequent symptom was abdominal pain (n = 12). Delay in care seeking after onset of symptoms ranged from 24 h to 15 years. The most common site for GISTs was the stomach (n = 8). The median tumor size was 11 cm and the majority (n=10) was metastatic or locally advanced at the time of diagnosis. The tumors were often spindle-shaped at histology (n = 13) and the majority expressed KIT (n = 14). Most of the tumors (n = 12) were at high risk of recurrence according to the Joensuu scoring system. The availability of imatinib has improved the outcome of GIST with response in all cases it was used in neoadjuvant setting (n = 7).ConclusionGISTs are rare tumors and preferentially affect the stomach in Cotonou). Most of the tumors were large, unresectable at the time of diagnosis and at high risk of recurrence. Access to imatinib has revolutionized the management of those tumors in our country.

Erfahrungen von Menschen mit Fluchtgeschichte bei der Inanspruchnahme der Gesundheitsversorgung in Deutschland – Erkenntnisse einer qualitativen Studie

ZusammenfassungHintergrundMenschen mit Fluchtgeschichte sind mit einer Vielzahl von rechtlichen, strukturellen, administrativen, kulturellen und sprachlichen Barrieren im Zugang zur Gesundheitsversorgung konfrontiert. Derzeit liegen jedoch wenig Daten zu gesundheitlichen Bedarfen und Bedürfnissen von Geflüchteten vor. Insbesondere ihre subjektiven Erfahrungen im Zugang zur Gesundheitsversorgung sind bisher wenig berücksichtigt worden.Ziel der ArbeitIn diesem Beitrag sollen die subjektiven Erfahrungen von Menschen mit Fluchtgeschichte beim Zugang zur Gesundheitsversorgung und bei deren Nutzung beschrieben werden. Strategien bei der Bewältigung von Herausforderungen werden dargestellt.MethodenDie Rekrutierung der InterviewpartnerInnen erfolgte anhand von quantitativen Querschnittsdaten, die im Rahmen einer Studie zur Gesundheit von Geflüchteten (FlüGe-Gesundheitsstudie) erhoben wurden. Personen, die einer erneuten Kontaktaufnahme zugestimmt hatten, wurden telefonisch kontaktiert. Es wurde eine im Hinblick auf Alter, Geschlecht, Nationalität, Gesundheitszustand und Inanspruchnahmeverhalten heterogene Teilstichprobe (n = 18) mittels dolmetschergestützter problemzentrierter Interviews nachbefragt. Die Datenauswertung erfolgte in einem deduktiv-induktiven Prozess.Ergebnisse und DiskussionDie wenig migrationssensible Gesundheitsversorgung von Menschen mit Fluchtgeschichte ist geprägt durch Sprachbarrieren, Orientierungslosigkeit, Ablehnungserfahrungen, Fehlbehandlungen und strukturelle Barrieren. Fremdheitserfahrungen in und mit dem Gesundheitssystem können dazu führen, dass die Versorgung nicht (mehr) oder nur verzögert in Anspruch genommen wird. Gleichzeitig werden individuelle Strategien von Geflüchteten und VersorgerInnen angewendet, um den genannten Herausforderungen zu begegnen.

Delayed Care Seeking and Outcomes of Testicular Torsion among Children during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Since the onset of coronavirus disease 2019 (COVID-19), stay-at-home orders and fear caused by the pandemic have had a significant effect on the timing and outcomes of testicular torsion. However, the evidence was limited since the study results were inconsistent. This study aims to examine the hospitalization rates, timing, and outcomes of testicular torsion in children before and during the pandemic. Using PubMed, Embase, and Google Scholar databases, we conducted a systematic search and meta-analysis of studies reporting the timing and outcomes of children admitted with testicular torsion before and during the COVID-19 pandemic. Subgroup analyses were conducted to explore possible sources of heterogeneity. The outcomes of 899 testicular torsion patients from eight studies were evaluated. Our study found an increased hospitalization rate for patients with testicular torsion (incidence rate ratio = 1.60, 95% confidence interval [CI]: 1.27-2.03; p = 0.001). Despite a significant increase in the duration of symptoms during the COVID-19 pandemic (weighted mean difference = 11.04, 95% CI: 2.75-19.33; p = 0.009), orchiectomy rates did not increase (odds ratio = 1.33, 95% CI: 0.85-2.10; p = 0.147). During the COVID-19 pandemic, hospitalization rates for testicular torsion and the duration of symptoms among children increased significantly. Moreover, the rate of orchiectomy did not increase during the pandemic, indicating that pediatric emergency services have remained efficient and have prevented an increase in the number of orchiectomies performed despite pandemic-related closures and delays in transporting patients to medical care.

Prognostic Factors and Outcomes of Adolescent and Adult Burkitt Lymphoma and Leukemiafrom a Low-Middle Income Country: An Experience from Hematology Cancer Consortium

The treatment of BL/L has evolved on the principles of short-course, intensive, non-cross resistant, alternating chemotherapy. These intensive high-dose methotrexate-based treatment regimens (CODOX-M/IVAC, Hyper-CVAD, BFM, LMB) have led to high response rates and cures in a significant proportion of children and young adults. The addition of rituximab has led to overall survival benefit. There is limited data that dose adjusted EPOCH-R provides a low intensity treatment option for patients who may not be able to tolerate high-dose methotrexate-based regimens. Efficacy of these regimens in real-world, more so in an LMIC setting need to be evaluated given the delays in seeking care, higher risk of treatment-related complications including infections and antecedent treatment interruptions. This retrospective multicentric study collected the data from eight-member centers of Hematology Cancer Consortium (www.hemecancer.org) using an electronic database, to analyze the clinical characteristics, treatment patterns, outcomes and prognostic factors in adolescent and adult newly diagnosed Burkitt lymphoma and leukemia diagnosed between 2012-2019 (including HIV positive). Patients who had received more than 2 weeks of chemotherapy or steroids prior to presentation were excluded. The data included demographic details, performance status (ECOG), HIV serology, bone marrow and CNS involvement, stage, treatment type, use of rituximab, response to treatment, and treatment-related mortality as assessed by the investigator of the respective centre. The primary objective was to evaluate event-free survival at 2 years. Secondary objectives were to evaluate the overall survival, impact of the treatment protocol, use of rituximab, stage, age, performance status, CNS involvement, and HIV positive status on the overall and event-free survival. A total of 312 patients were included in this study. Out of these 257 patients received treatment and were analyzed for the outcome and prognostic factors. The treated and untreated cohorts differed in age [ median age 37 years (range-25-49 years) versus 42 years (range-32-51 years); with the untreated cohort being older. Table 1 provides the baseline characteristics of the patients who received treatment. The HIV positive patients (in treated cohort) had higher LDH [median - 967.5 (range, 509- 2355) vs 589 (311-1141), p=0.003). A total of 100 (42%) patients received intensive and high-dose methotrexate-based chemotherapy, 81 (34%) patients received dose-adjusted EPOCH-based treatment whereas 56 (24%) received other low-intensity or palliative chemotherapy. Patients with HIV were largely treated with a dose-adjusted EPOCH-based regimen (25/32 patients). Patients who received a high-dose methotrexate-based regimen were younger than those who received dose-adjusted EPOCH and other lower intensity regimens (Mean age 29 years versus 42.4 and 43.9 years) At the median follow-up of 36.5 months, the 2-year EFS was 61% and 2-year OS was 73%. There was no significant difference in outcomes in HIV-positive and negative patients. On univariate analysis lack of use of rituximab and use of protocols other than high-dose methotrexate and dose-adjusted EPOCH negatively affected EFS and OS. Age had an adverse impact on the OS but not EFS whereas stage 2 or above had a negative impact on EFS. On multivariate analysis use of regimens other than high-dose methotrexate-based and dose-adjusted EPOCH was a negative prognostic factor for both EFS and OS. The HR favored high dose methotrexate and dose-adjusted EPOCH-based regimen for both EFS and OS; HR- 0.42 (95% CI,0.22,0.77) and 0.27(95% CI,0.13-0.59), respectively. Use of rituximab was associated with better OS HR-0.44(95% CI,0.21-0.93) and a trend toward better EFS - HR-0.58 (95%CI, 0.31-1.07). The treatment-related mortality was 11.2% (29/257) and high serum LDH was associated with higher mortality (p=0.003). Treatment of adolescent and adult Burkitt lymphoma and leukemia with intensive regimens (high-dose methotrexate-based) and dose-adjusted EPOCH regimen resulted in similar survival. Dose-adjusted EPOCH-based regimen was preferred in older patients. The use of rituximab in these patients adds to the overall survival benefit. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Disparities in Mortality Among Myelodysplastic Syndrome-Related Hospitalizations

Introduction: Myelodysplastic syndromes (MDS) are a diverse group of disorders characterized by clonal proliferation of hematopoietic stem cells, ineffective hematopoiesis, and cytopenia. These disorders can be difficult to diagnose and carry a high risk of evolution to acute myeloid leukemia (AML). Prognostic risk is determined by cytogenetic and molecular features. Outcomes are dependent on pathologic, molecular, and clinical features. However, it is becoming increasingly apparent that socioeconomic and racial/ethnic differences also contribute to disparate outcomes in hematologic malignancies and MDS. Here, we analyzed in-hospital death among MDS-related hospitalizations and evaluated differences in sociodemographic characteristics, focusing on the effect of primary payer on MDS mortality. Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS), the largest all-payer database of hospital admissions in the United States, from January 1st, 2010 through December 31st, 2019. The study sample consisted of adult (18 years and above) hospitalizations with MDS diagnosis captured using ICD-9 and 10 codes indicative of MDS. We performed adjusted survey logistic regression analyses to assess associations between sociodemographic characteristics (exposure) and in-hospital mortality among MDS hospitalization (outcomes). Results: Our data captured 304,050,043 hospital encounters of adult patients from 2010 to 2019, and 787,105 of those had a MDS diagnosis. Overall, patients who self-paid were more likely to have in-hospital mortality compared to those with private insurance [odds ratio (OR), 95% confidence interval: 1.85 (1.61-2.12)]. In contrast, patients with Medicare or Medicaid had less in-hospital mortality compared to those with private insurance [OR: 0.80 (0.75-0.85) and 0.65 (0.55-0.76) respectively). This trend was observed in NH-White, NH-Black, and NH-other patients and was most pronounced and significant in the NH-White population. Among NH-White patients, in-hospital mortality in self-paid was nearly double to their privately insured counterparts [OR 1.99 (1.70-2.33)]. Additional findings noted were relatively higher in-hospital mortality among overall males compared to female [OR 1.22 (1.16-1.27)] and higher among NH-white compared to NH-black or Hispanic (Table 1). Interestingly, the Midwest region had better outcomes than the other regions, and Medicaid patients had better outcomes than other payer groups (Table 1). Conclusion: In-hospital mortality was higher in self-paid patients, both overall as well as in multiple racial/ethnic groups. Patients with Medicaid were relatively younger which might have resulted in better mortality outcome noted in our study. It is possible that those who are self-paid are too young to qualify for Medicare, are low-income but not enough to qualify for Medicaid, or do not qualify for public assistance due to other unmeasured variables, such as undocumented residency status. Self-paid patients may delay seeking care and have fewer interactions with the healthcare system prior to hospitalization due to associated cost and thus are sicker at time of hospitalization. Further research is needed to explore if this disparity in mortality in self-paid patients is related to access to care, treatment received including transplant status, or the disease severity and its complications. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 15281: Patient and System-Related Delays in Presentation and Invasive Coronary Angiography in Patients Presenting With Acute Myocardial Infarction Secondary to Spontaneous Coronary Artery Dissection: A Report of the ISCAD Registry

Introduction: Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome especially in young patients. Factors associated with delays in presentation and care delivery are not well understood. Methods: We used data from the iSCAD Registry which is a prospective multicenter US registry of patients with SCAD. Early vs. delayed hospital presentation (&lt; 24 vs. ≥ 24 hours), and early vs. delayed coronary angiography (time from hospital presentation to coronary angiography &lt; 24 vs. ≥ 24 hours) for SCAD patients with AMI were assessed. Patient characteristics, and in-hospital events were compared between the two groups. Factors associated with delayed presentation and angiography were explored using multivariable logistic regression. Results: A total of 346 SCAD (294 white, 52 non-white) patients presented with STEMI (34%) or NSTEMI; 57 had a delayed presentation to the hospital after symptoms onset. No significant factors were identified for delays in seeking care. However, white race was less likely to have delayed invasive coronary angiography (multivariable OR=0.38; 95% CI 0.19 to 0.76; p=0.0059). Patients undergoing delayed angiography were also more likely to be medically managed (91.7% vs. 69.8%, p=0.0008), but less likely to receive dual antiplatelet therapy (57.0% vs. 73.1%, p=0.007). In-hospital outcomes were similar between the two groups. Conclusion: In this study, no patient-related variables were identified that predicted a delay in presentation with AMI secondary to SCAD. On the other hand, non-white race was associated with delays in performing invasive coronary angiography. Further investigation is required to determine the factors contributing to this potential disparity.

OR05-6 Designing a Gender Affirming Hospital: Patient Perspectives on Gender Inclusive Care

Abstract Background Studies have shown transgender and non-binary individuals encounter discrimination and harassment in medical settings leading to delays in seeking care and worse physical and mental health outcomes. Organizations, including the American Academy of Pediatrics, published recommendations for medical centers to foster respectful and inclusive care through systems, environmental, and educational changes. However, it is unclear whether health systems are making these changes and what the impact may be for transgender and non-binary youth. Objective To explore perspectives of transgender and non-binary patients regarding the current state of gender inclusive care at our medical center and identify areas for improvement. Design/Methods A qualitative study was conducted at a large academic center. Participants aged 13-21 years were recruited from the Center for Gender Affirming Care to participate in a semi-structured interview and demographics survey regarding their experiences across various clinical settings within the medical center. Interviews were audio-recorded and transcribed verbatim. Survey results were analyzed using descriptive statistics. Two independent coders reviewed the transcripts, developed a preliminary coding scheme, and reached consensus on any coding discrepancies. ATLAS.ti® was used for thematic analysis. Results Thirty participants completed an interview and survey. Mean age of participants was 17 years, with 30% identifying as female/trans female, 47% male/trans male, and 23% identifying as nonbinary or gender fluid. Several key themes emerged. Overall participants are satisfied with their care and attributed improvements to societal progress and systems/environmental changes. Parent advocacy and diversity among staff promoted positive and affirming experiences. However, participants identified personnel, systems, and environmental areas needing improvement including: 1) Provider training on use of pronouns, gender affirming terminology, and exam techniques, 2) Reliable and accurate display of chosen name and pronouns in the electronic medical record (EMR) and patient labels, and standardized check-in processes to prevent misnaming/misgendering, 3) Desire for more LGBTQ-inclusive décor and resources. Conclusions While national recommendations were published more than 5 years ago, it is clear from our participants that not all recommendations have been implemented consistently across all clinical settings. Eliciting feedback from patients may provide tangible ways to improve care for this population. Presentation: Saturday, June 11, 2022 12:45 p.m. - 1:00 p.m.

Delay in care seeking for menstrual regulation among the women attending a selected clinic

Each year women around the world experience 75 million unwanted pregnancies. Millions of women around the world risk their lives and health to end unwanted pregnancies. This descriptive type of cross-sectional study was conducted among 103 respondents from Mohammadpur Fertility Centre, Dhaka, Bangladesh to find out the factors influencing delay in care seeking for menstruation regulation among the women attending selected MR clinic from March to June 2015. Respondents were enrolled in the study using Purposive sampling technique. Data was collected by face to face interview with a semi-structured questionnaire. Here, 85% gave right answer about Knowing of MR. Respondent's main personal cause for delaying MR was that 37% home abortion by taking gynaecosid or other tablet. About familial causes of delaying MR shows that majority (47%) had in security of the house, 38% resistance by husband/others. The main social causes of delaying MR shows that majority (61%) was due to spiritual bindings and service or service center related causes for delaying MR due to treatment cost, male doctor, complexity of services and rest due to the substandard services. Women had good knowledge about MR and its timing even they make delay due to unawareness of their legal rights, personal, social and service related causes.