Medical Indications Research Articles

Evaluating the effect of making the indication field compulsory in electronic prescriptions: A pre-post study in a hospital prescribing system.

Recording the indication for a medicine in the prescription supports communication. In May 2023, our district hospitals made the free-text indication field in prescriptions compulsory for all medicines in the inpatient prescribing system. This study aimed to evaluate the effect of introducing a compulsory indication field in an inpatient prescribing system. Text in the indication field was manually classified as an indication, 'other text', 'rubbish text', 'to be determined' and 'blank'. Prescribing data were extracted from the district data warehouse. The change in proportion of prescriptions with an indication was compared for 8 weeks after introduction of a compulsory indication field to an equivalent 8 weeks in 2022. Secondary outcomes included medication cessation and indication recording before discharge. We analysed 81 634 prescriptions before and 82 726 after indications were made compulsory. The proportion of prescriptions with an indication increased from 29.2% to 75.6%. 'Rubbish text' increased from 0% to 2.3%, 'other text' from 2.5% to 14.7%, and 'to be determined' from 0.0% to 6.6%. Of 5557 prescriptions with 'to be determined' initially, 18.1% were ceased and 2.7% had an indication before discharge. After making the prescription indication field compulsory, the proportion of medicines with an indication increased from 29% to 76%, with only a small increase in 'rubbish text'. Following the system change, the quality of information recording improved but there was no change in medicine use. Compulsory fields should be combined with improvements in other components of care to improve medicine use.

To Consent and to Refuse Electroconvulsive Therapy: A Study of Consent Documents and Court Orders in the Province of Quebec, Canada

The objective of this article is to offer a critical analysis of policies and practices concerning consent and refusal of electroconvulsive therapy (ECT) in terms of their compliance with the legal principles concerning consent to treatment. Using the province of Quebec, Canada, as a case study, we first identified consenting documents and court orders for ECT treatments; we then critically appraised them using National Institute for Health and Care Excellence guidelines on ECT as a gold standard. We find that consent documents suffer lack of clarity and transparency regarding ECT’s medical indication, risks, and benefits. The review of court orders reveals a paucity of information pertaining to the diagnosis, clinical indications, benefits, and potential risks associated with ECT for patients who lack the capacity for consent.

Prevention of medication-related osteonecrosis of the jaw: institutional insights from a retrospective study.

Medication-related osteonecrosis of the jaw (MRONJ) is a serious, debilitating condition of the jaw bones. Dental extraction is the most significant independent risk factor for MRONJ. This interim study aimed to evaluate the demographics, medical data and outcomes of patients at risk for MRONJ who underwent dental extractions in a dedicated MRONJ clinic following a risk reduction protocol at a large public dental clinic in New South Wales Health. A retrospective study analysed demographic and clinical data of patients at risk for MRONJ who underwent dental extractions between March 2020 and April 2024. Data from 329 at-risk patients who underwent 836 dental extractions were included. Most patients were women (75.1%) with a median age of 74 years (IQR 67-80). The primary indication for medications was osteoporosis (85.4%), with Denosumab being the most frequently prescribed (66.9%). Eighteen patients (5.5%) developed MRONJ at 8 weeks of follow-up. Patients categorized as high-risk had a higher incidence of MRONJ (72.2%) compared to the low-risk group (22.2%). This study is the first retrospective audit carried out after implementing preventive protocols in this dedicated MRONJ clinic. The higher incidence of MRONJ in patients classified as 'high risk' underscores the importance of considering individual risk factors in their treatment.

Experience of patients and healthcare practitioners with interdisciplinary care in immune-mediated inflammatory diseases with skin manifestations: A systematic scoping review.

Immune-mediated inflammatory diseases with skin manifestations (skIMIDs) may affect multiple organs. Interdisciplinary care (IC) can overcome the fragmented knowledge used in the management of skIMIDs. In skIMIDs-care, patient and healthcare practitioner (HCP) satisfaction with IC is unknown. Yet, patient experience influences adherence and medical outcomes. Moreover, HCP experience influences professional satisfaction, perception of care quality and autonomy. Thus, measuring patient and HCP experience can identify areas for improvement in care delivery. The aim of this scoping review was to gather evidence on patient- and HCP perceptions on skIMID-IC and their measurement. We systematically searched on 30 August 2023 PubMed/EMBASE/Cinahl/Web of Science. Eligible studies had to address explicitly experience of IC by patients or HCPs. A conceptional synthesis appraised how experiences were measured and IC was perceived by patients and HCPs. The database search resulted in 21 eligible studies. Fourteen described positive patient and HCP experiences with a specific IC programme. These studies were heterogenous on the levels of IC models, medical conditions, measurement methods and outcomes. Despite that patients and HCPs rated such tailored IC models positively, seven studies on a geographically broader region reported less satisfaction with IC. A conceptual analysis identified domains deemed as important regarding IC: 'general satisfaction', 'patient-HCP interaction', 'information', 'functioning of IC', 'benefits of IC'. For patients, 'access to care' and 'disease management' were added. For HCPs 'illness perception' was deemed relevant. The heterogeneous way in how IC experience is captured hinders strong conclusions, which mandates the development of standardized analysis tools. Experience with IC in skIMIDs strongly depends on the context of the provided IC and patient experience seems to be better in local IC programmes than systems rolled out in larger geographical regions. Future need is to develop a core IC outcome set including medical outcomes, process indicators, financial indicators, plus patient and HCP care experience measures.

Evaluating the patient's serum for thyroid stimulating immunoglobulin and Cytotoxic -T-lymphocyte associated protein 4 in Graves hyperthyroidism

Graves' disease (GD) is a common autoimmune disorder that causes an excess of thyroid hormone production. It is mainly due to the production of IgG antibodies that activate the thyrotropin receptor. The aim of this study is to measure the levels of Cytotoxic -T-lymphocyte associated protein 4 and thyroid stimulating immunoglobulin in individuals with GD. It also seeks to establish the connection between thyroid stimulating immunoglobulin and thyroid stimulating hormone (TSH), as well as to assess the predictive value of CTLA4 for Graves' disease. The study was a case-control investigation conducted at the Alrusafa Center for Diabetes and Endocrinology. It involved a total of 45 people diagnosed with Graves' illness. The healthy group consisted of 45 individuals who had no previous medical history or clinical indications of hyperthyroidism or any other chronic condition. Blood samples from 90 individuals diagnosed with Graves' illness and a control group were analyzed to measure the levels of CTLA4, TSI by ELISA. The findings indicated a robust and statistically significant association (P.value<0.01) serum levels of CTLA4 in the patients for Graves' disease comparing to the control group. The patient samples included 13 men (28.89%) and 32 women (71.11%). There was no significant relationship found between TSI and TSH.

A Pharmacoeconomic Study of Post-Exposure Prophylaxis Strategies for Influenza Virus Infections in Japan.

Vaccines can prevent influenza (flu) infections and are cost-effective for society and healthcare. However, the cost-effectiveness of post-exposure prophylaxis as a follow-up strategy is unclear. This study aims to evaluate the cost utility of post-exposure prophylaxis and treatment strategies with neuraminidase inhibitors and a cap-dependent endonuclease inhibitor for flu infections from the perspective of healthcare costs in Japan. A base-case analysis was used to compare oseltamivir, zanamivir, and laninamivir for neuraminidase inhibitors and baloxavir marboxil for the endonuclease inhibitor. The costs of the first visit to a physician and pharmacy were excluded because of the policy on out-of-pocket expenses for post-exposure prophylaxis in Japan. Direct medical costs include the second physician visit, pharmacy and hospital admission expenses, and drug prices, based on the 2020 Japanese Medical Fee Index. The EuroQol-5Dimention-5Level was utilized to measure healthy participants' quality of life scores, with a time horizon of 14days. Deterministic and probabilistic sensitivity analyses were conducted. We have found baloxavir marboxil as the post-exposure prophylaxis agent and laninamivir as the treatment agent to be the most cost-effective strategy in Japan, followed by oseltamivir as the post-exposure prophylaxis agent and zanamivir as the treatment agent. Baloxavir marboxil and oseltamivir are cost-effective prophylactic agents for flu from the perspective of healthcare costs in Japan. This strategy to select baloxavir marboxil or oseltamivir would be helpful to manage a formulary for post-exposure prophylaxis in Japan.

COMPARATIVE ANALYSIS OF IRON, COPPER AND COBALT CONTENT IN HAIR, BLOOD SERUM AND URINE OF STUDENTS FROM CENTRAL ASIA, MIDDLE EAST AND CENTRAL RUSSIA DURING THE PERIOD OF ADAPTATION TO STUDY

Introduction. The most popular education in Russian higher education institutions is enjoyed by immigrants from Central Asian countries, including Kazakhstan, Tajikistan, Turkmenistan, Uzbekistan and Kyrgyzstan. They account for more than half of all foreign citizens studying in Russian universities. Changed environmental conditions lead to the development of stressful situations, decreased learning ability and, in the future, the possible development of a number of diseases closely associated with the presence of various elementoses. In this regard, in addition to the socio-cultural adaptation of students, it is very important to pay attention to the study of the elemental status of students in the process of their further adaptation to the changed living conditions. The purpose of the study – comparative analysis of iron, copper, cobalt content in hair, blood serum and urine of students from Central Asian countries, the Middle East and Central Russian regions during the adaptation period to study. Material and methods. In the period from September 1, 2022 to January 1, 2023, a study of the elemental composition of hair was conducted using inductively coupled plasma mass spectrometry in 180 first-year students of RUDN University, who previously lived in the countries of Central Asia (170 people), the Middle East (60 people) and in the regions of Central Russia (120 people) aged 18–26 years. The average age of the subjects was 22.7 ± 4 years. Gender differences in the comparison groups were not taken into account. Differences in samples were determined using the Mann–Whitney test for independent samples (significance level p < 0.05). Results. The article presents the results of a comparative analysis of the content of iron, copper, chromium in the hair, urine and blood serum of students who arrived from the countries of the Middle East, Central Asia and the regions of Central Russia during the adaptation period to study in 2023. Features of the elemental profiles of students were established. Conclusions. It is shown that the hair of the subjects reflects the territorial climatic and geographical features of the region of residence of the examined persons. Despite statistically significant differences in the content of iron, copper, chromium in the examined students of different regions, their elemental profile did not affect the objective medical indicators (heart rate, saturation level, hemoglobin index).

Clinical aspects of the preparation, performance, and follow-up of afirst trimester abortion

In January 2023, the "S2k guideline on abortion in the first trimester" of the Association of Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V.", AWMF) was published, which was commissioned by the Federal Ministry of Health ("Bundesministerium für Gesundheit", BMG). The guideline deals with surgical and medical abortion after counseling, with criminological or medical indication in the first 14weeks of pregnancy, based to the last menstrual period. In this review article, based on this guideline, the procedures for medical and surgical abortion are compared as well as the advantages and disadvantages of the two methods. Clinical and practical aspects of preparation and implementation, complication management, and immediate aftercare for abortion are presented.

Reporting a regular medical doctor index: A new measure of patient-physician affiliation for health administrative data.

Having a regular medical doctor is associated with better process of care and health outcomes. The goal of this study was to harness the richness in health administrative data to create a measure which accurately predicted whether patients self-identified as having a regular medical doctor. The Canadian Community Health Survey (2007-2012) was linked with health administrative data (HAD) (2002-2012) from Quebec, Canada's second largest province. The Canadian Community Health Survey includes respondents' answer to whether they have a regular medical doctor, but health administrative data does not. We therefore used LASSO and Random Forests to build prediction models that predict whether a patient reports having a regular medical doctor using their data only available in the HAD. Our results show that predicting patient responses to 'do you have a regular medical doctor?' using an average of single-year Usual Provider Continuity over 3 years results in an area under the receiver operator characteristic curve of 0.782 (0.778-0.787). This was almost a 14% improvement in predictive accuracy compared to the frequently used single-year Usual Provider Continuity (0.688 (0.683-0.694)). We have called this new measure the Reporting a Regular Medical Doctor (RRMD) index. The RRMD index is easy to implement in HAD, is an elegant solution to the difficulties associated with low-users having unstable UPC scores, and brings a patient-oriented perspective to previous efforts to capture patient-physician affiliations in HAD. We recommend that researchers seeking to measure whether patients have a regular medical doctor using HAD consider using the RRMD index.

Pathways to depressive symptoms in Chinese pregnant women and their influence on delivery approach: a qualitative comparative analysis.

The aim of this study was to apply complexity theory to explain and understand how risk factors combined in complex ways, eventually leading to a high prevalence of depressive symptoms among pregnant women. We also aimed to evaluate whether depressive symptoms affected delivery approach. The study had a longitudinal design and was conducted between May and September 2017. A total of 481 pregnant women were recruited to participate and completed closed-end surveys at two distinct times: during prenatal care at the hospital after 26 weeks of pregnancy and 1 to 4 weeks after delivery. This study identified eleven different pathways that led to an increase in depressive symptoms. Each pathway differentiated the effects of different influencing factors. Among the 481 pregnant women, 128 (26.6%) had cesarean deliveries without medical indications. Although depressive symptoms could affect delivery approach, it was not the most important factor. Surprisingly, the first production emerged as the key factor determining delivery mode. This study was innovative in that it examined which factors and which combinations of factors were necessary for the development of depressive symptoms. Additionally, this study provided a better understanding of the mechanisms underlying the choice of cesarean section without medical indications.

Association Between Neuropsychiatric Event and Systemic Lupus Erythematosus Clinical Manifestation: A Meta-Analysis.

To uncover the clinical characteristics and investigate the underlying causes of psychiatric manifestations in patients with systemic lupus erythematosus (SLE), including its subset, neuropsychiatric systemic lupus erythematosus (NPSLE). Through comprehensive database searches in PubMed, Embase, Medline, and Cochrane, from their inception to August 2023, the study focused on adult SLE and NPSLE cases. From the selected studies, data were synthesised via a random-effects meta-analysis, encompassing a total of 2,997 subjects across six studies. The findings highlighted differences in medical indicators such as discoid rash, hypertension, mean disease duration, and various autoantibodies between SLE and NPSLE patients, indicating a nuanced approach to treatment is necessary, particularly with NPSLE requiring extended treatment periods. The analysis suggests that the causality behind these manifestations is multifactorial, encompassing mental state, autoantibody profiles, and environmental factors, thus providing valuable insights into the clinical management and understanding of SLE and NPSLE. This study emphasises the complexity of SLE, particularly in its neuropsychiatric manifestations, and underscores the importance of targeted treatment strategies. Key Words: Systemic lupus erythematosus, Neuropsychiatric systemic lupus erythematosus, Neuropsychiatric event, Meta-analysis.

Construction of a Clinical Prediction Model for Complications After Femoral Head Replacement Surgery.

While femoral head replacement is widely used with remarkable efficacy, the complexity and diversity of postoperative complications pose a serious prognostic challenge. There is an urgent need to develop a clinical prediction model that can integrate multiple factors and accurately predict the risk of postoperative complications to guide clinical practice and optimize patient management strategies. This study is dedicated to constructing a postoperative complication prediction model based on statistics and machine learning techniques, in order to provide patients with a safer and more effective treatment experience. A total of 186 patients who underwent femoral head replacement in the Orthopedic Department of our hospital were collected in this study. Forty-two of the patients had at least one postoperative complication, and 144 had no complications. The preoperative and postoperative data of patients were collected separately and medical history was collected to study the correlation factors affecting the occurrence of postoperative complications in patients and to establish a prediction model. Possibly relevant factors were included in a one-way logistic regression, which included the patient's gender, age, body mass index, preoperative diagnosis of the mode of injury, osteoporosis or lack thereof, as well as medical history, surgical-related information, and laboratory indices. After analyzing the results, it was concluded that operation time, alanine transaminase (ALT), aspartate aminotransferase (AST), white blood cell count, serum albumin, and osteoporosis, were the risk factors affecting the development of complications after femoral head replacement in patients (P < 0.2). The data obtained were further included in a multifactorial regression, and the results showed that operation time, AST, white blood cell count, serum albumin, and osteoporosis were independent risk factors for complications after the patients underwent femoral head replacement (P < 0.05). Based on the results of this study, five factors, including duration of surgery, AST, white blood cell count, serum albumin, and osteoporosis, were identified as independent risk factors for complications after patients underwent femoral head replacement. In addition, the prediction model developed in this study has a high scientific and clinical application value, providing clinicians and patients with an important tool for assessing the risk of complications after affected femoral head replacement.

TNFα-inhibitors cycling with golimumab as second drug in inflammatory arthritis patients: Data from the multicenter GO-REAL registry

Introduction/ObjectivesThere are still controversies about the efficacy of cycling to a second tumor necrosis factor inhibitor (TNFi) in patients with inflammatory arthritis. The aim of this study was to evaluate survival, persistence and effectiveness of golimumab (GLM) in patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) with previous experience with other TNFi and to compare these results with TNFi naive patients. MethodsObservational cohort of consecutive patients with RA, PsA and axSpA who had started treatment with GLM according to medical indication. bDMARD naive and TNFi experienced patients were selected. ResultsA total of 147 (62.3%) bDMARD naive and 45 (19.1%) TNFi experienced patients were included. Patients were followed up for a total of 441.5 patients/year, 55 (28.6%) discontinued GLM, 42 (28.6%) and 13 (28.9%) in each group, respectively (p=0.967). The majority (63.6%) suspended due to inefficacy, followed by lack of access (23.6%) and adverse events (9.1%). Median GLM survival was 74.0 months (95% CI 57.0, 91.0) and 71.0 months (95% CI 37.0, 105.0), in the bDMARD naive and TNFi experienced patients, respectively (p=0.695). Drug persistence at 6, 12, 24 and 36 months was 92.8%, 88.1%, 76.1%, 65.4% and 93.1%, 77.4%, 74.2%, 68.5%, respectively. In the multivariable analysis, having public health insurance was associated with higher risk of drug discontinuation (HR 2.56, 95% CI 1.28–5.00, p=0.008). TNFi experienced patients did not show significantly higher risk of GLM suspension (HR 1.35, 95% CI 0.70–2.57, p=0.370). ConclusionIn this cohort, TNFi experienced patients had comparable survival and persistence of treatment with GLM. Having public health insurance was associated with lower drug retention rates.

Discussion about Testing Scheme of Intelligent Medical Devices

Intelligent medical devices are flourishing with the deep integration of modern information and artificial intelligence technologies into healthcare. Testing is an important means of performance evaluation and quality control for intelligent medical devices. Compared with traditional medical devices, the testing methods and technologies of intelligent medical devices are still immature, and need active research to promote the progress in this area. Intelligent medical devices are classified according to their characteristics as artificial intelligence medical devices in the form of software and medical robots based on a general discussion of their development. The medical-device Internet of Things (IoT) system has also been included due to its close relation to the construction of smart hospitals. For each type of intelligent medical device, testing indexes and testing plans are discussed. It is suggested that specific test rules should be further developed for various specific devices. Besides, the evaluation method of complex intelligent systems should be introduced and real-world data should be used for evaluation. This paper aims to accelerate the development of intelligent medical device testing, laying the foundation for quality control and performance evaluation of intelligent medical devices.

Assessment of tibialis anterior tendon insertion variations in relation to hallux valgus utilizing magnetic resonance imaging

BackgroundHallux valgus is a deformity characterized by lateral deviation of the big toe and medial deviation of the first metatarsal, causing difficulty in walking and requiring various treatments. Despite its multifactorial etiology, the role of the tibialis anterior tendon in hallux valgus and its variations in the morphology of tibialis anterior tendon distal insertion sites have not been fully explored. This study aimed to evaluate the effect of such variations on hallux valgus using magnetic resonance imaging.MethodsThis was a retrospective study and included 115 individuals aged 18 years and older who underwent foot radiographs and MRI. The participants were divided into a hallux valgus group of 53 patients and a control group of 62 people based on radiographic measurements. Tibialis anterior tendon distal attachment was classified into five types according to the attachment morphology. Statistical analyses were performed to evaluate the relationship between the tibialis anterior tendon types and hallux valgus severity.ResultsAmong the participants, patients who underwent foot radiography and MRI due to any medical indication 70.4% were female, with a mean age of 43.83 ± 15.25 years. In terms of tibialis anterior tendon distal attachment, the most common type was Type 5 (40.9%), followed by Type 2 (34.8%). Type 4 was not observed in any case. In all participants, the mean hallux valgus angle was 20.63 ± 8.42o, and the mean intermetatarsal angle was 9.69 ± 2.68o. Tibialis anterior tendon distal attachment Type 5 was significantly associated with an increased hallux valgus angle but not with the intermetatarsal angle. We found a significant relationship between the diameter of the tibialis anterior tendon and hallux valgus angle.ConclusionsThis study revealed a significant association between hallux valgus and Type 5 tibialis anterior tendon distal attachment, suggesting that tibialis anterior tendon morphology influences hallux valgus severity. The findings underscore the importance of considering variations in tibialis anterior tendon distal attachment sites in the etiopathogenesis and treatment planning of hallux valgus.

Medication-related Burden and Experience With Medications in Indonesian Older Adults With Chronic Diseases: A Mixed-method Study.

This study explored the specific medication-related burdens experienced by older adults with chronic disease and the contributing factors. An exploratory mixed-method study was conducted at a teaching hospital in Surakarta City, Central Java, Indonesia. Combining the Indonesian version of the Living with Medicine Questionnaire (LMQ) and semi-structured interviews allowed for a comprehensive understanding of the medication-related burden. Differences in LMQ scores related to patient characteristics were analyzed using the t-test, F-test, or other alternatives. Quantitative and qualitative data triangulation was used to derive trustworthy and dependable results. The overall LMQ mean score was 90.4 (n=129), indicating a moderate burden. The average LMQ scores varied significantly based on the number of medications, treatment duration, and the presence of cardiovascular disease (CVD), diabetes mellitus (DM) and stroke. The qualitative study found 3 themes in the chronic medication use of older adults: experiences, challenges, and motivation. Despite their limited understanding of a medication's name and indication, some patients managed their medications based on the physical look and packaging of the medication. The study also found that patient motivation and familial support could effectively counteract the fatigue and dissatisfaction associated with taking medication. Older adults with chronic diseases faced medication-related burdens associated with the presence of CVD, DM, stroke, a treatment duration >5 years, and the use of >10 medications. Effective communication with healthcare professionals is required to understand patients' needs and concerns, thereby helping manage the challenges of medication-related burdens.

Findings from an expert focus group on psychotropic medication deprescribing practices for children and youth with complex needs

IntroductionPsychotropic medication can be effective at stabilizing emotional and behavioural disturbances associated with physiological processes in children and youth. When medication benefits, indication or adverse effects are queried, deprescribing should be considered. Current guidelines for deprescribing are mainly for adults/elderly and largely theoretical, not practical, especially for polypharmacy.MethodsAt a tertiary center for children and youth with complex emotional and behavioural needs, physicians on staff have expertise in conducting assessments of medication efficacy, side effect burden, and safety concerns. Deprescribing is routinely undertaken in the context of inpatient and outpatient services in partnership with children/youth and their families. A qualitative initiative leveraged the specialized deprescribing expertise of eight physicians (six psychiatrists and two pediatricians).ResultsEmerging themes were medication review, timing, a stepwise approach, and setting conditions (inpatient and outpatient), with recurring subcategories of patient/family engagement as well as the underlying importance of continuity of care with psychosocial/behavioural supports.DiscussionThe findings from this expert focus group serve as a step towards supporting prescribing clinicians in mindful deprescribing when medications are no longer in the best interest of young patients.

Allostatic load modelling, lifestyle and cardiological risk factor: evidence for integrating patient profiling in the optimisation of pharmacological therapies during follow-ups in hospital setting – PLAY-UP cohort study protocol

IntroductionThe allostatic load (AL) is a framework for conceptualising the physiological multisystemic impact of prolonged exposure to stress and its related side effects on mental health.Stress due to AL can...

Analysis and Prediction of Risk Factors for Heart Failure

Abstract. Heart failure is a grave and progressive illness. It is associated with multiple risk factors such as age and other possible factors. Accurately identifying and quantifying these risk factors is critical to developing personalized prevention and treatment strategies. However, it is difficult for common patients to predict heart failure without the professional diagnosis of doctors, and relying on human resources to predict heart failure is more subjective. This study proposes a method to evaluate and predict the factors related to heart failure based on multiple body indicators by using random forest algorithm. The random forest prediction model was applied to assess the correlation between multiple medical indicators such as creatinine phosphokinase (CPK), serum creatinine (SCR), ejection fraction (EF), age and heart failure. CPK was found to be the most associated with heart failure. In addition, increasing follow-up period can also effectively monitor heart failure progression in patients. In this high dimension prediction problem, the prediction effect of random forest is better, and the overall accuracy is higher. The approach used in this research is important for forecasting the risk of heart failure, enhancing the survival rates of patients, and alleviating the burden on healthcare systems.

Metabolic syndrome and spatial disparities: The role of socioeconomic deprivation and medical resource availability in the Cijin district, Taiwan.

Metabolic syndrome (MetS) is a global health concern with spatial disparities, especially in disadvantaged neighborhoods. This study aimed to examine the association between area-level socioeconomic deprivation, the availability of medical resources in disadvantaged areas such as the Cijin district, and the prevalence of MetS in Taiwan. We used two representative secondary cross-sectional datasets, including physical examinations and lifestyle surveys from 2016 to 2020, sourced from the Taiwan Biobank and the Cijin District Adult Lifestyle and Health Survey. Our findings indicate that residing in the Cijin district, characterized by socioeconomic deprivation and limited medical resources, is associated with significantly higher odds of MetS (aOR = 1.45, 95% CI = 1.28-1.64, p <0.001). Additionally, living in areas with medium (aOR = 1.12, 95% CI = 1.07-1.17, p <0.001) and high area-level socioeconomic deprivation indexes (aOR = 1.13, 95% CI = 1.01-1.25, p <0.001) is linked to a higher likelihood of MetS. Conversely, residing in high medical resource availability index areas is associated with a lower risk of MetS (aOR = 0.92, 95% CI = 0.86-0.99, p = 0.026). We found a link between socioeconomic deprivation and limited medical resources, especially in disadvantaged areas such as the Cijin district, contributing to a higher MetS risk. Residents in these areas often struggle to access healthcare and preventive care. Addressing these disparities requires comprehensive public health initiatives and targeted policy interventions to improve residents' well-being.