Medical Assessment Research Articles

Deciphering the Role of Androgen in the Dermatologic Manifestations of Polycystic Ovary Syndrome Patients: A State-of-the-Art Review

Polycystic ovary syndrome is a presvalent endocrine disorder affecting women globally, characterized by hormonal imbalance, metabolic disturbances, and reproductive dysfunction. Diagnosis relies on clinical evaluation, medical history assessment, physical examination, and laboratory tests, with the Rotterdam criteria being widely used. The pathophysiology of PCOS involves genetic predisposition, environmental factors, and lifestyle influences, with hormonal dysregulation, particularly elevated androgens, insulin resistance, and chronic inflammation, playing a pivotal role. These mechanisms not only contribute to reproductive and metabolic disturbances but also to the various cutaneous manifestations, such as acne, hirsutism, and alopecia. This review aims to analyze the role of androgens in the dermatological manifestations in patients with polycystic ovary syndrome, providing insights into underlying mechanisms and guiding the development of effective therapeutic strategies. By synthesizing available evidence, this review aims to deepen understanding of related dermatological manifestations and improve outcomes for affected individuals.

A Mixed-Methods Investigation of First-Year Medical Students’ Professionalism Competency Development over the Gross Anatomy Course

Abstract Background While competency-based medical education (CBME) and competency assessment in clinical training are well documented, they are less commonly included in preclinical medical education. The gross anatomy laboratory is an opportune setting to incorporate competency assessment and reflection during preclinical medical education. This mixed-methods study determined how first-year medical student assessments of professionalism skills in the gross anatomy lab change over time and analyzed student reflections to contextualize the experiences they had developing the Professionalism competency. Methods First-year medical students at the University of Louisville completed self- and peer-assessments using the Professionalism Assessment Scale (PAS) at the beginning and end of their gross anatomy course (n = 83). The students also completed three competency development portfolio (CDP) entries throughout the course (n = 83). Qualitative thematic analysis with grounded theory was used to analyze comments related to professionalism skill development in the CDP reflections during the course. Results There was no statistical difference in PAS self-assessment scores from Time 1 (M = 4.81, SD = .209) to Time 2 (M = 4.85, SD = .217), p = .108. There was a statistically significant increase in PAS-peer-assessment scores from Time 1 (M = 4.89, SD = .165) to Time 2 (M = 4.93, SD = .127), p = .005. Thematic analysis of CDPs revealed that students believed they developed interpersonal relations/social skills, responsibility skills, and gross anatomy lab-specific skills over the gross anatomy course. Conclusions The Professionalism competency is inherently present and able to be assessed in the gross anatomy lab context for first-year medical students.

Experiences and outcomes of patients participating in a perioperative shared decision-making pathway.

The Complex Decision Pathway (CDP) is a novel perioperative shared decision-making pathway that was established in the Bay of Plenty, New Zealand in 2018. Unique features of the pathway include the use of a structured communication tool to facilitate a goals-of-care conversation in addition to medical assessment, and the use of a tikanga Māori framework for Māori patients. From May 2019 until May 2022, 81 patients attending the CDP clinic were recruited to a prospective study of their demographics, health status and experience at the time of presentation, along with outcomes and opinions over the subsequent 12 months. Participants were mostly elderly and frail with multiple comorbidities, and just over half of participants chose to undergo surgery. Participants who chose, or were recommended, not to undergo surgery were older, more comorbid and had worse outcomes over the subsequent 12 months. Qualitative data suggested an overall positive patient experience of the pathway, and an economic analysis demonstrated its cost-effectiveness. Overall, the data presented here suggested that the CDP assisted in risk-stratifying patients into operative and non-operative groups, provided a positive patient experience, and was a cost-effective intervention.

International medical graduates' experiences of clinical competency assessment in postgraduate and licensing examinations: A scoping review protocol.

An international medical graduate (IMG) is a doctor who has received their basic medical qualification from a medical school located in a different country from that in which they practice or intend to practice. IMGs are known to face difficulties in their working lives, including differential attainment in assessment. The objective of this review is to map key concepts and types of evidence in academic and gray literature relating to international medical graduates' experiences of clinical competency assessment and to identify knowledge gaps on this topic by systematically searching, selecting, and synthesizing existing knowledge. All studies will relate to IMGs. The concept of interest will be IMGs' experiences of assessment. The context will be postgraduate, licensing or credentialing medical assessments of clinical competence. This review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Seven electronic databases will be searched for literature published between 2009 and 2024: the Australian Education Index, British Education Index, ERIC, PubMed, PsycINFO, Scopus, and SocINDEX. Gray literature will be searched using Google, Google Scholar, and published reports from postgraduate training bodies and medical licensing organizations. Documents will be independently screened, selected, and extracted by two researchers using a piloted data-extraction tool. Data will be analyzed and presented in tables and in a narrative format. Trial resgistration: Scoping review registration: Open Science Framework: https://osf.io/8gdm7.

A Qualitative Assessment of South Africa's Central Chronic Medication Dispensing and Distribution Program for Differentiated Antiretroviral Therapy Delivery in Umlazi Township, South Africa: Client Perspectives after 12 Months of Participation.

South Africa's Central Chronic Medicine Dispensing and Distribution (CCMDD) program provides community-based medication delivery for clinically stable people with HIV (PWH) on antiretroviral therapy (ART). To evaluate CCMDD implementation, we conducted semi-structured interviews with 60 PWH enrolled in CCMDD for at least 12 months. In a directed content analysis based on the Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework, key themes were compared with qualitative data collected from PWH enrolling in CCMDD at an earlier time-point. Results indicated consistently positive views of CCMDD, primarily attributed to convenient and smooth medication pick-up. At the later (vs. earlier) time-point, participants discussed less clinic crowding, mentioned few medication errors, and noted improved communication around refills. Community HIV stigma was a persistent challenge, as was nurses' judgmental communication style. To ensure CCMDD's success, continued focus is needed on decreasing HIV stigma beyond the clinic context and improving provider-patient relationships.

Colour vision deficiency is associated with increased prevalence of amblyopia, strabismus and ametropia: a large population study

AimsTo examine the association between colour vision deficiency (CVD) and other ophthalmic disorders including amblyopia, strabismus and ametropia in a large population study.MethodsThe retrospective, cross-sectional study included 916 388 Israeli...

"Vulva," Not "Private Part": The Importance of Accurate Genital Terminology.

Effective communication in pediatric dermatology is critical for accurate diagnosis and treatment, particularly in sensitive areas such as the anogenital region. Unfortunately, children and their families often use euphemisms or incorrect terms when referring to this area, and many adults lack knowledge of anogenital terminology. Pediatric dermatologists can play a unique role in educating children and their families on correct anatomical language, which enhances body awareness, empowers young patients, improves safety, and contributes to accurate medical assessments and treatment adherence. By promoting the use of correct anatomical terms, pediatric dermatologists can improve patient outcomes and foster a healthier understanding of body anatomy and health.

Role of Cardiovascular Risk in Associations of Brain-Derived Neurotrophic Factor with Longitudinal Brain and Cognitive Trajectories in Older Adults

ABSTRACT Background Higher levels of brain-derived neurotrophic factor (BDNF) have been associated with better neurocognitive outcomes. BDNF is present in cardiovascular tissue, and some evidence suggests it may benefit cardiovascular function. The current study assessed whether there is a mediating and/or moderating role of cardiovascular health in the relationship between BDNF and brain and cognitive outcomes. Method We examined longitudinal data from 397 older adults (aged 54–89;164 females, 233 males) enrolled in the Alzheimer’s Disease Neuroimaging Initiative with available plasma BDNF, medical, neuroimaging, and cognitive assessments. We used path analysis and linear regression to estimate the mediating and moderating roles of two measures of cardiovascular health, the Framingham Risk Score (FRS) and pulse pressure, in the relationships between BDNF and longitudinal changes in brain structure (white matter hyperintensity volume, hippocampal volume, and primary visual cortex volume) and cognitive function (executive function, episodic memory, and language). Results There was no significant association of plasma BDNF with FRS or pulse pressure (ps > 0.31), precluding mediation. There were no robust associations between BDNF and longitudinal change in any brain structural or cognitive measures (ps > .12). Higher FRS was significantly associated with greater increases in WMH volume (ps < .01). FRS and pulse pressure were not associated with any other brain structural or cognitive outcomes (ps > .07). Conclusion These results suggest that cardiovascular health may not play an important role in the influence of BDNF on neurocognitive health in older adults.

Associations among frailty conditions and pain indicators: Data from 22 356 European older adults.

Recent studies supported the presence of a relationship between pain and frailty, but more research is needed to highlight the pain-frailty association. The study aimed to investigate the prevalence and the influence of different pain indicators on frailty while controlling for age, sex and country. This observational study used data from the sixth wave of the SHARE survey. A sample of 22 356 community-dwelling individuals aged >60 years from six European countries (Spain, Estonia, France, Greece, Czech Republic and Sweden) was analyzed. The pain was measured through assessment of medication used for joint pain or other types of pain, pain location, polypharmacy and pain level. Frailty was assessed with the modified Fried Frailty phenotype. Pain indicators, especially widespread pain and pain severity, were significantly associated with prefrailty (odds ratio 3.30, 95% CI 2.40, 4.55; and odds ratio 0.61, 95% CI 0.51, 0.72) and frailty status (odds ratio 4.69, 95% CI 3.31, 6.67; and odds ratio 0.37, 95% CI 0.30, 0.44). Advancing age and female sex consistently correlated with increased prefrailty (odds ratio 1.06, 95% CI 1.05, 1.07; and odds ratio 1.36, 95% CI 1.22, 1.53) and frailty risk (odds ratio 1.11, 95% CI 1.10, 1.12; and odds ratio 1.71, 95% CI 1.48, 1.96). Country-specific differences emerged, with Spaniards showing higher odds ratios of prefrailty and frailty compared with Swedish, French and Czech individuals, whereas Greeks showed elevated odds ratios compared with Spaniards. The factors associated jointly explained 27.5% of the variance in frailty categories. Significant associations were identified, particularly with widespread pain and pain severity, highlighting their impact on frailty. Country-specific variations in frailty prevalence were observed, alongside consistent associations with advancing age and female sex. These findings provide valuable insights into the intricate interplay between pain and frailty, offering the potential for targeted interventions in older adults' care through tailored pain management strategies. Geriatr Gerontol Int ••; ••: ••-••. Geriatr Gerontol Int 2024; ••: ••-••.

Intraprofessional boundary crossing in acute paediatric care: A rich journey for general practice and paediatric residents.

Achieving optimal collaboration between general practitioners and hospital-based critical care doctors is vital yet challenging, necessitating targeted collaborative training during residency. Despite apparent benefits, implementing intraprofessional learning faces constraints. Understanding its occurrence is crucial for engaging and educating residents. Considering boundaries' learning potential, we developed and evaluated an educational programme for general practitioner (GP) and paediatric (P) residents in paediatric emergency care based on Akkerman's Boundary Crossing Theory. The study investigated how intraprofessional learning mechanisms occurred and what learning conditions facilitated or impeded learning of GP and P residents, aiming to optimise educational programme design for intraprofessional collaboration. We developed an educational programme with three activities: joint medical assessments of paediatric patients in each other's context, mutually mini-Clinical Evaluation Exercises (mini-CEXs) about intraprofessional collaboration skills and educational meetings about collaborative care. We performed a qualitative study with a constructivist approach to explore experiences of the programme. We conducted focus group interviews and analysed mini-CEXs, utilising Boundary Crossing theory for template analysis. Ten GP and eight P residents participated in our study. Learning mechanisms of identification and coordination dominated the joint medical assessments. Mini-CEXs stimulated reflection. Educational meetings with supervisors about intraprofessional barriers initiated transformation. Facilitated learning conditions were bidirectional crossing, enthusiastic supervisors, residents being familiar with each other, clear mini-CEX design and authentic paediatric cases. Unclear mutual expectations during joint medical assessments impeded learning of residents. Working in each other's context triggers learning mechanisms of identification, coordination and reflection, forming the basis for intraprofessional learning in paediatric emergency care for GP and P residents. For development of new collaboration practices, supervisors are necessary to translate reflection into transformation. Mutual responsibilities and expectations should be made more explicit to create a safer intraprofessional learning environment. Our findings extend to other medical training contexts, leveraging boundaries for learning.

Real-Time IMU-Based Kinematics in the Presence of Wireless Data Drop.

Wireless inertial motion capture holds promise for real-time human-machine interfaces and home-based rehabilitation applications. However, wireless data drop can cause significant estimation errors deteriorating performance or even making the system unusable. It is currently unclear how to estimate non-periodic kinematics with wearable inertial measurement units (IMUs) in the presence of wireless data drop (packet loss). We thus propose a novel inference encoder-decoder network model for real-time kinematics during dynamic movement. Twenty-four healthy subjects performed yoga, golf, swimming, dance, and badminton movement activities while wearing IMUs and 10-90% of each IMU's data were randomly removed to determine the effects of data drop on estimation accuracy with and without the proposed model. Results demonstrated a reduction in RMSE of 45.2% to 51.5% in the upper limb kinematic estimation of the proposed model compared to the No Prediction strategy, and a reduction of 19.1% to 31.3% of the proposed model compared with an baseline LSTM model. In addition, the proposed model has significantly less error (p<0.05) than the No Prediction strategy and the baseline LSTM model for 10%, 20%, 30%, 40%, 50%, 60%, 70%, and 80% data drop. These results could enable wearable, wireless IMU dynamic motion analysis and assessment with reduced kinematic estimation error in the presence of varying amounts of wireless data drop and thus could further facilitate human-machine interaction and home-based medical assessment and treatment.

Hysterosalpingographic Pattern of Primary Sub-fertility and Secondary Sub-fertility in Women of Reproductive Age

Objective: To evaluate the structural abnormalities of uterus and fallopian tubes in women diagnosed with primary and Secondary Sub-fertility using hysterosalpingogram. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Jul to Nov 2019. Methodology: This study investigated potential anatomical causes of primary and secondary subfertility in women of reproductive age. A total of 500 participants, referred from Gynecology and Obstetrics Departments, underwent hysterosalpingography during the pre-proliferative phase following comprehensive medical history assessment. Results: Out 500 women, 340(68.0%) had Primary Sub-fertility while 160(32%) had Secondary Sub-fertility. Mean age of presentation was 31.5±3.5 years. Bilateral free peritoneal spill was recorded in 340(68%) patients. Unilateral tubal blockage was present in 50(10%) patients while bilateral tubal blockage was observed in 40(8.0%) patients. Bilateral hydrosalpinx was present in 15(3 %) women. Patients with uterine congenital anomalies were also examined, and bicornuate uterus was seen in 25(5%) women and unicornuate uterus was noted in the same number, that is, 25(5%) women. Conclusion: Hysterosalpingography is a baseline assessment test done for evaluation of patency of uterus and uterine tubes. Positive hysterosalpingography cases were more prevalent in Secondary Sub-fertility. Tubal abnormalities were more commonly observed as compared to uterine cavity pathologies. Secondary Sub-fertility was found to be more associated with older age groups.

Predictors of ongoing attendance at an Australian publicly funded specialist obesity service.

There is a demand for publicly funded specialist obesity services in Australia. A range of factors can impact on patient attendance which can result in poorer health outcomes. To identify patient factors that predict ongoing in-person attendance following initial medical assessment at the Canberra Obesity Management Service. Data were collated from two retrospective reviews (July 2016-June 2017 and July 2018-June 2019). Predictive modeling was used to determine the likelihood of ongoing attendance. A total of 396 patients were identified. Mean age was 45.4years (SD 13.1), mean weight was 139.5kg (SD 27.8) and mean Body Mass Index was 49.87kg/m2 (SD 8.7). Demographics and anthropometrics were not predictive of ongoing attendance. Patients with a higher comorbidity burden were more likely to continue attending (p<0.001). Patients with obstructive sleep apnea (OSA) were 4.9 times more likely to continue attending (p<0.001). Hypertension was more common among patients who continued attending (p=0.005); however, this relationship was no longer significant when using a multi-adjusted model. Comorbid depression and/or anxiety diagnoses were not predictive of ongoing attendance although the p-value for anxiety severity classification approached significance. Findings are consistent with existing evidence linking OSA and attendance at specialist obesity services. Hypertension was predictive of ongoing attendance and warrants further research. Determining if anxiety is a true barrier to attendance at specialist obesity services may have implications in terms of optimizing diagnosis and treatment prior to referral or in the early stages of obesity management.

Real-Time precision prehospital stroke diagnosis in weightlifting athletes using cutting-edge non-invasive sensors

This research paper presents an investigation into the efficacy of a novel diagnostic technology designed for the real-time monitoring of weightlifting athletes, focusing on precision, time efficiency, and user convenience compared to traditional diagnostic systems. The study introduces an advanced non-invasive sensor system, integrated into a cohesive Internet of Medical Things (IoMT) framework, which facilitates the immediate and accurate assessment of athletes' health parameters. To empirically test the benefits of this new technology, a pedagogical experiment was conducted involving two distinct groups: an experimental group that utilized the proposed technology for medical checkups, and a control group that continued with traditional diagnostic methods. Each group consisted of 30 athletes, and the outcomes were measured across three dimensions: the precision of diagnostic results, the time expended for medical checkups, and the user-reported convenience of the equipment. The findings indicate that the proposed technology not only significantly enhances the precision of health diagnostics but also reduces the time required for medical examinations, thereby increasing overall efficiency. Additionally, the higher convenience scores reported by the experimental group suggest improved user satisfaction and usability. These results demonstrate the potential of the proposed diagnostic system to transform athlete health monitoring by providing more accurate, efficient, and user-friendly medical assessments, suggesting a significant step forward in the application of advanced technologies in sports medicine.

TRENDS IN CLINICAL REASONING ASSESSMENT: A BIBLIOMETRIC ANALYSIS SPANNING 1974-2024

Introduction: Clinical reasoning guides diagnosis and patient care. Bibliometric analysis helps navigate scholarly publications, offering insights into trends and influential works, aiding evidence-based decisions, and improving patient outcomes. This study aims to analyze clinical reasoning assessment literature, exploring distribution across document types and languages, influential sources, volume of publications and citations, thematic clusters from author keywords, and innovative research shaping the forefront of investigation. Materials and Methods: A bibliometric analysis was performed using the Scopus database as of February 10th, 2024, covering data from 1974 to the research date. Data extraction involved document types, languages, key sources, globally cited publications, and trends over time, with network visualization of author keywords. Analysis employed the Bibliometrix package in Rstudio and VOSviewer software. Reporting adhered to PRIBA guidelines by Koo &amp; Lin. Results: The Scopus database search yielded 1827 documents, predominantly in English in the article format. Notable sources included BMC Medical Education (UK), Academic Medicine (USA), Advances in Health Sciences Education (Netherlands), and Diagnosis (Germany). Trends from 1974 to 2024 showed increasing publications and citations. Recent publications highlighted emerging themes such as artificial intelligence, electronic health records, and chatGPT, reflecting the evolving landscape of medical assessment practices. Conclusions: This bibliometric analysis highlights the evolving landscape of clinical reasoning assessment within medical education, where recent trends embrace innovative methodologies like artificial intelligence, electronic health records, and chatGPT. These trends reflect a dynamic shift towards the use of technology to enhance diagnostic accuracy and decision-making processes.

Oral Nutritional Supplementation in Older Adults with a Hip Fracture-Findings from a Bi-National Clinical Audit.

Evidence-based guidelines and care standards recommend offering oral nutrition supplements to all older adults with hip fracture, not just those already malnourished. This study aimed to identify the proportion of inpatients in a sample of hospitals in two countries that were provided with oral nutritional supplementation (ONS) following a hip fracture and to identify factors associated with ONS provision. An analysis of prospectively collected data from a bi-national Hip Fracture Registry nutrition sprint and registry audit data limited to older adults (≥65 years) undergoing surgical intervention for a fractured hip from 1 to 31 August 2021. Multivariable logistic regression was used to identify factors associated with providing ONS. Patient-level data was available for 385 older adults (median 85 years; 60.5% female) admitted to twenty-nine hospitals. Less than half (n = 47.3%) of the audited inpatients were provided ONS. After adjusting for covariates, ONS was more likely to be provided to older adults who were identified as malnourished on formal testing (OR 11.92; 95%CI 6.57, 21.69). Other factors associated with prescription of ONS included those who did not have a preoperative medical assessment (OR 2.26; 95%CI 1.19, 4.27) or were cognitively impaired (OR 1.83; 95%CI 1.01, 3.32), severely frail, or terminally ill (OR 3.17; 95%CI 1.10, 9.17). ONS was provided in line with evidence-based recommendations for less than half of the older adults with a hip fracture in 29 hospitals in two countries. A structured approach to implementation may be required to reduce complications and improve outcomes for all older adults after a hip fracture, not just those assessed as cognitively impaired, frail, and/or malnourished.

Measurements and medication data are indispensable for population blood pressure monitoring

Abstract Background The National Study on Health of Older People in Germany “Gesundheit 65+” included blood pressure (BP) measurements at home by a study nurse and classification of all current medication. Methods Nationally representative examination survey of the population aged 65 years and older residing in Germany using two-stage population registry sampling from 128 sample points, with a standardized examination at home from June 2022 to April 2023. Three standardized blood pressure measurements at two-minute intervals were taken after 5 minutes rest with an oscillometric device (Mobil-O-Graph) using one of five cuffs according to upper arm circumference. The mean of the second and third measurement was used for analysis. Hypertension was defined as mean systolic BP (SBP) at or above 140 mmHg, or mean diastolic BP (DBP) at or above 90 mmHg, or the use of antihypertensives (antihypertensives, diuretics, beta-blockers, calcium-channel blockers, ACEI and ARB) in participants with self-reported hypertension diagnosis. Provisional weights account for unequal sampling and participation probabilities. Results The “Gesundheit 65+” examination part included 1,493 participants of whom 1,475 (98.8%) had successful BP measurements (763 men and 712 women, aged 66 to 101 years). Based on self-reported diagnoses alone, the prevalence of hypertension would be 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. However, overall hypertension prevalence was estimated at 70.4% [65.8-74.7] in men and 72.3% [66.9-77.1] in women based on the study definition which combines self-reported diagnoses, standardized BP measurements and medication. Conclusions The prevalence of hypertension is greatly underestimated in the absence of examination survey data with standardized measurements and recording of medication use. In addition, measurement and medication data are needed for monitoring the hypertension cascade, i.e. awareness, treatment and control of hypertension. Key messages • Hypertension prevalence is underestimated in the absence of health examination surveys with measurements and medication data. • The hypertension cascade, i.e. assessment of awareness, treatment and control of hypertension needs population surveys with measurements and medication assessment.

Multidisciplinary approach to asylum seekers health assessment: a 5-year experience in Modena, Italy

Abstract Background Asylum seekers’ well-being represents a global health issue. They face significant challenges to their physical and mental health due to their migratory path. In the Modena province (Northern Italy), a multidisciplinary approach has been applied to the care of asylum seekers by Department of Public Health (DPH), with a team of specialists in infectious diseases, dermatology, gynaecology, obstetrics, psychology and preventive medicine. Asylum seekers receive a first visit, including medical and psychological assessment and screening for infectious diseases. Ad hoc pathways are also active for asylum seekers who need secondary-level care. This study aims to investigate the health status of asylum seekers referred to Modena Centre. Methods This cohort study enrolled asylum seekers hosted in Modena between November 2018 and May 2023. During the first visit, personal and anamnestic data were collected aided by cultural mediators, along with clinical assessment. Furthermore, Tuberculin-Skin-Test (TST) and blood tests for HBV-HCV-HIV-Syphilis were performed. Results A total of 646 migrants were included, 94% were males with a median age of 26 years (range: 15-50), the majority from Bangladesh (39%). Females were mostly from Ivory Coast (36%), median age of 30 years (range: 17-45). Most conditions were treated at the primary care level and were related to cutaneous disease (22%), only 11% of subjects required second-level diagnostics. Positive TSTs were 41% (N = 265). Of them, 55.5% (N = 147) also tested positive for QuantiFERON-TB. Screening for infectious diseases revealed positivity rates of 4% for HBsAg, 1% for HCVAb, 0.8% for HIV and 1.4% for TPPA+RPR. Conclusions The multidisciplinary approach is the innovative and strength point of this protocol for asylum seekers’ health ensuring prompt management of pathologies after their arrival. Moreover, data collection is useful for improving intake services and implementing public health programs for vulnerable individuals. Key messages • The innovation of this protocol for asylum seekers’ health lies in its multidisciplinary approach. • Clinical data collection will support health policies’ choices to protect vulnerable individuals.

Characteristics predisposing to the utilization of Internet websites offering e-prescriptions

Abstract Background The introduction of e-prescriptions in the Polish healthcare system was accompanied by the emergence of websites offering easy access to medication without adequate medical assessment. This study aimed to analyze the characteristics of Polish users of such services. Methods The analysis presented here is based on the online survey conducted in June 2023 among 1661 adult Internet users. The multivariable logistic regression model (MLRM) was developed for the variable reflecting the use of e-prescribing web services (EPWS). Sociodemographic variables, self-assessed health status, the presence of chronic disease (CHR) and disabilities (DIS), the frequency of Internet (IU) and social media use (SMU), and finally, digital health literacy (DHL) were included in MLRM as independent variables. Results The percentage of respondents who used EPWS was equal to 18.2% (n = 303). MLRM revealed that age, vocational and income status, CHR, SMU, and DHL were significant predictors of EPWS use. Older respondents were less likely than younger ones to use EPWS (odds ratio (OR), 95% confidentiality interval (95%CI): 0.97, 0.97-0.99. Persons suffering from the chronic disease, when compared to those without such disease, used EPWS less frequently (OR, 95CI: 0.59, 0.43-0.80) and unemployed when compared to employees (OR, 95%CI: 0.53, 0.32-0.88). A higher likelihood of using EPWS was observed among respondents with the highest income in comparison to those from the group with the lowest income (OR, 95%CI: 1.52, 1.02-2.52) and among more frequent social media users (OR, 95%CI: 3.88, 1.90-7.93). Finally, the increase of DHL score by 1 unit was associated with the increase of the likelihood of EPWS use by 9% (OR, 95%CI: 1.09, 1.05-1.12). Conclusions A significant number of adult Internet users utilize EPWS in Poland. Lower age, unemployment, and chronic diseases are negative predictors of EPWS use. More intense SMU and unexpectedly higher DHL predispose to the use of such services. Key messages • Even persons with high e health literacy are inclined to use web portals offering e-prescriptions. • The high prevalence of the utilization of e-prescribing websites requires awareness campaigns warning about related potential risks.

More 911 calls may get a mental health co‐responder in Denver

Since it launched in 2020, Denver's Support Team Assisted Response (STAR) mental distress response unit has expanded exponentially. After starting with a skeleton crew and just one van, it now has a fleet of eight vans and responds to nonviolent crises citywide, Denverite reported Oct. 22. The police alternative is set to expand again in 2025, thanks to a grant from an external group and a bump in city funding, although Mayor Mike Johnston has denied a request for additional money beyond that. STAR started four years ago as advocates across the city called for police reform. Through STAR, paramedics and mental health professionals are sent to respond to nonviolent crises, especially people who are in distress or experiencing a mental health issue. Staff are trained in medical assessment, crisis intervention and de‐escalation. The new $1.5 million grant will help STAR continue its partnerships for one year with the nonprofits Servicios de la Raza and WellPower, which help to operate the program. The one‐year grant will allow WellPower to hire a behavioral health clinical supervisor and “create a more organized, responsive and effective operational structure for STAR,” among other things. The grants have averaged roughly $650,000 a year, so this year's grant represents a significant expansion. The Denver City Council approved the grant last week. STAR officials said they could increase their response rates through more funding, which would allow the service to hire more staff, purchase more vehicles for its fleet and become a 24/7 service.