Care Issues Research Articles

“I get the referral because nobody else wants to work with this person”: A critical realist analysis of social workers providing care to people living with borderline personality disorder

Borderline personality disorder (BPD) is a mental health condition characterized by unstable relationships, self-image, and emotions, as well as impulsive behaviors and high rates of morbidity and mortality. Provider-based stigmatization of individuals with BPD is associated with poor health outcomes and increased mortality risk. However, little is known about social workers' experiences in providing care to people living with BPD (PLBPD). This study explored social workers' perspectives on the impact of stigma on care for PLBPD. Between April 2020 and January 2021, qualitative semi-structured interviews were conducted with 41 social workers practicing across the continuum of care (e.g., community services and hospitals) in Ontario, Canada. Data were analyzed using Critical Realist Analysis. Four primary themes emerged: (1) stigmatization of PLBPD due to the complexity of their needs (e.g., avoidance, blame, name-calling by providers); (2) lack of BPD-specific training and education in social work curricula; (3) observed stigmatization of PLBPD by social workers and other professionals (e.g., psychologists and physicians); and (4) suggestions for improving care experiences for PLBPD. Results suggest that provider-based stigma remains a significant quality of care issue affecting PLBPD. Further research is needed to understand the scope of these issues among diverse PLBPD populations, within social work practice, and across interprofessional care settings.

Advocacy in Practice: Who Advocates for the Advocates?

Advocacy has been defined as promoting social inclusion, equality and social justice to empower people - principles closely associated with social work’s professional values. However, in-depth literature on advocacy and the current challenges it faces is sparse. Little is known about the day-to-day realities faced by advocates and the pressures they currently experience. This raises the question of who might advocate for the advocates themselves? This article reports on findings from a larger study to explore local recruitment and retention issues in adult social care from the perspective of different populations of interest in the South of England. A mixed methods approach was undertaken. One group of participants were advocates drawn from LA contracted services (n = 7) who participated in a focus group. Comments relating to the challenges facing advocacy and knock-on impacts on advocates from the recruitment and retention issues currently being experienced in adult social care were themed together and are described. The findings highlight a number of challenges currently facing advocacy and advocates alongside an urgent need for more research to take place within this area. The authors also offer suggestions for consideration to help improve this picture.

Polish medical students’ awareness about reproductive physiology

Introduction: Falling fertility rates and prevalence of infertility become serious problems of public health that affect families all over the world. Both men and women are delaying parenthood for several reasons, such as undertaking further education, pursuing careers, travelling, finding a partner later in life and facing the challenges of establishing secure finances and housing. Unfortunately their fertility declines with age and this awareness may influence the prioritization of life plans. Medical students are specially dedicated to promote health literacy in their future practice as well as in they private life. Aim of the study and methodology: Aim of this study was to examine polish medical students’ awareness about the basic reproductive physiology. It was based on on-line authors’ own questionnaire among 445 female and 97 male medical students of a mean age 22.3 years from 13 polish medical universities. Results It showed that awareness of basic fertility physiology is on relatively high level what can be promising. Students who plan to start a family in the future have the highest overall mean score of correct answers (83%). Statistically lower levels of knowledge about fertility is presented by the students that have no decision about the future family or do not want to raise a family (80% and 72% respectively). The results seem to be similar irrespective of the participants’ gender, year of study, sexual activity and potential pregnancy prevention method. Conclusions It is still essential to introduce modern knowledge about fertility care and prophylaxis issue among future medical staff, so that they will properly take care of their health and educate their patients.

Ongoing and emerging issues for residential long-term care in the context of Covid-19.

Background: Long-term care facilities have been confronted with various workforce challenges, including a poor image within the nursing profession, a shortage of staff, and a growing demand for long-term care. Furthermore, these facilities have been significantly impacted by the pandemic and the respective measures with detrimental effects on residents, staff, and their family members. Aim: This study explored issues in working in residential long-term care from the perspective of nurses and their perception on amplifying and additional effects of Covid-19. Methods: It applied a qualitative design focusing on experiences and views of 25 LTC nurses working in Austrian long term care facilities during the pandemic. Data were collected by conducting in-depth interviews either virtually or in presence. The data analysis was conducted by applying a thematic analysis. Results: The four identified themes are: (1) Work motivation, (2) Dealing with vulnerability, (3) Human Resource Planning and (4) External view on long-term care. For each theme it was delineated which aspects have been present in the pre-Covid-19 situation and which became more visible or arose additionally. Conclusions: Nurturing connection between LTC nurses and with residents and relatives as well as signaling the positive aspects of LTC such as relationships, challenge and responsibility may allow to tackle Human Resource Planning issues.

New urbanization; Urban resilience; Coupled coordination model; Huaihe River Basin

Contemporary China's pension system revolves around the allocation and acquisition of pension resources, relying on the enforcement of political power as a guarantee, and is closely integrated with the formulation of laws to form a normative system. This system is composed of a variety of specific systems, and the sub-systems are interconnected and complementary in function, forming a comprehensive pension security network. In the process of promoting the modernization of the national governance system and governance capacity, the pension field needs to achieve a benign governance model, which requires a complete pension system as a support. Under the framework of the existing political system and constitutional system, the basic governance logic remains unchanged. To further promote the development of the pension system, the key lies in optimizing the pension legal system and establishing an effective coordination mechanism between laws and systems. Specifically, it is necessary to start from the following aspects: first, reconstruct the pension legal system with a coordinated and development approach, enhance the fairness of the pension legal system on the basis of objectively analyzing the social situation, and ensure the sustainability of social pension security; second, optimize the pension legal system from the perspective of national strategic layout, including improving the form of family pension responsibility and accelerating the legalization of social pension security; finally, strengthen the development of pension laws by giving full play to the leading role of the National People's Congress in legislation and improving the review mechanism of administrative normative documents. Only in this way can we form a modern system to deal with the issue of elderly care under the increasingly severe aging situation.

Riding the gene therapy wave: challenges and opportunities for rare disease patients and clinicians.

A growing number of gene therapies are getting FDA-approved for pediatric rare disorders to treat once incurable diseases. Opportunities for preventing lifetime illness and improving quality of life for these patients is now becoming a reality. Challenges exist in navigating the complexities of determining which patients will benefit from these new gene therapies and how to effectively deliver them as a standard of care. Gene therapies have been approved for pediatric hematological, neuromuscular, cancer, and other disorders that have improved the quality of life for rare disease patients. FDA approval of these drugs has been on a case-by-case basis leading towards gaps in drug approval, physician and patient knowledge of new gene therapies, and ultimate delivery of these drugs. Identifying patients that would benefit from these drugs and other coordination of care issues have arisen with each unique gene therapy product. These gene therapies have unique requirements and patient indications that require a knowledgeable group of physicians and hospital administrators to incorporate their use as a standard of care. With more gene therapies on the near horizon for FDA approval, multidisciplinary teams may improve patient access to these drugs by streamlining approaches towards adapting gene therapies into clinical use. The rapid increase in the number of FDA-approved gene therapies has not only created a number of challenges but also opportunities to improve the lives of pediatric patients with rare disorders. The adaptability of physicians, hospitals, and governmental regulatory boards is essential for delivering these new gene therapies safely and efficiently to these rare disease patients. Challenges still remain as to future requirements for additional gene therapy dosing and how to best manage financial burdens placed on the patient and providing institution.

Sociodemographic associated factors with non-disclosure of HIV sero-status to sexual partners in Maputo, Mozambique

The HIV prevalence in Maputo city is 16.2%. There is a lack of data describing associated factors with disclosure or non-disclosure of HIV-positive sero-status to sexual partners. This analysis describes associated factors of non-disclosure of HIV sero-status to sexual partners among people living with HIV (PLHIV) participating in a serostatus disclosure support program at three health facilities in Maputo, Mozambique. We used a cross-sectional design of PLHIV aged over 18 years. Datas were collected between December 2019 and September 2020. Univariate and multivariable logistic regression models were used to evaluate factors associated of non-disclosure of HIV sero-status. A total of 377 patients were enrolled in the HIV sero-status disclosure Program. Of these, nearly two-thirds (61.5%) were women, 52.9% had completed secondary school, 47.7% were 25–34 years old, 50.9% had informal employment with low income, and 73.2% were married. Univariate logistic regression model showed greater odds of non-disclosure among patients who had an employment contract with a maximum wage (Crude Odds Ratio [cOR] 2.02, 95% confidence interval [CI] 1.15–3.55, p = 0.015); were single (cOR 3.85, 95% CI 2.22–6.69, p < 0.001); were living with parents (cOR 2.30, 95% CI 1.07–4.93, p = 0.033); received financial support for their monthly household expenses from parents or a close relative (cOR 7.15, 95% CI 2.19–23.36, p = 0.001); or brought a parent/close relative and/or a friend as a confidant during HIV care(cOR 3.17, 95% CI 1.74–5.76, p < 0.001; and cOR 5.97, 95% CI 1.57–22.66, p = 0.009, respectively). Multivariable logistic regression model showed: from parents/close relative and from partner (Adjusted Odds Ratio [aOR] 8.19, 95% CI 1.44–46.46, p = 0.018; and aOR 4.34, 95% CI 1.05–17.17, p = 0.043), respectively); in those who brought a parent/close relative and/or a friend as a confidant during HIV care (aOR 8.86, 95% CI 2.16–36.31, p = 0.002; and 195 aOR 21.68, 95% CI 3.02–155.87, p = 0.002, respectively). Non-disclosure of serostatus is a critical issue for HIV care and treatment programs, given that non-disclosure of HIV serostatus increases risk of HIV transmission. Understanding the factors associated with non-disclosure is crucial for designing strategies to address these factors and end the HIV epidemic by 2030. Our findings suggest that HIV serostatus disclosure programs might target the sociodemographic factors strongly associated with non-disclosure.

Development and validation of a nomogram for predicting critical respiratory events during early anesthesia recovery in elderly patients

BackgroundElderly patients undergoing recovery from general anesthesia face a heightened risk of critical respiratory events (CREs). Despite this, there is a notable absence of effective predictive tools tailored to this specific demographic. This study aims to develop and validate a predictive model (nomogram) to address this gap. CREs pose significant risks to elderly patients during the recovery phase from general anesthesia, making it an important issue in perioperative care. With the increasing aging population and the complexity of surgical procedures, it is crucial to develop effective predictive tools to improve patient outcomes and ensure patient safety during post-anesthesia care unit (PACU) recovery.MethodsA total of 324 elderly patients who underwent elective general anesthesia in a grade A tertiary hospital from January 2023 to June 2023 were enrolled. Risk factors were identified using least absolute shrinkage and selection operator (LASSO) regression. A multivariate logistic regression model was constructed and represented as a nomogram. Internal validation of the model was performed using Bootstrapping. This study followed the TRIPOD checklist for reporting.ResultsThe indicators included in the nomogram were frailty, snoring, patient-controlled intravenous analgesia (PCIA), emergency delirium and cough intensity at extubation. The diagnostic performance of the nomogram model was satisfactory, with AUC values of 0.990 and 0.981 for the training set and internal validation set, respectively. The optimal cutoff value was determined to be 0.22, based on a Youden index of 0.911. The F1-score was 0.927, and the MCC was 0.896. The calibration curve, Brier score (0.046), and HL test demonstrated acceptable consistency between the predicted and actual results. DCA revealed high net benefits of the nomogram prediction across all threshold probabilities.ConclusionsThis study developed and validated a nomogram to identify elderly patients in the PACU who are at higher risk of CREs. The identified predictive factors included frailty condition, snoring syndrome, PCIA, emergency delirium, and cough intensity at extubation. By identifying patients at higher risk of CREs early on, medical professionals can implement targeted strategies to mitigate the occurrence of complications and provide better postoperative care for elderly patients recovering from general anesthesia.

Development and Evaluation of a Direct Care Hospitalist Service Internal Medicine Sub-internship Rotation.

Direct Care Hospitalist Services (DCHS) can increase internal medicine (IM) sub-internship rotation availability while providing hospitalists additional teaching opportunities. Implement and evaluate a DCHS sub-internship. Urban Academic Medical School. IM sub-interns, hospitalists. One to two sub-interns were paired with three hospitalists on 3 weeks of day service and five nights in an apprenticeship model. Sub-interns admitted and followed patients on days and cross-covered and admitted on nights. DCHS sub-intern rotation satisfaction and skills preparedness were surveyed over 2 years. Sub-interns rotating on resident-covered service (RCS) were surveyed in year 2, and results compared to DCHS. Hospitalists were surveyed year 1 to rate satisfaction. Year 2 DCHS cross-cover paging data was tabulated to evaluate clinical content. DCHS and RCS sub-interns rated satisfaction and preparedness similarly. DCHS sub-interns rated time management (3.86 vs 4.33, p = 0.19) and calling consults (4.4 vs 4.8, p = 0.56) lower, but cross-cover higher (4.14 to 3.67, p = 0.34) than RCS. DCHS sub-interns averaged 39.4 (SD 4.1) nightly cross-cover pages with most related to acute symptoms (46%). Hospitalists were highly satisfied with their rotation experience. Sub-interns were highly satisfied with DCHS sub-internship. Future work will target gaps in preparedness for urgent patient care issues.

How Will Our Retirement Life Be? An Analysis of Elderly Care through the Lens of the Forest Therapy Industry

With the development of the social economy and the arrival of the aging era, the issue of elderly care has increasingly gained social attention. This matter not only concerns the personal interests of individuals but also represents a significant focal point in the construction of social welfare systems, influencing the development direction of multiple industries. As the elderly population continues to grow, there is a pressing need for innovative and sustainable care solutions. Among the diverse elderly care models, the forest therapy industry emerges as a new direction, providing seniors with a comfortable natural environment that promotes physical and mental health. This approach not only enhances the well-being of older adults but also serves as an important avenue for rational and sustainable development through the utilization of forest ecological products. This paper explores the connection between elderly care models and the forest therapy industry, offering insights into the current state and future development of the Chinese elderly care sector. By examining the benefits of integrating forest therapy into existing care frameworks, this study aims to provide practical recommendations. It is hoped that these insights will serve as a reference for stakeholders in the Chinese elderly care industry, promoting the positive role of forest therapy in optimizing and enhancing elderly care models for a healthier, happier aging population.

The Correlation Between Quality of Care and Mental Health and Behavioral Problems Among Vietnamese Adolescents in Social Support Facilities

Background: Previous studies have shown the negative impact of institutional care on children’s physical and mental health. However, in addition to the form of care, the quality of care is an important factor in children’s mental health. This study explored the quality of care and the association between the quality of care and mental health issues among adolescents in Vietnam social support facilities (SSFs). Methods: A cross-sectional study was conducted with 273 institutionalized adolescents who lived in SSFs and 273 adolescents cared for by family. Depressive symptoms, anxiety symptoms, sleep problems, behavioral problems, and quality of care were measured. Descriptive statistics were calculated, and multiple linear regression analysis was performed. Results: The quality of care was rated as quite high by institutionalized adolescents. However, the mean score for quality of care was significantly lower for institutionalized adolescents than for the comparison group. The quality of physical care did not show a significant relationship with mental health risk, except for anxiety. In contrast, emotional care was negatively associated with all common mental health problems including anxiety (beta = –0.40, P &lt; .001), depression (beta = –0.31, P &lt; .01), conduct behavior (beta = –0.30, P &lt; .01) and sleep problems (beta = –0.30, P &lt; .01). An increase in emotional care was therefore associated with a decrease in mental health problems. Conclusions: Emotional care is more important than physical care for adolescents in SSFs. It is necessary to improve the quality of care, particularly emotional care, for adolescents to reduce the risk of mental health problems.

Violent encounters on the front line: Sequential explanatory mixed-methods investigation of physical violence factors in the prehospital setting

ObjectiveWorkplace violence (WPV) is an important issue in prehospital care, especially for emergency medical technicians ( EMTs) who are at increased risk of physical violence due to the nature of their work. This study aimed to shed light on the specific factors that contribute to the underlying causes of physical WPV in the prehospital context through direct experience and insight into the work of EMTs.MethodsSequential explanatory mixed methods were applied in five western provinces of Iran from 2022 to 2023. In total, 358 EMTs that met the criteria for the quantitative phase were selected using a multi-stage clustering method. In the quantitative phase, the researchers used a questionnaire on workplace violence in the healthcare sector. Based on the results of the quantitative phase, 21 technicians who had experienced physical violence in the past 12 months were invited for in-depth interviews in the qualitative phase.ResultsThe average age of the EMTs was 33.96 ± 6.86 years, with an average work experience of 10.57 ± 6.80 years. More than half (53.6%) of the staff worked 24-hour shifts. In addition, most EMTs were located in urban bases (50.3%), and 78 (21.8%) reported having experienced physical violence. No significant correlations were found between the demographic characteristics of the technicians and the frequency of physical violence, except base location in the last 6 months. The qualitative study also created one theme (the complexity of WPV in the prehospital setting), four categories, and ten subcategories.ConclusionThe study’s results emphasize the need for comprehensive WPV factors in the prehospital setting. These factors can lead to identifying and improving strategies such as organizational support, improving communication and collaboration between responders, and training in de-escalation techniques. In addition, it is crucial to address the root causes of WPV such as poverty and lack of education in the community to create a safer and more supportive environment for patients and staff.

Evaluation of foot analysis in the presence of dental malocclusion: A systematic review

Background: Previous studies have reported that the imbalance of occlusion, cervical spine, length of the limb, and asymmetric leg length are related to the presence of muscle compensation. These issues influence some strategies in orthodontic diagnosis for developing an updated stomatognathic system over multidisciplinary care issues. Purpose: This study aimed to obtain orthodontic findings and an orthopedic relationship between foot posture/function and dental malocclusion based on cross-sectional studies. Review: Some findings about postural system disequilibrium in static and dynamic foot postural related to occlusal changes have been reported following the mixed dentition phase. From 248 articles, 5 articles were selected and assessed with the Joanna Briggs Institute critical appraisal cross-sectional checklist and analyzed. Conclusions: Although the selected eligible articles demonstrated a low risk of bias in agreement (p &gt; 0.05) among authors, the evaluation of those cross-sectional studies is still limited and requires further longitudinal studies with precise diagnostic parameters. Those parameters for evaluating the relationship between foot posture and malocclusion should encompass both static and dynamic approaches, including those related to mandibular position, tongue posture and function, bad habits, and temporomandibular disorder.

Analysis of Rural Elderly Care Strategies: “Policy Guidance-Resource Integration” Pathway

With the development of China's social economy and the aging population, rural areas are facing increasingly challenging elderly care issues due to labor outflow and economic development lagging behind urban areas. To address this problem, this study collected a large amount of relevant literature, summarized and analyzed existing research, and explored pathways to effectively improve the quality of rural elderly care services. Through interdisciplinary theoretical analysis and practical research, the study proposed the “Policy Guidance-Resource Integration” pathway, confirmed its effectiveness, and elaborated on specific implementation methods and underlying rationale. The research findings demonstrate that the “Policy Guidance-Resource Integration” pathway can effectively address some of the current issues in rural elderly care, offering new insights and guidance for academic research and policy formulation in the field of rural elderly care.

The flare up of immune-mediated inflammatory dermatoses during COVID-19 pandemic—a cross sectional study in a tertiary care hospital

Background and aim COVID-19 disease raises many critical issues in dermatology and dermatological care. Addressing these issues is necessary, yet also challenging, because there are only a few direct data available. We attempted a study to provide a better understanding regarding the impact of COVID-19 pandemic on the course and management of chronic immune-mediated inflammatory skin disease during COVID-19 pandemic. Methods A Questionnaire based study was conducted on patients with chronic immune-mediated inflammatory skin diseases started on immunosuppressant therapy before COVID period and questioned regarding the treatment taken for skin disease, follow up, COVID-19 infection and vaccination status, flare up of skin disease, management of the disease flare up. The data collected are tabulated and analyzed in epi-info software/MS excel. Result Among 500 patients, 462 (92.4%) discontinued the treatment which was mainly due to their inability to reach the hospital (99.5%) and remaining 0.5% were afraid of taking immune suppressants during pandemic. 385 (83.3%) of 462 patients who discontinued the drug had disease flare up. 75 (15%) out of 500 patients turned COVID–19 positive. 50 (66.6%) out of 75 COVID-19 (+) patients developed disease flare up. 293 (58.6%) out of 500 patients were vaccinated, among which 12 patients (4%) had flare up. Conclusion COVID-19 infection as well as vaccination has both direct and indirect influence in disease progression/flare up of preexisting inflammatory dermatoses. Knowledge regarding the course and management of chronic inflammatory skin conditions during this pandemic helps in providing better quality of life.

Nature and Determinants of Fear of Cancer Recurrence After Endoscopic Submucosal Dissection for Early Gastric Cancer: A Cross-Sectional Study.

Gastric cancer is one of the most prevalent tumors in China and other countries, with high morbidity and mortality. Fear of cancer recurrence is common among cancer survivors. Fear of cancer recurrence experiences and psychological interventions have been investigated in breast and other cancers. However, this phenomenon and associated factors have not been evaluated in early gastric cancer survivors in China. The objective of this study was to investigate the nature of fear of cancer recurrence and influencing factors in Chinese patients with early gastric cancer treated with endoscopic submucosal dissection. This cross-sectional study in two centers included 312 early gastric cancer patients who answered self-report questionnaires and were treated with endoscopic submucosal dissection between June 2022 and May 2023 to assess fear of cancer recurrence. Gender, family history of gastrointestinal tumor, tumor recurrence, Helicobacter pylori infection, disease perception, and self-perceived burden were significant factors influencing fear of cancer recurrence (p < .05). More than half of early gastric cancer patients have fear of cancer recurrence, and how to deal with it has become a key issue in the postoperative care of patients. Medical professionals should address these factors to reduce fear of cancer recurrence in at-risk patients.

Cancer Care in Resource-Limited Countries: Jordan as an Example.

Jordan, a lower- to middle-income country, is relatively small, but with rapidly growing population and a challenged economy. Cancer is a growing health care problem and currently ranked second, after cardiovascular diseases, as a cause of death. Jordan's national cancer registry continues to suffer from problems mostly related to long lag time in reporting, absence of outcome data, and accurate staging. The number of new patients with cancer diagnosed in Jordan is increasing at an expected, none disturbing rate, fueled by population growth, improving life expectancy, changing population structure that hosts more older population, high rate of obesity, smoking, and lack of adequate exercise. However, age-standardized rate for cancer incidence is significantly lower than Western societies, yet, mortality rate is higher. Despite efforts, cancer is still diagnosed at more advanced stages and at younger age. The Jordan breast cancer program represents a great example of opportunistic screening that led to significant downstaging of breast cancer. Efforts to evaluate the feasibility of screening programs for colorectal and lung cancers are underway. Tremendous efforts resulted in the execution of the largest clinical cancer genetics program in the region that helps identify patients and at-risk relatives for hereditary cancers. Low-resourced countries, including Jordan, will not be able to keep up with the rapidly increasing cost of cancer care. A better access to clinical trials and moving cancer care to ambulatory settings should offset some of this cost. A cancer control program that addresses all issues of cancer care from screening and early detection, through active cost-effective treatment that assures wider access to palliative care, hospice, and survivorship programs under an expanded universal health coverage, is an urgent national health priority.

P041 COMMUNITY-BASED STRATEGIES TO IMPROVE HEALTH-RELATED OUTCOMES IN PEOPLE LIVING WITH HYPERTENSION IN LOW MIDDLE-INCOME COUNTRIES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background and objective: Hypertension affects one billion people globally and is a major risk factor for cardiovascular diseases. Currently, it is estimated that high blood pressure (BP) is related to the deaths of more than 10 million people every year. Interventions to mitigate the looming hypertension crisis in low- and middle-income countries (LMIC) need strong community involvement whilst concurrently addressing access to care and quality of care issues. The objective of this systematic review was to evaluate community-level interventions to improve hypertension control among patients living in LMICs. Methods: Nine databases were searched (July 22, 2023) for randomized controlled trials (RCTs) and cluster randomized control trials (cRCTs) implementing community-level interventions in adults with hypertension in LMICs. Studies were included based on an explicit focus on BP control. Quality assessment was done using the Revised Cochrane Risk of Bias tool for randomized trials (ROBS 2). Results were presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Fixed-effect meta-analysis were conducted for studies that reported continuous outcome measures. Results: We identified and screened 7125 articles. Eighteen studies were included in the analysis, 7 RCTs and 11 cRCTs. The overall summary effect of BP control from the meta-analysis was significant, risk ratio = 1.48 (95%CI = 1.40–1.57, n=12). For the RCTs risk ratio was 1.68 (95%CI = 1.40–2.01, n=5), and for the cRCTs 1.46 (95% CI = 1.32 – 1.61, n=7). For studies that reported on the individual components of the composite interventions, the risk ratio was 1.27 (95%CI = 1.04–1.54, n=3). Conclusions: Community-based strategies are relevant in addressing the burden of hypertension in LMICs. Community-based interventions can help decentralize hypertension care in LMIC and address the access to care gap without diminishing the quality of hypertension control.

An Overview of Prosthetic Implant Attachments in EdentulousPatients

Edentulism is an unresolved health care issue of sustained significance and prevalence in the aged population. Adaptation to wearing complete dentures is a complex process and must be considered from both somatic and psychological standpoints. The difficulties of wearing dentures have been attributed to deficiencies of the denture-bearing tissues, reduced salivary flow,vulnerable tissue and severe ridge resorption. The prosthetic management of the edentulous patient has always been a major challenge. Complete maxillary and mandibular dentures have been the traditional treatment option. However, most of the patients report problems adapting to the mandibular denture due to lack of comfort, retention and stability. It is well known that implantretained/supported overdentures provide improved retention, support, stability, function, and comfort for patients

Management of Bilateral Congenital and Juvenile Cataracts in a Low-Income Country: Patient Identification, Treatment Outcomes, and Follow Up.

Childhood blindness remains a neglected issue in eye care within low-income countries, with congenital and juvenile cataracts being the most common treatable causes. This study aims to investigate the factors influencing the management of congenital and juvenile bilateral cataracts, provide data on general outcomes and postoperative findings, and discuss treatment in a low-income country context. In this prospective study, data from clinical care were continuously entered into a database, and one follow-up examination of a cohort of 91 patients with congenital and juvenile bilateral cataracts in Kinshasa, Democratic Republic of the Congo, was conducted. Multiple factors that affect the first clinical presentation, the clinical management, and outcome were investigated. Most patients (88.5%) who received medical treatment were identified by cataract finders. A patient's presentation time was independent of the parent's education, social status, income, and sex of the child. The median age at first presentation was 5.8 years (ranging from 0 days to 17.3 years). The best visual acuity outcomes were achieved by patients who underwent surgery during early childhood. According to WHO grades and on an eye level basis, 51.1% (93 out of 182 eyes) showed improvement, while 34.6% (63 eyes) had unchanged results post-surgery. Among the cases without improvement, 76.2% were blind prior to surgery. Postoperative findings were observed in 56% of the patients, with secondary cataracts being the most common, affecting 26.37% of the operated eyes. Optimal management of childhood cataracts involves early identification, efficient hospital infrastructure, high-quality medical care, and long-term follow up. In sub-Saharan Africa, this approach must be adapted to the context of available resources, which differs significantly from those in high- and middle-income countries.