Medical Outpatient Clinic Research Articles

Factors associated with mobile medical clinic use: a retrospective cohort study

BackgroundMobile medical clinics have been used for decades to provide primary and preventive care to underserved populations. While several studies have examined their return on investment and impact on chronic disease management outcomes in the Mid-Atlantic and East Coast regions of the United States, little is known about the characteristics and clinical outcomes of adults who receive care aboard mobile clinics on the West Coast region. Guided by the Anderson Behavioral Model, this study describes the predisposing, enabling, and need factors associated with mobile medical clinic use among mobile medical clinic patients in Southern California and examines the relationship between mobile clinic utilization and presence and control of diabetes and hypertension.MethodsWe conducted a retrospective cohort study of 411 adults who received care in four mobile clinic locations in Southern California from January 1, 2018, to December 31, 2019. Data were collected from patient charts on predisposing (e.g., sex, race, age), enabling (e.g., insurance and housing status), and need (e.g., chronic illness) factors based on Andersen’s Behavioral Model. Zero-truncated negative binomial regression was used to examine the association of chronic illness (hypertension and diabetes) with number of clinic visits, accounting for potential confounding factors.ResultsOver the course of the 2-year study period, 411 patients made 1790 visits to the mobile medical clinic. The majority of patients were female (68%), Hispanic (78%), married (47%), with a mean age of 50 (SD = 11). Forty-four percent had hypertension and 29% had diabetes. Frequency of mobile clinic utilization was significantly associated with chronic illness. Patients with hypertension and diabetes had 1.22 and 1.61 times the rate of mobile medical clinic visit than those without those conditions, respectively (IRR = 1.61, 95% CI, 1.36–1.92; 1.22, 95% CI, 1.02–1.45).ConclusionsMobile clinics serve as an important system of health care delivery, especially for adults with uncontrolled diabetes and hypertension.

Assessing social needs among patients with cardiovascular and psychiatric comorbidities in free community health clinics.

Community-related health assessments have been shown to improve several outcomes in socioeconomically disadvantaged populations with comorbid chronic health conditions. However, while it is recognized that modifiable social determinant of health (SDH) factors might be responsible for up to 60% of preventable deaths, it is not yet standard of care to routinely screen and address these at preventive health appointments. The objective of this study was to identify the social needs of socioeconomically disadvantaged patients. We performed a retrospective review of the socioeconomic screening questionnaires distributed to under- and uninsured patients seen at a medical student-run free primary care-based community clinic. This study included participants of all ages (0 and up), genders, languages, and ethnicities who filled out the social screening questionnaire. Socioeconomic screening questionnaires assessed the need for critical resources such as food, housing, utilities, finances, transportation, childcare, employment, education, legal support, companionship, health literacy, and community assistance. The primary study outcome was to identify unmet social needs of our medical student-run free clinic patients. We secondarily sought to identify associations between these needs and chronic health conditions. We hypothesized that patients with multiple chronic health problems and financial stressors would have the highest requests for resources. Our retrospective review identified 264 uninsured participants who were evaluated for social needs using a screening questionnaire. Participants who reported unmet social needs had significantly more cardiovascular risk factors than those who did not. Cardiovascular comorbidities and a history of psychiatric illness were the two most common medical problems significantly associated with several unmet social needs. This study provides support for the preemptive identification and appropriate management of physical, mental, and social care to improve disproportionate disparities in long-term health outcomes.

Use of Bridge with Path Drawings with Military Service Members Experiencing Traumatic Brain Injury and Post-Traumatic Stress Disorder

This article introduces the use of an art therapy assessment, the Bridge with Path Drawing, for service members experiencing effects of Traumatic Brain Injury (TBI) and/or Post-Traumatic Stress Disorder (PTSD) during treatment at an outpatient clinic. Brief clinical vignettes describe the processes and outcomes of Bridge with Path Drawing Assessment for two service members. Bridge to Path Drawing aided service members with TBI/PTSD in discovering and disclosing thoughts and feelings through symbolic and metaphorical associations to their drawings. Service members shared meanings related to their senses of identity, their futures, the transitions to civilian lives, strategies to overcome obstacles, and purposes and meanings in their lives. Providers working with service members experiencing effects of TBI/PTSD and military-to-civilian transition found an art therapy assessment, the Bridge with Path Drawing, useful to explore patients’ meaning in life at an outpatient medical clinic on a military base.

HORMON RESEPTÖR POZİTİF, HER-2 NEGATİF METASTATİK MEME KANSERLİ HASTALARDA CDK4/6 İNHİBİTÖRÜ TEDAVİSİ ÖNCESİ SİSTEMİK İMMÜN İNFLAMASYON İNDEKSLERİNİN VE PROGNOSTİK NUTRİSYONEL İNDEKSİN PROGNOSTİK ÖNEMİ

Abstract
 Purpose: As systemic inflammatory indices and prognostic nutritional index are associated with poor prognosis in many tumor types, the goal of the present study was to ascertain their effect along with the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, lymphocyte/monocyte ratio, C-reactive protein/albumin ratio, and systemic inflammatory response index on the progression-free survival (PFS) and overall survival (OS) of hormone receptor-positive HER2-negative (HR+/HER2−) metastatic breast cancer patients before CDK4/6 inhibitor treatment. 
 Materials and Method: The medical records of 79 patients with HR+/HER2− metastatic breast cancer who presented at the Medical Oncology Outpatient Clinic between January 2018 and May 2022 were retrospectively analyzed to gather relevant data measured before CDK4/6 inhibitor treatment in order to establish the effect of key markers on their PFS and OS.
 Results: The median age of the participating patients, 70 (88.6%) of whom were postmenopausal, was 53 years (range 26−80 years). While 68 patients (86.1%) had a 0 performance score, 10 (12.7%) developed metastases during adjuvant endocrine therapy. Factors affecting PFS were age

Diagnosis Rates Through Cancer Screening Programs in Patients with Breast Carcinoma.

This study investigated whether breast cancer patients had ever applied for Cancer Early Diagnosis Screening and Training Centers (KETEM). This study, conducted from November 2020 to April 2021, adopts a cross-sectional research design and is planned as a survey study. The "Diagnosis Rates with Screening Programs in Breast Cancer Patients" survey was conducted on women over 45 who were diagnosed with breast cancer in the Medical Oncology Clinic of İzmir Katip Çelebi University Atatürk Education and Research Hospital. Further information about the cancer stage was gathered from the Medical Oncology outpatient clinic file records. Data obtained in the study were evaluated using the the Statistical Package for Social Sciences version 26.0 software (IBM Corp.; Armonk, NY, USA), using the number, percentage distribution, arithmetic mean, and chi-square test methods. It has been determined that most patients diagnosed did not receive a diagnosis through screening programs, were not aware of KETEM, and did not apply to KETEM. A positive relationship was found between the level of education and participation in screening programs. It was observed that women who knew about the KETEM's participated more often in the scans. The study discovered a lack of knowledge and inadequacy in screening programs for patients with breast cancer. We believe that it is essential to introduce and disseminate KETEMs so that cancers can be detected early through screening.

Improving antiepileptic drug tolerability among patients living with epilepsy: the impact of pharmaceutical care services

ABSTRACT Therapeutic management of epilepsy is usually long term; thus, patient tolerability of prescribed antiepileptic drugs should be a major consideration as it affects compliance to therapy. The aim of this study was to determine the impact of pharmaceutical care services on antiepileptic drug tolerability among patients living with epilepsy. This study was an open, randomized, controlled, longitudinal and two-arm parallel prospective study with a 6-month patient follow-up period. Patients were recruited from the neurology and medical out-patient clinics of two selected epilepsy referral centres. Recruited patients were randomized into one of the two study groups: pharmaceutical care (PC) or usual care (UC) groups. Patients in the UC group received the usual care provided in the hospitals, while patients in the PC group received PC services in addition to the usual care provided in the hospitals. The impact of PC on patient tolerability of antiepileptic drugs was evaluated using a patient judged antiepileptic drug tolerabiltity scale. The evaluation was done at baseline (pre-intervention), 3 months and 6 months post-intervention. Patients in the PC group had a significantly lower antiepileptic drug tolerability score than those of the UC group at 3 months and 6 months - (Pre-intervention: 0.97 versus 1.13; t = −1.081; p = 0.281), (3 months: 1.13 versus 0.71; t = 3.084; p = 0.001), (6 months: 1.00 versus 0.60; t = 3.083; p = 0.001), indicating a significant improvement in the tolerability of antiepileptic drugs among those in the PC group over time. Pharmaceutical care interventions that included education and counseling services significantly improved tolerability of antiepileptic drugs among patients living with epilepsy.

Hospitalization due to adverse drug events in older adults with cancer: A retrospective analysis

IntroductionGeriatric oncology is a rapidly evolving field of practice, where comprehensive geriatric assessments (CGA) and multidisciplinary team (MDT) input have the potential to improve patient outcomes. Polypharmacy and potential drug interactions (PDI) have been associated with an increased risk of adverse outcomes in older adults with cancer, receiving systemic anti-cancer therapy (SACT). Our aim was to assess the incidence of unplanned hospitalization in older adults with cancer attending medical oncology outpatient clinics and to determine whether an unplanned hospitalization was potentially due to an adverse drug event (ADE). Materials and MethodsWe identified patients who attended a medical oncology outpatient appointment from January 1 to March 31, 2018. Medical records were examined to identify any unplanned hospital admissions between the clinic visit date and three and six months after initial clinic visit. Incidences of unplanned hospitalization were assessed to determine if an ADE potentially occurred. ResultsData collected from 174 patients were analyzed. Over half (57%) were female, median age was 75 years and 53% had a favorable performance status. The most common malignancies were gastrointestinal (GI) at 31% (n = 54), breast 29% (n = 51), and genitourinary 22% (n = 37). Seventy-two percent had advanced disease (stage III/IV) and 61% had systemic therapy (SACT and hormonal therapy). Polypharmacy (≥5 medications) was observed in 77% of patients. The total number of admissions at six months was 99, with 55% of these potentially due to an ADE. On multivariate analysis breast cancer (p ≤0.001), lung cancer (p = 0.034), performance status (p ≤0.001), monochemotherapy (p = 0.012), polychemotherapy (p ≤0.001), and radiotherapy (p = 0.048) were independent predictors of unplanned hospitalization. Breast cancer (p = 0.008), GI cancer (p = 0.019), monochemotherapy (p = 0.039), and polychemotherapy (p ≤0.001) were independent predictors of unplanned hospitalization due to ADE on multivariate analysis. DiscussionWe observed that older adults with cancer have a high risk of unplanned hospitalization due to ADE. Medication review as part of a CGA in newly diagnosed older adults with cancer by a clinical pharmacist is recommended. This may identify opportunities to avoid medications that could potentially lead to unplanned hospitalization.

Ask Questions (ASQ): Implementation of a question prompt list communication intervention in a network of outpatient medical oncology clinics.

e24185 Background: High-quality, patient-centered communication is not experienced equitably across patient populations, likely contributing to healthcare disparities. Question Prompt Lists (QPL) improve patient active participation and other aspects of patient-physician communication in diverse populations and settings. This descriptive, single-arm study assessed the implementation and patient perceptions of a previously-developed, evidence-based QPL, the ASQ brochure, across a network of oncology clinics providing care in a diverse population across Michigan. Methods: The QPL was revised in collaboration with community and physician stakeholders. Implementation was assessed through the reach, adoption, and efficacy domains of the RE-AIM framework. Eligible patients had a cancer diagnosis and were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before their appointment, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and univariable and multivariable linear mixed-effects models. Results: Reach: A total of 81 patients participated with a consent rate of 68.3%. Self-identified racial/ethnic groups were representative of the population served by the clinic network (72.4% white, 21.0% black, 3.7% American Indian/Native Alaskan, and 1.2% Mexican/Hispanic). Adoption: All eight invited clinics participated and recruited patients. Efficacy: All outcomes improved significantly, with no significant differences by clinic site or patient race. Patient perceptions of the ASQ brochure were overwhelmingly positive. Conclusions: The implementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population. Findings suggest this simple, evidence-based communication intervention should be implemented widely in similar clinical contexts.

EFFECT OF SITAGLIPTIN ON BLOOD PRESSURE IN PRE-HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES

Objective: To determine the effects of Sitagliptin on pre-hypertensive type-2 diabetes mellitus patients.
 Methods: This Quasi-Experimental study was conducted at Medical inpatient and outpatient department and Diabetic Clinic of Mayo Hospital, Lahore, from February 2019 till January 2020. A total of 146 patients were included in study. Blood pressure (BP) was recorded at baseline and then at 3, 6 and 12 months of treatment. Patients were called for follow up at 3 and 6 months, their BP was checked and haemoglobin A1c (HbA1c) was also sent to check for glycemic control. At 12 months, final follow up was called. BP and HbA1c of every patient were checked and recorded. The blood pressure values at baseline, 3 months, 6months and 12 months were comparatively analyzed by using a paired t-test and p-value of 0.05 was considered significant.
 Results: Total 146 patients of type-2 diabetes with HbA1c ≤ 9 % not taking sitagliptin previously were selected for this study. Mean age of the patients was 57.5±10.7 years. Total 93(63.7%) were males and 53(36.3%) females. There was statistical difference of HbA1c, systolic and diastolic blood pressure values (p<0.05) after 3 months, 6 months and 12months of sitagliptin therapy as compared to baseline.
 Conclusions: Sitagliptin therapy significantly decreases blood pressure and levels of HbA1c in type 2 diabetic-hypertensive patients.

Ask questions (ASQ): Implementation of a question prompt list communication intervention in a network of outpatient medical oncology clinics

ObjectiveThis descriptive, single-arm study assessed the implementation and patient perceptions of an evidence-based Question Prompt List (QPL), the ASQ brochure, across a network of oncology clinics in a diverse patient population. MethodThe QPL was revised in collaboration with stakeholders. Implementation was assessed using the RE-AIM framework. Eligible patients were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (perceived knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and linear mixed-effects models. ResultsReach: Participants (n = 81) represented the diverse population served by the clinic network. Efficacy: All outcomes improved significantly, with no significant differences by clinic site or patient race. Adoption: All eight invited clinics participated and recruited patients. Patient perceptions of the ASQ brochure were overwhelmingly positive. ConclusionImplementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population. Practical ImplicationsThis evidence-based communication intervention can be implemented widely in similar medical contexts and populations.

Effectiveness of mHealth in improving medication adherence among hypertensive patients on follow-up in a tertiary hospital in central Kenya: a randomized controlled trial

Background: Non-adherence to medication is documented in the literature as a major barrier to blood pressure control among patients on treatment for hypertension. This study sought to evaluate the potential effectiveness of a mHealth intervention in supporting medication adherence among hypertensive patients on follow up. Methods: We undertook a single blind parallel randomized controlled trial among hypertensive patients undergoing follow up care in Nyeri County Referral Hospital between January and December, 2020. The trial comprised of two arms, with a total of 120 patients randomized on a 1:1 ratio. Patients in the experimental group were put on an educational health intervention comprising of mobile phone delivered SMS messages and interactive voice calls. Patients in the control group were continued on the usual care offered in the hospital’s medical outpatient clinic. The primary endpoint was medication adherence. Data was analyzed through the intention to treat approach at 5% significance level. Results: A total of 112 participants (93.3%) were retained in the study at the end of follow up. The proportion of patients who were adherent to their prescribed medications was higher by 38.3% among participants in the experimental arm compared to those in the control group (p<0.001). The odds of being adherent to medications was 6.1 times higher for patients who had received the study’s intervention compared to those in the control group (95% CI 2.6, 14.3). Conclusions: The mHealth intervention applied in this study was effective in improving medication adherence among patients on treatment for hypertension.

Study Physiology and Immunology Emergency Clinic Diseases in Patients Experiencing Clinical Consideration and Contamination.

Emergency clinic diseases or medicinal services related contaminations happen in patients experiencing clinical consideration. This contamination happens worldwide in both created and creating nations. Generally, Staph, Streptococcus, an d Escherichia coli have been triple clinic diseases. Emergency clinic pneumonia, careful injury contaminations, and vascular-related septicemia made access most illnesses and passings in medical clinic patients; concentrated consideration units were the foca l point of anti-infection obstruction. The procured antimicrobial opposition is the primary issue, and the obstruction of Staphylococcus aureus is the greatest concern. The move to outpatient care departs the most powerless patients in medical clinics, with emergency clinic disease representing 7% in created nations and 10% in creating nations. Since this disease happens duri ng medical clinic remain, it causes delayed remain, incapacity and financial weight. Visit diseases incorporate focal line circulato ry system contaminations, urinary tract diseases related with a catheter, careful site contaminations and ventilation-related pneumonia. Clinic pathogens incorporate microscopic organisms, infections, and contagious parasites. As indicated by WHO gauges, almost 15% of all patients endure in medical clinics these contaminations. During hospitalization, the patient is presented to pathogens through an alternate asset condition, human services work force, and other contaminated patients.

Patient factors associated with appointment non-attendance at an ophthalmology department in Aotearoa New Zealand.

Appointment non-attendance is a problem for medical outpatient clinics, which can result in interruption of continuity of care and poor health outcomes for patients. Furthermore, non-attendance creates a significant economic burden to the health sector. This study aimed to identify factors that are associated with appointment non-attendance in a large public ophthalmology clinic in Aotearoa New Zealand. This study was a retrospective analysis of clinic non-attendance within Auckland District Health Board's (DHB) Ophthalmology Department between 1 January 2018 to 31 December 2019. Demographic data collected included: age, gender and ethnicity. Deprivation Index was calculated. Appointments were classified as new patients and follow-ups, and acute or routine. Categorical and continuous variables were analysed using logistic regression to assess likelihood of non-attendance. The research team's expertise and capacity align with the CONSIDER statement guidelines for Indigenous health and research. In total, 52,512 patients were scheduled to attend 227,028 outpatient visits, of which 20,580 visits (9.1%) were not attended. Median age of patients who received one or more scheduled appointments were 66.1 years (interquartile range [IQR] 46.9-77.9). Fifty-one point seven percent of patients were female. Ethnicity comprised 55.0% European, 7.9% Māori, 13.5% Pacific peoples, 20.6% Asian and 3.1% Other. Multivariate logistic regression analysis for all appointments showed that males (odds ratio [OR] 1.15 p<0.001), younger patients (OR 0.99 p<0.001), Māori (OR 2.69 p<0.001), Pacific peoples (OR 2.82 p<0.001), higher deprivation status (OR 1.06 p<0.001), new patient appointments (OR 1.61 p<0.001) and patients referred to acute clinics (OR 1.22 p<0.001) were more likely to not attend appointments. Māori and Pacific peoples disproportionately experience higher rates of appointment non-attendance. Further investigation of access barriers will enable Aotearoa New Zealand health strategy planning to develop targeted interventions addressing unmet patient needs of at-risk groups.

MP21-14 INCREASING HEALTH EQUITY THROUGH VOTER REGISTRATION IN OUTPATIENT CLINICS; THE ACTION PROJECT

You have accessJournal of UrologyCME1 Apr 2023MP21-14 INCREASING HEALTH EQUITY THROUGH VOTER REGISTRATION IN OUTPATIENT CLINICS; THE ACTION PROJECT Farah Rahman, Katherine Campbell, and Ranjith Ramasamy Farah RahmanFarah Rahman More articles by this author , Katherine CampbellKatherine Campbell More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While national organizations such as the AUA demonstrate the importance of advocacy on the federal and state level by lobbying government officials, advocacy can also take the face of patient empowerment. Voter registration in the US is an individually-driven responsibility. In turn, the group of registrants is not representative of community demographics. Voting disparities in marginalized communities are correlated with higher health disparities. Sicker or uninsured citizens are more supportive of expanding governmental healthcare, but are less likely to vote due to barriers such as registration. ACTION is built on the notion that outpatient clinics are uniquely positioned within minority communities to serve as non-partisan voter registration sites. The goal is to lessen disparities in civic engagement and increase downstream health equity through patient empowerment. METHODS: ACTION was based out of Loyola Outpatient Clinic in Maywood, Illinois. Volunteers were instructed to speak to patients about their registration and mail-in ballot status. All patient interactions were conducted in the clinic waiting room. The intervention was evaluated on the number of registrants, mail-in ballot applications, and survey results. RESULTS: Over 3 months, students volunteered for 43 shifts on 25 days. During this time, volunteers registered 52 patients, 29% of which identified as first-time voters. Volunteers submitted 78 mail-in ballot applications. 84.5% of survey respondents agreed that ACTION was a good idea and 78% agreed that they would like to see this service provided in more medical spaces, such as the main hospital, other specialty clinics, and the emergency room. Lastly, 88% of respondents claimed they had the correct identification at their doctor’s appointment for online voter registration, overcoming a major identified barrier in voter registration. CONCLUSIONS: The results of the study demonstrate the important role outpatient medical clinics can play in easing the civic engagement process for traditionally disenfranchised patients. Volunteers averaged 2.08 registered voters and 3.12 mail-in ballot applications per day. For reasons of efficiency, proper documentation to register, and the number of newly registered first-time voters—health clinics prove to be an efficacious location for voter registration. As the AUA commits itself to supporting diversity and equity, the option of mobile voter registration to increase patient empowerment and equitable health policies presents itself as a medium to achieve this success. Source of Funding: New York Academy of Medicine © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e291 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Farah Rahman More articles by this author Katherine Campbell More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Epidemiology Trend of Chronic Kidney Disease in a Semi-Urban Tertiary Hospital in Sub-Saharan Africa.

Background The global burden of chronic kidney disease (CKD) has been on an alarming increase in the last two decades. The morbidity and mortality associated with CKD are even worse in Nigeria, like other developing countries, due to multiple socioeconomic and demographic factors in the country. CKD contributes to the increasing need for hospital admission. Hypertension and chronic glomerulonephritis have been the leading causes of CKD in Nigeria. However, diabetic nephropathy has recently gained more significance as a cause of CKD in developing countries. Aim and methods This study aimed to describe the current trend in the burden and population characteristics of CKD in Southern Nigeria. This is a cross-sectional, hospital-based study. The study recruited adult patients with prehemodialysis CKD seen in renal clinics over a two-year period (November 2014 to October 2016). Data were obtained using a questionnaire and from the clinic register. All participants were clinically assessed, including history, anthropometric measurements, and urinary albumin-creatinine ratio. Results A total of 1,549 patients were seen at the Medical Outpatient Clinic over the study period. CKD accounted for 9.7% of medical outpatient clinic attendance. The mean age of participants was 49±13 years. The leading causes of CKD were diabetes mellitus (32%), chronic glomerulonephritis (30%), and hypertension (22%). Among the participants, CKD stages 3, 4, and 5 were prevalent in 26.7%, 43.3%, and 14.7%, respectively. Conclusion and recommendation CKD is very prevalent among medical clinic patients. Diabetic nephropathy seems to be a more significant cause of CKD than was previously reported. Late presentation of patients to nephrologists remains an obstacle to improving CKD outcome in Nigeria. There is need for more intensive preventive measures and early intervention.

Rates of and Factors Associated With Primary and Booster COVID-19 Vaccine Receipt by US Veterans, December 2020 to June 2022

COVID-19 vaccination rates remain suboptimal in the US. Identifying factors associated with vaccination can highlight existing gaps and guide targeted interventions to improve vaccination access and uptake. To describe incidence and patient characteristics associated with primary, first booster, and second booster COVID-19 vaccination in the Veterans Health Administration (VHA). This retrospective cohort study assessed US veterans receiving care in VHA medical centers and outpatient clinics as of December 1, 2020. All VHA enrollees with an inpatient, outpatient, or telehealth encounter in VHA as well as a primary care physician appointment in the preceding 24 months were included. Demographic characteristics, place of residence, prior SARS-CoV-2 infection, and underlying medical conditions. Cumulative incidence of primary, first booster, and second booster COVID-19 vaccination through June 2022. Cox proportional hazards regression was used to identify factors independently associated with COVID-19 vaccination. Among 5 632 413 veterans included in the study, 5 094 392 (90.4%) were male, the median (IQR) age was 66 (51-74) years, 1 032 334 (18.3%) were Black, 448 714 (8.0%) were Hispanic, and 4 202 173 (74.6%) were White. Through June 2022, cumulative incidences were 69.0% for primary vaccination, 42.9% for first booster, and 9.3% for second booster. Cumulative incidence for primary vaccination increased with increasing age, from 46.9% (95% CI, 46.8%-47.0%) among veterans aged 18 to 49 years to 82.9% (95% CI, 82.8%-83.0%) among veterans aged 80 to 84 years. More Black veterans completed primary vaccination (71.7%; 95% CI, 71.6%-71.8%) compared with White veterans (68.9%; 95% CI, 68.9%-69.0%), and more urban-dwelling veterans completed primary vaccination (70.9%; 95% CI, 70.9%-71.0%) compared with highly rural-dwelling veterans (63.8%; 95% CI, 63.4%-64.1%). Factors independently associated with higher likelihood of both primary and booster vaccination included older age, female sex, Asian or Black race, Hispanic ethnicity, urban residence, and lack of prior SARS-CoV-2 infection. In this cohort study of US veterans, COVID-19 vaccination coverage through June 2022 was suboptimal. Primary vaccination can be improved among younger, rural-dwelling veterans. Greater uptake of booster vaccination among all veterans is needed.

Effects of Six-Minute Walk Test on Cardiovascular Variables among Type 2 Diabetics

The study investigated the effects of six-minute walk test on functional capacity, cardiac workload, rate of perceived exertion and selected cardiovascular variables among type 2 diabetic patients. A total of forty (40) patients who had been diagnosed of type 2 diabetes mellitus and are attending the medical outpatient clinic of the Ekiti State University Teaching Hospital Ado-Ekiti were recruited through purposive sampling technique in which twenty (20) formed the experimental group and the remaining twenty (20) were control group. The pretest responses were obtained from both groups while the experimental group was subjected to eight (8) weeks of walking exercise, thereafter, the posttest responses were taken. The results from the study revealed that there was significant effect of six-minute walk test on functional capacity, rate of perceived exertion, systolic blood pressure and heart rate of type 2 diabetic patients but found no significant effect on cardiac workload and diastolic blood pressure. These changes were significant at p&lt; 0.05. Therefore it was recommended that six-minute walk test could be used as home based exercise training designed on a long term basis to constitute a potent exercise therapy for enhancing health related quality of life among Type 2 diabetic patients as well as improve functional capacity, promote independence, and reduces exertion among Type 2 diabetic patients.

Analysis of Health and Demographic Data of the Rural Population of the Aiyrtau District

The task of restructuring the network of medical organizations, taking into account regional characteristics, in order to ensure maximum accessibility of medical care, fell into the national project "Quality and affordable healthcare for every citizen "Healthy Nation". The purpose of the study: to assess the availability of medical care for the rural population based on the analysis of medical and demographic indicators of the Aiyrtau district. Methods. In this study, in order to analyze the medical and demographic situation of the rural population of the Aiyrtau district, as well as to determine the accessibility of the healthcare system for the rural population, statistical data, accounting and reporting documentation of medical organizations were studied. Demographic indicators, morbidity rates, the number of medical institutions in the region, the equipment ofmedical organizations, the provision of medical workers, etc. were analyzed. Results. Medical and demographic indicators do not reach republican values. The overall mortality rate (15.87 per 1000 people) is 1.6 times higher than in the republic (9.53 per 1000 population). The birth rate (12.27 per 1000 population) is 1.9 times lower than the republican level (23.41 per 1000 population). Over the past 5 years (from 2017 to 2021), the birth rate in the region has decreased by 6.4% from 13.11 to 12.27 per 1000 population (Kazakhstan - a decrease of 7.5%). When studying the mortality rates of the population, a similar situation is observed, when in 2021 there was an increase to 15.07, and in 2022 it decreased by 10.6% to 13.46 per 1000 population. The total number of diseases was 23710, the leading position, as well as throughout the country, is occupied by respiratory diseases - 9519 (40.1%), followed by diseases of the circulatory system - 5348 (22.5%), endocrine diseases - 1844 (8%), followed by diseases of the digestive system - 880 (5.1%), neoplasms - 522, infectious and parasitic diseases - 427, injuries, poisoning - 422 (2.7%) and congenital anomalies (malformations), deformities and chromosomal disorders - 188 (1.79%). The healthcare system of the region is represented by 19 hospitals, 63 outpatient organizations (58 outpatient clinics, 5 outpatient clinics, including AIDS center, regional dentistry, etc.), 41 feldsher-obstetric and 403 medical centers. The bed fund of state medical organizations is 3223 beds. The district hospital with a polyclinic and a hospital is equipped with 85 beds for a round-the clock stay and 31 beds for a day stay, it has 10 medical outpatient clinics, 3 feldsher-obstetric stations, 46 medical stations. Conclusions. The results of the study show that the incidence among the rural population remains high. The main problems of the rural healthcare system, which significantly affect the availability of medical care for the rural population, are undeveloped infrastructure, under equipped medical organizations, which in turn leads to low detection of pathology, late diagnosis and treatment. There is also a shortage of personnel, especially a shortage of narrow specialists, which leads to low availability of specialized medical care.

Prevalence of periodontitis and oral hygiene practices among diabetic and non-diabetic patients in a tertiary hospital in Lagos: a cross-sectional study.

periodontitis is the sixth leading long-term complication of diabetes mellitus which can impair diabetic patients' metabolic control. Patients with both diabetes mellitus and periodontal disease present with the challenge of managing these two chronic diseases, each of which may impact the other. The aim of this study was to determine and compare the prevalence of periodontitis and oral hygiene practices among diabetic and non-diabetic patients attending a large tertiary hospital in Lagos, Nigeria. this was a cross-sectional comparative study involving 110 diabetics and 110 non-diabetic patients aged 40 years and above. They were recruited from the diabetes and general medical out-patient clinics respectively in a large tertiary hospital in Lagos using a systematic sampling method. Data was collected using an interviewer-administered questionnaire. In addition, blood tests for glycated haemoglobin and oral examination using a simplified periodontal examination were conducted. The prevalence and severity of periodontitis and oral hygiene practices were compared between both groups. Data were analyzed with IBM SPSS version 21 Software. the prevalence of periodontitis was higher among the diabetics 100 (90.9%) compared to the non-diabetic patients 79 (71.8%), and this was statistically significant (p<0.001). Severity of periodontitis among both groups was also statistically high 54 (49.1%) vs. 35 (31.8%) p<0.001. the prevalence of periodontitis was higher and more severe among diabetics compared to non-diabetics. Oral hygiene practices in both groups are not statistically significant p>0.05. Oral health education programs targeted at diabetic patients should be carried out to prevent and control periodontitis.

Knowledge of the medical resident about diagnosis and treatment of patients with headache

Introduction Considering the high prevalence of headache, it is necessary a study about the effectiveness of the care of patients with headache by medical resident in Emergency Care Units (EDU) and medical outpatient clinics. Objective The objective of this study was to analyze the effectiveness of care in EDUs, outpatient clinics and medical wards and the management of patients with headache complaints. Method The study was observational descriptive (cross-sectional cohort) through the application of an online questionnaire answered by the medical residents. Results There were 115 residents who answered the survey. In the group of residents who see patients with headache (n=95) the number of visits was 4.87 per week. The resident's idea is that headaches are symptoms of an underlying disease in 49.5% of them. On the question about feeling able to differentiate primary from secondary headaches, 50% of the residents said yes. On the question, "Is Migraine the same as Headache?" 6.1% answered yes. On the question, "Would you use morphine derivatives to treat headache?" 19.1% of the residents answered that they would. On the question about having knowledge about the harms of using morphine derivatives in headache, 60% answered that they did not have in-depth knowledge or that they have no knowledge. In this sample of residents, 74/115 (65%) suffer from headache. Only 36/115 (31%) of the residents sought care because of the headache. Of the residents, 3/115 (2.6%) have chronic daily headache. In the question about knowing what is "chronic daily headache" and from medication overuse, about 35% do not know or did not delve into the concept. Conclusion We conclude that there is a lack of teaching about types of headaches, criteria for diagnosis and treatment. Urgent modifications should be made in the medical course to enable newly graduated doctors to diagnose and treat patients with headache.