Lack Of Transportation Research Articles

Clinical and psychosocioeconomic impact of COVID-19 pandemic on patients of the Indian Progressive Systemic Sclerosis Registry (IPSSR).

ObjectivesThe aim was to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on access to health care among patients with scleroderma and to analyse the economic and psychosocial impacts and the infection prevention measures taken by them during the pandemic.MethodsA 25-item questionnaire designed to assess the components of the objectives was tele-administered between October 2020 and January 2021 to the patients enrolled in the Indian Progressive Systemic Sclerosis Registry.ResultsOf the 428 patients in the registry, 336 took part in the study. A scheduled outpatient visit was missed by 310 (92.3%) patients, and 75 (22.3%) skipped prescription drugs. During the pandemic, 75 (22.3%) had a family member lose a job. Financial difficulties were reported by 155 (46.1%), with 116 (34.5%) patients having to spend an additional INR 4000 (2000–10 000) [USD 54.9 (27.0–137.4)] to continue treatment. Although 35 patients (10.4%) had at least one symptom suggestive of COVID-19, infection was confirmed in only 4. None of them needed hospitalization or had adverse outcomes. Worsening of scleroderma was seen in 133 (39.6%) individuals, with 15 (4.5%) requiring hospitalization. Most (96%) of the patients were aware of infection prevention measures, and 91 (27.1%) had taken unproven prophylactic medications.ConclusionIndividuals with scleroderma in India have been affected during the pandemic owing to closure of hospital services, lack of transport, loss of jobs and the additional financial burden. Health-care providers should continue to educate patients to stay on their medications and encourage them to be vaccinated for COVID-19.

Research on Sustainable Development Evaluation of Reservoir Water Source Area in Island Area

This study takes Taiwan’s Sun Moon Lake Reservoir as the research object to discuss the sustainable development decision-making of the reservoir water source area in the island area. The grounded theory was adopted to construct the framework; 835 questionnaires were analyzed by statistical test; 10 interviewees’ feelings were collected through interviews and discussions, and multiple verification methods were used for exploration. Conclusion: The study found that the current development of the reservoir water source area of the outlying islands has brought much garbage; affecting the quality of the natural environment; lake; and water source; caused the disappearance of distinctive culture and architecture. The poor interaction between businesses and communities has led to an overlap in the types of industries, consumer goods, attractions and a lack of transportation and medical facilities, affecting people’s desire to travel. The government’s future decisions include: Increasing the variety of consumer goods; improving medical and transportation facilities; preserving unique culture and architecture; linking foreign-invested enterprises with community interactivity; enhancing local people’s interaction; and compensating for the deficiencies in human resources for industrial development are the key points for future improvement of the reservoir water source area of the outlying islands.

'My coupons are like gold': experiences and perceived outcomes of low-income adults participating in the British Columbia Farmers' Market Nutrition Coupon Program.

The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers' markets. Our objective was to explore FMNCP participants' experiences of accessing nutritious foods, and perceived programme outcomes. The current study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers' market season. Directed content analysis was used to analyse the data, whereby the five domains of Freedman et al.'s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework's domains were coded inductively. One urban and two rural communities in British Columbia, Canada. Twenty-eight adults who were participating in the FMNCP. Three themes emerged: autonomy and dignity, social connections and community building, and environmental and programmatic constraints. Firstly, the programme promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development and mitigating stigma and shame. Secondly, shopping in farmers' markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers' markets, lack of transportation and challenges with redeeming coupons. Participation in the FMNCP facilitated access to nutritious foods and enhanced participants' diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies and expanding programmes may help improve participants' experiences and outcomes of farmers' market food subsidy programmes.

Service Coordination to Address Maternal Mental Health, Partner Violence, and Substance Use: Findings from a National Survey of Home Visiting Programs.

Maternal risks such as poor mental health, partner violence, and substance misuse can undermine child health and development. Maternal and early childhood home visiting programs address these risks primarily through referral and coordination with community-based services, yet effects on these outcomes have been small. This study assessed the strengths of local home visiting sites' systems to support coordination of mental health, partner violence, and substance use services. Investigators recruited home visiting sites (N = 88) representing diverse models from a national practice-based research network, the Home Visiting Applied Research Collaborative (HARC). Web-based surveys assessed five implementation system supports for coordination and nine coordination activities drawn from the Measurement Framework for Coordination developed earlier in the project. Surveys also assessed seven coordination barriers identified in previous research. Sites varied in their implementation supports and coordination activities; on average, sites had stronger systems in place to support screening and referring families than to support linkage and follow-up. Implementation supports and activity scores were higher for mental health and partner violence than for substance use. Across all service needs, scores were highest for offering a referral and documenting the caregiver's agreement for exchange of information between providers. Scores were lowest for offering a warm handoff. Lack of open slots and lack of transportation were major barriers to successful coordination for all three services. Results suggest that home visiting coordination could be strengthened by focusing on infrastructure for linkage and follow-up with services in the broader system of care.

Diabetes management among underserved older adults through telemedicine and community health workers.

Diabetes mellitus (DM) disproportionately affects older adults from marginalized communities. In the United States, the prevalence of DM in ages ≥65 years is twofold higher than the national average for adult populations. Telemedicine and community health workers (CHWs) are emerging diabetes care models but their impact on older adults with limited resources are relatively neglected within the medical literature. The purpose of this systematic review was to explore the impact of telemedicine and CHW interventions for improving A1C levels and self-management behaviors among underserved older adults with DM. A systematic literature search was performed in PubMed, CINAHL, Embase, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a reporting guideline. Diabetes self-management education (DSME) administered through telemedicine and CHW interventions were effective for improving A1C levels, self-care adherence, and patient and provider satisfaction among adults aged ≥50 years. Common barriers to diabetes care include inadequate resources, lack of transportation, inconsistent means of communications, social isolation, and low motivation. Community health workers and telemedicine were effective in improving disease management and optimizing care coordination within the vulnerable adult populations. Well-coordinated, evidence-based, and population-centered interventions can overcome the unique disparities experienced by underserved older adults with diabetes. Incorporating DSME-guided telemedicine and CHW interventions into primary care can mitigate diabetes-related complications in older populations. The lack of evidence specific to adults aged ≥65 years calls for a universally accepted age range when referring to older adults in future research.

POS-293 Physical Activity In Renal Disease (PAIRED) and the effect on hypertension: a randomized controlled trial

Hypertension is a key determinant of both cardiovascular (CV) events and progressive renal dysfunction in people with chronic kidney disease (CKD). Exercise is an effective strategy for blood pressure (BP) reduction in the general population but in CKD, hypertension is mediated by advanced vascular stiffness and volume expansion, and it is unclear whether exercise will mitigate this. The primary aim of this randomized trial was to determine the effect of exercise training compared to usual care on 24-hour ambulatory systolic blood pressure (SBP) in people with CKD at eight weeks. Participants with an eGFR of 15-44 ml/min per 1.73m2 and SBP >120 mmHg were recruited from a single center Canadian renal program. Participants were randomized, stratified by eGFR (<30 versus ≥30), to receive thrice weekly, moderate intensity aerobic exercise (50–60% heart rate reserve) supplemented with isometric resistance exercise, targeting 150 minutes per week and delivered over 24-weeks, or usual care. For exercise participants, Phase 1 (eight weeks) included an in-center weekly session and home-based sessions, and Phase 2 (16 weeks) included home-based sessions. The primary outcome was the difference in 24-h ambulatory SBP after 8 weeks of exercise training compared to control. Secondary outcomes included markers of CV risk, arterial stiffness (pulse wave velocity), aerobic capacity as measured by cardiopulmonary exercise testing and physical activity as measured by 7-day accelerometry. Outcomes were analyzed using mixed linear regression including fixed effects terms for time point, intervention, baseline eGFR, the outcome variable measured at baseline, and a random effects term for participant. Missing values were multiply imputed using chained equations with predictive mean matching. 44 people were randomized (30% of target enrolment) prior to stopping due to COVID-19. Of those randomized, 36% were female, mean age was 66, 55% were diabetic, and mean GFR was 29. Eligibility was 25%, primarily due to transportation barrier to attend the in-center sessions. Compared with usual care, there was no significant change in 24-ambulatory SBP at eight weeks 2.86 mmHg (95% CI -2.64, 8.35; P=0.31) or 24 weeks. There was no significant change in arterial stiffness as measured by pulse wave velocity. VO2peak improved by 235 ml/min in the exercise group (95% CI 18, 452; P=0.03) and there was a significant increase in BMI at 8 weeks 2.01 kg/m2 (95% CI 0.13, 3.89; 0.04) which was reflected in an increase in kilograms of fat free mass but this was not sustained at 24 weeks. The daily mean step count did not differ significantly between groups at 8 weeks, -62 (95% CI -821, 698) or at 24 weeks. In Phase 1, 90% of participants initiated at least 70% of the prescribed sessions versus only 48% of participants in Phase 2. Exercise training improved VO2peak and optimized body composition in people with moderate to severe CKD. However, the trial was under powered to detect a difference in blood pressure and additional trials are needed. To address limitations to trial recruitment resulting from a lack of transportation as well as the pandemic, effective home-based exercise interventions are needed.

Technology-driven methodologies to collect qualitative data among youth to inform HIV prevention and care interventions.

The use of technology as a platform for delivering HIV prevention interventions provides an efficient opportunity to reach those at risk for HIV with targeted and timely prevention and treatment messages. Technology-delivered HIV interventions are becoming increasingly popular and include interventions that use mobile text messaging and mobile phone apps or deliver prevention messages through telehealth platforms. Community-centered approaches of intervention development can help address the potential gap between science and practice by ensuring that interventions are appropriate and driven by community needs and desires. Common approaches to gaining community input rely on qualitative data gathered through in-person focus group discussions (FGD), in-depth interviews (IDI) and youth advisory boards (YABs). While these proven methodologies have strengths, youth engagement can be limited by structural barriers (e.g., lack of transportation, inconvenient timing) and reluctance to participate due to stigma or discomfort with group settings. This results in a number of biases that limit the quality of face-to-face qualitative data collection, i.e., social desirability bias or selection biases created by differential likelihood of recruitment and attendance. As an increasing number of HIV prevention and care interventions are successfully delivered online, innovative approaches to youth engagement in virtual spaces can also be applied across the intervention lifespan to increase the quality and validity of formative data. In this paper, we describe a range of qualitative data collection techniques that can be used via online platforms to collect qualitative data, and we outline their relative advantages over face-to-face FGD or IDI. We use four case studies to highlight the methodologies and findings and provide recommendations for researchers moving forward.

BARRIERS IN UPTAKE OF CATARACT SURGERY IN THE COVID ERA: PATIENT'S PERCEPTIONS

Purpose: To evaluate the barriers in acceptance of cataract surgery during COVID-19(Coronavirus disease-2019) era. Material and methods: A cross sectional descriptive study was conducted in months of August and September 2020. Number of patients who refused the surgery were noted and compared with retrospective data of patients who refused cataract surgery in August and September 2019. The patients who refused cataract surgery were administered semi structured interview noting sociodemographic data, characteristics of cataract, reasons for refusing cataract surgery related to COVID-19 and otherwise and reasons for refusal to get tested for COVID-19. Results:Atotal of 100 patients (57 females and 43 males) who refused cataract surgery, 12 patients had visual acuity (VA) less than 6/60 and 50 had VAbetween 6/18-6/60. Amongst the barriers not relating to COVID-19 were daily activity not suffering(45) followed by fear of the surgery(25) and relating to hospital services were unwillingness for COVID-19 testing( 85), getting COVID-19infection from the hospital(24), lot of time is wasted (25)and they do not trust the level of precautions taken by the hospital at this point of time.(20) . Barriers related to COVID-19 were: refusal to get COVID-19 tested prior to surgery(85) , procedure is not an emergency, they want to defer it(51), their family members may get COVID-19 infection from them, if they get surgery at this time(15) , increase in nancial burden and owing to that they cannot get cataract surgery in this period(65) and lack of transport (25). Conclusions:COVID-19 has negatively impacted on cataract surgery uptake

Debate: Quantity of impatient beds and quality of child psychiatric and psychotherapeutic care provision - a German perspective.

Provision of care for children with mental health disorders or behavioural difficulties differs from country to country. Historically, Germany has the highest number of inpatient beds throughout Europe (64 inpatient beds per 100,000 young people). In addition, nearly 146 departments for child and adolescent psychiatry offer day-care beds as well as ambulatory care. A high number of resident child and adolescent psychiatrists/psychotherapists (more than 12,000 professionals) complement provision of care in the different regions of Germany. Yet, only 50% of children and adolescents with mental health problems receive the treatment they need. Barriers to care - for example lack of transportation, fear of stigmatization, long distances in rural regions or fear of long hospital inpatient stays - keep families from presenting their child/adolescent to the relevant institutions. Recently, a new treatment module: StäB, an intensive daily home treatment, delivered by a multiprofessional team, has been added to the portfolio of treatment options in Germany. This closes the gap between highly intensive inpatient care and low-frequency outpatient treatment, allowing a continuum of care in intensity and frequency within the treatment alternatives.

63 Risk Factors Associated with Lack of Patient Outpatient Follow Up at a Regional Burn Center

Abstract Introduction Burn patients are a vulnerable population at risk for poor follow up after injury. With few burn centers throughout the country, there is often limited access to specialized care. We investigated barriers to patient compliance with recommended outpatient burn care at a single ABA-verified burn center after presentation at referring Emergency Departments (ED). Methods A retrospective review was performed on patients who presented at two EDs located 60–75 miles from our burn center over a two-year period. Recommendation for follow up was made by a burn surgeon at our regional burn center after telephone consultation. Medical record review was performed to determine what specific follow up occurred. Data on patient demographics, burn size/location/etiology were also recorded. Results Out of 135 consults from the two EDs, a total of 60 patients were recommended for outpatient follow up (vs. transfer, local management, or no follow up). Median age was 35 years [IQR 27–38] and most patients were male (n=40, 66%). Most patients had burns measuring &amp;lt; 1% total body surface area (TBSA) (n=43, 72%). Half scheduled a follow up appointment (n=31, 52%) and fewer came to that appointment (n=26, 43%). Median time from initial presentation to burn clinic follow up was 2 days (range 1–8 days). Of patients who did not attend recommended follow up, 24% (n=8/34) presented for additional visits to the ED or another local provider. Patients who did not follow up were more likely to be male (79% vs. 50%, p=0.03), lack insurance (27% vs. 4%, p=0.05), be homeless/institutionalized (18% vs. 0%, p=0.03) and have facial burns as compared to other body regions (32% vs. 8%, p=0.05). Patients who followed up were more likely to have scald burns versus flash/flame/contact burns (69% vs. 18%, p&amp;lt; 0.001) and were more likely to have been injured at home/work as opposed to outdoors/other location (100% vs. 38% p&amp;lt; 0.001). Age, marital status, race/ethnicity, having a primary care physician, %TBSA, and other comorbidities were not associated with follow up. Although reasons for not following up were rarely noted in the medical record, anecdotal reasons included lack of transportation (n=4), incarceration (n=3), and feeling that burns were healing (n=1). Conclusions Less than half of patients followed up at the regional burn center as recommended, while nearly a quarter followed up at local EDs/clinics. Barriers to follow up include patient gender, insurance, and resources (transportation).

Patient perceived barriers to surgical follow-up: Study of 6-month post-operative trichiasis surgery follow-up in Tanzania.

BackgroundPost-surgical follow-up is a challenge in low- and middle-income countries. Understanding barriers to trachomatous trichiasis (TT) surgical follow-up can inform program improvements. In this study, patient perceived barriers and enabling factors to follow-up after TT surgery are identified.MethodsA longitudinal study was carried out in a community-based cohort of persons who received TT surgery in Bahi district, Tanzania. Questionnaires were administered before TT surgery and again after the scheduled 6-month follow-up. Those who did not return were examined at their homes.ResultsAt baseline, 852 participants were enrolled. Of these, 633 (74%) returned at 6 months and 128 (15%) did not and were interviewed at home. Prior to surgery, attenders were more likely to report familiarity with a community health worker (CHW) (22% vs. 14%; p = 0.01) and less likely to state that time constraints are a potential reason for failure to follow-up (66% vs. 74%; p = .04). At follow-up, non-attenders were more likely to endorse barriers pertaining to knowledge about the need for follow-up, lack of transportation, and satisfaction with surgery. There was no difference in post-operative TT between attenders and non-attenders (23% vs. 18% respectively; p = 0.25).ConclusionsThe outcome of surgery was not a barrier to follow-up. However, better integration of CHWs into their communities and work at coordinating post-surgical care may improve follow-up rates. Moreover, provision of transportation and implementation of effective reminder systems may address patient-perceived barriers to improve follow-up.

Unmet Behavioral Health and Social Needs of Home Healthcare Patients and Their Caregivers

Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.

Beginning to Find the Missing Piece: Social Determinants of Health as a Contributor to Disparities in Plastic Surgery.

At few times during recent history have social determinants of health been more glaring. Effects of the coronavirus disease of 2019 pandemic have accentuated existing sociodemographic disparities. Considering the tenets of medical ethics and the current social climate, including the Black Lives Matter movement, each medical discipline is called to examine barriers to equitable health care across racial, ethnic, and socioeconomic spectrums. Within the field of plastic surgery, our understanding of how poor social determinants contribute to disparities in surgical access and outcomes is incomplete, limiting our ability to develop targeted interventions. Social determinants of health are the conditions in which people are born, grow, live, work, and age, which are shaped by the distribution of economic resources and power. Factors such as socioeconomic status and stability, education, living environment, social support, and health care provider availability and cultural competency influence patient behaviors and health equity. These factors may account for a greater percentage of patients’ health outcomes than the specific medical care provided.1 Examples in Philadelphia are representative of many American metropolitan areas. Just 5 miles from Center City, the average life expectancy drops by 20 years as less affluent neighborhoods with greater minority representation are reached.2 Current and historical structural drivers of inequity may account for a greater proportion of Black and Hispanic patients facing unfavorable social determinants than do white patients.1 Slowed efforts in reducing school segregation have limited the well-known contributions of desegregation to improved health and well-being of minority students.3 People of color may be shown fewer properties when purchasing or renting homes.3 Despite declining unemployment rates for all races, income for indigenous, Black, and Hispanic people has only modestly improved, presenting difficulty for households to keep pace with rising living costs.1 These structural drivers shape patients’ health behaviors and approach to the health care system. Low health literacy, challenges with navigating the insurance and health care systems, medical distrust, and lack of transportation or childcare, in addition to geographic constraints, are barriers to using medical services, remaining in the system, and maintaining the actual quality of care.4 Implicit bias toward minority patients may compound existing issues by compromising communication and trust. Consider that minority patients are less likely to receive a referral for reconstruction after mastectomy, and more likely to be unaware of options for breast reconstruction.5 Or that Black and Hispanic patients are more likely to be referred later than white patients for the treatment of craniofacial conditions. Understanding that these observations likely influence outcomes is a first step in providing equitable care. As the majority of plastic surgical research on disparities has involved descriptive studies of breast reconstruction, a gap exists in developing subspecialty best practices. Culturally congruent programs are likely to have the greatest impact.5 We are called to deepen our knowledge of the barriers patients face, the discrepancies in care provided, and most importantly, the interventions that best promote equitable care. As plastic surgeons practice in diverse settings, understanding the social barriers that impact patient care is not only essential, it is our moral duty. DISCLOSURE The authors have no financial interest to disclose. No funding was received for this article.

Abstract P228: Developing a Community Paramedicine Program to Reduce Stroke All-Cause Readmissions

Introduction: According to the Centers for Medicare &amp; Medicaid Services (CMS) readmission is a key indicator of hospital quality. Readmitted stroke patients experience greater mortality, longer lengths of stay, and higher costs. Lessening these occurrences have been challenging; but a growing Emergency Medical Services (EMS) concept- Community Paramedicine (CP) - provides a solution. The CP program is designed to provide follow-up home visits to patients after discharge. This program does not bill for services; its executive approval and subsequent expansion was instead predicated on cost avoidance. Methods: In 2018, following success in reducing readmissions in the heart failure population (which resulted in $1.38 saved over 2 years), CP was implemented in the stroke population. The intervention was modified to meet the needs of stroke patients and address key factors in stroke readmissions. The financial impact model consists of comparing readmission rates in the same primary disease category. A projection of readmissions that would have occurred for patients without the intervention is made using the rates observed in patients not seen by CP, allowing for projection of readmissions prevented through this intervention. The number of saved bed days is calculated using average length-of-stay and cost avoidance is calculated by multiplying the saved days with the average cost/day. Results: From July 2018-December 2019, CP visited 164 stroke patients, of which only 2 became a 30 day readmission (1.22%). Of the 658 stroke patients that did not receive a visit, 67 were readmitted (10.18%) in the same time period. Applying the same financial impact model, it is estimated that 9 readmissions were prevented, resulting in a cost avoidance of more than $191,029. Conclusion: Community Paramedicine is a versatile tool that decreases readmissions. During the visits, key barriers were addressed, such as medication discrepancies, absence of help in the home, lack of transportation, progressing symptoms, and overwhelmed caregivers. This successful model is replicable and well-supported by hospital leadership due to demonstrable cost avoidance. It’s a “win” for all; patients avoid readmission; the organization saves money; and patients receive optimal care.

Optimization of passive solar design and integration of building integrated photovoltaic/thermal (BIPV/T) system in northern housing

In the Canadian north, the cost of space heating is very high due to the harsh weather, its remoteness, lack of transportation, and dependency on the high cost of fossil fuel imported from the South. Since the North has an abundance of solar energy, significant energy savings with some added construction cost in houses could be achieved by applying high-performance building envelopes and solar design strategies. The objective of this paper is to investigate the potential of both passive and active solar design strategies in improving the energy efficiency of northern housing. Firstly, a reference house representing a typical single-family home in the North is modeled using EnergyPlus, and the key passive design parameters are optimized to minimize life-cycle cost. Then, the air-based building integrated photovoltaic/thermal (BIPV/T) system is applied to the optimized house and integrated with HVAC systems. It is found that optimal passive solar design can reduce the heating energy demand by 42% with an incremental cost of 8% for Yellowknife and by 27% without incurring an incremental cost for Kuujjuaq. Integrating BIPV/T with HVAC systems can reduce the defrost time of heat recovery ventilator (HRV), extend the working hours and improve the COP of air source heat pump (ASHP). The reduction in the total energy consumption is in the range of 1.4%–3.0% by integrating HRV and 0.3%–0.6% by integrating ASHP due to the mis-match of solar availability and heating energy demand. To maximize the utilization of solar energy available, the optimal use of thermal energy recovered from BIPV/T system in northern housing requires further investigation.

Abandonment of health monitoring of babies of mothers with vertical transmission grievance

Objective: to analyze the abandonment of the health monitoring of babies of mothers with vertical transmission grievance. Methods: a retrospective documental study. The data came from children’s records stratified as high risk by the Paranaense Mother Network Program, due to being daughters of women diagnosed with syphilis, toxoplasmosis or Human Immunodeficiency Virus in the gestational period, attended in a reference center of maternal-infant care. For the analysis of factors associated with abandonment of treatment, univariate analysis and Fisher’s Exact Test with sociodemographic variables were performed. All ethical precepts were observed. Results: a total of 136 medical records were analyzed. The cases with the highest abandonment rate were the children of women with toxoplasmosis and gestational syphilis, presenting rates of 48.4% and 45.7%, respectively. Conclusion: the abandonment of baby health monitoring is recurrent. The reasons for frequent abandonment were: lack of active search, lack of transportation and unforeseen family events.

Challenges in Risk Assessment with Rural Domestic Violence Victims: Implications for Practice.

Through interviews the present study examined the perspectives of service providers (n = 14) in the violence against women (VAW) sector regarding risk factors and challenges in assessing risk for women experiencing domestic violence (DV) in rural locations. The present study also examined what promising practices VAW service providers are utilizing when working with women experiencing DV in rural locations. Interviews were coded and analyzed in a qualitative analysis computer program. Analysis indicated several risk factors including the location (i.e., geographic isolation, lack of transportation, and lack of community resources) and cultural factors (i.e., accepted and more available use of firearms, poverty, and no privacy/anonymity). Moreover, analyses indicated several challenges for VAW service providers assessing risk including barriers at the systemic (i.e., lack of agreement between services), organizational (i.e., lack of collaboration and risk assessment being underutilized/valued), and individual client (i.e., complexity of issues) level. However, participants outlined promising practices being implemented for rural locations such as interagency collaboration, public education, professional education, and outreach programs. The findings support other research in the field that highlight the increased vulnerability of women experiencing DV in rural locations and the added barriers and complexities in assessing risk for rural populations. Implications for future research and practice include further examination of the identified promising practices, a continued focus on collaborative approaches and innovative ways to prevent and manage risk in a rural context.

A socially prescribed community service for people living with dementia and family carers and its long-term effects on well-being.

Support services for people with dementia are variable depending on the area or town they live. People with dementia and family carers can often get very little support after a diagnosis. Services might not be suitable or they may not be aware of the service in the first place. The aim of this study was to evaluate a socially prescribed community service provided to people with dementia and family carers offering physical and mental activities. People with dementia and family carers were recruited from a community centre in the North West of England to complete in this study. Participants provided demographic information and completed the Short Warwick-Edinburgh Mental Well-Being Scale at baseline, and after 3 and 6months. Postcode data were used to generate an Index of Multiple Deprivation score for information on participants' socioeconomic background. Data were analysed using paired samples t-tests to compare well-being scores between baseline and follow-up assessments. A total of 25 people with dementia (n=14) and family carers (n=11) participated in the service. Visits ranged from 1 to 36, with 22 and 15 participants completing the 3- and 6-month follow-up respectively. Some reasons for discontinuation were lack of transport and other commitments. Most participants lived in some of the most disadvantaged neighbourhoods. Compared to baseline, well-being was significantly higher at both follow-ups. This is one of the first studies reporting the benefits of a social prescribing service in dementia. Future implementation work needs to design an implementation plan so that the service can be implemented in other community centres across the country.

Ambulatory care for epilepsy via telemedicine during the COVID-19 pandemic

ObjectiveTo assess feasibility, patient satisfaction, and financial advantages of telemedicine for epilepsy ambulatory care during the current COVID-19 pandemic. MethodsThe demographic and clinical characteristics of all consecutive patients evaluated via telemedicine at a level 4 epilepsy center between March 20 and April 20, 2020 were obtained retrospectively from electronic medical records. A telephone survey to assess patient satisfaction and preferences was conducted within one month following the initial visit. ResultsAmong 223 telehealth patients, 85.7% used both synchronous audio and video technology. During the visits, 39% of patients had their anticonvulsants adjusted while 18.8% and 11.2% were referred to laboratory/diagnostic testing and specialty consults, respectively. In a post-visit survey, the highest degree of satisfaction with care was expressed by 76.9% of patients. The degree of satisfaction tended to increase the further a patient lived from the clinic (p = 0.05). Beyond the pandemic, 89% of patients reported a preference for continuing telemedicine if their epilepsy symptoms remained stable, while only 44.4% chose telemedicine should their symptoms worsen. Inclement weather and lack of transportation were factors favoring continued use of telemedicine. An estimated cost saving to patient attributed to telemedicine was $30.20 ± 3.8 per visit. SignificanceOur findings suggest that epilepsy care via telemedicine provided high satisfaction and economic benefit, without compromising patients’ quality of care, thereby supporting the use of virtual care during current and future epidemiological fallouts. Beyond the current pandemic, patients with stable seizure symptoms may prefer to use telemedicine for their epilepsy care.

AFFIRM Online: Utilising an Affirmative Cognitive-Behavioural Digital Intervention to Improve Mental Health, Access, and Engagement among LGBTQA+ Youth and Young Adults.

Digital mental health interventions may enable access to care for LGBTQA+ youth and young adults that face significant threats to their wellbeing. This study describes the preliminary efficacy of AFFIRM Online, an eight-session manualised affirmative cognitive behavioural group intervention delivered synchronously. Participants (Mage = 21.17; SD = 4.52) had a range of sexual (e.g., queer, lesbian, pansexual) and gender (e.g., non-binary, transgender, cisgender woman) identities. Compared to a waitlist control (n = 50), AFFIRM Online participants (n = 46) experienced significantly reduced depression (b = −5.30, p = 0.005, d = 0.60) and improved appraisal of stress as a challenge (b = 0.51, p = 0.005, d = 0.60) and having the resources to meet those challenges (b = 0.27, p = 0.059, d = 0.39) as well active coping (b = 0.36, p = 0.012, d = 0.54), emotional support (b = 0.38, p = 0.017, d = 0.51), instrumental support (b = 0.58, p < 0.001, d = 0.77), positive framing (b = 0.34, p = 0.046, d = 0.42), and planning (b = 0.41, p = 0.024, d = 0.49). Participants reported high acceptability. This study highlights the potential of digital interventions to impact LGBTQA+ youth mental health and explores the feasibility of digital mental health to support access and engagement of youth with a range of identities and needs (e.g., pandemic, lack of transportation, rural locations). Findings have implications for the design and delivery of digital interventions for marginalised youth and young adults.