General Health Care Providers Research Articles

Online Ambulance Booking System

Abstract: The Online Ambulance Booking Service is a vital healthcare innovation designed to address the critical need for efficient and timely emergency medical transportation. In the modern world, access to medical care is of utmost importance, and this service aims to bridge the gap between patients and emergency medical services. This abstract provides an overview of the key features and functionalities of the system. The Online Ambulance Booking Service leverages technology to create a userfriendly platform that enables individuals to request ambulance services with ease. Users can access the service through a web application or mobile app, making it accessible to a wide range of people. The Online Ambulance Booking Service is a solution that enhances emergency medical response, saving valuable time in critical situations. It fosters a sense of security and reliability in healthcare services, benefiting both the general public and healthcare providers. This abstract highlight the importance of such a service in the healthcare industry, emphasizing its role in improving patient outcomes and reducing response times during emergencies.

Understanding the Burden of Nonalcoholic Fatty Liver Disease: Time for Action.

The prevalence of nonalcoholic fatty liver disease (NAFLD) in the United States is 38%, having increased by 50% within the past 3 decades. The estimated NAFLD prevalence among people with type 2 diabetes is 55-70%. The presence of type 2 diabetes is associated with a higher likelihood of progression of NAFLD to fibrosis development, liver transplant, and death. Cardiovascular disease is the main cause of mortality among people with NAFLD, and the risk of death is significantly higher in people with both NAFLD and type 2 diabetes. NAFLD carries high patient and economic burdens but low awareness among both the general public and health care providers. This article reviews the epidemiology of NAFLD and discusses the need for appropriate risk stratification, referral for specialty care, management of cardiometabolic risk factors, and treatment of the disease. The authors present a call to action to raise awareness of NAFLD and address its increasing burden in a systematic and efficient manner.

Innovative insight: ChatGPT's contribution to advanced health research articles

The current technological advancement follows a pattern of both disruptive and gradual changes. The field of communication is currently the most extensively utilized technology. The rapid development of AI has enabled those without a background in computer coding or specialized health knowledge to utilize this technology, which gives rise to numerous issues. This phenomenon elicits curiosity and engenders debate among the general public, scholars, healthcare providers, and researchers in the health industry. Utilizing AI in the composition of scientific publications necessitates explicit norms and regulations, a robust validation procedure, and effective collaboration between AI systems and human expertise. Ensuring transparency and acknowledgment of AI usage is crucial to maintaining human researchers' accountability for the ultimate outcomes of their research.

Collaboration of health and education sectors drives equity for children with complex disabilities in China.

Medical professionals often find it challenging to assess children having both complex disabilities and visual impairment, which may lead to excluding such children from educational programs and limiting their full participation in family and community activities. Identification and assessment of these children are essential to close this exclusion gap. A five-year project in Shanxi province, China, provided comprehensive training to eye health providers and educators as they learned to assess, identify, refer and serve children with visual impairments, both with and without complex disabilities. A team of teachers, vision and general healthcare providers worked to assess the vision of these children at schools, residential settings, and in homes throughout Shanxi. The project led to deep collaboration between Shanxi's health and education sectors, and established replicable precedents for policy and system changes toward the inclusion of children with complex disabilities and visual impairment.

Potential effectiveness and efficiency issues in usability evaluation within digital health: A systematic literature review

Context:Digital Health (DH) is widely considered essential for sustainable future healthcare systems. Software quality, particularly usability, is crucial for the success and adoption of most DH products. However, concerns about the effectiveness and efficiency of usability evaluation of DH products have been raised. Objective:This article aims to analyse the prevalence and application contexts of usability evaluation methods in DH and to highlight potential issues related to their effectiveness and efficiency. Method:A systematic literature review of usability evaluation studies, published by (academic) practitioners between 2016 and April 2023, was conducted. 610 primary articles were identified and analysed, utilising five major scientific databases. Results:Our findings show a preference for inquiry (85%) and testing (63%) methods, with inspection used less frequently (17%). The published studies employed methods like questionnaires (75%); notably the SUS (49%), semi-structured interviews (25%), and heuristic evaluations (73%), with percentages based on their group. Data collection mainly involved the use of participant feedback (45%), audio/video recordings (44%), and system logs (20%), with both qualitative and quantitative data analyses prevalent in studies. However, several usability characteristics such as accessibility, memorability, and operability were found to be largely overlooked, and automation tools or platforms were not widely used. Among the systems evaluated were mHealth applications (70%), telehealth platforms (36%), health information technology (HIT) solutions (29%), personalized medicine (Per. Med.) (17%), wearable devices (12%), and digital therapeutics (DTx) interventions (6%), with the participation of general users, patients, healthcare providers, and informal caregivers varying based on the health condition studied. Furthermore, insights and experiences gathered from 24 articles underscored the importance of a mixed-method approach in usability evaluations, the limitations of traditional methods, the necessity for sector-specific customisation, and the potential benefits of remote usability studies. Moreover, while eye-tracking emerged as a promising evaluation technique, careful execution and interpretation are crucial to avoid data misinterpretation. Conclusion:The study’s findings showed that employing a combination of inquiry and testing-based methods is prevalent for evaluating DH platforms. Despite an array of DH systems, method distribution remained consistent across platforms and targeted user groups. The study also underlines the importance of involving target user groups in the process. Potentially affected cognitive abilities of participants and potential user groups of interest have to be taken into account when choosing evaluation methods, and methods might therefore need to be tailored. Complementary inspection methods might be particularly useful when recruiting representative participants is difficult. Several potential paths for future research are outlined, such as exploring novel technologies like artificial intelligence, for improved automation tool support in the usability evaluation process.

SAT365 Prevalence of Polycystic Ovary Syndrome (PCOS) in Health System and Insurer Records vs. the Prevalence in the Population: Evidence for the Significant Underdiagnosis and Undertreatment of PCOS

Abstract Disclosure: S. Hatoum: None. M. Amiri: None. D. Hopkins: None. R.P. Buyalos: Employee; Self; Fertility & Surgical Associates of California. F. Bril: None. R. Azziz: Advisory Board Member; Self; Arora Forge. Consulting Fee; Self; Rani Therapeutics, Fortress Biotech, Spruce Biosciences, Core Access Surgical Technologies. Grant Recipient; Self; Foundation for Research and Education Excellence, Ferring Pharmaceuticals. Stock Owner; Self; Martin Imaging. Background: Polycystic Ovary Syndrome (PCOS) is a common disease, a complex genetic trait, and the most common endocrine disorder of women, clinically evident in 5-15% of all reproductive-aged women globally. PCOS is associated with reproductive, cardio-metabolic, dermatologic, and mental-health morbidities, with an estimated healthcare-associated economic burden exceeding $15 billion yearly for the USA alone. Despite its high prevalence and broad range of associated morbidities, women with PCOS often have difficulty finding appropriate health care and the disorder is frequently underdiagnosed and/or undertreated.Objective: We aimed to determine the extent of underdiagnosis/undertreatment of PCOS, by comparing the prevalence of PCOS reported in health system and insurer records (HSIR) with the populational prevalence of PCOS.Materials and methods: We performed a systematic review of PubMed and Embase through December 2022 to identify studies on PCOS prevalence in an unselected population. Results: Of 6201 studies retrieved from databases and other sources, 6 studies reported the prevalence of PCOS in HSIR and two studies reported the prevalence of PCOS in the population. HSIR data included records from the Thomson Reuters MarketScan Commercial databases, the Department of Defense Military Health Systems DataMart, Louisiana Medicaid, the Kaiser Permanente Southern California Children’s Health Study, and Kaiser Permanente Northern California. In the USA, the prevalence of diagnosed PCOS in HSIR ranged from 0.2% to 2.2%. In contrast, the prevalence of PCOS in the general unselected population ranged from 4.0% to 6.6% using the NIH 1990 criteria. Overall, the prevalence of PCOS in HSIR is 2 to 33-times less than the prevalence of PCOS in the U.S. population. Conclusion: The prevalence of PCOS in health system and insurer records is 2 to 33-times less than the prevalence of PCOS in the population; highlighting the significant underdiagnosis and/or undertreatment of PCOS patients in the U.S. The underlying causes for the paucity of PCOS in these records are currently unknown but may reflect a reluctance of patients to seek medical care, a lack of understanding of affected women regarding the significant morbidity of the disorder, and/or a lack of clinical awareness among healthcare providers. Either way, these data strongly suggest the need for enhanced education of the general population and healthcare providers regarding this highly prevalent and morbid disorder. Presentation Date: Saturday, June 17, 2023

Extraction of a metallic susceptor after accidental ingestion of the heated tobaccostick TEREA™: a case report

BackgroundTobacco ingestion is widely known to cause nicotine toxicity, which may result in severe symptoms. Two heated tobacco sticks, called TEREA™ and SENTIA™, were launched in 2021 by Philip Morris International (New York, NY, USA), and their ingestion is associated with a risk of bowel injury because they contain a partially pointed metallic susceptor. However, this risk is not well known to the general public or healthcare providers. To increase awareness of this risk, we herein report a case involving extraction of a metallic susceptor after ingestion of the heated tobacco stick TEREA™.Case presentationA 7-month-old girl presented to the emergency department of a nearby hospital because she was suspected to have accidentally swallowed heated tobacco. Although she presented with no symptoms related to nicotine poisoning, abdominal X-ray examination revealed a metal object in her stomach. According to a statement released by the Japan Poison Information Center, the TEREA™ heated tobacco stick contains a metallic susceptor with a rectangular shape and sharp corners. The patient was transferred to our department because of the risk of bowel injury, and upper gastrointestinal endoscopy was performed. No cigarettes were found by endoscopic observation; however, a metallic susceptor was located in the second part of the duodenum. We grasped it with biopsy forceps and carefully removed it using an endoscope with a cap attached to the tip. The post-endoscopic course was uneventful.ConclusionsSome patients who ingest heated tobacco sticks might be exposed not only to the effects of nicotine but also to physical damage caused by a metallic susceptor. Infants and toddlers especially could swallow these sticks, therefore tobacco companies need to make the problem more public. Clinicians also should alert the problem, and pay attention to this risk in the clinical setting.

Reasons for non-disclosure of HIV-Positive status to healthcare providers: a mixed methods study in Mozambique

BackgroundNon-disclosure of known HIV status by people living with HIV but undergoing HIV testing leads to waste of HIV testing resources and distortion of estimates of HIV indicators. In Mozambique, an estimated one-third of persons who tested positive already knew their HIV-positive status. To our knowledge, this study is the first to assess the factors that prevent people living with HIV (PLHIV) from disclosing their HIV-positive status to healthcare providers during a provider-initiated counseling and testing (PICT) campaign.MethodsThis analysis was nested in a larger PICT cross-sectional study performed in the Manhiça District, Southern Mozambique from January to July 2019, in which healthcare providers actively asked patients about their HIV-status. Patients who tested positive for HIV were crosschecked with the hospital database to identify those who had previously tested positive and were currently or previously enrolled in care. PLHIV who did not disclose their HIV-positive status were invited to participate and provide consent, and were interviewed using a questionnaire designed to explore barriers, patterns of community/family disclosure, and stigma and discrimination.ResultsWe found that 16.1% of participants who tested positive during a PICT session already knew their HIV-positive status but did not disclose it to the healthcare provider. All the participants reported previous mistreatment by general healthcare providers as a reason for nondisclosure during PICT. Other reasons included the desire to know if they were cured (33.3%) or to re-engage in care (23.5%). Among respondents, 83.9% reported having disclosed their HIV-status within their close community, 48.1% reported being victims of verbal or physical discrimination following their HIV diagnosis, and 46.7% reported that their HIV status affected their daily activities.ConclusionPrevious mistreatment by healthcare workers was the main barrier to disclosing HIV-positive status. The high proportion of those disclosing their HIV status to their community but not to healthcare providers suggests that challenges with patient-provider relationships affect this care behavior rather than social stigma and discrimination. Improving patient-provider relationships could increase trust in healthcare providers, reduce non-disclosures, and help optimize resources and provide accurate estimates of the UNAIDS first 95 goal.

Gender-specific association of loneliness and health care use in community-dwelling older adults

BackgroundLoneliness in older adults is common, particularly in women. In this article, gender differences in the association of loneliness and health care use are investigated in a large sample of community-dwelling older adults.MethodsData of 2525 persons (ages 55–85 years)—participants of the fourth follow- up (2011–2014) of the ESTHER study- were analyzed. Loneliness and health care use were assessed by study doctors in the course of a home visit. Gender-specific regression models with Gamma-distribution were performed using loneliness as independent variable to predict outpatient health care use, adjusted for demographic variables.ResultsIn older women, lonely persons were shown to have significantly more visits to general practitioners and mental health care providers in a three-month period compared to less lonely persons (p = .005). The survey found that outpatient health care use was positively associated with loneliness, multimorbidity, and mental illness in older women but not in older men. Older men had significantly more contact with inpatient care in comparison to women (p = .02).ConclusionsIt is important to consider gender when analyzing inpatient and outpatient health care use in older persons. In older women loneliness is associated with increased use of outpatient services.

Bilateral Steroid Induced Glaucoma In A 10-year-old Boy

Introduction: Topical steroids are used in the treatment of various ocular disorders. However, it can cause numerous side effects. Steroid-induced glaucoma is the most severe complication of the unmonitored use of steroids. It is diagnosed by visual field defects, increased intraocular pressure (IOP), and glaucomatous optic neuropathy (GON) due to prolonged usage of steroids. Case Presentation: a 10-year-old boy presented to the outpatient clinic in Undaan Eye Hospital complaining of headache, re dness and itchiness in both eyes. He started using dexamethasone 0.1% eye drops without a physician's supervision for the last 2 years. Steroid-induced glaucoma was diagnosed in both eyes. Topical and oral glaucoma medications were given. Both eyes IOP were still elevated in the following months. Trabeculectomy in both eyes was performed due to medically uncontrolled glaucoma. Furthermore, both eyes IOP were getting normal without any topical and oral glaucoma medications. Conclusion: Unmonitored steroid usage must be avoided. This case suggests general practitioners and health care providers in the front line be aware of the usage of topical steroids. By increasing awareness concerning steroid-induced glaucoma, a patient's visual acuity can be saved, and irreversible blindness can be prevented, especially in children.

(049) Project SEXUS – Baseline Findings from a Nationwide Cohort Study on Sexual Behavior and Health in Denmark

Abstract Introduction Project SEXUS (www.projectsexus.dk) is a nationwide cohort study on sexual behavior and health in Denmark that was initiated in 2017 by two state research institutions. The aim of this presentation is to introduce the methodology of the study and to present key findings from its baseline data collection. Objective The objectives of the Project SEXUS study were 1) to provide a thorough insight into the sexual landscapes of the general Danish population, 2) to shed light on the sexual health of understudied groups such as elderly people, chronically ill individuals and LGBT+ persons and 3) to investigate the interplay between sex lives, lifestyles and general health. Methods The cohort was created using a probability-based sampling frame, and the questionnaire comprised more than 600 items, including brief versions of validated measurement instruments such as the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI). Due to strategic filter questions, the median number of items addressed by respondents was 180. Between September 2017 and August 2018, 187,084 Danes aged 15-89 years were invited to participate in the study by filling out an online questionnaire. 64,706 individuals gave complete or almost-complete responses (AAPOR response rate 1: 34.6%). Individual weighting procedures ensured exact national representativeness regarding sex, birth year, region of residence, marital status, cultural background and twin status, and logistic regression analyses provided age-adjusted odds ratios as measures of relative risk at baseline. Results Based on complete and validated questionnaire data from 62,675 participants, key findings concerning sexual orientation, needs, experiences, satisfaction and current behaviors will be presented, and various dimensions of sexual health in the Danish population will be discussed. Moreover, topics such as relationship satisfaction, pornography consumption, risky sexual behavior, body contentment and childhood gender non-conformity will be addressed. Further, noteworthy associations between general and sexual lifestyles and health will be emphasized, and main findings regarding general and sexual wellbeing in strata of different sexual and gender identities will be shown. Conclusions The presented baseline findings from Project SEXUS provide a detailed account of the sex life situation in contemporary Denmark. Due to its huge size, national representativeness and ability to follow individual cohort members over time through identity-secure linkage with information in national health registers, the study offers internationally unique opportunities for detailed prospective assessments of the complex interplay between sex life, lifestyles and health. This is of obvious relevance to sexologists, sexual health promoters and general health-care providers around the world. Disclosure No

The Good, the Bad and the Ugly: Spinal Posture

osture is defined as the position or physical attitude of the body, which serves to maintain stability [1]. ‘Sit Up Straight’, ‘Correct your posture’, and ‘Be aware of bad posture’ are commonly used commands by the general public, teachers and health care providers such as physiotherapists. These short commands reflect some persistent stereotypical beliefs that bad postures relate to spinal pain [2-4].

Characteristics and related factors of family functioning in Chinese families during early pregnancy.

Family functioning has been found to significantly impact each family member's health mentally, physically, and socially. A number of the research has focused on the impact of impaired family functioning in general, but limited studies explore family functioning in the vulnerable period, early pregnancy. Therefore, the study aimed to investigate the characteristics and related factors in Chinese females and partners during early pregnancy. The cross-sectional study enrolled 226 pregnant women and 166 partners. Assessment tools included the McMaster Family Assessment Device (FAD), Edinburgh Postnatal Depression Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, Social Support Rating Scale, and Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form. Correlation analysis was applied to investigate the related factors. In the present study, FAD-Behavior Control (BC) was the only dysfunctional dimension and had the highest dysfunctional rates than other dimensions. Length of time living with a partner, depressive and anxious symptoms, and quality of life were all associated with the dysfunctional family functioning of BC. The study reinforced the important clues of family functioning during early pregnancy. Also, it provided new entry points for the general population and healthcare providers to minimize the negative impact that impaired family function might bring to a family.

Awareness and attitude toward contact lens complications in the Eastern Region of Saudi Arabia

Objectives: This study aimed to investigate the awareness and attitude toward contact lens (CL) complications among the general public in AlAhssa, AlKhobar, AlDammam, AlQatif, and AlJubail regions of Saudi Arabia and guide prevention efforts against CL complications. Methods: This was a cross-sectional survey study design conducted among the adult population of the Eastern Region of Saudi Arabia (AlAhssa, AlDammam, AlKhobar, AlQatif, and Al-Jubail). A pre-determined electronic questionnaire was modified and carried out after gaining authorization from the questionnaire developer. The questionnaire consisted of sociodemographic data and some questions about awareness and attitude toward CL and its side effects (SE). The questionnaire survey was sent to both the general population and healthcare providers. Results: The mean awareness score toward CLSE was 8.39 ± 1.66 out of 12, with 51.4% of participants having poor awareness of CLSE. Regarding attitude, the mean score was 1.99 ± 1.04 out of 5, of whom 59.8% of participants had a negative attitude. The most commonly known CLSE was red-eye and itching. Being a female and being professionals were the significant independent predictors of having better awareness. Simultaneously, males and less educated participants were the factors associated with a negative attitude toward CLSE. Conclusion: There was moderate awareness toward CLSE among the general population in the Southern Region of Saudi Arabia with inadequate attitude levels. Educated female participants had better awareness and attitude toward CLSE, whereas less-educated males had a negative attitude regarding CL complications.

Differential diagnosis of bone marrow failure syndromes guided by machine learning

AbstractThe choice to postpone treatment while awaiting genetic testing can result in significant delay in definitive therapies in patients with severe pancytopenia. Conversely, the misdiagnosis of inherited bone marrow failure (BMF) can expose patients to ineffectual and expensive therapies, toxic transplant conditioning regimens, and inappropriate use of an affected family member as a stem cell donor. To predict the likelihood of patients having acquired or inherited BMF, we developed a 2-step data-driven machine-learning model using 25 clinical and laboratory variables typically recorded at the initial clinical encounter. For model development, patients were labeled as having acquired or inherited BMF depending on their genomic data. Data sets were unbiasedly clustered, and an ensemble model was trained with cases from the largest cluster of a training cohort (n = 359) and validated with an independent cohort (n = 127). Cluster A, the largest group, was mostly immune or inherited aplastic anemia, whereas cluster B comprised underrepresented BMF phenotypes and was not included in the next step of data modeling because of a small sample size. The ensemble cluster A–specific model was accurate (89%) to predict BMF etiology, correctly predicting inherited and likely immune BMF in 79% and 92% of cases, respectively. Our model represents a practical guide for BMF diagnosis and highlights the importance of clinical and laboratory variables in the initial evaluation, particularly telomere length. Our tool can be potentially used by general hematologists and health care providers not specialized in BMF, and in under-resourced centers, to prioritize patients for genetic testing or for expeditious treatment.

Mental health status of healthcare providers during the Covid-19 pandemic: A cross-sectional study across India.

Background From the beginning of the Covid-19 pandemic, studies have observed an increased prevalence of psychological symptoms in the general population and healthcare providers. We studied the prevalence of psychological symptoms among the latter. Methods We did this study using a self-administered questionnaire among healthcare providers across India who were involved in caring/treating patients. The questionnaire collected information on demographics, Depression, Anxiety and Stress Scales (DASS-21) and semi-structured questions related to the Covid-19 pandemic. Results A total of 612 healthcare providers participated in the study; 254 were doctors of various specialties and 358 were nursing care-providers. According to the DASS-21 assessment, the prevalence of depression was 12.4%, anxiety was 19.1% and stress was 10.8%. The prevalence of psychological problems was more among nursing staff compared to doctors (depression risk ratio [RR] 2.4, anxiety RR 1.73 and stress RR 2.93) and they were equal among both genders (depression RR 1.05, anxiety RR 1.06 and stress RR 1.21). Conclusions Our study shows that there is a higher prevalence of depression, anxiety and stress among healthcare providers, particularly among nursing care-providers. We suggest psychological interventions to nursing care-providers and also those who are vulnerable among doctors, to improve their mental health status.

Shortening the Time Interval for the Referral of Patients With Soft Tissue Sarcoma to Expert Centers Using Mobile Health: Retrospective Study.

According to guidelines, all patients with sarcoma must be managed from initial diagnosis at expert sarcoma centers. However, in everyday practice, the time interval to an expert center visit can be long, which delays presentation to an expert multidisciplinary tumor board and increases the risk of inappropriate management, negatively affecting local tumor control and prognosis. The advent of mobile health offers an easy way to facilitate communication and cooperation between general health care providers (eg, general practitioners and radiologists) and sarcomas experts. We developed a mobile app (Sar'Connect) based on the algorithm designed by radiologists from the French Sarcoma Group. Through a small number of easy-to-answer questions, Sar'Connect provides personalized advice for the management of patients and contact information for the closest expert center. This retrospective study is the first to assess this mobile app's potential benefits in reducing the time interval for patient referral to an expert center according to the initial clinical characteristics of the soft tissue tumor. From May to December 2021, we extracted tumor mass data for 78 patients discussed by the multidisciplinary tumor boards at 3 centers of the French Sarcoma Group. We applied the Sar'Connect algorithm to these data and estimated the time interval between the first medical description of the soft tissue mass and the referral to expert center. We then compared this estimated time interval with the observed time interval. We found that the use of Sar'Connect could potentially shorten the time interval to an expert center by approximately 7.5 months (P<.001). Moreover, for half (31/60, 52%) of the patients with a malignant soft tissue tumor, Sar'Connect could have avoided inappropriate management outside of the reference center. We did not identify a significant determinant for shortening the time interval for referral. Overall, promoting the use of a simple mobile app is an innovative and straightforward means to potentially accelerate both the referral and management of patients with soft tissue sarcoma at expert centers.

Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial

Peptic ulcers in patients receiving aspirin are associated with Helicobacter pylori infection. We aimed to investigate whether H pylori eradication would protect against aspirin-associated ulcer bleeding. We conducted a randomised, double-blind, placebo-controlled trial (Helicobacter Eradication Aspirin Trial [HEAT]) at 1208 primary care centres in the UK, using routinely collected clinical data. Eligible patients were aged 60 years or older who were receiving aspirin at a daily dose of 325 mg or less (with four or more 28-day prescriptions in the past year) and had a positive C13 urea breath test for H pylori at screening. Patients receiving ulcerogenic or gastroprotective medication were excluded. Participants were randomly assigned (1:1) to receive either a combination of oral clarithromycin 500 mg, metronidazole 400 mg, and lansoprazole 30 mg (active eradication), or oral placebo (control), twice daily for 1 week. Participants, their general practitioners and health-care providers, and the research nurses, trial team, adjudication committee, and analysis team were all masked to group allocation throughout the trial. Follow-up was by scrutiny of electronic data in primary and secondary care. The primary outcome was time to hospitalisation or death due to definite or probable peptic ulcer bleeding, and was analysed by Cox proportional hazards methods in the intention-to-treat population. This trial is registered with EudraCT, 2011-003425-96. Between Sept 14, 2012, and Nov 22, 2017, 30 166 patients had breath testing for H pylori, 5367 had a positive result, and 5352 were randomly assigned to receive active eradication (n=2677) or placebo (n=2675) and were followed up for a median of 5·0 years (IQR 3·9-6·4). Analysis of the primary outcome showed a significant departure from proportional hazards assumptions (p=0·0068), requiring analysis over separate time periods. There was a significant reduction in incidence of the primary outcome in the active eradication group in the first 2·5 years of follow-up compared with the control group (six episodes adjudicated as definite or probable peptic ulcer bleeds, rate 0·92 [95% CI 0·41-2·04] per 1000 person-years vs 17 episodes, rate 2·61 [1·62-4·19] per 1000 person-years; hazard ratio [HR] 0·35 [95% CI 0·14-0·89]; p=0·028). This advantage remained significant after adjusting for the competing risk of death (p=0·028) but was lost with longer follow-up (HR 1·31 [95% CI 0·55-3·11] in the period after the first 2·5 years; p=0·54). Reports of adverse events were actively solicited; taste disturbance was the most common event (787 patients). H pylori eradication protects against aspirin-associated peptic ulcer bleeding, but this might not be sustained in the long term. National Institute for Health and Care Research Health Technology Assessment.

Knowledge, attitude, and practice related to COVID-19: A comparison between patients with mental illness and the general population in Qatar.

In 2020, the World Health Organization (WHO) declared COVID-19 a global health pandemic. The rapid spread and high fatalities associated with COVID-19 have increased interest in assessing Knowledge, Attitude, and Practice (KAP) toward this illness among the general population in comparison to specific subgroups. Most publications to date have explored KAP among the general public, healthcare providers, and people with chronic conditions, but not amongst those with mental illness. Yet, research has shown patients with mental illness are at higher risk of poor outcomes related to infectious diseases such as COVID-19. The objective of this study is to compare KAP toward COVID-19 between people with mental illness and the general public. This is a cross-sectional study, done over 3°months in 2020, to compare KAP during the COVID-19 pandemic in three groups: outpatients from outpatient Psychiatry clinics (N = 165), inpatients admitted to a Psychiatry ward (N = 100), and the general public (N = 345). KAP parameters were assessed through online surveys. The proportion of subjects in the public group (84.8%) giving the correct responses to most Knowledge questions was significantly higher than those in the inpatient and outpatient groups. Compared to the public and inpatient groups, subjects in the outpatient group (92.7%) were significantly more optimistic and confident that COVID-19 would be brought under control. A higher proportion of subjects from the general public (82.9%) indicated that they attended crowded places and were more compliant in wearing masks. Multiple linear regression analyses showed that poorer COVID-19 knowledge was associated with being single and having a young age (18-29), with both inpatients and outpatients and with primary-or secondary-level education. Patient populations, both inpatients and outpatients, had inadequate Knowledge, more positive attitudes and confidence regarding the outcome of COVID-19, and less safe practices than the public. This highlights the need for targeted approaches around COVID-19 and pandemics in general in this vulnerable population.

A SURVEY OF VIRGINITY TESTING IN THE UNITED STATES

The aim of the study was to determine the prevalence of virginity testing and evaluate the attitudes and effects of virginity testing in the United States, as reported by the general population and healthcare providers.