High Treatment Costs Research Articles

Clinical comparison of lateral supine position mini-percutaneous nephrolithotomy and anatrophic nephrolithotomy in the treatment of complete staghorn renal calculi

BackgroundAt present, the guidelines for urology recommend percutaneous nephrolithotomy (PCNL) as the preferred treatment for staghorn renal calculi (SRC). However, for complete SRC, it has been questioned by clinicians and patients due to high residual stone rate, complications, repeated hospitalizations and high treatment cost. Anatrophic nephrolithotomy (ANL) is a traditional and classic method for the treatment of SRC. Due to its high trauma and high technical requirements, it is difficult to carry out in primary hospitals, and gradually replaced by PCNL. The purpose of this study is to compare the efficacy of PCNL and ANL in the treatment of complete SRC.MethodsOverall, 238 patients with complete SRC were divided into mini-PCNL in lateral supine position group, (n = 190) and ANL group (n = 94) according to treatment for a retrospective cohort study. The calculi parameters, renal function index, comorbidities of calculi, surgical complications, length and frequency of hospitalization, treatment costs, results of postoperative satisfaction survey were compared between the two groups.ResultsThe risk of the residual stone rate after mini-PCNL in lateral supine position was 239 times (OR = 238.667, P < 0.0001), the number of residual stone 1.3 times (OR = 1.326, P < 0.0001), the amount of residual stone 2.2 times (OR = 2.224, P < 0.0001) that of ANL. The risk of the cost of initial treatment after mini-PCNL in lateral supine position was 3.3 times (OR = 3.273, P < 0.0001), the total cost of treatment 4 times (OR = 4.051, P < 0.0001), the total length of hospital stays 1.4 times (OR = 1.44, P < 0.0001) that of ANL, the incidence of postoperative renal atrophy was 2.2 times (OR = 2.171, P = 0.008) higher in the ANL than in the mini-PCNL in lateral supine position. Glomerular filtration rate (GFR) reduction after ANL was 1.4 times (OR = 1.381, P = 0.037) greater than that after mini-PCNL in lateral supine position at 24-month follow-up. The risk of the overall satisfaction of ANL was 58 times (OR = 57.857, P < 0.0001) higher than that of mini-PCNL in lateral supine position, the number of branches of staghorn greater than 8 is a high risk factor for the occurrence of residual stone after mini-PCNL in lateral supine position (OR = 353.137, P < 0.0001).ConclusionAlthough the risk of renal atrophy and decreased GFR after ANL is higher than that of mini-PCNL in lateral supine position, the efficacy of traditional ANL in the treatment of complete SRC was generally superior to that of mini-PCNL in lateral supine position. Moreover, number of branches of staghorn greater than 8 are the preferred ANL for complete SRC.Trial registrationChiCTR2100047462. The trial was registered in the Chinese Clinical Trial Registry; registration date: 19/06/2021.

COVID-19 and Acute Myocardial Infarction: Exploring Clinical Factors and Treatment Expenditures

Background: The concurrence of acute myocardial infarction (AMI) with COVID-19 can complicate the clinical conditions of patients and affect the patterns of hospital resource utilization. This study aimed to investigate and analyze the direct treatment costs of AMI patients with concurrent COVID-19. Methods: This cross-sectional study collected and analyzed clinical data, including symptoms, readmission, and interventions, and treatment cost data for all patients at Tehran Heart Center using SPSS26 software. The mean medical costs of patients from January through May 2022 were also calculated. Results: The COVID-19 group was composed of 72.9% male and 27.1% female patients, whereas the non-COVID-19 group consisted of 67.3% male and 32.7% female patients. Most of the patients in the COVID-19 group (60%) were in the elderly age group (&gt;65 y). The length of stay was 8.70±5.84 days for the COVID-19 group and 6.31±4.42 days for the non-COVID-19 group. The mortality rate in the COVID-19 group was 24%, higher than the 5% rate in the other group. Additionally, the average total treatment costs were $6384.54±$6760.13 in the COVID-19 group and $6362.49±$4343.07 in the non-COVID-19 group (P&gt;0.78 and P&gt;0.050). Conclusion: The study found that the COVID-19 group had a significantly higher in-hospital mortality rate than the non-COVID-19 group. During the follow-up period, the incidence of complications (chest pain and heart failure) was higher in the non-COVID-19 group. It also showed that longer hospital stays resulted in higher treatment costs.

Eco-friendly and sustainable synthesis of carbon quantum dots from waste sulfuric acid of alkylation

Waste sulfuric acid of alkylation (WSAA) poses a challenge in industrial alkylation oil production due to its substantial yield and high treatment costs. This study introduces a novel hydrothermal method that ingeniously couples the treatment of WSAA with the synthesis of high-quality carbon quantum dots (CQDs), offering a cost-effective and controllable approach. Through this method, the particle size and surface functional groups of the resulting CQDs can be precisely regulated. The average particle size tunes from 17.97 nm to 2.42 nm via increasing the hydrothermal temperature, and nitrogen-containing groups can be introduced through adding nitrogen sources during hydrothermal process. The prepared CQDs exhibit notable performance in photocatalysis and heavy metal detection, such as CQDs modified graphite carbon nitride has improved photocatalytic degradation ability and Hg (II) detection ability. Additionally, the environmental impact of the proposed method is substantially minimized, demonstrating a smaller footprint on ecosystems compared to conventional industrial disposal processes. Moreover, the economic cost associated with the method is significantly reduced by approximately 48.4 %, further highlighting its efficiency. Utilizing WSAA as a raw material for CQDs not only facilitates the recycling and sustainable utilization of waste but also enables low-cost production of high-performance carbon materials, presenting a mutually beneficial approach.

Biomarkers in Cutaneous Keratinocyte Carcinomas.

Skin cancer is the most common cancer type in the USA, with over fivemillion annually treated cases and one in five Americans predicted to develop the disease by the age of 70. Skin cancer can be classified as melanoma or non-melanoma (NMSC), the latter including basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC). Development of BCC and SCC is impacted by environmental, behavioral, and genetic risk factors and the incidence is on the rise, with the associated number of deaths surpassing those caused by melanoma, according to recent reports. Substantial morbidity is related to both BCC and SCC, including disfigurement, loss of function, and chronic pain, driving high treatment costs, and representing a heavy financial burden to patients and healthcare systems worldwide. Clinical presentations of BCC and SCC can be diverse, sometimes carrying considerable phenotypic similarities to benign lesions, and underscoring the need for the development of disease-specific biomarkers. Skin biomarker profiling plays an important role in deeper disease understanding, as well as in guiding clinical diagnosis and patient management, prompting the use of both invasive and non-invasive tools to evaluate specific biomarkers. In this work, we review the known and emerging biomarkers of BCC and SCC, with a focus on molecular and histologic biomarkers relevant for aspects of patient management, including prevention/risk assessments, tumor diagnosis, and therapy selection.

The perspectives of caregivers and health service providers on barriers to clubfoot management in Puri-Urban health facility in Ghana.

Clubfoot is a common disabling condition that is prevalent across all populations. Approximately, one out of 750 children globally suffers from clubfoot, and around 150,000 to 200,000 children are born with clubfoot every year with 80% of the cases occurring in developing countries. Clubfoot can result in mobility impairments when not properly managed and researchers have argued that understanding knowledge and perceptions are key components to early identification and effective management of clubfoot. The study explored the barriers to clubfoot management from the perspectives of caregivers and healthcare providers in Duayaw Nkwanta, Ghana. A total of 26 participants made up of 22 caregivers of children with clubfoot and six healthcare providers were purposively sampled for the study guided by a set of inclusion and exclusion criteria. Qualitative data were collected using a semi-structured interview guide through in-depth face-to-face interviews. Interviews were transcribed and analyzed thematically and presented as findings. High cost of treatment, long travel distance, long hours spent at the treatment facility, non-availability of clubfoot treatment services, late reporting of clients for treatment, and non-compliance of parents/caregivers with treatment protocols were identified as the barriers to effective management of clubfoot. These findings have substantial implications for current interventions to effectively manage clubfoot in Ghana.

Cost of cardiovascular disease events in patients with and without type 2 diabetes and factors influencing cost: a retrospective cohort study

BackgroundCardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are non-communicable diseases that impose a significant economic burden on healthcare systems, particularly in low- and middle-income countries. The purpose of this study was to evaluate the hospital treatment cost for cardiovascular disease events (CVDEs) in patients with and without diabetes and identify factors influencing cost.MethodWe conducted a retrospective, cross-sectional study using administrative data from three public tertiary hospitals in Malaysia. Data for hospital admissions between 1 March 2019 and 1 March 2020 with International Classification of Diseases 10th Revision (ICD-10) codes for acute myocardial infarction (MI), ischaemic heart disease (IHD), hypertensive heart disease, stroke, heart failure, cardiomyopathy, and peripheral vascular disease (PVD) were retrieved from the Malaysian Disease Related Group (Malaysian DRG) Casemix System. Patients were stratified by T2DM status for analyses. Multivariate logistic regression was used to identify factors influencing treatment costs.ResultsOf the 1,183 patients in our study cohort, approximately 60.4% had T2DM. The most common CVDE was acute MI (25.6%), followed by IHD (25.3%), hypertensive heart disease (18.9%), stroke (12.9%), heart failure (9.4%), cardiomyopathy (5.7%) and PVD (2.1%). Nearly two-thirds (62.4%) of the patients had at least one cardiovascular risk factor, with hypertension being the most prevalent (60.4%). The treatment cost for all CVDEs was RM 4.8 million and RM 3.7 million in the T2DM and non-T2DM group, respectively. IHD incurred the largest cost in both groups, constituting 30.0% and 50.0% of the total CVDE treatment cost for patients with and without T2DM, respectively. Predictors of high treatment cost included male gender, non-minority ethnicity, IHD diagnosis and moderate-to-high severity level.ConclusionThis study provides real-world cost estimates for CVDE hospitalisation and quantifies the combined burden of two major non-communicable disease categories at the public health provider level. Our results confirm that CVDs are associated with substantial health utilisation in both T2DM and non-T2DM patients.

Randomised, double-blind, placebo-controlled study evaluating the effect of allopurinol on the risk of cardiovascular events in patients with high and very high cardiovascular risk, including the presence of long-COVID-19 syndrome: the ALL-VASCOR study protocol

IntroductionNumerous studies, but not all, have suggested a positive effect of allopurinol on the cardiovascular system. The randomised, double-blind, placebo-controlled study evaluating the effect of allopurinol on the risk of...

“Just as expensive as sending him to college:” barriers and perceptions of treatment in justice-involved youth

BackgroundJustice-involved youth have higher rates of substance use disorders (SUDs) than the general population. Many do not connect with or complete treatment, leading to recidivism. This qualitative study explores perceptions and barriers to treatment in this population.ResultsJustice-involved youth participating in a larger study focused on access to SUD treatment were interviewed about available treatment and justice system involvement. Twenty-one dyads (youth and a guardian) and 3 individual guardians (total N = 45) were interviewed by phone. Inclusion criteria were youth aged 14–17 involved in the justice system that screened positive for SUD. Youth sample was 43% male. Thematic analysis guided the process. The study was Indiana University Institutional Review Board approved (#1802346939).Data was interpreted within the ecological system theory. Youth barriers included willingness to engage in treatment, time constraints/scheduling conflicts, and low perceived usefulness of treatment. Major guardian themes included high cost of treatment, lack of communication by the justice system about treatment, youth unwillingness or disinterest to engage in treatment, and limited program availability.ConclusionsThe barriers to treatment for justice-involved youth are multifaceted and occur across the spectrum of levels of the ecological system, which include parents, peers, social systems, and cultural elements. Many youth and guardians suggested improvements for their interactions with the juvenile justice system. Further examination is needed of current policy implementation to address these concerns.

Unraveling patient satisfaction, associated factors, and dissatisfaction reasons in the provision of health care services for rural communities in Bangladesh: A cross-sectional investigation

BackgroundAccess to high-quality healthcare is a fundamental right, but rural communities in Bangladesh face challenges in accessing such services. Patient satisfaction plays a crucial role in healthcare outcomes. Identifying factors influencing satisfaction is vital for targeted interventions. MethodsA cross-sectional investigation was conducted in rural areas of Sirajganj, Rajshahi, Bangladesh, from April to June 2023. Convenient sampling was employed, and face-to-face interviews were conducted using a semi-structured questionnaire. A total of 411 participants were included in the final analysis. Descriptive statistics, as well as bivariate and multivariable logistic regression analyses, were carried out using SPSS software. ResultsMost unmarried participants (mean age: 41.93 ± 14.54 years; age range: 18–88 years) had primary education and a family income below 15,000 BDT. Among them, 80.3 % reported dissatisfaction with treatment. Significant factors linked to dissatisfaction included low education, being a businessman, living in nuclear families, daily physical exercise, difficulty accessing healthcare, average doctor-patient communication, high treatment costs, long waiting times, government hospital services, proximity to healthcare centers, lack of follow-up services, and absence of Telemedicine or M-health services. ConclusionThis study identifies key factors affecting patient satisfaction in rural Bangladesh. Interventions should focus on improving doctor-patient communication, reducing treatment costs and waiting times, enhancing access to healthcare and follow-up services, and incorporating Telemedicine or M-health services. Special attention is needed for businessmen, nuclear family residents, those who exercise daily, and patients using government hospitals or living near healthcare centers, as these groups report higher dissatisfaction.

Cervical cancer in Malaysia.

Cervical cancer is preventable due to effective screening to detect pre-malignant lesion, and vaccination against its causative organism namely human papillomavirus (HPV). This review article described current situation of cervical cancer in Malaysia. There is decreasing cervical cancer incidence in the country, with age-standardized rate of 10.3, versus 14.1 and 7.5 per 100 000 for worldwide and high-income countries, respectively. School-based HPV vaccination is part of national immunization since 2010, with yearly coverage rate of 83%-91%. The figure declined during coronavirus disease-19 pandemic due to scarce vaccine supply and movement-control order, resulting in about 500 000 students missing their course, with catch-up program currently onboard. Opportunistic cervical screening program started in 1960s with cervical smear cytology, which is succeeded by HPV DNA screening since 2020. Cervical cytology remains indispensable screening method in healthcare facility without access to HPV test kit, and used to triage high-risk HPV positive with abnormal cytology that require urgent colposcopy. Computed tomography is the main imaging modality to assess local and distal extent of cervical cancer. Primary surgical treatment for early-stage cancer is performed by trained gynecologic oncologist, with long waiting list for radiation therapy in locally advanced disease due to limited available public facility. There is restricted access to targeted therapy due to high treatment cost. In conclusion, Malaysia is heading toward cervical cancer elimination through rigorous investment in primary and secondary prevention, and increase in public engagement with the support of government policy enforcement.

Posaconazole-hemp seed oil loaded nanomicelles for invasive fungal disease

Invasive fungal infections (IFI) pose a significant health burden, leading to high morbidity, mortality, and treatment costs. This study aims to develop and characterize nanomicelles for the codelivery of posaconazole and hemp seed oil for IFI via the oral route. The nanomicelles were prepared using a nanoprecipitation method and optimized through the Box Behnken design. The optimized nanomicelles resulted in satisfactory results for zeta potential, size, PDI, entrapment efficiency, TEM, and stability studies. FTIR and DSC results confirm the compatibility and amorphous state of the prepared nanomicelles. Confocal laser scanning microscopy showed that the optimized nanomicelles penetrated the tissue more deeply (44.9µm) than the suspension (25µm). The drug-loaded nanomicelles exhibited sustained cumulative drug release of 95.48 ± 3.27% for 24 h. The nanomicelles showed significant inhibition against Aspergillus niger and Candida albicans (22.4 ± 0.21 and 32.2 ± 0.46 mm, respectively). The pharmacokinetic study on Wistar rats exhibited a 1.8-fold increase in relative bioavailability for the nanomicelles compared to the suspension. These results confirm their therapeutic efficacy and lay the groundwork for future research and clinical applications, providing a promising synergistic antifungal nanomicelles approach for treating IFIs.

A randomized controlled trial of a self-led, virtual reality-based cognitive behavioral therapy on sick role adaptation in colorectal cancer patients: study protocol

BackgroundSignificant concomitants of the sick role maladaptation in colorectal cancer (CRC) patients include inappropriate cognitions, emotional states, and overt conducts associated to disease. This protocol was developed to implement and evaluate the effects of a self-led, virtual reality-based cognitive behavioral therapy (VR-CBT) on the sick role adaptation among working-age CRC patients.MethodsThis is an assessor-blinded, randomized controlled trail that adheres to the SPIRIT 2013 Statement guidelines. A total of 60 working-age CRC patients will be recruited from the colorectal wards of a cancer center and randomly assigned to the VR-CBT group or attention control (AC) group. The VR-CBT group will receive a 7-sessions VR-CBT targeted to sick role adaptation, while the AC group will receive weekly attention at the same time the VR-CBT group receives the intervention. The sick role adaptation, anxiety and depression, illness perceptions, and quality of life will be measured at baseline, 1, 2 and 3-month after completion of the intervention. Side-effects related to VR in the VR-CBT group will be measured at the end of each session. The participants will receive invitations to participate in semi-structured interviews to explore their experiences with the intervention.DiscussionThe positive outcomes and user experience of VR-CBT will advance researches on the effectiveness of psychosocial interventions that aims to promote adaptation to the unexpected sick role on cancer populations. This protocol can be tested as an accessible and feasible alternative to traditional high-cost treatment in a randomized controlled study to improve the outcomes of younger cancer survivors.Trial registration.The protocol was registered on 21 June, 2023 in Chinese Clinical Trial Registry (No.: ChiCTR2300072699) at https://www.chictr.org.cn/.

Economic Viability of Cutting-Edge Genetic Treatments: Balancing Innovation and Fiscal Sustainability in India's Healthcare Sector

Recent breakthroughs in genetic treatments offer unprecedented opportunities for addressing previously incurable conditions, but their astronomical costs present significant challenges to healthcare systems globally, particularly in developing economies like India. This comprehensive study conducts an in-depth economic analysis of three recently approved genetic treatments, meticulously comparing their long-term financial impacts with traditional care methods in the Indian healthcare context. Utilizing advanced economic modeling techniques and drawing from a diverse array of data sources including clinical studies, real-world evidence, and Indian health databases, we evaluate the treatments' cost-effectiveness, budget impact, and potential for long-term savings over an extended 30-year period. Our findings reveal a complex economic landscape: while these cutting-edge treatments require substantial initial investments, ranging from Rs. 10 crore to Rs. 18 crore per patient, they may offer significant long-term economic benefits in specific scenarios. The study goes beyond mere cost analysis, exploring the broader economic implications of these treatments, including their potential impact on workforce productivity, caregiver burden, and the development of India's biotechnology sector. We propose a comprehensive framework for assessing the economic sustainability of such high-cost treatments, taking into account both immediate budgetary constraints and potential long-term societal benefits. Furthermore, we discuss detailed policy implications for the integration of these treatments into India's healthcare system, emphasizing the need for innovative financing mechanisms, value-based pricing models, and adaptive health technology assessment methods. This research aims to provide policymakers, healthcare providers, and industry stakeholders with crucial insights to navigate the complex intersection of medical innovation and economic sustainability in the rapidly evolving landscape of genetic treatments.

The Role of Artificial Intelligence in Early Diagnosis and Molecular Classification of Head and Neck Skin Cancers: A Multidisciplinary Approach.

Cancer remains a significant global health concern, with increasing genetic and metabolic irregularities linked to its onset. Among various forms of cancer, skin cancer, including squamous cell carcinoma, basal cell carcinoma, and melanoma, is on the rise worldwide, often triggered by ultraviolet (UV) radiation. The propensity of skin cancer to metastasize highlights the importance of early detection for successful treatment. This narrative review explores the evolving role of artificial intelligence (AI) in diagnosing head and neck skin cancers from both radiological and pathological perspectives. In the past two decades, AI has made remarkable progress in skin cancer research, driven by advances in computational capabilities, digitalization of medical images, and radiomics data. AI has shown significant promise in image-based diagnosis across various medical domains. In dermatology, AI has played a pivotal role in refining diagnostic and treatment strategies, including genomic risk assessment. This technology offers substantial potential to aid primary clinicians in improving patient outcomes. Studies have demonstrated AI's effectiveness in identifying skin lesions, categorizing them, and assessing their malignancy, contributing to earlier interventions and better prognosis. The rising incidence and mortality rates of skin cancer, coupled with the high cost of treatment, emphasize the need for early diagnosis. Further research and integration of AI into clinical practice are warranted to maximize its benefits in skin cancer diagnosis and treatment.

Treatment of low-C/N nitrate wastewater using a partial denitrification-anammox granule system: Granule reconstruction, stability, and microbial structure analyses

Industrial wastewater discharged into sewer systems is often characterized by high nitrate contents and low C/N ratios, resulting in high treatment costs when using conventional activated sludge methods. This study introduces a partial denitrification-anammox (PD/A) granular process to address this challenge. The PD/A granular process achieved an effluent TN level of 3.7 mg/L at a low C/N ratio of 2.3. Analysis of a typical cycle showed that the partial denitrification peaked within 15 min and achieved a nitrate-to-nitrite transformation ratio of 86.9%. Anammox, which was activated from 15 to 120 min, contributed 86.2% of the TN removal. The system exhibited rapid recovery from post-organic shock, which was attributed to significant increases in protein content within TB-EPS. Microbial dispersion and reassembly were observed after coexistence of the granules, with Thauera (39.12%) and Candidatus Brocadia (1.25%) identified as key functional microorganisms. This study underscores the efficacy of PD/A granular sludge technology for treating low-C/N nitrate wastewater.

Follow-Up Care for Brain Tumors in Low- and Middle-Income Countries: A Systematic Review of Existing Challenges and Strategies for the Future.

Brain tumors have a poor prognosis and a high death rate. Sufficient aftercare is necessary to enhance patient results. But follow-up care provision is fraught with difficulties in low- and middle-income countries (LMICs), where a variety of variables can impede access to care. Therefore, our systematic review aimed to identify challenges to follow-up care for brain tumors and possible solutions in LMICs. A thorough search of the literature was performed from the beginning until October 20, 2022, using Google Scholar, PubMed, Scopus, and CINAHL. Studies focusing on the aftercare of brain tumors in LMICs met the inclusion criteria. Two reviewers used the National Surgical, Obstetric, and Anesthesia Plan categories to identify themes, extract relevant data, and evaluate individual articles. After being discovered, these themes were arranged in Microsoft Excel to make reporting and comprehension simpler. A total of 27 studies were included in the review. Among the studies included, the most frequently cited barriers to follow-up care were financial constraints (54%), long-distance travel (42%), and a lack of awareness about the importance of follow-up care (25%). Other challenges included preference for traditional or alternative medications (4%) and high treatment costs (8%). Proposed strategies included implementing mobile clinics (20%), establishing a documentation system (13%), and educating patients about the importance of follow-up care (7%). In LMICs, several issues pertaining to personnel, infrastructure, service delivery, financing, information management, and governance impede the provision of follow-up treatment for patients with brain tumors. As established by the suggested techniques found in the literature, addressing these issues will necessitate concurrent action by stakeholders, legislators, health ministries, and government agencies.

Enhancing textile wastewater sustainability through calcium hypochlorite oxidation and subsequent filtration with assistance from waste blast furnace iron slag

AbstractThe textile industry is vital to Bangladesh's economy, employing over three million women and being the top foreign exchange earner. However, it severely impacts the environment because of untreated wastewater discharge. High treatment costs, reliant on expensive imported chemicals, worsen the issue. The Environmental Conservation Rules (ECR) 2023 of Bangladesh requires textile wastewater discharge to have a colour of less than 150 Pt‐Co, which current systems struggle to meet affordably. A pilot project tested a sustainable solution using chemical oxidation with calcium hypochlorite and sand filtration with blast furnace iron slag. This method effectively removed colour, and the treated water showed total dissolved solids (TDS) levels of 157 ± 4 mg/L, total suspended solids (TSS) levels of 8 ± 2 mg/L and chemical oxygen demand (COD) levels of 9 ± 3 mg/L, with reductions of 92%, 87% and 94%, respectively, making it a viable solution for resource‐limited economies.

Patients poorly recognize lesions of concern that are malignant melanomas: is self-screening the correct advice?

Australia is known for its outdoor culture, with a large percentage of its population engaging in outdoor recreational activities, aquatic, non-aquatic and outdoor occupational activities. However, these outdoor enthusiasts face increased exposure to ultraviolet radiation (UVR), leading to a higher risk of skin cancer, including malignant melanoma (MM). Over the past 40 years, there has been a significant rise in skin cancer rates in Australia, with two out of three Australians expected to develop some form of skin cancer by age 70. Currently, skin cancer examinations are not endorsed in asymptomatic or low-risk individuals in Australia, with only high-risk individuals recommended to undergo regular skin examinations. Notably, the Melanoma Institute Australia suggests that one-half of patients identify MMs themselves, although this claim appears to be based on limited Australian data which may not reflect contemporary practice. Therefore this study sought to determine the percentage of patients who were able to self-identify MMs as lesions of concern when presenting for a skin cancer examination. Multi-site, cross-sectional study design incorporating a descriptive survey and total body skin cancer screening, including artificial intelligence by a skin cancer doctor. A total of 260 participants with suspect MM lesions were biopsied, with 83 (31.9%) found to be melanomas. Of the true positive MMs only a small percentage of participants (21.7% specificity) correctly had concerns about the suspect lesion being a MM. These MMs were located primarily on the back (44.4%), shoulder (11.1%) and upper leg (11.1%). There was no significant difference in the size between those participants aware of a MM versus those who were not (P=0.824, 24.6 vs 23.4 mm2). Significantly more males identified lesions of concern that were MMs as compared to females (P=0.008, 61.1% vs 38.9%, respectively). With regard to true negatives males and females were similar (52.1% vs 47.9%, respectively). With regard to false negatives (n=65), a greater percentage of males than females did not recognize the MM as a lesion of concern (66.2% vs 33.8%, respectively). Participants were more likely to correctly identify an invasive MM as opposed to an in situ MM (27.3% versus 21.3%). Only a small percentage of participants in this study were able to self-identify either in situ or invasive MM as a lesion of concern with a tendency to identify the more advanced, thicker MMs. Given that MM is associated with a high mortality and cost of treatment, particularly when invasive, the inability of lay persons to identify these cancerous lesions will likely lead to delayed treatment and a possible adverse outcome. We believe the current melanoma screening practices in Australian general practice should be revisited to improve patient outcomes with regard to MM. Additionally, prevention campaigns should include images and primary risk factors for MM.

O-242 Why do we need to act NOW?

Abstract In the early 1970s, the Report of Rome represented a powerful wake up call to the world. If the world population would continue to grow the way it did until then, catastrophe was predicted and the future of the planet would be in danger. All attempts should focus on decreasing world population growth. At that time the global total fertility rate (the number of children born per woman) was around 5. Policies were implemented worldwide aiming to reduce the number of children born, and the widespread introduction – at least in the more developed world - of various contraceptive strategies in the 1970s certainly helped to reach this goal. Especially in Western societies, the liberation in women (increased participation in higher education, more focus on work and career, and control over when to start a family if at all) was significantly enhanced, dramatically reducing the number of children born. In this context, it is no surprise that organizations like the European Union or the World Health Organization gave very low priority to fertility care, which would potentially increase the number of children born. For a population to remain stable, approximately 2.1 child needs to be born per woman. At present, in more than 50% of all countries worldwide – mainly the more prosperous ones – the number of children born is below replacement level. It is anticipated that societies below replacement will increase up to 90% of all countries worldwide during the 21th century. Hence, underpopulation - causing distinct society challenges - rapidly becomes of distinct concern to many governments, especially in European countries, China, and Japan. It is a generally recognized human right, in case individuals or couples wish to establish a family. However, historically little attention has been dedicated by policy makers to fertility care, mainly because the justified concerns for overpopulation. However, the incidence of infertility remains around 15% worldwide and treatment options have significantly improved. In addition, demand for fertility care is increasing year by year, especially by single individuals, lesbian or gay couples and other members from the LGBTQ+ community who wish to establish a family. At present, at least 10% of all children born are due to infertility therapies in some wealthy countries. However, access to fertility care varies dramatically due to high cost of treatment and lack of insurance coverage of such treatments in the great majority of countries. At present, governments increasingly introduce so called “child friendly” policies (such as financial compensations, extended pregnancy and parental leave, free child care, tax benefits, etc), aiming to decrease barriers for people who wish to have children. Unfortunately, improved access to fertility care is not yet part of this discussion. Over half a century, family planning strategies exclusively focused on the prevention of unwanted pregnancies aiming to reduce world population growth. However, at present family building strategies (helping people who wish to establish a family) should also be included in future family planning strategies.

Understanding the Health-Seeking Behaviour of Multiple Sclerosis Patients in Ghana Through Vignettes

Abstract Background: Autoimmune conditions occur when the immune system cannot differentiate between foreign substances and the body’s cells. In multiple sclerosis (MS), the immune system attacks the central nervous system and causes debilitating symptoms. Various factors impact healthcare choices in Africa, including beliefs and social class. Methods: This qualitative study explored the health-seeking behavior of five (5) purposively selected patients with MS in Ghana through in-depth interviews. Results: The results of the study, as reported using vignettes, showed a lack of awareness about MS, and the high cost of treatment caused patients to seek non-biomedical forms of care, such as herbal remedies and divine healing. Conclusion: This study highlights a lack of awareness regarding MS and how this affects the health-seeking behavior of patients. Desperation for an absolute cure to end suffering and the unending drain on their finances led patients to seek other modes of care. Public awareness is needed regarding the condition and alternative means of funding.