Inadequate Care Research Articles

Social Factors Associated with Congenital Syphilis in Missouri.

Congenital syphilis disproportionately affects individuals impacted by adverse social determinants of health. Understanding these determinants may help facilitate holistic care. We performed a retrospective review of mother-infant dyads with potential congenital syphilis in a Missouri hospital system. Cases were classified per Centers for Disease Control and Prevention clinical scenarios. Information was collected regarding demographics, prenatal care, substance use, and other social factors. Dyads with confirmed/highly probable or possible congenital syphilis ("congenital syphilis outcomes") were compared to those with less likely/unlikely congenital syphilis ("non-congenital syphilis outcomes") using descriptive statistics. We identified 131 dyads with infant dates of birth from 12/2015-6/2022: 74 (56%) with congenital syphilis outcomes and 56 (43%) with non-congenital syphilis outcomes. Most mothers were Black/African American (n = 84, 65%) and lived in areas with high Social Vulnerability Indices. Many had inadequate prenatal care (n = 61, 47%) and/or substance use histories (n = 55, 42%). Significant associations with congenital syphilis outcomes included limited prenatal care (OR 3.01, 95% CI 1.38-6.56), no prenatal care (OR 16.08, 95% CI 1.96-132.11), substance use (OR 3.42, 95% CI 1.61-7.25), housing instability (OR 3.42, 95% CI 1.39-8.38), and justice system interactions (OR 2.29, 95% CI 1.00-5.24). Substance use correlated with prenatal care adequacy (p < 0.001). 30% of infants with congenital syphilis outcomes were taken into protective custody. Adverse social determinants of health are common in dyads impacted by congenital syphilis. Health systems should consider interdisciplinary programming to improve testing and linkage to care. Future studies should evaluate social support for congenital syphilis prevention and management.

Inadequate weight gain and factors influencing it among preterm neonates in neonatal intensive care units in the Amhara region, Ethiopia, in 2022

BackgroundAdequate weight gain is crucial for the health and development of preterm neonates admitted to neonatal intensive care units (NICUs). Understanding the factors influencing weight gain in this vulnerable population is essential for improving outcomes. This study aimed to assess the weight gain status and associated factors among preterm neonates admitted to NICUs in specialized hospitals in the Amhara region of Ethiopia.MethodsA cross-sectional study design involving 363 preterm neonates admitted to NICUs in specialized hospitals within the Amhara region was used. Data were collected using structured questionnaires and the Kobo Tool Box. Daily weight measurements were recorded for three consecutive days. Descriptive statistics, logistic regression analysis, and graphical presentations were utilized for data analysis and presentation.ResultsThe study revealed that a significant proportion (80.8%) of preterm neonates experienced poor weight gain during their NICU stay. The factors significantly associated with poor weight gain were older maternal age, delayed initiation of enteral feeding, lack of kangaroo mother care (KMC), and inadequate antenatal care visits.ConclusionAddressing the identified factors, such as providing adequate support during the antenatal period, promoting a timely initiation of enteral feeding, and encouraging KMC practices, is crucial for improving weight gain outcomes in preterm neonates. The findings highlight the importance of a comprehensive approach to neonatal care targeting both maternal and neonatal factors. Policymakers and healthcare providers should prioritize interventions aimed at optimizing weight gain in preterm neonates to improve these neonates’ overall well-being and long-term outcomes.

Redesigning Death Rounds: Alleviating distress for residents in end-of-life care

Introduction Residents report limited end-of-life care training, resulting in negative socio-emotional impacts, burnout, and inadequate patient care. An academic urban county hospital adopted the Death Rounds (DR) conference for residents in the medical intensive care unit as a monthly free-form discussion to help residents cope with the emotional aspects of caring for dying patients. Our goal was to implement and evaluate a newly structured DR curriculum to help residents further reflect on experiences of caring for dying patients, reduce emotional burnout, and improve physician well-being. Methods Using a mixed-methods design, we conducted a qualitative needs assessment using interviews of residents. DR conference modifications based on the needs assessment include shorter, more frequent sessions; breakout groups; prompts for facilitating discussion; and multidisciplinary facilitators. A pre-post modification survey using the Likert scale was administered to all residents to assess the programmatic changes. Results Pre- and post-modification data was received from 30 and 50 of 116 residents, respectively. A greater proportion of post-test DR attendees reported that DR helped them feel less distressed when caring for dying patients (p=0.018). Among residents who did not attend DR, there was greater agreement in feeling emotionally supported by their team when caring for dying patients (p=0.046). Overall, 81% of post-test respondents agreed DR was worthwhile of their time, and almost all respondents agreed discussing the emotional impacts of patient death is important. Conclusion Adding a structured framework to Death Rounds, including small-groups and facilitation cards, may help residents cope with caring for dying patients by improving self-awareness and team support, while reducing distress.

Abstract PO1-12-04: Exploring Factors Associated with Sexual Well-being and Breast Satisfaction Among Women with Early-stage Breast Cancer

Abstract BACKGROUND: Breast cancer affects not only physical health but also psychological and emotional well-being. Among the various aspects that impact the quality of life of breast cancer patients, sexual well-being and body image in terms of breast satisfaction play a crucial role. Unfortunately, these aspects are often overlooked and undervalued in healthcare, leading to inadequate care and support for breast cancer patients. This study delved into the factors that influence breast satisfaction and sexual well-being in early-stage breast cancer patients who have recently received a cancer diagnosis. We aim to offer providers a more patient-centered and comprehensive approach to breast cancer care. METHODS: This prospective questionnaire-based study screened 175 early-stage breast cancer patients recently diagnosed at a university-affiliated community hospital in Michigan from October 2022 to June 2023. Participants with a previous history of chemoradiation and advanced-stage breast cancer were excluded. Structured telephone interviews were conducted to obtain informed consent and assess patients' breast satisfaction and sexual well-being. Participants were interviewed after their recent breast cancer diagnosis and before undergoing surgical intervention. A validated BREAST-Q questionnaire was used, and their scores were converted to equivalent Rasch scores for interpretation (0=worst, 100=best). Pre-existing medical conditions, social history, and other variables were collected through electronic medical records review and confirmed by interview. Statistical analyses were performed using SPSS version 28.0, and a p-value less than 0.05 was considered statistically significant. RESULTS: Of 175 patients initially screened, 56 met the selection criteria. 75% (N=42) participated, while 25% (N=14) were excluded as they declined to participate or were unreachable via telephone. 81% were White, 14% were Black, and 5% were Hispanics. The cancer stages of the patients were Stage 0 (29.3%), I (48.8%), II (12.2%), and III (9.8%). The mean breast satisfaction score of participants was 67.1 (N=42), and the mean sexual well-being score was 44.6 (N=36). The study found that only the type of surgery was observed to be significantly related to the breast satisfaction of patients. Interestingly, patients who chose mastectomy had higher breast satisfaction scores (75.6 vs. 62.9, p&amp;lt; 0.05) and were relatively younger (59 years vs. 67 years, p&amp;lt; 0.05) than those undergoing lumpectomy. No other demographic factors (race, education, marital status, BMI), social history (smoking), bra size, or pre-existing medical conditions (hypertension, diabetes) were found to affect breast satisfaction among these patients. On the other hand, age had a negative correlation with sexual well-being (mean age=64 years, p&amp;lt; 0.05), while income had a positive correlation (mean income=$ 76,170 annually, p&amp;lt; 0.05). No other variables were significantly associated with patients’ sexual well-being. CONCLUSION: The study revealed that the patient's sexual well-being was significantly associated with age and income, while breast satisfaction was only related to the type of surgery. These findings underscore the importance of considering multiple aspects of a patient's life when designing a comprehensive treatment plan following a cancer diagnosis. By providing additional support and resources tailored to these specific needs, healthcare providers can enhance patients' overall quality of life and promote greater satisfaction with their treatment outcomes. Citation Format: Kim Abbegail Aldecoa, Yi Lee, Lisa Deptula, Chioma Mbionwu, Ewomamobuho Eto, Esentur Salamatov, Megan Frame, Andrea Briefs Ferris, Geetha Krishnamoorthy, Amy Kirby, Judie Goodman. Exploring Factors Associated with Sexual Well-being and Breast Satisfaction Among Women with Early-stage Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-12-04.

Alpha-gal syndrome: exploring the link between tick bites and red meat allergy

Introduction: Alpha-gal syndrome (AGS) arises from tick bites, triggering excessive IgE antibodies to galactose-α-1,3-galactose (α-Gal). Symptoms vary, often appearing post-α-Gal ingestion, ranging from mild to severe, including urticaria, angioedema and respiratory issues. Delayed symptom onset complicates diagnosis, posing challenges for patients. AGS can also result from contact with medical animal-derived products, such as bovine-derived heart valves, necessitating heightened healthcare provider awareness, especially in tick-exposed regions. Management involves allergen avoidance and emergency medications like epinephrine. Further research is needed to refine diagnostic and therapeutic approaches. Purpose: Through literature review and clinical presentation description, we aim to raise awareness and enhance understanding of alpha-gal syndrome. Description of the state of knowledge: AGS, an emerging atypical food allergy, stems from immune reactions to α-Gal oligosaccharide in mammalian meat and other animal products. Avoiding medical items containing alpha-gal is crucial to prevent iatrogenesis. Summary: Understanding AGS etiology and symptoms is vital for diagnosis and management. Healthcare providers' lack of awareness may lead to underdiagnosis, inadequate patient care, and underestimation of affected individuals.

Traditional vs. Scientific Eri Silkworm Rearing: A Study in Bhubaneswar Zone

Sericulture holds significant importance in the tribal economy of India, with the country being the sole producer of various natural silks including mulberry, tasar, muga, oak tasar and eri silk. Eri silkworm rearing is particularly prevalent in the Bhubaneswar zone of Odisha, encompassing districts such as Khurdha, Jagatsinghpur, Nayagarh, Cuttack and Kendrapada. This study focuses on the traditional eri culture methods in the region, highlighting indigenous rearing techniques, food plant selection, larvae management etc. Observations revealed that traditional practices were consistent across the Bhubaneswar region, emphasizing the need for adopting scientific methods. Implementing tray/platform rearing, precise feeding techniques, strategic food plant selection during different larval stages, well-designed rearing rooms and advanced spinning methods can optimize space usage, ensure disease-free larvae, promote uniform cocoon production, increase the effective rate of rearing and silk production. The disparities in shell percentage between cocoons at the farmer level and the farm level in the Bhubaneswar zone are indicative of varying practices and care in sericulture. Farmer-level cocoons exhibit a lower shell ratio ranging from 9.17% to 9.82%, implying inadequate care and nutrition provided to growing silkworms. This discrepancy suggests that these farmers might face challenges in maintaining suitable conditions such as proper temperature, humidity and nutrition, leading to inferior cocoon quality. Conversely, at the farm level, the shell ratio ranges from 10.14% to 10.71%, indicating that farmers in this category are comparatively more adept at silk rearing practices. They provide better nutrition, suitable temperature, humidity and other necessary facilities, resulting in higher-quality cocoons. The superior environment and care provided at the farm level are reflected in the Effective Rate of Rearing (ERR%) consistently above 40%, reaching a maximum of 50.85%. This signifies that farm-level cocoons have better attributes such as cocoon weight, shell thickness and filament size compared to those reared by individual farmers, where ERR% ranged from 31% to 42%. The integration of modern techniques not only enhances production potential but also creates employment opportunities for rural youth. This approach fosters better income generation, surpassing the limitations of traditional methods and paving the way for a thriving sericulture industry.

Maternal care utilization and provision during the COVID-19 pandemic: Voices from minoritized pregnant and postpartum women and maternal care providers in Deep South.

The COVID-19 pandemic has significantly affected maternal care services especially for minoritized individuals, creating challenges for both service users (i.e., African American and Hispanic pregnant/postpartum women) and maternal care providers (MCPs). Guided by a socioecological framework, this study aims to investigate the experiences of African American and Hispanic pregnant and postpartum women, as well as MCPs, in accessing and providing maternal care services during the COVID-19 pandemic in the Deep South. We conducted semi-structured interviews with 19 African American women, 20 Hispanic women, and 9 MCPs between January and August 2022. Participants were recruited from Obstetrics and Gynecology clinics, pediatric clinics, and community health organizations in South Carolina, and all births took place in 2021. Interview transcripts were analyzed thematically. Maternal care utilization and provision were influenced by various factors at different socioecological levels. At the intrapersonal level, women's personal beliefs, fears, concerns, and stress related to COVID-19 had negative impacts on their experiences. Some women resorted to substance use as a coping strategy or home remedy for pregnancy-induced symptoms. At the interpersonal level, family and social networks played a crucial role in accessing care, and the discontinuation of group-based prenatal care had negative consequences. Participants reported a desire for support groups to alleviate the pressures of pregnancy and provide a platform for shared experiences. Language barriers were identified as an obstacle for Hispanic participants. Community-level impacts, such as availability and access to doulas and community health workers, provided essential information and support, but limitations in accessing doula support and implicit bias were also identified. At the institutional level, mandatory pre-admission COVID-19 testing, visitation restrictions, and reduced patient-MCP interactions were women's common concerns. Short staffing and inadequate care due to the impact of COVID-19 on the health care workforce were reported, along with anxiety among MCPs about personal protective equipment availability. MCPs emphasized the quality of care was maintained, with changes primarily attributed to safety protocols rather than a decline in care quality. The pandemic has disrupted maternal care services. To overcome these issues, health facilities should integrate community resources, adopt telehealth, and develop culturally tailored education programs for pregnant and postpartum women. Supporting MCPs with resources will enhance the quality of care and address health disparities in African American and Hispanic women.

A qualitative study of the experiences of interdisciplinary nurses during the COVID-19 outbreak following the announcement of the "Ten new guidelines" in China.

On December 7, 2022, the Joint Prevention and Control Mechanism of China's State Council released the "Ten New Guidelines" to optimize the coronavirus disease 2019 (COVID-19) prevention policies further. This signaled a broader shift from "dynamic clearing" to "coexisting with the virus" nationwide. This study aims to examine the experiences and perspectives of interdisciplinary nurses during the COVID-19 outbreak in China after the implementation of the "Ten New Guidelines". The goal is to understand the challenges faced by this unique nursing group and inform organizational support to bolster their well-being and resilience. Two tertiary hospitals in southeastern Zhejiang Province were selected, with interdisciplinary nurses chosen as subjects. A constructivist qualitative research approach was employed, using semi-structured face-to-face interviews. Research data were collected through interviews and analyzed using content analysis. Fifteen interdisciplinary nurses were included in this study. The analysis revealed four main themes and nine sub-themes. The main themes were: (1) ineffective organizational support (inadequate organizational care, poor PPE, excessive workload), (2) physiological distress after contracting COVID-19 (extreme physical fatigue, leakage of urine due to severe coughing), (3) fear of being wrong (fear of being reprimanded in public, psychological anxiety), and (4) family responsibility anxiety (difficulty of loyalty and filial piety, obligations to their children). We provide new evidence that organizations must proactively address the support, training, and communication needs of staff, particularly interdisciplinary nurses, to supplement epidemic containment. This is also essential in helping mitigate the work-family conflicts such roles can create.

Exploring nurses' difficulties and strategies when caring for patients with dementia in a neurological ward.

Nurses in neurological wards face numerous challenges when caring for patients with dementia, particularly those who also present other acute illnesses. However, studies focusing on this area are limited. This study aimed to explore the difficulties and strategies in caring for patients with dementia among nurses working in a neurological ward. A qualitative descriptive design was adopted. Twelve nurses from a neurology ward participated in individual semi-structured interviews. The data collected through these interviews were subjected to qualitative content analysis. Two main themes emerged from the analysis: (i) various shortcomings and concerns, which include subthemes: insufficient support, worry about patient safety, inadequate care ability of the caregiver, and insufficient self-competence, and (ii) unique clinical strategies, which include subthemes: cooperate with the caregiver, improve self-competence in dementia care, and employ meticulous resorts. The findings highlighted the nurses' dedication to minimizing patient risks and utilizing available resources as well as stakeholders to provide optimal care. To enhance patient care quality, it is essential to support nurses by addressing care-related barriers, offering continuous education, and establishing care pathways.

[Anaesthesia for Emergent Caesarean Section: A Population-based Study on Icelandic and Migrant Women during 2007-2018].

General anaesthesia for emergent caesarean section, though uncommon, is vital in expediting deliveries. Studies indicate higher complication risks among pregnant migrant women. This research investigates if migrant women in Iceland are more likely to undergo general anaesthesia for emergent caesarean section compared to their Icelandic counterparts. This population-based cohort study analysed 4,415 emergency caesarean sections in Iceland between 2007 and 2018, sourced from the National Birth Registry. Participants were categorized by citizenship, with migrants further stratified by their country's Human Development Index (HDI). NCSP-IS and ICD-10 codes indexed diseases, interventions, and complications. The impact of variables was assessed through multiple logistic regression analysis. Migrant women received general anaesthesia in 16.1% of cases, slightly surpassing Icelandic women's 14.6%. Adjusting for risk factors showed no increased risk for migrant women. However, they had a higher likelihood of urgent caesarean sections (OR 1.45, 95% CI 1.08-1.94, p=0.015), a known risk factor for general anaesthesia, despite fewer comorbidities. Adjusting for confounders revealed reduced odds with a history of previous caesarean section (aOR 0.73, 95% CI 0.59-0.89, p=0.003) and placement of epidural anaesthesia in the delivery room (aOR 0.49, 95% CI 0.40-0.60, p< 0.001). Migrant women in Iceland do not face increased risks of general anaesthesia for emergent caesarean sections. However, their elevated risk of urgent caesarean sections suggests potential challenges, including language barriers or inadequate antenatal care. Early information dissemination and targeted interventions may mitigate these risks in this vulnerable community.

Abstract LB095: ASPYRE-Lung addresses critical gaps in NGS-based biomarker testing: Robust variant calling from NGS QC fails

Abstract Advanced NSCLC treatment guidelines recommend testing patients for genomic biomarkers to utilize over 30 FDA-approved targeted therapies. A major challenge with current NGS-based testing methods is that ~45% of patient samples fail NGS quality control (QC), leading to inadequate patient care. The ASPYRE® technology addresses the urgent need for rapid, accessible and affordable diagnostics informing actionable genomic target variants. The ASPYRE-Lung® panel covers 114 variants in 11 genes (ALK, BRAF, EGFR, ERBB2, KRAS, RET, ROS1, MET &amp; NTRK1/2/3) to robustly inform clinical management, based on clinical practice guidelines. The assay concurrently detects single nucleotide variants, insertions, deletions, and gene fusions from NSCLC tissue-derived DNA and RNA. In this study, we investigated an NSCLC patient sample set from Precision for Medicine, including biobanked clinical specimens that had previously failed NGS QC, and for which genomic biomarker data were unavailable. 120 matched DNA and RNA biobanked NSCLC FFPE patient samples previously analyzed by Illumina TSO 500 were tested using ASPYRE-Lung in Biofidelity’s CLIA laboratory, including 94 samples which failed NGS QC parameters for DNA, RNA, or both, and 26 control samples which passed NGS QC. Samples were tested by ASPYRE-Lung using an input of 20 ng DNA and 6 ng RNA, except for 5 patient samples that were run at lower inputs, ranging from 4.25 to 14 ng DNA. Key findings:•Of the 94 patient samples that failed NGS QC, 98% of samples (92/94) passed ASPYRE-Lung QC and could inform patient care.•In the 92 patient samples that passed ASPYRE-Lung QC, 47% (43/92) had a detectable variant identified by ASPYRE-Lung.•All 26 control samples that passed NGS QC also passed ASPYRE-Lung QC.•Of the 5 samples with 4.25 to 14 ng DNA inputs to ASPYRE-Lung, data were generated on 4/5 samples and 2/4 had a detectable variant.•ASPYRE-Lung has the potential to provide actionable clinical information on patient samples deemed to be of insufficient quantity for NGS testing.ASPYRE-Lung has a high success rate, is easily adoptable and cost effective making it suitable as a first-line testing option, or for samples that are either QNS or fail NGS QC, and can provide a large fraction of NSCLC patients with actionable biomarker information, with potentially smaller tissue requirements. ASPYRE-Lung genomic testing is transformative for cancer care management, and allows more patients with NSCLC to benefit from effective and better tolerated therapies. Citation Format: Ryan T. Evans, Elyse Shapiro, Elizabeth Gillon-Zhang, Julia N. Brown, Candace King, Cory Kiser, Mary Beth Rossi, Darren Davis, Michelle L. Taylor, Jennifer Clower, Jian Yang, Cullen A. Taylor, Robert W. Snyder, Wendy J. Levin. ASPYRE-Lung addresses critical gaps in NGS-based biomarker testing: Robust variant calling from NGS QC fails [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB095.

Nature, prevalence, and risk factors for self-neglect among older people: a pilot study from Vellore, South India

Changes in demography in developing countries haves led to new issues among older rural populations, such as self-neglect which is under researched.Self-neglect identified as poor self-care, unsafe living quarters, inadequate medical care and poor utilization of services increase the odds of morbidity and mortality.Methods Our study was conducted in Kaniyambadi, a rural block in Vellore district in the state of Tamil Nadu, India. Ten villages were randomly selected. The study was conducted among people older than 60 years who were selected by random sampling using a computer-generated list. The following assessments were done: (i) A 19-item questionnaire was used to assess self-neglect, (ii) Katz index of daily living to assess functional activity, (iii) Mini Mental State Examination to evaluate cognition, (iv) Geriatric Depression Scale to identify depression, (v) Duke Social Support Index to measure social supports. Clinical data and anthropometric data were also collected. Data were entered into Epidata v3.1. All analyses were performed using SPSS v23.0.Results One hundred fourteen people above 60 years of age participated. The prevalence of self-neglect was 21.1% (95% CI 14.9%—29%); about half of the elderly population (47.38%) refused to seek or follow medical advice. Lower levels of education (OR 3.678, 95% CI 1.017 – 13.301), lower social class (OR 4.455, 95% CI 1.236 – 16.050) and functional impairment (3.643, 95% CI 1.373 – 9.668) were found to be significant factors associated with self–neglect. Though prevalence of comorbidities (70%) and depression (27%) were high, there was no statistical evidence of association with self-neglect.

Hypertension clinical pathway: Experience of Aseer region, Saudi Arabia

BACKGROUND: Hypertension (HTN) is a common chronic health problem with many complications and high morbidity rates. This study aimed to describe the HTN pathway, to assess the performance of screening and registration programs, to explore the challenges and suggest solutions for those challenges. MATERIALS AND METHODS: This study was conducted in primary care centers in the Aseer region, Saudi Arabia, at the end of 2022. The study consisted of three parts namely: Screening for HTN, registration of known hypertensive patients and opinions of representatives of Primary Healthcare Centers (PHCs) on challenges to the implementation of HTN pathway and suggestions for overcoming these challenges. Three Google forms were developed by the investigators to achieve the objectives of this study. The first two forms were completed by doctors and nurses at each PHC and reviewed by the leader of HTN pathway, and the third form completed by a representative of each PHC. SPSS version 26 was used for data management and analysis. Chi-square test was used to determine association between categorical variables; binary logistic regression analysis was performed to determine the correlates of being hypertensive and having good control of HTN. RESULTS: A total of 159,243 individuals were screened for HTN, 55% of whom were females and 94% were Saudis. The prevalence of HTN was 13%; 70% were overweight or obese and 14% had diabetes. The total registered number of patients was 55,628; 50% had good HTN control. Major challenges were inadequate health coaches, care coordinators, laboratory and radiology facilities, lack of coordination with hospitals, and ineffective appointment system. CONCLUSION: This study revealed that the current HTN pathway was successful with regard to screening and registration of patients with HTN. Many challenges need an executive plan with SMART objectives to optimize the care for HTN patients in the region.

Gay & Gray XI: Somewhere Over the Rainbow - Aging with Pride!

Having previously tackled topics such as LGBTQ military sexual trauma, revisiting aging populations and HIV, and the intersectional experience of black queer older adults, Gay & Gray this year will focus on the transitional process of aging itself. While seniors cope with life changes as they grow older, LGBTQ seniors face specific challenges that may be especially burdensome. Often, older LGBTQ adults “have to make a hard choice at the end of their lives: Go ‘back into the closet’ or accept inferior care and discrimination” (CBC). This predicament embodies “a fear of loss of autonomy, identity, and freedom of sexual expression,” and often results in compromise “in order to feel safe during a period in which they anticipate… being vulnerable and lacking in power” (Wilson, et al.).In this session, we will discuss powerful issues including the threat of isolation while aging, healthcare access, and moving to long-term housing through the lens of gender and sexual minorities. First, we will explore how older LGBTQ adults are often more isolated than their heterosexual counterparts, with higher rates of living alone, fewer sources of family and social supports, and greater stigma among their peers (SAGE “US Army Vet”, Progress Lifeline). We will also consider reasons why LGBTQ adults may be hesitant to disclose their sexual orientation and gender identity to healthcare providers, fearing inadequate care and even outright discrimination. Afterwards, we will discuss how LGBTQ adults’ transitions from independent living into assisted living and nursing homes are further complicated by concerns about experiencing physical and verbal harassment, as more and more LGBTQ individuals fear “being forced back into the closet” and “conceal… their true selves” in order to access services and avoid harassment (Wilson, et al.). Lastly, we will evaluate potential solutions to promote community and enhance access to safe housing for aging LGBTQ individuals.

A Qualitative Exploration of Acceptance of a Conversational Chatbot as a Tool for Mental Health Support among University Students in Sudan

Background: Sudan’s political and economic challenges have increased mental health issues among university students, but access to mental healthcare is limited. Digital health interventions, such as chatbots, could provide a potential solution to inadequate care. This study aimed to evaluate the level of acceptance of a mental health chatbot prototype among university students in Khartoum, Sudan. Materials and Methods: This qualitative study investigated the perspectives of university students regarding a mental health chatbot prototype designed specifically for this research and deployed on Telegram. Twenty participants aged 18+, owning smartphones, and not receiving mental health treatment tested the prototype. Data was collected through individual, face-to-face, in-depth, semi-structured interviews. The data was analysed using both deductive and inductive content analysis methods. Results: Most of the participants acknowledged the importance of mental health but felt that it was an overlooked issue in Sudan. Participants considered the chatbot to be a unique and innovative concept, offering valuable features. They viewed the chatbot as a user-friendly and accessible tool, with advantages such as convenience, anonymity, and accessibility, and potential cost and time savings. However, most participants agreed that the chatbot has many limitations and should not be seen as a substitute for seeing a doctor or therapist. Conclusion: The mental health chatbot was viewed positively by participants in the study. Chatbots can be promising tools for providing accessible and confidential mental health support for university students in countries like Sudan. Long-term studies are required to assess chatbot’s mental health benefits and risks. Keywords: mental health, chatbots, university students, Sudan, young adults

Race and Place Matter: Inequity in Prenatal Care for Reservation-Dwelling American Indian People.

Early initiation and consistent use of prenatal care is linked with improved health outcomes. American Indian birthing people have higher rates of inadequate prenatal care (IPNC), but limited research has examined IPNC among people living on American Indian reservations. The current study uses birth certificate data from the state of Montana (n = 57,006) to examine predictors of IPNC. Data on the community context is integrated to examine the role of community health in mediating the associations between reservation status and IPNC. Results suggest that reservation-dwelling birthers are more likely to have IPNC, an association partially mediated by community health. Odds of IPNC are higher for reservation-dwelling American Indian people compared to reservation-dwelling White birthers, highlighting intersecting inequalities of race and place.

Fear, gratitude, and the normalization of obstetric violence in Cuban maternity hospitals

AbstractObstetric violence is endemic in Cuba, a highly medicalized society where the obstetrics institution is unquestioned and, in the afterlives of Atlantic slavery and US occupation and intervention, emotions of fear and gratitude work to normalize obstetric violence and control birthing bodies for the state. I draw on ethnographic observations, birth stories, and experiences as a patient to examine how birthing people, providers, and the Revolutionary state negotiate care and responsibility for health. I describe three fears: the fear of failure to protect maternal‐infant health (and its repercussions for clinicians and the state); the fear of physiological childbirth; and fears of inadequate or violent care. Obstetric violence in Cuba is structural. As birthing people shift between primary and tertiary healthcare infrastructures with distinct epistemologies of care, they exert ambiguous agency to domesticate the hostile space of the hospital, building relations of reciprocity and performing docility and compliance. Finally, I look at the gratitude expected of patients and the consequences of refusing to recognize healthcare as a “gift.” This contemporary account of obstetric violence in Cuba contributes to calls by abolition feminists to study the obstetric institution in order to refuse and dismantle it, building life‐affirming futures for maternity care worldwide.

Factors Associated With Poor Sleep Quality Among Primary Healthcare Workers During the SARS-CoV-2 Pandemic.

Sleep is one of the most important activities for health and the processes related to the central nervous system. Healthcare workers commonly present alterations in the sleep-wake cycle due to complex work schedules because 24-hour attention to the population is required in public health institutions. The increase in care needs caused by the COVID-19 pandemic causedchanges in work schedules; as in Mexico, the number of patients requiring consultation in all public health units increased. Chronic partial sleep deprivation (< 7 hours of sleep in the 24-hour cycle) is the most frequent sleep alteration in Mexican health workers. However, it has not been explored whether work modifications due to the pandemic had an impact on the sleep quality of workers. We aimed to describe the prevalence of poor sleep quality and the associated factors in workers (clinical and non-clinical) of a primary care medical unit. We conducted an analytical and cross-sectional studyduring November and December 2022.We used the following tools for studying clinical and non-clinical staff working at a family medicine primary care unit: Pittsburgh Sleep Quality Index, Hamilton Anxiety Scale, Beck Depression Inventory, Maslach Burnout Inventory, and Graffar-Méndez-Castellanos socioeconomic level scale, as well as a data collection sheet and a survey of workers' knowledge, attitudes, fears, and needs regarding COVID-19. A total of 233 workers were surveyed. The prevalence of poor sleep quality was 56.7%. A higher score on the Beck Depression Inventory (OR: 1.21, CI 95%: 1.13-1.29), being a doctor (OR: 3.48, CI 95%: 1.5-8.01), and frequent alcohol consumption (OR: 2.4, CI 95%: 1.13-5.2) were identified as risk factors for poor sleep quality. A lower score in the depersonalization dimension of the Maslach Burnout Inventory (OR: 0.5, CI 95%: 0.26-0.99) was identified as a protective factor for poor sleep quality. During the pandemic, the stress of health workers increaseddue to work alterations that were necessary to treat the greatest number of patients, so theirquality of sleep decreased. Unfortunately, the mental health of healthcare workers is often under-assessed in many institutions. Thus, it is relevant to identify risk factors for alterations (especially those of sleep), since by identifying the target population, comprehensive interventions can be carried out, which can reduce the prevalence of burnout, anxiety, and depression, but if not addressed, the alterations can lead to inadequate care for users of health units.

Clinical Biomarkers of Acute Vaso-Occlusive Sickle Cell Crisis.

It is known that an inherited blood condition called sickle cell disease (SCD) is a result of one gene. A number of blood and urine biomarkers have been determined in association with lab and clinical history for SCD patients. SCD has numerous interacting pathways associated with it, which have been identified by biomarkers. These mechanisms consist of some examples, such as endothelial vasodilation response, hypercoagulability, hemolysis, inflammation, oxidative stress, vascular dysfunction, and reperfusion injury among others. To effectively manage SCD, a comprehensive panel of validated blood and urine biomarkers must be established. Despite its monogenic inheritance, the complex nature of the SCD phenotype has impeded progress in its treatment. However, significant strides have been made in clinical biotechnology, paving the way for potential breakthroughs. In SCD, a panel of verified blood and urine biomarkers must be established, however. Despite monogenic inheritance, the great complexity of the SCD phenotype has hindered progress in its management. With few exceptions, clinical biomarkers of illness severity have been found through epidemiological investigations; nevertheless, systematic integration of these biomarkers into clinical treatment algorithms has not occurred. Furthermore, sickle cell crisis, the primary acute consequence of SCD, has been difficult to diagnose with the biomarkers now in use. Inadequate care and a lack of appropriate outcome measures for clinical research are the consequences of these diagnostic constraints. A new chapter in SCD customized treatment has begun with recent advancements in molecular and imaging diagnostics. Strategies in precision medicine are especially relevant now that molecular therapies are within reach. The significance of biochemical indicators linked to clinical manifestation and sub-phenotype identification in SCD is reviewed in this research.

Maternal delay for institutional delivery and associated factors among postnatal mothers at Southeastern Ethiopia: a cross sectional study.

Maternal delay in timely seeking health care, inadequate health care and the inability to access health facilities are the main causes of maternal mortality in low and middle income countries. The three-delay approach was used to pinpoint responsible factors for maternal death. There was little data on the delay in decision making to seek institutional delivery service in the study area. Therefore, the aim of this study was to assess the extent of the first maternal delay for institutional delivery and its associated factors among postpartum mothers in the Bale and east Bale zones. An institutional-based cross-sectional study was conducted among 407 postpartum mothers from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analysis was done by using binary logistic regression model to identify factors associated with maternal delay for institutional delivery services. Statistical significance was declared at P-value < 0.05. In this study, the magnitude of the first maternal delay in making the decision to seek institutional delivery service was 29.2% (95% CI: 24.9, 33.9). Previous pregnancy problems (AOR = 1.8; 95% CI: 1.06, 3.08), knowing the danger signs of labor and childbirth (AOR = 1.78; 95% CI: 1.11, 2.85) and decision-making (AOR = 0.42; 95% CI: 0.20, 0.85) were significantly associated with the first maternal delay. This study identified a significant number of postnatal mothers experienced delay in making decisions to seek institutional delivery service in the study area. Promoting women's empowerment and building on key danger signs should be emphasized.