Care Information Research Articles

Motivational Interviewing to Address Vaccine Hesitancy in a Rural Population.

Background: Individuals experience vaccination hesitancy for many reasons. However, not receiving vaccinations leaves individuals at increased risk for vaccine-preventable illnesses. Individuals in rural areas are more likely to experience vaccine hesitancy. Objective: Motivational interviewing is an effective strategy for addressing behavior change, including vaccine hesitancy. This evidence-based practice project provided an education session for Michigan State University Extension Vaccine Team members, who deliver health care information statewide. Methods: An educational information session on motivational interviewing was delivered via Zoom. This session focused on employing motivational interviewing in rural populations to address vaccine hesitancy. A survey was administered to participants pre and postmotivational interviewing educational sessions to assess changes in knowledge and confidence in using motivational interviewing. Results: Participants' knowledge and confidence regarding motivational interviewing improved. They reported an increased understanding of the concept and confidence in deploying this technique to the rural population. Conclusions: This project highlights the process and need for delivering an educational motivational interviewing session to health care team members who regularly interact with the rural population regarding vaccine hesitancy. Implications for Nursing: Teaching individuals who regularly interact with the rural population the technique of motivational interviewing can help expand the reach of the discussions in health care settings.

Long-Term Family Needs After a Traumatic Brain Injury: A VA TBI Model Systems Study.

To describe the self-reported needs of family caregivers of service members and veterans (SMVs) with traumatic brain injury (TBI) at 10 to 15years post-injury and to identify unique predictors of unmet family needs. Five Department of Veterans Affairs Polytrauma Rehabilitation Centers. A total of 209 family caregivers of SMVs with TBI from the VA TBI Model Systems national database who completed a 10- or 15-year follow-up assessment. Observational study. Family Needs Questionnaire-Revised (FNQ-R). Item-, domain-, and total score-level descriptive analyses of FNQ-R responses were conducted. On average, 56.3% of the FNQ-R family caregiver needs were reported as met. Health information and involvement in care needs were the most often met, and emotional support and instrumental support needs were the least often met. Adjusted multivariable regression models demonstrated that urban-dwelling SMVs (compared to suburban) and spouses/significant others (compared to parents) were associated with more unmet family needs. Distinct associations were identified between the 6 FNQ-R domains and SMV environmental factors (ie, urbanicity, rurality, and being active duty at follow-up), SMV comorbidities (ie, receiving mental health treatment in the year prior to the follow-up), and caregiver factors (ie, spouses/significant others). Family caregivers of SMVs with TBI reported multiple unmet needs at 10 to 15years post-injury, emphasizing the importance of ongoing caregiver support after TBI. Policy and programming to support military caregivers should consider the current findings to direct resources to address the identified unmet needs.

Comparisons of Physicians', Nurses', and Social Welfare Professionals' Experiences With Participation in Information System Development: Cross-Sectional Survey Study.

The integration of health care and social welfare services together with the consolidation of health care information systems (HISs) and client information systems (CISs) has become a timely topic. Despite this development, there is a scarcity of systematic research on physicians', registered nurses' (RNs) and social welfare professionals' (SWPs) experiences of participating in the development of HISs and CISs. This study aimed to examine how physicians, RNs and SWPs experience collaboration with HIS or CIS vendors, and what kinds of end users have participated in HIS or CIS development. National cross-sectional usability surveys were conducted in Finland among RNs and SWPs in 2020 and physicians in 2021. Questions concerning participation experiences were analyzed by professional group, working sector, managerial position, and age. In total, 4683 physicians, 3610 RNs, and 990 SWPs responded to the surveys. In all 3 professional groups, those working in nonmanagerial positions and the youngest respondents participated least in HIS or CIS development, and 76% (n=3528) of physicians, 78% (n=2814) of RNs and 67% (n=664) of SWPs had not participated at all. When comparing the groups, physicians were least aware of feedback processes and least satisfied with vendors' interest in end-user feedback and the manner and speed of HIS development. Those who had dedicated working time for HIS or CIS development were less critical of vendors' interest and responsiveness to development ideas than those who had not participated at all. In all 3 professional groups, the youngest were most dissatisfied with HIS and CIS vendor collaboration. Experiences of participation in HIS and CIS development were relatively negative across all 3 professional groups, with physicians being the most critical. Dialogue and collaboration between developers and end users-also the youngest ones and frontline workers-need improvement; simply increasing allotted working time is unlikely to produce more positive participation experiences.

Association between Mortality and Time Spent Out of Bed in Older-Adult Nursing Home Residents.

For older adults, spending time out of bed is important for preventing functional decline, but its relationship to mortality is not clear. In this study, we aimed to investigate the association between mortality and time spent out of bed in Japanese older-adult nursing home residents. We conducted a cohort study using data from the Long-term Care Information System for Evidence database. We used data collected between April 2022 and March 2024 from older-adult nursing home residents who required assistance with the activities of daily living. We compared outcome data between residents who spent 6 or more hours per day out of bed (group L) and those who spent less than 6 hours per day out of bed (group S). The outcome was all-cause mortality. Data were analyzed using Kaplan-Meier curves and Cox regression models. Data from 185 older-adult nursing home residents (median age: 89years; 141 women) were analyzed. Group L included 144 residents (77.8% of all participants). Of the 185 participants, 40 died during the observation period. Mortality in group L was significantly lower than in group S (16.7% vs 39.0%, P= .002). Kaplan-Meier curve analysis after the log-rank test revealed a significantly higher mortality in group S than group L. Univariate and multivariate Cox regression analyses with robust (Huber-White) standard errors identified the factor of time spent out of bed (≥6h) as a significant and independent risk factor for mortality. More time spent out of bed is associated with lower mortality in older-adult nursing home residents who require assistance with the activities of daily living.

Health literacy levels and self-rated health in the state of Delaware: a cross-sectional study

BackgroundBetter health literacy has been found to be associated with better health outcomes across varied populations. This study aimed to (1) examine the health literacy levels of individuals with respect to the extent to which they acquire, understand, appraise, and apply health information, and (2) to assess the relationship between health literacy and self-reported health in the state of Delaware.MethodsThe sampling frame consisted of 60 purposively selected faith-based organizations across the state of Delaware who predominantly serve minorities. Accounting for clustering design, a sample size was determined based on a Mixed Methods test. In total, 1095 participants responded to a survey questionnaire which included a validated short version of the European Health Literacy Questionnaire (HLS-EU-Q16). The data was analyzed using descriptive statistics, reliability techniques, chi-square test of independence, and ordinal logistic regression.ResultsThe study found that about a quarter of the participants had inadequate level of health literacy and about another quarter had problematic level of health literacy. These results are reflected across the health domains—health care, disease prevention, and health promotion. Health literacy was predictor of self-rated health. The odds of better self-rated health are 0.360 times lower for people with inadequate health literacy levels compared to those with sufficient health literacy.ConclusionHealth literacy profoundly shapes health outcomes. The high proportion of people expressing difficulty concerning accessing, comprehending, appraising, and using health information in the health care, disease prevention, and health promotion domains in state of Delaware would require a concerted effort.

Integrating Infant Safe Sleep and Breastfeeding Education Into an App in a Novel Approach to Reaching High-Risk Populations: Prospective Observational Study.

Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and nonrecommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth. This study aims to assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end user push notifications for engagement. This prospective observational study was conducted from September 23, 2019 to March, 22 2022; push notifications were removed on October 26, 2021. TodaysBaby (University of Virginia, Boston University, and Washington University), a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app (Naima Health LLC). Pregnant mothers who received prenatal care within the University of Pittsburgh Medical Center hospital system were randomized to receive either safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post partum. Pregnant persons were designated as high risk if they lived in the 5% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least 1 video either in response to a push notification or directly from the app's learning center. A total of 7572 pregnant persons were enrolled in the TodaysBaby Program-3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8% with push notifications and 3.0% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little postpartum engagement. There was no difference in engagement between pregnant persons who were low and high risk. The most viewed videos were ones addressing the use of pacifiers, concerns about infant choking, and the response of the body to the start of breastfeeding. Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID-a leading cause of infant death after 1 month of age-appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact.

Quality of life in people with syndromic heritable thoracic aortic disease and their relatives: a qualitative interview based study

IntroductionThe purpose of this study was to investigate perceptions and opinions on what constitutes determinants for quality of life (QoL) in individuals with syndromic Heritable Aortic Disease (sHTAD), utilizing a qualitative study approach. Further to discuss clinical implications and direction for research.MethodA qualitative focus group interview study was conducted of 47 adults (Marfan syndrome (MFS) = 14, Loeys-Dietz syndrome (LDS) = 11, vascular Ehlers Danlos syndrome (EDS) = 11, relatives = 11). The interviews were digitally recorded and transcribed verbatim. Significant themes were identified, extracted, and organised undergoing content analyses.ResultsThe two main themes and 10 subthemes identified; I. Psychosocial well-being; (i) Social engagement and activity, (ii) Self-sufficient in daily living, (iii) Participation in education and work life, (iv) Coping with fear related to the disease, (v) Being able to control and accept fatigue and pain, (vi) Maintaining active engagement with family and friends (vii) Finding health-promoting physical activities. II. Monitoring and meetings with the health service: (viii) Feeling safe and receiving coordinated care, (ix) Being recognized, seen, and accepted, (x) Receiving factual and sober information and advice. The sub-themes seemed mutually interrelated in terms of barriers, strategies, and facilitators for improving quality of life. There was high degree of consensus regarding the factors emphasized as important for QoL among the various diagnostic groups and the relatives.ConclusionBased on our findings, to improve QoL in patients with sHTAD we should more effectively integrate the patient`s perspectives and voice on the elements crucial to QoL. In addition, it is vital for developing and customizing validated questionnaires to accurately reflect the factors deemed significant by this specific patient cohort. The research is limited on patients’ perspectives on QoL, and more research is warranted. This might also be crucial for identifying relevant validated QoL instruments that reflect the patients` perceptions of what is vital for QoL.

Patient Experiences of Receiving Stroke Discharge Information in Accordance With Preferences.

To examine survivors' experiences of discharge information including risk communication after hospitalisation for a stroke and the characteristics associated with receiving information in accordance with their preferences. With advances in acute stroke care and an ageing population, the number of survivors of stroke is increasing. It is important that healthcare providers ensure patients have adequate information after a stroke-related hospitalisation. Cross-sectional study. Adults recently discharged after a stroke from eight Australian hospitals were mailed a survey. Items examined risk and discharge care information, with participants asked to indicate both their preferences for and receipt of the information. Concordance with preferences was calculated, and characteristics associated with information preference concordance were assessed with binomial logistic regression. Study reported in accordance with STROBE Checklist. Of 1161 eligible patients invited, 403 (35%) completed the survey. All items were endorsed by 80% or more of respondents as being wanted. However, for all items, fewer respondents reported the care as received. Only 28% of participants received information on all five items according to their preferences. Hospital site, Body Mass Index and age were statistically significantly associated with participants receiving information in accordance with their preferences. Most participants indicated a preference to receive recommended discharge information. Findings suggest that patients may benefit from increased information provision prior to hospital discharge after stroke. Nurses have an important role in the provision of stroke care and information. The findings of this study may be used to improve the provision of post-hospital discharge care and support for survivors of stroke, and assist in identifying patients at lower odds of experiencing information aligned with their preferences and who may benefit from support. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. No patient or public contribution.

Subjective cognitive functioning in patients with cancer: A network approach

Purpose The current study aimed to (1) examine the sociodemographic, clinical and psychological factors related to subjective cognitive functioning (SCF); (2) analyze the complex mutual interconnections between SCFs; and (3) address patients’ perspectives on SCF and supportive care. Method A heterogeneous sample of oncological patients (N = 566) was recruited. Items inquiring about the senses, attention, memory, spatial functions, decision-making and speech were administered. A network of subjectively perceived changes in cognitive functions was estimated while three open-ended questions addressed patients’ perspectives on SCF. Results Within the network, deficits in spatial perception, attention focus and problem-solving ability had the highest strength index while the deficits related to the senses were the least influential. Conclusion The findings indicate that psychological-based interventions focused on higher cognitive functions could improve patients’ quality of life. The presence of supportive care and available information could strengthen SCF intervention and prevention for patients with cancer.

Increased Hospital Encounters in Individuals With Spina Bifida Compared to the General Population: Statewide Health Care Utilization in California From 1995 to 2017.

Our goal was to understand health care utilization by comparing hospital encounters among individuals with spina bifida and the general population and to identify the factors associated with utilization. Using the Department of Health Care Access and Information database (1995-2017), individuals with spina bifida were identified and matched to controls by birth year. The primary outcome measures were the number of hospital encounters (stratified as ≤2 vs ≥3 encounters) and the time between the first and second encounters. Univariate, multivariate, and subgroup analyses were performed to identify factors associated with ≥ 3 encounters. When compared to controls, individuals with spina bifida had more ≥ 3 hospital encounters (69% vs 29%), spent more days in the hospital (58 days vs 13 days), and had a higher average charge per hospital stay ($433,537 vs $99,975, P < .001 for all). After adjusting for covariates, we found that having spina bifida was associated with increased hospital encounters compared to controls (odds ratio 3.95, 95% CI 3.77-4.14, P < .001). Individuals with spina bifida were found to have less time between their first and second encounters (2.5 vs 3.3 years, P < .001). Within the spina bifida population, sex, race, ethnicity, comorbidities, and nonprivate insurance were associated with ≥ 3 encounters. Spina bifida is associated with more hospital encounters and fewer days between first and second encounters compared to the general population. These findings highlight factors driving increased utilization of resources, thereby empowering providers to better support this vulnerable population.

Value-based health care for Aboriginal peoples with chronic conditions in the Northern Territory: a cohort study.

ObjectiveThis study aimed to investigate associations between patient activation, healthcare use and clinical outcomes for Aboriginal peoples living with a chronic condition in remote Northern Territory (NT) communities.MethodsA retrospective cohort study was undertaken between 2 April 2020 and 1 April 2022 to measure activation and its associations with chronic conditions secondary prevention treatment targets and healthcare usage: hospitalisations, potentially preventable hospitalisations and patient travel. All Aboriginal peoples enrolled at NT Government health services, who had one or more preventable chronic conditions and were prescribed one or more oral chronic condition medications identified in the Primary Care Information System, were included in the study. Patient activation was defined as a 90-day medicine possession ratio ≥80%. An activated patient has the belief, knowledge, skills and behaviours to manage their chronic conditions.ResultsA total of 5356 patients met the inclusion criteria; 9% of these patients were activated. Activated patients were older and sicker but were significantly more likely to achieve treatment targets for glycosylated haemoglobin, blood pressure and total and low-density lipoprotein cholesterol. Activated patients used more primary healthcare and outpatient resources and had a non-significant trend for less acute care use.ConclusionsThe remote NT Government primary healthcare system is providing low-value chronic conditions care for patients. As identified by Aboriginal peoples, strengthening culturally appropriate self-management support could lead to more patients becoming activated, better health outcomes and decreased acute care demand.

CARE TRANSITION EXPERIENCES OF HISPANIC PATIENTS WITH DEMENTIA FOLLOWING EMERGENCY DEPARTMENT DISCHARGE

Abstract Older patients report fragmented emergency department (ED) care, including insufficient communication with clinicians and inadequate referrals to outpatient care and social services. These challenges are likely even greater for those with cognitive impairment (CI) and their care partners (CPs) and especially for non-English speaking populations, where language differences bring additional challenges. This study seeks to fill a gap in the literature by exploring ED discharge care transition experiences for Hispanic patients with dementia. Ten dyads - consisting of a patient with CI or dementia diagnosis and their CP - were enrolled in the ED and completed semi-structured interviews (via video or telephone) 1 week later addressing their ED and post-discharge experiences. Interviews investigated participants’ experiences in the ED and subsequent care transitions back to the community. Interviews were recorded, transcribed and coded by three research team members for thematic content, adopting a combined deductive-inductive approach until thematic saturation was reach across all dyads. Prespecified codes were adapted using the National Quality Forum’s Quality Measurement Framework on ED Transitions of Care and included eight outcomes for ED transitions of care: accessibility of services, shared decision-making, connection and alignment, care coordination, information sharing/communication, safety, healthcare utilization/costs, and experience of care. Key study findings emphasize patient and care partner priorities of shared decision-making with the ED treating team, how patients and care partners manage language barriers and cognitive impairment challenges and identifying factors that either support or hinder the quality and safety of ED discharge care and transitions back home.

Exploring the Socio-Demographic Profile of Non-Completion in Public Oral Healthcare Services: A Cross-Sectional Study in Melbourne, Victoria

(1) Background: Completion of the full oral health course of care (CoC) is essential to prevent further deterioration of oral and overall health. Understanding these patterns, particularly in public oral healthcare services, is crucial for improving access to and the delivery of care. This study aims to identify the socio-demographic and clinical characteristics of adult patients who did not complete required dental treatments within a 12-month period at Monash Health Dental Services (MHDS), Melbourne, Victoria. (2) Methods: Data were collected on patients’ course of care (CoC), socio-demographic characteristics, and clinical information from the MHDS Titanium electronic database. This study represents a secondary data analysis from adult patients who attended MHDS between November 2022 and October 2023, excluding emergency dental care visits. Logistic regression analyzed the socio-demographic and clinical variables affecting CoC. (3) Results: Our findings identified several significant predictors of incomplete CoC; being a non-priority group, mental health clients, refugees, and identifying as Aboriginal or Torres Strait Islanders (OR = 1.41; 95% CI: 1.08–1.84). Conversely, speaking a language other than English increased the odds of completing treatment (OR = 0.85; 95% CI: 0.74–0.98). By age, patients in the 36-to-55- or the 56-to-75-year-old age groups were more likely to be in the incomplete group (OR = 1.65; 95% CI: 1.37–1.98; and OR = 1.43; 95% CI: 1.22–1.66, respectively). (4) Conclusions: This study identified predictors of discontinued care, emphasizing accessibility and equitable outcomes for users of public oral healthcare. The findings indicate that the predictors of course of care (CoC) completion differ from barriers to accessing care. This highlights key objectives in public health dentistry, focusing on improving accessibility and promoting equitable oral health outcomes for vulnerable populations.

Usability testing of a palliative care information resource - outcomes from the formative evaluation of the CarerHelp Toolkit prototype.

CarerHelp is an online resource supporting Australian family carers providing palliative care to loved ones at home. To confidently care for a dying person, family carers require access to evidence-based resources, accessible day or night when healthcare professionals or services are unavailable. Given carer diversity, usability evaluations assist online developers in shaping information experiences to family carer's needs and abilities. This study aimed to use a comprehensive usability testing protocol to evaluate the prototype, with a sample involving six family carers aged 36-74 years. A concurrent think-aloud approach generated quantitative and qualitative feedback from scenario-based tasks. Single ease questions (SEQ) and computer satisfaction usability questionnaire (CSUQ) assessed end-user attitudes. Performance, SEQ, and CSUQ were calculated, errors were analyzed, and severity rating applied. Overall, family carers identified 54 errors. All carers detected highly severe errors impacting critical function; technical ability influenced error detection, affecting navigation, utility, and content. Language modification was guided by family carers' narratives, contextualizing interface use with real-life experiences. For the multidisciplinary development team, formal reporting of findings was advantageous in informing meaningful reiterative interface changes and giving a voice to family carers. This approach was essential to assist as many carers as possible in accessing palliative care information when needed.

European recommendations from health care professionals and people living with obesity on safe practice for bariatric and metabolic surgery medical tourism: a modified delphi consensus statement from EASO, IFSO-EC and ECPO.

Bariatric and metabolic surgery tourism (BMT) is becoming an increasingly popular route to treatment for patients living with obesity. Recent reports have highlighted that some patients travelling abroad for bariatric surgery have received inadequate care, fraudulent care, and, tragically, some cases have resulted in death. This study aimed to define consensus in Europe regarding safe practices concerning BMT. IFSO-EC, EASO and ECPO initiated a task force to delineate safe practices in BMT. Two expert European panels were convened, one comprised of healthcare professionals (identified from EASO and IFSO-EC) and the other of patient representatives (identified from ECPO). The study utilised a modified Delphi consensus methodology, and 135 questions were administered. Surveys were conducted anonymously online, and consensus was defined as 70% agreement. Themes analysed regarding BMT included regulation, pre-operative evaluation, operative care, post-operative care, advertising and online information. One hundred and nineteen healthcare professionals and 88 patient representatives participated from 26 countries. The healthcare professional panel included 66 bariatric surgeons, 28 endocrinologists, 18 dietitians, three nurses, two psychologists, one general practitioner and one gastroenterologist. Three questionnaire rounds were conducted for the healthcare professional panel, and two were performed for the patient representative panel. Consensus recommendations were given across all themes relevant to BMT. These included evaluating and managing psychological health, sleep apnoea, cardiovascular disease, liver health and dietetic assessment. The recommendations covered the requirements for regulatory standards, including surgeon accreditation and procedural volume. They also included recommendations regarding patient education, standardised operative care, online information provision, and follow-up. Through collaboration with healthcare professionals and patients living with obesity, we provide European recommendations regarding safe practices concerning BMT. Further evaluation is required regarding outcomes following BMT. These data, alongside the Delphi consensus recommendations, will inform BMT clinical guideline development.

Prioritization of Surgical, Obstetric, Trauma, and Anesthesia Care in South and Southeast Asian Countries' Health Planning and Policy‑making: SOTA Care Policies in South and Southeast Asia.

Background: Lack of policy prioritization of surgical, obstetric, trauma and anesthesia (SOTA) care in South and Southeast Asian countries could be a potential contributor to limited access to care. Objective: To assess the SOTA care prioritization in National Health Policies, Strategies, and Plans (NHPSPs). Methods: We analyzed NHPSPs from twelve South and Southeast Asian countries. These documents are considered the most important health‑related policy statements. Bangladesh was excluded due to a lack of English translations. We searched sixteen electronic documents for a predefined list of keywords. The list included 52 keywords related to SOTA care and 7 keywords unrelated to SOTA care (used as a control). We used the keyword frequency (mentions per keyword or MPK) as a measure to compare prioritization between SOTA care and non‑SOTA care. We further categorized the SOTA care keywords into five different Lancet Commission on Global Surgery (LCoGS) domains and eight subgroups. Findings: Across twelve NHPSPs, MPK value for SOTA care was 54.09 compared with 202.86 for non‑SOTA, with eight NHPSPs having lower MPK values for SOTA care than non‑SOTA keywords. Four NHPSPs had no mentions related to SOTA care financing and information management. Pediatric surgery and anesthesia were among the neglected subgroups. Conclusion: The analysis of South and Southeast Asian NHPSPs suggests that SOTA care issues are not prioritized in most countries. Pathways to greater policy attention include integrating SOTA care into ongoing health policy‑making and planning efforts and developing and implementing specific national SOTA care plans.

The Use, Profile, Uptake, Characteristics and Attributes of Users of Homeopathy: Initial Findings from a Student Teaching Tele-Healthcare Clinic Based in North America

Research into the uptake profile and usage of Homeopathy has hitherto tended to be buried amongst complementary medicine research. Despite high levels of uptake of homeopathy, and robust numbers of over-the-counter sales of homeopathic products the current evidence evaluating the uptake of homeopathy remains limited on several fronts. The aim of this study is to explore the basic demographic features and characteristics of users of homeopathy services. The setting is a student teaching tele-health facility based in NA. Concurrent intake forms from 303 participants were analyzed. Intake forms were entered into a coding frame instrument designed and developed to explore health care information. A majority of participants (70%) who attend this clinic are female. The average age is 31 years old. Almost half of the participants in this clinic were using other additional complementary therapies in the management of their conditions. Almost the same number of participants (134) were only using homeopathy. The majority had some prior use of homeopathic products (91.6%), but 52.8% of participants had never worked with a professional homeopath. Twenty-four conditions are listed by participants as chief health complaints. Findings are in alignment with what is already known about the uptake in complementary medicine. Findings also reveal that the users of Homeopathy are seeking an ‘alternative’ to conventional medicine rather than only using Homeopathy as ‘complementary’ medicine. A proportion of participants in this clinical setting find homeopathy through over-the-counter sales and are, for a period, self-prescribing in chronic conditions. Further comparative research is needed to compare this to other complementary medicine avenues as well as conventional medicine settings. Conclusion: This in-depth empirical study of the users of homeopathy at one clinical facility represents initial, novel measured preliminary insights into the participants features and characteristics.

Low sexually transmitted infection (STI) screening and presumptive treatment and high STI positivity among United States females visiting the emergency department after sexual assault.

The Centers for Disease Control and Prevention sexually transmitted infection (STI) treatment guidelines state that the decision to provide STI/human immunodeficiency virus (HIV) testing and presumptive treatment after sexual assault (SA) should be made on an individual basis to minimize retraumatization of the patient. However, little is known about STI screening, presumptive treatment, and positivity in the emergency department (ED) setting. The objective of this study was to evaluate STI testing rates and positivity, presumptive gonorrhea and chlamydia treatment, pregnancy testing, and emergency contraception offered to SA survivors in the ED in the United States. The Premier Healthcare Database, a national administrative data set containing health care information from inpatient and hospital-based outpatient encounters, was used. Approximately 30% of encounters have available laboratory test results. ED visits for SA (identified by ICD-10-CM codes) among female patients aged 15-44 years between 2019 and 2023 were included. For patients presenting multiple times to the ED, only the first ED visit after SA was included. Of 49,047 total visits where females ages 15-44 years presented to the ED for SA, chlamydia, gonorrhea, syphilis, and HIV tests were conducted in 18.6%, 18.6%, 13.4%, and 16.9%, respectively, and pregnancy tests in 33.1% of visits. Presumptive gonorrhea and chlamydia treatment was provided in 53.7% and 52.2%, respectively, and emergency contraception in 27.2% of visits. Approximately 40% of patients were neither tested nor treated for either chlamydia or gonorrhea. Of patients with available laboratory test results, chlamydia, gonorrhea, and syphilis positivity rates were 10.0%, 3.8%, and 1.0%, respectively. Low STI testing and treatment rates and high STI positivity identified in this study suggest that an important opportunity exists for improving STI screening and presumptive treatment for female patients presenting to the ED after SA.

Endocrine management of transgender and gender diverse adolescents: expert opinion of the ESPE Working Group on Gender Incongruence and the Endo-ERN main thematic group on Sexual Development and Maturation.

Increasing numbers of transgender and gender diverse adolescents seek endocrine treatment to align their body to their gender identity. In this relatively young field of medicine, there is a limited body of evidence, and the available evidence generally is of low quality. However, in the absence of randomised trials, much can be learned from prospective observational studies. While evidence on somatic and psychosocial outcomes has increased in recent years, areas with little or no research rely on expert opinion. In order to reduce practice variation in paediatric endocrine care for transgender adolescents, we describe endocrine care for transgender and gender diverse adolescents in Europe in this statement, based on the available evidence as well as the experience of experts from the ESPE Working Group on Gender Incongruence and from the European Reference Network Endo-ERN, main thematic group 'Sexual Development and Maturation'. This document aims to provide practical information and tools for clinical care, with sections on the multidisciplinary team, counseling, fertility, hormone suppression, gender affirming hormone treatment, support for non-binary adolescents, long-term follow up and transition of care, altered treatment wishes, lifestyle and sexual health, and in addition includes a paragraph on ethical considerations regarding this care.

Video Remote Sign Language Interpreting in Health Communication for Deaf People: Protocol for a Randomized Controlled Trial.

The current standard of interpretation provision is not efficacious or not acceptable to Deaf patients who communicate using sign language. In-person or video relay interpretation (VRI) sign language interpretation is largely unavailable. There are no clear data on the availability of VRI or in-person interpretation. Given the limited number of available sign language interpreters and the cost, VRI may be more available than in-person. Existing evidence tends to focus on assessing personal preferences of Deaf users regarding interpretation and interpreters' preferences. Although respecting preferences is essential, there is a vacuum of knowledge on how the format of access to interpretation impacts the quality of communication between Deaf persons and health personnel. This study aims to look at the effectiveness of the VRI system in improving communication outcomes between Deaf patients and doctors versus the available standard of care of the usual communication tools, including informal interpretation, lip- or note-reading, and using their mobile phones to contact a formal or informal interpreter, for Deaf patients aged 18 years and older in Bogota, Colombia. This is a randomized controlled trial with a total sample size of 216 participants, divided into 2 groups: an intervention group, which receives a medical appointment using VRI, and a control group, which receives a medical appointment using standard communication. Both the Deaf participants and the health care professionals will be blinded to the allocation, as they will not know whether the appointment will involve VRI or standard communication until they arrive at the office. The primary outcome measure will be an assessment of communication using a Doctor-Patient Communication Scale. This scale was translated into Colombian Sign Language following a rigorous cultural adaptation and translation procedure. Furthermore, the database contains key clinical variables and recommendations provided by the doctor during a general medicine appointment. We will compute associations. Recruitment opened on August 24, 2023. As of July 2024, 180 participants had been enrolled. The intervention and data collection were finalized in October 2024. The findings of this study are expected to be submitted for publication in early 2025. This study will provide rigorous evidence regarding information and communications technology intervention in health care, addressing empirical challenges in using inclusive research designs in public health. In addition, effective VRI models that address the challenges faced by Deaf people will be tested, implemented, and maintained in low- and middle-income countries. A disability-inclusive evaluative tool for quality communication mediated by VRI in health care is also tested. Ultimately, this will lead to evidence-based recommendations for implementing the Convention on the Rights of Persons with Disabilities (CRPD) in mobile health contexts. ClinicalTrials.gov NCT05966623; https://clinicaltrials.gov/study/NCT05966623. DERR1-10.2196/64590.