Frequency Of Visits Research Articles

Primary care seeking among adults with chronic neck and low back pain in Norway: A prospective study from the HUNT study linked to Norwegian primary healthcare registry.

To describe the frequency of primary care seeking for neck or back-related conditions among people with chronic neck and low back pain and to develop prediction models of primary care seeking and frequent visits. We included participants of the Trøndelag Health Study (HUNT4, 2017-19) in Norway who self-reported chronic neck and/or low back pain in the preceding year, and extracted data of primary care visits from the Norwegian primary healthcare registry. We investigated a total of 23 potential predictors and used multivariable logistic regression models to predict primary care seeking for neck or back-related conditions and frequent visits by healthcare provider (i.e., the highest quartile of number of visits). Among the 15,352 HUNT4 participants with chronic neck and/or low back pain, 6231 participants (40.6%) sought primary care for neck or back-related conditions (median = 5 visits, IQR 2-15) within 2 years after the study. Participants who consulted physical therapists sought care the most frequently (median = 10 visits, IQR 3-26). Discrimination of the best-fit prediction model of primary care seeking and frequent visits by healthcare provider, assessed by C-statistic, ranged from 0.66-0.76. Participants who made frequent primary care visits in the preceding year were highly likely to continue frequent care seeking in the following 2 years. Around 40% of people seek primary care for chronic neck and low back pain, and frequent care seeking may continue for years. Future studies should investigate strategies to reduce recurrent primary care visits, especially seeking physical therapist care, and promote self-management of chronic pain. People with chronic neck and low back pain who seek physical therapist care had the highest frequency of care seeking, underscoring the significant burden on healthcare systems. The high frequency of visits and associated healthcare expenditures highlight the critical need for effective and valuable primary care for chronic pain management. To mitigate recurrent visits and reduce costs, it is essential to provide patients with evidence-based treatments and self-management interventions.

Social and built environmental factors associated with adult asthma hospital admission in the North Central Texas

Asthma, one of the most common chronic diseases of adults and children, is an important public health concern. The cause of asthma is thought to be a combination of genetic and environmental factors, and a growing body of research has investigated the possible geographic and contextual factors that contribute to asthma prevalence. However, few studies have incorporated geographic and environmental variables into their designs, despite evidence that geography is associated with asthma exacerbation. Additionally, studies of asthma exacerbations among adults are limited. The situation regarding asthma is particularly concerning in North Central Texas (NCT) compared to the national context. In light of this, we analyzed the geographic variation of approximately 12,000 adult patients hospitalized for asthma in the North Central Texas Region, and their association with built environmental features such as land use types, dwelling characteristics, exposure to traffic parameters at the Census Block Group (CBG) level, and pollutant concentrations in the relevant counties for the year 2014. We applied the Hierarchical Linear Model (HLM), and our analysis indicates that there are significant health disparities in the region. We found that the adult asthma hospitalization rate is significantly higher in low-income, low-education neighborhoods with a significant Black population. Furthermore, factors such as increased travel distance to work and substandard dwelling conditions have been found to trigger an increase in hospital visits for asthma patients. Conversely, the presence of greenspace in the surrounding area has been found to help reduce the frequency of asthma-related hospital visits. It is worth noting that both indoor and outdoor environmental quality contribute to adult asthma hospitalizations. Overall, our study highlights the importance of considering geographic and environmental factors in understanding the prevalence and exacerbation of asthma. Our findings suggest that targeted interventions, such as improving indoor and outdoor environmental quality and increasing access to greenspace, may help reduce the burden of asthma in high-risk communities.

A 2-year prospective evaluation of the Prostate Health Index in guiding biopsy decisions in a large cohort.

To prospectively evaluate how the Prostate Health Index (PHI) impacts on clinical decision in a real-life setting for men with a prostate-specific antigen (PSA) level between 4 and 10 ng/mL and normal digital rectal examination. Since 2016, the PHI has been available at no cost to eligible men in all Hong Kong public hospitals. All eligible patients who received PHI testing in all public Urology units (n = 16) in Hong Kong between May 2016 and August 2017 were prospectively included and followed up. All included men had a PHI test, with its result and implications explained; the subsequent follow-up plan was then decided via shared decision-making with urologists. Patients were followed up for 2 years, with outcomes including prostate biopsy rates and biopsy findings analysed in relation to the initial PHI measurements. A total of 2828 patients were followed up for 2 years. The majority (82%) had PHI results in the lower risk range (score <35). Knowing the PHI findings, 83% of the patients with elevated PSA decided not to undergo biopsy. In all, 11% and 45% opted for biopsy in the PHI score <35 and ≥35 groups, respectively. The initial detection rate of International Society of Urological Pathology (ISUP) Grade Group (GG) ≥2 cancer was higher in the PHI score ≥35 group (23%) than in the PHI score <35 group (7.9%). Amongst patients with no initial positive biopsy findings, the subsequent positive biopsy rate for ISUP GG ≥2 cancer was higher in the PHI score ≥35 group (34%) than the PHI score <35 group (13%) with a median follow-up of 2.4 years. In a real-life setting, with the PHI incorporated into the routine clinical pathway, 83% of the patients with elevated PSA level decided not to undergo prostate biopsy. The PHI pathway also improved the high-grade prostate cancer detection rate when compared to PSA-driven strategies. Higher baseline PHI predicted subsequent biopsy outcome at 2 years. The PHI can serve as a tool to individualise biopsy decisions and frequency of follow-up visits.

P-666 Comparison of IVF outcomes in women undergoing IVF stimulation using progestin primed ovarian stimulation (PPOS) Vs GnRH antagonist (GnRH-Antag) protocol

Abstract Study question Can PPOS achieve improved patient &amp; provider satisfaction while simultaneously blocking LH-surge, maintaining similar IVF outcomes like oocyte/embryo yield/clinical pregnancy rates(CPR) when compared to GnRH-Antag? Summary answer PPOS can achieve similar IVF outcomes as compared to GnRH-Antag protocol and is a patient friendly, cost-effective choice for ovarian stimulation without affecting oocyte/embryo yield/CPR. What is known already GnRH-Antag protocol is among the most widely used methods, as it blocks LH surge &amp; significantly lowers the risk of OHSS [Lambalk CB,2017]. However, this protocol has disadvantages like frequent monitoring, dose adjustment, high therapeutic cost and multiple injections[Ata B,2015]. PPOS successfully prevents ovulation and provides comparable IVFoutcomes (oocyte yield, blastocyst/euploid embryo rates, CPR) along with patient cost savings and increased convenience across all infertility diagnoses [Annalyn M.Welp, 2023]. It should be noted that most studies are non-randomized and comprise low to moderate-quality evidence. However, the consistency of the findings across different studies from different centres provides assurance in effect estimates. Study design, size, duration A retrospective cohort study conducted at a tertiary care fertility unit. Data for 449 women aged 21 to 40 years undergoing IVF stimulation using PPOS (n = 226) and GnRH-Antag (n = 223) protocol was retrieved from the hospital’s electronic database and analysed for a period between September 2022 to October 2023. Study population consisted of women undergoing freeze-all strategy either for lowering the risk of OHSS (hyper-responders) or for embryo pooling in view of very low ovarian reserve. Participants/materials, setting, methods For both groups either rFSH/rLH/HMG were used &amp; doses were indivisualised based on patient’s age, BMI &amp; ovarian reserve. PPOS group received twice daily dose of medroxyprogesterone acetate tablet(10 mg)/dydrogesterone(10 mg) from Day2 of cycle. GnRH-Antag group received Inj.Cetrorelix acetate (0.25 mg) daily as flexible protocol. Final oocyte maturation was induced with Triptorelin(0.2mg)/Choriogonadotropin alfa(250mcg)/both, once 2-3follicles reached 18-20mm. Transvaginal oocyte pick-up was performed 35-36h later. Women in PPOS group underwent freeze-all strategy followed by Frozen-Thawed Embryo-transfer. Main results and the role of chance Normally distributed continuous variables were compared using independent t-test, and categorical variables were compared by χ2 and Fisher’s exact test, where appropriate. Patient demographics, clinical/ovarian stimulation characteristics, embryological and IVF outcomes were compared for two groups. Patient demographics {Age(p-value:0.08), BMI(p-value:0.06), duration(p-value:0.09)/type(p-value:0.76) of infertlity}, total gonadotropin dose (p-value: 0.39) and duration of ovarian stimulation (p-value: 0.81) were comparable between the two groups. Though the mean LH level on trigger day was slightly higher in PPOS group (5.53 IU/L) than GnRH-Antag group (3.24 IU/L) (p-value: 0.02), statistically significant difference was not seen in the oocyte yield (p-value: 0.18), M-II oocytes (p-value: 0.17) &amp; fertilization rate (p-value: 0.23) in the two groups. The number of Day3 (p-value: 0.65), Day5 (p-value: 0.07) &amp; Day6 (p-value: 0.08) embryos available in the two groups were also comparable. IVF outcomes in terms of positive B-HCG result (p-value: 0.68), clinical pregnancy rate (p-value: 0.61) &amp; miscarriage rate (p-value: 0.27) showed no statistically significant difference in the two groups. Thus, we conclude that PPOS can achieve similar IVF outcomes as compared to the GnRH-Antag protocol, while at the same time proving to be patient friendly by reducing the need of multiple injection pricks, injection cost and the frequency of hospital visits. Limitations, reasons for caution This is a retrospective study and hence randomized comparison was not possible. PPOS can be used only when freeze-all strategy is planned, fresh embryo-transfer cannot be considered if need arises depending upon embryo quality. IVF service providers have to depend on patient compliance for using oral progestins to block LH-surge. Wider implications of the findings Study findings suggest that PPOS is a patient friendly and equally effective and safe IVF stimulation protocol when compared to GnRH-Antagonist. More RCT will be useful for investigating different aspects of PPOS (it’s utility for women with different ovarian reserve functions, conventional versus flexible approach, optimal dose of each progestin). Trial registration number Not applicable

Periodontal Health Among Pregnant Women in Sri Lanka: A Cross‐Sectional Study

ABSTRACTIntroductionThe prevalence of periodontal disease among Sri Lankan women in the reproductive age group is considerably high. The present study aimed to assess the oral hygiene status, gingival status, and the associated factors among pregnant women attending community Antenatal Clinics (ANC) in Sri Lanka, against the challenging sociopolitical backdrop.MethodsThis cross‐sectional study was conducted among 576 pregnant women attending community ANCs within a specific Medical Officer of Health area in Sri Lanka. The clinics were selected using a two‐stage cluster sampling method with probability proportionate to size technique. Pregnant women were recruited from each clinic using a systematic sampling method. Data was collected with an interviewer‐administered questionnaire and an oral health examination form.ResultsPoor oral hygiene was detected among over 60% of pregnant women. Moderate‐to‐severe gingivitis was seen among 23.3% of them. Nearly 67% of the participants demonstrated limited knowledge of periodontal diseases. Approximately, 67% of them were unemployed, and 32.5% had a monthly income of less than 40,000 Sri Lankan rupees. Regression analysis revealed that the trimester, socioeconomic factors, frequency of dental visits, recency of full mouth scaling, and knowledge of periodontal diseases predicted the oral hygiene status, and age, trimester, frequency of brushing, recency of full mouth scaling, and knowledge of periodontal diseases were significant predictors of gingival health. Particularly, individuals with a lower socioeconomic status experienced both poor oral hygiene and gingival health.ConclusionThe suboptimal oral hygiene and gingival health, limited access to dental care, and inadequate periodontal health knowledge, highlight an urgent need for interventions such as empowering young women through educational and employment initiatives.

노인 저장행위에 대한 메타리뷰: 개입과 영향요인

This study sought to identify practical methods and influencing factors for intervening in hoarding behavior. To achieve this, a meta-review was conducted. A meta-review is a research methodology that summarizes and presents findings from existing systematic reviews. An electronic search was conducted in PubMed, SCOPUS, and Web of Science, using the following search phrase: “hoarding” OR “self-neglect” OR “squalor” AND “older adults” AND “systematic review.” A narrative synthesis was conducted to identify effective interventions and influncing factors. The initial search yielded 102 studies. After the screening processes, four studies were eligible for review. The analysis revealed that cognitive-behavioral therapy emerged as an effective intervention method for hoarding behavior. From the data synthesis, four factors that positively influence the intervention emerged: 1) adherence to manualized cognitive-behavioral therapy; 2) demographic characteristics (gender, age); 3) individual and group therapy, treatment duration, and frequency of home visits; and 4) pharmacological treatment. Conversely, factors that negatively affected the intervention included: 1) a small sample size; 2) higher dropout rates; and 3) a lack of focus on intervention. Based on the results, this study provides an effective intervention method and implications applicable in social work settings. Also, it proposes strategies to mitigate factors that negatively impact interventions and suggests the establishment of an educational system to enhance practitioners’ capabilities.

Artificial intelligence utilization in the healthcare setting: perceptions of the public in the UAE

ABSTRACT Understanding the use of AI in healthcare is essential for the successful implementation of AI-driven healthcare solutions. The aim of this study was to evaluate public perception of AI utilization in healthcare settings. A validated questionnaire assessed general perceptions towards AI utilization, the use of AI by physician , and the use of AI by pharmacists . The study included 770 participants. The median perception score indicated an unfavorable attitude. Participants who had lower education level and those with no employment had a significantly lower perception scores than their counterpart. Participants who reported low income and those who visited the pharmacy five to ten times on average had a higher perception than their counterparts did. The reported negative perception necessitates the implementation of education campaigns to improve AI literacy and dispel any misconceptions and concerns, particularly among individuals with low education, high income, unemployment, and frequent pharmacy visits.

Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study.

Cyclic vomiting syndrome (CVS) is an enigmatic and debilitating disorder of gut-brain interaction that is characterized by recurrent episodes of severe vomiting and nausea. It significantly impairs patients' quality of life and can lead to frequent medical visits and substantial health care costs. The diagnosis for CVS is often protracted and complex, primarily due to its exclusionary diagnosis nature and the lack of specific biomarkers. This typically leads to a considerable delay in accurate diagnosis, contributing to increased patient morbidity. Additionally, the absence of approved therapies for CVS worsens patient hardship and reflects the urgent need for innovative, patient-centric solutions to improve CVS management. We aim to develop a digital patient assistant (DPA) for patients with CVS to address their unique needs, and iteratively enhance the technical features and user experience on the initial DPA versions. The development of the DPA for CVS used a design thinking approach, prioritizing user needs. A literature review and Patient Advisory Board shaped the initial prototype, focusing on diagnostic support and symptom tracking. Iterative development, informed by the design thinking approach and feedback from patients with CVS and caregivers through interviews and smartphone testing, led to significant enhancements in user interaction and artificial intelligence integration. The final DPA's effectiveness was validated using the System Usability Scale and feedback questions, ensuring it met the specific needs of the CVS community. The DPA developed for CVS integrates an introductory bot, daily and weekly check-in bots, and a knowledge hub, all accessible via a patient dashboard. This multicomponent solution effectively addresses key unmet needs in CVS management: efficient symptom and impacts tracking, access to comprehensive disease information, and a digital health platform for disease management. Significant improvements, based on user feedback, include the implementation of artificial intelligence features like intent recognition and data syncing, enhancing the bot interaction and reducing the burden on patients. The inclusion of the knowledge hub provides educational resources, contributing to better disease understanding and management. The DPA achieved a System Usability Scale score of 80 out of 100, indicating high ease of use and relevance. Patient feedback highlighted the DPA's potential in disease management and suggested further applications, such as integration into health care provider recommendations for patients with suspected or confirmed CVS. This positive response underscores the DPA's role in enhancing patient engagement and disease management through a patient-centered digital solution. The development of this DPA for patients with CVS, via an iterative design thinking approach, offers a patient-centric solution for disease management. The DPA development framework may also serve to guide future patient digital support and research scenarios.

Flower-visiting lizards as key ecological actors for an endemic and critically endangered plant in the Canary Islands

Oceanic islands are places where biological assemblages are relatively simple, as compared to the mainland. On islands, however, pollinator assemblages may to be composed of a taxonomically disparate group of organisms (e.g. insects, lizards, and birds), some of them with opportunistic nectar-feeding behaviour. Here we investigated some components of pollination effectiveness of Lotus maculatus (Fabaceae), an endangered Canary Islands endemic. In a flower exclusion experiment, we bagged flowers and compared their subsequent fruit and seed set to that of control flowers. Number of interactions with vertebrate and invertebrate flower visitors was counted and it was recorded whether interactions were legitimate (potentially pollinating) or non-legitimate (nectar robbing). Additionally, we estimated pollen loads on lizards and looked for any relationship between reproductive success of individual plants and number of visits made by the top three flower-visiting species (in terms of both frequency of occurrence at censuses and number of floral visits). Bagged flowers fruited less and with fewer seeds than control flowers. The only observed flower-visiting vertebrate was the Tenerife lizard Gallotia galloti, whose interactions were always legitimate and with around a half of captured individuals carrying pollen grains. The most frequent flower-visiting insect was the honeybee Apis mellifera followed by the solitary bee Lasioglossum arctifrons. The honeybee, however, was only a nectar robber, and the solitary bee was not an effective pollinator, but rather a pollen gatherer. Fruit set by individual plants was positively related only to frequency of visits by the lizard. Thus, the lizard seems to play a key role in the conservation management of L. maculatus.

Relationship Between Frequency of Remote Visitation and Postpartum Depression in Mothers of Hospitalized Neonates During the COVID-19 Pandemic

ObjectiveTo explore the relationship between symptoms of postpartum depression and the number of remote visitations among mothers of infants in the NICU. DesignRetrospective cohort study. SettingNICU in a medical university in Iwate, Japan. ParticipantsA total of 89 mothers of infants who spent more than 1 month in the NICU from June 2021 to December 2022. MethodsParticipants completed the Edinburgh Postnatal Depression Scale (EPDS) at 4 days and 1 month after birth. We used a one-way analysis of variance with Tukey–Kramer or Games–Howell post hoc tests to examine differences in postpartum depression among three groups based on the frequency of remote visitation: frequent visitation, rare visitation, or no visitation. ResultsOf the 89 mothers, 41 scored 9 points or higher on the EPDS conducted 4 days after birth; among them, 14 did not visit, 13 rarely visited, and 14 frequently visited the NICU remotely through a web camera. The rare visitation group had significantly higher EPDS scores 1 month after birth (M = 9.7, SD = 5.2) than the frequent (M = 5.3, SD = 3.7) and no visitation (M = 5.1, SD = 4.2) groups (p < .05). The rare visitation group demonstrated lower improvement on the EPDS than the frequent and no visitation groups (nonsignificant). ConclusionIt is unclear whether remote visitation reduces symptoms of postpartum depression; however, the frequency of remote visitation could be assessed to identify at-risk mothers in need of social support.

Effect of telemedicine use on medical spending and health care utilization among patients with gastrointestinal cancer

BackgroundWe sought to assess the impact of telemedicine on healthcare utilization and medical expenditures among patients with a diagnosis of gastrointestinal (GI) cancer. MethodsPatients with newly diagnosed GI cancer from 2013 to 2020 were identified from the IBM MarketScan database (IBM Watson Health) . Healthcare utilization, total medical outpatient insurance payments within 1 year post-diagnosis, and out-of-pocket (OOP) expenses among telemedicine users and non-users were assessed after propensity score matching (PSM). ResultsAmong the 32,677 patients with GI cancer (esophageal, n = 1862, 5.7%; gastric, n = 2009, 6.1%; liver, n = 2929, 9.0%; bile duct, n = 597, 1.8%; pancreas, n = 3083, 9.4%; colorectal, n = 22,197, 67.9%), a total of 3063 (9.7%) utilized telemedicine. After PSM (telemedicine users, n = 3064; non-users, n = 3064), telemedicine users demonstrated a higher frequency of clinic visits (median: 5.0 days, IQR 4.0–7.0 vs non-users: 2.0 days, IQR 2.0–3.0, P < .001) and fewer potential days missed from daily activities (median: 7.5 days, IQR 4.5–12.5 vs non-users: 8.5 days, IQR 5.5–13.5, P < .001). Total medical spending per month and utilization of emergency room (ER) visits for telemedicine users were higher vs non-users (median: $10,658, IQR $5112–$18,528 vs non-users: $10,103, IQR $4628–$16,750; 46.8% vs 42.6%, both P < .01), whereas monthly OOP costs were comparable (median: $273, IQR $137–$449 for telemedicine users vs non-users: $268, IQR $142–$434, P = .625). ConclusionTelemedicine utilization was associated with increased outpatient clinic visits yet reduced potential days missed from daily activities among patients with GI cancer. Telemedicine users tended to have more ER visits and total medical spending per month, although monthly OOP costs were comparable with non-users.

The use of telehealth in a large community oncology practice prior to and during the COVID-19 pandemic.

1631 Background:The COVID-19 pandemic prompted implementation of telehealth services in oncology following CMS approval for reimbursement. Using data from a single large US-based community oncology practice, we characterized the adoption of telehealth, evaluated telehealth’s impact on patient transit to the site of care, and the frequency of ER visits and hospitalizations. Methods: A retrospective cohort analysis was conducted using data from January 2019 through June 2022 from the FCS EMR database, IQSS’s RefineIQ database, which captures and standardizes patient treatments for consistent analysis, InfoDive, a reimbursement platform with data on clinic visits, and Oncology Care Model data. The target population included all patients with cancer aged 18 or older under active management at FCS during the study window with at least 60 days of follow-up. Patient disease and demographic characteristics and ER/hospital care visits were compared between telehealth groups, as well as impact of telehealth use on transit time and distance traveled for patients was summarized using descriptive statistics. Results:178,531 patients were analyzed. Median age was 68, with 64% female and 47% white. 97% of patients lived in a metropolitan area, 97% in Florida, and 77% in areas with less than $78,000 median income. Median duration of disease was 41 months, 24% of patients were stage IV and 93% ECOG 0-1. 20% of patients used telehealth, with 81% having only one telehealth use per year. Patients using telehealth, compared to those that did not, were more likely to be white (50% vs 46%), have commercial insurance (30% vs 27%), live in areas where annual median income was &gt; $78,000 (25% vs 22%) and ≥95% of the population graduated high school (31% vs 26%). Telehealth saved a median of 5 miles driven per user annually. Users tended to have more advanced disease than non-users, with a higher proportion of metastatic disease (27% vs 23%), high CMS risk score (16% vs 15%), and line of therapy 2 or greater (10% vs 7%). Users had higher median annual oncology clinic visits both pre- (5 vs 3) and post-telehealth approval (6 vs 5). Hospital admissions after ER visits were more frequent among users both pre- (14% vs 13%) and post-telehealth approval (29% vs 25%). Conclusions: Telehealth was somewhat more likely to be used by patients with cancer in more affluent communities, white patients, patients who had more advanced disease and more frequent clinic and hospital visits. Most patients who used telehealth used it only once, and the low utilization of telehealth had limited impact on patient transit effort to the clinic. This study is limited by its concentration at a single large practice in Florida, the relatively low use of telehealth, retrospective design, and selection bias, as the telehealth population had more advanced disease and likely needed more frequent intervention.

Evaluating the utility of routine survivorship exams in breast cancer: Modality of detection of recurrence in a prospective cohort study.

1629 Background: National Comprehensive Cancer Network surveillance guidelines for invasive breast cancer recommend a history and physical exam every 3-12 months for the first 5 years, followed by annually, and mammography every 12 months. However, frequent in-office visits create time toxicity for breast cancer survivors, may have low utility in recurrence detection, and can create false reassurance. This study evaluates the modality of breast cancer recurrence in an integrated health system with access to primary and specialty care. Methods: We investigated mode of detection of recurrent breast cancer in the Pathways Study, a prospective cohort study of adult women diagnosed with and treated for invasive breast cancer in Kaiser Permanente Northern California, with enrollment from 2006 to 2013, and follow-up through December 2021. In this analysis, we included 4,431 women diagnosed at Stages I-III. Cohort members were followed for recurrences, deaths, and other outcomes. Of primary interest was modality of detection of recurrence, categorized as patient-driven symptoms, surveillance mammogram, diagnostic testing (i.e., other surveillance imaging for recurrence such as PET CT or MRI), routine clinical breast exam, or incidental finding. Results: A total of 617 (13.9%) women were identified as having breast cancer recurrence. Patients with recurrence shared similar demographic characteristics to those without recurrence. The recurrence population had median age of 59.2 years, BMI of 28.2 kg/m2, and racial/ethnic composition of 63% white,13% Hispanic,12% Asian, and 10% black. The median time from diagnosis to recurrence was 4 years. Seventy percent of recurrences were found to have distant metastatic disease, of which only 6.7% had concurrent local nodal and/or breast involvement. For those without metastases, 17.7% had recurrence localized in the ipsilateral breast, 2.8% in both the breast and locoregional nodes, and 9.3% only in locoregional nodes. Most recurrences were detected by patient driven symptoms (69.4%). Among the total cases, 8.1% of patients were diagnosed by routine mammogram, 10.9% with diagnostic testing and 4.5% by incidental finding. Recurrences in 6.8% of patients were detected by routine physician exam. Overall survival for those with recurrence was 31.1% and most deaths were attributed to breast cancer (89%). Conclusions: Our study, the largest investigation of breast cancer recurrence modality of detection in a US community oncology setting with comprehensive care, revealed the majority of recurrences were identified through patient self-detection with only 6.8% detected by physician exam. Most recurrences were distant, underscoring the need for alternative screening modalities to detect metastatic recurrences earlier, especially in the context of emerging treatments and improved survival rates for oligometastatic disease.

Factors Associated with Sickle Cell Crisis Among Sickle Cell Disease Patients Aged ≤15 Years in Three Kenyan Health Facilities

In view of the dearth of definitive therapeutic measures for sickle cell disease (SCD) and its associated crises, the resulting financial burden on parents and caregivers, coupled with psychological distress, social stigma, and other far-reaching consequences, remains incalculable. This research assessed the determinants of sickle cell crises among individuals with SCD aged 15 years and below, focusing on three healthcare facilities in Nairobi County. Using a descriptive cross-sectional design, the study aimed to establish the correlation between SCD crises and various variables in this specific age group within the selected health facilities. Structured interviewer-administered questionnaires, featuring both open-ended and dichotomous questions, were meticulously validated, optimized, and employed to gather pertinent data from the participants. The findings revealed that a majority of SCD patients below 15 years in sampled hospitals were female (52.85%), and the highest incidence of SCD occurred in the age range of 0-5 years (46.63%). Educational attainment among patients predominantly peaked at the primary school level (65.80%), with a minimal 7.77% reaching a secondary school level. Moreover, female caregivers (92.23%) were prevalent among those responsible for SCD patients aged 15 years and below. Primary caregivers, aged between 26- 30 years (37.82%) and 31-35 years (26.42%) were predominately married (75.13%) and engaged in agricultural activities (63.73%). This study revealed that out of the sampled SCD patients under 15 years old, a staggering 83.94% experienced crises related to their sickle cell disease, manifesting as abdominal pains for nearly 70 %, joint discomfort for over 72.22%, acute chest pain occurring approximately 25 %, with bone ache accounting about 32 %. Multiple logistic regression analysis demonstrated that female gender, the age group of 6-10 years, and frequent hospital visits (more than twice a month) significantly increased the log odds for severe SCD crises. Therefore, this study underscores the impact of patient and caregiver factors on the severity of SCD and its crises. Modifying these factors appropriately holds the potential to enhance the prognosis and wellbeing of both patients and caregivers, and strategic interventions must be devised to improve adherence to treatment protocols for SCD patients aged 15 years and below, thereby enhancing prognosis and overall quality of life.

Gender Differences in Adoption and Frequency of Virtual Primary Care Among Men and Women Veterans.

Background: Women Veterans have unique health care utilization patterns; however, video-based primary care utilization among and between women and men has not been well examined. Methods: In a retrospective cohort study, we calculated gender-stratified video visit adoption (i.e., likelihood) and frequency (i.e., rate of use among users) between April 1, 2020, and March 31, 2022, by demographic and clinical characteristics known to impact health care utilization. Results: Among 5,389,139 Veterans (9.2% women), 32% of women and 18.6% of men had a video-based primary care visit over the 2-year study period. Gender interacted with Veteran characteristics and the likelihood of any video care. Men often had associations stronger in magnitude (both positive and negative) than women, including by age, rurality, history of housing instability, mental health conditions, and marital status. The direction of effect never diverged by gender. A positive association among women always coincided with a positive association among men, and vice versa, across all characteristics assessed. Only the risk ratio for video care use comparing Veterans of Black race with White race was stronger among women. In contrast to the video care adoption differences by gender, we found few differences in the frequency of video-based care by gender. Conclusions: The findings suggest there are fewer disparities by demographic and clinical characteristics in any video care use among women compared with men and little to no disparities in the frequency of video care use by gender. Understanding the variation in video care utilization by gender could help improve acceptance, appropriate utilization, and uptake of video-based visits for all.

A comparative analysis of needs and role of patient navigation among early-phase cancer clinical trial participants and non-participants at a single cancer center.

e23127 Background: Early phase clinical trials (EPCTs) assess the safety and toxicity of novel anticancer agents and represent opportunities for patients (pts) to try novel therapies when standard therapies have become ineffective. However, EPCT participants represent a vulnerable population with high financial toxicity and symptoms related to their cancer and previous treatments. EPCTs often require frequent visits and additional procedures which may be burdensome. Pt navigators perform needs assessments and provide guidance to pts as they move through the health care system. Navigation, which has a high level of acceptance among pts with cancer, can improve time from diagnosis to treatment, decrease pt anxiety, and improve participation of minoritized individuals in clinical trials. We hypothesized that EPCT participants would have higher navigation needs than those of non-EPCT participants with cancer. Methods: Utilizing a needs assessment conducted in person or by telephone, pts with cancer treated at Mount Sinai are assessed for 26 individual and systemic social drivers of health (SDoH) barriers by pt navigators at their trial screening visit. EPCT participants were defined as pts participating in a study in the Early Phase Trials Unit. Descriptive characteristics were assessed for all participants regarding demographic characteristics and SDoH barriers. Welch's T-test was used to compare differences in navigation encounters, SDoH barriers and navigator interventions between the EPCT and non-EPCT pt groups. Results: From February to December 2023, 31 EPCT pts and 3126 non-EPCT pts completed the assessment. Median age was 55.9 and 56.1 years, respectively. Racial and ethnic self-identification included 13% vs. 23% Black pts and 19% vs. 20% Hispanic pts. EPCT pts had a mean 4.87 navigation encounters per pt compared to 1.94 in non-EPCT pts (p &lt; 0.001). Pts in the EPCT group were found to have an average of 24.97 SDoH barriers identified, in contrast to 2.68 in the non-EPCT group (p &lt; 0.001). The most common barriers identified in EPCT pts were institutional, knowledge, and psychosocial; in non-EPCT pts, institutional, treatment adherence, and transportation barriers were most common. Furthermore, based on the identified barriers, EPCT pts required an average of 17.23 interventions, compared to 1.80 among those not in the EPCT group (p &lt; 0.001). Interventions most frequently involved coordination with the primary team and education for pts in both groups. Conclusions: EPCT pts had more navigation encounters, SDoH barriers identified, and resultant interventions than non-EPCT pts. Participants in EPCTs are a vulnerable pt population for whom navigation is particularly warranted. [Table: see text]

Extreme heat exposure of host plants indirectly reduces solitary bee fecundity and survival.

Extreme heat poses a major threat to plants and pollinators, yet the indirect consequences of heat stress are not well understood, particularly for native solitary bees. To determine how brief exposure of extreme heat to flowering plants affects bee behaviour, fecundity, development and survival we conducted a no-choice field cage experiment in which Osmia lignaria were provided blueberry (Vaccinium corymbosum), phacelia (Phacelia tanacetifolia) and white clover (Trifolium repens) that had been previously exposed to either extreme heat (37.5°C) or normal temperatures (25°C) for 4 h during early bloom. Despite a similar number of open flowers and floral visitation frequency between the two treatments, female bees provided with heat-stressed plants laid approximately 70% fewer eggs than females provided with non-stressed plants. Their progeny received similar quantities of pollen provisions between the two treatments, yet larvae consuming pollen from heat-stressed plants had significantly lower survival as larvae and adults. We also observed trends for delayed emergence and reduced adult longevity when larvae consumed heat-stressed pollen. This study is the first to document how short, field-realistic bursts of extreme heat exposure to flowering host plants can indirectly affect bee pollinators and their offspring, with important implications for crop pollination and native bee populations.

Smallholder Farmers' Use of Indigenous Knowledge Practices in Agri-food Systems: Contribution of Food Security Attainment Drive

Most of the world's poor, including those in Nigeria, live in rural and agrarian settings and are engaged in agricultural practices for sustenance. Meanwhile, increasing agricultural productivity requires the adoption of modern technologies and improved farming systems, which entail considerable cost outlays for initial adoption and continued use. These costs may be out of reach for resource-poor smallholder farmers, hence the need to embrace indigenous knowledge practices (IKPs) in an agrarian economy such as Nigeria. This research examined the contribution of farmers' food security attainment efforts through the use of IKPs. Drawing on a documentary review of literature and empirical evidence, as well as data collected from 349 randomly selected smallholder farmers, the study applied descriptive statistics, a standardized food insecurity experience scale survey module, and a multivariate probit regression model to analyze the dataset. The findings revealed that almost 86% of the farmers have a strong and positive perception of the effectiveness of IKPs on agricultural production, while approximately 90% of the farmers are food insecure (those in the chronic and moderate food insecurity categories). The results also indicated that farmers’ food security status, household size vis-à-vis dependency ratio, awareness of IKPs, age of the farmers, years of farming experience, access to extension services, and frequency of visits by extension personnel significantly influenced farmers’ use of traditional farming practices, crop selection/rotation strategies, and water management techniques in the study area. Despite the farmers' use of IKPs, most of them are still largely food insecure, which raises serious concerns. Given this, the study recommends a multi-stakeholder partnership to foster synergies between the use of indigenous knowledge and modern scientific approaches by farmers, harnessing the complementary strengths of both knowledge systems to address the contemporary challenges faced by smallholder farmers in the agri-food systems.

Associations between Parental Engagement in the Neonatal Intensive Care Unit and Neighborhood-Level Socioeconomic Status.

This study aimed to (1) determine the effect of neighborhood-level socioeconomic status (SES), which considers the social and physical environment where a person lives, on parental engagement in the Neonatal Intensive Care Unit (NICU) and (2) compare the relationships between parental engagement and individual versus neighborhood-level measures of SES. In this cohort study, parents (n = 45) of premature neonates ≤34 weeks' gestation were assessed at 2 and 6 weeks after birth from December 2017 to October 2019. Neighborhood-level SES was determined using census data per the Association of Maternal and Child Health Programs' methodology, and parents self-reported their education level as an individual-level measure of SES. Data on frequency of engagement in NICU activities, including telephone updates, visitation, providing expressed breastmilk, and participating in kangaroo care, were collected from the electronic medical record. Parent psychosocial factors were assessed using validated surveys. Statistical analysis was performed using Fisher's exact test, t-test, and logistic regression. In multivariate regression analysis, disadvantaged neighborhood-level SES was associated with decreased odds of kangaroo care (OR = 0.16, 95% CI: [0.03-0.89]) and visitation (OR = 0.14, 95% CI: [0.02-0.87]), while lower individual-level SES was not significantly associated with kangaroo care, visiting, calling, or pumping (p > 0.05). Parental engagement was more consistently and significantly associated with neighborhood-level SES than with individual-level SES. Therefore, neighborhood-level SES measures may be more explanatory than individual-level SES measures. Further studies and targeted interventions are needed to address disparities in the frequency of kangaroo care and visitation according to SES. · Parents from disadvantaged neighborhoods are less likely to do kangaroo care and visit the NICU.. · Parent engagement was more significantly associated with neighborhood than with parent education.. · Neighborhood-level SES measures may be more explanatory than individual-level SES measures.. · Interventions are needed to address SES-related disparities in NICU kangaroo care and visitation..

Perceptions of stimulant and buprenorphine diversion and strategies to address it.

There is ongoing policy debate on the prescribing of controlled substances such as buprenorphine and stimulants via telemedicine. The goal of federal and state policymakers is to ensure access to care while limiting diversion risk. However, there is little evidence on how clinicians view and address diversion and on telemedicine's role in diversion. From December 2023 to January 2024, we conducted semi-structured interviews with 21 psychiatrists and primary care physicians engaged in hybrid (telemedicine and in-person) care models in which we explored perceptions of diversion and strategies used to monitor for diversion. Most physicians reported monitoring for diversion, but there was little consistency on how monitoring was done and reported strategies did not differ between telemedicine vs in-person care. When physicians suspected diversion, there was also wide variation in responses: some clinicians did not immediately take any action while others imposed more requirements on patients (e.g., more frequent visits), no longer prescribed the controlled substance, or terminated the patient from their practice. Few physicians had ever reported a case of suspected diversion to law enforcement. Our findings suggest that the Drug Enforcement Administration could clarify reporting requirements and professional societies could provide additional guidance on how to respond to suspected diversion, given the current variation in practice across clinicians could be exploited by individuals who want to divert.