High Rate Treatment Research Articles

Midwives' and obstetricians' practice, perspectives and experiences in relation to altered fetal movement: A focused ethnographic study

BackgroundReducing avoidable stillbirth is a global priority. The stillbirth rate in England compares unfavourably to that of some other high-income countries. Poorly-managed episodes of altered fetal movement have been highlighted as a key contributor to avoidable stillbirth, and strategies introduced in England in 2016 to reduce perinatal mortality included recommendations for the management of reduced fetal movement. Despite a downward trend in stillbirth rates across the UK, the effects of policies promoting awareness of fetal movement remain uncertain. ObjectiveTo provide in-depth knowledge of how practice and clinical guidance relating to altered fetal movement are perceived, enacted and experienced by midwives and obstetricians, and explore the relationship between recommended fetal movement care and actual fetal movement care. DesignA focused ethnographic approach comprising over 180 h of observation, 15 interviews, and document analysis was used to explore practice at two contrasting UK maternity units. SettingsAntenatal services at two UK maternity units, one in the Midlands and one in the North of England. ParticipantsThirty-six midwives, obstetricians and sonographers and 40 pregnant women participated in the study across 52 observed care episodes and relevant unit activity. Twelve midwives and three obstetricians additionally participated in formal semi-structured interviews. MethodsFieldnotes, interview transcripts, policy documents, maternity notes and clinical guidelines were analysed using a modified constant comparison method to identify important themes. Resultsfetal movement practice was mostly consistent and in line with guideline recommendations. Notwithstanding, most midwives and obstetricians had concerns about this area of care, including challenges in diagnosis, conflicting evidence about activity, heightened maternal anxiety, and high rates of monitoring and intervention in otherwise low-risk pregnancies. To address these issues, midwives spent considerable time reassuring women through information and regular monitoring, and coaching them to perceive fetal movement more accurately. ConclusionsPractice relating to altered fetal movement might be more uniform than in the past. However, a heightened focus on fetal movement is associated by some midwives and obstetricians with potential harms, including increased anxiety in pregnancy, and high rates of monitoring and intervention in pregnancies where there are no ‘objective concerns’. Challenges in diagnosing a significant change in fetal movement with accuracy might mean that interventions and resources are not being directed towards those pregnancies most at risk. More research is needed to determine how healthcare professionals can engage in conversations about fetal movement and stillbirth to support safe outcomes and positive experiences in pregnancy and birth. RegistrationNot registered. Tweetable abstractMidwives and obstetricians take #reducedfetalmovement seriously but worry this ‘unreliable’ symptom increases anxiety, monitoring and intervention in many ‘low risk’ pregnancies.

Atherogenic lipid profile in patients with acute coronary syndrome

Abstract Background Adverse atherogenic lipid profile is associated with an increased risk of major adverse cardiac events in patients with acute coronary syndrome (ACS). Objective To evaluate the control status of atherogenic lipid profile among ACS patients within 12 months after discharge. Methods We retrospectively analyzed the data from the multi-center iHeart program. Twenty tertiary hospitals in China were included. Natural language processing technique was used to extract real-world data from electronic health records (EHRs). Patients with a diagnosis of ACS from January 2014 to December 2021 during index hospitalization and having at least one medical record after discharge within 12 months were enrolled. Measurements of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non–high-density lipoprotein cholesterol (non-HDL-C), triglycerides (TGs), apolipoprotein B (ApoB), lipoprotein (a) (Lp[a]) at baseline and follow-up were collected and analyzed. Remnant cholesterol (RC) was calculated as TC minus HDL-C minus LDL-C. The treatment goal of LDL-C was defined as <1.8 mmol/L according to the guideline. An even lower LDL-C goal of <1.4 mmol/L was recommended in specific patients at extremely high risk with concomitant diabetes or ischemic cerebral vascular diseases. Results Among the 3956 patients, the mean age was 72 (12) years, and 64.8% were men. Diabetes was common (22.7%). There were 1612 (40.7%) patients with unstable angina, 391(9.9%) patients with non-ST-elevation myocardial infarction, 1146 (29.0%) patients with ST-elevation myocardial infarction, and 807 (20.4%) patients with undetermined ACS category. At baseline, the mean values for TC, LDL-C, HDL-C, non-HDL-C, ApoB, and RC were 4.61 (1.26) mmol/L, 2.83 (0.98) mmol/L, 1.12 (0.30) mmol/L, 3.38 (0.75) mmol/L, 96 (34) mg/dL, and 0.65 (0.56) mmol/L, respectively. The median values for TGs and Lp(a) were 1.44 mmol/L [1.06, 2.00] and 27.22 mg/dL [12.34, 39.2], respectively. The rate of lipid-lowering treatment was 94.8% (statins 93.1%, PCSK9 inhibitors 0.4%). The levels of TC, TGs, LDL-C, HDL-C, non-HDL-C, and ApoB were significantly decreased (P < 0.001) within 12 months. Median Lp(a) was 19.52 mg/dL [8.73, 39.08] (P = 0.117). Mean RC was 0.69 (1.10) mmol/L (P < 0.001). Overall, the proportion of patients achieving the LDL-C level of <1.8 mmol/L at baseline increased from 13.42% to 36.6% during follow-up. In patients with concomitant diabetes or ischemic cerebral vascular diseases, the rate of LDL-C <1.4 mmol/L was 17.79% and 17.52%, respectively. Conclusion Only 1/3 of patients had LDL-C <1.8mmol/L within 12 months after ACS. Despite the high treatment rate of statins, Lp(a) level had no change beyond the reduction in LDL-C. Elevated remnant cholesterol may be a critical contributor to residual risk. Novel therapeutics targeting the whole atherogenic lipid profile will be warranted to improve cardiovascular outcomes.LDL-C control rate within 12 months

Survival of Patients with Multiple Myeloma Treated with Bortezomib-Based Triplets and Autologous Hematopoietic Stem Cell Transplant As First Line in Latin America

Background In transplant-eligible newly diagnosed multiple myeloma (NDMM), triplet combinations including proteasome-inhibitors and immunomodulators are the backbone of induction therapy before autologous stem cell transplant (ASCT). Post-ASCT maintenance with lenalidomide is the standard of care. This approach yields deep responses and long overall survival. In Latin America (LATAM) there is scarce data about the outcome of bortezomib-based triplets and ASCT. The aim of this study was to evaluate overall survival (OS) in Latin American transplant-eligible NDMM patients induced with bortezomib-based triplets and ASCT. Methods Retrospective international multicenter cohort study. Patients older than 18 years with MM, who received bortezomib-based triplets followed by ASCT as first line, between 2010 and 2022 were analyzed. Data were collected from clinical records in a standardized report form. We analyzed clinical characteristics at diagnosis and frontline therapy outcomes. Descriptive statistics were performed. Comparisons of characteristics between groups were made using the Chi-square test, Student´s T-test and ANOVA, as appropriate. Survival analysis was performed using Kaplan-Meier curves, comparisons between groups by Log Rank method, and calculations of the risk relationships by Cox regression. Statistical analysis was performed by using IBM SPSS version 25.0. Results A total of 279 patients with NDMM were included, 124 from Argentina, 20 from Chile, 30 from Mexico, 20 from Paraguay, 43 from Peru, 33 from Uruguay, and 9 from Venezuela. Median age was 57 years (range 29-75) with a male predominance (54.8%). Most patients (58%) were treated in private centers. 56.1% were IgG subtype, 24.8% IgA and 17.3% light chain MM. According to the ISS, 69.2% were classified as ISS II or III. Bone disease was the most frequent myeloma-defining events (75.9%), followed by anemia (61.4%), renal failure (24.2%), and hypercalcemia (20.1%). Fluorescence in situ hybridation (FISH) analysis was performed in 53.4% of patients (only 41% with plasma cell sorting), del17p was the most frequent anomaly found (17.4%), followed by t(4;14) (6%), and t(14;16) (2%). The most frequently used induction regimen was cyclophosphamide-bortezomib-dexamethasone (CyBorD) (38.7%), followed by bortezomib-thalidomide-dexamethasone (VTD) (33.7%), and bortezomib-lenalidomide-dexamethasone (VRD) (27.6%). Very good partial remission (VGPR) or better was achieved in 88.3% for VRD, 81.9% for VTD, and 76.8% for CyBorD (p=0.138). Median time from diagnosis to ASCT was 261.5 days. Only 7 patients received tandem ASCT as first-line consolidation. Maintenance treatment was administered to 88.2% of patients and was based on lenalidomide, thalidomide, bortezomib, and lenalidomide+bortezomib in 67.9%, 16.3%, 8.9% and 3.3%, respectively. Treatments and responses are shown in detail in Table 1. With a median follow-up of 45 months (range 7-140), median progression-free survival (PFS) was 33 months (95% CI, 26.7 - 39.3). Median PFS according to treatment was 21 months (95% CI, 14.3 - 27.7) for VRD, 35 months (95% CI, 22.2 - 47.8) for VTD, and 36 months (95% CI, 28 - 44) for CyBorD, p=0.004. Median OS of the whole cohort was not reached (NR), and 86% at 45 months; 75 months for VRD (95% CI, 44 - 106), and NR for CyBorD and VTD (p=0.284) (Figure 1). In the multivariate analysis hypercalcemia (p=0.01) and extramedullary disease (p=0.03) were the only independent risk factors. Discussion FISH was performed only in half of our patients, and the majority without plasma cell sorting. The main used regimen was CyBorD. Although better PFS was obtained with CyBorD, no significant differences in responses or OS were found between VRD, VTD or CyBorD. The reason why VRD PFS and OS were lower merits further study. We report a high rate of maintenance treatment.

P031 A Novel Oral Appliance Implementation Protocol Using Nightly Portable Monitoring for OSA Patients Failing CPAP therapy

Abstract Introduction Oral Appliance Therapy (OAT) is an effective second line treatment for OSA. However, OAT devices do not have active efficacy monitoring, hence little is known about methods to best identify the optimal degree of mandibular advancement. Methods Consecutive OSA patients undergoing OAT at a sleep disorders service were recruited to participate in a novel titration protocol using nightly monitoring via a portable device (NightOwl®, Ectosense, Belgium). Demographic & sleep study (PSG) data, and key NightOwl® metrics were collected. A treatment PSG was conducted at conclusion of OAT implementation using identified optimal point of mandibular advancement. Results 80 subjects were recruited (52 male, 65%) with mean (±SD) age 49±12 years, BMI 28±4.4 kg/m2, Epworth score (ESS) 9.1±4.9. Baseline PSG showed mean AHI 28±20 events/hr, nadir SpO2 84±21%, time SpO2<90% 8.3±30 minutes. Blood pressure monitoring at baseline showed mean day BP 123/70mmHg and night BP 106/57mmHg. The mean mandibular advancement implemented was 2.9±1.7mm. Post treatment mean ESS was 5.1±3.5 (p<0.001). 62/68 (91%) subjects reported perceived benefit on OAT, 49/53 (92%) reduced snoring, 51/62 (82%) improved sleep, 49/62 (79%) increased energy. Treatment PSG on completion of the protocol showed AHI 14±10 events/hr (p<0.001), nadir SpO2 82±33% (p>0.05), time SpO2<90% 1.2±21 minutes (p=0.04). 48/63 (76%) met the AHI definition of OAT success. Discussion This study demonstrates a novel OAT protocol which led to minimal degree of mandibular advancement, resulting in high rates of symptom benefit and effective treatment of OSA.

Clinical, imaging, and management features of symptomatic carotid web: Insight from CAROWEB registry.

Although carotid web (CaW) is increasingly diagnosed as a cause of cryptogenic stroke, data are still limited to monocentric small sample cohort. To broaden knowledge on symptomatic CaW, CAROWEB registry has been recently implemented. In a large cohort of symptomatic CaW patients, we described epidemiologic characteristics, admission clinical and imaging features, and the current management including the secondary preventive strategy choice made in comprehensive French Stroke Units. CAROWEB is an ongoing French observational multicenter registry enrolling consecutive CaW patients diagnosed after an ipsilateral ischemic stroke (IS) or transient ischemic attack (TIA). Submitted cases were validated by two experienced neurologist and neuroradiologist. Clinical, imaging, and management features were collected for this study. Between June 2019 and December 2021, 244 cases were submitted by 14 centers, 42 rejected, and 202 included (IS, 91.6%; TIA, 7.9%; retinal infarction, 0.5%; mean age, 50.8 ± 12.2 years; female, 62.9%; Caucasian, 47.5%; Afro-Caribbean, 20.3%). IS patients showed median (interquartile range (IQR)) admission National Institutes of Health Stroke Scale (NIHSS) score, 8 (2-15); intracranial artery occlusion, 71.8%; ipsilateral chronic cerebral infarction (CCI), 16.3%; and reperfusion treatment, 57.3%. CaW was not identified during the mechanical thrombectomy procedure in 30 of 85 (35.3%) patients. Secondary prevention was invasive in 55.6% (stenting, n = 80; surgery, n = 30). In multivariable analysis, the invasive therapeutic option was associated with ipsilateral CCI (odds ratio (OR): 4.24 (1.27-14.2), p = 0.019) and inversely associated with risk factors (OR: 0.47 (0.24-0.91), p = 0.025) and admission NIHSS score (OR: 0.93 (0.89-0.97), p = 0.001). CaW must be considered in all ethnic groups including Caucasians. Secondary prevention is heterogeneous in large French Stroke Centers. The absence of risk factors, milder severity strokes, and ipsilateral CCI were predictive variables of secondary invasive treatment. The high rate of invasive treatment suggests that medical treatment alone is deemed ineffective to avoid recurrence and emphasize the need of randomized trials.

Exploration of eMSCs with HA-GEL system in repairing damaged endometrium after endometrial cancer with fertility-sparing treatment.

Despite the high complete response rate of fertility-sparing treatment in early-stage endometrial cancer (EC), the low pregnancy rate is a clinical challenge. Whether endometrium-derived mesenchymal stem cells (eMSCs) can repair damaged endometrium after EC reversal remains unclear. This study explored the potential therapeutic effects of eMSCs with suitable scaffold materials on endometrial damage caused by EC. Here, appropriate engineering scaffold materials were compared to identify the most suitable materials to carry eMSCs. Then, safety and efficacy evaluations of eMSCs with a suitable hyaluronic acid hydrogel (eMSCs/HA-GEL) were investigated in in vivo experiments with subcutaneous xenotransplantation in Balb/C nude mice and a model of endometrial mechanical injury in rats. HA-GEL has minimal cytotoxicity to eMSCs compared to other materials. Then, in vitro experiments demonstrate that eMSCs/HA-GEL enhance the inhibitory effects of progestins on EC cell biological behaviors. eMSCs/HA-GEL significantly inhibit EC cell growth and have no potential safety hazards of spontaneous tumorigenesis in Balb/C nude mouse subcutaneous xenotransplantation assays. eMSCs/HA-GEL intrauterine transplantation effectively increases endometrial thickness and glandular number, improves endometrial blood supply, reduces fibrotic areas, and improves pregnancy rates in a rat endometrial mechanical injury model. GFP-eMSCs/HA-GEL intrauterine transplantation in rats shows more GFP-eMSCs in the endometrium than GFP-eMSCs transplantation alone, and no tumor formation or suspicious cell nodules are found in the liver, kidney, or lung tissues. Our results reveal the safety and efficacy of eMSCs/HA-GEL in animal models and provide preliminary evidence for the use of eMSCs/HA-GEL as a treatment for EC-related endometrial damage.

Examining the Role of Race in End-of-Life Care in the Intensive Care Unit: A Single-Center Observational Study.

Prior studies have shown variation in the intensity of end-of-life care in intensive care units (ICUs) among patients of different races. We sought to identify variation in the levels of care at the end of life in the ICU and to assess for any association with race and ethnicity. An observational, retrospective cohort study. A tertiary care center in Boston, MA. All critically ill patients admitted to medical and surgical ICUs between June 2019 and December 2020. Self-identified race and ethnicity. The primary outcome was death. Secondary outcomes included "code status," markers of intensity of care, consultation by the Palliative care service, and consultation by the Ethics service. A total of 9083 ICU patient encounters were analyzed. One thousand two hundred fifty-nine patients (14%) died in the ICU; the mean age of patients was 64 years (standard deviation 16.8), and 44% of patients were women. A large number of decedents (22.7%) did not have their race identified. These patients had a high rate of interventions at death. Code status varied by race, with more White patients designated as "Comfort Measures Only" (CMO) (74%) whereas more Black patients were designated as "Do Not Resuscitate/Do Not Intubate (DNR/DNI) and DNR/ok to intubate" (12.1% and 15.7%) at the end of life; after adjustment for age and severity of illness, there were no statistical differences by race for the use of the CMO code status. Use of dialysis at the end of life varied by self-identified race. Specifically, Black and Unknown patients were more likely to receive renal replacement therapy, even after adjustment for age and severity of illness (24% and 20%, p = 0.003). Our data describe a gap in identification of race and ethnicity, as well as differences at the end of life in the ICU, especially with respect to code status and certain markers of intensity.

Renal hemodynamics in patients with resistant hypertension and type 2 diabetes mellitus.

Aim To study renal hemodynamics in patients with resistant arterial hypertension (RAH) in combination with type 2 diabetes mellitus (DM2) and to identify factors involved in the increase in intrarenal vascular resistance.Material and methods This study included 59 patients (25 men) with RAH in combination with DM2. Mean age of patients was 60.3±7.9 years; 24-h blood pressure (24-BP) (systolic, diastolic, SBP/DBP) was 158.0±16.3 / 82.5±12.7 mm Hg during the treatment with 4.3 [4.0;5.0] antihypertensive drugs; glycated hemoglobin (HbA1c) was 7.5±1.5 %; estimated glomerular filtration rate (eGFR) was 73.1±21.8 ml/min / 1.73 m2 (CKD-EPI equation). Measurement of office BP, 24-h BP monitoring, renal artery (RA) Doppler, routine lab tests including determination of GFR (CKD-EPI), 24-h urine albumin excretion, and ELISA measurement of blood lipocalin-2, cystatin C, high-sensitive C-reactive protein (hsCRP), and asymmetric dimethylarginine (ADMA) were performed for all patients.Results Incidence of increased RA resistive index (RI) was 39% despite the high rate of vasodilator treatment (93% for renin-angiotensin-aldosterone system inhibitors, 78% for calcium antagonists). According to a correlation and regression analysis, RA RI values were correlated with the kidney function (r=-0.46, p<0.001 for eGFR, r=0.56; p=0.006 for lipocalin-2), age (r=0.54, p<0.001), increases in concentrations of hsCRP (r=0.35, p<0.001) and ADMA (r=0.39, p=0.028), the increase in vascular stiffness (r=0.59, p<0.001 for pulse BP (PBP) as well as DM2 duration, and HbA1c (r=0.33, p<0.001 for both). The independent association of RA RI with the age, PBP, and duration of DM2 was confirmed by the results of multivariate regression analysis. According to the ROC analysis, the threshold level of RA RI corresponding to a decrease in GFR <60 ml / min / 1.73 m2 was ≥0.693 conv. units.Conclusion In more than one third of patients with RAH in combination with DM2, increased renal vascular resistance was documented, which was closely associated with impaired kidney function, age, DM2 duration and severity, and markers of low-grade inflammation, endothelial dysfunction, and vascular stiffness. The value of RA RI ≥0.693 conv. units was a threshold for the development of chronic kidney disease (CKD).

Assessment of the state of patients with spastic cerebral palsy at transition to adult medical institutions: a cross-sectional study

Introduction The purpose of this cross-sectional study was anamnestic evaluation of the treatment performed in patients with GMFCS levels I, II, III spastic cerebral palsy and to assess their motor status, quality of life and anatomical disorders in the lower extremities in the age range from 17 to18.5 years.Material and methods A cross-sectional study was conducted in patients with spastic types of cerebral palsy at the age of 17-18.5 years. The completeness and consistency of previous treatment (according to medical documentation), motor abilities, quality of life, radiographic anatomy of the lower extremities were studied.Results We selected 73 patients meeting the inclusion criteria out of 201 cases. Insufficient systematic implementation of complex therapeutic measures was revealed, which was reflected in a high rate of orthopedic interventions (93.1 %). Fibromyotomies, triceps lengthening surgeries performed at an early age (6-7 years) contribute to the development of an iatrogenic crouch gait pattern, a decrease in motor abilities and quality of life by the age of 17-18 years. The probability of maintaining a positive result and improving motor ability by the end of the childhood period is significantly higher in the subgroup of multilevel orthopedic interventions than in patients after fibromyotomies or who did not undergo orthopedic treatment; the differences are significant as the chi-square test for binary samples shows (p = 0.012).Conclusions The severity of impairment of motor abilities, quality of life, incidence of the crouch gait pattern in patients with spastic types of cerebral palsy are close between subgroups at the time of transition to adult medical and diagnostic institutions. The quality of life and motor status after multi-level intervention improves and remains stable by the end of the childhood. Early surgical interventions for lengthening the triceps, fibromyotomy reduce motor potential in the long term, cause the development of the iatrogenic crouch gait pattern, and decrease the quality of life of adolescents with mild neurological disorders.

The first alongside midwifery unit in Spain: A retrospective cohort study of maternal and neonatal outcomes.

Midwife-led units have been shown to be safer and reduce interventions for women at low risk of complications at birth. In 2017, the first alongside birth center was opened in Spain. The aim of this study was to compare outcomes for women with uncomplicated pregnancies giving birth in the Midwife-led unit (MLU) and in the Obstetric unit (OU) of the same hospital. Retrospective cohort study comparing birth outcomes between low-risk women, depending on their planned place of birth. Data were analyzed with an intention-to-treat approach for women that gave birth between January 2018 and December 2020. A total of 878 women were included in the study, 255 women chose to give birth in the MLU and 623 in the OU. Findings showed that women in the MLU were more likely to have a vaginal birth (91.4%) than in the OU (83.8%) (aOR 2.98 [95%CI 1.62-5.47]), less likely to have an instrumental delivery, 3.9% versus 11.2% (0.25 [0.11-0.55]), to use epidural analgesia, 19.6% versus 77.9% (0.15 [0.04-0.17]) and to have an episiotomy, 7.4% versus 15.4% (0.27 [0.14-0.53]). There were no differences in rates of postpartum hemorrhage, retained placenta, or adverse neonatal outcomes. Intrapartum and postpartum transfer rates from the MLU to the OU were 21.1% and 2.4%, respectively. The high rate of obstetric interventions in Spain could be reduced by implementing midwife-led units across the whole system, without an increase in maternal or neonatal complications.

Mathematical model for the dynamics of bacterial meningitis (Meningococcal meningitis): a case study of Yobe State Specialist Hospital, Damaturu, Nigeria

A model for bacterial meningitis was created by adding a class of transporters to the basic Susceptible Carrier Infected and Recovered (SCIR) model, since vaccination and treatment are the best methods of controlling the transmission of most overpowering sicknesses. Immunization assists helpless people with building either a drawn out invulnerability or transient resistance while treatment decreases the quantity of sickness actuated passing and the quantity of irresistible people locally or country. This study comprises of a mathematical model for bacterial meningitis dynamics that can be used to a wide range of mathematical modeling problems. In this exploration, a nonlinear deterministic model with time reliance controls has been proposed to depict the elements of bacterial meningitis in a populace. We discovered that the (EEP) and (DFE) are locally asymptotically stable in our study. We now advise the researcher to determine whether it is globally asymptotically stable in order to achieve optimal disease control. The presence of an endemic harmony and the calculation of the reproduction number . The mathematical arrangement shows that vaccinating vulnerable people will prompt disposal of the infection in the public and furthermore it will lessen the weight on wellbeing suppliers. Numerical simulations were presented to explain the parameters in the end path in the model were carried out by using MAPLE software. Most likeable of this research work shows that the rate at which treatment and vaccination rate increases to the higher value the recovered compartment increases to the peak point. This means treatment and vaccination has an impact on reducing the case of bacterial meningitis in a population. Now we conclude that a high infection transmission rate requires a high vaccine and treatment rate on the effect of vaccination against meningitis.

The increasing association between child poverty and children in out-of-home care - an ecological longitudinal analysis of Finnish municipalities in the period 1992–2021

BackgroundInternational evidence indicates that child poverty increases the risk of child welfare intervention needs but Finland, paradoxically, has low child poverty rates and high child welfare intervention rates. We investigate the extent to which the rate of social assistance use in families with children, as a proxy for child poverty, can be associated with the rate of children in out-of-home care in Finnish municipalities. MethodsData on the annual rate of social assistance use and out-of-home care were drawn from national registers for 216 Finnish municipalities from 1992 to 2021. Linear regression models were utilised to investigate the extent to which the social assistance use rate explained child out-of-home care rates, both spatially and temporally, across municipalities and years while adjusting for the unemployment rate. ResultsThe rate of out-of-home care increased from some 700 to 1600 per 100,000 children over the period 1992–2021. A percentage point higher rate of the social assistance use was associated with 44–72 more children placed in out-of-home care per 100,000 children, net of the unemployment rate. This association was stronger in more recent time periods. A smaller association was observed within municipalities over time: a percentage point increase in social assistant use was linked to some 4–25 more children placed in out-of-home care per 100,000 children. ConclusionOut-of-home care is increasingly concentrated in Finnish municipalities with high rates of families receiving social assistance. Preventative child welfare interventions are therefore required in areas with higher rates of economic difficulties among families.

Bone Health Management in Elective Orthopaedic Surgery: A Claims-Based Observational Study.

There are limited data on the management of bone health, including bone mineral density (BMD) evaluation and osteoporosis (OP) treatment, in patients undergoing elective orthopaedic surgeries. This was a retrospective cohort study using administrative claims data from Symphony Health, PatientSource for patients aged ≥50 years with documented kyphoplasty/vertebroplasty (KP/VP), total knee arthroplasty (TKA), and total hip arthroplasty (THA). Risk stratification to identify patients at very high risk for fracture (VHRFx) was based on clinical practice guideline recommendations to the extent information on variables of interest were available from the claims database. A total of 251919 patients met inclusion criteria: KP/VP (31018), TKA (149849), and THA (71052). The majority were female (80.3%) with a mean (SD) age of 68.5 (7.5) years. Patients undergoing KP/VP were older and had a greater comorbidity burden associated with risk for falls, mobility issues, muscle weakness, and respiratory and cardiovascular diseases. In the 6 months before surgery, 11.8% of patients were tested and/or received treatment for OP. Patients undergoing KP/VP were more likely to be tested and/or treated (17.5%) than patients undergoing TKA (11.0%) or THA (10.9%). Overall, men had a lower rate of testing and/or treatment than women (4.6% vs 13.5%). In the 12 months before surgery, patients with an OP diagnosis and at VHRFx (30.8%) had a higher rate of treatment and/or testing than those without OP (11.5%), or those without OP but with a fracture in the year preceding surgery (10.2%). Bone health management is suboptimal in patients undergoing elective orthopaedic surgeries and is worse in men than in women. Proper management of OP before and after surgery may improve outcomes.

Trauma Experience Among Women Who Have Substance Use Disorders and are Homeless or Near Homeless

Women with substance use disorders (SUDs) who are homeless or near homeless have high rates of mental health, behavioral health, and SUD treatment needs. To effectively respond to these needs, it is critical to understand the population-specific trauma experiences of these women. This descriptive study examined the extent and nature of trauma experience among women who have an SUD and are homeless or near homeless. Results (n = 851 women) indicated high rates of trauma experience. All participants (100%) reported at least one type of trauma experience in their lifetime, with the majority (75.3%) having experienced five to seven of the seven types of trauma experiences assessed. Participants reported high levels of emotional severity related to the majority of traumatic events experienced. The pervasiveness of the trauma experiences and the related emotional impact among women with SUDs who are homeless or near homeless reinforce the necessity for trauma-informed care in treatment settings.

Patient journey for hypertension and dyslipidemia in Saudi Arabia: highlighting the evidence gaps

BackgroundIn recent years, Saudi Arabia has witnessed staggering rates of hypertension and dyslipidemia-related cardiovascular (CV) deaths, overburdening the healthcare ecosystem of the country. Appropriate public health interventions can be devised through quantitative mapping of evidence. Identification of potential data gaps can prioritize future research needs and develop a ‘best-fit’ framework for patient-centric management of hypertension and dyslipidemia.MethodsThis review quantified data gaps in the prevalence and key epidemiological touchpoints of the patient journey including awareness, screening, diagnosis, treatment, adherence, and control in patients with hypertension and dyslipidemia in Saudi Arabia. Studies published in English between January 2010 and December 2021 were identified through a structured search on MEDLINE, Embase, BIOSIS, and PubMed databases. An unstructured search on public and government websites, including Saudi Ministry of Health, without date limits was carried out to fill data gaps. After exclusion of studies based on predefined criteria, a total of 14 studies on hypertension and 12 studies and one anecdotal evidence for dyslipidemia were included in the final analyses.ResultsThe prevalence of hypertension was reported to be 14.0%–41.8% while that for dyslipidemia was 12.5%–62.0%. The screening rate for hypertension was 100.0% as revealed by the nationwide surveys. Among hypertensive patients, only 27.6%–61.1% patients were aware of their condition, 42.2% patients underwent diagnosis, 27.9%–78.9% patients received antihypertensive treatment, 22.5% patients adhered to treatment medication, while blood pressure (BP) control was achieved in 27.0%–45.0% patients. Likewise, among patients with dyslipidemia, 10.5%–47.3% patients were aware of their condition, 34.6% patients were screened, and 17.8% underwent diagnosis. Although high treatment rates ranging from 40.0%–94.0% were reported, medication adherence recorded was 45.0%–77.4% among the treated patients. The overall low control rates ranged from 28.0%–41.5%.ConclusionsThe study findings highlight evidence gaps along key touchpoints of patient journey. Reinforcing the efforts for high-quality evidence-based research at a national level may pave a path for better resource utilization and provide guidance to practice and amend health policies for patients, healthcare practitioners (HCPs), and healthcare policy makers for better patient outcomes in Saudi Arabia.

Leveraging National Data and Regional Innovations to Right-Size Tobacco Treatment Policy for Behavioral Health in a Midwestern State.

People with mental health (MH) and substance use disorders (SUD) have high rates of tobacco use and tobacco-related mortality. They want to stop smoking and studies have shown they can quit, but few behavioral health facilities provide tobacco treatment. The purpose of this paper is to describe how a midwestern statewide behavioral health collaboration used regional data to pinpoint strengths and weaknesses in tobacco treatment trends, identified policies in neighboring states that were associated with high rates of tobacco treatment, and worked with state leaders to implement these policies to enhance treatment. We used publicly available data from 2 SAMHSA annual national surveys of MH/SUD facilities to describe tobacco treatment services and policies in behavioral health facilities in Kansas and 3 neighboring states (Missouri, Nebraska and Oklahoma). We interviewed neighboring state leaders to identify policies they had implemented to boost tobacco recovery services in behavioral health. We collaborated with our state behavioral health agency to encourage adoption of similar policies. Using 7 years of survey data (2014-2020), rates for screening, counseling, and medications for tobacco dependence were highest in Oklahoma and Missouri facilities. Oklahoma had the highest percentages of facilities reporting smoke-free campuses. In all states, rates of tobacco service provision and smoke-free campuses were lower among SUD facilities than in MH facilities. State leaders associated several policies with high performance, including (a) requiring programs contracting with the state to conduct screening, provide counseling, and adopt smoke-free campuses (Oklahoma and Missouri); (b) state-based collection of tobacco treatment service provision data (Oklahoma); (c) providing facilities with free NRT for clients (Oklahoma); (d) setting benchmarks for service provision (Oklahoma); (e) comprehensive Medicaid coverage of cessation medications (Missouri). Upon review of these findings, Kansas behavioral health officials adopted a 2-year process to implement similar policies and are integrating tobacco treatment requirements into the state Certified Community Behavioral Health Clinic program. Summarizing and sharing freely-available data across states laid the groundwork for cross-border networking and policy change. State and federal agencies should integrate these policies into contracts and block grants to reduce tobacco-related disparities among individuals with behavioral health conditions.

An Overview of the PRESYON 4 Trial and Its Impact on Practice

Cardiovascular diseases have overtaken infectious diseases as the most common causes of morbidity and mortality in the Philippines. Among Filipinos, hypertension is the most common risk factor associated with cardiovascular diseases. The Philippine Heart Association–Council on Hypertension Report on Survey of Hypertension (PRESYON study series) were initiated to assess the problems of increased cardiovascular disease prevalence. The PRESYON studies found an increase in the prevalence of hypertension, from 22% in the 1990s to 37% in 2021. There was also an increase in obesity in the hypertensive population, and the prevalence of smokers was persistently high. However, the incidence of diabetes, stroke and MI decreased slightly. The 2021 survey (PRESYON 4) found a higher BMI and central obesity rate among hypertensive individuals. Angiotensin receptor blockers are the most commonly used drugs for the treatment of hypertension. Despite high rates of treatment (68%) and compliance (86%), the rate of blood pressure control remains low (37%). Most patients are on monotherapy. There was a high level of unawareness of high blood pressure. Hypertension remains a problem in the Philippines due to its increasing prevalence, high rates of unawareness, low rates of blood pressure control and a poor risk profile. Physicians should be more aggressive in achieving blood pressure control, especially through the use of drug combinations, and controlling risk factors through patient education, promoting a healthy lifestyle and smoking cessation.

(012) Vulvovaginal Atrophy (VVA) Treatment Compliance Correlates with Improved Outcome

Abstract Introduction To effectively manage chronic conditions such as VVA, daily or semi-daily patient compliance to a treatment regimen is essential. Despite the fact that risk of cancer or cancer recurrence prevents many women from treating their VVA with hormone therapy, patient compliance to over-the-counter moisturizers and lubricants is relatively low: 40% of women find them completely unsatisfactory due to difficulty of use and lack of desired treatment outcome. As an alternative to current therapies, an at-home, easy-use therapeutic ultrasound device was developed with the potential to increase treatment compliance and help women successfully manage their VVA. This study aimed to optimize patient compliance by increasing ease of device use, minimizing therapy side effects, and tracking self-reported patient data electronically. Objectives To assess the correlation between patient-reported and objectively tracked actual compliance to therapy, as well as the association between treatment compliance and improvement in patient condition. Methods This randomized (1:1), double-blind, sham-controlled trial assessed the effectiveness of a daily, at-home ultrasound therapy, applied to the vaginal introitus for 8 min/day over the course of 12 weeks, on menopausal vaginal dryness in an ambulatory setting (Clinicaltrials.gov NCT00583-1). In 30 post- menopausal women (ages 48-70), device use compliance was collected via a self-reported electronic diary completed daily on a mobile phone. Objective compliance data were obtained from a logger installed in all devices, which recorded the duration and time the device was used every day. Participants self- assessed change (from baseline to 12 weeks) in VVA symptoms (vaginal dryness, soreness, irritation, dyspareunia) measured by the Vaginal Assessment Scale (VAS) with a 4-level response score ranging from none, mild, moderate, to severe. Healthcare providers evaluated change in vaginal tissue response (tissue elasticity, vaginal fluid, pH, mucosa, and vaginal moisture) assessed by the Vaginal Health Index (VHI) giving a numerical score (1-5) for each of the 5 parameters. Results After week-12 follow-up, participants in the operating group self-reported compliance (mean ± SE%) of 85.4 ± 5.4% and the device log objectively tracked compliance of 80.7 ± 7.2% (paired t-test, P=0.17). The sham group had self-reported compliance of 89.5 ± 2.1% and the device log compliance of 82.5 ± 5.2% (P=0.14). There was no significant difference (ANOVA) between operating and sham groups compliance for self-reported (P =0.46) or objective log data (P =0.83). With both operating and sham groups combined, there was a significant strong correlation (r=0.76, P<0.0001) between self-reported and device log compliance. Linear regression showed a significant positive dose-response between treatment and change in VHI score from baseline to week 12 (r=0.51, P=0.04). A smaller positive correlation was observed between treatment compliance and participants’ self-assessed change in VAS score (r=0.40, P=0.28). Conclusions Objective device use compliance was high (80.7-82.5%) across both groups assessed, indicating general participant desire to receive the therapy. In addition, participants with higher treatment rates had better scores in VHI, which indicated decreased VVA severity. For post-menopausal women, high adherence to the daily at-home ultrasound therapy proved efficacious in improving their condition of VVA and could offer a new therapeutic option. Disclosure Yes - Madorra. Industry funding only - investigator initiated and executed study – Yes.

Shattered Kidney After Renal Trauma: Should It Be Classified As an American Association for the Surgery of Trauma Grade V Injury?

To study the prevalence and management of shattered kidney and to evaluate if the new description of "loss of identifiable renal anatomy" in the 2018 American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) would improve the ability to predict bleeding control interventions. We used high-grade renal trauma data from 21 Level-1 trauma centers from 2013 to 2018. Initial CT scans were reviewed to identify shattered kidneys, defined as a kidney having ≥3 parenchymal fragments displaced by blood or fluid on cross-sectional imaging. We further categorized patients with shattered kidney in two models based on loss of identifiable renal parenchymal anatomy and presence or absence of vascular contrast extravasation (VCE). Bleeding interventions were compared between the groups. From 861 high-grade renal trauma patients, 41 (4.8%) had shattered kidney injury. 25 (61%) underwent a bleeding control intervention including 18 (43.9%) nephrectomies and 11 (26.8%) angioembolizations. 18 (41%) had shattered kidney with "loss of identifiable parenchymal renal anatomy" per 2018 AAST OIS (model-1). 28 (68.3%) had concurrent VCE (model-2). Model-2 had a statistically significant improvement in area under the curve over model-1 in predicting bleeding interventions (0.75 vs 0.72; P=.01). Shattered kidney is associated with high rates of active bleeding, urinary extravasation, and interventions including nephrectomy. The definition of shattered kidney is vague and subjective and our definition might be simpler and more reproducible. Loss of identifiable renal anatomy per the 2018 AAST OIS did not provide better distinction for bleeding control interventions over presence of VCE.

The bacterial culture of urine relevance in the complex treatment of incontinence in dogs

To date in Russian federation there is widespread in veterinary medicine to empiric prescription of broad-spectrum antibacterial drugs in the treatment of bacterial cystitis in dogs. The main danger of this approach is associated with the provocation of the development of antibiotic resistance of microorganisms, with the surgical treatment of animals in the active stage of the inflammatory process and associated complications, with the development of ascending infections of the urinary system. Very important for a positive clinical result in the treatment of dogs with urinary incontinence against the background of ureteral ectopia or urethral sphincter insufficiency has a compliance with the preanalytical rules when taking biomaterial (urine) for bacteriological examination by pyelocentesis or cystocentesis. So there is data how to obtaining a biomaterial and its laboratory research in this article. This article presents arguments to the feasibility and necessity of conducting a laboratory study of the bacterial composition of urine in the treatment of inflammatory diseases of the urinary system associated with urinary incontinence. This approach makes it possible to prevent the development of antibiotic resistance in bacteria, stop the actual infectious process and ensure high rates of treatment. Вacterial culture of urine is one of the most important tests to ensure the successful treatment of patients with such diseases. Also in analyzes results we can see the insufficiency and associated risks of broadspectrum antibacterial drugs’s "blind" prescription, which has negative affect for treatment