Outpatient Clinic Of General Hospital Research Articles

Awareness of Hepatitis B Virus Infection and Vaccination Rate Among Adults Attending the Out-Patient Clinic of General Hospital, Ilorin, Nigeria

Background: Hepatitis B virus (HBV) is a potentially life-threatening infection affecting the liver from acute disease to chronic infection state and sometimes even leading to death. This study was done to determine the level of awareness of the hepatitis B virus as a disease, the availability of its vaccine, as well as the vaccination rate among the study population. Methods: This study was a descriptive cross-sectional study, and it was done at the General Hospi-tal Ilorin, Kwara State, Nigeria. The study population was adults aged 18 years and above attend-ing outpatient clinics. The sample size for this study was 377, with a male to female ratio of 128:249. The study instrument was a structured and semi-structured interviewer-administered questionnaire. The data was analyzed using Statistical Packages for Social Sciences IBM (SPSS) 21. Results: The overall level of awareness of HBV infection was very low (19.4%), only 38% of the participants knew HBV infection as a disease, while very few of them knew the causative agent (4.9%), and only 15.4% of the participants knew the transmission routes of the HBV. However, about half of the participants were aware of the existence of the HBV vaccine (50.8%). Only very few participants had ever received the vaccine as an adult, with a vaccination rate of 4.6%. There were statistically significant associations between HBV vaccination status, knowledge of the dis-ease, knowledge of HBV causative agent (P <0.001), and knowledge of HBV transmission routes (P <0.001). These factors positively impact vaccination uptake in this study. It was also observed that more young people were more likely to have received the HBV vaccine when compared to the elderly ones (P <0.001). Similarly, secondary education students were more likely to receive the HBV vaccine (P = 0.039). Conclusion: The awareness of HBV infection and the knowledge of the disease were very low, same with vaccination uptake. Young people and those with formal education would likely obtain the HBV vaccination.

Characteristics and economic burden of patients with somatoform disorders in Chinese general hospitals: a multicenter cross-sectional study

BackgroundIn China, patients with somatoform disorders (SFD) often seek medical treatment repeatedly in outpatient clinics of general hospitals, which increases unreasonable medical expenses. It is imperative to provide early screening to these patients and specialized treatment to reduce the unnecessary cost. This study aimed to screen patients with SFD in general hospitals using a new Chinese questionnaire and explore the characteristics and economic burden of these patients.MethodsPatients (n = 1497) from the outpatient department of neurology, cardiology and gastroenterology of three large general hospitals were included. Participants were screened using a newly developed questionnaire, the Self-screening Questionnaire for Somatic Symptoms (SQSS), to identify the patients with SFD (total SQSS score ≥ 29 points). We compared the demographics and clinical information of patients with and without SFD. Logistic regression was used to explore potential factors related to medical expenses, visits to doctors and sick leave days taken.ResultsThe frequency of detection of patients with SFD was 17.03%. There were significant differences in employment, doctor visits, symptom duration, medical expenses, sick leave days, PHQ-15 scores, and PHQ-9 scores between patients with SFD and without SFD. General nonspecific somatic symptoms were frequently present in patients with SFD. Several potential factors were associated with higher medical expenses, repeated doctor visits, and sick leave days taken in the regression analysis.ConclusionThe findings indicate that patients with SFD are common in general hospitals, and their direct and indirect economic burden is higher than that of non-SFD patients, which indicates that more screening effort should be made to this group to early identify their problems. Certain characteristics were identified among patients with SFD and several factors were associated with negative consequences of SFD, all of which might be prevented by developing a preventive intervention program to reduce the economic burden of the patients.

Profile of Skin Tumors at Dr. Zainoel Abidin General Hospital Dermatology and Venerology Outpatient Clinic in 2017 – 2021 : A Retrospective Study

Background: Skin tumors are swellings caused by proliferation or failure of cell death mechanisms. Based on the type of growth, skin tumors are divided into benign tumors and malignant tumors. Purpose: To investigate the incidence of skin tumors in Dr. Zainoel Abidin General Hospital outpatient clinic. Methods: This study is a descriptive study with total sampling. The diagnosis of skin tumors is assessed based on medical records filled by Dr. Zainoel Abidin General Hospital Dermatovenerologist in January 2017-September 2021. Result: The results showed patients diagnosed with benign skin tumors had as many as 360 subjects and malignant tumors had as many as 4 samples. The majority of women are affected by benign and malignant skin tumors. Based on the age of benign tumors dominated by the age of 22-45 years while in malignant tumors dominated by 45-64 years. The majority of the sample comes from Banda Aceh, based on where the most of them reside. Based on the size of lesions, benign tumors are dominated by lesions that are less than 0.5 cm in size, while malignant tumors are dominated by lesions that are larger than 0.5 cm in size. Based on the presence and absence of recursion the entire dominant sample has no recursion. Based on the physical treatment in benign tumors are dominated by electrocautery action while malignant tumors are the same number between general surgery and FNAB. Conclusion: most of the skin tumors found in Dr. Zainoel Abidin General Hospital dermatology and venerology outpatient clinic are benign

Utilization of Health Resources During the Coronavirus Pandemic in Israel: Meuhedet Health Services’ Real Data Analysis and Future Conclusions

Aim: This study aimed to examine the utilization of health resources during the first year of the COVID-19 pandemic in Israel through the analysis of Meuhedet Health Services’ real-world database. Background: The history of COVID-19 in Israel comprises three waves: from February to May 2020, from May to November 2020, and from November 2020 to April 2021. Restrictions imposed on the Israeli population included travel limitations and even lockdowns. Meuhedet Health Services, the third largest health management organization in Israel, manages all its medical data through computerized electronic files and has collected various types of health services data from 2018 to 2020. This paper compared the consumption of Meuhedet Health Services over two consecutive years of the pandemic using a real-world database. Methods: Electronic medical records from primary care physicians, laboratory tests, hospitalization medical histories, treatments in hospitals and institutes, visits to and treatments by community physicians, and prescriptions and medical equipment consumption were collected from 2018 to 2020. This research used aggregated, non-personalized, and decoded data from a cohort of insured individuals, and the research was approved by all the relevant institutional Helsinki Committees. The data analysis compared the corresponding data in a chosen month of the year with the data in the same month of the previous year. The differences were then scaled by the data corresponding to the month of the previous year, and the result was multiplied by 100 and plotted. To analyze drug consumption, we used the fixed price of every drug in a year multiplied by the difference in consumption of the drug in question between the month of the current year and the same month of the previous year, multiplied by 100. Results: A significant decrease was noted in hospitalization days, general hospital outpatient clinic visits, general hospital emergency room visits, and total numbers of visits to community physicians during the first lockdown in the first wave of the pandemic in comparison to 2019. At the end of the lockdown, however, a compensatory increase was noted in all services. In terms of drug consumption, the data showed no differences in the effects of the different waves. Our findings revealed that the first wave of COVID-19 was a shock, with a significant reduction in the consumption of health services, but this decrease attenuated with the second wave due to immediate management interventions and safety rules implemented in hospitals and clinics. Conclusion: People shun medical services during a fast-spreading epidemic that causes significant mortality. Since new variants of COVID-19 could be part of our lives for the next few years, we should learn how to continue living with the pandemic and develop alternative medical services to maintain healthy states. Digitization, remote services, telemedicine, and home care, including home hospitalization, should be part of the health services to cope with pandemic situations.

Utilization of Health Resources during the Coronavirus Pandemic in Israel: Meuhedet Health Services’ Real Data Analysis and Future Conclusions

Aim To examine the utilization of health resources during the first year of the COVID-19 pandemic in Israel through the analysis of Meuhedet Health Services’ real-world database. Background The history of COVID-19 in Israel comprises three waves: from February to May 2020, from May to November 2020, and from November 2020 to April 2021. Restrictions imposed on the Israeli population included travel limitations and even lockdowns. Meuhedet Health Services, the third largest health management organization in Israel, manages all its medical data through computerized electronic files and has collected various types of health services data from 2018 to 2020. This paper compares the consumption of its services between two consecutive years. pandemic for Meuhedet Health Services using a real-world database. Method Electronic medical records from primary care physicians, laboratory tests, hospitalization medical histories, treatments in hospitals and institutes, visits to and treatments by community physicians, and prescriptions and medical equipment consumption were collected from 2018 to 2020. This research used aggregated, non-personalized, and decoded data from a cohort of insured persons, and the research was approved by all the relevant institutional Helsinki Committees. The data analysis compares the corresponding data in a chosen month of a year with the data in the same month of the previous year. The differences are then scaled by the data corresponding to the month of the previous year and the result multiplied by 100 and plotted. To analyze drug consumption, we use the fixed price of every drug in a year multiplied by the difference in consumption of the drug in question between the month of the current year and the same month of the previous year, multiplied by 100. Result A significant decrease was noted in hospitalization days, general hospital outpatient clinic visits, general hospital emergency room visits, and total numbers of visits to community physicians during the first lockdown in the first wave of the pandemic in comparison to 2019. At the end of the lockdown, however, a compensatory increase was noted in all services. In terms of drug consumption, the data show no differences in the effects of the different waves. Our findings reveal that the first wave of COVID-19 was a shock, with a significant reduction in the consumption of health services, but this decrease attenuated with the second wave, due to immediate management interventions and safety rules implemented in hospitals and clinics. Conclusion People shun medical services during a fast-spreading epidemic that causes significant mortality. Since new variants of COVID-19 could be part of our lives for the next few years, we should learn how to continue living with the pandemic and develop alternative medical services to maintain health states. Digitization, remote services, telemedicine, and home care, including home hospitalization, should be part of the health services to cope with pandemic situations.

Behavioral Problems Among Type 1 Diabetes Mellitus Children with Good and Poor Metabolic Control During COVID-19 Pandemic

Background: Children with type-1 diabetes mellitus (T1DM) often experience emotional and behavioral problems such as anxiety and depression. Social restrictions during the COVID-19 pandemic caused social restrictions and limited access to healthcare facilities, which may have worsened the metabolic control. Objectives: This study aimed to analyze the behavioral problems among type 1 diabetes mellitus children with good and poor metabolic control during COVID-19 pandemic. Methods: This cross-sectional study was conducted in January - August 2021 in the Endocrine Outpatient Clinic of General Hospital Dr. Soetomo Surabaya. Type-1-DM children who fulfilled the inclusion criteria were divided into two groups based on metabolic control, including good (HbA1C ≤ 8) and poor (HbA1C > 8). The Pediatric Symptom Checklist-17 (PSC-17) was used as a screening tool with the domain internalizing problems (IP), externalizing problems (EP), and attention problems (AP). The data were analyzed using Pearson or Spearman test with Statistical Product and Service Solution (SPSS) version 18.0. Results: In this study, 27 subjects (17 boys and 10 girls, aged 12.63 ± 3.39 years) were investigated. Of all subjects, only 8 subjects had good metabolic control during the COVID-19 pandemic. Furthermore, 33.3% of the participants had behavioral problems (14.8% IP; 18.5% EP). The frequencies of IP, EP, and AP in the good metabolic control group were 12.5%, 37.5%, and 0%, respectively; while those in the poor metabolic group were 15.8%, 10.5%, and 0%, respectively. There was no significant difference between the good and poor metabolic control groups in terms of behavior problems (P = 1.00, IP; P = 0.14, EP). Conclusions: No significant difference was found between good and poor metabolic control groups (P = 1.00, IP; P = 0.14, EP). However, the frequency of EP was higher in good metabolic control, and the frequency of IP was higher in poor metabolic control.

478-P: Effect of Nonpharmacological Management of Chronic Constipation in Diabetic Patients

Background: Chronic constipation is highly prevalent in diabetic patients. The treatment of chronic constipation in general patients is mainly lifestyle modification and pharmacological therapy. The efficacy of non-pharmacological treatment, i.e., behavioral therapy to improve lifestyle and defecation habits, for chronic constipation in diabetic patients is not well known. This study aimed to determine the efficacy of non-pharmacological management for chronic constipation in diabetic patients. Methods: We conducted a questionnaire on defecation for diabetic patients aged 20 to 75 years at Asama General Hospital outpatient clinic. Patients diagnosed with chronic constipation according to Rome IV criteria were randomly assigned to two groups. The intervention group instructed behavior therapy to improve constipation. Specifically, we provided guidance on defecation behavior, exercise, water and dietary fiber intake, and guidance on a defecation diary recording daily defecation status. The other group received usual medical care as a control group. The questionnaire was conducted again at the next outpatient clinic. Results: Eighty of 545 diabetic patients (14.7%) had chronic constipation. The average age of constipated patients was 59.3 years, frequency of defecation 3.7 times/week, stool form (Bristol Stool Form Scale) 2.8, straining during defecations 78,8% and sensation of incomplete evacuation of defecations 42.5%. After the intervention, there was a significant increase in the frequency of defecation (4.8 vs. 3.9 times/week, P=0.008) and improvement in constipation symptoms (P=0.018) in the intervention group compared to the control group. In addition, stool form and straining during defecations were significantly improved before and after comparison within the intervention group (P <0.05). Conclusion: Our findings suggest that non-pharmacological management, including behavioral therapy for chronic constipation in diabetic patients, was effective. Disclosure E. Nishimori: None. M. Naka: None.

The intergated approach to the management of arterial hypertension: The Campania Salute Network

The second half of the last century was characterized by intense research in the field of arterial hypertension and related therapies. These studies showed that the management of arterial hypertension requires a robust coordination with close integration of the "health care systems" and "health care professionals." In 1998, the healthcare organization named "Campania Salute Network" was set up at the Federico II University, Naples, Italy. The Campania Salute Network involves 23 outpatient hypertensive clinics distributed in different community hospitals of the Regione Campania's area, 60 randomly selected general practitioners uniformly distributed in the same area, and the Hypertension Clinic of the Federico II University (coordinating center). Through this network, clinical data collected at each visit are shared (via text messages or e-mails) with peripheral units (general practitioners and community hospital outpatient hypertensive clinics). The coordinating centre works in cooperation with the peripheral units in the treatment and follow-up of all hypertensive patients (i.e. assessing hypertension mediated organ damage and associated diseases). Information about patients are shared through on-line access to the remote web-based database. The integrated approach to the mamangement of hyperetension determined a better control of blood pressure, that was associated with a reduction of hypertension mediated organ damage and decreased incidence of fatal or non-fatal cardiovascular events. Furthermore, this innovative approach improved the adherence and the persistence to the initial pharmacologic treatment. Campania Salute Network is also a powerful tool for the clinical and translational research with more 15,000 hypertensive patients followed for more than 15 years. This database allowed, in prospetic, large scale studies, to identify the hemodiminamic and metabolic determinants of hypertension mediated organ damage and major cardiovascular events. The experience of Campania Salute Netwiork indicates that the creation of large databases from real life experiences becomes an indispensable condition also for artificial intelligence which, in the near future, thanks to scientific knowledge, the availability of particularly advanced hardware and software, will also be able to transform the management of arterial hypertension.

Assessment of the structured clinical interview (SCID) for DSM-5 for somatic symptom disorder in general hospital outpatient clinics in China

BackgroundIt is still unknown whether the “Somatic symptom disorders (SSD) and related disorders” module of the Structured Clinical Interview for DSM-5, research version (SCID-5-RV), is valid in China. This study aimed to assess the SCID-5-RV for SSD in general hospital outpatient clinics in China.MethodsThis multicentre cross-sectional study was conducted in the outpatient clinics of nine tertiary hospitals in Beijing, Jincheng, Shanghai, Wuhan, and Chengdu between May 2016 and March 2017. The “SSD and related disorders” module of the SCID-5-RV was translated, reversed-translated, revised, and used by trained clinical researchers to make a diagnosis of SSD. Several standardized questionnaires measuring somatic symptom severity, emotional distress, and quality of life were compared with the SCID-5-RV.ResultsA total of 699 patients were recruited, and 236 were diagnosed with SSD. Of these patients, 46 had mild SSD, 78 had moderate SSD, 100 had severe SSD, and 12 were excluded due to incomplete data. The SCID-5-RV for SSD was highly correlated with somatic symptom severity, emotional distress, and quality of life (all P < 0.001) and could distinguish nonsevere forms of SSD from severe ones.ConclusionsThis study suggests that SCID-5-RV for SSD can distinguish SSD from non-SSD patients and severe cases from nonsevere cases. It has good discriminative validity and reflects the DSM-5 diagnostic approach that emphasizes excessive emotional, thinking, and behavioural responses related to symptoms.

A Comparison of the Anthropometrical Measurements of External Ear between Normal persons and Diabetic Patients in Iraq

The human ear is an important distinguishing organ of the human face. Defects on the auricle surface of the ear may allow a person to be identified. Since the auricle's structure is complex, a plastic surgeon needs to know its different auricular dimensions, which will be useful for designing an ear prosthesis that will aid in forensic recognition of the person. Objectives: The objective of the current study to compare the anthropometric measures of Pinna bilateral external ear in normal and diabetic patients in Iraq with sexual differences Subject and Methods: Research performed at the Al-Faiha General Hospital outpatient clinic and the Basra Teaching Hospital. Two groups were obtained from 95 patients with an average age of 40-60 years in normal as well as Type II diabetes mellitus. Vernier caliper measured anthropometric measurements of the outer ear, including total ear length (TEL), total ear width (TEW), total lobules length (TLL) and total lobules width (TLW), to the nearest 0.1mm. Results: Each group in our study consisted of 55 female patients (58%) and 40 male patients (42%) aged 40-60 (50±9.8). In the study, high measurements were found when comparing anthropometric measurements in male and female persons. It was observed, in each group, that the measurements of the right ear for males and females are larger than the left ear and there were significant differences in anthropometric measurements (P&lt;0.05). As for the results of patients with type II diabetes, there were a decrease in all parameters, but there were no significant differences except for the overall width of the ear. Conclusion: In this study, anthropometric measurements between normal persons and diabetics were measured with proposals for the planned surgical correction of congenital ear defects and hearing aids in normal persons and diabetics at increased risk of future hearing loss, so that these anthropometric data enhance the level of hearing.

Rituximab in multiple sclerosis at general hospital level.

The use of rituximab (RTX) in multiple sclerosis (MS) is a rapidly increasing choice of disease-modifying therapy. Efficacy outside specialized university hospital-based care is not yet systematically investigated. Our aim was to evaluate off-label RTX treatment for MS at a general hospital in Sweden. Subjects with definite MS with at least one rituximab infusion were eligible for inclusion in this retrospective, observational study. Effect was evaluated by monitoring clinical disability, annual relapse rate, new lesions on MRI, and safety by the incidence and severity of adverse events. Among the 83 included subjects, 15 had clinical worsening of disease during the median 23.5 (1-76) months of follow-up after RTX initiation: 7/66 with relapsing-remitting multiple sclerosis (RRMS) and 8/17 with progressive subtypes (PMS). Cumulative survival without worsening was 86% in RRMS and 30% in PMS. The annual relapse rate before RTX vs follow-up dropped from 0.38 to 0.05 (P<.00001). Subjects with new enhancing lesions on MRI during the first year before RTX initiation vs the year after dropped from 0.94 to 0.024 (P<.00001) and was only seen in RRMS (1.05-0.31, P=.00003). Adverse events were mainly mild. Thirty-six out of 53 non-infusion-related adverse events were infections, of which four were serious, including a case of pneumonia with concomitant late-onset neutropenia. Rituximab was as effective and safe when given at a general hospital outpatient clinic compared with results from previous university hospital-based studies. Vigilance is required concerning severe adverse events.

Prevalence of DSM-5 somatic symptom disorder in Chinese outpatients from general hospital care

ObjectiveWe aimed to explore the prevalence of somatic symptom disorder (SSD) according to DSM-5 criteria in Chinese outpatients from general hospital departments. MethodsThis multicentre cross-sectional study enrolled 699 patients from outpatient departments, including the neurology, gastroenterology, Traditional Chinese Medicine [TCM] and psychosomatic medicine departments, in five cities in China. The structured clinical interview for DSM-5 (SCID-5) for SSD was administered by trained clinical professionals to diagnose SSD. ResultsSSD was diagnosed in 33.8% (236/697) of all enrolled patients. The prevalence of SSD differed significantly among the departments (χ2 = 34.049, df = 2, p ≤0.001). No differences were found between SSD patients and non-SSD patients in terms of gender, residence, marital and living statuses, family income, education, employment status and lifestyle factors. However, patients with SSD reported higher levels of depression, health-related and general anxiety, lower physical and mental quality of life, higher frequency of doctor visits, increased time devoted to physical symptoms and longer duration of somatic symptoms. In a binary linear regression analysis, SSD was significantly associated with an increase in health-related anxiety, time devoted to symptoms and impact of somatic symptoms on daily life. The explained variance was Nagelkerke R2 = 0.45. ConclusionThere is a high prevalence of SSD in Chinese general hospital outpatient clinics. The diagnosis is associated with high levels of emotional distress and low quality of life. There is a danger of over-diagnosis if we include the mild and moderate forms of SSD. Future studies are warranted to investigate the prevalence of SSD in inpatient departments and the development of psychological interventions for these patients.

Effect of Physiotherapy Protocol on Post Burn Upper Limbs' Function

Introduction: Burns of the hand have devastating consequences not only for the functional outcome but also for the esthetic appearance. Post burn functional disabilities of the upper extremity are better prevented than treated. Aim: this study aimed to evaluate the effect of physiotherapy protocol on upper limbs’ function post burn. Design: A quasi-experimental (time series) design submitted to meet the aim of the study. Subjects: A purposive sample of 27 male and female adult patients with 2nd degree burn in hand assigned in the current study which was carried out in Burn Department and its outpatient clinic of General hospital at Minia city. Tools: Four tools were utilized to collect data of this study; demographic questionnaire, Disabilities of the Arm, Shoulder and Hand Scale (DASH), Manual Muscle testing, and Vancouver Scar Assessment Scale (VSS). Results: Twenty seven adult 2nd degree burned patients with mean age 36.0 ± 11.22 are included in the study. Gradual improvement of the upper limbs' function measured through DASH scale was observed after application of physiotherapy protocol, this appear through significant decrease in complain from severe dysfunction among 25.9% after 2 months to 0% after 6 months; significant increase in muscle force (22.2%, 59.3%) and prominent improvement of burn scar measured by VSS. Conclusions: The data suggest that the upper limbs' function post burns can be improved by preventive nursing interventions including early range of motion, anti-contracture positioning and splinting of hand which has positive effects on burn scar. Recommendations: regular training programs to keep nurses in burn units updated with the evidence-based practices and array interventions for reducing burn scar and improving limbs' function and therefore patients' productivity.

Prevalence of DSM-5 Somatic Symptom Disorder in Chinese Outpatients from General Hospital Care

Objective: We aimed to explore the prevalence of somatic symptom disorder (SSD) according to DSM-5 criteria in Chinese outpatients from general hospital departments. Methods: This multicentre cross-sectional study enrolled 699 patients from outpatient departments, including the neurology, gastroenterology, Traditional Chinese Medicine [TCM] and psychosomatic medicine departments, in five cities in China. The structured clinical interview for DSM-5 (SCID-5) for SSD was administered by trained clinical professionals to diagnose SSD. Results: SSD was diagnosed in 33.8% (236/697) of all enrolled patients. The prevalence of SSD differed significantly among the departments (X2 = 34.049, df=2, p=<0.001). No differences were found between SSD patients and non-SSD patients in terms of gender, residence, marital and living statuses, family income, education, employment status and lifestyle factors. However, patients with SSD reported higher levels of depression, health-related and general anxiety, lower physical and mental quality of life, higher frequency of doctor visits, increased time devoted to physical symptoms and longer duration of somatic symptoms. In a binary linear regression analysis, SSD was significantly associated with an increase in health-related anxiety, time devoted to symptoms and impact of somatic symptoms on daily life. The explained variance was Nagelkerke R2 = .45. Conclusion: Patients with SSD have a high prevalence in Chinese general hospital outpatient clinics. The diagnosis is associated with high levels of emotional distress and low quality of life. There is a danger of over-diagnosis if we include the mild and moderate forms of SSD. Future studies are warranted to investigate the prevalence of SSD in inpatient departments and the development of psychological interventions for these patients. Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Interests: The authors have no competing interests to report. Ethical Approval Statement: The study was approved by the ethics committees of Peking Union Medical College Hospital (PUMCH) and the University Medical Centre Freiburg, Germany.

Internalized stigma, disclosure and self-esteem among psychiatric patients in a general hospital outpatient clinic

Psychiatric patients often experience internalized stigma. This occurs when persons accept the negative attitudes of others towards them, then internalize and apply these beliefs to themselves. We assess the effects of internalized stigma on illness disclosure and on self-esteem in psychiatric outpatients, hypothesizing that internalized stigma is more pronounced in psychiatric patients than in medical patient controls and that internalized stigma is associated with avoidance of disclosure, as well as reduced self-esteem. Psychiatric and medical outpatients were randomly selected to participate in the study, conducted at a general hospital specialist outpatient clinic. Psychiatric patients demonstrated significantly lower self-esteem than controls. Internalized stigma was the highest for singles, and the lowest among married and older patients. Among psychiatric patients, a higher internalized stigma was significantly associated with experienced discrimination and with lower levels of self-esteem. Those who avoided disclosure had significantly higher internalized stigma than those who self-disclosed. The results confirmed our study hypotheses. Marriage and older age seemed to confer a protective effect on self-esteem.

Improving the quality of hospital care provided for asthma out-patients in a country in turmoil: a report from Syria.

In low resources settings, especially during periods of turmoil, asthma care becomes emergency-oriented, and adherence to international asthma management guidelines such as long-term inhaled corticosteroids (ICS) prescription is limited. The role of education for inhaler technique to guarantee treatment efficacy is neglected and follow up is hampered by war-related displacement. In Syria, asthma care is not included in primary care, and frequently, internal medicine general hospital outpatient clinics are the first contact. The main objective of our study was to evaluate the adequacy of prescription of controller medications (ICS/LABA) by residents on initial contact with patients, and the effect of regular onsite personalized supervision and coaching by a trainer pulmonologist on improving their practice. The second objective was to evaluate the efficacy of mobile training for inhaler technique, and asthma mobile follow up. We developed an audit form to assess initial prescription of ICS/LABA by residents. Filled forms were reviewed by a trainer pulmonologist for compliance with international guidelines. When discrepancies were noted, onsite training was provided. Auditing of new presenting asthma patients is continual to evaluate improvement of initial prescription by the same residents. In parallel, video-mobile education of patients for inhaler technique, and mobile interviewing follow up were tested. Implementation of these strategies resulted in improved adherence of residents to ICS dosing guidelines (P=0.002), optimal inhaler technique by patients, and efficacy of mobile follow up. WHO programs for CRD in developing countries, especially in regions of conflict and war, should include auditing of care by residents with onsite coaching by trainer pulmonologists, and mobile education for technology of inhaler and patient follow up.

The Correlation between Hemoglobin Concentration during Pregnancy with the Maternal and Neonatal Outcome.

BACKGROUND:The prevalence of anaemia is higher among women, including pregnant women. The estimation was about 24.8% of the population in the world suffering anaemia. Anaemia during pregnancy is a big problem because it can contribute morbidity and mortality, either in mother or newborn. The impacts of anaemia during pregnancy included post-partum haemorrhage, low birth weight (LBW), preterm delivery, and low Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score.AIM:This study aimed to determine the correlation between haemoglobin concentration during pregnancy and the outcome of mothers and newborns.METHODS:It was a cohort study that included 200 pregnant women in second or third trimester at antenatal care of Sundari General Hospital Outpatient Clinic on February until September 2018. The participants were interviewed using a questionnaire, and their blood was checked to measure haemoglobin concentration using portable Easy Touch Hemoglobinometer. In the next three until six months, the following investigation was conducted to assess the maternal and neonatal outcome.RESULTS:The result of this study showed among the maternal outcome, only antepartum haemoglobin concentration had a statistically significant correlation with the haemoglobin concentration during pregnancy (p < 0.05), meanwhile, among the neonatal outcome. LBW was the only factor that statistically significantly correlated to the haemoglobin concentration during pregnancy (p < 0.05).CONCLUSION:We can conclude that once anaemia occurs in pregnant women, then the women kept suffering from anaemia with its correlation was statistically significant.

Regional differences in the risk of insomnia symptoms among patients from general hospital outpatient clinics.

BackgroundRegion-specific differences in the prevalence of insomnia symptoms in outpatient clinics in China have received little systematic study. This study was conducted preliminarily to examine region-specific differences in the risk of insomnia symptoms in Chinese outpatients.MethodIn total, 4,399 adult outpatients (urban vs rural residents: 1,768 vs 2,631) who completed three questions focusing on insomnia symptoms were included. Their sociodemographic and clinical information were collected with standardized questionnaires.ResultsThe prevalence of self-reported insomnia symptoms in urban residents (23.4%) was more frequent than the prevalence in rural residents (21.2%). The estimated prevalence of insomnia symptoms was significantly lower in rural than urban residents after adjusting for the potential confounders (P=0.015). Similarly, more urban (22.9%) than rural (13.4%) residents with insomnia symptoms had significantly higher treatment rates (χ2=14.9, P<0.001). Multiple regression analyses showed that depressive symptoms, old age, and low education level were the most common risk factors for insomnia symptoms in both urban and rural residents.ConclusionOur findings show that the prevalence of insomnia symptoms was relatively lower in rural than urban residents. Longitudinal studies are warranted to confirm the current findings.

Adapting International Asthma Management Guidelines to Regions of Turmoil: The Syrian Experience

Background: Adherence to international asthma management guidelines is suboptimal even in developed countries. In low resources settings, especially during periods of turmoil, asthma care becomes emergency-oriented, long-term Inhaled corticosteroids prescription is limited, and follow up is rare. The current conditions in Syria have weakened the health system. It is not multisectoral and asthma management is not routinely included in primary care centers. There is a weak referral system to secondary care and specialists. Frequently, internal medicine general hospital outpatient clinics are the first contact. To our knowledge, no studies have evaluated asthma knowledge and management skills of internal medicine physicians and residents in regions of turmoil like present-time Syria. Purpose: The purpose of this study was to assess asthma knowledge and management skills of general internists and residents, barriers to adherence to international management guidelines, and means to improve compliance and outcome. Methods: We developed and administered to general practitioners asthma management audit forms which were reviewed by a trainer pulmonologist for compliance with international management guidelines. When discrepancies were noted, onsite training was provided in weekly sessions. Follow up of care of asthma patients was done by mobile devices to track patients unable to return to the hospital clinic. Findings: Implementation of these strategies resulted in improved adherence to ICS dosing guidelines (P=0.002) and optimal technique for inhaler use by patients. Interpretation: We recommend that WHO programs for CRD include auditing of care by internists with onsite supervision and teaching and mobile follow up technology. We believe these recommendations will be useful and add value to existing programs and will improve asthma care. Funding Statement: We declare no funding. Conflict of Interest: We declare no conflict of interest. (We declare no conflict of interest, and no funding.) Ethics Approval Statement: Ethical approval was secured from hospital [Damascus General Hospital] institutional board, and patient consent forms were collected.

Clinical characteristics of Black patients with hypertensive urgency.

Hypertensive urgency is defined as a severely elevated systolic blood pressure (SBP) of ≥ 180mmHg and/or diastolic blood pressure (DBP) of ≥ 120mmHg, in the absence of end organ damage. It is known that there are racial differences in prevalence and severity of hypertension but there is a dearth of studies looking at hypertensive urgency in Black populations living in Europe. We sought to define the clinical characteristics of Black patients presenting with hypertensive urgency, in order to better define the risks and complications this growing population of patients faces. This was a single-centre retrospective cohort study of 63 consecutive Black and Afro-Caribbean patients attending a South London district general hospital outpatient hypertension clinic from April 2014 to June 2016. All patients had initially presented with hypertensive urgency to their GP, the Emergency Department, or the hospital's medical take. The cohort had a mean age of 52.7years and an even gender balance. Thirty-four patients had a pre-existing diagnosis of hypertension, with a 9-year median time since diagnosis. This was the first presentation of hypertension for the remaining 46%. Other comorbidities found were diabetes mellitus (10%), ischaemic heart disease (5%), hyperlipidaemia (5%), and cerebrovascular disease (2%). Patients who drank alcohol regularly were found to have significantly higher blood pressures than those who did not. Most patients presented with typical symptoms of uncontrolled hypertension, with headache (25%) and chest pain (16%) being most common. Features of end organ damage were also common, with 32 patients having hypertensive retinopathy, 16 patients having proteinuria and 14 patients found to have left ventricular hypertrophy on echocardiography. The large proportion of newly diagnosed hypertensive patients presenting with end organ signs of prolonged uncontrolled hypertension suggests that there are significant numbers of undiagnosed Black patients in the community, suggesting that we should more actively conduct test for hypertension and its complications when we encounter these patients, who constitute a growing part of the populations in Europe.