Frequent Encounters Research Articles

Treatment-seeking behavior and obstacles to treatment compliance in diabetic patients in Mangaluru, India

AimTo evaluate the local treatment-seeking behaviors of diabetics with a focus on the root causes of culture-specific barriers to treatment compliance and define targets for intervention. MethodsA cross-sectional survey was administered in the local language to 204 diabetic adults in rural and urban clinical settings. Fasting blood glucose level was measured in all participants prior to the survey. Questions included sociodemographic characteristics, treatment-seeking behavior, and perceptions of obstacles. ResultsOut of 204 participants, predictors of at target status included age (OR 1.06, 95% CI 1.02–1.11) and rural living area (OR 1.92, 92% CI 1.02–3.60). Participants were commonly diagnosed with symptoms of diabetes (44.6%). Participants demonstrated frequent healthcare provider contact (51% in last one month, 74.5% in last three months). Accidental or purposeful deviation from the recommended medications or treatment plan was reported by 18.7% and 12.8%, respectively. From the sample, 111 participants (54.4%) were capable of receiving SMS messages and 79 (71.1%) were willing to receive messages about diabetes. The most frequently self-reported obstacles to diabetes management were: medication costs (49.3%), treatment costs (46.6%), diabetic diet (33.8%), lack of relief on current treatment (17.4%), and transportation (16.7%). ConclusionThough most diabetics have frequent encounters with healthcare providers and report compliant behaviors, the majority do not meet recommended diabetes management guidelines. Screening of at-risk populations, targeted SMS campaigns, or diabetes-specific training for healthcare providers may improve clinical outcomes.

The available intravenous iron formulations: History, efficacy, and toxicology.

A number of intravenous iron formulations have been developed over the past 65 years which rely on dextran or other compounds to prevent uncontrolled release of free iron to the circulation. High molecular weight dextran was associated with a number of serious adverse reactions and was removed from markets worldwide in 2009. The preponderance of published evidence suggests that the formulations of parenteral iron currently available in the United States, including low molecular weight iron dextran, are all safe and effective and there are no major, clinically important differences among them in terms of either efficacy or safety. For patients with chemotherapy induced anemia or with anemia of end stage renal disease who are being treated with hemodialysis, it is reasonable to use any of the iron formulations, including iron sucrose and ferric gluconate, as frequent patient encounters with health caregivers are a routine part of care and the need to administer multiple low doses of IV iron is not a major disadvantage. However, a single infusion of a total iron dose is as effective and safe when giving iron preparations containing low molecular weight iron dextran, ferumoxytol, iron isomaltoside, or ferric carboxymaltose. Use of a single total dose infusion results in a decreased number of intravenous infusions with a lower cumulative risk for infusion reactions or extravasations, a reduced need for multiple office visits and repeated utilization of medical staff, and increased convenience for physicians and patients.

Healthcare providers' caring: Nothing is too small for parents and children hospitalized for heart surgery

BackgroundParents of children with congenial heart disease (CHD) face frequent healthcare encounters due to their child’s care trajectory. With an emphasis on assuring caring in healthcare, it is necessary to understand parents’ perceptions of healthcare providers’ actions when their child undergoes heart surgery. ObjectivesTo describe parents’ perceptions of healthcare providers’ actions when their child is diagnosed with CHD and undergoes heart surgery. MethodsThis is a qualitative study with in-depth interviews. Parents of children with CHD were interviewed twice after surgery. We analyzed data using directed content analysis guided by Swanson Caring Theory. ResultsFindings of the study indicate that parents perceive caring when providers seek to understand them (knowing); accompany them physically and emotionally (being with); help them (doing for); support them to be the best parents they can be (enabling); and trust them to care for their child (maintaining belief). ConclusionsHealthcare providers play an irreplaceable role in alleviating parents’ emotional toll when their child undergoes cardiac surgery. Providers' caring is an integral component in healthcare.

Application of potential assessment of risk (PARK) model in Korea waterways

Korean coastal waterways are potentially the most dangerous zones for marine accidents owing to a high volume of traffic, irregular traffic patterns of fishing vessels, frequent ship encounters, and narrowness of navigable area because of offshore construction and port enlargement construction. However, there are only few marine traffic assessment models that can be referenced from other countries, and none of them contain a risk assessment model suitable for the situation regarding Korean waterways. Therefore, it is necessary to develop a quantitative assessment of marine traffic environments based on ship navigator’s consciousness. To develop a new, suitable assessment model for marine traffic, the internal and external elements of vessels, based on a questionnaire survey and simulation experiment, are considered. The ship’s internal static parameters, vessel type, length, and width, as well as mariner’s experience, license, and rank on board are determined for the risk value. Furthermore, the external dynamic elements are calculated by the results of the questionnaire, which addresses the ship’s encounter situations and distances. Through this potential assessment of risk model, we used function as navigation equipment onboard to prevent a collision accident, applied it as a solution of a Vessel Traffic System (VTS) decision-making support system, and used the vessel evacuation route to recover the vessel’s normal situation from an emergency.

Correlates of Interpersonal Ethnoracial Discrimination Among Latino Adults with Diabetes: Findings from the REACH Detroit Study

ABSTRACTThe purpose of this study is to identify the social and economic correlates of reported experiences of interpersonal ethnoracial discrimination among Latino adults in Detroit. We examine whether the correlates of interpersonal ethnoracial discrimination vary according to the domain of discrimination and compare findings for individual domains of discrimination to a composite measure of experiences of discrimination. This study suggests that the frequency of reported discrimination is moderately high, and relatively common among Latinos with diabetes who live in Detroit. The findings demonstrate that immigration and ethnicity-related factors, such as greater comfort speaking Spanish and being born in the United States, were persistent correlates of more frequent encounters of interpersonal ethnoracial discrimination. Implications for social work research and practice are presented.

Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD.

CKD patients have several features conferring on them a high risk of adverse safety events, which are defined as incidents with unintended harm related to processes of care or medications. These characteristics include impaired kidney function, polypharmacy, and frequent health system encounters. The consequences of such events in CKD can include new or prolonged hospitalization, accelerated kidney function loss, acute kidney injury, ESRD, and death. Health information technology administered via telemedicine presents opportunities for CKD patients to remotely communicate safety-related findings to providers for the purpose of improving their care. However, many CKD patients have limitations that hinder their use of telemedicine and access to the broad capabilities of health information technology. In this review, we summarize previous assessments of the pre-dialysis CKD populations' proficiency in using telemedicine modalities and describe the use of interactive voice-response system to gauge the safety phenotype of the CKD patient. We discuss the potential for expanded interactive voice-response system use in CKD to address the safety threats inherent to this population.

Association Between Acute and Routine Health Care Utilization and Disease-Related School Absences for Children with Sickle Cell Disease

Introduction: Many children with sickle cell disease (SCD) experience frequent interactions with the health care system for the treatment and management of acute and chronic disease complications. For many children with SCD, these encounters occur during school. There is limited data available which quantifies the association between health care encounters and disease-related absences among children with SCD. The aims of this study were to 1) quantify disease-related school absences for children with SCD and 2) assess the association between health care encounters and school absences. We hypothesized that health care utilization is associated with increased school absences for children with SCD.Methods: We conducted a longitudinal study of 101 children with SCD in a large urban pediatric hospital. Upon enrollment, parents completed a baseline questionnaire that assessed their child's health care utilization and school absences in the previous 12-months. The primary independent variables were acute care (number of emergency department visits and hospitalizations), preventive care (number of routine medical and dental visits), and total health care utilization (summation of all encounter types). The primary outcome measure was the number of disease-related missed school days. The covariates consisted of both child characteristics (age, gender, insurance type, parent-reported health status) and parent characteristics (education, marital status, social support, and number other children in household). Multivariate negative binomial regression was conducted to assess associations. Results were expressed as odds ratios (OR) and 95% confidence intervals (CI).Results: Among children with SCD, the average number of acute care encounters was 3 and preventive care encounters was 9 in the previous 12 months. There was an average of 12 total health care encounters during the same period. Children missed an average of 12 school days attributable to SCD in the past 12 months. Acute care (OR = 1.15, 95% CI = 1.13 -1.17), preventive care (OR = 1.04, 95% CI = 1.03 - 1.05) and total health care encounters (OR = 1.05, 95% CI =1.04 - 1.06) were all significantly associated with disease-related missed school days.Conclusion: Routine care accounted for three-fourths of the total health care encounters among children with SCD. While vital to the management of SCD, these frequent health care encounters may increase school absenteeism. This is particularly impactful during formative years as this can have long-term effects on the academic and socio-economic achievement of children with SCD. To ensure that children with SCD can stay on par with their peers, while undergoing recommended treatment, supplemental educational instruction and support coordinated across the health care and education systems may be needed. Larger longitudinal studies are warranted to determine the educational consequences of frequent health care encounters for children with SCD. DisclosuresNo relevant conflicts of interest to declare.

Examining the shifting patterns of poaching from a long-term law enforcement intervention in Sumatra

Current levels of illegal wildlife trade for many in-demand species are unsustainable and place them at a heightened risk of extinction. While several Asian protected areas standout for their remarkable successes in tackling poaching, the threat continues nonetheless. We analyse a decade of law enforcement data from a Sumatran protected area to investigate tiger and prey poaching trends, the arrests and subsequent prosecution of those involved. Some 3882 snare traps were destroyed, but a recent spike in tiger poaching revealed that twice the number of snares were annually encountered in 2013 and 2014 than the eight preceding years. We detected a change in the techniques employed for poaching tigers from 2011 onwards, with more frequent encounters of snare trap clusters that contained six or more tiger traps set in a single location. Comparing monthly patterns of poaching within years revealed an increase in deer, but not tiger, poaching during the month of Ramadan. This result confirmed long-held views by the ranger teams that local demand for meat increases in the build up to Idul Fitri, a main Islamic holiday. Finally, from 24 law enforcement operations conducted, 40 tiger poachers/traders were arrested with >90% being prosecuted. However, the fines and prison sentences issued were much lower than the maximum available, and the highest sentence was for firearms possession and not illegal activities towards wildlife. Our site-based study demonstrates what can be achieved, but also identifies areas for strengthening the sub-national and national law enforcement response to an escalating tiger poaching trend.

Experiences and Perspectives on Advance Care Planning among Individuals Living with Serious Physical Disabilities.

Despite frequent encounters with the healthcare system and high risk for secondary conditions, it is unclear how frequently individuals living with serious physical disabilities document advance directives (AD) or engage in advance care planning (ACP). Their perspectives on these topics are largely unknown. We aimed to characterize the perspectives of individuals with serious physical disabilities receiving care from two different healthcare delivery settings on the value of AD and ACP. Key informant interviews were conducted, audiorecorded, transcribed, and analyzed using thematic analysis and constant comparative analysis. Twenty-five adults with serious physical disabilities were interviewed. Five organizing themes emerged as follows: (A) AD is a right versus responsibility, (B) past medical experiences influence ACP engagement, (C) ACP requires relationship-centered decision support, (D) concerns for care after death, and (E) suggestions for improving ACP experiences. Participants wished to engage in a relationship-centered approach to ACP, yet voiced hesitation due to experiences of significant medical bias and mistreatment, typically surrounding judgments of their quality of life. Better health professional training in ACP and heightened awareness of the unique ACP considerations pertaining to people with disabilities are recommended.

Personality traits, gender roles and sexual behaviours of young adult males.

BackgroundPrevious studies have shown that personality characteristics affect sexual functioning. The aim of this exploratory study was to assess and describe the relationship between global personality traits and the stereotypical femininity and masculinity levels with the broad aspects of sexual behaviours and attitudes in the group of 97 heterosexual young adult men aged 19–39 and living in Poland.MethodsThe ‘Big Five’ personality traits were measured with the NEO-FFI questionnaire; stereotypical femininity and masculinity with the Bem sex role inventory (BSRI); sexual disorders with the International index of erectile function (IIEF); socio-epidemiological data, sexual behaviours and attitudes towards sexuality with a self-constructed questionnaire.ResultsWe identified weak to moderate associations with particular sexual behaviours and attitudes. Neuroticism correlated positively with lower sexual satisfaction, self-acceptance and more negative attitudes towards sexuality; extraversion with higher desire, frequency of sexual intercourses, their diversity, sexual satisfaction, masculinity level and lower report of erectile problems; openness to experience with better quality of partnership, more positive attitudes towards sexual activity and masculinity level; conscientiousness with later sexual initiation age, more frequent and diverse sexual behaviours (but lower interest in masturbation and coitus interruptus), overall sexual satisfaction, satisfaction with one’s body and femininity level; agreeableness with a better quality of relationship with a partner, satisfaction from body, lower number of previous partners and more frequent sexual encounters (but less masturbation). Stereotypical masculinity, more so than femininity, was related to a wide range of positive aspects of sexuality.ConclusionsThe Big Five personality traits and stereotypical femininity/masculinity dimensions were found to have a noticeable, but weak to moderate influence on sexual behaviour in young adult males.

Missing the mark: ongoing missed opportunities for HIV diagnosis at an urban medical center despite universal screening recommendations.

Despite established recommendations from the Centers for Disease Control (CDC) to scale up testing efforts in the USA, this study shows full scale implementation of these recommendations may still be lacking. We hypothesize that patients experience ongoing missed opportunities for earlier diagnosis of HIV, despite frequent encounters to Montefiore Medical Center (MMC), an integrated hospital system in the Bronx, NY. Retrospective chart review via electronic medical records of patients newly diagnosed with HIV in 2012 and 2013 at varied MMC clinical sites. Missed opportunities were defined as > 1 prior health care encounter at MMC within three calendar years of diagnosis, in which HIV testing was not offered for those who had a prior negative test or no prior test. There were 218 patients newly diagnosed with HIV at MMC during the study period; 31% presented with a CD4 <200 cells/mm3; 22% were asymptomatic at diagnosis. Patients (56%) without a prior HIV test had an average 4.72 clinical encounters at MMC within the 3 years prior to their HIV diagnosis. Over 95% of visits prior to diagnosis occurred in emergency departments (EDs) or primary care outpatient department (OPDs) and accounted for the vast majority of missed opportunities. HIV infected patients continue to present late to care, with low CD4 and commonly utilize OPDs and EDs, where missed opportunities for earlier diagnosis are common. Practices that address augmentation of current HIV testing strategies are needed, especially in outpatient and first-contact acute care settings.

Resource predictability and specialization in avian malaria parasites.

We tested the hypothesis that avian haemosporidian (malaria) parasites specialize on hosts that can be characterized as predictable resources at a site in Amazonian Ecuador. We incorporated host phylogenetic relationship and relative abundance in assessing parasite specialization, and we examined associations between parasite specialization and three host characteristics - abundance, mass and longevity - using quantile regression, phylogenetic logistic regression and t-tests. Hosts of specialist malaria parasite lineages were on average more abundant than hosts of generalist parasite lineages, but the relationship between host abundance and parasite specialization was not consistent across analyses. We also found support for a positive association between parasite specialization and host longevity, but this also was not consistent across analyses. Nonetheless, our findings suggest that the predictability of a host resource may play a role in the evolution of specialization. However, we also discuss two alternative explanations to the resource predictability hypothesis for specialization: (i) that interspecific interactions among the parasites themselves might constrain some parasites to a specialist strategy, and (ii) that frequent encounters with multiple host species, mediated by blood-sucking insects, might promote generalization within this system.

Pragmatic Trials in Maintenance Dialysis: Perspectives from the Kidney Health Initiative.

Pragmatic clinical trials are conducted under the real-world conditions of clinical care delivery. As a result, these trials yield findings that are highly generalizable to the nonresearch setting, identify interventions that are readily translatable into clinical practice, and cost less than trials that require extensive research infrastructures. Maintenance dialysis is a setting especially well suited for pragmatic trials because of inherently frequent and predictable patient encounters, highly granular and uniform data collection, use of electronic data systems, and delivery of care by a small number of provider organizations to approximately 90% of patients nationally. Recognizing the potential for pragmatic trials to generate much needed evidence to guide the care of patients receiving maintenance dialysis, the Kidney Health Initiative assembled a group of individuals with relevant expertise from academia, industry, and government to provide the nephrology community with information about the design and conduct of such trials, with a specific focus on the dialysis setting. Here, we review this information, and where applicable, use experience from the ongoing Time to Reduce Mortality in End Stage Renal Disease Trial, a large cluster-randomized, pragmatic trial evaluating hemodialysis session duration, to illustrate challenges and solutions to operational, ethical, and regulatory issues.

Intensive glycemic control and the risk of end-stage renal disease: an ADVANCE in the management of diabetes?

Posttrial follow-up of participants randomized to intensive versus standard glycemic control in the ADVANCE trial has demonstrated a significant benefit of intensive glycemic control on the risk of end-stage renal disease. In a more detailed analysis, intensive glycemic control appears to be of benefit only before the development of clinically evident kidney disease or in patients with documented early-stage chronic kidney disease.

A framework for transitioning patients from pediatric to adult health settings for patients with neurogenic bladder

Adolescents with neurogenic bladder are a vulnerable population that severely lacks consistent transitional care from pediatric to adult urology settings. Our practice determined that 100 patients with spina bifida and other neurogenic bladder conditions were not appropriately transferred to the adult setting once reaching adulthood. We initiated a transitional program to establish a dedicated and formal process for adolescent patients to transition to adult urology. The REACH clinic implements a formalized staging framework to facilitate migration of adolescents and young adults to the adult health setting. A social worker was incorporated to act as a patient advocate, behavioral health consultant, and resource specialist. To date 45 patients have been enrolled in the transition program. We have identified and categorized according to the appropriate stage. The REACH clinic has appropriately outlined the goals and mission of the program and resources utilized are financially practical and feasible by conducting a monthly combined clinic. The program has been instrumental in improving tracking and monitoring of these patients through their transition period. Through the efforts of the pediatric and adult urology teams, the REACH program is a dedicated framework that provides structure for transition of the adolescent patient. The addition of a social worker has resulted in enriched rapport and will likely result in improved compliance. This program allows for surveillance and evaluation of patient outcome indicators in this patient population. We believe that early introduction and frequent encounters with the adult urologic team is crucial to successful transitions. Neurourol. Urodynam. 36:973-978, 2017. © 2016 Wiley Periodicals, Inc.

Fast and reliable symplectic integration for planetary systemN-body problems

We apply one of the exactly symplectic integrators, that we call HB15, of \cite{HB15}, along with the Kepler problem solver of \cite{WH15}, to solve planetary system $N$-body problems. We compare the method to Wisdom-Holman methods (WH) in the \texttt{MERCURY} software package, the \texttt{MERCURY} switching integrator, and others and find HB15 to be the most efficient method or tied for the most efficient method in many cases. Unlike WH, HB15 solved $N$-body problems exhibiting close encounters with small, acceptable error, although frequent encounters slowed the code. Switching maps like \texttt{MERCURY} change between two methods and are not exactly symplectic. We carry out careful tests on their properties and suggest they must be used with caution. We then use different integrators to solve a 3-body problem consisting of a binary planet orbiting a star. For all tested tolerances and time steps, \texttt{MERCURY} unbinds the binary after 0 to 25 years. However, in the solutions of HB15, a time-symmetric Hermite code, and a symplectic Yoshida method, the binary remains bound for $>1000$ years. The methods' solutions are qualitatively different, despite small errors in the first integrals in most cases. Several checks suggest the qualitative binary behavior of HB15's solution is correct. The Bulirsch-Stoer and Radau methods in the \texttt{MERCURY} package also unbind the binary before a time of 50 years, suggesting this dynamical error is due to a \texttt{MERCURY} bug.

Antarctic skuas recognize individual humans.

Recent findings report that wild animals can recognize individual humans. To explain how the animals distinguish humans, two hypotheses are proposed. The high cognitive abilities hypothesis implies that pre-existing high intelligence enabled animals to acquire such abilities. The pre-exposure to stimuli hypothesis suggests that frequent encounters with humans promote the acquisition of discriminatory abilities in these species. Here, we examine individual human recognition abilities in a wild Antarctic species, the brown skua (Stercorarius antarcticus), which lives away from typical human settlements and was only recently exposed to humans due to activities at Antarctic stations. We found that, as nest visits were repeated, the skua parents responded at further distances and were more likely to attack the nest intruder. Also, we demonstrated that seven out of seven breeding pairs of skuas selectively responded to a human nest intruder with aggression and ignored a neutral human who had not previously approached the nest. The results indicate that Antarctic skuas, a species that typically inhabited in human-free areas, are able to recognize individual humans who disturbed their nests. Our findings generally support the high cognitive abilities hypothesis, but this ability can be acquired during a relatively short period in the life of an individual as a result of interactions between individual birds and humans.

Skip the dishes? Not so fast! Sex and housework revisited.

Using data from 1,338 couples who remained partnered over the first 5 waves of the German Panel Analysis of Intimate Relationships and Family Dynamics (pairfam) project, this study investigated longitudinal associations between male partner contributions to housework and couple sexual satisfaction and frequency. The effect of 2 housework variables was examined: male partners' share of housework and perceived fairness of male partners' housework contributions. Results from a series of autoregressive cross-lagged models revealed no direct or indirect longitudinal associations between male partner share of housework and sexual frequency or satisfaction. Rather, when male partners reported making a fair contribution to housework, the couple experienced more frequent sexual encounters, and each partner reported higher sexual satisfaction 1 year later. This study provides a robust counterpoint to recent findings suggesting that men's participation in housework is harmful to a couple's sex life.

Authenticating Family

Authenticating family is a process of becoming a lesbian stepfamily, working to affirm strong and healthy family relationships, and learning to accept nothing less than acknowledgment and inclusion as legitimate. Authenticating family demonstrates that the internal function of becoming a stepfamily is not dissimilar to that of heterosexual stepfamilies. Frequent encounters that are heterosexist underscore the challenges faced by lesbian stepfamilies. The new stepfamily faces obstacles that contest the sense of legitimacy for all family members. These families learn from multiple interactions among themselves and with outsiders how to negotiate a new understanding of family. The conditions that impact the process are age of the children, support, and heterosexism. The lesbian stepfamily develops the ability to demonstrate pride to a society that has marginalized in the past, even as society is evolving in acceptance. There are three stages in authenticating family: accepting the challenge, building the bonds, and thriving.

Temporal Patterns and Predictors of Rate vs Rhythm Control in Patients Attending a Multidisciplinary Atrial Fibrillation Clinic

BackgroundContemporary trends in the selection of and persistence with rate vs rhythm control for atrial fibrillation (AF) are not well studied, particularly in the context of multidisciplinary AF clinics. MethodsThe initial arrhythmia management strategy in 1031 consecutive patients attending a multidisciplinary AF clinic from 2005-2012 was analyzed. ResultsThe 397 (38.5%) patients initially treated with rhythm control were younger (57.4 ± 14 years vs 65.6 ± 13 years; P < 0.0001) and more likely to be men (64.5% vs 56.9%; P = 0.019). They also had fewer comorbidities, lower CHADS2 (Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack) scores, and greater symptom burden. The proportion treated with rhythm control declined from 46.9% in 2005-2006 to 28.4% in 2012 (P for trend < 0.0001). Compared with those initially selecting rate control, patients treated with rhythm control required more frequent clinic encounters (7 [interquartile range {IQR}, 3-12] vs 3 [IQR, 2-7]; P < 0.001) and longer follow-up (266 days [IQR, 84-548 days] vs 99 days [IQR, 0-313 days]; P < 0.001). Younger age, absence of diabetes and sleep apnea, earlier treatment year, higher symptom burden, and rural residence were independently associated with rhythm control. Persistence with the initial treatment strategy was reduced in the rhythm-control group (P = 0.003). ConclusionsUse of rhythm control as the initial arrhythmia management strategy for AF in a specialty AF clinic is declining. Rhythm control requires more intensive follow-up and was more likely to lead to a change in arrhythmia management strategy.