Health Care Providers Research Articles

Breaking Barriers: Addressing STI Healthcare Access Challenges among Rohingya Refugees in Bangladesh

Background: The Rohingya refugee crisis, stemming from Myanmar's Rakhine State, has led to a significant displacement of nearly a million Rohingya seeking refuge in Bangladesh's Cox's Bazar district. Among the myriad health challenges faced by this population, Sexually Transmitted Infections (STIs) present a pressing concern. The study aimed to explore the burden of STIs among Rohingya refugees in Cox's Bazar, Bangladesh, by examining the prevalence of STIs, associated risk factors and access to healthcare services. Materials and methods: A cross-sectional study was conducted from January to December 2023, involving 150 Rohingya refugees residing in refugee camps in Cox's Bazar. Data collection included demographic characteristics, STI symptoms, healthcare-seeking behavior, perceived barriers to healthcare access and access to transportation. Descriptive statistics, bivariate correlation analysis and logistic regression were employed for data analysis. Results: Preliminary findings revealed a high prevalence of STI symptoms among Rohingya refugees, with 20.0% experiencing genital ulcers, 33.3% reporting vaginal discharge and 26.7% suffering from painful urination. However, only 46.7% sought treatment from healthcare providers, with perceived barriers such as financial constraints (40.0%) and lack of awareness (26.7%) hindering access to healthcare. Conclusion: By shedding light on the complex interplay of demographic, socioeconomic and healthcare-related factors, this study contributes to a deeper understanding of the health challenges faced by displaced populations and underscores the importance of tailored healthcare strategies in humanitarian settings. IAHS Medical Journal Vol 7(1), June 2024; 32-34

Interventions employed to address vaccine hesitancy among Black populations outside of African and Caribbean countries: a scoping review.

Black people are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. This scoping review explored interventions that have been employed to address vaccine hesitancy among Black population outside of African and Caribbean countries. This review provides several strategies for addressing this deep-rooted public health problem. The scoping review followed the five-step framework outlined by Arksey and O'Malley. It complies with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Research studies that examined interventions utilized to promote vaccine confidence within Black populations living outside of African and Caribbean countries were reviewed. A total of 20 articles met the inclusion criteria for this study: 17 were quantitative studies and three were mixed-method studies. This scoping review highlighted six themes: educational advancement, messaging, multi-component approaches, outreach efforts, enhancing healthcare access, and healthcare provider leadership. The review identified effective interventions for addressing vaccine hesitancy among Black populations outside Africa and the Caribbean, emphasizing education, multidimensional approaches, and healthcare provider recommendations. It calls for more qualitative research and interventions in countries like Canada and the UK to enhance vaccine confidence and reduce mistrust.

Advances in wearable biotechnology for cardiac monitoring

Wearable biotechnology is enhancing cardiac health monitoring by enabling continuous data collection for early detection and better management of cardiovascular diseases (CVDs). Recent advancements, such as multi-sensor integration, combine electrocardiography (ECG), heart rate variability, blood pressure, and oxygen saturation monitoring to provide a comprehensive cardiovascular assessment and improve diagnostic precision. Innovations in energy-harvesting technologies, like thermoelectric and piezoelectric materials, extend battery life, reducing the need for frequent recharging and increasing patient adherence. Despite these advances, challenges remain, particularly concerning data security, which requires robust encryption methods and secure data transmission protocols. Regulatory frameworks like the GDPR and HIPAA need to evolve to accommodate technological progress, ensuring new devices are safe and quickly brought to market. Enhancing interoperability with electronic health records (EHRs) is crucial to maximizing the clinical utility of wearable devices. Future research should focus on developing biochemical sensors to detect specific biomarkers in bodily fluids, refining AI algorithms for personalized diagnostics, and establishing standards for data sharing and integration. Collaboration among healthcare providers, regulatory bodies, and technology developers is essential to overcoming current barriers, expanding clinical applications, and ultimately improving patient outcomes and public health.

Exploring Non-Communicable Disease Risks in Postmenopausal Rural Women of Bangladesh: A Cross-Sectional Study

Background: Non-Communicable Diseases (NCDs) pose a significant health challenge globally, particularly in countries underwent rapid demographic transitions like Bangladesh. Rural populations, including postmenopausal women, are disproportionately affected by NCDs due to various socio-economic and lifestyle factors. This study aimed to investigate the prevalence of NCD risk factors among postmenopausal women in a rural village. This cross-sectional study was conducted in a rural village of Gazipur, Bangladesh from November 2023 to February 2024. Materials and methods: A sample of 108 postmenopausal women was selected using a convenience sampling technique. Data on socio-demographic characteristics, lifestyle habits and health outcomes were collected through structured interviews and assessments. Chi-square tests were employed to analyze the associations between sociodemographic variables, lifestyle factors and the presence of NCDs. Results: The study revealed a high prevalence of NCD risk factors among postmenopausal rural women. Engaging in physical activity for 2-4 hours daily was significantly associated with both Diabetes Mellitus (p 0.04) and Hypertension (p 0.006). Similarly, occupation showed a significant association with Hypertension (p 0.012) with housewives exhibiting higher prevalence rates. However, there were no significant associations between salt intake, sweet consumption and the presence of NCDs. Conclusion: This study highlights the urgent need for targeted interventions to address NCD risk factors among postmenopausal rural women in Bangladesh. Strategies focusing on promoting physical activity and addressing occupational factors could help mitigate the burden of NCDs in this vulnerable population. By understanding the socio-demographic and lifestyle determinants of NCDs, policymakers and healthcare providers can develop effective public health interventions tailored to the needs of rural communities. IAHS Medical Journal Vol 7(1), June 2024; 35-39

Exploring practice staffs' perspectives regarding professional roles, confidence, and motivations in delivering mental health care within rural general practice: a qualitative exploration.

General practice is pivotal in delivering mental health care within communities, yet the attitudes and professional factors influencing this provision remain underexplored. This study seeks to understand the perspective of general practice staff around the professional factors that influence the provision of primary mental health care. A qualitative study was conducted with semi-structured interviews of 14 general practice staff involved in mental health care. Participants included receptionists (n = 3), nurses (n = 4), practice managers (n = 3), and general practitioners (n = 4), recruited via purposive sampling. The Theoretical Domains Framework (TDF) guided the interviews, and thematic analysis was used to identify themes and subthemes. Three themes were identified. The first, 'Role identity, skills, and leadership in mental health care,' included subthemes of distinct role recognition with overlap, essential relational and practical skills, and leadership valued among experienced GPs. The second theme, 'Confidence and involvement in mental health care,' covered variability in confidence levels, differing perceptions of involvement, and attitudes towards further involvement. The third theme, 'Drivers for and outcomes of delivering mental health care,' revealed intrinsic motivations and acknowledged both benefits and serious consequences. This study explored general practice staff beliefs about role identity, skills, leadership, confidence, involvement, motivations, and perceptions of benefits in mental health care provision. The findings offer valuable insights into the complexities of mental health care in general practice, with significant implications for practice management and healthcare policy development.

Barriers and enablers to shared decision-making in assessment and management of risk: A qualitative interview study with people using mental health services

The assessment and management of risk are fundamental to mental health care provision and are considered high-priority tasks by professionals worldwide. Clinical guidance recommends for risk to be identified and managed collaboratively with the individual, but studies indicate that this may not be happening in practice. The aim of this study was to identify the barriers and enablers to collaborative risk assessment and management based on shared decision-making from service users’ perspectives. A qualitative approach using semi‐structured interviews was employed. The Theoretical Domains Framework for behaviour change, which consists of fourteen theoretical domains that have been found to influence behaviour, informed data collection and analysis. Thirteen service users living with severe mental illness took part in an interview. The majority of participants reported not having been involved in the identification of their risk and most were unaware of the information included in their risk management plan. Perceived barriers to involvement were power dynamics between professionals and service users, difficulty talking about sensitive risk topics, and the emotional impact of engaging in these discussions. Perceived enabling factors for involvement included the possibility of gaining a better understanding of risk issues, and discussion about risk enhancing the individual’s ability to maintain their own well-being and safety. Most participants expressed a willingness to be involved in shared decision-making and believed that their friends and family would enable them to be involved. The findings of this study offer valuable insights for targeting behaviour change in future intervention design that seeks to increase shared decision-making in risk assessment and management with individuals with severe mental illness.

Epidemiology of International Patients with Lower-Limb Deficiencies Treated at a United States–Based Pediatric Prosthesis Clinic

ABSTRACT Introduction Limited epidemiological or clinical research exists describing pediatric lower-limb deficiency (LLD) patients born outside the United States (US). Objectives The purpose of this study was to characterize a cohort of international patients treated at a single tertiary care orthopedic hospital. We set out to quantify the prevalence of international patients within a broader cohort of pediatric limb deficiency patients. In addition, we evaluated similarities and differences between adopted and nonadopted internationally born patients as well as their US-born counterparts. Study Design Retrospective chart review was performed on patients born outside the US between 1995 and 2020. Methods Patients were divided into groups based on place of birth, country of residence, and adoption status. Statistical analysis was performed using χ2 and t-test. Results A total of 111/579 (19.2%) patients seen in our limb difference clinic were born outside the US, with 39.6% adopted. Geographically, patients represented 32 countries, and 96.4% were born in low- or middle-income countries (LMICs). The most common causes of LLD were congenital malformations (72.1%), trauma (17.1%), and tumor (5.4%). Syme was the most common amputation level (26.6%), followed by knee disarticulation (23.7%) and transtibial (18.7%). Congenital diagnoses were more frequent in adoptees (93.1% vs. 58.2%), whereas nonadoptees often had trauma (25.4%) or tumor (8.9%) diagnoses leading to amputation (P = 0.0003). A total of 23/60 (38.3%) international patients with preexisting lower-limb amputations had never worn a prosthesis at the time of initial presentation. Conclusions Many pediatric patients with prosthetic needs presenting for care in the US were born in LMIC. Adopted and nonadopted internationally born patients had significant differences in clinical etiologies of their LLD. Clinical Relevance Statement Internationally born patients may constitute a substantial percentage of US-based specialty clinics treating children with lower-limb differences, particularly from low- or middle-income countries where access to orthopedic and prosthetic care may be limited. This study highlights the importance of multidisciplinary health care providers addressing these children’s distinct clinical needs for improved patient-centered care.

Alignment of Audiologists' Values With Best-Practice Standards: Insights From a National Survey.

Previous research documented the values of audiology through a qualitative content analysis of documents representing traditional, best-practice hearing health care. The primary objective of this study was to validate the existing list of audiology values. Through a nationwide survey, this study aimed to elicit the values of practicing audiologists, with a specific focus on the prescription and dispensing of amplification devices, to ensure a comprehensive understanding of their priorities. Additionally, this study sought to identify any values missing from the original list and determine the rank order importance of these values, comparing this to the prioritization of values found in best-practice audiology documents. This comparison aimed to assess the alignment of recommended guidelines and real-world practices in hearing health care. An online survey was distributed to audiologists to elicit the prioritization of values from hearing health care providers. Participants were tasked with sorting and ranking 18 items, each representing a specific value in hearing health care, based on importance. Respondents were encouraged to suggest and rank the importance of additional values not included in the list. Audiologists were recruited from professional association mailing lists and direct contact. Respondent demographics were representative of U.S. audiologists. Qualitative content analysis was used to interpret values suggested by audiologists. Kendall's rank distance test was used to compare values prioritization between audiologists and best-practice audiology documents. After filtering out incomplete or disqualifying responses, data from 289 audiologists across 46 states were analyzed. Additional values suggested by respondents aligned with existing values from best-practice documents; thus, no new values were added as a result of this study. A ranked list of values based on mean order of importance was elicited from U.S.-based audiologists. There was substantial agreement between survey results and the rank order of values found in best-practice audiology documents. A demographic subgroup analysis revealed a broad agreement among audiologists in the rank order of values. This study validated a comprehensive list of values in audiology and identified the rank order of values among a nationally representative sample of audiologists. The findings provide a foundation for future investigations into how these values influence decision-making processes for individuals with hearing difficulty. Addressing values conflicts as potential barriers to hearing health care usage can lead to solutions aligned with values of specific populations, ultimately improving the adoption and effectiveness of hearing health care interventions. https://doi.org/10.23641/asha.27478149.

Impact of integrating traditional care with the modern healthcare system in reducing tuberculosis diagnosis delays in Ethiopia: a clustered randomized controlled study.

Diagnosis and treatment initiation delays for tuberculosis (TB) are significant challenges in resource-limited settings. These delays can result in poor treatment outcomes, disease transmission, and increased costs. This study aimed to assess the effect of integrating traditional care with modern healthcare systems on reducing TB diagnosis delay. A cluster randomized controlled trial was conducted among TB patients, with 510 participants, 255 individuals were assigned to the intervention group and 255 to the control group. Training in the intervention group was provided for both traditional and modern healthcare providers in three rounds to enhance their knowledge, attitudes, and skills in TB screening and referral. A non-parametric independent sample test was used to compare the baseline and end-line data. The effect size was determined using Cohen's d. To account for individual and cluster-level variations, a mixed-effect parametric survival model was employed. Furthermore, conditional (fixed only) and marginal (random effects) graphs were used to compare between the intervention and control groups. A total of 510 participants were included in the baseline study, with a similar number of participants included in the endline study. In the intervention group, the delay in diagnosis was 4.185 per 1000 person-days post-intervention, compared to 4.608 per 1000 person-days pre-intervention. In the control group, the delay for diagnosis was 4.759 per 1000 person-days pre-intervention and 5.031 per 1000 person-days post-intervention. The median time to diagnosis was 135days. The non-parametric comparison showed that the intervention significantly reduced patient delays in the intervention group compared to the control group (p = 0.006), with a Cohen's d effect size of 0.246. The intervention also significantly reduced diagnosis delay in the intervention group compared to the control group (p = 0.036), with a Cohen's d effect size of 0.187. The diagnosis of TB was accelerated by 1.076 times due to the integration of traditional care with the modern healthcare system in the intervention group compared to the control group (δ: 1.076; 95% CI 1.021, 1.134). The involvement of traditional care providers in TB control programs significantly reduced diagnosis delays in Ethiopia. These findings suggest the need for integrating traditional care with modern healthcare systems for the effective prevention of TB in high-burden countries. Clinical trial registration ClinicalTrials.gov ID: NCT05236452.

An update on incisional hernias

After abdominal surgery, incisional hernias are a common occurrence that may occur, and the frequency of these hernias may vary considerably depending on a number of different circumstances. This article presents a comprehensive analysis of the characteristics of incisional hernias, including their occurrence, causes, potential complications, and treatment options. Therefore, it is essential for healthcare providers to have a comprehensive understanding of these aspects in order to provide effective treatment and reduce the negative effects of this condition on patients.

Cross sectional survey of maternal and newborn quality of care in Niger: Selected findings, lessons learned and recommendations.

Comprehensive assessments of quality of care (QoC) are essential for monitoring progress towards meeting global and national maternal and newborn health (MNH) targets. Liverpool School of Tropical Medicine (LSTM) and the Niger Ministry of Public Health adapted a 2014 WHO QoC tool to cover antenatal care (ANC) and postnatal care (PNC) and include client voices through exit interviews. The objectives of the study were to assess quality of MNH care in Niger and to document lessons learnt from implementing the LSTM QoC tool. Quality of Care (QoC) was assessed using five tools: health facility survey (using register and official record data), partograph reviews, healthcare provider knowledge assessment, exit interviews with clients, and observation of antenatal and postnatal care. A nationally representative sample of 110 public healthcare facilities at three levels (integrated health centres, district hospitals and mother-child hospitals) and 2153 women were included. Descriptive analysis with 95% confidence intervals was presented. The health facility survey showed variable access to electricity (63% [53-72]), water (72% [62-81]), and transportation (40% [31-50]). Tests and treatment for HIV, TB, and malaria were found in more than 90% of relevant facilities. During observation of first ANC visit, 62% [48-74] women were tested for HIV; 13% [5-30] for pre-eclampsia and 22% [12-36] for anaemia. Observation of PNC showed much lower rates of screening (15% [7-27] tested for HIV and 4% [0;11] for malaria). Partographs were used in 86% of deliveries with inconsistent completion. At client interviews, respectful care indicators were variable, with providers not always explaining results to clients (59% [50-67]). Targeted allocation of resources and training could impact on QoC and reduce missed opportunities for prevention, screening and management of diseases among pregnant women and babies. The QoC assessment tool proved capable of offering a comprehensive overview of priorities in MNH, while maintaining feasibility in the Nigerien context.

Machine Learning in Health Anylitics and Patient Monitoring Solomon Kavuta and Mr Joel Mulepa Dmi St John The Baptist University, Lilongwe, Malawi

The integration of machine learning techniques in healthcare has revolutionized the way predictive analytics and patient monitoring are conducted. This transformation is reshaping traditional healthcare practices by harnessing the power of advanced computational methods to analyze vast amounts of patient data. Machine learning algorithms, which excel at detecting patterns and making predictions, leverage this data to forecast disease onset, progression, and treatment outcomes. This capability enables healthcare providers to adopt proactive measures, facilitating early intervention and the development of personalized treatment plans tailored to individual patients' needs. The potential of machine learning in healthcare is vast and multifaceted. By continuously analyzing real-time patient data streams from various sources such as electronic health records (EHRs), medical imaging, genomic information, and data from wearable devices, these algorithms can identify subtle changes in a patient's condition that may indicate the early stages of a disease or the risk of an adverse event. This continuous monitoring allows for timely interventions that can prevent complications, reduce the severity of diseases, and improve overall patient outcomes. For example, machine learning can help predict the likelihood of a patient developing conditions like diabetes or heart disease, allowing for lifestyle changes and medical interventions that can mitigate these risks before they become severe health issues. Moreover, machine learning facilitates remote patient monitoring, which has become increasingly important in the context of modern healthcare. With the advent of wearable devices and Internet of Things (IoT) sensors, it is now possible to collect and analyze health data outside of traditional clinical settings. These technologies enable healthcare providers to monitor patients in real-time, regardless of their location, ensuring continuous care and oversight. This is particularly beneficial for managing chronic diseases, where regular monitoring can significantly improve patient management and outcomes. For instance, remote monitoring of patients with heart conditions can detect early signs of arrhythmias or other issues, prompting immediate medical responses that can prevent more serious complications. The transformative impact of machine learning on healthcare delivery extends beyond patient monitoring and predictive analytics. It also includes enhancing diagnostic accuracy, optimizing treatment protocols, and streamlining administrative processes. By reducing the need for frequent hospital visits and enabling more efficient use of healthcare resources, machine learning can help lower healthcare costs while improving the quality of care provided to patients. Additionally, the ability to analyze large datasets quickly and accurately can aid in medical research, uncovering new insights into disease mechanisms and potential treatments.

Assessing the impact of contraceptive use on reproductive cancer risk among women of reproductive age—a systematic review

BackgroundContraceptives play a crucial role in women's reproductive health, their hormonal components may be linked to cancer risks, specifically breast, and gynecological cancers. Given the high usage rates of hormonal contraceptives, it is vital to systematically evaluate their potential impact on cancer outcomes, especially among women with a family history of gynecological cancers.ObjectivesThis study aims to evaluate the evidence on the association between modern contraceptive use and the risk of breast and reproductive cancers (ovarian, endometrial, and cervical cancer) among women of reproductive age, to inform healthcare providers, women, and program managers about cancer outcomes related to contraceptive use.MethodsA systematic review was conducted according to PRISMA guidelines. Searches were performed in databases such as CINAHL, OVID Medline, EMBASE, and more from inception to February 2022. Eligible studies included randomized controlled trials, cohort studies, and case-control studies that compared cancer outcomes between contraceptive users and non-users. Data extraction, quality assessment, and meta-analyses were conducted following predefined protocols. Subgroup and sensitivity analyses examined variations in contraceptive methods, doses, and duration.ResultsA total of 51 studies were included, comprising 2 RCTs and 49 observational studies. The review identified a significant reduction in ovarian and endometrial cancer incidence among contraceptive users. Hormonal contraceptive users had a 36% lower risk of ovarian cancer (RR 0.64, 95% CI 0.60–0.68), with specific reductions seen in combined oral contraceptive users (RR 0.62, 95% CI 0.57–0.68) and hormonal IUD users (RR 0.68, 95% CI 0.48–0.96). The rate ratio of cervical cancer was higher among non- users compared to hormonal contraceptive users when we pooled the results (1.28, 95% CI 1.21, 1.35). No significant association was found between contraceptive use and breast cancer risk among healthy women (RR 1.00, 95% CI 0.94–1.06). However, BRCA1/2 mutation carriers using oral contraceptives showed a heightened risk of breast cancer (HR 1.39, 95% CI 1.15–1.67).ConclusionThis systematic review highlights the protective effects of modern contraceptives against ovarian and endometrial cancers while identifying an increased risk of cervical. No significant breast cancer risk was found for healthy women, but BRCA1/2 mutation carriers faced increased risks. These findings underscore the need for personalized contraceptive counselling that considers cancer risk factors. Further research is needed to explore contraceptive impacts across different genetic profiles and dosing regimens.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, Prospero (CRD42022332647).

Abstract Su602: Categorizing Witnessed Out-of-Hospital Cardiac Arrest by Bystander Type

Witnessed out-of-hospital cardiac arrests (OHCA) are associated with improved outcomes with increased likelihood of rapid activation of the emergency response system thus decreasing no-flow or low-flow times. Current literature has largely treated witnessed cardiac arrest as binary (i.e. was a cardiac arrest witnessed Yes/No). We hypothesize there is a need to further delineate and categorize distinct bystander types; these differences may have important downstream contributions to outcomes and survival and targets for improving training and recognition. For example, a bystander who is a healthcare provider with formal training or has experience performing resuscitation may be associated with better outcomes than a non-medical layperson. We examined a national-level database of emergency medical services (EMS) activations in the United States (NEMSIS). Inclusion criteria were any adult (18+ years) cardiac arrest activation between January 2022 and December 2023. Cardiac arrests taking place after EMS arrival (EMS-witnessed) were excluded. Witnessed status was described as unwitnessed, witnessed by healthcare provider, witnessed by family member, or witnessed by bystander. Across basic demographic variables, we compared overall witnessed rates, family member witnessed rates, and healthcare worker witnessed rates. A total of 791,217 cardiac arrests met inclusion criteria. Overall, 62.5% of arrests were unwitnessed, 22.8% were witnessed by a family member, and 6.3% were witnessed by a healthcare provider. Across sex, cardiac arrests in male patients were more likely to be witnessed, however, cardiac arrests in female patients were more likely to be witnessed by a family member or healthcare provider (p<0.05). Significant differences in witnessed status were also seen across race/ethnicity. For instance, cardiac arrests in Black/African American patients were less likely to be witnessed by family members and cardiac arrests in Hispanic/Latino patients were less likely to be witnessed by healthcare workers (p<0.05). Our analysis of a large and nationally-representative database of cardiac arrest suggests differences in rates of witnessed cardiac arrest and – perhaps, more importantly – the existence of different types of bystanders. Moreover, when considering these differences, there is heterogeneity among demographic variables. Future research is needed to understand whether these differences in bystander type may contribute to differences in outcomes.

Telehealth Use and Legal Considerations in Drug Health Services During Pandemics: Systematic Scoping Review.

The COVID-19 pandemic impacted patients with substance use disorder (SUD) more than the general population and resulted in substantially increased emergency department admissions. Routine care of patients attending drug health services during the pandemic transitioned, with telehealth being important in delivering appropriate care. However, telehealth introduces unique risks such as privacy, confidentiality, and data safety. Providing health care through telehealth may fail if the legal impacts are not fully identified and acted on by health professionals. It also poses unintended risks for patients and can result in ineffectiveness, damages, medical negligence, and detracts from the best intentions of governments and health professionals. Understanding the legal framework ensures that medical professionals operate health care through telehealth within the law. Providing health care successfully through telehealth depends on the balance between innovation and legal compliance. By considering these aspects, clinicians and practitioners can provide effective and safe telehealth services during pandemics or any other natural disaster. We aimed to explore the legal impact of autonomy consent, confidentiality, privacy, data security, professional indemnity, and liability when delivering telehealth to patients with SUD. The scoping review also aimed to provide legal, ethical, and clinical considerations to minimize legal risks with using telehealth in drug health service outpatient settings. We performed a scoping review to provide an overview of existing research, statutes, and case laws for the incorporation of clinical, ethical, and legal considerations into telehealth use. Six databases for medical and 6 databases for legal publications were searched, as well as Australian national and selected international regulatory standards. Medical articles published up to June 2022 were included in this review. Our search yielded 1436 publications, 614 abstracts were reviewed, and 80 published studies met the inclusion criteria from 614 legal and medical search results. Current regulations related to technology use in drug health services, relevant cases, and international regulatory standards are discussed. In total, 43 legal documents including 15 statutes, 4 case laws, and 37 medical publications were reviewed. The themes arising from the literature were consent and autonomy (20/80, 25%), confidentiality (8/80, 10%), privacy (8/80, 10%), data security (7/80, 9%), and professional indemnity issues (3/80, 4%) in telehealth use. Further, 24 studies identified legal issues associated with telehealth use in patients with SUD. Our review identified potential legal issues associated with telehealth use in patients with SUD. Several legal and medical research articles provide frameworks, codes of conduct, or suggestions for clinicians to consider, but there was little discussion or evidence of how legal considerations are being applied when providing telehealth consultations at drug health services. Clinicians should be aware of the medicolegal implications when providing health care via telehealth at drug health services.

Survivor Health Connection Project: Understanding Experiences of Accessing Health Care Among Those Affected by Intimate Partner Violence During the COVID-19 Pandemic.

Intimate partner violence (IPV) has short- and long-term health effects, including physical injuries and traumatic brain injury, as well as sexual, reproductive, and mental health issues. However, accessing necessary health care is often challenging for IPV survivors and became even more difficult during the COVID-19 pandemic. We examined access to health care among those affected by IPV during the COVID-19 pandemic to better connect survivors to health and social support services. The Health Resources and Services Administration's Office of Women's Health partnered with its Bureau of Primary Health Care, the Administration for Children and Families' Office of Family Violence Prevention and Services, and the National Domestic Violence Hotline (Hotline) on the 2-year Survivor Health Connection Project. The Hotline administered 2 surveys to its contacts: a 2-question postinteraction survey from March 29, 2021, through September 30, 2022, and a longer focused survey in 2021 and 2022 that measured barriers and restrictions to accessing health care, telehealth safety, and interactions with health care providers. Of 9918 respondents to the postinteraction survey, 6173 (62.2%) reported current health needs related to their abusive experience. Nearly half of 242 respondents to the 2021 survey (n = 106, 43.8%) indicated that the frequency or intensity of abuse increased during the COVID-19 pandemic, and 157 of 338 respondents to the 2022 survey (46.4%) reported that their partner had controlled and/or restricted their access to health care. Participants described barriers to accessing health care, including finances, health insurance coverage, and transportation. Findings illuminate opportunities to further support the health and social needs of those experiencing IPV, including continued coordination of efforts across health care and social service delivery partners.

Validity and Reliability Study of the Turkish Form of the Family Support Scale for the Older People.

The Family Support Scale is a used scale to assess family support in older people. The purpose of this study was to test the Family Support Scale for older people in Turkish and to examine its validity and reliability. This was a methodological study. This study sample enrolled 250 older individuals. The study was conducted between July-December 2022. In data collection, sociodemographic information form and The Family Support scale were used. The inclusion criteria for this study selected participants who were 65 years or older, literate, open to communication, living with at least one family member, and who volunteered to participate in the research. In the study, who developed the original scale, was contacted via e-mail and the necessary permission was obtained for the Turkish validity and reliability of the scale. Language equivalence, content validity, exploratory factor analysis, and confirmatory factor analysis of the scale were performed. Internal consistency and total item score correlation were calculated to ensure validity and reliability. The scale is compatible in terms of language and content suitability, CVI (Language)= 0.87; CVI (Content)=0.099. In the validity analyzes of the scale; the factor loadings values of the scale were found to be between 0.36 and 0.83, and the explained variance (54.78%) was at a sufficient level according to the EFA results. It was determined that factor loading values for all items were varied between 0.58 and 0.97 and factor load values were statistically significant in CFA (p<.05). It was determined that the fit indices were RMSEA=0.064, GFI=0.99, CFI=0.99, NFI=0.99, x2/df=2.03 at the desired level. In the reliability analysis, it was found that the internal consistency coefficient (α: 0.94) was quite reliable, and the total correlation values of the scale ranged between 0.48 and 0.83. The cross-cultural adaptation of this scale has been realized successfully in Turkish. Health care providers may utilize this tool to evaluate family support for older people.

Abstract 4137644: Association of Prolonged QTc with Development of Heart Failure after Hematopoietic Stem Cell Transplantation

Background: Use of hematopoietic stem cell transplantation (HSCT) continues to rise in the United States, particularly in older age groups; however, HSCT is associated with various cardiovascular complications including heart failure (HF). We sought to examine whether prolonged QTc prior to HSCT was associated with the risk of HF post-HSCT. Methods: We used data from the Cardiovascular Registry in Bone Marrow Transplantation (CARE-BMT) study, a multicenter observational study of adult patients (aged ≥18 years) who underwent autologous/allogeneic HSCT for malignant or nonmalignant bone marrow disorders at the University of Michigan Health System (UMHS) and Rush University Medical Center (RUMC) between 2008-2019. In this analysis, only patients from the UMHS site were included (n=2,435). Baseline electrocardiogram (EKG) data were recorded prior to transplant (median (IQR) 14 (3, 30) days). QTc prolongation was defined per CTCAE grading criteria as Normal (&lt;440ms), Grade 1 (440-480ms), and Grade ≥2 (&gt;480ms). The primary outcome was new-onset HF defined as a diagnosis documented by health care providers after the date of hospitalization for HSCT. Analyses were conducted using a Fine-Gray model adjusted for the pre-HSCT CARE-BMT cardiovascular risk score. Results: Of the 2,435 patients (mean age at HSCT 55±13.4 years; 59.7% male; 90.5% White), 534 (21.9%) had long QTc pre-HSCT. Of those, 440 were Grade 1 and 94 were Grade ≥2. In all, 138 HF events occurred over median period of 2.3 (1.0-5.3) years. The 5-year cumulative incidence of HF was 5.0% in patients with normal QTc, 8.4% in patients with Grade 1 QTc prolongation, and 19.0% in patients with Grade ≥2 QTc prolongation (Figure). Patients with Grade 1 and Grade ≥2 prolongation had a 1.57 (95% CI: 1.05, 2.33) and 2.71 (95% CI: 1.51, 4.86) times higher risk of HF, respectively, compared to those with normal QTc. Conclusions: In this contemporary cohort of adult HSCT patients, those with QTc prolongation prior to HSCT had a higher incidence of HF compared to normal QTc, with greater degree of prolongation associated with higher risk. These findings highlight the importance of accounting for the QTc as part of the pre-transplant cardiovascular evaluation

Differences in Time of Birth between Spontaneous and Operative Vaginal Births.

Previous studies have identified an association between obstetric interventions and the time of day in which they are performed; however, they do not account for granular variations in the temporality of delivery interventions, which is influenced by both health care providers and resource availability. We sought to assess differences in time of birth among spontaneous vaginal births (SVBs) versus operative (forceps- and vacuum-assisted) vaginal births (OVBs). This cross-sectional study used birth certificate data from the National Vital Statistics System from 2016 to 2021, which includes the time of birth and delivery method for recorded U.S. births. The number of SVBs and OVBs at each minute was normalized relative to the total births within each delivery group to facilitate balanced comparisons between groups. Logistic regression analysis assessed the odds of OVBs per time of day. A total of 15,412,129 subjects who underwent vaginal birth were included in this analysis, 690,905 (4.5%) of whom underwent OVBs. Compared to births at other time intervals, those between 4:30 and 7:30 p.m. were more likely to be OVBs (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.12-1.14). Conversely, births between 3:00 and 6:00 a.m. were less likely to be OVBs (OR = 0.87, 95% CI: 0.86-0.88). After adjusting for adjusting for maternal age, gestational age, and induction of labor, births between 4:30 and 7:30 p.m. remained more likely to be OVBs (adjusted odds ratio [aOR] = 1.09, 95% CI: 1.08-1.10) and births between 3:00 and 6:00 a.m. remained less likely to be OVBs (aOR = 0.91, 95% CI: 0.90-0.92). In this population-based study, we identified temporal differences between SVBs and OVBs with increased use of instrumentation during the late afternoon and reduced use in the early morning. These findings prompt further investigation into the indications for OVBs and root causes of these temporal variations, which are likely multifactorial and involve provider and resource availability. · This study identifies temporal differences between SVBs and OVBs.. · Compared to SVBs, operative births are more likely in the late afternoon.. · OVBs are also less likely in the early morning.. · These temporal trends suggest the influence of provider and resource availability..

Evaluation of routine health monitoring for metabolic disorders in patients with serious mental illness on psychotropic medications: a study from Ethiopia.

Compared to the overall population, patients with mental health problems are more likely to experience concurrent physical illnesses, poorer health outcomes, and mortality. Psychotropic medications, which are the pillars in the management of mental health conditions, are associated with adverse effects such as weight gain, an increased level of glucose, and elevated circulating lipid levels, all of which contribute to metabolic disorders. Inadequate health monitoring may led to suboptimal interventions and worsening of these conditions. However, there is a lack of studies assessing routine health monitoring practices for metabolic disorders and their determinants among patients with serious mental illnesses taking psychotropic medications in Ethiopia. This study aimed to evaluate routine health monitoring for metabolic disorders and its determinants in patients with serious mental illnesses on psychotropic medications in Ethiopia. A hospital based prospective follow-up study was conducted among patients with serious mental illness taking psychotropic medications who attended the outpatient psychiatry department at Debre Markos Comprehensive Specialized Hospital. Eligible participants were selected using a simple random sampling technique. Routine health monitoring was evaluated using guidelines and previous literature. Binary logistic regression was employed to identify the determinants of routine health monitoring, with statistical significance determined by a p-value of less than 0.05 and a 95% confidence interval (CI). The overall routine health monitoring practice for metabolic disorders was found to be sub-optimal. Vital signs were the most commonly assessed parameters. Key determinants of routine health monitoring included participants aged 45 and above (AOR (95% CI): 2.82 (1.34-5.92), having social insurance (AOR (95% CI): 2.94 (1.86-4.64), availability of laboratory tests at the hospital (AOR (95% CI): 3.46 (2.16-5.55), and reporting of medication-related side effects (AOR (95% CI): 1.96 (1.21-3.17)). Routine health monitoring for metabolic disorders in patients with serious mental illnesses attending the outpatient psychiatry department was inadequate. Health care providers should give more attention to younger patients, those without health insurance, and who are not reported side effects. These findings provide crucial insights for improving routine health monitoring and promoting better health outcomes.