Outpatient Facilities Research Articles

Heart failure outcomes by left ventricular ejection fraction in a contemporary region-wide patient cohort.

This study aimed to characterize a contemporary population with subtypes of incident or prevalent heart failure (HF) based on reduced (HFrEF), mildly reduced, or preserved (HFpEF) left ventricular ejection fraction (LVEF) and to assess how outcomes, healthcare, treatments, and healthcare costs vary between each subtype of incident HF. Using Swedish data from the CardioRenal and Metabolic disease Heart Failure (CaReMe HF) study, updated to cover a more recent time period, this population-based study characterized patients from Stockholm County, Sweden, with incident HF (patients with a first HF diagnosis between 1 January 2015 and 31 December 2019) or prevalent HF (patients with a first HF diagnosis before 1 January 2020). Patients with incident HF had LVEF measured by echocardiography within ±90days of their first HF diagnosis, and patients with prevalent HF within 5years prior to the index date. The 13375 patients with prevalent HF (39.2% women, mean age 73.9years) had multiple comorbidities (cardiovascular diseases, chronic kidney disease, diabetes, and cancer). These were already highly prevalent at the time of the first HF diagnosis in the 8042 patients with incident HF (40.5% women, mean age 72.3years). Patients with incident HFpEF received less specialist HF care at outpatient secondary care facilities following their first HF diagnosis than those with incident HFrEF. Patients with HFrEF had higher risks of complications and exerted a higher burden, in terms of care for and costs of HF, on the healthcare system. This study of contemporary patients with incident HF demonstrates that those with HFpEF and HFrEF differ considerably in terms of clinical presentation, prognosis, and care, highlighting a potential to improve HF outcomes.

Smoking Policies of Outpatient and Residential Substance Use Disorder Treatment Facilities in the United States.

Tobacco use is associated with morbidity and mortality. Many individuals who present to treatment facilities with substance use disorders (SUDs) other than tobacco use disorder also smoke cigarettes or have a concomitant tobacco use disorder. Despite high rates of smoking among those with an SUD, and numerous demonstrated benefits of comprehensive SUD treatment for tobacco use in addition to co-occurring SUDs, not all facilities address the treatment of comorbid tobacco use disorder. In addition, facilities vary widely in terms of tobacco use policies on campus. This study examined SUD facility smoking policies in a national sample of N = 16,623 SUD treatment providers in the United States in 2021. Most facilities with outpatient treatment (52.1%) and facilities with residential treatment (67.8%) had a smoking policy that permitted smoking in designated outdoor area(s). A multinomial logistic regression model found that among facilities with outpatient treatment (n = 13,778), those located in a state with laws requiring tobacco free grounds at SUD facilities, those with tobacco screening/education/counseling services, and those with nicotine pharmacotherapy were less likely to have an unrestrictive tobacco smoking policy. Among facilities with residential treatment (n = 3449), those with tobacco screening/education/counseling services were less likely to have an unrestrictive tobacco smoking policy. There is variability in smoking policies and tobacco use treatment options in SUD treatment facilities across the United States. Since tobacco use is associated with negative biomedical outcomes, more should be done to ensure that SUD treatment also focuses on reducing the harms of tobacco use.

Effect of a multimodal prevention strategy on dialysis-associated infection events in outpatients receiving haemodialysis: The DIPS stepped wedge, cluster-randomized trial

ObjectivesPatients with haemodialysis catheters are susceptible to dialysis-associated infections, particularly bloodstream infections. There have been few systematic attempts to reduce this burden. Our study aimed to investigate the effect of a multimodal prevention strategy on dialysis-associated infection events (DAIE) among haemodialysis outpatients. MethodsA multicentre, stepped wedge, cluster-randomized controlled trial was done from October 2019 to September 2021. Outpatient dialysis facilities entered into the intervention phase in three randomly assigned clusters, at three predefined time points. The multimodal prevention strategy consisted of infection surveillance and hand hygiene (HH) compliance observation with active feedback and teaching aseptic procedures, and a patient flyer.The primary outcome was incidence rates of different DAIE, such as bloodstream infections, intravenous antimicrobial starts, and local access-site infections per 1000 dialysis. As secondary outcome, we analysed the HH compliance change. ResultsA total of 43 haemodialysis outpatient facilities with 11 251 patients and 1 413 457 proceeded haemodialysis were included in the DIPS-trial. Incidence rates were 0.71 DAIE per 1000 dialysis (95% CI, 0.65–0.78) in the control and 0.31 (95% CI, 0.27–0.36) in the intervention group. The univariable analysis yielded an incidence rate ratio (IRR) of 0.44 (95% CI, 0.33–0.59) for DAIE. Especially in patients with a central venous catheter, we saw a significant decrease in DAIE in the intervention group (IRR 0.4; 95% CI, 0.28–0.58). The HH observation combined with feedback and intensified training, resulted in an increase of HH compliance from 58–65%. DiscussionA multimodal prevention strategy showed a significant preventive effect on DAIE among haemodialysis outpatients. This reduction also applied to bloodstream infections, especially in patients with a central venous catheter.

Assessment of Risk Factors and Rate of Conversion to Total Hip Arthroplasty Within 2 Years After Hip Arthroscopy Utilizing a Large Database of Commercially Insured Patients in the United States.

The conversion rate of hip arthroscopy (HA) to total hip arthroplasty (THA) has been reported to be as high as 10%. Despite identifying factors that increase the risk of conversion, current studies do not stratify patients by type of arthroscopic procedure. To analyze the rate and predictors of conversion to THA within 2 years after HA. It was hypothesized that osteoarthritis (OA) and increased patient age would negatively affect the survivorship of HA. Cohort study; Evidence level, 3. The IBM MarketScan database was utilized to identify patients who underwent HA and converted to THA within 2 years at inpatient and outpatient facilities between 2013 and 2017. Patients were split into 3 procedure cohorts as follows: (1) femoroacetabular osteoplasty (FAO), which included treatment for femoroacetabular impingement; (2) isolated debridement; and (3) isolated labral repair. Cohort characteristics were compared using standardized differences. Conversion rates between the 3 cohorts were compared using chi-square tests. The relationship between age and conversion was assessed using linear regression. Predictors of conversion were analyzed using multivariable logistic regression. The median time to conversion was estimated using Kaplan-Meier tests. A total of 5048 patients were identified, and the rates of conversion to THA were 12.86% for isolated debridement, 8.67% for isolated labral repair, and 6.76% for FAO (standardized difference, 0.138). The isolated labral repair cohort had the shortest median time to conversion (isolated labral repair, 10.88 months; isolated debridement, 10.98 months; and FAO, 11.9 months [P = .034). For patients >50 years, isolated debridement had the highest rate of conversion at 18.8%. The conversion rate increased linearly with age. Factors that increased the odds of conversion to THA were OA, having an isolated debridement procedure, and older patient age (P < .05). Older patients and those with preexisting OA of the hip were at a significantly increased risk of failing HA and requiring a total hip replacement within 2 years of the index procedure. Younger patients were at low risk of requiring a conversion procedure no matter which arthroscopic procedure was performed.

A cost-consequence analysis of the Xpert Xpress CoV-2/Flu/RSV plus test strategy for the diagnosis of influenza-like illnesses

Aims Influenza-like illnesses (ILI) affect millions each year in the United States (US). Determining definitively the cause of symptoms is important for patient management. Xpert Xpress CoV-2/Flu/RSV plus (Xpert Xpress) is a rapid, point-of-care (POC), multiplex real-time polymerase chain reaction (RT-PCR) test intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, influenza A/B, and respiratory syncytial virus (RSV). The objective of our analysis was to develop a cost-consequence model (CCM) demonstrating the clinico-economic impacts of implementing PCR testing with Xpert Xpress compared to current testing strategies. Methods A decision tree model, with a 1-year time horizon, was used to compare testing with Xpert Xpress alone to antigen POC testing and send-out PCR strategies in the US outpatient setting from a payer perspective. A hypothetical cohort of 1,000,000 members was modeled, a portion of whom develop symptomatic ILIs and present to an outpatient care facility. Our main outcome measure is cost per correct treatment course. Results The total cost per correct treatment course was $1,131 for the Xpert Xpress strategy compared with a range of $3,560 to $5,449 in comparators. POC antigen testing strategies cost more, on average, than PCR strategies. Limitations Simplifying model assumptions were used to allow for modeling ease. In clinical practice, treatment options, costs, and diagnostic test sensitivity and specificity may differ from what is included in the model. Additionally, the most recent incidence and prevalence data was used within the model, which is not reflective of historical averages due to the SARS-CoV-2 pandemic. Conclusion The Xpert Xpress CoV-2/Flu/RSV plus test allows for rapid and accurate diagnostic results, leading to reductions in testing costs and downstream healthcare resource utilization compared to other testing strategies. Compared to POC antigen testing strategies, PCR strategies were more efficient due to improved diagnostic accuracy and reduced use of confirmatory testing.

Provider perceptions and use of mental health services in the Veterans Health Administration during the COVID-19 pandemic.

The COVID-19 pandemic significantly altered the way in which health care is delivered, challenging providers, and systems of care to innovate to maintain access to services. This article describes the delivery of mental health services during the pandemic in two Veterans Health Administration (VHA) regions that include 15 hospitals and over 100 outpatient facilities in the southern United States. Data were derived from (a) a survey of provider perspectives (n = 1,175) on delivering mental health care prior to and during the pandemic and (b) VHA administrative data on mental health service delivery. Providers reported that access, quality, and timeliness of services remained high during the pandemic; indicated increased use of telehealth services; and reported challenges in delivering evidence-based psychotherapies (EBPs) and measurement-based care (MBC). Administrative data indicated no drop in the number of Veterans receiving mental health care during the pandemic but showed fewer total visits relative to prepandemic levels and confirmed a dramatic increase in telehealth services during the first 6 months of the pandemic (+ 459% telephone and + 202% video) and a decrease in use of EBPs (-28%) and MBC (-31%). Data at 12 months showed a continued increase in video services (+ 357%) and modest improvement in EBP and MBC use. Rapid shifts in the use of telehealth services, coupled with organizational efforts, ensured that Veterans continued to have access to mental health services during the pandemic. Although mental health services remained accessible, challenges existed in the delivery of specialized mental health services, including EBPs and MBC. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceived shared decision making and satisfaction with care among children and adolescents with special healthcare needs and their parents: Cross-sectional evidence from the PART-CHILD Study

ObjectivesTo compare shared decision making (SDM) and satisfaction with care (SWC), an indicator of care quality, between children with special healthcare needs (CSHCN) and parents and to assess the association between SDM and SWC in both groups. MethodsWe recruited CSHCN ≥ 7 years and parents from 15 outpatient facilities that completed a paper questionnaire assessing SDM (highest vs. lower levels of SDM) and SWC. Differences in SDM and SWC were assessed with McNemar and paired t-tests. We used adjusted linear mixed models to investigate cross-sectional associations between SDM and SWC. ResultsBased on data from 275 CSHCN and 858 parents, 39% and 64% of CSHCN and parents reported the highest level of SDM (p < 0.0001). No difference in SWC was observed (p = 0.36). Perceived SDM was associated with SWC in both groups (both p < 0.0001). ConclusionAssociations between SDM and SWC reinforce the role of SDM for care quality. Large proportions of CSHCN and parents reporting suboptimal levels of SDM highlight the need for effective programs to promote SDM in the target population. Practice implicationsUntil effective programs become available, healthcare professionals can use existing opportunities to involve CSHCN and parents in consultations (e.g., provide sufficient opportunities to ask questions).

The Medications for Opioid Use Disorder Study: Methods and Initial Outcomes From an 18-Month Study of Patients in Treatment for Opioid Use Disorder.

Opioid use disorder (OUD) affects approximately 5.6 million people in the United States annually, yet rates of the use of effective medication for OUD (MOUD) treatment are low. We conducted an observational cohort study from August 2017 through May 2021, the MOUD Study, to better understand treatment engagement and factors that may influence treatment experiences and outcomes. In this article, we describe the study design, data collected, and treatment outcomes. We recruited adult patients receiving OUD treatment at US outpatient facilities for the MOUD Study. We collected patient-level data at 5 time points (baseline to 18 months) via self-administered questionnaires and health record data. We collected facility-level data via questionnaires administered to facility directors at 2 time points. Across 16 states, 62 OUD treatment facilities participated, and 1974 patients enrolled in the study. We summarized descriptive data on the characteristics of patients and OUD treatment facilities and selected treatment outcomes. Approximately half of the 62 facilities were private, nonprofit organizations; 62% focused primarily on substance use treatment; and 20% also offered mental health services. Most participants were receiving methadone (61%) or buprenorphine (32%) and were predominately non-Hispanic White (68%), aged 25-44 years (62%), and female (54%). Compared with patient-reported estimates at baseline, 18-month estimates suggested that rates of abstinence increased (55% to 77%), and rates of opioid-related overdoses (7% to 2%), emergency department visits (9% to 4%), and arrests (15% to 7%) decreased. Our results demonstrated the benefits of treatment retention not only on abstinence from opioid use but also on other quality-of-life metrics, with data collected during an extended period. The MOUD Study produced rich, multilevel data that can lay the foundation for an evidence base to inform OUD treatment and support improvement of care and patient outcomes.

Availability of substance use disorder treatment in Spanish: Associations with state-level proportions of Spanish speakers and treatment facility characteristics in the United States.

Spanish is the second most spoken language in the United States. Not all substance use disorder (SUD) treatment facilities provide treatment in Spanish. This study examined factors associated with SUD treatment facilities having counselors that provide treatment in Spanish. State-level estimates of Spanish-speaking individuals were derived from the American Community Survey 2019. SUD treatment facility characteristics were captured from the National Survey of Substance Abuse Treatment Services 2020. We examined a sample of 15,246 facilities which included 12,798 outpatient, 3554 nonhospital residential, and 1106 with both outpatient and residential programs. Binary logistic regression models were used to observe state-level proportions of Spanish speakers and facility-level characteristics as factors associated with a facility having counselors that provide treatment in Spanish. Approximately 23.3% of facilities had counselors able to provide treatment in Spanish. Among outpatient or nonhospital residential SUD facilities, those in a state with a larger proportion of Spanish-speaking individuals, facilities with pay assistance, facilities that accept Medicaid, and facilities that engage in community outreach had higher odds of having counselors that provide treatment in Spanish. Considering that less than a quarter of facilities provide treatment in Spanish, increasing the availability of linguistically appropriate and culturally responsive services for SUD is imperative. This national study is the first of its kind to examine associations between estimates of Spanish speakers and treatment facility characteristics associated with counselors that provide treatment in Spanish in outpatient and nonhospital residential SUD treatment.

Kidney Transplantation Contraindications: Variation in Nephrologist Practice and Training Vintage

IntroHealth system leaders aim to increase access to kidney transplantation in part by encouraging nephrologists to refer more patients for transplant evaluation. Little is known about nephrologists’ referral decisions and whether nephrologists with older training vintage weigh patient criteria differently (e.g., more restrictively). MethodsUsing a novel, iteratively validated survey of U.S.-based nephrologists, we examined how nephrologists assess adult patients’ suitability for transplant, focusing on established, important criteria: seven clinical (e.g., overweight) and seven psychosocial (e.g., insurance). We quantified variation in nephrologist restrictiveness—proportion of criteria interpreted as absolute or partial contraindications versus minor or negligible concerns—and tested associations between restrictiveness and nephrologist age (proxy for training vintage) in logistic regression models, controlling for nephrologist- and practice-level factors. ResultsOf nephrologists invited (n=144), 42 survey respondents (29% response rate) were 85% male and 54% non-Hispanic white, with mean age 52 years, and 67% spent ≥1 day/week in outpatient dialysis facilities. Nephrologists interpreted patient criteria inconsistently; consistency was lower for psychosocial criteria (intraclass correlation coefficient [ICC] 0.28) than for clinical criteria (ICC 0.43; p<0.01). With each additional 10 years of age, nephrologists’ odds of interpreting criteria restrictively (top tertile) doubled (adjusted odds ratio [aOR] 1.96, 95% CI 0.95-4.07), with marginal statistical significance. This relationship was significant when interpreting psychosocial criteria (aOR 3.18, 95% CI 1.16-8.71) but not when interpreting clinical criteria (aOR 1.12, 95% CI 0.52-2.38). ConclusionNephrologists interpret evaluation criteria variably when assessing patient suitability for transplant. Guideline-based educational interventions could influence nephrologists’ referral decision-making differentially by age.

Clinical Needs Assessment of a Machine Learning-Based Asthma Management Tool: User-Centered Design Approach.

Personalized asthma management depends on a clinician's ability to efficiently review patient's data and make timely clinical decisions. Unfortunately, efficient and effective review of these data is impeded by the varied format, location, and workflow of data acquisition, storage, and processing in the electronic health record. While machine learning (ML) and clinical decision support tools are well-positioned as potential solutions, the translation of such frameworks requires that barriers to implementation be addressed in the formative research stages. We aimed to use a structured user-centered design approach (double-diamond design framework) to (1) qualitatively explore clinicians' experience with the current asthma management system, (2) identify user requirements to improve algorithm explainability and Asthma Guidance and Prediction System prototype, and (3) identify potential barriers to ML-based clinical decision support system use. At the "discovery" phase, we first shadowed to understand the practice context. Then, semistructured interviews were conducted digitally with 14 clinicians who encountered pediatric asthma patients at 2 outpatient facilities. Participants were asked about their current difficulties in gathering information for patients with pediatric asthma, their expectations of ideal workflows and tools, and suggestions on user-centered interfaces and features. At the "define" phase, a synthesis analysis was conducted to converge key results from interviewees' insights into themes, eventually forming critical "how might we" research questions to guide model development and implementation. We identified user requirements and potential barriers associated with three overarching themes: (1) usability and workflow aspects of the ML system, (2) user expectations and algorithm explainability, and (3) barriers to implementation in context. Even though the responsibilities and workflows vary among different roles, the core asthma-related information and functions they requested were highly cohesive, which allows for a shared information view of the tool. Clinicians hope to perceive the usability of the model with the ability to note patients' high risks and take proactive actions to manage asthma efficiently and effectively. For optimal ML algorithm explainability, requirements included documentation to support the validity of algorithm development and output logic, and a request for increased transparency to build trust and validate how the algorithm arrived at the decision. Acceptability, adoption, and sustainability of the asthma management tool are implementation outcomes that are reliant on the proper design and training as suggested by participants. As part of our comprehensive informatics-based process centered on clinical usability, we approach the problem using a theoretical framework grounded in user experience research leveraging semistructured interviews. Our focus on meeting the needs of the practice with ML technology is emphasized by a user-centered approach to clinician engagement through upstream technology design.

National and state-level trends in the availability of mental health treatment services tailored to individuals ordered to treatment by a court: United States, 2016, 2018, and 2020.

We sought to identify trends and characteristics associated with the availability of tailored mental health services for individuals involved in the criminal justice system and ordered to treatment by a court, nationally in the US and by state. We used National Mental Health Services Survey to identify outpatient mental health treatment facilities in the US (2016 n=4744; 2018 n=4626; 2020 n=4869). We used clustered multiple logistic regression to identify changes over time as well as facility- and state-level factors associated with the availability of specialty court-ordered services. Slightly more than half of the outpatient mental health treatment facilities offered specialized services for individuals ordered to treatment by a court, with wide variation between states. Nationally, there was a significant increase in the odds of offering court-ordered treatment in 2020 compared to 2016 (aOR=1.16, 95% CI=1.06-1.27, p<0.01). Notable associations included offering integrated substance use treatment (versus none, aOR=2.95, 95% CI=2.70-3.22, p<0.0001) and offering trauma therapy (versus none, aOR=2.05, 95% CI=1.85-2.27, p<0.0001). The availability of mental health services for individuals ordered to treatment by a court is growing nationally but several states are lagging behind. Court ordered treatment is a promising strategy to improve health and reduce reliance on the carceral system as a healthcare provider. At the same time, we express caution around disparities within behavioral health courts and advocate for equity in access to incarceration alternatives.

Outpatient Clinics, Visiting Nurses and Propaganda: Spaces, Actors and Tools of Mental Hygiene in Interwar Italy

Summary In interwar Italy, the mental hygiene movement enacted a series of measures in order to control, prevent and contain psychiatric diseases. Developing as a pillar of social medicine, mental hygiene represented a challenging outlook for the psychiatric field, as far as it filled a gap in existing assistance, providing outpatient facilities and avoiding the pitfalls of hospitalisation’s legal constraints. This article analyses the debates aimed at reforming the 1904 law on asylums and the issues at stake, as autonomy from judiciary powers and screening and follow-up in free consultations. It then examines the functioning of dispensaries that responded to these issues, the role of the visiting nurses, as well as that of propaganda deployed by the local sections of The League of Mental Hygiene. Relying on diverse case studies, it aims at reopening the debate on a controversial phase of Italian sociopolitical history through the analysis of psychiatric practices.

Use of saliva-based qPCR diagnostics for the accurate, rapid, and inexpensive detection of strep throat.

Outpatient health care facilities are essential for quickly diagnosing common infectious diseases such as bacterial and viral pharyngitis. The only form of pharyngitis requiring antibiotics is strep throat (ST); however, antibiotic prescription rates are much higher than ST prevalence, suggesting antibiotics are being inappropriately prescribed. Current rapid ST diagnostics may be contributing to this problem due to the low sensitivity and variable specificity of these tests. It is best practice to verify a negative ST diagnosis with a group A Streptococcus (GAS) culture, but many clinics do not perform this test due to the additional cost and 24-72 h required to obtain results. This indicates there is great need for more accurate rapid diagnostic tools in outpatient facilities. We hypothesized that next generation qPCR technology could be adapted to detect GAS DNA from saliva samples (instead of the traditional throat swab) by creating a simple, fast, and inexpensive protocol. Saliva specimens collected from patients at James Madison University Health Center were used to test the effectiveness of our Chelex 100-based rapid DNA extraction method, followed by a fast protocol developed for the Open qPCR machine to accurately detect ST. Our final saliva processing and qPCR protocol required no specialized training to perform and was able to detect ST with 100 % sensitivity and 100 % specificity (n=102) in 22-26 min, costing only $1.12 per sample. Saliva can be rapidly analyzed via qPCR for the accurate and inexpensive detection of ST.

Towards an integrated type 1 diabetes management in low-resource settings: barriers faced by patients and their caregivers in healthcare facilities in Ghana

Background In Low-Middle-Income Countries (LMICs), young people living with Type 1 Diabetes Mellitus (T1DM) face structural barriers which undermine adequate T1DM management and lead to poor health outcomes. However, research on the barriers faced by young people living with T1DM have mostly focused on patient factors, neglecting concerns regarding plausible barriers that may exist at the point of healthcare service delivery.Objective This study sought to explore barriers faced by young people living with T1DM and their caregivers at the point of healthcare service delivery.MethodsData were drawn from a qualitative research in southern Ghana. The research was underpinned by a phenomenological study design. Data were collected from 28 young people living with T1DM, 12 caregivers, and six healthcare providers using semi-structured interview guides. The data were collected at home, hospital, and support group centres via face-to-face interviews, telephone interviews, and videoconferencing. Thematic and framework analyses were done using CAQDAS (QSR NVivo 14).ResultsEight key barriers were identified. These were: shortage of insulin and management logistics; healthcare provider knowledge gaps; lack of T1DM care continuity; poor healthcare provider-caregiver interactions; lack of specialists’ care; sharing of physical space with adult patients; long waiting time; and outdated treatment plans. The multiple barriers identified suggest the need for an integrated model of T1DM to improve its care delivery in low-resource settings. We adapted the Chronic Care Model (CCM) to develop an Integrated Healthcare for T1DM management in low-resource settings.ConclusionYoung people living with T1DM, and their caregivers encountered multiple healthcare barriers in both in-patient and outpatient healthcare facilities. The results highlight important intervention areas which must be addressed/improved to optimise T1DM care, as well as call for the implementation of a proposed integrated approach to T1DM care in low-resource settings.

Сравнительный анализ исходов беременности и родов у женщин с аномальным прегравидарным индексом массы тела

Abstract Aim. To study the outcomes of pregnancy and childbirth in women with abnormal pregravid body mass index. Design. Retrospective comparative study. Materials and methods. A retrospective comparative study was conducted using medical records from an outpatient facility from 2018 to 2019. Using a continuous sampling method, the outcomes of pregnancy and childbirth were studied in 750 women aged 18 to 49 years. The examination of patients was carried out in accordance with the regulatory documents of the Russian Ministry of Health. Results. There were 363 (48.40%) pregnant women with normal pregravid body weight, and 387 (51.6%) with abnormal prenatal weight: women with initial underweight — 189 (25.20%), c excess body weight — 102 (13.60%), with obesity — 96 (12.8%). The data obtained indicate that the presence of both deficiency and excess body weight/obesity in women on the eve of pregnancy contributes to an increase in the frequency of complicated births, cesarean sections, births of low birth weight children, etc. Conclusion. Our data indicate the need for an individual approach to patients, aimed at identifying deficiency or excess body weight/obesity before pregnancy. with subsequent implementation of preventive measures. The implementation of a properly formed concept of preconception preparation for patients with an abnormal body mass index will reduce the frequency of complicated births, cesarean sections, and the birth of low-birth-weight babies. Key words: underweight, overweight, pregnancy, obesity, body mass index, complicated childbirth, relative risk.

Effects of differences in facility types on occurrence of COVID‐19 cases and response after testing positive in nursing homes for the elderly: Case study on Kyoto City

AbstractThe outbreak of COVID‐19 became a major problem at various facilities, and aged‐care facilities were no exception. In the event of a person detected positive for the disease, outpatient facilities were suspended, but inpatient facilities could not be suspended, and it became necessary to deal with the residents and positive people. This study aimed to obtain knowledge that would lead to the prevention of the spread of COVID‐19. The effects of differences in facility types were first examined on the occurrence of COVID‐19 cases and then on the response after testing positive in nursing homes for the elderly.

Factors associated with testing positive for SARS-CoV-2 and evaluation of a recruitment protocol among healthcare personnel in a COVID-19 vaccine effectiveness study.

The objective of this study was to determine factors associated with testing positive for SARS-CoV-2 among healthcare personnel. Secondary objectives were to assess representativeness of recruited participants and the effectiveness of a multiple-contact protocol for recruiting healthcare personnel in this COVID-19 study. Survey study, conducted as part of an observational test-negative study of COVID-19 vaccine effectiveness. University of Utah Health system, including both inpatient and outpatient facilities. Clinical and non-clinical healthcare personnel at University of Utah Health. 1456 were contacted and 503 (34.5%) completed the survey. Cases were all eligible employees testing positive for COVID-19, with 3:1 randomly selected, matched controls (test negative) selected weekly. Online survey. Significant differences in the demographics of participants and the source population were observed; e.g., nursing staff comprised 31.6% of participants but only 23.3% of the source population. The multiple-contact recruitment protocol increased participation by ten percentage points and ensured equal representation of controls. Potential exposure to illness outside of work was strongly predictive of testing positive for SARS-CoV-2 (OR = 3.74; 95% CI: 2.29, 6.11) whereas potential exposure at work was protective against testing positive (OR: 0.51, 95% CI: 0.29, 0.88). Carefully designed recruitment protocols increase participation and representation of controls, but bias in participant demographics still exists. The negative association between potential workplace exposure and positive test suggests testing bias in the test-negative design. Healthcare personnel's potential exposures to COVID-19 outside of the workplace are important predictors of SARS-CoV-2 seropositivity.

A National Laboratory Perspective: The Impact of the Covid-19 Pandemic on the Management of Patients With Non-Communicable Disease in South Africa: Impact of COVID-19 on patients with noncommunicable diseases.

The aim of this study was to determine the impact of the COVID-19 pandemic on test requests for the diagnosis and routine care of patients with various non-communicable diseases (NCD) across South Africa (SA). A retrospective audit of laboratory test requests received from hospital outpatient departments and primary healthcare facilities across SA was performed. The following analytes were studied: glycated hemoglobin (HbA1c), lipids profiles, thyroid-stimulating hormone (TSH), and thyroxine (fT4), as well as triiodothyronine (fT3), serum protein electrophoresis (SPE), serum free light chains (SFLC), and prostate specific antigen (PSA); these tests were used as a proxy of NCD detection and follow-up. Requests received during the 3 waves of the pandemic were compared to requests received within the same period during 2017 - 2019. During the first wave, requests for all analytes were reduced, with the biggest reduction observed for SPE (- 37%); TSH (- 29%); fT4 (- 28%); and HbA1c (- 25%). Requests received from urban facilities showed a larger decrease compared to those from rural facilities. During the third wave there was an increase in requests for all analytes; the biggest increase observed was for fT3 (21%) and HbA1c (18%). The COVID-19 pandemic had a significant impact on the South African population receiving care in the public healthcare sector.

Use of antibiotics in long-term care facilities for the elderly in Germany - point prevalence as a possible first step for data-based antibiotic stewardship.

In Germany, hospitals, rehabilitation facilities and outpatient surgery facilities are required by law to perform antibiotic-consumption surveillance. Established IT programs are available for recording the defined daily doses. These do not exist for long-term care facilities (LTCFs). Antibiotic stewardship is also recommended for LTCFs. In view of the lack of IT solutions for consumption surveillance, this study investigated whether point prevalence studies could be a suitable basis for a data-based antibiotic stewardship program in LTCFs. In May 2023, 18 elderly-care facilities in Berlin, Germany, participated in a point prevalence survey on antibiotic consumption according to the established HALT (healthcare-associated infections in long-term care facilities) method. The number of residents present and their risk factors (including the use of catheters and antibiotic therapy) were recorded. The results were compared with comparable data from previous surveys in LTCFs in Berlin, Germany as well as with the HALT data for Europe as a whole and for Germany. On the day of the survey, 2040 residents were present, 7.7% of whom bore a urinary catheter and 0.5% a vascular catheter. 0.2% of the residents had a port access, 0.4% a dialysis catheter and one resident (0.05%) a tracheostoma. Twenty-seven (1.3%) residents were receiving an antibiotic on the day of the survey. Of these, 29.6% had a urinary tract catheter. 63.0% of the antibiotics were given for a urinary tract infection, 14.8% for a respiratory tract infection and 11.1% for a wound/soft tissue infection. The overall prevalence of antibiotics was in the range of previous surveys from Germany (1.2-2.4%) and significantly lower than in the Europe-wide HALT survey overall (4.3-4.5%). The survey showed low use of antibiotics in the LTCFs in comparison with Europe-wide surveys. The time required was less than 2 hours for a 100-bed facility. Until appropriate IT programs to determine the defined daily doses are also available for LTCFs, such easy-to-perform and standardized point-prevalence surveys - if repeated several times a year - can be a suitable method for recording the use of antibiotics in nursing homes for the elderly.