History Of Visits Research Articles

Factors Influencing Nasoalveolar Molding Treatment Completion and Noncompletion in Infants with Cleft Lip and Palate.

Identify sociodemographic factors and comorbidities predictive of nasoalveolar molding (NAM) treatment completion and noncompletion in infants with cleft lip with or without (+/-) cleft palate in a rural-suburban population. Retrospective cohort study. Tertiary medical center. Infants diagnosed with cleft lip +/- cleft palate who initiated NAM treatment between 2013 and 2023. Forty-seven patients met inclusion criteria. Prevalence of NAM treatment completion, defined as continued attendance of NAM appointments until initial lip repair surgery. NAM treatment noncompletion rate of 23.4%. Noncomplete NAM treatment was associated with greater additional unscheduled NAM visits (P < .001); increased days inpatient after birth (P < .001); NICU admission (P < .001); public insurance (P = .007); preterm birth (P = .008); history of social work visits (P = .024); increased comorbidities (P = .028); non-Caucasian race (P = .034); and presence of siblings (P = .036). Associated comorbidities included use of feeding tube (P < .001); and conditions related with renal (P < .001); cardiac (P = .004); failure to thrive (P = .009); syndromes (P = .009); orthopedic (P = .011); pulmonary (P = .022); and ophthalmologic systems (P = .041). Increased overall health complexity, public insurance status, and need for social work support were identified as factors associated with NAM noncompletion. These variables can help identify patients at risk of noncompletion and empower providers to supply individualized support and resources.

Dental Health Literacy among Highly Skilled Professionals in India: A Pilot Study

Purpose: Research in medical settings has consistently demonstrated that health literacy is essential for patient adherence and comprehension to medical/dental instructions including prescriptions and improving positive holistic health outcomes. Despite its recognized importance, the role of literacy in dentistry has received limited focus. This study aimed to assess the level of oral health literacy among professionals in a multinational company, using the Rapid Estimate of Adult Literacy in Dentistry-30 (REALD-30) as the measurement tool. Methods: A convenience sample of 111 adults was recruited from a dental camp held at two locations within an IT firm. Oral health literacy was measured and analysed using the REALD-30 scale. Participants also participated in interviews to collect sociodemographic information, dental visit history, dental needs, global oral health ratings, dental knowledge, practices, and comprehension. Additionally, clinical examinations were conducted to record the DMFT index (Decayed; D component, Missing; M component, and Filled; F component Teeth), as well as the presence of dental stains and calculus. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 13. Results: REALD-30 scores ranged from a low of 8 to a high of 25. Participants who had decayed, missing, or filled teeth, or a DMFT score higher than one, exhibited lower oral health literacy compared to the reference group. Similarly, lower oral health literacy was observed in participants with dental stains or calculus. Conclusions: Effective communication with patients is crucial for delivering high-quality dental care. The study concluded that a significant proportion of the highly educated professional group of people has less oral health literacy, which may obstruct their basic ability to understand and process the fundamental oral health information.

Incorporating familial risk, lifestyle factors, and pharmacogenomic insights into personalized noncommunicable disease (NCD) reports for healthcare funder beneficiaries participating in the Open Genome Project.

An ethics-guided decision-making framework was developed for applying pathology-supported genetic testing, a multifaceted pharmacodiagnostic approach that translates population risk stratification into clinical utility. We introduce this service, supported by the Open Genome Project, which aligns with the beneficence principle in personalized medicine. Genetic testing of six noncommunicable disease pathways was conducted as part of a pilot program, benchmarked against a readiness checklist for implementation of genomic medicine in Africa. Patient referral criteria were determined using healthcare funder claims data, employing the Adjusted Clinical Groupers and Resource Utilization Band risk rating structure to identify potential nonresponders to treatment. Three of the 135 doctors (2.2%) invited expressed immediate disinterest in the pilot, while 24 (17.8%) actively participated. Inherited, lifestyle-triggered, and therapy-related pathologies were simultaneously assessed in case reports, with special medical scheme reimbursement tariff codes applied to 25 patient referrals. The findings were used by the participating genetic counselor to select three patients for whole exome sequencing, utilizing a novel, level-up data processing algorithm for adaptive reporting. This study demonstrated the implementation of genomics into an evolving workflow for patients with a history of frequent clinic visits. Eliminating the cost barrier provided valuable insights to guide future reimbursement policy decisions.

Peri-implant clinical profile and subgingival yeasts carriage among cigarette-smokers with peri-implant mucositis

BackgroundThe present observational clinical investigation is based on the hypothesis that subgingival yeast carriage (SYC) is higher in cigarette-smokers with peri-implant mucositis (PM) than non-smokers with and without PM.ObjectiveThe aim was to assess peri-implant clinical profile and SYC among cigarette-smokers with PM.MethodologyParticipants were divided into four groups: Group-1—Cigarette-smokers with PM; Group-2—Cigarette-smokers without PM; Group-3—Non-smokers with PM; and Group-4—Non-smokers without PM. Information on duration and daily frequency of cigarette smoking (pack years), age, gender, familial history of smoking and most recent visit to a dentist and/or dental hygienist was collected. The following information was retrieved from healthcare records: implant dimensions, implant insertion torque, depth of insertion (credidastal or subcrestal), implant abutment connection, jaw location, implant surface characteristic, and mode of implant prosthesis retention. Peri-implant modified plaque and gingival indices (mPI and mGI), probing depth (PD) and crestal bone loss were recorded. Subgingival biofilm samples were collected, and SYC was recorded in colony forming units per milliliter (CFU/ml). P < 0.05 were considered statistically significant.ResultsEighty male individuals (20, 19, 21 and 20 individuals were included in groups 1, 2, 3 and 4, respectively) were included. The mPI was higher in Group-1 than groups 2 (P < 0.05) and 4 (P < 0.05). The mPI was higher in Group-3 than groups 2 (P < 0.05) and 4 (P < 0.05). The mGI was higher in Group-3 than groups 1 (P < 0.05), 2 (P < 0.05) and 4 (P < 0.05). The PD was higher in Group-1 than groups 2 (P < 0.05) and 4 (P < 0.05). The PD was higher in Group-3 than Groups 2 (P < 0.05) and 4 (P < 0.05). The CFU/ml were higher in Group-1 than groups 2 (P < 0.05) and 4 (P < 0.05). The CFU/ml were higher in Group-3 than groups 2 (P < 0.05) and 4 (P < 0.05).ConclusionPeri-implant soft-tissue inflammatory parameters are worse and SYC is higher in moderate smokers than light smokers with PM and non-smokers without PM.

Shared parameter modeling of longitudinal data allowing for possibly informative visiting process and terminal event.

Joint modeling of longitudinal and time-to-event data, particularly through shared parameter models (SPMs), is a common approach for handling longitudinal marker data with an informative terminal event. A critical but often neglected assumption in this context is that the visiting/observation process is noninformative, depending solely on past marker values and visit times. When this assumption fails, the visiting process becomes informative, resulting potentially to biased SPM estimates. Existing methods generally rely on a conditional independence assumption, positing that the marker model, visiting process, and time-to-event model are independent given shared or correlated random effects. Moreover, they are typically built on an intensity-based visiting process using calendar time. This study introduces a unified approach for jointly modeling a normally distributed marker, the visiting process, and time-to-event data in the form of competing risks. Our model conditions on the history of observed marker values, prior visit times, the marker's random effects, and possibly a frailty term independent of the random effects. While our approach aligns with the shared-parameter framework, it does not presume conditional independence between the processes. Additionally, the visiting process can be defined on either a gap time scale, via proportional hazard models, or a calendar time scale, via proportional intensity models. Through extensive simulation studies, we assess the performance of our proposed methodology. We demonstrate that disregarding an informative visiting process can yield significantly biased marker estimates. However, misspecification of the visiting process can also lead to biased estimates. The gap time formulation exhibits greater robustness compared to the intensity-based model when the visiting process is misspecified. In general, enriching the visiting process with prior visit history enhances performance. We further apply our methodology to real longitudinal data from HIV, where visit frequency varies substantially among individuals.

Risk score model for predicting mortality among patients with lung cancer.

To develop an accurate mortality risk predictive model among patients with lung cancer. The development cohort included 96,255 patients with lung cancer aged ≥19 years, who underwent a Korean National Health Insurance Service health check-up from 2005 to 2015. The validation cohort consisted of 18,432 patients (≥19 years) with lung cancer from another region. The outcome was all-cause mortality between January 1, 2005, and December 31, 2020. Approximately 60.5% of the development cohort died within a median follow-up period of 2.32 (0.72-5.00) years. Risk score was highest in participants aged ≥65 years, followed by those who underwent treatment, had a history of emergency room visits, and were current smokers. Participants treated by surgery had the lowest risk score, followed by combined surgery and chemotherapy, combined surgery and radiation therapy, women, and regular exercisers. The C statistic in the development and validation cohorts was 0.78 (95% confidence interval, 0.77-0.78) and 0.81 (95% confidence interval, 0.78-0.84), respectively. Advanced age, lung cancer stage, and treatment type were strong risk factors of mortality in lung cancer patients, while being a woman and exercise were preventive factors. These will aid in the prediction of mortality and management of lung cancer patients.

Federated learning of medical concepts embedding using BEHRT.

Electronic health record data is often considered sensitive medical information. Therefore, the EHR data from different medical centers often cannot be shared, making it difficult to create prediction models using multicenter EHR data, which is essential for such models' robustness and generalizability. Federated learning (FL) is an algorithmic approach that allows learning a shared model using data in multiple locations without the need to store all data in a single central place. Our study aims to evaluate an FL approach using the BEHRT model for predictive tasks on EHR data, focusing on next visit prediction. We propose an FL approach for learning medical concepts embedding. This pretrained model can be used for fine-tuning for specific downstream tasks. Our approach is based on an embedding model like BEHRT, a deep neural sequence transduction model for EHR. We train using FL, both the masked language modeling (MLM) and the next visit downstream model. We demonstrate our approach on the MIMIC-IV dataset. We compare the performance of a model trained with FL to one trained on centralized data, observing a difference in average precision ranging from 0% to 3% (absolute), depending on the length of the patients' visit history. Moreover, our approach improves average precision by 4%-10% (absolute) compared to local models. In addition, we show the importance of the usage of pretrained MLM for the next visit diagnoses prediction task. We find that our FL approach reaches very close to the performance of a centralized model, and it outperforms local models in terms of average precision. We also show that pretrained MLM improves the model's average precision performance in the next visit diagnoses prediction task, compared to an MLM without pretraining.

The association between cigarette smoking and dementia with Lewy bodies

IntroductionCigarette smoking is associated with a reduced risk of Parkinson's disease (PD). As dementia with Lewy bodies (DLB) and PD share core neuropathologic features, we set out to examine the relationship between smoking and DLB. MethodsDiagnosis at baseline visit and smoking history of participants ≥50 years old in the National Alzheimer's Coordinating Center (NACC) cohort were evaluated in this cross-sectional study. Odds of diagnosis of cognitive impairment due to DLB, PD, vascular dementia (VD), or Alzheimer's disease (AD) compared to normal cognition based on smoking status and duration were determined using logistic regression. Results37,478 participants were included (mean age 72 years (SD 9), 57 % female). The odds of DLB were reduced in all smoking status groups compared to never smokers (OR (95 % CI)): ever smokers 0.850 (0.745–0.971), former smokers 0.871 (0.761–0.997), current smokers 0.640 (0.419–0.947)) and in all smoking duration groups. As expected, the odds of PD were reduced in all smoking groups and fell with longer smoking duration. The odds of VD were increased in the current smoking group and rose with greater smoking duration. The odds of AD were unchanged in current smokers, decreased in ever and former smokers, and increased with longer cumulative smoking duration. ConclusionsCigarette smoking is associated with lower odds of diagnosis of DLB at baseline visit in the NACC cohort. In the context of the well-established reduced risk of PD among smokers, this preliminary evidence of a potential protective effect of smoking on DLB warrants further study.

Non-uptake of dual protective polio vaccine and its determinants among children in Ethiopia using Ethiopian Demographic Health Survey 2019: a mixed-effect model

IntroductionThe polio vaccine is the live-attenuated antigen that prevents poliomyelitis. According to a report by the WHO, about 1 million less than 5-year-old children missed the polio vaccination from 2018...

Do Parental and Children’s Dental Anxiety Affect Childhood Dental Caries?

Background: Dental anxiety is an unpleasant reaction to fear or stress related to the dental environment and can be observed in both parents and children as dental patients. Despite several studies challenging the significance of parental anxiety in influencing a child's response to dental treatment, conflicting results have emerged regarding the impact of both parental and children's anxiety on the development of dental caries. Objectives: This study aimed to explore the association between parental and children's dental anxiety and the occurrence of dental caries in children. Methods: A cross-sectional study involving 7 - 12-year-old students and their parents in schools of Rasht, Iran, utilized the Modified Dental Anxiety Scale (MDAS) for parents and the Modified Child Dental Anxiety Scale (MCDAS) questionnaire for children. Participants were chosen through a multistage sampling process. A trained dentist assessed children's dental caries using the DMFT/dmft (decayed, missing, and filled teeth) Index. The data were analyzed using the chi-square test and linear regression. Results: The study included 275 parents and an equal number of children, with a mean child age of 9.32 ± 1.85 years. The findings indicated a significant relationship between maternal dental anxiety and DMFT + dmft scores in boys (P = 0.049). The study revealed that the number of teeth with caries experience (P = 0.023), child's sex (P = 0.007), history of dental clinic visits (P = 0.045), and maternal dental anxiety (P = 0.043) significantly influenced the child's dental anxiety. Conclusions: Children with anxious parents showed lower DMFT/dmft values, suggesting increased attention to their dental health. The study highlights the impact of parental dental anxiety on children's oral well-being and emphasizes the need for comprehensive strategies to address dental anxiety in both parents and children.

Multiple myeloma: unplanned diagnostic pathways and association with risk factors and survival – a nationwide register-based cohort study in Denmark

BackgroundMultiple myeloma often presents with vague and non-specific symptoms. Many patients are diagnosed in unplanned rather than elective (planned) diagnostic pathways. This study investigates the diagnosis of multiple myeloma in unplanned pathways and the association with patient characteristics, disease profile, and survival.MethodsWe conducted a nationwide register-based study, including all patients diagnosed with multiple myeloma in Denmark in 2014–2018. Patients were categorised as diagnosed in an unplanned pathway if registered with an acute admission within 30 days prior to the multiple myeloma diagnosis and no other previously registered pathway to this diagnosis. Unplanned pathways were compared to all other pathways combined.ResultsWe included 2,213 patients diagnosed with multiple myeloma, hereof 32% diagnosed in an unplanned pathway. Comorbidity, no prior cancer diagnosis, a history of few visits to the general practitioner (GP), multiple myeloma complications at diagnosis, high-risk cytogenetics, and advanced cancer stage were associated with a higher probability of being diagnosed in an unplanned pathway. For example, 24.4% (95% confidence interval (CI): 21.8–27.0) of patients with low comorbidity (Charlson Comorbidity Index (CCI) score 0) were diagnosed in an unplanned pathway as were 50.9% (95% CI: 45.6–56.1) of patients with high comorbidity (CCI score 3+). For patients with dialysis need at the time of diagnosis the probability was 66.0% (95% CI 54.2–77.8) and 30.9% (95% CI: 28.9–32.9) for patients with no dialysis need. Patients diagnosed in an unplanned pathway had inferior survival (hazard ratio 1.44 (95% CI: 1.26–1.64)). However, this association was not seen in analyses restricted to patients surviving for more than three years.ConclusionsHigh comorbidity level, few usual GP visits, advanced disease status at diagnosis, and complications were associated with diagnosis in an unplanned pathway. Further, patients diagnosed in an unplanned pathway had inferior survival. Promoting earlier diagnosis and preventing unplanned pathways may help improve survival in multiple myeloma.

Relationship between malnutrition according to the global leadership initiative on malnutrition criteria and oral health among community-dwelling elderly aged 85 years and older: a cross-sectional study

BackgroundA new diagnostic criterion for malnutrition, the Global Leadership Initiative on Malnutrition (GLIM) criteria, has been proposed. Despite a recognized link between malnutrition and oral health, further clarification is needed regarding this association when using the GLIM criteria. This study examined the association between malnutrition and oral health in community-dwelling older adults aged ≥ 85.MethodsThis study was conducted using data from the Tokyo Oldest Old Survey on Total Health study, and altogether 519 participants ≥ 85 years were enrolled. Malnutrition was assessed using the GLIM criteria. Oral health information, on the number of teeth, maximum occlusal force (MOF), saliva production, denture-related questions (dissatisfaction and frequency of use), dental visit history in the past year, whether participants enjoyed meals, and oral-related quality of life was assessed using the Geriatric Oral Health Assessment Index (GOHAI) were collected. MOF was assessed the average values of three measurements and lower tertile by sex as decline in MOF. For GOHAI, the score for each items (Q1-Q12) was also evaluated, and further, the decline in each item (score: 1–2 points on a 5-point scale) was assessed as a “problem with each items.” Oral health factors differing between those with and without malnutrition were analyzed. For differing items, malnutrition risk was evaluated using Cox regression.ResultsEighty-nine (17.1%) participants experienced malnutrition. Significant differences were observed in the decline in MOF, enjoyment of meals, individual scores for Q2, Q4, and Q6, and the problem with Q3, Q6, Q7, and Q11. Cox regression analysis showed that decline in MOF (odds ratio [OR]: 1.728, 95% confidence interval [CI]: 1.010–2.959), enjoyment of meals (OR: 0.502, 95% CI: 0.289–0.873), problem with Q3 (OR: 5.474, 95% CI: 1.301–23.028), Q6 (OR: 5.325, 95% CI: 1.026–27.636), and Q7 (OR: 2.867, 95% CI: 1.397–5.882) were associated with ORs of malnutrition.ConclusionDecline in MOF, enjoyment of meals, swallowing problem (problem with Q3), limit contact due to oral condition (problem with Q6), and esthetics problem (problem with Q7) were associated with malnutrition as assessed using the GLIM criteria.

Identifying risk factors for COVID-19 cluster infections in schools in the Republic of Korea: a case-control study.

No study has yet analyzed risk factors to determine whether students with confirmed coronavirus disease 2019 (COVID-19) infections may affect students at neighboring schools. Therefore, this study aimed to determine risk factors for COVID-19 transmission among schools within a community in the Republic of Korea. An epidemiological investigation was conducted among 696 students and school staff members at 3 schools where COVID-19 clusters began on October 15, 2021. Interviews, visit history surveys, a facility risk assessment, and closed-circuit television were used to identify risk factors. The statistical significance of risk factors was also evaluated. We confirmed 129 cases (18.5%) among the individuals exposed to COVID-19 at the 3 schools, many of whom had a history of visiting the same multi-use facilities. The odds ratio of having visited multi-use facilities such as karaoke rooms was 1.90 (95% confidence interval, 1.03-3.50); the number of visits to a karaoke room and the visit durations were significantly higher among confirmed cases than non-confirmed cases (p=0.02 and p=0.03, respectively). Having a history of visiting karaoke rooms often and spending a long time there were risk factors for COVID-19 infection and inter-school transmission. Thus, it is necessary to investigate the status of multi-use facilities frequently visited by adolescents and consider incorporating them into the scope of school quarantine to prevent infectious diseases at schools in a community.

The association between continuous polypharmacy and hospitalization, emergency department visits, and death in older adults: a nationwide large cohort study.

This study aimed to investigate the association between continuous polypharmacy and hospitalization, emergency department (ED) visits, and death. This retrospective study utilized 6,443,896 patients aged between 65 and 84years of National Health Insurance claims data from 2016 to 2018. Polypharmacy and excessive polypharmacy were defined as the concurrent use of 5 or more and 10 or more medications, respectively, for durations of both 90days or more and 180days or more within a 1-year observation period. The primary outcome measures included all-cause hospitalization, ED visits, and mortality. Multiple logistic regression models were used adjusting for patients' general characteristics, comorbidities, and history of hospitalization or ED visits. Among 2,693,897 patients aged 65-84years who had used medicines for 180days or more (2,955,755 patients taking medicines for 90days or more), the adverse outcomes were as follows: 20.5% (20.3%) experienced hospitalization, 10.9% (10.8%) visited the ED, and 1% (1%) died, respectively. In patients who exhibited polypharmacy for more than 180days, the adjusted odds ratio of adverse outcomes was 1.32 (95% confidence interval [CI], 1.31-1.33) for hospitalization, 1.32 (95% CI, 1.31-1.33) for ED visits, 1.63 (95% CI, 1.59-1.67) for death, and that in excessive polypharmacy patients for more than 180days was 1.85 for hospitalization, 1.92 for ED visits, and 2.57 for death, compared to non-polypharmacy patients. Our results suggest that polypharmacy in older adults might lead to negative health consequences. Thus, interventions to optimize polypharmacy may need to be implemented.

Early detection of pediatric health risks using maternal and child health data

Machine learning (ML)-driven diagnosis systems are particularly relevant in pediatrics given the well-documented impact of early-life health conditions on later-life outcomes. Yet, early identification of diseases and their subsequent impact on length of hospital stay for this age group has so far remained uncharacterized, likely because access to relevant health data is severely limited. Thanks to a confidential data use agreement with the California Department of Health Care Access and Information, we introduce Ped-BERT: a state-of-the-art deep learning model that accurately predicts the likelihood of 100+ conditions and the length of stay in a pediatric patient’s next medical visit. We link mother-specific pre- and postnatal period health information to pediatric patient hospital discharge and emergency room visits. Our data set comprises 513.9K mother–baby pairs and contains medical diagnosis codes, length of stay, as well as temporal and spatial pediatric patient characteristics, such as age and residency zip code at the time of visit. Following the popular bidirectional encoder representations from the transformers (BERT) approach, we pre-train Ped-BERT via the masked language modeling objective to learn embedding features for the diagnosis codes contained in our data. We then continue to fine-tune our model to accurately predict primary diagnosis outcomes and length of stay for a pediatric patient’s next visit, given the history of previous visits and, optionally, the mother’s pre- and postnatal health information. We find that Ped-BERT generally outperforms contemporary and state-of-the-art classifiers when trained with minimum features. We also find that incorporating mother health attributes leads to significant improvements in model performance overall and across all patient subgroups in our data. Our most successful Ped-BERT model configuration achieves an area under the receiver operator curve (ROC AUC) of 0.927 and an average precision score (APS) of 0.408 for the diagnosis prediction task, and a ROC AUC of 0.855 and APS of 0.815 for the length of hospital stay task. Further, we examine Ped-BERT’s fairness by determining whether prediction errors are evenly distributed across various subgroups of mother–baby demographics and health characteristics, or if certain subgroups exhibit a higher susceptibility to prediction errors.

Development of Electronic Health Record System for Mobile-Based Medical Service Application in Pekanbaru Military Hospital

Pekanbaru Military Hospital has implemented an Electronic Health Record System to improve the health service system to patients. Currently, the registration process available at the hospital is still offline, this will cause a buildup of waiting time due to patients who arrive at the same time in the morning. In addition, the absence of information regarding the ongoing queue at the polyclinic causes patients to not know the queue number at the polyclinic where the patient is treated. This research aims to develop a multiplatform mobile-based medical service application using Flutter technology. The software development methodology used in this research is Rapid Application Development (RAD) where the development process is carried out in stages and iteratively, with a focus on speed and flexibility. The testing technique is carried out using the Black Box Testing method to ensure that all application functionality runs according to predetermined specifications and the User Acceptance Test technique to evaluate the extent to which this application can be accepted and used by users. The result of this research is a multiplatform mobile-based medical service application with several features including: online registration for polyclinic services, polyclinic running queue information for patients to find out the queue number and estimated waiting time, visit history for presenting service history information and patient medical resumes, and running bill info for providing general patient transaction information during inpatient services. Black Box Testing results show that all functionality runs well and as expected. The results of testing with the User Acceptance Test show that this application gets a satisfaction percentage of 84%, which indicates that this application can be well received by users and is suitable for use.

Comparison of 30-day retention in treatment among patients referred to opioid use disorder treatment from emergency department and telemedicine settings

IntroductionTelemedicine is a feasible alternative to in-person evaluations for people with opioid use disorder (OUD). The literature on medications for opioid use disorder (MOUD) telemedicine has focused on ongoing OUD treatment. Emergency department (ED) visits are an opportunity to initiate MOUD; however, little is known regarding the outcomes of patients following telemedicine referrals for MOUD from emergency settings. The current study describes rates of initial outpatient clinic appointment attendance and 30-day retention in care among patients referred by telemedicine compared to ED referrals. MethodsThis paper reports a retrospective review of data for patients referred from EDs or telemedicine through the Medication for Addiction Treatment and Electronic Referrals (MATTERS) Network. The MATTERS online platform collects data on patient demographic information (e.g., age, gender, race/ethnicity, and insurance type), reason for visit, prior medical and mental health history, prior OUD treatment history, and past 30-day substance use behaviors. Analyses compared initial visit attendance and 30-day retention among the patients for whom follow-up data were received from clinics by demographic and initial treatment factors. ResultsBetween October 2020 and September 2022, the MATTERS Network made 1349 referrals; 39.7 % originated from an ED and 47.8 % originated from telemedicine. For patients with available data, those referred from telemedicine were 1.64 times more likely to attend their initial clinic appointment and 2.59 times more likely be engaged in treatment at 30 days compared to those referred from an ED. More than two-thirds of patients referred from the emergency telemedicine environment followed up at their first clinic visit and more than half of these patients were still retained in treatment 30 days after referral. ConclusionsThe rates of initial clinic visit and 30-day retention when referred following a telemedicine evaluation are encouraging. Further development of telemedicine programs that offer evaluations, access to medications, and referrals to treatment should be considered.

ORAL MALODOUR: AN INDICATOR OF ORAL NEGLECT AND POOR SELF-ESTEEM AMONG SLUM DWELLING CHILDREN IN NIGERIA

Objective: Oral malodour, an inadequately studied disease in children, is the third most prevalent reason for dental consultations, with negative impacts on psychosocial health. This study assessed self-rated and normatively assessed oral malodour and its impact on quality of life among a cohort of slum dwelling children in Lagos, Nigeria. Method: This descriptive survey was conducted among slum dwelling children in Lagos State, Nigeria. A multi-stage sampling method was utilized to select participants for the study. The Organoleptic test was utilized by two calibrated dentists to assess oral malodour. The Self-Reported Scale for Oral Health (SOHO) and the Rosenberg Self-Esteem Scale (RSE) were used to assess quality of life and self-esteem. Regression analysis was done using sociodemographic, clinical, self-esteem and QOL variables as the predictor variables to identify their strength of association with oral malodour. The probability level of p&lt;0.05 was considered significant. Results: Majority of the 427 respondents were aged between 10-14 years of age (67%), and were females (54.4%). Thirty four percent of the respondents self-rated themselves as having oral malodour; Normatively, 22.6% of the respondents had oral malodour. There was a significant association between OHRQOL (aOR: 2.724; CI: 1.563-4.932), gingival inflammation (aOR: 2.402; CI: 1.417-4.078), self-esteem (aOR: 2.546; CI :2.015-5.246), self-rated oral malodour (aOR: 3.846; CI: 2.118-8.571), parental education (aOR: 1.483; CI: 1.034-1.940), history of dental visit (aOR: 8.375; CI: 2.435-28.810), reason for dental visit (aOR: 2.224; CI: 0.932-5.310), and number of children in in the family (aOR: 1.106; CI: 1.010-1.212), with oral malodour. Conclusion: Oral malodour was significantly associated with low self-esteem, poor OHRQOL poor oral health and dental attendance pattern. The oral health of slum dwelling children needs to be seen by policymakers as an important predictor of their mental health and wellbeing.

Communicating cardiovascular health information and improving coordination with primary care: A Childhood Cancer Survivor Study randomized trial.

10011 Background: Childhood cancer survivors are at risk of early cardiovascular disease (CVD). We conducted a survivorship care plan (SCP)-based counseling intervention to improve CVD risk factor control in adult-aged survivors. Methods: Randomized (1:1) trial of survivors at high CVD risk based on history of anthracycline or chest radiotherapy exposures with undertreated hypertension (≥130/80 mmHg), dyslipidemia (LDL ≥160 mg/dL or triglyceride ≥200 mg/dL), and/or glucose intolerance (threshold varied if history of pre-diabetes or diabetes) based on in-home testing. Approximating a survivorship clinic visit, the intervention consisted of a remotely delivered session with an advanced practice provider to review results, a SCP with personalized CVD risk information, and an action plan to help manage CVD risk factors. A remote booster session was provided 4 months later with the action plan updated. Control participants only received a copy of their in-home results with abnormalities noted and written encouragement to follow-up with their primary care provider (PCP). Blood pressure, lipid profile, and glucose tolerance were retested after 1y. For both groups, all participant materials were sent to PCPs throughout the study, and PCP medical records were abstracted at study completion. Logistic regression assessed the odds ratio (OR) for undertreatment at 1y associated with the intervention, adjusting for pre-specified variables (sex, current age, time since cancer, insurance status, recent history of survivorship clinic visit, and undertreated CVD risk factor). Results: Among 644 survivors who completed in-home testing, 347 met inclusion criteria and were randomized (175 intervention; overall 52% male, mean age 40y, 31y since cancer diagnosis); 264 with 1y follow-up (126 intervention). At baseline, rates of hypertension, dyslipidemia, and glucose intolerance were 53%, 52%, and 49%, respectively; 43% had &gt; 1 undertreated condition. Although the intervention achieved &gt; 95% satisfaction, it was not associated with reduced undertreatment vs control (OR 0.9, 95% CI 0.7-1.3). Notably, 48% of intervention and 44% of control participants had less undertreatment after 1y. In secondary analysis, greater internal locus of control was associated with less undertreatment at 1y (OR 0.7, 95% CI 0.6-0.9). The intervention group was more likely than controls to have CVD risk (+10 vs -1%), SCP (+17 vs -2%), and some late effects surveillance plan (+8 vs +2%) documented within PCP records at 1y vs baseline (p &lt; 0.05 for all). Conclusions: While a remotely delivered counseling intervention did not reduce CVD risk factor undertreatment compared with provision of test results alone, both study arms had &gt; 40% reduction in undertreatment. These results suggest that simply providing a formal CVD risk assessment to high-risk cancer survivors and their PCPs may be effective. Clinical trial information: NCT03104543 .

Relationship History of Parenting and Antenatal Care Visits with Stunting Events in Children Aged 24-36 Months in West Aceh Regency

Stunting is the inability of children under five to grow normally due to the effects of chronic lack of nutrition so that their height is very short for their age. Data from SSGI in 2022, Aceh Province has a prevalence rate of stunting among children under five which is ranked fifth with a percentage of 31.2 percent. According to SSGI data for 2021, stunting in West Aceh Regency was 27.4 percent and increased to 30.4 percent in 2022 with a very high category. The aim of this research is to analyze the relationship between parenting styles and the incidence of stunting in children 24-36 months in West Aceh Regency. This type of research is quantitative research with a case control design. The sample size was 100 toddlers, 50 toddlers were selected for the case group and 100 toddlers for the control group. The results of the study showed that the variables that were related were parenting patterns for breastfeeding and food (p=0.016), personal hygiene parenting patterns (p=0.028) and history of antenatal care visits (p=0.007) with the incidence of stunting. Suggestions for this research to the government are expected to be able to synergize better in creating programs to overcome stunting and poverty and improve the performance of services and implementation of specific nutritional intervention programs for pregnant women. One of them is an examination program during pregnancy both in terms of quantity of visits and also inspections carried out during ANC activities.