Need For Care Research Articles

Global and Community Health: Neurologic Care and a Case Study for Immigrants and Refugees in West Philadelphia.

Philadelphia is a diverse city that has experienced an increasing immigrant and refugee population in recent decades. Although many academic medical centers also call Philadelphia their home, lack of accessibility and difficulty with insurance limit access to health care for many of its newest residents. The Social Health and Medical Services (SHAMS) Free Health Clinic was started to help address some of these disparities, especially for immigrant and refugee populations. Despite initial setbacks, the clinic has thrived and even moved locations to accommodate increasing patient demand. While many patients initially presented for primary care, there was a growing need for specialist care and coordinated multidisciplinary management. We present an example of a partnership between an academic center (Hospital of the University of Pennsylvania) and a community health center (SHAMS clinic), whereby patients have access to a dedicated neurology clinic that is run by residents and staffed by neurology attendings. This has allowed patients to have access to outpatient neurologic care, has facilitated referral to inpatient care when needed for serious conditions such as status epilepticus (as in the case study discussed), and has allowed for continuity of care between the hospital and the outpatient setting. Although this clinic is an endeavor to create an academic-community partnership, there is still much work to do to improve medical access in the immigrant and refugee communities.

Exploring the Knowledge, Attitudes, and Practise of Healthy Eating Among Lactating Mothers in a Poor Rural Setting in North‐Western Ghana

ABSTRACTIntroductionRecognised as one of the most effective ways to guarantee positive maternal and child health outcomes, optimal nutrition for lactating mothers has received significant attention and investment both globally and locally. Despite this recognition, studies on maternal and child nutrition in Ghana have revealed that adherence to prescribed healthy eating regimens among lactating mothers in deprived settings has not received adequate scholarly attention. Thus, this study explores lactating mothers knowledge, attitudes, and practices regarding healthy eating to better understand the barriers to optimal nutritional outcomes for mothers and children, especially when chronic poverty is widespread.MethodsThis was a case study to explore the knowledge, attitudes, and practise of healthy eating among lactating mothers in the Wa West District. Convenience and purposive sampling procedures were followed to select lactating mothers and healthcare providers, respectively. Semi‐structured interviews were used to collect the data. The data were analysed using Anderson's behavioural model. The model offers a comprehensive analysis of factors—predisposition, enabling factors, and need for care—potentially influencing lactating mothers' knowledge, attitudes, and practise of healthy eating.ResultsThe findings show that while lactating mothers in the district were aware of the importance of optimal nutrition for their health and wellbeing; food insecurity and pervasive poverty limit their opportunities to adhere to a balanced eating regimen.ConclusionAn integrated development approach is needed to expand and sustain awareness of the importance of optimal nutrition for maternal and child health, improve local food production, and promote household economic empowerment.

What is the Relationship Between Older People's Housing Characteristics and Their Care Needs?

ABSTRACT Housing conditions and quality are well-established structural or social determinants of health. Poor quality housing also has the potential to affect care needs, but there is much less research on the topic, particularly on nonspecialist housing. Based on analysis of in-depth interviews with 44 people aged 65 and older living in England, their unpaid carers (N = 22), or as a carer-care recipient dyad (N = 6), (total N = 72), this study sought to explore the perceived relationship between people’s housing conditions and characteristics and their care needs. Findings indicate three key themes within this relationship: condition of home (cold and damp; state of repair; cleanliness and clutter); space and design (space, access); and legal relationship with the home (ability to carry out remedial work; precarity). There was variation in how and whether housing affected care needs by housing tenure, financial resources, and the type and level of care need. Care needs can increase requirement for warmer, less damp homes and be a barrier to improving homes. In turn, housing has a role to play in preventing the occurrence or worsening of care needs. Improving housing through policy and practice actions could reduce care needs and improve the lives of older people now and in the future.

Unmet Palliative Care Needs of Patients with Stage B Chronic Heart Failure Classified by the American Heart Association/American College of Cardiology

This study sought to explore the unmet palliative care needs of patients diagnosed with Stage B chronic heart failure (CHF) according to the American Heart Association (AHA) and American College of Cardiology (ACC) classifications. We conducted this cross-sectional study between June 1 and August 31, 2020, at Kobe University Hospital. Patients were asked to complete the Integrated Palliative care Outcome Scale (IPOS) along with a customized questionnaire developed by a multidisciplinary team. These tools were filled out by the patients themselves or with help from family members. A total of 101 patients participated in the study, with 55 of them (55%) falling into the Stage B CHF group as classified by AHA/ACC. Among the physical symptoms, 22% reported dyspnea and 20% reported drowsiness as common concerns. Regarding specific problems, 47% identified issues related to exercise, 62% with eating, 26% with finances, and 18% with employment. Notably, financial difficulties were found to be significantly more common among Stage B patients when compared to those in Stages C and D (odds ratio [OR]: 5.22; 95% confidence interval [95% CI]: 1.03–26.5; p = 0.032). Almost 79% of Stage B patients expressed a desire to understand the progression of their disease. In conclusion, stage B CHF patients may face financial difficulties and have unmet informational needs. Therefore, further research is necessary to explore these aspects in greater detail.

Unmet Needs for Dental Care Before and During the COVID-19 Pandemic in Greece: A Cross-Sectional Study

Background/Objectives: Unmet dental needs involve cases wherein someone needed dental care and did not receive it. Published data on unmet dental needs are limited. This cross-sectional study investigates unmet dental needs in Greece before and during the COVID-19 pandemic. Methods: For this study, a questionnaire was created and distributed to a non-random sample. It was completed by 277 individuals. The questionnaire was based on the European Union Statistics on Income and Living Conditions (EU-SILC) tool, which is used to investigate unmet health needs. It was enriched with questions about unmet dental needs before and during the COVID-19 pandemic. Results: Of the 277 participants, 23.1% reported unmet dental needs before the onset of the COVID-19 pandemic, which decreased to 13.4% after the onset of the pandemic. However, a significant proportion of the sample (48.3%) reported no need for dental care after the onset of the COVID-19 pandemic. It is also worth noting that there were instances of dental visit avoidance, both when symptoms were present and for standard check-up/follow-up purposes, at rates of 17% and 27.8%, respectively. Conclusions: Unmet dental needs occurred at lower rates after the onset of the COVID-19 pandemic than those recorded before the pandemic. The main reasons for unmet needs before the pandemic were the cost of dental services and fear of treatment procedures or the visit to the dentist, while after the onset of the COVID-19 pandemic, lack of time and fear of coronavirus transmission were added.

Treatment of thoracic outlet syndrome to relieve chronic migraine.

Prior case reports have suggested that treating thoracic outlet syndrome (TOS) may relieve intractable migraine headaches, but there has been no case series large enough to show when underlying TOS should be suspected as a contributor to migraine burden. This observational followed by questionnaire study was performed in an outpatient neurology practice to identify clinical features of patients with migraine in which TOS contributed to migraine burden. We report the clinical features of 50 consecutive patients (48 women, 2 men, age = 43.9+/12.7 years) who were treated for chronic migraine and TOS (20 migraine with aura, 28 migraine without aura, two hemiplegic migraines). Headaches had become chronic within 1 year of onset in 21 patients (42%) with characteristics as follows (percentages are based on known data): greater severity ipsilateral to TOS limb pain (38/50=76%), presence of limb swelling (32/48=67%), and worsened by recumbency (32/38=84%). Thirty-two patients eventually needed surgery, which included percutaneous transluminal venoplasty, 1st rib removal, scalenectomy, pectoralis minor tenotomy, and/or vein patching. The mean improvement of headaches on the treated side was 72 ± 26.7%; 12 patients experienced complete resolution of headaches after treatment of TOS (follow-up 7.2 ± 5.2 months). Questionnaire responders reported significant reductions in headache days (18.3 ± 8.6 to 11.1 ± 10.8 days/month, p < 0.0016), severity (7.8+/2.5 to 5.4 ± 2.9, p < 0.00079), and need for emergency care (3.6 ± 4.0 to 0.71 ± 1.3 visits/year, p < 0.0029). Chronic migraines can be important manifestations of TOS. Early transition to a chronic state, lateralized limb pain, and headaches worsened by recumbency are clues to the contribution of TOS pathology. Addressing the TOS contribution to migraine can significantly reduce migraine headache burden.

Old age from the perspective of LGBTQ+ and heterosexual young: A comparative study.

In today's world, the challenges and achievements of LGBTQ+'s throughout their lives are increasingly gaining attention. However, the specific needs of LGBTQ+'s in the aging process and potential challenges they might face during this period are often overlooked. This study aims to demonstrate LGBTQ+'s and heterosexual young's perspectives on old age. This descriptive, cross-sectional comparative study collected data from 230 LGBTQ+ and 201 heterosexual individuals. Data were collected using a digital survey comprising an 8-item Personal Information Form and a 17-item Questionnaire for Opinions Regarding Old Age. Compared to others, LGBTQ+'s consider old age to be a more problematic period. In this study, it was determined that LGBTQ+'s perceive old age as a bigger problem compared to those in the heterosexual group. It was determined that the possible difficulties that LGBTQ+'s expect to face in old age are mostly related to basic needs such as the need for care and lack of social support. In the heterosexual group, concerns about age-related physical changes such as loss of youth were observed more frequently. It is recommended that studies to be conducted and services to be offered in this area should be of nature that would ensure safety of LGBTQ+'s, protect their basic humanitarian rights and respond to their needs.

Paediatric Hand Fractures - A Review.

Paediatric hand fractures account for approximately 25% of hand-related emergency department visits, making them the second most common childhood fractures after distal forearm fractures. These injuries are more prevalent in boys and peak ages between 9 and 14 years. Hand fractures in children are primarily caused by crushing injuries and, increasingly in older children, by sports-related activities. The little finger (52%) and thumb (23%) are the most frequently fractured digits, with phalangeal fractures, especially of the proximal phalanx, being common. Metacarpal fractures are more prevalent in adolescents (13-16 years) compared to younger children. Accurate diagnosis in the paediatric population is complicated by difficult clinical examinations and the presence of growth plates, leading to an 8% misdiagnosis rate, mainly due to misinterpretation of the ossification centres and physes. High-quality radiographic evaluation combined with a thorough clinical assessment is critical for correct diagnosis and appropriate management. The robust periosteum and high remodelling potential of paediatric bones allow most hand fractures to be managed non-operatively with splinting or casting. However, fractures with significant angulation, rotation, intra-articular involvement or open wounds may require surgical intervention, such as closed or open reduction and internal fixation with Kirschner wires. Most paediatric hand fractures heal well with excellent functional outcomes due to the high remodelling capacity of paediatric bones. Early mobilisation and appropriate immobilisation are key to preventing stiffness. Despite the generally favourable prognosis, certain fractures remain challenging to diagnose and treat, highlighting the need for specialised care. The aim of this review article is to discuss the epidemiology, fracture patterns, diagnostic challenges and management strategies essential for optimising functional outcomes and minimising long-term complications in treating paediatric hand fractures. Level of Evidence: Level V (Therapeutic).

Wish to die trying to live: unwise or incapacitous? The case of University Hospitals Birmingham NHS Foundation Trust versus ‘ST’

The recent legal dispute about medical treatment for a 19-year-old patient, Sudiksha Thirumalesh, (known initially by the Court of Protection as ‘ST’) in A NHS Trust versus ST & Ors...

OGC SO46 - Gastric Cancer: A Comprehensive Literature Review

Abstract Background Gastric cancer stands as a significant global health concern with high mortality rates urging urgent attention. This article comprehensively explores the epidemiology, anatomy, risk factors, pathophysiology, clinical presentation, diagnosis, staging, treatment modalities, prevention strategies, and survival rates associated with gastric cancer. Notably, Helicobacter pylori infection, dietary choices, and intricate stomach anatomy play pivotal roles in disease development. Early detection, utilizing staging, grading, and genetic testing for personalized treatment approaches is emphasized. Treatment modalities encompass surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Prevention strategies involve lifestyle changes, and genetic counseling. Survival rates vary by stage, highlighting the need for individualized care. Method This comprehensive review was conducted by systematically analyzing a wide range of published literature on gastric cancer. The search strategy involved utilizing electronic databases such as PubMed, Google Scholar, and Scopus, with specific keywords including "gastric cancer," "stomach cancer," "epidemiology," "anatomy," "risk factors," "pathophysiology," "diagnosis," "treatment modalities," "prevention," and "survival rates." Results Risk Factors: Factors such as Helicobacter pylori infection, dietary choices, tobacco use, and genetic predispositions contribute to gastric cancer risk. Pathophysiology: Genetic alterations, chronic inflammation, and dysregulated signaling pathways drive the development of gastric cancer. Clinical Presentation: Symptoms vary &amp; diagnosis involves a combination of methods, including endoscopy and molecular profiling. Treatment Modalities: Treatment options include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Prevention Strategies: Prevention efforts focus on minimizing risk factors through lifestyle changes, screening, and genetic counseling. Survival Rates: Survival rates vary significantly by stage, ranging from 90-95% for stage 0 to less than 5% for stage IV Conclusion The intricate anatomy of the stomach plays a crucial role in disease localization, staging, and treatment planning, with genetic mutations and inflammation central to the pathophysiology. Early detection is underscored through clinical presentation and diagnosis processes, utilizing staging, grading, and genetic testing for personalized treatment approaches, including surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Prevention strategies emphasize lifestyle changes and screening, while survival rates vary by stage, underscoring the need for individualized care. In conclusion, addressing gastric cancer requires a collaborative effort to reduce its impact and enhance outcomes on a global scale.

Changes in healthcare costs and utilization for Medicaid recipients who received supportive housing through a payer-community-based housing partnership.

To evaluate healthcare cost and utilization changes among Medicaid and dually eligible participants of a supportive housing program implemented by a managed care organization and community-based organization. Healthcare claims were reviewed retrospectively for 80 program participants in one urban Pennsylvania county between 1/1/2018 and 9/28/2023 who had ≥6 months of claims data in both pre- and post-housing periods. Eligibility included age >18 years, Medicaid/Special Needs Plan enrollment, and housing need. Due to limited housing units, potential participants were prioritized by medical need and history of unplanned care. Healthcare cost and utilization were compared during pre- (i.e., 12 months before housing initiation) and post-periods (i.e., 12 months after housing initiation). Compared to the pre-period, significantly lower medical (-40.4%, p = 0.004), emergency department (-62.7%, p = 0.02), and total (-33.3%, p = 0.02) costs of care were observed in the post-period. Significantly lower primary care (-50.0%, p = 0.0003), specialist (-31.3%, p = 0.02), and emergency department (-50.0%, p = 0.03) utilization were also observed. Healthcare cost and utilization among medically complex individuals were lower with supportive housing. Future evaluations with randomized designs can address the potential causal impact of supportive housing as a healthcare intervention on specific outcomes.

A case-control study on oral health knowledge and dental behavior among individuals with developmental delays in Jordan: caregiver perspective

Aimthe aim of this study is to assess oral health knowledge and dental behavior among individuals with developmental delays intellectual and developmental disabilities (IDD) in comparison with individuals without (IDD) in Jordan.MethodsA case–control study was conducted among 317 caregivers of individuals with IDD (n = 168) and control (n = 149) groups, which involved the completion of the questionnaire. A closed-ended, validated self-designed questionnaire was distributed. The questionnaire included questions addressing participants’ oral health knowledge and behavior. Convenience sampling was used to select the caregivers from centers associated with IDD by collecting data from nearby locations. Using SPSS® software Version 22 with a 0.05 level of significance data were analyzed. A Chi-square test and contingency-table analysis were performed on the data.ResultsCaregivers for individuals with IDD in Jordan were less knowledgeable about different oral health aspects than control group (P value &amp;lt; 0.05). Fewer individuals in the IDD caregiver group brushed their teeth once or twice daily (83.2%), compared to the control group (93.3%). Only 22.6% of the IDD participants could brush their teeth without assistance. On the other hand, the IDD group consumed significantly less sugary foods and soda than the control group (P value &amp;lt; 0.05).ConclusionThe lack of knowledge among IDD caregivers in Jordan is critical which can result in poor oral health outcomes for this vulnerable population. Increasing the knowledge level for the IDD caregivers on the specific needs for IDD individuals is highly important to enhance their understanding of oral health and improve their quality of life. Caregivers with IDD should receive training programs given by oral health professionals about the need for regular dental check-up and effective oral hygiene care reduce the risk of having dental problems and oral disease.

Oncology Survivorship Care Clinics: Design and Implementation of Survivorship Care Delivery Systems at NCCN Member Institutions.

It is estimated that there are >18 million cancer survivors in the United States, and there is a growing number of survivorship programs across the country to care for these individuals. There is a clear need for survivorship care; however, evidence is still emerging on how to best operationalize the guidance from nationally recognized organizations and clinical practice guidelines. The NCCN Best Practices Committee (BPC) recently conducted a survey to better understand survivorship clinics at NCCN Member Institutions. Representatives from 24 of the 33 NCCN Member Institutions (73%) submitted responses to the survey. Although all responding centers see cancer survivors, most (92%) have ≥1 dedicated survivorship clinics. Of those centers with dedicated survivorship clinics (n=22), 9 (41%) reported general survivorship clinics for all cancer types, and 13 (59%) indicated their center offered ≥1 disease-specific survivorship clinics. Most centers (55%) use a mix of physicians and advanced practice providers (APPs; nurse practitioners and/or physician assistants) to staff survivorship clinics; however, 9 (41%) are staffed entirely by APPs and 1 (4%) is staffed entirely by physicians. The vast majority (91%) have dedicated scheduling templates, and most (73%) have dedicated clinic space for survivorship clinics. The referral process for survivorship clinics varies across centers, with 16 (73%) using algorithms, guidelines, or pathways to determine when a patient is referred to a survivorship clinic. Findings may reflect the evolution of survivorship care and indicate a move toward standardizing which patients are seen and when. It is notable that >50% of institutions reported a model in which they follow survivors for their lifetime. Given the number of patients impacted by cancer, these data highlight the need to continue refining how survivorship care models are integrated into cancer centers to best serve patients with cancer and cancer survivors.

Effectiveness of Foot Care in Preventing Skin Damage and Risk of Diabetic Foot Wounds in Diabetes Mellitus Patients

Introduction: Diabetes mellitus (DM) type II is a disease characterized by increased blood sugar levels which can cause many complications. The complications of DM that often occur are skin damage and diabetic foot wounds, because in general patients are not aware of the presence of ulcers due to the neuropathy they are experiencing. The risk of foot injuries can increase the need for treatment and care in patients. However, the risk of foot injuries can be detected early by the patient independently by carrying out regular examinations of the patient's feet. Providing foot care can reduce the incidence of skin damage and the risk of diabetic foot wounds. Objective: The aim of the research is to analyze the effectiveness of foot care in preventing skin damage and the risk of diabetic foot wounds in diabetes mellitus patients. Method: This research method uses a quasi-experimental design with a pretest posttest one group design. This research was conducted at the Undata Hospital in the Bougenvile room with a population of 31 participants. The selection of respondents was based on inclusion criteria, namely: age ? 30 years and suffering from DM. Result: The results of the analysis used the paired sample t-Test. The average skin damage prevention score for DM patients before giving foot care was 2.97 and the skin damage prevention score after being given foot care was 2.52, respectively, experiencing a decrease in skin improvement of 0.45. These results show that the average value of diabetic ulcer risk for DM patients before being given foot care was 2.81 and the average value after being given foot care was 2.16 with a difference in improvement in the risk of diabetic ulcers of 0.65 which shows that the p-value is 0.000 &lt; ? (0.005) then H0 is rejected and H1 is accepted. This shows that there is an effect after being given effective foot care on preventing skin damage and the risk of diabetic ulcers in DM patients at Undata Regional Hospital. Conclusion: This research proves the influence of the effectiveness of foot care on preventing skin damage and the risk of diabetic ulcers in DM patients at Undata Hospital.

Abstract 4137805: Loss to Follow-Up Among Adults with Congenital Heart Defects: A Report from Congenital Heart Disease Project to Understand Lifelong Survivor Experience (CHD PULSE)

Background: Many of the 1.4 million adults with congenital heart disease (CHD) are lost to follow up (LTF). We aimed to identify factors associated with LTF and compare to those who remained in care. Methods: In the Congenital Heart Disease Project to Understand Lifelong Survivor Experience (CHD PULSE), we performed a cross-sectional survey in 2021-2023 of CHD survivors with a history of intervention at 11 centers in the Pediatric Cardiac Care Consortium, a large US-based registry of CHD procedures. Participants reported their cardiac history, general health, education, income, health insurance, healthcare utilization, and marital status. LTF was defined as having seen a cardiologist three or more years ago. Results: Among the 3109 respondents with CHD (median age 33) there were 1157 (37%) LTF and 1952 (63%) in care. Age, sex, marital status, and household income were not risk factors for LTF; but lack of health insurance, lower severity of CHD, and increasing time since last heart surgery were. Notably, respondents who reported being told in adolescence about the lifelong need for a cardiologist were almost three times as likely to report being in care (79% vs 28%, p&lt;0.0001). Among women, most reported no LTF if counseled about concerns with pregnancy or told to avoid pregnancy. The most common reasons for being LTF for 5 years or more (N=857) included feeling well (60%), not thinking there was a need for lifelong care (49%), and a doctor told them they no longer needed to see a cardiologist (47%). Those LTF were more likely to report excellent or very good general health, physical health, and quality of life than those not LTF. There were no differences in self-assessment of mental health between groups. Conclusion: Adults with CHD and LTF were more likely to report less severe heart defects, a younger age at last surgery and a lack of counseling about the need for lifelong care.

Per-Patient Illness Trajectory Analyses.

Background: Summary statistics often hide individual patients' suffering, thereby impeding quality improvement efforts. Objectives: We aimed to show the experience of a population with health care toward the end of life while preserving the experience of the individual. Design: We developed a data display method called per-patient illness trajectory analysis. We tested it using a demonstration cohort of 192 patients with cancer referred to a regional Swedish specialized home-based palliative care practice. Chart review provided detailed information about illness trajectory events with a focus on unplanned hospitalization. Results: We created per-patient timelines spanning from cancer diagnosis until death and using a logarithmic scale: Compared with a conventional, linear timescale, this scale expands the time resolution toward the end of life. The method fosters the assessment of unmet palliative care need and care quality for individuals, small high-need groups, and populations. Conclusion: In populations of up to 200 people, per-patient illness trajectory analysis is feasible and promising. Using random sampling, it could be extended to larger populations.

Pregnant Women's Care Needs During Early Labor-A Scoping Review.

Pregnant women face the challenge of managing early labor on their own until they feel the need to seek professional support. However, professional support during such a vulnerable stage of labor may sometimes be insufficient. This study aims to understand pregnant women's care needs during early labor in order to improve the quality of care provided at the onset of labor. A scoping review was conducted following a systematic search strategy in May 2021 and in August 2022 concentrating on pregnant women in early labor with spontaneous onset of labor. A sensitive search strategy was used with five different databases. The articles were screened by two independent researchers. Data were extracted and mapped to answer the research question. 52 articles were included. Major reasons for seeking professional help are to receive reassurance and get advice and information on how to cope with early labor. Furthermore, many women express the need for professional guidance. Several articles demonstrated women's preferences for hospital admission or a continuous care model. While some women want empowerment and empathy from a midwife, others require clear instructions on helpful measures or even clinical interventions within the process. Managing early labor without professional support creates a major challenge for pregnant women and nurtures insecurities and anxiety. Protecting women from unnecessary interventions is a well-intentioned plan, yet a lack of support in early labor may sometimes jeopardize a positive birth experience. New ways need to be elaborated to support women-centred and individualized approaches to providing early labor care.

Fibromyalgia, mood disorders and chronic damage are the main determinants of worse quality of life in systemic lupus erythematosus patients: Results from a cross-sectional analysis.

As suggested by the EULAR recommendations, a comprehensive management of Systemic Lupus Erythematosus (SLE) should include the evaluation of disease activity, chronic damage, and quality of life (QoL). QoL is significantly impaired in SLE patients, even in those achieving a state of remission, suggesting the possible contribution of other factors. Thus, in the present study we aimed at analyzing QoL in a large SLE cohort by using LupusQoL, and at identifying the main determinant of poorer QoL. We conducted a cross-sectional study by including consecutive SLE patients diagnosed according to the 2019 ACR/EULAR criteria. Clinical, laboratory and therapeutical data were collected. Disease activity was assessed by SLEDAI-2k, while chronic damage by the SLICC Damage Index (SDI). The diagnosis of fibromyalgia was made in accordance with the ACR criteria (2016). At the time of the enrollment, all patients completed the following questionnaires: LupusQoL to assess quality of life and hospital anxiety and depression scale (HADS) for anxiety and depression. Our analysis included 237 SLE patients [92.4% female, median age 46years (IQR 19.5), median disease duration 156.8months (IQR 180.6)]. At the time of enrollment, we found a mean SLEDAI-2k of 1.7 (DS 2.4); 104 patients (43.9%) had chronic damage, with a mean SDI value of 0.8 (DS 1.3). Patients diagnosed with fibromyalgia were 69 (29.1%); moreover, HADS questionnaire identified a condition of anxiety and depression in 112 (47.3%) and 94 (39.7%) patients, respectively. The most compromised domain in the LupusQoL resulted "fatigue", followed by "burden to others". Patients with SDI ≥ 1 showed lower quality of life than patients without chronic damage, as demonstrated by significantly lower values in all items of the LupusQoL (p < .01). Furthermore, significantly lower values in all the LupusQoL domains were observed in patients with fibromyalgia, anxiety and depression, in comparison to those patients without these manifestations (p < .0001). No association was demonstrated between QoL and disease activity. Finally, the linear regression analysis confirmed mood disorders, in particular depression, and fibromyalgia as the main determinants of worse quality of life in our cohort. The present study demonstrated the influence of different factors in the quality of life of SLE patients. In particular, the presence of mood disorders, fibromyalgia and chronic damage resulted the main determinants of poorer QoL. This evidence reinforces the need for a comprehensive patient care.

Simplifying acquisition of essential diagnostics: A comprehensive costing tool for anatomic pathology.

Histopathology is the core diagnostic tool for cancer in pathology laboratories around the world, but there are disparities in access to diagnostics globally. As recognition of the need for cancer care and treatment grows, especially in the wake of World Health Organization programs for cervical, breast, and pediatric cancers, policymakers and health care funders are seeking tools and processes that allow for the largest number of patients to receive a diagnosis at the lowest cost. As histopathology represents the most cost-effective diagnostic method by sheer number of tumor types and volume, understanding the detailed logistics and costs for histology as well as the impactful benefits of economies of scale (ie, larger volumes are less expensive per patient) and scope (ie, the multiple stains available after basic histology sectioning) is paramount to planning an effective publicly funded or government laboratory. Understanding the economic structure of a country's population along with the financial model of a histology laboratory also leads to a market understanding of private laboratories, which can provide services at a profit as well as pro bono services more cost-effectively than purely public laboratories. We have developed a comprehensive, scalable costing tool of a functioning histology laboratory that accounts for all feasible costs and variations in models of service. The tool allows for a standardized approach to selecting goods needed to provide histology services and serves as a guide for implementation of pathology services. Using the tool, laboratories can achieve self-sustainment and long-term financial health while incorporating a proportion of impoverished patients who cannot afford out-of-pocket expenses.

Impact of Dental Anxiety on the Dental Health Status of Nepali Adult Patients.

Patients with high dental anxiety are found to visit dental offices less frequently and have a higher number of severely diseased teeth so they are at a greater need for intensive oral care and rehabilitation. The aim of this study was to assess the prevalence of dental anxiety and its impact on the dental status of Nepali adult patients. A semi-structured questionnaire of the Modified Dental Anxiety Scale (MDAS) in the Nepali version was used for data collection. The data analysis was done using Statistical Package for Social Sciences (SPSS IBM, Chicago, IL, USA, version 24). Variables were calculated as frequency and percentage, while the comparisons of different factors were done using the ANOVA and t-test. A difference with p < 0.05 was considered statistically significant. The study population consisted of 446 subjects, among them 205 were male (45.96%), 241 were female (54.04%), 357 (80.04%) were married, and 222 (49.78%) were employed. The mean age of the patients was 41.24 years (ranging between 18 and 79 years). Only 41 subjects (9.19%) showed high dental anxiety (MDAS ≥ 19). The mean MDAS for the total study population was 10.81. The highest mean MDAS was seen in the age group 30-39 (11.78) and the lowest mean MDAS was seen in the age group 40-49 (9.64). While comparing dental anxiety among genders, dental anxiety was higher in females (mean MDAS = 11.78) compared to males (mean MDAS = 9.67). Patients having high dental anxiety had a significantly higher number of decayed teeth (p-value = 0.001, t-test). Oral health and dental status both are negatively affected by dental anxiety. It interferes with dental attendance, service delivery, prevention of dental diseases, and early diagnosis. Thus, dental practitioners have a major role to play in the management of dental anxiety.