Health Care Contacts Research Articles

Mental health of children with epilepsy compared to their peers: population-based cohort from linked primary and secondary healthcare record in England

BackgroundChildren with epilepsy have higher rates of internalising mental health (MH) conditions compared to their peers, although available evidence is limited by small and selective samples. We used linked primary care and hospital admission records covering approximately 4.42% of English population to describe incidence of mental health problems in children with epilepsy compared to their peers. MethodsWe developed a cohort of young people aged 7-17 years old between 2010-2019, with minimum 1 year of follow-up until death, 18th birthday or 2020 using linked data from the Clinical Practice Research Datalink and Hospital Episodes Statistics. Epilepsy (exposure), depression and anxiety (outcomes) were identified using a combination of diagnostic codes, and primary care prescribing records. We estimated incident rate ratios (IRR) for anxiety/depression/any MH condition for children with epilepsy compared to their peers using negative binomial regression adjusted for sex, age, and area-level deprivation. ResultsStudy cohort included 510,177 children and young people, of whom 3,011 (0.59%) had epilepsy. Children with epilepsy had higher incidence of any MH condition (IRR: 1.39, 95% CI: 1.11–1.73) and anxiety (IRR: 1.38, 95% CI: 1.06–1.77), with differences in depression being non-significant (IRR: 1.25, 95% CI: 0.92–1.66). DiscussionChildren with epilepsy have higher rates of MH problems than their peers. Further work will examine if this can be partially explained by increased opportunity for MH diagnosis due to more healthcare contacts. Our findings emphasise the importance of integrated care models that address both neurological and psychological aspects of epilepsy management.

The transition from children to young people living with home mechanical ventilation

ABSTRACT Purpose This study aimed to examine how young people living with Home Mechanical Ventilation experience the transition from childhood to young adulthood in relation to everyday life, perceived health and transition into adult professional healthcare. Methods Nine young adults (three females and six males aged 18–31) were interviewed, and data was primary analysed using phenomenological hermeneutics. In the actual study, data was reworked using secondary analysis as described by Beck. Two interviewees were ventilated invasively and six non-invasively, and one was treated with continuous positive airway pressure (CPAP). Results The results are presented in two main categories. First; moving towards adulthood; and second, To handle changes in health and healthcare contacts. The study highlights the importance of ongoing social relations and being part of a socializing and physically active community. The transfer from paediatric to adult healthcare was solid and worked out well but was a process in which the participants struggled to find their own voice. Conclusions The transition into adulthood is a sensitive and challenging time for young people with HMV, but stable, close relationships and a well-organized transfer can enable this group to feel safe and able to find and use their own voice.

Time toxicity among older patients with cancer treated with palliative systemic therapy.

The time toxicity of anticancer therapy, defined as days spent with healthcare contact during treatment, represents a critical but understudied outcome. This study aims to quantify time toxicity among older patients with cancer receiving palliative systemic treatment. All patients aged ≥ 65 years with metastatic cancer receiving cytotoxic chemotherapy, immunotherapy, or targeted therapy at a single center in Mexico were selected from a prospective patient navigation cohort. Patients completed a baseline assessment, including the G8 screening and quality of life measures. Physical healthcare contact days within the first 6months were extracted from medical records and divided by days alive during the same period. Beta regression models were used to identify predictors of time toxicity. We identified 158 older patients (median age 71 years); 86% received cytotoxic chemotherapy. Seventy-three percent had an impaired G8 score and were considered vulnerable/frail. Six-month overall survival was 74%. Within the first 6months, patients spent a mean of 21% (95% confidence interval (CI) 19-23%) of days with healthcare contact. Concurrent radiotherapy (odds ratio (OR) 1.55; 95%CI 1.21-1.97), cytotoxic chemotherapy versus targeted therapy (OR 1.64; 95%CI 1.13-2.37), and an impaired G8 (OR 1.27; 95%CI 1.01-1.60) were associated with increased time toxicity. Older adults with metastatic cancer spend 1 in 5days with healthcare contact during treatment, with a higher burden of time toxicity for patients receiving radiotherapy or cytotoxic chemotherapy and those with potential frailty. These findings underscore the importance of informing patients about their expected healthcare contact days within the context of a limited life expectancy.

Contacts with health services for COVID-19-related reasons during the first wave of the pandemic in Portugal: a longitudinal study

IntroductionAccess to COVID-19-related care during the pandemic deserve attention and study to inform future strategies to deal with similar health emergencies in the future. We aimed to describe access to...

Building and validating trend-based multiple sclerosis case definitions: a population-based cohort study for Manitoba, Canada

ObjectiveThis study aims to (1) build and validate model-based case definitions for multiple sclerosis (MS) that use trends (ie, trend-based case definitions) and (2) to apply dynamic classification to identify...

How GPs can help young people avoid future self-harm: a qualitative study.

Self-harm is a growing problem in young people. GPs are usually the first point of healthcare contact for young people aged 16-25 years, after self-harm. GPs can experience barriers to supporting young people and behaviour change theory can help to understand these, and the influences on, GP behaviour. To explore the capabilities, opportunities, and motivations (COM-B model of behaviour) of GPs, and their perceived training needs, to help young people aged 16-25 years avoid future self-harm. This was a qualitative study of GPs in England. Semi-structured interviews were conducted with NHS GPs who were purposively sampled. Interviews occurred in 2021. Data were analysed using reflexive thematic analysis and mapped onto the COM-B model domains. The study's patient and public involvement group supported data analysis. Fifteen interviews were completed. Four themes were generated. GPs described mixed capabilities, with many feeling they had the physical and psychological skills to support young people to avoid future self-harm, but some felt doing so was emotionally tiring. GPs identified opportunities to better support young people, such as use of electronic consultation tools, but cited lack of time as a concern. GPs reported motivation to help young people, but this can be influenced by their workload. Unmet training needs around communication, knowledge, and optimising safety were identified. GPs are supported by their practice teams to support young people after self-harm, but a lack of time hinders opportunities to do so. Future effective GP-led interventions may improve GP motivation to support young people after self-harm.

EVisits to primary care and subsequent health care contacts: a register-based study

BackgroundEvidence concerning health care use related to virtual visits is conflicting. More research has been called for regarding the effectiveness of text-based virtual visits (eVisits). Therefore, we investigated patient characteristics, diagnoses, and subsequent health care contacts after eVisits to primary care.MethodsWe conducted a register-based cohort study of eVisits to an all-virtual public primary care unit in Sweden and subsequent health care contacts within 14 days. Data for 2021 were acquired from the regional health care databases. Diagnoses were sorted into relevant diagnostic groups, such as skin diagnoses and respiratory tract diagnoses. Multiple logistic regression was performed with subsequent health care contact as the outcome variable and diagnostic group for the eVisit as the predictor variable. Analyses were adjusted for age, sex, and socioeconomic index.ResultsThere were 5817 eVisits to a nurse and 4267 eVisits to a general practitioner (N = 10 084). Most patients were 20 to 39 years of age (41.8%). Skin diagnoses were most frequent (47.3%), followed by respiratory tract diagnoses (19.9%). Approximately one-fourth (25.8%) of the patients who completed an eVisit with a nurse or a general practitioner had a subsequent face-to-face visit within 14 days, mostly in primary care. Subsequent contacts were more frequent after an eVisit to a nurse than to a general practitioner. After an eVisit to a general practitioner, patients with infections (especially respiratory tract but also urinary tract) and unspecified diagnoses (especially skin-related) were more likely to require further health care contact compared to a group with various other diagnoses.ConclusionseVisits to an all-virtual primary care unit may be appropriate for uncomplicated medical complaints. Nonetheless, the effectiveness of eVisits in terms of substitution of physical visits, and resource utilization in relation to the more complex care needs of a primary care population, should be further studied.

Vascular Care Delivery during the COVID-19 Pandemic: Impact of Office-Based Laboratory and Ambulatory Surgery Center

Objective: To evaluate how access to an office-based laboratory (OBL) and ambulatory surgery center (ASC) impacted vascular care during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: Vascular procedures performed by our group during the 6-week period before COVID-19 restrictions (group 1) and in the first 6-week period during the COVID-19 restrictions (group 2) were reviewed. The number of procedures performed was categorized as hospital inpatient (HIP), hospital outpatient (HOP), OBL, ASC, and vein center (VC). The procedures were also grouped by type: aneurysm (AAA), carotid (CAR), peripheral arterial disease (PAD), amputation/wound care (AMP), vascular access (VA), deep vein thrombosis (DVT), and venous reflux (CVI). The number of healthcare provider contact points for each patient undergoing care at the HOP, OBL, and ASC were also collected and compared between groups 1 and 2. Differences between groups were determined using the two-way ANOVA. Results: There were no statistically significant differences between groups 1 and 2 for procedure location or type of procedure (p > 0.05). Patient contact with healthcare providers decreased between groups 1 and 2 for ambulatory care. However, projecting the number of contacts for patients in group 2 if they had to have ambulatory care in the HOP setting (913) compared to contacts in the OBL and ASC setting (588) was statistically significant (p < 0.05). No patient or staff member at the OBL or ASC developed COVID-19 infection because of the care received at these venues. Conclusions: The ability to provide essential care for patients in an ambulatory environment was enhanced using our OBL and ASC without compromising safety, efficacy, or transmission of the virus to patients or staff during the height of the COVID-19 pandemic and limited their contact with healthcare workers and therefore reduced the consumption of personal protective equipment by healthcare personnel.

Rising incidence, health resource utilization and costs of Polycystic Ovary Syndrome in the United Kingdom.

Trends in incidence of Polycystic Ovary Syndrome (PCOS) and effects on health resource utilization are unclear. To describe trends in prevalence and incidence of PCOS in the United Kingdom. To establish healthcare resource use and associated costs. Data were extracted from the Clinical Practice Research Datalink Aurum and Hospital Episode Statistics databases. Point prevalence and incidence were calculated (2004-2020). Patients with PCOS were matched to controls (1:1) by age, body mass index and primary care practice. Primary care contacts were assigned an average cost and prescription items assigned a net ingredient cost. Inpatient admissions and outpatient consultations were processed into Healthcare Resource Groups and costed to the National Tariff. PCOS incidence increased from 1.22 per 1000 person years in 2004 to 1.77 (2012) and 2.20 (2019). Point prevalence increased from 1.02% (2004) to 2.2% (2012) and 3.5% (2020), and was highest in Asians. Mean contacts per person year (ppy) for patients with PCOS versus controls were 0.48 vs 0.29 for inpatients (p<0.001), 3.81 vs 2.15 for outpatients (p<0.001) and 6.43 vs 4.68 (p<0.001) for primary care. Mean healthcare costs (ppy) were £837 vs £493 (p<0.001) for inpatients, £444 vs £253 (p<0.001) for outpatients, £157 vs £112 for primary care and £109 vs £83 (p<0.001) for primary care prescriptions. Total health care contacts ppy were 10.72 vs 7.11 (p<0.001) and total associated costs £1,546 vs £940 (p<0.001). The incidence of PCOS has risen significantly. Health resource utilization and costs of PCOS are significantly greater than controls.

Native Infective Endocarditis: A State-of-the-Art-Review.

Native valve infective endocarditis (NVE) is a global phenomenon, defined by infection of a native heart valve and involving the endocardial surface. The causes and epidemiology of the disease have evolved in recent decades, with a doubling of the average patient age. A higher incidence was observed in patients with implanted cardiac devices that can result in right-sided infection of the tricuspid valve. The microbiology of the disease has also changed. Previously, staphylococci, which are most often associated with health-care contact and invasive procedures, were the most common cause of the disease. This has now been superseded by streptococci. While innovative diagnostic and therapeutic strategies have emerged, mortality rates have not improved and remain at 30%, which is higher than that for many cancer diagnoses. The lack of randomized trials and logistical constraints impede clinical management, and long-standing controversies such as the use of antibiotic prophylaxis persist. This state of the art review addresses clinical practice, controversies, and strategies to combat this potentially devastating disease. A multidisciplinary team will be established to provide care for patients with presumptive NVE. The composition of the team will include specialists in cardiology, cardiovascular surgery, and infectious disease. The prompt administration of combination antimicrobial therapy is essential for effective NVE treatment. Additionally, a meticulous evaluation of each patient is necessary in order to identify any indications for immediate valve surgery. With the intention of promoting a more comprehensive understanding of the procedural management of native infective endocarditis and to furnish clinicians with a reference, the current evidence for the utilization of distinct strategies for the diagnosis and treatment of NVE are presented.

Antipsychotic use in a large community sample of patients with delusional disorder

BackgroundTo examine clinical and sociodemographic differences between patients with delusional disorder; with and without diagnoses of an additional severe mental disorder (SMD) or cognitive impairment. MethodsPopulation-based study including all individuals diagnosed with DD between 2005 and 2021 from a large catchment area in Madrid, Spain. Sociodemographic and clinical characteristics and the antipsychotic prescription patterns of the study population was described. Patients were divided into (i) patients with DD and no additional diagnosis of SMD or cognitive impairment (DD group), (ii) patients with DD and a diagnosis of an additional SMD (DD-SMD group), and (iii) patients with DD and cognitive impairment (DD-CI group). ResultsOf 1109 patients with a DD diagnosis (62.5 % female), 131 (11.8 %) patients were diagnosed with an additional SMD, and 69 (6.2 %) were diagnosed with cognitive impairment. DD-SMD patients were on average 10 years younger and had longer time between first mental healthcare contact and DD disorder than DD patients. DD-CI patients were on average 10 years older and had a higher proportion of females. Paliperidone (21.9 %) and aripiprazole (20.6 %) were the modal antipsychotic drugs chosen overall. DD-SMD patients were more likely to receive paliperidone and to be prescribed long-acting injectable medication; DD-CI were more likely to receive risperidone or quetiapine; and DD patients were more likely to receive olanzapine. ConclusionsSociodemographic and clinical characteristics and choice of antipsychotic drug and delivery method for individuals with DD vary based on its comorbidity.

Register-based study on prescription renewal without the prescriber meeting the patient.

Renewing prescriptions is important for the continuity of pharmacotherapy. However, renewing without the prescriber meeting the patient might lead to insufficient pharmacotherapy monitoring. This study investigated the prevalence of renewed prescriptions, prescriptions renewed without the prescriber meeting the patient and the factors associated with renewals made without meeting the patient. This register-based study employed data on electronic prescriptions and health care contacts from Finnish registers. Prescriptions were classified as renewed if there was a renewal request or a previous prescription for the same ATC code. Prescriptions were considered as being renewed without meeting the patient if there was no patient contact on the renewal date. Descriptive and logistic generalized estimating equation analyses were conducted. The random sample of prescriptions (10%) from the year 2019 amounted to 2 804 048. Of these, 41.9% were original, 35.4% were renewals without meeting the patient and 22.7% were renewed with meeting the patient. Characteristics such as male sex, age 35-54 years, prescription for cardiovascular system preparations and the prescription being renewed during the summer (June-August) were associated with renewals made without meeting the patient. Further research is needed on the implementation of pharmacotherapy monitoring in the case of renewals without the prescriber meeting the patient.

Patients' experiences of living with low anterior resection syndrome three to six months after colorectal cancer surgery: A phenomenological study.

Increased use of sphincter-preserving surgery following colorectal cancer has led to more people living with low anterior resection syndrome (LARS), a disordered bowel function that significantly impacts quality of life. Little is known about how patients experience the first months following sphincter-preserving surgery and having LARS. To shed light on what it means to live with LARS in the first three to six months after colorectal cancer sphincter-preserving surgery. A qualitative study with a phenomenological approach constitutes the study design. Semi-structured interviews were conducted with five participants from September 2022 to January 2023. The transcribed interviews were analysed using Giorgi's phenomenological method. Five themes emerged from the analysis: bowel emptying becomes all-consuming and affects both daily life and working life, you hear what they're saying, but don't understand what it means until your body goes through it, low anterior resection syndrome may impact sexual life, leaving feelings of guilt, it doesn't matter what the circumstances are, but rather how one deals with them, and support and follow-up from healthcare professionals, employers, family and friends are crucial for living a good life with LARS. Participants described struggles living with major LARS in the early period following hospital discharge. However, few months later, they had developed strategies enabling them to control their everyday life. Support and follow-up from healthcare professionals, employers, family, and friends were crucial when learning to live with major LARS. Participants expressed desire for a systematic and proactive follow-up from healthcare professionals and contact with peer-support groups.

Dual diagnosis and their care pathways for help-seeking: A multicenter study from India.

Understanding pathways to dual diagnosis (DD) care will help organize DD services and facilitate training and referral across healthcare sectors. The aim of our study was to characterize the stepwise healthcare and other contacts among patients with DD, compare the characteristics of the first contact persons with common mental disorder (CMD) versus severe mental illness (SMI), and estimate the likelihood of receiving appropriate DD treatment across levels of contacts. This cross-sectional, descriptive study in eight Indian centers included newly enrolled patients with DD between April 2022 and February 2023. The research spans varied geographic regions, tapping into regional variations in disease burden, health practices, and demographics. The study categorized healthcare contacts by using the WHO Pathways Encounter Form. The sample (n = 589) had a median age of 32 years, mostly males (96%). Alcohol was the most common substance; SMI (50.8%) and CMD were equally represented. Traditional healers were a common first contact choice (18.5%); however, integrated DD care dominated subsequent contacts. Assistance likelihood increased from the first to the second contact (23.1% to 62.1%) but declined in subsequent contacts, except for a significant rise in the fifth contact (97.4%). In the initial contact, patients with CMD sought help from public-general hospitals and private practitioners for SUD symptoms; individuals with SMI leaned on relatives and sought out traditional healers for psychiatric symptoms. Recognizing the cultural nuances, advocating for integrated care, and addressing systemic challenges pave the way to bridge the gap in DD treatment.

The 90-Day Risk of Hospitalization in Heart Transplant Recipients After COVID-19 Infection

BackgroundHeart transplant recipients are at a high-risk of complications from the coronavirus-2019 (COVID-19) infection. Heart transplant recipients are a special group of persistently immunosuppressed people, and COVID-19 may cause them to experience an unpredictable course of infection, with a risk of hospitalization occurring well beyond their initial infection period. The seriousness of COVID-19 disease in heart transplant recipients emphasizes how vital it is to refer patients promptly and early to specialized heart transplant centers. MethodsWe retrospectively reviewed all heart transplant recipients at a single center between March 2019 and October 2021. All recipients with positive nasopharyngeal reverse transcriptase-polymerase chain reaction tests for COVID-19 were included in this study. After IRB approval, we obtained medical records and patient data from electronic medical records. ResultsThis study followed 126 heart transplant patients from March 2019 to October 2021 of which only 49 had COVID-19 infections. The median age at infection was 58 years (49-65), with 41% female. Race distribution was as follows: 59% Caucasian and 39% African American. The median time from transplant to infection was 384 days (237-677). All infected patients had a 50% dose reduction in mycophenolate mofetil per institutional protocol. The majority of symptoms were cough, fatigue, shortness of breath, and fever. Among all patients with COVID-19, 45 (92%) were vaccinated. Of those vaccinated, 27 (60%) patients received Pfizer initial and booster doses, whereas 18 (40%) received Moderna initial and booster doses. Twelve patients (24%) were hospitalized within 90 days of infection, with only two requiring ICU level of care. The median duration of hospitalization was 5 days (4-9). Of the hospitalized patients, 11 (92%) were discharged, and 1 (8%) died in the hospital. Three of the four unvaccinated patients were hospitalized, and one died while hospitalized. The remaining 37 patients were managed as outpatients. ConclusionHeart transplant recipients have an increased risk of contracting COVID-19 and developing severe symptoms due to multiple healthcare contacts, preexisting health conditions, and weakened immune systems. Our data highlight that most vaccinated patients do not require hospitalization within 90 days of infection, and those hospitalized have a high likelihood of survival without needing ICU care.

Outbreak of Ralstonia pickettii associated with contamination of saline products distributed internationally, the United Kingdom, 2024.

We describe an outbreak of Ralstonia pickettii in the United Kingdom, with isolates genetically indistinguishable from a 2023 Australian outbreak linked to internationally distributed saline solutions. Confirmed cases (n = 3) had bacteraemia, clinically relevant infection, indwelling venous lines and frequent healthcare contact. Multi-stakeholder intervention was required including product recall and risk communications. We recommend a low threshold for investigating clusters of Ralstonia species and similar opportunistic pathogens, considering contaminated product sources. Effective mitigation requires multi-agency partnership and international collaboration.

Evaluation of Age-Friendliness in Primary Health Care Centers in Sulaimani Governorate, Iraq

Background: The aging of the global population has increased the demand for primary care of older adult’s health disorders. As the first point of contact for healthcare, primary care services should be accessible and adaptable to the needs of older people. This study aims to assess the age-friendliness of healthcare services at the primary healthcare centers (PHCCs) in Sulaimani Governorate, Iraq. Methods: This cross-sectional descriptive study included all 87 PHCCs in Sulaimani governorate (61 centers in Sulaimani city, 16 in Raparin Administration, and 10 in Garmyan Administration). In each of these health facilities, data were collected regarding the physical, architectural, and clinical age-friendliness of these centers. A modified age-friendly PHCCs toolkit was used as a tool for assessing the PHCCs, and then a scoring system was utilized to estimate the overall friendliness of the PHCCs. Results: The Sulaimani governorate selected 13 out of 87 PHCCs (14.9%) to be age-friendly; all of them were in Sulaimani city. However, this study found that only 3 out of 87 (3.4%) centers were in the range of the WHO age-friendly recommendations with a score of &gt;75%, while 64 (73.6%) centers were partially age-friendly with a score of 50–74% and 20 (23%) centers were not age-friendly with a score &lt;50%. Conclusion: Only 3.4% of PHCCs in Sulaimani Governorate were age-friendly, and most of the centers were partially age-friendly. Geriatric doctors and geriatric nurses were not recruited, and geriatric training programs for medical staff were not satisfactory.

The burden of sudden cardiac arrest in the setting of acute coronary syndrome

BackgroundThe incidence of sudden cardiac arrest (SCA) during acute coronary syndrome is somewhat unclear, since often subjects dying before the first healthcare contact are not included in the estimates. We aimed to investigate the complete incidence of SCA during ACS. MethodsThe study population consists of two cohorts. The first cohort includes 472 ACS patients from Northern Ostrobothnia, Finland from year 2016 and the second cohort 162 autopsy-verified SCD subjects (extrapolated) from the same region and year, whose death was attributable to coronary artery disease (CAD) and ACS. An extrapolation of SCA incidence during ACS was done by utilizing autopsy data and data from prior autopsy study on this sample. ResultsThe overall incidence of SCA in the setting of ACS was 17.5%. The incidence of SCA was 20.6% in all ACS subjects without prior CAD diagnosis, and 25.4% in STEMI subjects without prior CAD diagnosis. In subjects with previously diagnosed CAD, the incidence of SCA was 10.9% in all ACS subjects and 16.1% in STEMI subjects. There was a statistically significant difference in the incidence of SCA between subjects with and without prior CAD diagnosis (p = 0.0052). ConclusionThe inclusion of ACS-SCA subjects dying before the first emergency medical service (EMS) contact results in a higher and likely more accurate estimation of SCA during ACS. The incidence of SCA was higher among subjects without prior CAD diagnosis. The high mortality rate highlights the importance of early ACS detection to reduce the burden of CAD-related premature deaths.

High Prevalence of Colistin-Resistant Encoding Genes Carriage among Patients and Healthy Residents in Vietnam.

Background and Objectives: We aimed to investigate the carriage of colistin-resistant genes among both patients with a history of antibiotic exposure and apparently healthy adults with no recent healthcare contact. Materials and Methods: Stool swabs were collected from healthy people, and specimens were collected at the infection foci from the patients. Eleven primer/probe sets were used to perform the Multiplex Real-Time PCR assay with the QuantiNova Multiplex Probe PCR kit for screening the carriage of colistin-resistant genes (mcr-1 to mcr-10) and 16S rRNA gene as internal control. Results: In total, 86 patients and 96 healthy residents were included. Twenty two patients (25.9%) were positive with at least one colistin-resistance encoding gene. The mcr-1 gene was the most frequent (16.5%), followed by mcr-9, mcr-6, and mcr-4 genes, where the prevalence was 11.8%, 10.6%, and 9.4%, respectively. No patient was positive with mcr-3, mcr-7, and mcr-8 genes. Eight patients (9.4%) were positive with multiple colistin-encoding genes. Twenty-three healthy people (24.0%) were positive with at least one colistin-resistance encoding gene, and the mcr-10 gene was the most frequent (27.0%), followed by the mcr-1, mcr-8, and mcr-9 genes, where the prevalence was 24.3%, 21.6%, and 13.5%, respectively. No person was positive with the mcr-2 and mcr-5 genes. Conclusions: Our findings underscore the urgent need for enhanced surveillance, infection control measures, and stewardship interventions to mitigate the spread of colistin resistance in Vietnam.

Screening for adverse social conditions in child healthcare settings: protocol for a systematic review

IntroductionAdverse social conditions affect children’s development and health outcomes from preconception throughout their life course. Early identification of adverse conditions is essential for early support of children and their families....