Number Of Health Care Providers Research Articles

Estimating the Health Care Providers’ Number Needed in Northwest Health Service Centers of Tehran Based on Workload Index

Background: One of the major challenges of primary health care (PHC) in developing countries is supplying the growing needs of the populations with sufficient and skilled health workers. In this context, use of a simple and relevant workforce planning method such as Workload Indicators of Staffing Need (WISN) could help authorities allocate adequate number of professionals to health centers to meet the health needs of target populations. Methods: This was a descriptive-analytical study, and WISN methodology was used at 48 Comprehensive Health Centers (CHC) located in the northwest of Tehran, in 2022. The present study was conducted in 7 steps and included measures such as the available work Stime, initial and final required manpower, extracurricular activities and their coefficients, standard work activity and workload, and scheduling activities. Results: According to the collected data, the total number of health care workers needed for the covered population was calculated to be approximately 1018 people, and the ratio of available manpower to the required manpower was reported as 24%; this indicated a 76% difference in the number of health care providers regarding the implementation of complete service package. Conclusion: The results of the research showed that if all the referrals are made through network, the network would likely have a shortage of human resources. Although the standard workload in most cases is lower than anticipated based on the reviewed performance regarding the health care provided, this can be caused by not going to the center to receive services, going to the private sector, and also not knowing about the services that can be provided.

Factors influencing maternal death in Cambodia, Laos, Myanmar, and Vietnam countries: A systematic review.

A maternal mortality ratio is a sensitive indicator when comparing the overall maternal health between countries and its very high figure indicates the failure of maternal healthcare efforts. Cambodia, Laos, Myanmar, and Vietnam-CLMV countries are the low-income countries of the South-East Asia region where their maternal mortality ratios are disproportionately high. This systematic review aimed to summarize all possible factors influencing maternal mortality in CLMV countries. This systematic review applied "The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist (2020)", Three key phrases: "Maternal Mortality and Health Outcome", "Maternal Healthcare Interventions" and "CLMV Countries" were used for the literature search. 75 full-text papers were systematically selected from three databases (PubMed, Google Scholar and Hinari). Two stages of data analysis were descriptive analysis of the general information of the included papers and qualitative analysis of key findings. Poor family income, illiteracy, low education levels, living in poor households, and agricultural and unskilled manual job types of mothers contributed to insufficient antenatal care. Maternal factors like non-marital status and sex-associated work were highly associated with induced abortions while being rural women, ethnic minorities, poor maternal knowledge and attitudes, certain social and cultural beliefs and husbands' influences directly contributed to the limitations of maternal healthcare services. Maternal factors that made more contributions to poor maternal healthcare outcomes included lower quintiles of wealth index, maternal smoking and drinking behaviours, early and elderly age at marriage, over 35 years pregnancies, unfavourable birth history, gender-based violence experiences, multigravida and higher parity. Higher unmet needs and lower demands for maternal healthcare services occurred among women living far from healthcare facilities. Regarding the maternal healthcare workforce, the quality and number of healthcare providers, the development of healthcare infrastructures and human resource management policy appeared to be arguable. Concerning maternal healthcare service use, the provisions of mobile and outreach maternal healthcare services were inconvenient and limited. Low utilization rates were due to several supply-side constraints. The results will advance knowledge about maternal healthcare and mortality and provide a valuable summary to policymakers for developing policies and strategies promoting high-quality maternal healthcare.

Estimating the Number of Health Care Providers Required in Outskirts Comprehensive Health Service Centers Using the Workload Indicator of the Required Staff

Estimating the Number of Health Care Providers Required in Outskirts Comprehensive Health Service Centers Using the Workload Indicator of the Required Staff

A real world study of cough burden and quality of life of UK patients who have undergone evaluation for chronic cough

Objective Treatment options for adults with chronic cough (CC) are limited. This study reports on the health status and experiences of patients with recent healthcare evaluation for CC. Methods This prospective, UK, cross-sectional study surveyed adults with a CC evaluation within the previous 12 months. All were never smokers (or ex-smokers for ≥12 months). Subjects completed five validated patient-reported outcome measures: cough visual analogue scale (VAS), EuroQoL 5 dimension, 5 level (EQ-5D-5L), EQ-5D VAS, Leicester Cough Questionnaire (LCQ), and Work Productivity and Activity Impairment (WPAI) questionnaire. Results A total of 101 participants were recruited: 71% were female, mean age was 54.9 ± 15.2 years. Median (IQR) CC duration was 36 (11, 120) months. Mean self-reported CC severity (Cough-VAS) was 51.3 ± 22.9 over the previous 2 weeks and 62.9 ± 23.7 on the worst day of coughing. EQ-5D values were lower for CC patients than population norms. Subanalyses revealed that EQ-5D and LCQ scores were significantly impacted by CC duration and the number of healthcare providers (HCPs) visited. WPAI analysis showed a 27.6% work time impairment because of participants’ CC. The number of HCP attendances ranged from 1 to 10 (3.3 ± 2.8) before diagnosis was confirmed. Treatment was being prescribed to 87% of participants and comprised mainly steroids (nasal [19%] and inhaled [25%]), beta agonists (24%), and proton pump inhibitors (21%); 44% of patients were dissatisfied with treatment efficacy. Conclusion Real-world data from a nationally representative UK population show significant unmet needs associated with CC, including multiple healthcare visits and limited treatment effectiveness, resulting in inadequate cough control and impaired health status.

SAT466 Inactive Thyroid Eye Disease Patient Journey

Abstract Disclosure: K. Cockerham: Consulting Fee; Self; Horizon Therapeutics plc, Viridian. T.J. Smith: Consulting Fee; Self; Horizon Therapeutics plc, Viridian, Lundbeck. Other; Self; US patents covering the use of IGF-1 receptor inhibitors in TED which are held by UCLA and the Lundquist Institute. E. Conrad: Employee; Self; Horizon Therapeutics plc. Stock Owner; Self; Horizon Therapeutics plc. R.J. Holt: Employee; Self; Horizon Therapeutics plc. Stock Owner; Self; Horizon Therapeutics plc. Objective: Limited long-term data are available on US patients with thyroid eye disease (TED). From an online survey conducted in January 2020 of patients who were assessed by their healthcare providers (HCPs) as having inactive TED, 100 patients (age 45.2 ± 7.6 years, 47% female) with current non-inflammatory/inactive TED were identified with an average duration of 2.7 years after active TED diagnosis.1 Here we examined the journey of these TED patients from active/inflammatory to inactive/non-inflammatory disease status. Methods: We collected patient demographics, diagnoses and symptom prevalence over time, number of HCPs seen, and treatments from an online survey conducted in January 2020. Results: Of 100 patients, 98 had a diagnosis (Dx) of thyroid autoimmunity. Active TED was typically diagnosed within 2.2 years of the thyroid Dx (N=98), approximately 2.1 years after first eye symptoms with an average of 5.7 TED symptoms while visiting a mean of 2 HCPs between first TED symptoms and Dx. Mostly ophthalmologists (69%), endocrinologists (49%), and primary care physicians (PCP; 45%) were consulted. By the time TED was assessed as inactive/non-inflammatory (2.7 years after active TED diagnosis1), patients typically visited 2 different HCP specialties within the past year (ophthalmologists 61%, endocrinologists 51%, and PCP 32%) and were experiencing 3.4 TED symptoms with an average of 19.7 ± 31.7 visits/year (median: 6 visits/year, range: 1-160 visits/year) and 2 prescribed medications for TED. Over-the-counter eyedrops (50%) and pain relievers (ibuprofen/naproxen [41%] and acetaminophen [33%]) were the most commonly used for inactive TED patients. Prescription eyedrops (27%) and topical steroids (22%) were also commonly used in inactive TED. Oral and intravenous steroids were used in 8% and 3%, respectively. Among the 27% of patients with any surgical TED procedure, orbital decompression (14/27; 52%, mean age 38) and strabismus surgery (8/27; 30%) were the most commonly performed. Discussion/Conclusion: From this analysis, patients with active/inflammatory TED typically experience ∼ 3 years of symptoms, HCP visits, and treatments prior to inactive TED diagnosis. TED diagnosis is often delayed in the US. Approximately 5 years elapse from first TED eye symptoms. This and other recent data1 indicate that inactive TED is typically symptomatic, and patients continue to experience impaired quality of life, requiring specialized care/medication for symptom management.

Nursing Students’ Intention to Work in Rural Areas after Graduation: A Mixed Approach Study

Introduction: A key issue of Human Resources for Health and constraint to Universal Health Coverage is a disparity between the number of healthcare providers in urban and rural areas. The accessibility to health services has been found difficult in rural areas due to shortage of health workers. As final-year nursing students are the prospective human resource for health, this study aimed to assess the intention of nursing students to work in rural areas and identify the motivating and discouraging factors associated with their intention. Methods: Cross-sectional research design with mixed methods was conducted among final-year bachelor-level nursing students of Pokhara, Nepal from December 2019 to July 2020. A census method using a self-administered questionnaire was used for the quantitative method and in-depth interviews were conducted for the qualitative method. For quantitative method, descriptive and inferential statistics were used while content analysis for the qualitative method was carried out. Results: About one-third (33.3%) participants intended to work in rural areas. The motivating factors were an opportunity for career advancement (AOR: 3.8; 95% CI: 1.35-10.77), locating near to family (AOR: 3.58, 95% CI: 1.36-9.45), high salary/incentives, and high healthcare needs in rural areas; whereas discouraging factors were separation from family and friends (AOR 4.10, 95% CI 1.34-12.52), less availability of recreational facilities (AOR 3.68, 95% CI 1.11-12.21), inadequate salary/incentives, lack of equipment and resources, low utilization of skills and knowledge and low self-perceived competency. Conclusions: Only one-third of the participants had the intention to have the job placement in rural areas. The participants preferred to work staying with or nearby their family. The enrollment of students of rural origin/residence or background in a nursing program should be ensured. Various motivating factors like training, attractive incentives, infrastructures, and facilities should be offered to make rural jobs more attractive.

MANAGEMENT OF AUTISM SPECTRUM DISORDER (ASD) AND COLLABORATIVE TEAMS

Autism Spectrum disorder (ASD) is a disorder that affects how the brain develops and can result in persistent challenges with socialization, restricted interests, and repeated behavior. Approximately 40% of children with ASD are nonverbal, 31% have intellectual disabilities1, 28% engage in self-harming activities, The American Psychiatric Association's DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is based on the diagnosis of ASD. Although the cause of ASD is still unknown, a number of strategies have been developed that have helped people around the world to live independently2. There are currently no verifiable statistics on the prevalence of ASD in Pakistan. However, the Pakistan Autism Society estimates that, roughly 350,000 children in Pakistan who have ASD3. In Pakistan ASD is still a new phenomenon, we have very restricted qualified human resources to provide a reliable rehabilitation service for a child with ASD. Apart from that due to inadequate awareness exposure, knowledge, and incompetency in diagnosis, these children go undiagnosed and are mishandled4.It can be crucial to take a multidisciplinary approach into account when planning initiatives to improve the efficiency of service delivery models for kids with ASD. It has been discovered that cross-disciplinary collaboration does not always occur, leaving practitioners to work independently. A multidisciplinary strategy is required for improved interprofessional collaboration given the rising complexity of autism and the number of healthcare providers’ involved9. ASD is often combined with comorbid gastrointestinal complications, diarrhea, feeding problems, sleep disturbances, and seizure disorders5.

Disparities in Receipt of Guideline-adherent Blood Pressure Screening: An Observational Examination of Electronic Health Record Data from a Massachusetts Healthcare System

To describe the prevalence of blood pressure (BP) screening according to the 2017 American Academy of Pediatrics (AAP) guidelines and differences according to social vulnerability indicators. We extracted electronic health record data from January 1, 2018, through December 31, 2018, from the largest healthcare system in Central Massachusetts. Outpatient visits for children aged 3-17years without a prior hypertension diagnosis were included. Adherence was defined by the American Academy of Pediatrics guideline (≥1 BP screening for children with a body mass index [BMI] of <95th percentile) and at every encounter for children with a BMI of ≥95th percentile). Independent variables included social vulnerability indicators at the patient level (insurance type, language, Child Opportunity Index, race/ethnicity) and clinic level (location, Medicaid population). Covariates included child's age, sex, and BMI status, and clinic specialty, patient panel size, and number of healthcare providers. We used direct estimation to calculate prevalence estimates and multivariable mixed effects logistic regression to determine the odds of receiving guideline-adherent BP screening. Our sample comprised 19 695 children (median age, 11years; 48% female) from 7 pediatric and 20 family medicine clinics. The prevalence of guideline-adherent BP screening was 89%. In our adjusted model, children with a BMI of ≥95th percentile, with public insurance, and who were patients at clinics with larger Medicaid populations and larger patient panels had a lower odds of receiving guideline-adherent BP screening. Despite overall high adherence to BP screening guidelines, patient- and clinic-level disparities were identified.

Health service factors influencing uptake of cervical visual inspection with acetic acid in selected health facilities in Embu County, Kenya

BACKGROUND &#x0D; Cervical cancer is the second most common cancer among females in developing countries. Despite widespread screening efforts for cancer of the cervix and training on VIA/VILLI, deaths due to cervical cancer remain high. This study aimed to determine Health Service Provider factors influencing the uptake of cervical cancer screening by VIA in selected health facilities in Embu County, Kenya. &#x0D; METHODOLOGY &#x0D; Data were collected from 14 healthcare providers who were the initial study respondents from 7 purposively selected health facilities. Data collection tools were self-administered questionnaires and structured interviews for key informants. Additional secondary data were obtained from the health facility records and KDHS 2014. For data analysis, both quantitative and qualitative techniques of analysis were applied.&#x0D; RESULTS &#x0D; Lack of awareness creation on VIA, lack of skills to do VIA, lack of supplies for VIA, cost and fear of speculum examination by women were some factors leading to low uptake of cervical cancer screening. &#x0D; CONCLUSIONS AND RECOMMENDATIONS &#x0D; Increasing awareness of VIA needs to be done such as through recruitment of male champions for cervical cancer screening to mobilize and participate in awareness campaigns. Moreover, there needs to be an increase in the number of health care providers trained in VIA and cryotherapy and creating a pool of trainers of other health service providers. Additionally, the provision of VIA supplies needs to be ensured and VIA services offered free of charge. MOH and county governments' departments of health should ensure support supervision at least once per quarter to the health care workers trained on VIA.

Risk Factors Associated with Nurses’ Infection with COVID-19

Nurses represent the largest number of health care providers and they are an essential part of the healthcare workforce working on the frontline during the COVID 19 pandemic. They are in direct contact with patients, providing high levels of care to promote patient safety and positive care outcomes while at the same time placing their own health and well-being at considerable risk. The Aim: To investigate the cause of COVID 19 infection amongst nurses. Methods: A self-administered online questionnaire was administered to the targeted sample who participated on a voluntarily basis. Result: 123 surveys were completed. The majority of the participants were compliant with infection precaution protocols. More than half of them were aware of the source of infection. Conclusion: Nurses are well oriented in dealing with Covid 19 crisis. However, more awareness is needed regarding infection precaution and reducing level of anxiety.

The prevalence of respectful maternity care during childbirth and its determinants in Ethiopia: A systematic review and meta-analysis.

Respectful maternity care is the provision of woman-centered health care during childbirth that is friendly, abuse-free, timely, and discrimination-free. Although several epidemiological studies on the magnitude and determinants of Respectful maternity care in Ethiopia have been conducted, the results have been inconsistent and varied. This makes drawing equivocal conclusions and evidence at the national level harder. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of respectful maternity care and its determinants in Ethiopia. Studies conducted from 2013 to June 30, 2022, were searched by using PubMed, Google Scholar, Science Direct, Scopus, ProQuest, Web of Science, Cochrane Library, and Direct of Open Access Journals. Searching was carried out from May 15- June 30, 2022. In total, sixteen studies were considered in the final analysis. The data were extracted using Microsoft Excel and analyzed using STATA 16 software. The methodological quality of included studies was assessed by using Joanna Briggs Institute's critical appraisal checklist for prevalence studies. To estimate the pooled national prevalence of respectful maternity care, a random effect model with a DerSimonian Laird method was used. To assess the heterogeneity of the included studies, the Cochrane Q test statistics and I2 tests were used. To detect the presence of publication bias, a funnel plot and Begg's and Egger's tests were used. Sixteen studies were eligible for this systematic review and meta-analysis with a total of 6354 study participants. The overall pooled prevalence of respectful maternity care in Ethiopia was 48.44% (95% CI: 39.02-57.87). Receiving service by CRC-trained health care providers [AOR: 4.09, 95% CI: 1.73, 6.44], having ANC visits [AOR: 2.34, 95% CI: 1.62, 3.06], planning status of the pregnancy [AOR = 4.43, 95% CI: 2.74, 6.12], giving birth during the daytime [AOR: 2.61, 95% CI: 1.92, 3.31], and experiencing an obstetric complication[AOR: 0.46, 95% CI: 0.30, 0.61] were identified as determinants of RMC. As per this meta-analysis, the prevalence of respectful maternity care in Ethiopia was low. Managers in the health sector should give due emphasis to the provision of Compassionate, Respectful, and Care(CRC) training for healthcare providers, who work at maternity service delivery points. Stakeholders need to work to increase the uptake of prenatal care to improve client-provider relationships across a continuum of care. Human resource managers should assign an adequate number of health care providers to the night-shift duties to reduce the workload on obstetric providers.

COVID-19 Increases Risk of Psychiatric Disorders

COVID-19 Increases Risk of Psychiatric Disorders

Využití telemedicíny v arytmologii

Telemedicine can be defined as a health care service that, specifically in the field of diagnostics, employs remote transfer of a large volume of data from a large number of subjects at the same time. This data is subsequently processed on a central basis and returned to a large number of health care providers by whom the service was ordered on national or international level. In arrhythmology, telemedicine is used particularly in long-term ECG monitoring to diagnose arrhythmias and check out treatment outcome via external recorders, smart watch, and implantable devices. To facilitate analysis of large telemedicine data volume, artificial intelligence is being increasingly exploited.

Federated learning and differential privacy for medical image analysis

The artificial intelligence revolution has been spurred forward by the availability of large-scale datasets. In contrast, the paucity of large-scale medical datasets hinders the application of machine learning in healthcare. The lack of publicly available multi-centric and diverse datasets mainly stems from confidentiality and privacy concerns around sharing medical data. To demonstrate a feasible path forward in medical image imaging, we conduct a case study of applying a differentially private federated learning framework for analysis of histopathology images, the largest and perhaps most complex medical images. We study the effects of IID and non-IID distributions along with the number of healthcare providers, i.e., hospitals and clinics, and the individual dataset sizes, using The Cancer Genome Atlas (TCGA) dataset, a public repository, to simulate a distributed environment. We empirically compare the performance of private, distributed training to conventional training and demonstrate that distributed training can achieve similar performance with strong privacy guarantees. We also study the effect of different source domains for histopathology images by evaluating the performance using external validation. Our work indicates that differentially private federated learning is a viable and reliable framework for the collaborative development of machine learning models in medical image analysis.

Patients' perceptions of nurses' communication in public hospitals of Harari Regional State, Eastern Ethiopia.

Introduction:The quality of nursing care has been evaluated using patient perception. Patients’ participation in nursing care and decision-making is regarded as a prerequisite for effective clinical practice; however, poor communication can lead to incorrect diagnosis and delayed, or ineffective medical treatment.Objectives:This study sought to assess admitted adult patients’ perceptions of, and factors influencing, nurse communication at public hospitals in Harar, eastern Ethiopia.Methods:Facility-based cross-sectional study was conducted among 377 admitted adult patients in Harar Town public Hospitals from 15 April to 30 May 2020. A proportionate stratified sampling technique was used to select the study participants. A pretested and structured questionnaire was used to collect data through a face-to-face interview and which were entered into EpiData and analyzed using SPSS. Bivariate and multivariate logistic regression analyses were conducted, odds ratio and confidence intervals were calculated and statistical significance was declared at p < 0.05.Results:This study outlined that the overall prevalence of good perception toward nurses’ communication was 41.9% (95% confidence interval = 37.1%, 46.9%). Patients whose age group were 26–35 years (adjusted odds ratio = 0.46 (95% confidence interval: 0.24, 0.86), Being female patients (adjusted odds ratio = 1.89; 95% confidence interval: 1.20, 2.98), admitted in private room (adjusted odds ratio = 3.25; 95% confidence interval: 1.91, 5.51), patients who have family support (adjusted odds ratio = 2.56; 95% confidence interval: 1.16, 3.64), urban residence (adjusted odds ratio = 0.65; 95% confidence interval: 0.02, 0.66) and language difference (adjusted odds ratio = 0.61; 95% confidence interval: 0.40, 0.94) were statistically significant.Conclusion:This study pointed out that less than half of the study participants had good perceptions toward nurses’ communication. As a result, increasing the number of health care providers who speak the same language as the patients and communication and behavioral change training must be prioritized.

Association of Socioeconomic Status With Postdischarge Pediatric Resource Use and Quality of Life.

Socioeconomic factors may impact healthcare resource use and health-related quality of life, but their association with postcritical illness outcomes is unknown. This study examines the associations between socioeconomic status, resource use, and health-related quality of life in a cohort of children recovering from acute respiratory failure. Secondary analysis of data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial. Thirty-one PICUs. Children with acute respiratory failure enrolled whose parent/guardians consented for follow-up. Resource use included in-home care, number of healthcare providers, prescribed medications, home medical equipment, emergency department visits, and hospital readmission. Socioeconomic status was estimated by matching residential address to census tract-based median income. Health-related quality of life was measured using age-based parent-report instruments. Resource use interviews with matched census tract data (n = 958) and health-related quality of life questionnaires (n = 750/958) were assessed. Compared with high-income children, low-income children received care from fewer types of healthcare providers (β = -0.4; p = 0.004), used less newly prescribed medical equipment (odds ratio = 0.4; p < 0.001), and had more emergency department visits (43% vs 33%; p = 0.04). In the youngest cohort (< 2 yr old), low-income children had lower quality of life scores from physical ability (-8.6 points; p = 0.01) and bodily pain/discomfort (+8.2 points; p < 0.05). In addition, health-related quality of life was lower in those who had more healthcare providers and prescribed medications. In older children, health-related quality of life was lower if they had prescribed medications, emergency department visits, or hospital readmission. Children recovering from acute respiratory failure have ongoing healthcare resource use. Yet, lower income children use less in-home and outpatient services and use more hospital resources. Continued follow-up care, especially in lower income children, may help identify those in need of ongoing healthcare resources and those at-risk for decreased health-related quality of life.

Augmenting Traditional Cardiac and Medical Care in Africa via Telemedicine: A Pilot Study.

BackgroundA critical decrease in the number of healthcare providers in developing countries is one of the major burdens to healthcare access in these countries. Many factors contribute to the lack of healthcare providers, including low doctor-to-population ratio, emigration of doctors to other countries, long travel distances to hospitals, increasing cost of healthcare, and concentration of doctors in urban cities. Several measures have been taken by both governmental and nongovernmental organizations in these countries to mitigate this crisis with varying outcomes. In this study, we investigate the use of technology in the form of telemedicine in a developing country. We evaluate patient predisposition to the use of telemedicine, their experience, and some challenges involved in the use of telemedicine in this setting.MethodologyWe set up an electronic medical record system, OpenMRS, and added telemedicine modules to the system. Then, we recruited doctors and gave them privileges on OpenMRS after carefully vetting their credentials. Finally, we set up a website through which patients could request telemedicine consultations. We registered a telephone number in Nigeria so that patients could also request consultations via SMS. Consult requests were then entered into OpenMRS. Doctors logged in periodically and checked for patients awaiting consults. They called patients, diagnosed them, requested further diagnostics, and/or sent prescriptions to patients via SMS directly from OpenMRS.ResultsData were collected over the first year of telemedicine service in Nigeria. These data were then analyzed to understand the effectiveness, patient experience, cost efficiency, and general utilization of this service. In the first year, there were 510 new patient registrations and 572 total consultations. Patient age ranged from less than one year to 77 years, with a median of 29 years. Among the users of the service, 51.8% (264) were female. For consult requests, 52.2% of requests were via the web, and others were via SMS requests. There were over 50 reviews of the service on the website and social media, and 95% of users reported a positive experience.ConclusionsFrom preliminary data, telemedicine can potentially be a good adjunct to help doctors reach their patients, especially in rural areas where there is an immense shortage of healthcare professions. Although most patients reported a positive experience, further investigations are needed to validate our experience.

Hidden Impact of Molluscum Contagiosum: A Survey of Caregivers’ Experiences with Diagnosis, Treatment, and Impact on Quality of Life

Objective: Molluscum contagiosum (molluscum) is considered benign and self-limiting. However, the caregiver and patient experience largely remains a mystery. This online survey aimed to collect caregivers’ views on their experiences with molluscum infection in their children, including diagnosis, treatment, and the impact of the virus on the caregivers’ and their child’s life. &#x0D; Methods: Parents, caregivers, and/or legal guardians (ages 18+, 20% male and 80% female) of children diagnosed with molluscum in the past 4 years (ages 3-16 years of age) answered a 15-minute paid online survey with questions about their experience with molluscum.&#x0D; Results: Caregivers (n=150) were mostly Caucasian (85%), 25-44 years of age (87%) and had at least one child with active molluscum (75%) at the time of the survey. The average number of health care providers (HCPs) consulted for molluscum was 1.95 and diagnosis was made by a variety of HCP types. The spread of molluscum to ≥ 1 child in the household was reported by 60% of caregivers in multi-child households. The average number of treatments used were 2.36 including HCP-administered treatments and consumer products. Caregivers reported moderate to major impact on their lives (62%) or their child’s life (74%) due to molluscum.&#x0D; Limitations: Questions were not validated, recall time was up to 4 years.&#x0D; Conclusions: Molluscum patients may receive a diagnosis from many sources. Caregivers may utilize more than one treatment modality to help clear the infection including consumer products. Molluscum can cause an impact on quality of life for affected children and their caregivers.

The association between breast cancer capacity and resources with incidence and mortality in Arizona's low populous counties.

While cancer deaths have decreased nationally, declines have been much slower in rural areas than in urban areas. Previous studies on rural cancer service capacity are limited to specific points along the cancer care continuum (eg screening, diagnosis or treatment) and require updating to capture the current rural health landscape since implementation of the 2010 Affordable Care Act in the USA. The association between current rural cancer service capacity across the cancer care continuum and cancer incidence and death is unclear. This cross-sectional study explored the association between breast cancer service capacity and incidence and mortality in Arizona's low populous counties. To measure county-level cancer capacity, clinical organizations operating within low populous areas of Arizona were surveyed to assess on-site breast cancer services provided (screening, diagnosis and treatment) and number of healthcare providers were pulled from Centers for Medicare and Medicaid Services National Provider Identifier database. The number of clinical sites and healthcare providers were converted to county-level per capita rates. Rural-Urban Continuum codes were used to designate rural or urban county status. Age-adjusted county-level breast cancer incidence and death rates from 2010 to 2016 were obtained from the Arizona Department of Health Services, Arizona Cancer Registry. Descriptive statistics were used to summarize the results. Multivariate regression was used to evaluate the association between cancer service capacity and incidence and mortality in 13 out of Arizona's 15 counties. Rural counties had more per capita clinical sites (20.4) than urban counties (8.9) (p=0.02). Urban counties had more per capita pathologists (1.0) than rural counties (0) (p&le;0.01). In addition to zero pathologists, rural counties had zero medical oncologists. Rural county status was associated with a decrease in breast cancer incidence (&beta;=-20.1, 95% confidence interval: -37.2-3.1). While Arizona's sparsely populated rural counties may have more physical infrastructure per capita, these services are dispersed over vast geographic areas. They lack specialists providing cancer services. Non-physician clinical providers may be more prevalent in rural areas and represent opportunities for improving access to cancer preventive services and care. Compared to urban counties, rural county status was associated with lower detected breast cancer incidence rates although there were no statistically significant differences in breast cancer mortality. Other factors may contribute to rural-urban differences in breast cancer incidence. Future research should explore these factors and the association between cancer capacity and local resources because the use of county-level data represents a challenge in Arizona, where counties average over 19 425 km2 (7500 square miles).

The tolerance of physiotherapy treatment in patients with COVID-19 and undergoing surgery for fragility hip fracture: An observational study.

The aim of the present work was to evaluate the tolerance of physiotherapy treatment implemented for patients with coronavirus disease (COVID-19) and undergoing hip surgeryCase-control study. During the period between March and May 2020, 9 patients were enrolled in the study with diagnosis of COVID-19 and hip fracture. In order to evaluate the tolerability of physiotherapy treatment a comparison group, involving 27 patients with a hip fracture but in the absence of suspicion of COVID-19 positivity, were put together. Blood saturation and heart rate, number of physiotherapy sessions, start of physiotherapy from surgery, number of healthcare providers, recovery of ambulation, execution of walking training and dyspnea measured by Borg scale were collected before and after each single physiotherapy session to describe the exercise tolerance of the patients.There are no significant differences between the two groups regarding basic characteristics. Average of Borg scale post treatment for COVID patients was 1.3 (DS = 1.3) compared to 0.6 (DS = 0.7) of non-COVID patients (P < .0005) but the breathing difficulty was light during the treatment, only 9% of COVID patients had a worsening superior of two points with Borg scale compared to 3% of non-COVID patients (P = .138). The incidence of walking recovery was 63% in the non-COVID patients group compared to 44.4% in the COVID group (P = .329).Physiotherapy treatment of patients with COVID-19 infection and undergoing surgery for hip fracture is well tolerated and should be encouraged and well monitored.