Different Levels Of Health Care Research Articles

Prognostic significance of socioeconomic deprivation in patients with colorectal liver metastasis undergoing liver resection: a retrospective cohort study.

To evaluate the effect of socioeconomic deprivation on overall survival (OS) in patients undergoing liver resection for colorectal liver metastasis (CRLM). The STROCSS guideline for observational studies was followed to conduct a single-centre retrospective cohort study. All consecutive patients undergoing resection of CRLM between 2013 and 2021 were considered eligible for inclusion. The Welsh Index of Multiple Deprivation (WIMD) rank was used to determine socioeconomic deprivation status of each patient. Prognostic significance of socioeconomic deprivation was determined by Kaplan-Meier survival statistics and stepwise Cox proportional-hazards regression model. A total of 455 patients were eligible for inclusion; 237 patients were classed as least socioeconomically deprived and 218 patients as most socioeconomically deprived. Kaplan-Meier survival statistics showed that socioeconomic deprivation was associated with significantly lower probability of overall survival (HR: 1.55, 95% CI 1.23-1.95; logrank test: P = 0.0001). The stepwise Cox proportional-hazards regression analysis identified socioeconomic deprivation as predictor of OS (HR: 1.56, P = 0.0003) alongside the following variables: ASA status 1 (HR: 0.43, P = 0.0349), presence of extrahepatic disease (HR: 1.51, P = 0.0075), number of tumours (HR: 1.07, P = 0.0221), size of largest tumour (HR: 1.01, P = 0.0003), extended hemihepatectomy (HR: 3.24, P = 0.0018) and absence of recurrence (HR: 0.55, P < 0.0001). Socioeconomic deprivation reduces the probability of long-term overall survival following liver resection in patients with CRLM. This should be taken into account at different levels of health care planning for management of patients with CRLM including preoperative risk assessment, health care need assessment and allocation of resources.

Cuidados de enfermagem em saúde mental para pessoas com diabetes mellitus: revisão integrativa

Objective: evaluate the evidence available on mental health nursing care for people with diabetes mellitus at different levels of health care. Method: integrative literature review. The search was conducted in five databases. The sample consisted of 14 studies. The studies were exported to the EndNote manager and their data to a Microsoft Excel spreadsheet. The methodological quality of the studies was evaluated using tools proposed by the Joanna Briggs Institute. Sampling, categorization, evaluation, interpretation of the results, and synthesis of the included studies were carried out by two reviewers independently. The descriptive analysis of the results is presented in three categories. Results: self-care guidelines enhanced by the social support network, encompassing physical and psychological tools and strategies; therapeutic communication and psychotherapy strategies, focusing on psychotherapy and therapeutic communication; and self-management interventions, addressing self-care based on behavioral theories. Conclusion: the synthesis of knowledge revealed that guidelines for self-care enhanced by the social support network, psychotherapy and therapeutic communication strategies, and self-management interventions are positive interventions that contribute to people with mental disorders and diabetes mellitus in the prevention of diseases.

The diagnostic yield of nasopharyngeal aspirate for pediatric pulmonary tuberculosis: a systematic review and meta-analysis

BackgroundTuberculosis (TB) is a leading cause of death in children, but many cases are never diagnosed. Microbiological diagnosis of pulmonary TB is challenging in young children who cannot spontaneously expectorate sputum. Nasopharyngeal aspirates (NPA) may be more easily collected than gastric aspirate and induced sputum and can be obtained on demand, unlike stool. However, further information on its diagnostic yield is needed.MethodsWe systematically reviewed and meta-analyzed the diagnostic yield of one NPA for testing by either culture or nucleic acid amplification testing (NAAT) to detect Mycobacterium tuberculosis from children. We searched three bibliographic databases and two trial registers up to 24th November 2022. Studies that reported the proportion of children diagnosed by NPA compared to a microbiological reference standard (MRS) were eligible. Culture and/or WHO-endorsed NAAT on at least one respiratory specimen served as the MRS. We also estimated the incremental yield of two NPA samples compared to one and summarized operational aspects of NPA collection and processing. Univariate random-effect meta-analyses were performed to calculate pooled diagnostic yield estimates.ResultsFrom 1483 citations, 54 were selected for full-text review, and nine were included. Based on six studies including 256 children with microbiologically confirmed TB, the diagnostic yield of NAAT on one NPA ranged from 31 to 60% (summary estimate 44%, 95% CI 36–51%). From seven studies including 242 children with confirmed TB, the diagnostic yield of culture was 17–88% (summary estimate 58%, 95% CI 42–73%). Testing a second NPA increased the yield by 8–19% for NAAT and 4–35% for culture. NPA collection procedures varied between studies, although most children had NPA successfully obtained (96–100%), with a low rate of indeterminate results (< 5%). Data on NPA acceptability and specifically for children under 5 years were limited.ConclusionsNPA is a suitable and feasible specimen for diagnosing pediatric TB. The high rates of successful collection across different levels of healthcare improve access to microbiological testing, supporting its inclusion in diagnostic algorithms for TB, especially if sampling is repeated. Future research into the acceptability of NPA and how to standardize collection to optimize diagnostic yield is needed.

O.4.1-4 Integrated geriatric care - a community approach to preventing falls and frailty of elderly Slovenian

Abstract Purpose The need for geriatric treatment is increasing with the aging of the population. Multimorbid patients with social care problems and increased need for rehabilitation and paliative care are more common. Mortality of the elderly, due to falls is 2.5 times higher in Slovenia than in the other EU countries. Until the national regulation of integrated geriatric care in Slovenian health system and in other relevant environments (community, long-term care, social care) and the establishment of appropriate, licensed postgraduate training for health professionals, it is necessary to start educating wider range of health and social care personnel, for most common geriatric syndromes such as frailty, falls and NCDs. Establishing a community approach to health is one effective way to address vulnerability of elderly population. Project description Project Integration of geriatric care for the elderly is implementing the existing commitment from WHO Decade of healthy ageing and the Slovenian Health Care Plan until 2025. With planned activities, it will ensure equal access to quality and safe health services, integrated and comprehensive treatment and will contribute to the deinstitutionalization of the Slovenian eldest population. It will develop a unified set of tools, for the systematic identification of elderly needs, new digital tools for optimization and better communication between different levels of providers and training a wider range of new and already employed health and social care personnel, for optimal health care. Evaluation of new competency models for health care personnel, training methods and proposed clinical pathways will be carried out at the end of the project. Based on final proposals, we will establish a new approach to the system level of integrated geriatric care and bring the treatment closer to the patient's home. Conclusions Project will also contribute to upgrading competences of physiotherapists, kinesiologists, standard health teams in Health Promotion Centers, community nurses, family medicine and internal medicine doctors and social care workers for the integrated geriatric care for the elderly. It will address especially treatment of the physical component in geriatric syndrome, such as decreased muscle strength, balance, impaired walking and frailty, at different levels of health care and communities.

İnfantil Dermatolojik Hastalık ve Tedavilerin Sıklığı: Özel Hastane ve Özel Klinik Analizi

The aim of this study was to determine the prevalence and distribution of dermatologic diseases and treatments in pediatric patients between the ages of 0-2 and the relation between skin diseases and age, gender and application year in private healthcare providers. The study was retrospectively analysed and conducted at dermatology department in a private hospital and private dermatology clinics. A total of 482 patients aged 0-2 years of outpatient admissions from January 1, 2015, to December 1, 2022 were included the study. The most common diseases group were eczemas (53.6%), nevus and benign skin tumors (8.3%), viral diseases (6%), pigmentation disorders (5.7%), and parasitic infections (4%). The dermatitis group was statistically significantly higher in 0-1 age group than 1-2 age. Atopic dermatitis was the most common diagnosis. The viral infections, parasitic infections, nail diseases, and dermatoses due to physical factors were higher in 1-2 age group (p&amp;lt;0.05). Benign skin tumors were commonly observed in girls and 0-1 age group (p&amp;lt;0.05). The topical treatment were usually prescribed to the patients. Systemic treatment was commonly prescribed in 1-2 age (p=0.007) and follow-up decision was usually given to girls than boys (p=0.001). Viral and bacterial infections were observed in higher rates after coronavirus disease 2019 pandemic (p&amp;lt;0.05). New studies in specific pediatric age groups will help to better understand the frequency of dermatological diseases and treatments and also studies conducted at different levels of health care may contribute better to develop health care policies, designing preventive health services and education programmes.

Multilevel barriers and facilitators to widespread use of preconception carrier screening in the United States

PurposeAlthough preconception reproductive genetic carrier screening (RGCS) is preferred to screening during pregnancy, population-wide preconception screening is not routinely performed in the United States. We explored the multilevel barriers to the widespread adoption of preconception RGCS in the United States via key informant interviews. MethodsSemi-structured virtual video interviews were conducted with 29 informants with a breadth of professional expertise between May and October 2022. Data collection and qualitative analyses were guided by the Consolidated Framework for Implementation Research and socioecological model. Analysis focused on identifying barriers to delivering preconception RGCS at and across different levels of health care and exploring potential facilitators of preconception RGCS delivery. ResultsBarriers to preconception RGCS were identified at the levels of test characteristics, patients and couples, clinicians and care teams, and the external health care and policy environments. Across the different levels of care delivery, 3 themes of barriers emerged: (1) fragmentation and inconsistencies hinder care delivery, (2) gaps in knowledge, misconceptions, and uncertainties about RGCS are pervasive, and (3) expanding preconception RGCS in the diverse US population presents unique implementation challenges. Potential solutions were detailed by informants. ConclusionIdentifying individual and thematic barriers to preconception RGCS delivery may help to define strategies to alleviate obstacles.

Evaluation of outpatient health services in diabetes mellitus in a middle-income setting: a retrospective cohort study involving secondary care

In Brazil, it is necessary to assess the different levels of health care in diabetes mellitus (DM) in order to integrate them. In this retrospective cohort study, we analyzed 1,122 medical records of patients with DM from specialized services with interdisciplinary health teams (IHT) in the city of Ourinhos, São Paulo state, Brazil, to assess the impact of secondary care on glycemic control in patients with DM in those places and to compare baseline and follow-up DM care indicators concerning clinical evaluation and drug treatment regimens in the aforementioned health services. The study covered consultations carried out from September/2013 to September/2017. Data were collected from initial and final appointments in medical records and revealed an increase of 31.21% in insulin introduction and of 73.53% in regimens with three or more non-insulin antidiabetic (NIA) medications. Among the 570 patients with at least two glycated hemoglobin (A1C) measurements in the aforementioned review, 146 did not require any therapeutic adjustment between initial and final appointments, 123 required a subtle adjustment, 95, a moderate adjustment, and 206, an intense adjustment. There was a noticeably higher A1C reduction between initial and final appointments when patients who required an intense drug adjustment were compared to those who did not need any different NIA drug (p-value &lt; 0.0001). In addition to optimizing drug treatment, essential exams in DM were performed with higher frequency, with an increase of 63% in ophthalmology evaluation performed during secondary care approach and 60.65% more individuals being screened for diabetic chronic kidney disease. IHT secondary care considered in this study, therefore, not only improved glycemic control of patients with DM, especially by optimization of NIA regimens and timely prescription of insulin, but also increased the screening for microvascular complications.

Prevalence and associated factors of metabolic-associated fatty liver disease in overweight Finnish children and adolescents.

Data on the prevalence of pediatric fatty liver disease remain limited, partly due to challenges in diagnosis. A novel concept of metabolic-associated fatty liver disease (MAFLD) makes it possible to establish the diagnosis in overweight children with sufficiently elevated alanine aminotransferase (ALT). We investigated the prevalence, risk factors, and metabolic co-morbidities of MAFLD in a large group of overweight children. Data on 703 patients aged 2-16 years examined due to overweight in different levels of healthcare in 2002-2020 were collected retrospectively from patient records. MAFLD was here defined as ALT >2x reference (>44 U/l in girls and >50 U/l in boys) in overweight children according to recently updated definition. Patients with MAFLD and without it were compared, and subgroup analyses were conducted among boys and girls. Median age was 11.5 years, and 43% were girls. Altogether 11% were overweight, 42% obese and 47% severely obese. Abnormal glucose metabolism was present in 44%, dyslipidemia in 51%, hypertension in 48% and type 2 diabetes (T2D) in 2%. MAFLD prevalence varied between 14-20% in examined years without significant change (p=0.878). The pooled prevalence over the years was 15% (boys 18%, girls 11%; p=0.018), peaking in girls at early puberty and increasing in boys with age and puberty. Associated factors in boys were T2D (OR 7.55, 95% CI 1.23-46.2), postpubertal stage (5.39, 2.26-12.8), increased fasting insulin (3.20, 1.44-7.10), hypertriglyceridemia (2.97, 1.67-5.30), hyperglycemia (2.88, 1.64-5.07), decreased high-density lipoprotein (HDL) cholesterol (2.16, 1.18-3.99), older age (1.28, 1.15-1.42) and higher body-mass-index (1.01, 1.05-1.15), and in girls T2D (18.1, 3.16-103), hypertriglyceridemia (4.28, 1.99-9.21), and decreased HDL (4.06, 1.87-8.79). Prevalence of MAFLD was 15%, with no statistically significant increase in the 2000s. The condition was associated in general with male gender, puberty stage and disturbances in glucose and lipid metabolism, and higher age and BMI in boys.

The burden of disease due to COVID-19 in Florianópolis, Santa Catarina, Brazil, over a one-year period

COVID-19 has had a powerful impact on society with high rates of morbidity and mortality. The use of an epidemiological indicator that estimates the burden of a disease by aggregating early mortality and non-fatal cases in a single measure has the potential to assist in the planning of more appropriate actions at different levels of health care. The scope of this article is to estimate the burden of disease due to COVID-19 in Florianópolis/SC from April 2020 through March 2021. An ecological study was carried out with data from notification and deaths by COVID-19 in the period of 12 months. The burden indicator called Disability-Adjusted Life Years (DALY) was used, obtained by adding the Years of Life Lost (YLL) to the Years of healthy life lost due to disability (YLD). A total of 78,907 confirmed COVID-19 cases were included. Of these, 763 died during the period under study. Overall, 4,496.9 DALYs were estimated, namely a rate of 883.8 DALYs per 100,000 inhabitants. In males, there were 2,693.1 DALYs, a rate of 1,098.0 DALYs per 100,000 males. In women, there were 1,803.8 DALYs, a rate of 684.4 DALYs per100,000 women. The age group most affected in both sexes was 60 to 69 years. The burden of COVID-19 was high in the city studied. The highest rates were in females and in the 60-69 age group.

Healthcare professionals’ experiences of job satisfaction when providing person-centred care: a systematic review of qualitative studies

ObjectivesThis qualitative systematic review aimed to explore and synthesise healthcare professionals’ (HCPs) experiences of job satisfaction when providing person-centred care (PCC) in healthcare settings in Europe.MethodThis systematic review of qualitative...

Psychometric properties of the Insomnia Severity Index (ISI) in Mexican adults

Background: Insomnia is the sleep disorder with the highest incidence worldwide. It is estimated that this condition increases the risk of developing psychiatric, neurological, and cardiovascular problems. Due to this, it is important to have brief, reliable and valid psychometric instruments that allow health personnel their timely detection in first level health centers. Objectives: Analyze the psychometric properties of the Insomnia Severity Index (ISI) in its version adapted to Spanish in a sample of Mexican adults. Methods: The sample consisted of 310 adults, 223 (71.9%) women and 87 (28.1%) men. The comparison of four ISI measurement models of one, two and three factors and a bifactor model was carried out, its internal consistency was analyzed, an analysis of invariance by sex and correlation analysis with the Athens and Epworth scales. Results: The ISI bifactor model with a general factor (G) and a specific factor for insomnia impact (I) showed the best fit indices (χ2= 29.48, gl = 11, SRMR= 0.03, CFI= 0.98, TLI= 0.96, RMSEA= 0.07), and demonstrated configural, metric, and scalar invariance by sex. Adequate reliability was demonstrated by Omega coefficients (General: ωG= 0.86, Impact: ωI= 0.86) showed adequate reliability; the scale showed very strong correlations with the Athens scale (rAGoverall= 0.84; rAImpact=0.75) and weak to moderate correlations with the Epworth scale (rEGeneral= 0.39; rEImpact=0.44). Conclusions: The ISI bifactor version in Spanish presents adequate psychometric properties for the measurement of insomnia and, as it is a brief tool, it can be used at different levels of health care.

Six months survival and risk factors for attrition for patients detected with cryptococcal antigenemia through screening in Malawi.

A cohort of adult Malawian people living with HIV (PLHIV) testing positive for cryptococcal antigenemia was observed and followed to determine the outcomes and risk factors for attrition. Eligible PLHIV were enrolled at 5 health facilities in Malawi, representing different levels of health care. ART naïve patients, ART defaulters returning to care, and patients with suspected or confirmed ART treatment failure with CD4 <200 cells/μL or clinical stage 3 or 4 were enrolled and received CrAg tests on whole blood specimens from August 2018 to August 2019. Hospitalized PLHIV were enrolled and tested for CrAg from January 2019 to August 2019, regardless of CD4 or clinical stage. Patients with cryptococcal antigenemia were managed per Malawian clinical guidelines and were followed up for six months. Survival and risk factors for attrition at six months were assessed. A total of 2146 patients were screened and 112 (5.2%) had cryptococcal antigenemia. Prevalence ranged from 3.8% (Mzuzu Central Hospital) to 25.8% (Jenda Rural Hospital). Of the 112 patients with antigenemia, 33 (29.5%) were diagnosed with concurrent CM at the time of enrollment. Six-month crude survival of all patients with antigenemia (regardless of CM status) ranged from 52.3% (assuming lost-to-follow-up (LTFU) patients died) to 64.9% (if LTFU survived). Patients who were diagnosed with concurrent CM by CSF test had poor survival (27.3-39.4%). Patients with antigenemia who were not diagnosed with concurrent CM had 71.4% (if LTFU died)- 89.8% (if LTFU survived) survival at six months. In adjusted analyses, patients with cryptococcal antigenemia detected after admission to inpatient care (aHR: 2.56, 1.07-6.15) and patients with concurrent CM at the time of positive antigenemia result (aHR: 2.48, 1.04-5.92) had significantly higher hazard of attrition at six months. Overall, our findings indicate a need for routine access to CrAg screening and pre-emptive fluconazole treatment as a way to detect cryptococcal antigenemia and prevent CM in outpatient and inpatient settings. Rapid access to diagnosis and treatment for cryptococcal meningitis (CM) with gold-standard antifungals is needed to improve survival of patients with advanced HIV in Malawi.

A Computational Platform to Support the Detection, Follow-up, and Epidemiological Surveillance of Mental Health and Substance Use Disorders: Protocol for a Development and Evaluation Study.

According to the World Health Organization, approximately 15% of the global population is affected by mental health or substance use disorders. These conditions contribute significantly to the global disease burden, which has worsened because of the direct and indirect effects of COVID-19. In Mexico, a quarter of the population between the ages of 18 and 65 years who reside in urban areas present a mental health condition. The presence of a mental or substance abuse disorder is behind a significant percentage of suicidal behaviors in Mexico, where only 1 in 5 of those who have these disorders receive any treatment. This study aims to develop, deploy, and evaluate a computational platform to support the early detection and intervention of mental and substance use disorders in secondary and high schools as well as primary care units. The platform also aims to facilitate monitoring, treatment, and epidemiological surveillance ultimately helping specialized health units at the secondary level of care. The development and evaluation of the proposed computational platform will run during 3 stages. In stage 1, the identification of the functional and user requirements and the implementation of the modules to support the screening, follow-up, treatment, and epidemiological surveillance will be performed. In stage 2, the initial deployment of the screening module will be carried out in a set of secondary and high schools, as well as the deployment of the modules to support the follow-up, treatment, and epidemiological surveillance processes in primary and secondary care health units. In parallel, during stage 2, patient applications to support early interventions and continuous monitoring will also be developed. Finally, during stage 3, the deployment of the complete platform will be performed jointly with a quantitative and qualitative evaluation. The screening process has started, and 6 schools have been currently enrolled. As of February 2023, a total of 1501 students have undergone screening, and the referral of those students presenting a risk in mental health or substance use to primary care units has also started. The development, deployment, and evaluation of all the modules of the proposed platform are expected to be completed by late 2024. The expected results of this study are to impact a better integration between the different levels of health care, from early detection to follow-up and epidemiological surveillance of mental and substance use disorders contributing to reducing the gap in the attention to these problems in the community. DERR1-10.2196/44607.

Perceptions of health professionals on structure and process of stroke rehabilitation in Ghana.

Ensuring quality in the structure and process of stroke rehabilitation helps to attain a good outcome. However, knowledge on this is limited in resource-constrained settings such as Ghana. This study aimed to explore healthcare professionals' (HCPs) views and experiences of the structure and process of stroke rehabilitation in three selected hospitals in Ghana. A qualitative study was carried out involving 26 HCPs directly involved in stroke rehabilitation from three selected hospitals in the Greater Accra Region of Ghana representing the different levels of healthcare. Interviews were conducted using an interview guide to understand participants' views and experiences of the structure and process of stroke rehabilitation. Interview transcripts were analysed using thematic analysis. HCPs reported limitations with the structure of stroke rehabilitation with regards to the availability of rehabilitation units, bed capacity, approach to care, availability of protocol, staff capacity development and payment systems. With respect to the process of rehabilitation, the primary and secondary level hospitals were found not to have computed tomography (CT) and magnetic resonance imaging (MRI) scanning equipment. Participants also reported limitations with discharge planning, basis for discharge and post-discharge care across all three hospitals. This study found limitations in the current structure and process of stroke rehabilitation, which when given some considerations for improvement, can help improve the quality of care and thereby improve the outcome of stroke patients in Ghana. This study provided data which helps to assess the quality of stroke rehabilitation in Ghana.

Factors associated with hopelessness, depression and anxiety in the Honduran-Central America population during the COVID-19 pandemic.

IntroductionThe mental health of the population has been affected by COVID-19, reporting in many populations higher levels of depressive, anxious and stress symptoms, however, in Honduras there are no studies showing the impact of COVID-19 on the mental health of the population.AimTo determine the factors associated with hopelessness, depression and anxiety in times of COVID-19 in the Honduran population.MethodsCross-sectional analytical study. Three scales were used, Beck for hopelessness, Hamilton for depression and anxiety, through interviews with the population attending different levels of health care throughout the country. Descriptive and analytical statistics were obtained. For hopelessness, the Beck Hopelessness Scale was used; for depression and anxiety, the Hamilton Scale was used.ResultsOf the 8,125 participants, the population in general showed results of hopelessness 14.9%, depression 12.9% and anxiety 1.2%, there was less hopelessness among women (p = 0.004), university students (p &amp;lt; 0.001), but greater among those who had a family member deceased by COVID-19 (p &amp;lt; 0.001), among those who had diabetes mellitus (DM) (p &amp;lt; 0.001), history of mental illness (p &amp;lt; 0.001) or had consumed drugs in the last 6 months (p &amp;lt; 0.001). There was more depression among those with arterial hypertension (p = 0.002), obesity (p = 0.019), DM (p = 0.004), history of mental illness (p &amp;lt; 0.001) or had consumed drugs in the last 6 months (p &amp;lt; 0.001). There was more anxiety among those infected with COVID-19 (p = 0.023), according to having a family member deceased by COVID-19 (p = 0.045) and in those with a history of mental illness (p &amp;lt; 0.001).DiscussionThe Honduran population presented important differences in the socio-pathological, according to the loss of family members or having previous illnesses, this according to the presentation of problems in the mental sphere.ConclusionWe found factors associated with hopelessness, we found factors associated with hopelessness, depression and anxiety in times of COVID-19 in the Honduran population.

Primenjivost i prognostička značajnost gerijatrijske procene

Aging implies a process during which changes occur in the function of all organic systems in the human body. For a detailed assessment of the health status of an elderly person, a comprehensive geriatric assessment (CGA) is recommended. CGA is defined as a multidisciplinary diagnostic and therapeutic approach that enables the identification of medical, psychosocial and functional limitations of an elderly person, all with the aim of developing a coordinated plan to improve the health of the elderly person. The aim of this review was to point out the significance, comprehensiveness, applicability and prognostic significance of geriatric assessment based on data from recent literature and by searching available electronic databases. Studies were collected from the electronic databases MEDLINE (via Ovid), Pubmed, COBSON database and Google Scholar database, as well as by manual search of relevant studies cited in the references of key articles. The search for papers as a whole is limited to the English language. All studies that used a comprehensive geriatric assessment in their methodology, in elderly people over 65 years of age, were included. CGA is very important for the elderly, for their families, health systems of countries, health professionals as well as the social community. Interventions resulting from a CGA are one way to improve the performance of activities of daily living in elderly patients. CGA has numerous advantages in practice, it is comprehensive, applicable, economically relatively acceptable and as such can be routinely implemented at different levels of health care. CGA has a high prognostic significance for the early detection of multimodal problems in the geriatric population.

The impact of the COVID-19 pandemic in Brazil: a study in tertiary dental care.

The pandemic caused by coronavirus has resonated throughout different levels of health care in Brazil and, in this context, the present research aimed to evaluate this impact on tertiary dental care provided by the Unified Health System (SUS). Therefore, an ecological study was conducted with data obtained from the Hospital Information System processed by the Portal of the Department of Informatics of SUS. The sample consisted of patients of all sexes and age groups, whose Hospital Admission Authorizations (AIHs) were approved for dental tertiary care procedures from January 2015 to December 2020. Descriptive analyses and the ANOVA test with a significance level set at p < 0.05 were used. When the annual mean numbers of AIHs approved were evaluated, findings showed that on an average, the Southeast region authorized a higher number of procedures (p-value < 0.001), however, in the pandemic year (2020), a reduction of approximately 24.5% of these hospitalizations occurred throughout Brazil, with the Midwest being the region most affected (32.12%). A percentage increase occurred in the Surgical Treatment of Oral sinus/Oral nasal Fistula (16.1%), in addition to a significant decrease in performing procedures for Resection of Mouth Lesion (33.4%). In the pandemic year, there was a reduction of 14% in expenditures related to hospital services and 23.26% related to professional services. It was concluded that the data presented demonstrated a significant reduction in AIHs for tertiary dental care in the pandemic year.

Implementation of Assisted Dying in Catalonia: Impact on Professionals and Development of Good Practices. Protocol for a Qualitative Study

The approval of the Spanish Law for the Regulation of Euthanasia in March 2021 entails a profound social change that has direct implications for professional practice at all levels of care. There is no information available about the experiences of the professionals participating in the process of implementing the law in our country, nor any guide as to what might represent good practices in euthanasia in the context of the Mediterranean countries. Due to the complexity of the concepts often associated with assisted dying processes (such as suffering, dignity and moral compass), it is essential that systematic and detailed research be conducted on how professionals understand their experiences of euthanasia, and that it be conducted during the initial stages. We intend to carry out a qualitative study with a constructionist orientation to gain insight to the social constructs underlying professionals’ initial experiences. It consists of a series of in-depth interviews conducted in two phases: the first being exploratory and the second phenomenological. Sampling will be purposive and substantiated and have the following variation criteria: profession, age, and gender. Participants will be recruited through the Guarantee and Review Commission of Catalonia, and the scope of the study is all of Catalonia. We expect the participation of 31 professionals. The research will be conducted by a multidisciplinary team with the direct participation of researchers from different levels of healthcare, university research centers and civil society through all phases of the study. The expected results are: (a) A detailed description of the experiences of the professionals involved in the implementation of the law; and (b) The identification of the foundations for a guide to good practices in euthanasia in the Mediterranean setting.

Вирусные циррозы печени: клинический профиль современного пациента, танатогенез и патоморфология

Objective. To analyze the profile of a patient with virus-related liver cirrhosis examined at different levels of healthcare, to identify the main causes of death, and describe morphological changes in liver tissue. Patients and methods. This study included 921 patients with chronic viral hepatitis (CVH) treated in day hospitals, 844 patients treated in inpatient facilities, and 455 CVH patients who died. We analyzed autopsy results of 97 patients with clinical signs of liver cirrhosis and described morphological characteristics of liver tissue depending on the Child–Turcotte–Pugh score. Results. Chronic hepatitis C is the most prevalent form of hepatitis in both inpatient and outpatient units. The highest incidence of latent hepatitis B was observed among inpatients. The majority of outpatients with virus-related liver cirrhosis were employable (or employed), socially adapted, not addicted to alcohol, and had compensated disease (class A in 97%) with minimal clinical manifestations, and were motivated for treatment and examination. The mean age of inpatients was 50 years; 100% of them had some comorbidities; 90% of them had subcompensated or decompensated cirrhosis; 60% of them systematically abused alcohol. Conclusion. The majority of deceased patients were employable, abused alcohol, and were not systematically followed-up by a specialist. Almost one-third of them (30%) had subcompensated disease and incomplete cirrhotic transformation of hepatic tissue; they died due to other reasons. This affects the course of chronic virus-related hepatitis and comorbidities and necessitates the creation of integrated comprehensive models of healthcare. Key words: virus-related liver cirrhosis, comorbidity, morphological examination, latent hepatitis, chronic viral hepatitis

HPB P13 Does Socioeconomic deprivation affect outcomes in patients undergoing liver resection for Colorectal Liver metastases?

Abstract Background It is well documented that socioeconomic deprivation (SED) has an overall negative impact on health outcomes. Many studies have shown this in primary cancers. The effect of SED on outcomes in patients undergoing liver resection for colorectal liver metastases (CRLM) is not well documented. As these patients are already under follow up, it is likely that the impact of SED on outcomes will be diminished. It was our aim to evaluate the effect of SED on overall survival (OS) in patients undergoing liver resection for CRLM. Methods The STROCSS guideline for observational studies was followed to conduct a single-centre retrospective cohort study. The tertiary centre treats patients over a wide geographical area with a population of 2.2 million. All consecutive patients undergoing liver resection for CRLM between January 2013 and December 2020 were eligible for inclusion. Demographics, prognostic variables for CRLM, operative variables, pathological variables and overall survival was recorded. Data was censored at 31 December 2021. Follow up was complete and checked with the Clinical Portal electronic database and by contacting General practitioners. The Multiple Deprivation score, that is nationally recorded was used to determine socioeconomic deprivation status of each patient. Prognostic significance of socioeconomic deprivation was determined by Kaplan–Meier survival statistics and stepwise Cox proportional-hazards regression model. Results A total of 455 patients were eligible for inclusion; 237 patients were classed as least socioeconomically deprived and 218 patients as most socioeconomically deprived. Both cohorts were comparable in terms of baseline characteristics except for age (69 most deprived vs 72 Least deprived, P=0.004). Kaplan–Meier survival statistics showed that socioeconomic deprivation was associated with significantly lower probability of overall survival (HR: 1.55, 95% CI 1.23–1.95; Logrank test: P=0.0001). The stepwise Cox proportional-hazards regression analysis identified socioeconomic deprivation as predictor of OS (HR: 1.56, 95% CI 1.23–1.98, P=0.0003) alongside the following variables: ASA status 1 (HR: 0.43, 95% CI 0.19–0.94, P=0.0349), presence of extrahepatic disease (HR: 1.51, 95% CI 1.12–2.03, P=0.0075), number of tumours (HR: 1.07, 95% CI 1.01–1.13, P=0.0221), size of largest tumour (HR: 1.01, 95% CI 1.00–1.01, P=0.0003), extended hemihepatectomy (HR: 3.24, 95% CI 1.56–6.76, P=0.0018), and absence of recurrence (HR: 0.55, 95% CI 0.43–0.70, P&amp;lt;0.0001). Conclusions Socioeconomic deprivation reduces the probability of OS following liver resection for CRLM. This should be taken into account at different levels of health care planning for management of patients with CRLM including preoperative risk assessment, health care need assessment, and allocation of resources. Our study shows that the deleterious effects of SED extends to patients who are already in the healthcare system and therefore factors other than access to healthcare need further exploration.