Early Detection Of Risk Factors Research Articles

A Study of Bacterial Vaginosis and Associated Risk Factors among Married Women in Zakho City, Kurdistan Region, Iraq

Bacterial Vaginosis (BV) is a leading cause of reproductive tract problems, affecting mostly women of reproductive age group, worldwide. The aim of this study is to detect the infection rate of BV and then evaluate the risk factors associated with this bacterium among married women in Zakho city, Iraq. This cross-sectional study was performed among a 150-reproductive-age women's group from October 2021 till April 2022. The administered and structured questionnaire was designed to measure demographic, risk factors, and clinical characteristics. The vaginal swabs were collected from each subject and used for microscopical examination, including wet mount, vaginal pH, germ tube, and Gram stain methods to analyze the infection rate. The analysis of univariate regression analysis was applied to determine the relationships between BV and associated risk factors and clinical characteristics. The average age of participants was 32.64 years (±8.01 SD). The prevalence of BV was 41 (27.33%) among married women. About 12 (8%) and 1 (0.67%) of participants had mixed infections with Candida albicans and Trichomonas vaginalis, respectively. BV was found mostly among the age group less than 20 years (41.67) followed by age group of 40-50 years (37.93%). We found a higher infection rate among subjects from rural area (34.78%), but statistically not significant (p=0.17). Higher number of births was statistically associated to BV (OR 1.17, 1.006-1.37; p=0.003). BV was also highly associated among symptomatic patients with abnormal vaginal discharges (OR 4.18, 1.89-1.9.23; p=0.002), genital ulcer (OR 0.34, 0.13-0.84; p=0.01), and vaginal pH level more than 4.5 (OR 0.009, 0.002-0.043; p=0.001). BV is still prevalent among married women in our region. The higher infection rate was significantly associated with higher birth numbers, vaginal discharges, genital ulcers, and higher vaginal pH. There is an urgent requirement for regular screening for bacterial vaginosis among symptomatic women. Therefore, the early detection of risk factors associated with bacterial vaginal growth is critical to enhancing the health condition of married women, in order to prevent the risk of BV.

Immunomodulation in age-related disorders and nanotechnology interventions.

Recently, the aging population has increased exponentially around the globe bringing more challenges to improve quality of life in those populations while reducing the economic burden on healthcare systems. Aging is associated with changes in the immune system culminating in detrimental effects such as immune dysfunction, immunosenescence, and chronic inflammation. Age-related decline of immune functions is associated with various pathologies including cardiovascular, autoimmune, neurodegenerative, and infectious diseases to name a few. Conventional treatment addresses the onset of age-related diseases by early detection of risk factors, administration of vaccines as preventive care, immunomodulatory treatment, and other dietary supplements. However, these approaches often come with systemic side-effects, low bioavailability of therapeutic agents, and poor outcomes seen in the elderly. Recent innovations in nanotechnology have led to the development of novel biomaterials/nanomaterials, which explore targeted drug delivery and immunomodulatory interactions in vivo. Current nanotechnology-based immunomodulatory approaches that have the potential to be used as therapeutic interventions for some prominent age-related diseases are discussed here. Finally, we explore challenges and future aspects of nanotechnology in the treatments of age-related disorders to improve quality of life in the elderly. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease Therapeutic Approaches and Drug Discovery > Nanomedicine for Neurological Disease Therapeutic Approaches and Drug Discovery > Emerging Technologies.

DETEKSI DAN PREDIKSI PENYAKIT DIABETES MELITUS TIPE 2 MENGGUNAKAN MACHINE LEARNING (SCOOPING REVIEW)

Diabetes Mellitus is a chronic disease and one of the non-communicable diseases whose growth is very fast. This study aims to explore and analyze the early detection and prediction system of risk factors for type 2 diabetes mellitus which utilizes machine learning methods. This type of research is a scoping review to accumulate and synthesize the results of previous studies on the early detection of risk factors and the prediction system of Diabetes Mellitus type 2 using machine learning methods. The inclusion criteria are articles in English or Indonesian, journals published in the 2017-2021 range, full text, and not systematic reviews. Article searches are 4 databases, namely Google Scholar, Pubmed, International Journal of Public Health Science/Hindawi, and IEEE Xplore. The results obtained as many as 2,941 articles, using the PRISMA method. The remaining 15 studies were maintained and met the criteria for qualitative analysis. The articles used machine learning methods in the creation of early detection models and prediction systems. Some articles use the merging of two methods (statistical and machine learning). The machine learning techniques mostly use supervised, unsupervised, and deep learning techniques. For the algorithms used, the majority of researchers used more than one algorithm such as algorithm support vector machine (SVM), random forest (RF), Decision Tree (DT), LASSO, and others, to compare the best accuracy of each algorithm. Risk factors associated with Diabetes Mellitus type 2 incidence are age, gender, obesity, family history of the disease, lack of physical activity, genetics, environment, smoking, blood pressure, and diet.

The Role of Oxidative Stress in the Risk of Cardiovascular Disease and Identification of Risk Factors Using AIP and Castelli Atherogenicity Indicators in Patients with PCOS.

Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathies in females of reproductive age and may affect 5–14% of women. In women with PCO syndrome, metabolic disorders such as insulin resistance, hyperinsulinemia, obesity, diabetes mellitus, and other elements of metabolic syndrome may occur. Patients with PCOS often have overweight and obesity, especially abdominal obesity, which is one of the risk factors for developing atherosclerosis. The atherogenicity indicators of AIP (atherogenic index of plasma) and Castelli’s index are used to assess the risk of developing atherosclerosis. Studies have shown an increase in the concentration and activity of oxidative stress markers in patients with PCOS compared to women without the disease. The aim of the present study was to evaluate oxidative stress parameters in patients with PCOS in relation to insulin resistance, BMI, and hyperandrogenemia and to correlate them with cardiovascular risk parameters. Conclusions: The severity of oxidative stress in women with PCOS correlates with exposure to cardiovascular diseases. The assessment of additional cardiovascular disease (CVD) parameters is useful in identifying the risk groups for cardiometabolic disease among PCOS patients. When additional risk factors such as hyperandrogenism and insulin resistance (IR) are present in patients with PCOS, it is reasonable to include preventive examinations early. It is also important to evaluate lipidograms, which will make it possible to determine indicators of atherogenicity. Patients with PCOS and IR are at particular risk for cardiovascular complications. PCOS should be considered an important risk factor for CVD, which occurs independently of the occurrence of obesity. This factor is related to the important role of insulin resistance, which occurs independently of obesity. Atherogenic factors (AIP and Castelli index) are useful additional parameters to assess the risk of cardiometabolic disease in PCOS patients, especially among groups with insulin resistance. The early detection of risk factors should be an integral part of the care of PCOS patients. In laboratory studies of women with PCOS, TG, TChol, HDL-c and LDL-c levels, and glutathione peroxidase (GPx) activity were most clearly correlated with exposure to cardiovascular disease.

Voice biomarkers as indicators of cognitive changes in middle and later adulthood

Voice prosody measures have been linked with Alzheimer's disease (AD), but it is unclear whether they are associated with normal cognitive aging. We assessed relationships between voice measures and 10-year cognitive changes in the MIDUS national sample of middle-aged and older adults ages 42–92, with a mean age of 64.09 (standard deviation = 11.23) at the second wave. Seven cognitive tests were assessed in 2003–2004 (Wave 2) and 2013–2014 (Wave 3). Voice measures were collected at Wave 3 (N = 2585) from audio recordings of the cognitive interviews. Analyses controlled for age, education, depressive symptoms, and health. As predicted, higher jitter was associated with greater declines in episodic memory, verbal fluency, and attention switching. Lower pulse was related to greater decline in episodic memory, and fewer voice breaks were related to greater declines in episodic memory and verbal fluency, although the direction of these effects was contrary to hypotheses. Findings suggest that voice biomarkers may offer a promising approach for early detection of risk factors for cognitive impairment or AD.

Challenges of Management and Outcome of Neonatal Medical Emergencies in a Peripheral Hospital, Bangladesh

Background: Respiratory distress and desaturation remains a significant cause of neonatal intensive care admission ,althoughmanagement has evolved gradually over the years resulting in improving survival for the these neonates . Still 10% of neonatesrequire respiratory support immediately after delivery due to respiratory disorder, and up to 1% of neonates are in need ofresuscitation. Objectives: The aim of the study is to present some fundamental steps of emergency neonatal management which includerapid identification and admission , followed by assessment for respiratory distress, hypoxemia and hypoglycemia ,initialstabilization when required and early administration of medications. Methods: This hospital based retrospective study was conducted at Combined Military Hospital ,sylhet ,Bangladesh fromApril 2021 to September 2022 .A total 224 sick neonates shortly after delivery included for this study. Results: From April ,2021 to september 2022, 917 newborn were born, of which 224 neonates were identified and admitted as a emergency cases immediate after delivery at combined military hospital,sylhet .Immediately after admission around allcases were assessed for hypoxemia ,hypoglycaemia and hypothermia.Around 66% were hypoxemic (preterm 71.4% ,22.3%in full term and 6.2% in post term ).There was male predominance 55% .Respiratory distress syndrome (RDS ) was found to bethe commonest 35.7% causes followed by persistent pulmonary hypertension with large patent ductus arteriosus(PPHN withPDA) 17.8% ,septicemia 16.9% ,meconium aspiration syndrome (MAS) 8.9%, transient tachypnea of newborn (TTN) 8%,congenital pneumonia 4.9% ,perinatal asphyxia (PNA) 3.5% , large atrial septal defect (ASD) with ventricular setal defect(VSD) 2.6% and 1.75% was hypoglycemic .All babies received immediately oxygenation . Bubble CPAP was required in 90(40.1%) cases. Vascular access was established in all cases and 2.6% neonates received medications bycentral (femoral) line.Mortality was 2( 0.8%) in neonates with respiratory distress due to respiratory distress syndrome with multiple congenitalanomalies . 2(0.8%) cases referred to tertiary hospital (Combined Military Hospital,Dhaka ) requiring mechanical ventilation. Conclusion: Early and appropriate treatment seeking is one of the most important aspects for interrupting the pathways to neonatal deaths due to severe illness. In developing countries, the role of Paediatrician is multidimensional . paediatrician by early detection of risk factors and timely intervention can reduce significantly neonatal mortality rate.

Assessment of risk factors for overweight and obesity in schoolchildren for the development of effective prevention programs

Introduction. This article presents the results of a large-scale research on monitoring the nutrition of students in educational institutions. Nutrition is one of the leading factors determining the health and harmony in the processes of growth and development of the child population. One of the most common consequences of unhealthy eating behavior is overweight and obesity. The study and early detection of risk factors is necessary for the prevention of overweight and obesity, which are an acute problem of modern science and education. The purpose of the study is to assess risk factors for overweight and obesity in schoolchildren in order to develop effective programs for the prevention of childhood obesity and nutritional diseases. Materials and Methods. The research data were collected and processed via the following methods: a questionnaire, analytical and statistical methods using parametric and non-parametric methods of statistics and t-test (in the case of normal distribution of data) and Fisher (U). Differences were considered statistically significant at p<0.05. The STATISTICA-10.0 package and Microsoft Excel were used. Results. As part of the global monitoring of schoolchildren’s nutrition (the survey covered 43.9 thousand schoolchildren from 49 regions of the Russian Federation), the following key risk factors for nutrition-related health disorders in schoolchildren were identified: a violation of the structure of nutrition, unhealthy eating behavior and eating habits, violations in the organization of nutrition in educational institutions and at home. Statistically significant correlation coefficients were found between indicators of normal body weight and family income, between overweight and unhealthy eating habits, and eating behavior, the prevalence of diseases of the digestive system. Forecast indicators of a decrease in the prevalence of obesity with a decrease in the proportion of children with unhealthy eating habits have been established. Conclusions. The results of the study characterize the key risk factors for the development of overweight and obesity in children associated with nutrition. In the future, the results obtained can be used to predict the effectiveness of implemented preventive measures at the level of individual educational institutions and territories of the Russian Federation.

DETERMINAN KEJADIAN ASFIKSIA DI NEONATORUM DI RSUD SIJUNJUNG

Asphyxia. In 2015, there were 33,278 infant mortality cases and in 2016, 32,007cases. in Sijunjung District, the infant mortality rate is 50 per 1,000 live births in2018. The main cause is Asfiction This study aims to determine the factors thatcause the incidence of asphyxia neonatorum in Sijunjung District Hospital in2019. Factors studied were KPD, Postterm, age mother, LBW, premature andinduction. This type of research is descriptive correlation with a retrospectiveapproach. The sampling technique in this study was total sampling, that is, theentire population of patients treated in the perinatology room were 179 samples.Data analysis was performed by univariate analysis and bivariate analysis bymeans of the Chi-square test. The results showed 53.1% incidence of asphyxia,48% had KPD, 20.7% had postterm pregnancy, 32.4% of mothers at risk, 48%had LBW, 35.8% of babies born prematurely, 20.1% of births with induction. Theconclusion of this study is there is a relationship between KPD, Postterm,maternal age, LBW, Premature, labor induction with the incidence of asphyxianeonatorum in Sijunjung Regional Hospital in 2019. It is recommended thathealth workers can be used as input in the early detection of risk factors that affectthe incidence of neonatal asphyxia so that the neonatal asphyxia incident occurs.Effective steps can be taken to prevent neonatal asphyxia in newborns, namely byincreasing ANC services by providing counseling that is expected to increaseawareness of pregnant women routinely examining pregnancy.
 Keywords: Asphyxia, newborns.

Abstract 5865: Analysis of RNA sequencing data to advance our understanding of colorectal cancer health disparity in Native Hawaiians

Abstract Background Colorectal cancer (CRC) is the third deadliest cancer among Americans. Native Hawaiians (NH) as a unique ethnic group in the US, exhibit many disproportionate health issues. In particular, they suffer from both elevated CRC incidence and mortality rates. This study aimed to investigate if genetic differences could contribute to disparities observed between NH and White CRC patients by defining the association between unique NH-genetic differences and CRC outcomes. Methods Paired tumor and adjacent normal biospecimens of NH CRC patients were collected from the Hawaii Tumor Registry (HTR), and gene expression and mutation were examined by RNA sequencing. Genomic data of CRC Whites was extracted from The Cancer Genome Atlas (TCGA) database as a comparative cohort. Differential expressed genes (DEGs) were identified for both NH and TCGA cohorts via DESeq2 with FDR q-value < 0.05 and a cutoff of 2-fold change. MutTecT2 and GATK were used to identify significant somatic mutations. Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression with 10-fold cross validation was performed to predict genetic risk factors for early detection, and Ingenuity Pathway Analysis (IPA) was processed for canonical pathways and network discovery. Univariate Cox proportional regression was performed to identify DEGs related to patient survival; multivariable Cox regression model with stepwise fitting generated a prognostic index (PI), and the prediction value was examined by the Area Under the Receiver Operating Characteristic Curve (AUC). A nomogram was developed by integrating PI and clinicopathologic factors; calibration curves were provided to internally validate the performance, and discriminative ability was appraised by concordance index. Results In total, 2096 DEGs were identified between NH tumor and normal groups, 1740 transcripts and 78 carrying mutations were unique to NH compared to the TCGA Whites cohort. A set of 23 genes including 10 NH specific DEGs were identified as genetic risk factors for detecting NH with CRC, and the AUC was 99.8%. A 9 gene-signature prognostic model including 5 NH specific DEGs was built with high survival prediction capability (AUC=0.99), and Kaplan-Meier curve showed that the low PI group had a better survival than the high PI group in NH with CRC (Logrank P=3.6E-05). After adjustment by age, gender, and tumor grade, the prognostic 9 gene-signature was still significant (P=0.0059). By integrating the above signatures with prognostic clinicopathologic features, a nomogram was constructed to stratified patients with overall survival rates for 3, 10, and 20 years. Conclusion This study demonstrated that CRC tumors from NH patients differ from White patients in their gene expression patterns and mutations, particularly those associated with clinical outcomes, which reinforced the necessity of NH race-specific biomedical research. Citation Format: Yuanyuan Fu, Devin Takahashi, Vedbar Khadka, Masaki Nasu, Mayumi Jijiwa, Heather Borgard, Peiwen Fei, Youping Deng. Analysis of RNA sequencing data to advance our understanding of colorectal cancer health disparity in Native Hawaiians [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5865.

Factors associated with depression during lockdown in college students who sought psychological consultation

PurposeThis paper aims to identify the risk factors that affect depression in students who sought psychological consultation during lockdown period in the health department at a university in Colombia.Design/methodology/approachThe sample consisted of 33 students (12 men and 21 women) with a mean age of 21 ± 2.5 years during the COVID-19 lockdown in 2020. Convenience sampling was used. The beck depression inventory-II instrument and a sociodemographic questionnaire were used to determine levels of depression and associated risk factors. A Google Form was designed with the respective instruments and sent along with the informed consent by email.FindingsThe results indicated that the population is characterized by presenting a level of mild (24.2%), moderate (15.2%) and severe (21.2%) depression. Concerning the levels of depression and risk factors, a significant difference was found with a history of violence (p-value = 0.000), mainly during childhood and adolescence, as well as objection to psychological therapy, belonging to a medium–high socioeconomic stratum, lack of family support and recent significant losses coupled with the lockdown because of the pandemic, which increased symptoms of depression and suicidal ideation.Research limitations/implicationsThis research was conducted using Google Forms, which meant that some questionnaires were incomplete. In addition, this study did not count with the full participation of patients who attended psychological consultation.Practical implicationsUniversities should generate programs for early detection of risk factors and prevention of depression in students, which could affect academic performance, school dropout, interpersonal relationships and trigger suicidal ideation. These results can also be applied to reducing family violence, which has increased since the pandemic, by improving students' family dynamics.Originality/valueBecause of the scarce research on this topic in Latin America, this study contributes to mental health in this population. The university becomes a fundamental scenario in which the ability to help students develop an adequate expression of emotions, positive coping strategies and sense of life as protective factors against depression can be enhanced.

Relationship characteristic of midwife in pregnancy services and patient satisfaction In Public Health Center, Soreang, Bandung

<p><strong>Background:</strong> Pregnancy/Antenatal Care (ANC) services are the main factors in determining <em>delivery outcomes including early detection of risk factors and also determining early treatment for pregnant women who experience complications during pregnancy. The quality of quality pregnancy services depends on the characteristics of health workers who provide services, the characteristics consist of age, educational qualifications, training and length of work.</em></p><p><strong><em>Objectives:</em></strong><em> This study aims to analyze the relationship between the characteristics of midwives in pregnancy services and patient satisfaction.</em></p><p><strong><em>Methods:</em></strong><em> This study used a cross-sectional analytical research design, namely the measurement of independent and dependent variables at the same time. The sample in this study were all midwives who worked at the Soreang District Health Center, namely 18 midwives. The midwives studied conducted examinations of 8 patients each for each pregnancy examination. Data collection techniques were carried out by filling out patient satisfaction questionnaires by pregnant women and observing pregnancy services by trained personnel using a pregnancy service checklist sheet. Furthermore, the data were analyzed by chi square test and multivariable multiple logistic regression analysis.</em></p><p><strong><em>Results:</em></strong><em> The results showed that there was a correlation between the characteristics of midwives and pregnancy services, namely the training indicator in a bivariable manner significantly affected the overall pregnancy service with a p-test of 0.007. Waiting time has a negative correlation with physical examination, laboratory, counseling and overall antenatal care with a p value of 0.002. Multivariable analysis showed that the characteristics of midwives that most influenced pregnancy care were age with p-value 0.040 [POR 1.83(1.028-3.259)], training with p-value 0.019 [POR 2.6(1.168-5.741)]. There is no relationship between pregnancy services and patient satisfaction with a p value of 0.796.</em></p><strong><em>Conclusion:</em></strong><em> In pregnancy services, the most influencing factors are age and training carried out by midwives. There is also a negative correlation between waiting time with physical and laboratory examinations, namely the longer the waiting time, the less physical examination services provided by midwives to patients. There is no relationship between pregnancy services and patient satisfaction.</em>

Impact of Maternal Age on Obstetric and Neonatal Outcome in Primiparous Women

Background: Pregnancy at extremes of age can be very challenging. The reflex of a woman to pregnancy is influenced by various factors through which woman's age at pregnancy time can be known as the single most important factor that has undeniable effect on pregnancy process and labour. Both adolescent and elderly pregnancy are considered to be high risk as they have unique outcomes. Objective: To assess the effect of maternal age on obstetric and neonatal outcome. Methods: This prospective observational study was conducted on 250 primiparous women who attended at Department of Obstetrics & Gynaecology, 300 Bed Hospital, Narayanganj, Bangladesh from March 2019-February 2020. A detailed history regarding maternal age, period of gestation, development of any signs and symptoms of various comorbidities is taken and antenatal examination is done. Routine antenatal investigations were done and all the cases were followed till delivery. Development of various maternal co-morbidities, mode of delivery and neonatal outcome was assessed. Results: Majority of our study population were in 20-34 years age group (72.0%), teenagers constituted 19.2%, advanced maternal age constituted 8.8%.The number of pre- term births in gestational age between 28 to 36 weeks were similar in teenage mothers (12.5%) and elderly primi (13.6%) where as in normal age group it was only 3.8%. Post term pregnancy where comparatively higher in elderly primi (18.8%) than teenagers (10.4%) Association of gestational age with maternal age is statistically significant (P <0.05). In our study 11% patients had Gestational Hypertension. Association of Hypertension in pregnancy with maternal age is statistically significant (p <0.05). In our study, GDM was present in 7.6%; in teenage mothers 2.1% and in elderly mothers 28.5%. In teenage 12.5% and in elderly mothers it is 31.8%. Association of Hypothyroid and maternal age is statistically significant (p<0.05). In our study anemia was seen in 4.1% of teenagers, 4.5% advanced maternal age, 3.3% in age group 20 to 34 years. In our study, 47.9% of teenage mothers delivered vaginally and 52.1% of them delivered by cesarean section. In age group 20 to 34 years, vaginal delivery was 50.2% and caesarean delivery was 49.7%. Whereas in elderly primis the rate of cesarean delivery was 71.4% and vaginal delivery was 28.5%. Association of mode of delivery with maternal age is statistically significant (p<0.05). In our study teenagers, term babies were 78.7%, pre-term babies were 12.7%, IUGR babies were 6.3% and IUD 2.1%. In advanced maternal age; term babies were 68.1%, pre- term were 13.6%, IUGR were 13.6% and IUD were 4.5%. Association of outcome of baby is statistically significant (p<0.05). In our study the babies which got admitted in NICU were 33.7% in teenage mothers and in elderly is 13.3%. Association of NICU admission among teenage and advanced maternal age is statistically significant. (p<0.05). Conclusion: Teenage pregnancy is an essential public health issue as it is associated with poor maternal and fetal outcome. Teenage and Elderly pregnancy are associated increased maternal and perinatal mortality and morbidity early detection of risk factors and prevention is necessary to reduce the morbidity.

Development of a surgical wound assessment tool to measure healing and risk factors for delayed wound healing in Vietnam: a Delphi process.

To identify items and develop a surgical wound assessment tool (SWAT) to measure progress in healing and early detection of risk factors for delayed healing in surgical wounds in patients in Vietnam. The development process included two phases: (i) development of the initial SWAT based on evidence-based guidelines, results of a literature review and consultation with surgeons; and (ii) a Delphi process with wound care nurse experts to refine and provide consensus on a final version of the SWAT. Data collection took place between April-August 2017. In phase one, 22 items were included and were evaluated by ten Vietnamese surgeons, with item-content validity index (I-CVI) scores of 1.00 in 17 out of 22 items. The remaining items had I-CVI ranking of 0.8 to 0.9. The overall scale-content validity index was 0.97. Eight more items were recommended for inclusion, increasing the total to 30 items. In phase two, 21 Vietnamese nurse wound care experts completed all three rounds of the Delphi process. After three rounds, 24 items out of 30 reached full consensus for the final tool. This study was the first step to confirm the content validity of the newly developed SWAT. Further development of the tool including the evaluation of validity and reliability was undertaken to strengthen the tool.

Abstract 260: Provider Perspectives On Peripheral Artery Disease: Uncovering Practice Patterns That May Contribute To Health Disparities

Background: PAD is often undiagnosed and undertreated. Black American and Hispanic patients experience greater disease severity and worse outcomes compared to white patients. Applying the Kilbourne et al.’s comprehensive framework which identifies multilevel determinants of health disparities, we sought to understand why disparities exist by identifying provider factors that explain gaps in health and health care. Methods: Semi-structured in-depth interviews were conducted with 19 providers across diverse specialties from two clinical sites. Interviews occurred from November 2021 to February 2022. Domains of interest were provider factors that contribute to delays in diagnosis, treatment, and management of PAD, as well as how providers communicate with patients about PAD. Interviews were professionally transcribed and analyzed using a qualitative content analysis methodology. Findings: Specialists noted that the diagnosis of PAD may be delayed due to the lack of consistent early detection of risk factors and screening. PCPs felt that diagnosis of PAD is difficult due to patient under recognition of symptoms, symptoms mimicking other diseases, and asymptomatic patients. Both specialists and PCPs highlighted delayed PAD diagnosis due to a lack of clear guidelines for screening. Broader institutional constraints on screening for and diagnosing PAD related to time, resources, and logistics for both specialists and PCPs. There was general agreement that disease awareness and knowledge was lacking by both providers and patients, and may contribute to gaps in screening, treatment, and management of disease across the health care system. Some providers noted differences across populations in access to care and interventions, which may contribute to health disparities around PAD. Implications for Cardiovascular and Health Disparities Research: Overall, there is a clear sense among providers representing multiple disciplines that diagnosis of PAD is challenging. To address these challenges, more work needs to be to develop clinic team approaches to screen for PAD symptoms in at-risk patients. To close the gap in health disparities, patient perspectives should also be sought to better understand specific needs among different populations.

Obesity in Polish Children and Parents' Perception of Their Children's Weight Status: The Results of the SOPKARD-Junior Study.

One way to counteract the spread of obesity in children is its early recognition by parents. Therefore, the aim of this study was to investigate whether parents’ perception of their children’s BMI category was consistent with their actual BMI assessment and to determine potential influential factors. The study was conducted as part of the “A program for the early detection of risk factors for lifestyle diseases SOPKARD-Junior” (SOPKARD-Junior), a preventive health program implemented in public elementary schools from 2017 to 2019. The results from 381 children with a mean age of 11.67 (SD = 1.52) were analyzed. Height and weight were measured and BMI was calculated. Surveys were conducted to assess parents’ perceptions of their child’s weight, along with their sociodemographic status. Nearly one in three parents were unable to correctly identify their children’s weight; 25.0% underestimated it, and 6.0% overestimated it. Underestimation was observed along with an increase in the children’s BMI weight category, with as many as 57.1% of parents of obese children misclassifying their weight. The child’s BMI was the only significant predictor of incorrect assessment. Polish parents cannot properly assess their children’s BMI, especially when their child is overweight or obese. In children, weight and height measurements should be taken regularly, rather than allowing weight category to be dependent upon parental weight assessments.

Cerebral Infarctions in New-borns and Infants: Early Detection of Risk Factors, and Sequelae in Neuroevolutionary Development

Cerebral Infarctions in New-borns and Infants: Early Detection of Risk Factors, and Sequelae in Neuroevolutionary Development

Neonatal External Description in Undiagnosed Placenta Accreta Referral Patients

Background: Cases of placenta accreta are increasing every year. Placenta accreta has an impact on maternal and neonatal externals. There are cases of placenta accreta that go undiagnosed during pregnancy called undiagnosed. This study aims to find out the neonatal exterior in undiagnosed placenta accreta referral patients at dr. Soetomo Hospital in 2016-2020. Method: This research method is descriptive with an observational approach. The study sample was the entire infant of a patient with a referral case of undiagnosed placenta accreta using the total samplingtechnique. The variable studied was the neonatal exterior. Results: Samples that met the inclusion criteria of 27 infants. The termination age of preterm pregnancy was 8 (29.6%) patients, BBLR as many as 6 (22.2%) infants, female sex (55.6%), babies with SGA as many as 2 (7.4%) babies and LGA as many as 1 (3.7%) babies. APGAR scores less than 7 as many as 6 (22.2%) babies in the first minute and 2 (7.4%) babies in the fifth minute. Nicu resuscitation and care measures were 14 (51.9%) infants and 2 (7.4%) deaths. Conclusion: Neonatal discharge in patients undiagnosed placenta accreta includes potential premature birth, BBLR, resuscitation measures, NICU care, neonate mortality rate of 7.4%. There needs to be an improvement in the quality of ANC, especially in early detection of risk factors so that undiagnosed cases are reduced and betteroutcomes are obtained.

The Overview of Student Knowledge about The Importance of Inverted Pyramid Antenatal Care at Faculty of Medicine, Universitas Sumatera Utara

Introduction. The old model antenatal care/simple pyramid in 1929 based on the third trimester, contributed substantially to the reduction of maternal and newborn mortality. Along with the development of science and technology, many complications of pregnancy including fetal abnormalities, miscarriage, stillbirth, preeclampsia, premature delivery, gestational diabetes, fetal growth disorders, and macrosomia can be detected in the first trimester. Therefore, the inverted pyramid antenatal care was developed with early detection of risk factors and complications at 11-13 weeks of gestation. However, the application of the inverted pyramid antenatal care in Indonesia has not been implemented and there is a lack of socialization about the importance of the inverted pyramid antenatal care. Objectives. The purpose of this research was to describe knowledge about importance of inverted pyramid antenatal care in student generation 2018-2020 of Faculty of Medicine Universitas Sumatera Utara. Methods. This research used a descriptive analytic study with cross sectional approach and primary data was collected using online questionnaire. Results. There is no significant difference about descriptions of knowledge between student of 3rd semester, 5th semester. and 7th semester. From 126 subjects, 77 subjects (61,1%) use more than one source of information. Conclusion. Student of generation 2018-2020 of Faculty Medicine Universitas Sumatera Utara have a good knowledge about the importance of inverted pyramid antenatal care by involving more than one source of information

EFFICACY OF RECREATIONAL PHYSICAL ACTIVITY FOR PERIMENOPAUSAL WOMEN WITH HYPERTENSION ONSET

The aim: To examine the effect of the developed wellness program on hemodynamic indices and psychological state of perimenopausal women. Materials and methods: The study involved 27 women aged 39 to 47 years. Inclusion criteria: recorded perimenopause, climacteric syndrome, history of episodic increase in blood pressure up to 140/85 or 150/90 mmHg. Exclusion criteria: primary hypertension, diabetes mellitus, chronic contagious, systemic, oncology diseases, and mental illnesses. Research procedure comprised tracing of the heart rate, blood pressure registration, and pulse pressure calculation. Robinson index, the coefficient of endurance according to A. Kvas formula were calculated. The assessment of psychological state was made using the Spielberger-Khanin Inventory. Results: Multidisciplinary professionals gave classes upon wellness program at “Women’s Health” school. The program included educational conversations, healthy walking, massage, psycho-corrective exercises. The dynamics of the studied parameters was analyzed after 12 weeks. Based on the anthropometric measures findings the tested women showed improvement of 6,76% weight loss; and their body mass index decreased by 6,77%. Initial numbers of Robinson index and the coefficient of endurance were above normal values. After working under the program statistically significant dynamics was observed (р <0,05), although there were still signs of cardiovascular disorders. There were statistically significant positive changes Spielberger-Khanin Inventory on State Anxiety (-9,09%) and Personal Anxiety Scales (-6,96%) (p <0,05). Conclusions: Early detection of risk factors and physical activity will help to bring a vast improvement to prognosis and quality of life of perimenopausal women with hypertension onset.

Acute kidney injury in the newborn – a challenge for the medical team

Acute kidney injury (AKI) is the sudden deterioration of kid­ney function, which causes a decrease in the glomerular filtration rate. Neonatal acute kidney injury is common in neonates ad­mit­ted to neonatal intensive care units (NICU) and is a major fac­tor for neonatal mortality and morbidity. The incidence of AKI is 6-24% in NICU neonates, 25% in oliguric forms, 60% in non-oliguric forms and 15% in anuric forms. AKI occurs more frequen­tly in very low birth weight babies. The diagnosis in­volves family and perinatal history, physical examination of the newborn, biochemical examinations, blood gas analysis, he­ma­to­logical examination, urine measurements, imaging stu­dies and histological studies. Prophylaxis is preferable to cu­ra­tive treatment, and involves early detection of risk factors, fe­tal ultrasound to detect renal malformations, prevention of de­creased renal blood flow or intravascular blood volume by pro­phy­lac­tic administration of dopamine and furosemide or man­ni­tol, along with avoidance of nephrotoxic drugs during preg­nan­cy. Neonatal dialysis in newborns and children who have reduced muscle mass is done at lower values of serum crea­ti­nine. Hemodialysis has been replaced by peritoneal dia­lysis and hemodiafiltration, the technique of choice for the treatment of vascular overload. Peritoneal dialysis is con­tra­in­di­ca­ted in newborns with respiratory distress, shock, pe­ri­to­ni­tis or ulceronecrotic enterocolitis. Knowing and using stan­dar­dized definitions and staging of AKI in newborn contribute to a more efficient approach to the patient by the complex me­di­cal team.