State Health Care Research Articles

Legal regulation of the health care system of the Federative Republic of Brazil

The article summarizes the views of legal scientists and medical scientists engaged in research in the field of public health. From the standpoint of the theory of medical law, legislative acts are analyzed that have led to significant achievements of the healthcare system of the Federal Republic of Brazil, which is a member of the BRICS and whose experience (legal and organizational) is of interest to specialists in the field of healthcare organization of other member countries of the international organization. The Brazilian health care system is not only in a stable legal field, but also in the first places in the ranking of world health systems. In this regard, experts study the experience of Brazil as a country with vivid geographical, social and economic contrasts, especially in the field of public health. The State pays primary attention to the legal issues of the organization of medical care and places healthcare in the priorities of national policy. A Unified healthcare system has been created and is functioning within the framework of the State healthcare system. Medical services provided in accordance with this system are free of charge and cover all citizens of the country regardless of socioeconomic status and territorial location of residence.

Assessment of Healthcare Associated Infections in a Medical Intensive Care Unit

Objective: This study was undertaken to assess the current status of healthcare associated infections (HAIs) in our institution during a 2-year period in relation to causative agents and their distribution, use and duration of invasive mechanical ventilation, and infection rate and incidence in comparison with national data.
 Methods: Patients admitted to Medical ICUs of Meram State Hospital between 1st Jan 2019 and 31st Dec 2020 wereincluded. During a 2-year period a total of 47 patients were diagnosed with HAIs based on Centers for Disease Control and Prevention (CDC) and National Nosocomial Infection Surveillance Network (NNISN) criteria.
 Results: During 6041 follow-up days for 922 patients admitted to ICU, a total of 47 HAIs cases were detected. The most common types of HAIs included healthcare-associated pneumonia in 21 patients (45.6%) and other infections of the respiratory system in 12 patients (26.1%). The most common causative agent was Acinetobacter baumannii, which was found in 27 patients (50.9%).
 Conclusion: HAIs is an unavoidable condition in ICUs owing to a number of factors such as frequent use of invasive devices, prolonged length of admission, and increased number of complications. One of the major health targets in healthcare facilities is to control an manage HAIs. Avoidance from unnecessary catheterizations, timely removal of invasive catheters, increased adherence to infection control measures, prevention of inappropriate antibiotic use, compliance with isolation procedures, and initiation of appropriate antibiotherapy based on documentation of causative organisms will significantly reduce HAIs incidence.

Effectiveness of a media campaign promoting health care provider tobacco dependence treatment

The New York State Department of Health (NYSDOH) developed a provider-focused media campaign to encourage provision of evidence-based, clinical tobacco dependence treatment (TDT). The purpose of this study was to assess providers’ awareness of the campaign and the relationship between campaign awareness and changes in campaign-related beliefs and clinical TDT intervention. We conducted a longitudinal, mailed survey of health care providers in New York State (n = 851; AAPOR3 RR: 24.6%). We estimated descriptive statistics and used multivariable regression analyses to assess whether changes in key outcomes (campaign-related beliefs and clinical TDT) from pre- to post-campaign vary by self-reported campaign awareness. Approximately 12% of providers were aware of the campaign. In multivariable analyses, changes from pre- to post-campaign in provider beliefs that the nicotine patch and gum are very effective at helping patients quit were greater for providers aware of the campaign compared with those not aware of the campaign (For patch: OR 2.17, CI 1.06–4.45, p = 0.03; for gum: OR 2.78, CI: 1.24–6.27, p = 0.01), but not for provider behavior. After seeing the NYSDOH campaign, providers’ beliefs about the effectiveness of the patch and gum increased. Many state tobacco control programs and health care organizations are implementing tobacco-related policies and systems to facilitate the provision of clinical TDT; this study suggests that a digital and print provider-focused media campaign has the potential to complement health systems change interventions. Future studies should seek to identify ways to modify ad delivery to increase campaign awareness to maximize potential campaign impact.

Digitalization of healthcare and health status of medical workers

The labor activity of modern doctors of various specialties is inextricably linked with pronounced mental, nervous and emotional stress, as well as the complex impact of physical, chemical and biological factors, the simultaneous influence of which can lead to the development of a wide range of occupational diseases. The intensive introduction of digitalization in healthcare also leads to a significant negative impact of modern technologies on the health of doctors and medical personnel.
 The analysis of the literature made it possible to identify priority areas for the introduction of digitalization in healthcare: improvement of the regulatory framework for the use of information systems, creation of specialized training centers for employees, development of convenient and well-optimized information systems and interface, scientific justification and development of preventive measures aimed at preserving the health of health workers. In this regard, it is advisable to take measures to develop the skills of safe use of electronic devices, leading a healthy lifestyle, which will further minimize the potential risks of negative impact of information and communication technologies on the health of medical workers.

Personality predicting relapse: A facet analysis of the NEO PI-R.

Revised NEO Personality Inventory (NEO PI-R) domains are associated with substance use disorders (SUD), including potential for relapse. However, individual facets of the NEO PI-R domains have not been rigorously analyzed. This paper assesses NEO PI-R individual facets among participants with SUD and their value in predicting relapse. Between 2015 and 2018, all patients admitted to a single private rehabilitation center (n = 642) were offered participation in this study. Participants who completed NEO PI-R questionnaires at the start of treatment and with known relapse outcomes up to 1-year posttreatment were included (n = 441). Statistical analysis included a series of unadjusted univariate logistic regressions and additional adjusted multivariate regression controlling for employment status in healthcare. Neuroticism, Agreeableness, and Conscientiousness domains had significant impacts on relapse. Three individual facets of Neuroticism were significant predictors of relapse, and seven individual facets within the Conscientiousness and Agreeableness domains were inversely related to relapse. When controlling for employment, Conscientiousness and three of its individual facets (Dutifulness, Competence, and Self-Discipline) continued to be significant in predicting relapse. The individual facets Impulsiveness and Straightforwardness also continued to be significant in predicting relapse. Several personality domains and facets were significantly related to relapse, confirming and expanding on prior literature. This study focuses on the risk of relapse as it relates to NEO PI-R individual facets, which have not been previously explored with a sample size of this magnitude. These findings can guide clinical care of patients with SUD, allowing for more targeted treatment.

Barriers to human papillomavirus vaccine uptake: role of state religiosity and healthcare professionals' participation in a state vaccine program.

Despite the known benefits of preventing human papillomavirus (HPV)-related cancers, HPV vaccine coverage is low in the United States. Grounded in Social Ecological theory, we assessed the macro-level (state) and meso-level (organization) factors associated with HPV vaccine initiation and up-to-date. Data from 2020 National Immunization Survey-Teen were used to study a sample of 20 163 US adolescents (aged 13-17 years). The data were collected from each teen's parents or guardians and health-care professionals. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted. The prevalence of HPV vaccine initiation was 75.1% and of remaining up-to-date was 58.6%. At the macro level, teens living in states with high and moderate religiosity had lower odds of HPV vaccine initiation (high religiosity adjusted odds ratio [AOR] = 0.63, 95% confidence interval [CI] = 0.50 to 0.78; moderate religiosity AOR = 0.68, 95% CI = 0.55 to 0.85) and up-to-date (high religiosity AOR = 0.69, 95% CI = 0.56 to 0.85; moderate religiosity AOR = 0.74, 95% CI = 0.61 to 0.91) than states with low religiosity. At the meso level, when none of their healthcare professionals ordered vaccine from the state, teens had lower odds of initiation (AOR = 0.68, 95% CI = 0.53 to 0.87) and up-to-date (AOR = 0.76, 95% CI = 0.60 to 0.95) than teens whose healthcare professionals ordered vaccine from the state. In addition, race and ethnicity, age, mother's education level, household income, well-child examination status, and doctor's recommendation were significantly associated with HPV vaccine uptake. A multiprong approach is needed to address religious and systemic barriers to HPV vaccination and expand healthcare professionals' access and enrollment in state vaccine initiatives, such as the Vaccine for Children program.

A trial-based economic evaluation of the CaFaSpA referral strategy for axial spondyloarthritis

Objective To assess the cost–utility from healthcare and societal perspectives of the digital CaFaSpA referral strategy (CS) for axial spondyloarthritis (axSpA) in primary care patients with chronic low back pain (CLBP). Method A cluster randomized controlled trial was performed in the Netherlands. General practice units were randomized into CS or usual care (UC). Economic evaluation was performed from the healthcare and societal perspectives within a 12-month time horizon. Outcome measures encompassed disability [Roland–Morris Disability Questionnaire (RMDQ)] and health-related quality of life (EQ-5D-3L). Direct medical (iMTA Medical Consumption Questionnaire) and indirect costs (iMTA Productivity Cost Questionnaire), including productivity loss, were evaluated. Incremental cost–utility ratios (ICURs) were calculated. Results The study included 90 GP clusters with 563 patients (CS: n = 260; UC: n = 303) (mean ± sd age 36.3 ± 7.5 years; 66% female). After 12 months, no minimal important differences in outcomes were observed for RMDQ (−0.21, 95%CI −1.52 to 1.13) or EQ-5D (−0.02, 95%CI −0.08 to 0.05). However, total costs were significantly lower in the CS group owing to lower productivity loss costs. The ICUR for RMDQ was €18,059 per point decrease and €220,457 per quality-adjusted life year increase. Conclusions Digital referral did not decrease the overall healthcare status of patients after 1 year of follow-up and appears to be more cost-effective than UC. Therefore, CS can be used as an appropriate primary care referral model for CLBP patients at risk for axSpA. This will accelerate timely provision of care by the right caregiver.

Impact of Hospitalization of People With Dementia or Cognitive Impairment on Family Caregivers.

People with dementia (PWD) have a higher risk of hospitalization than people without dementia. Hospitalizations are stressful events for PWD and their caregivers, representing a considerable change to their routines. The current descriptive longitudinal study aimed to identify the positive and negative reactions, experiences related to health and social integrated care, resource use, and work status of family caregivers of PWD or cognitive impairment admitted to the hospital with a proximal femur fracture undergoing surgery. Findings indicated that family caregivers (N = 174) are fully committed to providing assistance in activities of daily living and supervision, showing positive attitudes on self-esteem and negative attitudes toward lack of family support and impact on finances, schedule, and health. Overall caregiver experiences with integrated health and social care improved after hospitalization but decreased after discharge. One month after hospitalization, family caregivers maintained the same work hours but used fewer health care resources. Hospitalization represents a good opportunity to approach family caregivers and determine their needs to provide them with interventions to minimize their burden and improve their well-being. [Research in Gerontological Nursing, 16(6), 283-290.].

Screening for Health-Related Social Needs and Collaboration With External Partners Among US Hospitals

In recent years, hospitals and health systems have reported increasing rates of screening for patients' individual and community social needs, but few studies have explored the national landscape of screening and interventions directed at addressing health-related social needs (HRSNs) and social determinants of health (SDOH). To evaluate the associations of hospital characteristics and area-level socioeconomic indicators to quantify the presence and intensity of hospitals' screening practices, interventions, and collaborative external partnerships that seek to measure and ameliorate patients' HRSNs and SDOH. This cross-sectional study used national data from the American Hospital Association Annual Survey Database for fiscal year 2020. General-service, acute-care, nonfederal hospitals were included in the study's final sample, representing nationally diverse hospital settings. Data were analyzed from July 2022 to February 2023. Organizational characteristics and area-level socioeconomic indicators. The outcomes of interest were hospital-reported patient screening of and strategies to address 8 HRSNs and 14 external partnership types to address SDOH. Composite scores for screening practices and external partnership types were calculated, and ordinary least-square regression analyses tested associations of organizational characteristics with outcome measures. Of 2858 US hospital respondents (response rate, 67.0%), most hospitals (79.2%; 95% CI, 77.7%-80.7%) reported screening patients for at least 1 HRSN, with food insecurity or hunger needs (66.1%; 95% CI, 64.3%-67.8%) and interpersonal violence (66.4%; 95% CI, 64.7%-68.1%) being the most commonly screened social needs. Most hospitals (79.4%; 95% CI, 66.3%-69.7%) reported having strategies and programs to address patients' HRSNs; notably, most hospitals (52.8%; 95% CI, 51.0%-54.5%) had interventions for transportation barriers. Hospitals reported a mean of 4.03 (95% CI, 3.85-4.20) external partnership types to address SDOH and 5.69 (5.50-5.88) partnership types to address HRSNs, with local or state public health departments and health care practitioners outside of the health system being the most common. Hospitals with accountable care contracts (ACCs) and bundled payment programs (BPPs) reported higher screening practices (ACC: β = 1.03; SE = 0.13; BPP: β = 0.72; SE = 0.14), interventions (ACC: β = 1.45; SE = 0.12; BPP: β = 0.61; SE = 0.13), and external partnership types to address HRSNs (ACC: β = 2.07; SE = 0.23; BPP: β = 1.47; SE = 0.24) and SDOH (ACC: β = 2.64; SE = 0.20; BPP: β = 1.57; SE = 0.21). Compared with nonteaching, government-owned, and for-profit hospitals, teaching and nonprofit hospitals were also more likely to report more HRSN-directed activities. Patterns based on geographic and area-level socioeconomic indicators did not emerge. This cross-sectional study found that most US hospitals were screening patients for multiple HRSNs. Active participation in value-based care, teaching hospital status, and nonprofit status were the characteristics most consistently associated with greater overall screening activities and number of related partnership types. These results support previously posited associations about which types of hospitals were leading screening uptake and reinforce understanding of the role of hospital incentives in supporting health equity efforts.

The effect of a community-based group intervention on chronic disease self-management in a vulnerable population.

Chronic non-communicable diseases (NCDs) are predominantly related to modifiable health behaviors and account for 74% of global deaths at present. Behavior modification through self-management is a strategy to prevent NCDs. Chronic Disease Self-Management Programs (CDSMPs) have demonstrated improvements in health behaviors, health status, and use of healthcare. We evaluated the effects of a 6-week CDSMP on self-efficacy, health behaviors, mental health, health-related quality of life (HR-QoL), and health responsibilities among vulnerable populations with chronic disease in Europe. A prospective cohort study with a 6-month pre-post single-group design was conducted in five European countries. The intervention targeted adults with chronic conditions and low socioeconomic status, as well as their caregivers. The intervention was a 6-week community-based CDSMP in a group setting. Outcomes were measured per self-report questionnaire at baseline and 6-month follow-up: self-efficacy, health behaviors, mental health, HR-QoL, and health responsibilities. Of 1,844 participants, 1,248 (67.7%) completed follow-up and attended ≥4 sessions. For the chronic condition group, the following outcome measures at follow-up significantly improved compared with baseline (all P < 0.002): self-efficacy (SEMCD-6 6.7 vs. 6.4), mental health (PHQ-8 6.3 vs. 7.0), HR-QoL (SF-12 PCS 42.3 vs. 40.2, SF-12 MCS 42.8 vs. 41.4), health utility (EQ-5D-5L 0.88 vs. 0.86), self-rated health (EQ-5D-5L 67.2 vs. 63.9), communication with healthcare providers (2.28 vs. 2.11), understanding information (3.10 vs. 3.02), number of doctor visits (3.61 vs. 4.97), accident and emergency department visits (0.25 vs. 0.48), total nights in a hospital (0.65 vs. 1.13), and perceived medical errors (19.6 vs. 28.7%). No significant changes were detected in dietary habits, physical activity, substance use, and sleep and fatigue. For caregivers without a chronic condition, only doctor visits significantly decreased (1.54 vs. 2.25, P < 0.001). This CDSMP was associated with improvement in self-efficacy, depression, HR-QoL, and health responsibilities over 6 months in a diverse European population with a chronic condition. However, additional interventions targeting lifestyle risk factors are needed to improve health outcomes.

Health-promoting work schedules among nurses and nurse assistants in France: results from nationwide AMADEUS survey

BackgroundThe study aimed to investigate the relationship between different work schedules and self-reported working conditions and health risk behaviours among nurses and nurse assistants (NNA) in France. It hypothesized that work schedules, particularly long shifts, could impact work-life balance, workload, stress levels, burnout, and smoking habits. NNA had the option to work either with a 7-hour schedule, 5 days per week, or with long work schedules consisting of ten to twelve-hour shifts, three days per week. These schedules could potentially influence various aspects of their professional lives.MethodsThe survey followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and was administered to NNA working in public and private national healthcare facilities in France. The researchers used the Job Content Questionnaire to assess the work environment and the French version of the 22-item Maslach Burnout Inventory (MBI) scale to measure burnout.ResultsA total of 3,133 NNA participated in the study, including 2,369 nurses (75.6%) and 764 nurse assistants (24.4%). Among them, 1,811 individuals (57.8%) followed a 7-hour work schedule, while 1,322 individuals (42.2%) had a long work schedule. Multivariate analyses revealed that NNA working with long schedules reported higher psychological demands, more frequent burnout, a higher number of daily smoked cigarettes, and greater coffee consumption. These findings were independent of other factors such as sector of employment, type of healthcare facility, job status, work schedules, night shifts, department specialty, age, and family responsibilities.ConclusionsWhile some NNA may choose long schedules to have more days off, those working with these schedules experience greater work-related burdens and engage in worse health risk behaviours as a coping mechanism. It emphasizes the importance of considering health-promoting work schedules to address the high psychological demands and burnout experienced by NNA with long schedules. Implementing changes in work schedules could potentially improve the overall well-being and job satisfaction of these healthcare professionals.

Femoral Hernia Presenting as Richter’s Variant: A Rare Case Report

Background: Richter's hernia occurs when a portion of the anti-mesenteric border of a bowel wall is captured within the hernia sac, resulting in ischaemia, gangrene, and perforation. Only part of the circumference of the bowel wall is involved in Richter's hernia, which causes strangulation without obstruction. Femoral hernia presenting as a Richter’s hernia is rare. Aim: This is to report a case of Richter’s hernia in a femoral hernia occurring in an adult female. Case Report: In this case, a 62-year-old woman presented with a history of sudden generalized abdominal pain. Before the presentation, she had a six-year history of reducible left inguino-labial swelling that became irreducible two weeks ago. Pallor was present. Her temperature was 39.2°C, her pulse rate was 112 per minute, and her blood pressure was 132/62 mmHg. A diagnosis of a left femoral hernia was made. She was revived, and the groin swelling was explored through a midline incision over the abdomen. There was ischaemia of the anti-mesenteric border of the ileum, along with strangulated preperitoneal fat. The bowel vascularity over the anti-mesenteric border was doubtful, so a resection anastomosis of the segment of the bowel was done followed by a reduction of the bowel loop and herniorraphy. Conclusion: It is rare for a femoral hernia to present with a Richter's hernia, but it can happen even in the absence of obstructive symptoms. Any time there is groin swelling, it is important to get a quick, correct diagnosis and treatment. If there is a delay in identification and treatment, a spontaneous faecal fistula, an uncommon complication, may develop. The relevant authorities must address this as it reflects the status of healthcare in the developing world.

Overview of oral and dental healthcare in Dubai health authority: status, gaps, and initiatives, 2016-2021

This article provides an overview of the current status of oral and dental healthcare within the Dubai health authority (DHA) and highlights the gaps and the impact of initiatives implemented between 2016 and 2021. The oral and dental care program, part of the Dubai health strategy 2016-2021, aimed to enhance oral and dental care by ensuring widespread access to high-quality treatments and effective prevention programs. To gain a comprehensive understanding, an initial assessment of the current state of oral and dental care was conducted with the assistance of an external consultant. This assessment encompassed a review of existing clinical guidelines, frameworks, and awareness initiatives, as well as an evaluation of the patient journey and accessibility. While noteworthy innovative measures were already in place, certain gaps were identified, and recommendations were proposed to address them. Subsequently, specific initiatives and programs were implemented in alignment with these recommendations to bridge the identified gaps. A notable achievement was the development of the Dubai dental protocol, which governs a patient-centered model of care and emphasizes a life-course approach to dental health promotion, addressing the diverse stages of life from pre-pregnancy to geriatric care.

Using artificial intelligence to identify the top 50 independent predictors of subjective well-being in a multinational sample of 37,991 older European & Israeli adults

Subjective well-being (SWB) is widely recognized as an important health outcome, but its complexity, myriad predictors, and analytic requirements pose significant challenges to identifying the relative order and impact of SWB determinants. This study involved a representative sample of 37,991 older adults from 17 European countries and Israel. An aggregate index of SWB was developed and compared across countries, and machine-learning algorithms were used to rank-order the strongest 50 (of an initial 94) SWB predictors from 15 categories. General Additive Modeling (GAM) and low-degree polynomials (i.e., splines) were used to determine the independent effect sizes and significance levels for each of these top-50 SWB predictors. Of the 18 countries included in this study, Denmark had the highest mean SWB, while Greece had the lowest. The two top-ranked SWB predictors (loneliness, social activity satisfaction) were social factors, which also had the highest overall group ranking, followed by physical health, demographics, financial status and personality. Self-reported health was the strongest health-related predictor, neuroticism was the strongest personality predictor, and women reported higher SWB than men. SWB decreased with age, and increased with income up to 350,000 euros/year, after which it declined. Social factors were of primary importance for subjective well-being in this research, while childhood experiences and healthcare status exerted the smallest effects. The vast majority of the top 50 SWB predictors were statistically significant, with the notable exceptions of body mass index and most health behaviors, which may impact SWB indirectly through their effects on physical health. Future multivariate modeling is recommended to clarify the mechanisms for these and other observed relationships.

Factors influencing the decision to use state-funded healthy lifestyle centres in a low-income setting: a qualitative study from Sri Lanka

ObjectiveHealthy lifestyle centres (HLCs) in Sri Lanka provide screening and lifestyle modification services targeting major non-communicable diseases (NCDs). Even though the service is highly accessible and affordable, HLCs are underused...

Life histories of the founders of Kharkiv school of hygiene

This article describes the life history of the founders of Kharkiv school of hygiene Arkadiy Ivanovich Yakobiy (1827–1907) and Ezro Musiyovych Kahan (1887–1948). It is dedicated to the 150th anniversary of the Department of Hygiene and Ecology No.1 of Kharkiv National Medical University (KhNMU) and the 100th anniversary of Research Institute of Occupational Hygiene and Occupational Diseases. Both of these talented individuals left their places of birth, secondary and higher education at some point, due to certain unfavorable consequences of regional life, and arrived in prosperous Kharkiv. Having a wide range of knowledge, both worked in a wide aspect of science and practice that relate to the general well-being of various categories of the population, including environmental, household, epidemic, production, family and other statuses of human life. Both came to the conclusion that identifying and overcoming risk factors for health deterioration is a very promising direction for achieving global well-being of humanity. Based on this, both became the founders of the Kharkiv School of Hygiene. Yakobiy A.I. founded the first department of hygiene at Kharkiv University оn February 1, 1873, and headed it for the following 12 years. Kahan E.M. headed specialized institute for workers' health problems (the first on the territory of the USSR), namely the Institute of Occupational Medicine, іn May 1923, and managed it until 1931. During the term of their work at Kharkiv hygienic institutions, these professors provided a methodological basis for the multi-decade development of the corresponding scientific, pedagogical and practical field of state health care. Keywords: historical aspects, scientific research, health care, lifestyle, professor Yakobiy A.I., professor Kahan E.M.

Nourishing the Nation's Future: The Pioneering Role of Integrated Child Development Services in India's Effort to Combat Child Malnutrition

Background: In India, a considerable portion of the population suffers from undernutrition, contributing to poor health. Under and over-nutrition continue to pose a severe threat to the country despite the increase in economic development and significant measures taken by the Indian government to address the issue of the dual implications of malnutrition. India has the highest rates of underweight children worldwide. The Indian government has started several initiatives to address the issue of early childhood development. One such program with goals for nutrition intervention and early child development is called Integrated Child Development Services (ICDS). &#x0D; Method: It focuses on the helping hand given by ICDS in reducing malnutrition in children aged 0-5 years by comparing data from the National Family Health Survey rounds conducted in India during 2005-06 and 2015-16. The study utilizes several parameters to highlight the program contribution, such as the nutritional status of children, Anemia, immunization coverage, antenatal care, health care, and child mortality. It also highlights the main issues and challenges the policymakers face in implementing the ICDS program.&#x0D; Results: ICDS program has significantly improved in providing services to the beneficiaries, including children aged 0-59 months and pregnant and lactating women.&#x0D; Conclusion: Despite several positive changes in ICDS schemes, the program failed to deliver the services efficiently nationwide. It has great potential to contribute to child development, but several loopholes need to be channelized properly.

43-OR: Beliefs about Medicines, Self-Efficacy, and Health Care Coverage Predict Glycemic Control in Young Adults with Youth-Onset Type 2 Diabetes—The TODAY2 iCount Study

Background: Little is known about psychosocial factors that predict glycemic control (A1c) in young adults with youth-onset type 2 diabetes. Aim: To identify psychosocial predictors of A1c in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort. Design: Longitudinal, measured at T1 (baseline) and T2 (1 year later). Logistic and linear regressions, adjusted for covariates (including T1 A1c), identified T1 predictors of A1c at T2. Participants: N= 348 participants in TODAY2. Mean age=26.0 years, 65.8% female, 37.6% non-Hispanic Black, 36.5% Hispanic, 20.4% non-Hispanic white, mean A1c=9.4%. Measures: Reliable, valid measures of beliefs about medicines, depressive and anxiety symptoms, diabetes distress, diabetes self-efficacy, diabetes attitudes, self-management support and material need insecurities. A1c was examined categorically (high vs. low: high ≥8%) and continuously (percent). Key Results: The high A1c group had more belief in the necessity of (p=0.023), but concerns about (p=0.029), medicines, higher diabetes distress (p&amp;lt;0.001), and lower diabetes self-efficacy (p=0.017). In adjusted analyses, every 5-point higher score measuring beliefs that medicines are overused predicted 3.6 times higher odds of high A1c at T2 (p=0.010). Every 5-point higher self-efficacy score predicted 16.7% lower odds of high A1c at T2 (p=0.033). Surprisingly, those who lacked healthcare coverage were less likely to have high A1c at T2 vs. those with coverage (p=0.10). Every 5-point higher medicines are overused score predicted 48.5% higher % A1c at T2 (p=0.017). No other psychosocial measures predicted A1c. Conclusions: High A1c is common in young adults with youth-onset type 2 diabetes and is predicted over time by beliefs about medicines, diabetes self-efficacy and healthcare coverage status. We must address these factors to help this vulnerable group establish optimal glycemic control. Disclosure P.M.Trief: None. D.Uschner: None. B.Anderson: None. H.Wen: None. J.D.Bulger: None. R.S.Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110456)

DETERMINING COMMITMENT TO THE UNIVERSITY CLINIC OF O. O. BOGOMOLETS NATIONAL MEDICAL UNIVERSITY

Introduction. The article reveals the role of university clinics (hereinafter - UC) in the system of healthcare institutions in Ukraine and their role in implementing the right of every citizen to receive free medical care in state and communal healthcare institutions at the expense of the state budget under the program of medical guarantees. The results of a medical and social study to determine patients' attitudes towards UCs and identify risk factors for non-acceptance are presented.&#x0D; The aim. To determine the place of the University Clinic of the O.O. Bogomolets National Medical University in the medical-industrial cluster system of Kyiv city, conduct a medical and social study of patient attitudes towards the university clinic, and identify the main factors of non-acceptance.&#x0D; Materials and methods. The study was conducted on the principle of systematicity, using medical-statistical methods, methods of anonymous questionnaire survey, and analytical generalization. The construction of the sample of respondents is based on the fact that, based on the study of their opinion, it is possible to draw conclusions about the public opinion of potential clients.&#x0D; The results of the study show that university clinics, as a component of the healthcare system, meet the needs of citizens in terms of the effectiveness of services provided and accessibility to the population. With innovative equipment and the involvement of highly qualified specialists from the University's departments in the diagnostic and treatment process, university clinics are increasingly gaining the trust and support of patients.&#x0D; The results of the survey confirm that the university clinic of the National Medical University named after O.O. Bogomolets has successfully integrated into the medical-industrial cluster of Kyiv, establishing cooperation with the university, the Ministry of Health, other ministries and agencies, as well as with patients.&#x0D; Analysis of the socio-demographic indicators of the respondents in 2022 showed a significant volume of services provided by the clinic to the population of Kyiv and other regions of Ukraine (with the highest number of visits from pensioners - 83, and civil servants - 57 out of 213 surveyed), thus ensuring the implementation of the state program of medical guarantees for citizens. The risk of low probability recommendations by the clinic is influenced by increasing age (p=0.013) and decreasing educational level (p=0.040) of patients. The risk of low satisfaction with the comfort of the clinic increases (p=0.002) when patients visit the medical facility on the recommendation of acquaintances (patients of the clinic).&#x0D; Conclusions. The positive conclusion of the survey is the absence of a risk of probability of re-appealing to the UC based on the analyzed characteristics.

Experience of following up couples affected by hiv and planning pregnancy with use of assisted reproductive technologies in sverdlovsk region

Objective. To analyze the structure of discordant (DC) and concordant (CC) pairs and outcomes of assisted reproductive technologies (ART) without taking into account the correlation of antiretroviral therapy in the Regional Center for AIDS during 2021.&#x0D; Materials and methods. A retrospective analysis of medical records of 210 couples who were consulted at the State Healthcare Institution "RC AIDS" was conducted in order to obtain a conclusion from the medical commission on the possibility of carrying out the ART procedure. The following data were analyzed: channel of infection in men and women, age composition, stage of HIV infection, duration of ART use, ART outcomes.&#x0D; Results. The procedures using ART are carried out in the same percentage as both DC and CC pairs. The outcomes of the ART procedure in PrEP: 2 women (6.9 %) had miscarriage,4 (13.8 %) regression of pregnancy,23 (79.3 %) childbirth; in CC 1 woman (7.7 %) had miscarriage, in the remaining 12 (92.3 %) the procedure was completed with childbirth.&#x0D; Conclusions. As a result of implementing the procedure with ART,35 children were born, not a single case of HIV infection in children was registered.