Preventive Care Research Articles

Patient experiences of information-sharing and patient-centred care across the broad landscape of primary care practice and provision: a nationally representative survey of Australian adults

BackgroundAustralian government strategies and frameworks have been developed in recent years to encourage the integration and coordination of primary care delivery; including patient-centred approaches to clinical and preventative care, and health promotion. This study aims to explore patient experiences of information-sharing and patient-centred care across various primary care clinical settings, with a particular focus on clinical encounters with GPs, naturopaths, osteopaths and acupuncturists.MethodsData about healthcare utilisation and experiences from a 63-item cross-sectional survey obtained from a nationally representative sample of Australian adults aged ≥ 18 years were analysed. Chi-square and Kruskal-Wallis H tests were used to explore differences in the experiences of knowledge and information sharing during GP consultations among those who also consulted with a naturopath, osteopath or acupuncturist, compared those who had not. Logistic regression was used to investigate correlations between participants perceptions about GP consultation outcomes, and the GP’s information-sharing behaviour or perceived experience of patient-centredness.ResultsAcross 2354 participants, verbal explanation (76.3%) and/or individualised handouts (16.8%) were the most common type of information shared in GP consultations. Individuals who consulted with a GP and a naturopath, an osteopath, or an acupuncturist reported a lower rate of receiving a verbal explanation from their GP but higher rate of receiving other types of information sources including handouts. Over one quarter of study participants who visited a GP did not discuss any of their health information with their GP. Information sharing was lower for individuals who also visited a naturopath, osteopath or acupuncturist. Participants scored their consultations with a GP as patient-centred, but these scores were lower among participants who also consulted with at least one other primary care practitioner type included in the study.ConclusionsPublic health and health services researchers, policymakers and leaders of primary care professions have a role and responsibility to ensure practitioners are confident and competent in sharing health information with their patients that considers their health literacy needs, and the importance of patient-centred care. Research focussed on a more in-depth understanding of the differences and relationships observed across the primary care landscape in this study is recommended.

COVID-19 OUTBREAK IMPACT ON THE INDIANS

The impact of the COVID-19 outbreak in India, though possibly surpassing its peak caseload in 2023, continues to have a profound effect on the nation's health, society, and economy. While the public health system managed the initial surge, it now faces ongoing challenges due to resource and personnel strain. The heightened demands during the peak may have resulted in neglect of preventative and diagnostic care for non-COVID ailments. Socioeconomic gaps widened as the pandemic disproportionately affected informal workers and low-income communities, pushing many further into poverty through lockdowns, business closures, and job losses. The lasting economic consequences are still unfolding, potentially leading to a decline in GDP and investment. Mental health emerged as a significant concern, with lockdowns, social isolation, and fear contributing to increased depression, anxiety, and other issues. Although India has made progress in curbing the virus's spread, achieving full recovery will likely be a prolonged process requiring sustained efforts to bolster the healthcare system, address socioeconomic disparities, and offer mental health support to the population.

Immunization adherence among children with sickle cell disease and sickle cell trait: Results of a population-based study.

Despite the importance of timely vaccine completion for protection from infectious disease, there is limited knowledge of the immunization adherence rates of children with sickle cell disease (SCD). This is a retrospective cohort study comparing the immunization rates of children with SCD to those with sickle cell trait between 2008 and 2019 in Georgia. Completion rates for each vaccine and the proportion of children with up-to-date status at 24 and 35 months were calculated and compared between the cohorts. Chi-square tests with odds ratios (OR) for differences and 95% confidence intervals (CIs) were reported on the overall up-to-date rates and rates for individual vaccines at 24 and 35 months for the two cohorts. Children with SCD had higher up-to-date rates than children with sickle cell trait at 24 and 35 months. At 35 months, the overall up-to-date rates (OR=1.17; 95% CI, 1.04-1.31; p=.004) and the four-dose pneumococcal conjugate vaccine series (OR=1.36; 95% CI, 1.18-1.57; p<.001) were significantly different between the groups. Both cohorts had the highest completion rates for the hepatitis B series and the lowest rates for the varicella vaccine. Doses of diphtheria, tetanus, and acellular pertussis vaccine; varicella; and pneumococcal conjugate vaccines were most commonly missed by children in both cohorts. Children with SCD have better immunization coverage than children with sickle cell trait, but there is an opportunity for improvement. Policymakers and healthcare professionals should focus on increasing access to care coordination services among children with SCD to ensure on-time and preventive healthcare services.

DEVELOPMENT AND IMPLEMENTATION OF THE INFORM GUIDELINES FOR THE TREATMENT AND MANAGEMENT OF PROSTHETIC HIP INFECTION

Hip prosthetic joint infection (PJI) is a debilitating complication following joint replacement surgery, with significant impact on patients and healthcare systems. The INFection ORthopaedic Management: Evidence into Practice (INFORM:EP) study, builds upon the 6-year INFORM programme by developing evidence-based guidelines for the identification and management of hip PJI.A panel of 21 expert stakeholders collaborated to develop best practice guidelines based on evidence from INFORM \[1\]. An expert consensus process was used to refine guidelines using RAND/UCLA criteria. The guidelines were then implemented over a 12-month period through a Learning Collaborative of 24 healthcare professionals from 12 orthopaedic centres in England. Qualitative interviews were conducted with 17 members of the collaborative and findings used to inform the development of an implementation support toolkit. Patient and public involvement contextualised the implementation of the guidelines. The study is registered with the ISCRTN (34710385).The INFORM guidelines, structured around the stages of PJI management, were largely supported by surgeons, although barriers included limited awareness among non-surgical team members, lack of job planning for multidisciplinary teams, and challenges in ensuring timely referrals from primary care. Psychological support for patients was identified as a critical gap. Advanced Nurse Practitioners and multidisciplinary team (MDT) coordinators were seen as potential bridges to address these knowledge gaps. The guidelines were also viewed as a useful tool for service development.This study presents the first evidence-based guidelines for hip PJI management, offering a comprehensive approach to prevention, treatment, and postoperative care. Effective implementation is crucial, involving wider dissemination amongst primary and community care, as well as non-specialist treatment centres. Further resources are needed to ensure job planning for MDTs and psychological support for patients. Overall, this study lays the foundation for improved PJI management, benefiting patients and healthcare systems.

Abstract PO2-09-11: Breast Cancer Care Disparities in Sexual Minority Women: An Analysis of the National Institutes of Health All of Us Research Program

Abstract Background. Currently, sexual orientation data is not collected, nor is the language to study sexual orientation data defined by any national cancer database. Due to this limitation, little is known about breast cancer (BC) disparities in sexual minority women (SMW) despite several studies showing increased lifestyle risk factors. Our objective was to study this question in the All of Us database. Methods. We analyzed data from the All of Us research program, a national open enrollment database that registers diverse subjects through associated healthcare electronic medical records and collects survey data. We aimed to compare risk factors, as well as preventative and procedural healthcare utilization differences between SMW and straight women (StW) as they relate to BC care. Results were expressed as odds ratios (OR) with a 95% confidence interval [CI]. Results. Of 229,917 cisgender women who answered the sexual orientation question, 27,302 (11.9%) selected “non-straight orientation, prefer not to answer, or skipped” and thus were defined as SMW. In total, 6,905 (3.0%) women had received a BC diagnosis, including 423 (6.1%) SMW. SMW were less likely to have a BC diagnosis than StW (OR 0.48 [0.43-0.53]). Among all women, there were significant differences in frequency and types of visits and procedures performed. SMW women were less likely to undergo annual history and physical examination (0.79 [0.73-0.85]), mammography (0.61 [0.53-0.69]), and breast biopsy (0.55 [0.41-0.72]), as well as being less likely to undergo breast surgeries (mastectomy 0.53 [0.30-0.93]; lumpectomy 0.53 [0.38-0.74]). Survey data revealed differences in several lifestyle factors that relate to BC risk development. While StW were more likely to answer yes to being an “alcohol participant” (0.79 [0.77-0.82]), SMW reported higher rates of alcohol intake on a daily, weekly, and monthly basis, as well as being more likely to consume 6 or more drinks in one sitting. SMW also showed significantly increased history of smoking/nicotine usage. There were also significant differences in healthcare access and utilization: StW were more likely to receive health advice from a primary care provider (0.65 [0.65-0.69]), while SMW were more likely to utilize urgent and emergency care (1.44 [1.34-1.54]). SMW were also more likely to report being unable to afford care (1.82 [1.72-1.93]), medication (1.69 [1.61-1.76]), specialty care (1.98 [1.89-2.08]), and follow-up care (1.85 [1.75-1.95]), as well as to delay care due to cost concerns about the copay (2.13 [2.02-2.23]), deductible (1.64 [1.56-1.73]), paying out of pocket (1.70 [1.63-1.77]) or because they were nervous (2.80 [2.69-2.91]). SMW reported being more likely to experience healthcare discrimination based on questions about healthcare provider interactions (Table 1). Conclusions.Although likelihood of a breast cancer diagnosis in the All of Us database is significantly higher in StW than SMW, discrimination, lack of access, and underutilization of preventative and screening services by SMW likely creates an underrepresentation of the true number of SMW with BC. Further studies on characteristics at diagnosis, treatments, and survival are needed to address how these disparities affect BC outcomes in SMW. Table 1: Survey answers among sexual minority women (SMW) compared to straight women (StW) reporting on discrimination from healthcare provider interactions in the All of Us database. SMW: sexual minority women; StW: straight women; OR: odds ration; Lower 95 CI: lower 95% confidence interval; Upper 95 CI: upper 95% confidence interval; Sig. *: statistically significant with p &amp;lt; 0.05; OR&amp;gt;1: SMW most likely to answer; OR &amp;lt;1 StW most likely to answer. Citation Format: Lucas Houser, Collin Dougherty, Sean Figy, Jessica Maxwell, Juan Santamaria-Barria. Breast Cancer Care Disparities in Sexual Minority Women: An Analysis of the National Institutes of Health All of Us Research Program [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-09-11.

Abstract PO3-27-09: A Multidisciplinary Telehealth Approach to Breast Cancer Prevention in a Veteran Population

Abstract INTRODUCTION An estimated 13% of women will be diagnosed with breast cancer at some point in their lifetime. There are non-modifiable and modifiable risk factors including family history, genetics, obesity, and estrogen exposure. Interventions that reduce breast cancer risk and/or mortality include screening, chemoprevention, and lifestyle modification. A recent national survey shows that there are significant gaps in providing breast cancer prevention care for female Veterans. We describe the creation of a multi-disciplinary telehealth clinic aimed at reducing breast cancer risk in a high-risk female Veteran population. METHODS The breast cancer prevention clinic (BCPC) team consists of a medical oncologist, geneticist, genetic counselor, dietician, psychologist, and nurse navigator. High risk women are identified through a combination of screening questionnaires at annual mammography and genetics or primary care provider (PCP) evaluation, then referred to the clinic. Criteria for referral include age &amp;gt;=35, Gail 5 year risk &amp;gt;= 1.7%, Tyrer-Cuzick 10 year risk &amp;gt;= 5%, or history of thoracic radiation. At the BCPC telehealth visit, the medical oncologist makes individualized recommendations about chemoprevention by discussing the risks and possible complications of therapy. Use of screening magnetic resonance imaging (MRI) is also recommended to women with lifetime Tyrer-Cuzick score &amp;gt; 20%. Within the same visit, patients meet with a dietician to discuss nutrition modification, and a psychologist to address psychosocial barriers to lifestyle change. Those who start chemoprevention attend a 3 month follow-up with a nurse navigator to discuss tolerability and side effects. Subsequently, the patient’s PCP becomes responsible for management of chemoprevention and annual breast MRI. RESULTS Between January and December 2022, 33 patients were seen in BCPC. Patients had an average age of 52 years (range 42-70), Gail 5-year score of 2.53%, Tyrer-Cuzick 10-year score of 6.65%, and Tyrer-Cuzick lifetime score of 21.5%. Thirteen patients (39.4%) started chemoprevention, the majority of which were selective estrogen receptor modulators (SERM). Nine reported starting the medication at the 3 month follow-up appointment. The most reported side effect was hot flashes in 67%, although only the majority had mild symptoms. Three reported weight gain and one reported vaginal dryness. None reported worsening arthralgia or fatigue. Despite the low incidence of severe symptoms, only 3 continued to fill the medication at the time of chart review in August 2023. Twenty (60.6%) patients did not initiate chemoprevention. Four (20%) did not qualify due to cardiovascular or thrombotic risk factors, and three (15%) did not qualify due to concurrent use of hormone replacement therapy. Two (10%) elected not to start chemoprevention because they were planning for risk reducing mastectomies. Eleven (55%) did not initiate chemoprevention due to patient preferences and concern for side effects. Twenty-eight patients were recommended to obtain breast MRI in addition to mammogram for yearly screening. At time of chart review, 15 had at least one screening breast MRI ordered by PCP after BCPC visit, with 10 MRIs performed. CONCLUSIONS The unique interdisciplinary model of our breast cancer prevention clinic allows for a comprehensive and personalized evaluation for high-risk female Veterans on interventions to reduce their breast cancer risk. However, the current model does not ensure long-term compliance with these interventions. Studies have shown that more frequent/short-term follow up may improve compliance with endocrine therapies. Future directions include clinic expansion and providing additional follow-up with the multidisciplinary team to promote continued adherence to BCPC interventions. Citation Format: Hanqing Shang, Sarah Ansari, Shweta Dhar, Mahdieh Irranejadparizi, Stacey Edwards, Jessica Honkomp, Meagan Siehr, Bethany Aiena, Mary Nikityn, Diana Bearden, Deleene Menefee, Sita Bushan. A Multidisciplinary Telehealth Approach to Breast Cancer Prevention in a Veteran Population [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-09.

Association of Medicare Home Health Ratings With Older Adult Fall Injuries: An Instrumental Variables Analysis

ObjectivesTo understand the role of high-quality home health care for fall prevention. DesignA 100% sample of national Medicare claims and home health survey data (2015-2017) were used to assess fall injuries and receipt of a fall risk assessment among recently hospitalized Medicare fee-for-service home health users aged ≥66 years. Subanalyses examined patients by prior fall history status and hospital admission diagnosis type (eg, neurologic, respiratory, cardiovascular, infection, and orthopedic diagnoses). An instrumental variables design addressed potential endogeneity in home health care use by patient fall risk. Setting and ParticipantsHome health agencies and Medicare fee-for-service beneficiaries. MethodsMultivariate regression and instrumental variables. ResultsAmong 962,610 patients with hospital discharges to home health, being treated by home health agencies with the highest star ratings in a person's zip code was associated with a 1.8–percentage point (ppt) (95% CI: 0.1, 3.5; P = .03) higher likelihood of receipt of fall risk assessment. There was no overall change in 30-day (−0.6 ppt, 95% CI: −1.3, 0.1; P = .09), 15-day (−0.3 ppt, 95% CI: −0.0.8, 0.2; P = .35), or 7-day fall injury risk (−0.2 ppt, 95% CI: −0.5, 0.1; P = .22), but a 1.9-ppt (95% CI: −3.9, −0.02; P = .048) lower 30-day fall injury risk for individuals with a history of falls. Effects were directionally similar by diagnosis type. Conclusions and ImplicationsFall injury risk is reduced at higher-rated home health agencies. Star ratings may be adequate indicators of quality for key outcomes not explicitly measured in the ratings.

Mortality in French people with polyhandicap/profound intellectual and multiple disabilities.

In recent decades, progress has been made in the care of people with polyhandicap/profound intellectual and multiple disabilities (PIMD) through a better understanding of the pathophysiology and the development of new care management and rehabilitation strategies adapted to these extreme pathologies. Although there is a lack of knowledge about the health status and care management of the oldest people, a better understanding of the natural course of life of people with polyhandicap/PIMD would consequently allow the optimisation of preventive and curative care management strategies. Few robust data on mortality and life expectancy have been documented for this population in France. Our aims are to estimate the median survival time and assess the factors associated with mortality in people with polyhandicap/PIMD receiving care in France. This study included people with polyhandicap/PIMD, followed by the French national cohort 'Eval-PLH' since 2015. These individuals were included in specialised rehabilitation centres and residential institutions. The people included in the first wave of the cohort (2015-2016) were eligible for the present study. Vital status on 1 January 2022 (censoring date) was collected in two ways: (1) spontaneous reporting by the participating centre to the coordinating team and (2) systematic checking on the French national death platform. According to the vital status, survival was calculated in years from the date of birth to the date of death or from the date of birth to the censoring date. The factors associated with mortality were evaluated using the Cox proportional regression hazards model. Data from 780 individuals aged between 3 and 67years were analysed. At the censoring date, 176 (22.6%) had died, and the mean survival was 52.8years (95% confidence interval: 51.1-54.5). Mortality was significantly associated with a progressive aetiology, recurrent pulmonary infections, drug-resistant epilepsy and a higher number of medical devices. This study shows for the first time the survival and impact of factors associated with mortality in people with polyhandicap/PIMD in France.

Cost-effectiveness of population-based screening for chronic obstructive pulmonary disease in China: a simulation modeling study

China has the highest disease burden of chronic obstructive pulmonary disease (COPD) in the world; however, the diagnosis rate remains low. Screening for COPD in the population may improve early diagnosis and long-term health outcomes for patients with COPD. In this study, we aimed to evaluate the cost-effectiveness of population-based COPD screening policies in China. We developed a microsimulation model that simulated incidence, natural history, and clinical management of COPD over a lifetime horizon among the general population aged 35-80 years in China. We evaluated population-based screening policies with different screening methods (one-step with COPD Screening Questionnaire or two-step with additional portable spirometer test) and frequencies (one-time or every 1-10 years). We calculated the incremental cost-effectiveness ratio (ICER) of the screening policies compared with the status quo (without screening) and identified the most cost-effective screening policy. Scenario and sensitivity analyses were performed to assess the impact of key parameters and the robustness of model results. Compared with the status quo, all population-based COPD screening policies were cost-effective with estimated ICERs ranging between $8034 and $13,209 per quality-adjusted-life-year (QALY), all under the willingness-to-pay value of $38,441/QALY (three times China's gross domestic product per capita). A total of 0.39%-8.10% of COPD-related deaths and 0.58%-2.70% of COPD exacerbations were projected to be averted by COPD screening. Among all screening policies, annual two-step screening was the most cost-effective. Improving the linkage from screening to diagnosis and treatment could further increase population health benefits and the cost-effectiveness of COPD screening. Population-based screening for COPD could be cost-effective in China. Offering public programs for COPD screening similar to existing preventive health services for other chronic diseases could be a promising strategy to improve population health outcomes and mitigate the disease burden of COPD in China. Alexander von Humboldt Foundation, National Natural Science Foundation of China, CAMS Innovation Fund for Medical Science, Chinese Academy of Engineering project, and Horizon Europe.

Developing the Social Cognitive Factor Scale (SCFS) to Analyze the Determinants Influencing the Utilization of Traditional Chinese Medicine Preventive Health Services among Older Adults

Developing the Social Cognitive Factor Scale (SCFS) to Analyze the Determinants Influencing the Utilization of Traditional Chinese Medicine Preventive Health Services among Older Adults

The design and implementation of a multi-center, pragmatic, individual-level randomized controlled trial to evaluate Baby2Home, an mHealth intervention to support new parents

BackgroundBecoming a parent is a transformative experience requiring multiple transitions, including the need to navigate several components of health care, manage any mental health issues, and develop and sustain an approach to infant feeding. Baby2Home (B2H) is a digital intervention built on the collaborative care model (CCM) designed to support families during these transitions to parenthood. ObjectivesWe aim to investigate the effects of B2H on preventive healthcare utilization for the family unit and patient-reported outcomes (PROs) trajectories with a focus on mental health. We also aim to evaluate heterogeneity in treatment effects across social determinants of health including self-reported race and ethnicity and household income. We hypothesize that B2H will lead to optimized healthcare utilization, improved PRO trajectories, and reduced racial, ethnic, and income-based disparities in these outcomes as compared to usual care. MethodsB2H is a multi-center, pragmatic, individual-level randomized controlled trial. We will enroll 640 families who will be randomized to: [1] B2H + usual care, or [2] usual care alone. Preventive healthcare utilization is self-reported and confirmed from medical records and includes attendance at the postpartum visit, contraception use, depression screening, vaccine uptake, well-baby visit attendance, and breastfeeding at 6 months. PRO trajectories will be analyzed after collection at 1 month, 2 months, 4 months, 6 months and 12 months. PROs include assessments of stress, depression, anxiety, self-efficacy and relationship health. ImplicationsIf B2H proves effective, it would provide a scalable digital intervention to improve care for families throughout the transition to new parenthood.

Utilization of Health Care Services and Accessibility Challenges among Adults Aged 50+ before and after Austerity Measures across 27 European Countries: Secular Trends in the SHARE Study from 2004/05 to 2019/20.

This study aimed to assess and compare the utilization of preventive and other health services and the cost or availability in different regions of Europe, before and during the economic crisis. The data used in the study were obtained from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (2019/2020) and Wave 1 data (2004/5), with a sample size of 46,106 individuals aged ≥50 across 27 countries, adjusted to represent a population of N = 180,886,962. Composite scores were derived for preventive health services utilization (PHSU), health care services utilization (HCSU), and lack of accessibility/availability in health care services (LAAHCS). Southern countries had lower utilization of preventive services and higher utilization of other health services compared to northern countries, with a significant lack of convergence. Moreover, the utilization of preventive health services decreased, whereas the utilization of secondary care services increased during the austerity period. Southern European countries had a significantly higher prevalence of lack of accessibility. An increase in the frequency of lack of accessibility/availability in health care services was observed from 2004/5 to 2019/20. In conclusion, our findings suggest that health inequalities increase during crisis periods. Therefore, policy interventions could prioritize accessibility and expand health coverage and prevention services.

Electronic medical record system for school dental hygienists: a preventive focus

Relevance. Clinical documentation remains a cornerstone of medical practice. Over the last decade, there has been a notable evolution in the standards for medical documentation and the speed of processing due to advancements in healthcare information technology, including electronic medical record systems. Despite the Ministry of Health of Russia endorsing specific documentation procedures for healthcare organizations, pediatric preventive care dental services have not yet been provided with an appropriate electronic documentation format.Materials and methods. The development of the electronic medical record system for dental hygienists employed Qt Creator software (http://www.qt.io/), using the C++ programming language framework (http://www.isocpp.org/). The system's efficacy was evaluated through testing across the Omsk region over the period 2020-2021.Results. The project resulted in the successful creation of an electronic medical record system designed for dental hygienists.Conclusion. The new electronic medical record system is set to greatly improve the effectiveness of primary preventive care for dental specialists.

Challenges and Opportunities in Breast Cancer Care in Low-Resourced Countries, Jordan as An Example.

Jordan is a relatively small country with a rapidly growing population and a challenged economy. Breast cancer is the most diagnosed cancer among women worldwide and also in Jordan. Though the age-standardized rate (ASR) of breast cancer incidence is still lower than that in Western societies, the number of newly diagnosed cases continues to increase, involving younger women, and new cases are usually detected at more advanced stages. Improvements in breast cancer care across the health care continuum, including early detection, prevention, treatment, and survivorship and palliative care, have become very visible, but may not match the magnitude of the problem. More organized, goal-oriented work is urgently needed to downstage the disease and improve awareness of, access to, and participation in early detection programs. The cost of recently introduced anti-cancer therapies poses a great challenge, but the impact of these therapies on treatment outcomes, including overall survival, is becoming very noticeable. Though the concept of a multidisciplinary approach to breast cancer treatment is often used at most health care facilities, its implementation in real practice varies significantly. The availability of breast reconstruction procedures, survivorship programs, germline genetic testing, counselling, and palliative care is improving, but these are not widely practiced. In this manuscript, we review the status of breast cancer in Jordan and highlight some of the existing challenges and opportunities.

Health care: life stories by trans women in Colombia

BackgroundIn Colombia, health care for people with trans life experiences is characterised by countless barriers to health services and care. Commonly, trans people have experienced stigma and discrimination among health professionals, a lack of services and professionals specialized to guarantee affirmative processes from non-hegemonic gender perspectives, and there exists a marked pathologization and medicalization of services. Therefore, it is necessary to provide affirmative health services to improve health and well-being from the recognition of their needs and experiences. The article describes life narratives about health care for the gender transitions of trans women in Colombia.MethodsA qualitative narrative study was conducted with 139 trans women in seven cities in Colombia. In-depth interviews and discussion groups were conducted between June 2019 and March 2020. Data were analyzed using thematic analysis and the Atlas Ti cloud program. National and international ethical guidelines were followed in the development of the research.ResultsThis research provided an overview of the health experiences of Colombian trans women. They reported their experiences of pathologizing approaches to transgender healthcare, stigma, discrimination, and barriers to accessing preventive, specialized, and regular healthcare services. For this reason, they opted for self-medicated gender transition processes and self-management of health care. An important aspect to consider within healthcare is that not all women want binary gender transition processes.ConclusionParticipants felt that in Colombia there is a lack of affirmative health care for transgender women and that there are many limitations to care related to the gender transition processes. This exposes them to more situations that violate their rights and influences their lack of confidence and their search for professional health care. In Colombia, it is important to develop strategies for education, information, and communication, as well as a handbook for health workers on specialized healthcare for trans women.

Multistate outbreaks of salmonellosis linked to contact with backyard poultry-United States, 2015-2022.

Contact with backyard poultry (i.e., privately-owned, non-commercial poultry) was first associated with a multistate outbreak of salmonellosis in 1955. In recent years, backyard poultry-associated salmonellosis outbreaks have caused more illnesses in the United States than salmonellosis outbreaks linked to any other type of animal. Here, we describe the epidemiology of outbreaks from 2015-2022 to inform prevention efforts. During 2015-2022, there were 88 multistate backyard poultry-associated salmonellosis outbreaks and 7866 outbreak-associated illnesses caused by 21 different Salmonella serotypes. Salmonella Enteritidis accounted for the most outbreaks (n = 21) and illnesses (n = 2400) of any serotype. Twenty-four percent (1840/7727) of patients with available information were <5 years of age. In total, 30% (1710/5644) of patients were hospitalized, and nine deaths were attributed to Salmonella infection. Throughout this period, patients reported behaviours that have a higher risk of Salmonella transmission, including kissing or snuggling poultry or allowing poultry inside their home. Despite ongoing efforts to reduce the burden of salmonellosis associated with backyard poultry, outbreak-associated illnesses have nearly tripled and hospitalizations more than quadrupled compared with those in 1990-2014. Because this public health problem is largely preventable, government officials, human and veterinary healthcare providers, hatcheries, and retailers might improve the prevention of illnesses by widely disseminating health and safety recommendations to the public and by continuing to develop and implement prevention measures to reduce zoonotic transmission of Salmonella by backyard poultry.

Oral health statuses of individuals diagnosed with gastroparesis: A Cross-Section study.

Gastroparesis (GP) is a debilitating gastric motility disorder associated with digestive dysfunction, reduced quality of life (QoL), and increased mortality rates. There is no known cure for GP and treatment options are limited. The oral cavity is responsible for initiating digestion, yet the impact of GP symptom frequency on oral health status and oral healthcare utilization is not well understood. A 21-item electronic survey was developed and disseminated to a private GP social media forum. Survey questions explored GP symptom frequency, oral health status, dental care utilization, and oral health education post GP diagnosis. Descriptive and inferential statistics analysed data. There were 434 study participants. An overwhelming 83% reported GP negatively influenced their oral health and oral function. Significance was observed between GP symptom frequency and oral health status (p = <0.0001). The majority (81%) reported receiving dental care post GP diagnosis, yet (63%) reported current untreated dental concerns. Interestingly, (74%) of participants reported that they have never been educated about oral health risks associated with GP by any healthcare professionals. GP negatively affects oral health. Study participants reported a need for extensive dental treatments and high levels of untreated dental concerns. Results strongly support that preventive oral healthcare and education must be provided for individuals with a GP diagnosis. As leading oral disease prevention specialists, dental hygienists must be aware of the effects of GP on the oral cavity to help provide person-centred evidence-based care, improve digestive processes, and increase QoL for GP sufferers.

Health system inequities in Lao People's Democratic Republic: Evidence from a nationally representative phone survey.

Despite substantial economic growth in Lao People's Democratic Republic (PDR) over the past 20 years, high levels of income inequality and poverty persist and have likely been exacerbated by the COVID-19 pandemic. In this article, we use novel survey data to assess the extent to which socioeconomic status is associated with access to quality care in Lao PDR. We utilised data from the Lao People's Voice Survey (PVS), which was designed to measure health system performance from the perspective of the population. The survey was conducted between May and August 2022. Primary outcomes of interest were having a usual source of healthcare, using a government health centre (rather than a hospital or private clinic) as the usual source for care, receiving preventive health services, experiencing unmet healthcare needs, the quality of recent healthcare visit, and confidence in accessing and affording healthcare when needed. Poverty was measured using household asset ownership. We used logit models to assess the associations between poverty and health system performance measures, and additionally assessed differences between these associations in urban vs. rural areas by interacting urban residence with poverty. Poverty was negatively associated with having a regular provider for care (adjusted odds ratio (aOR) 0.45, 95% CI 0.26-0.78), receiving preventive health services (aOR 0.54, 95% CI 0.37-0.80), and confidence in the ability to receive care (aOR 0.50, 95% CI 0.34-0.72) and afford care (aOR 0.50, 95% CI 0.34-0.73) when needed. Poverty was positively associated with using government managed health centres as a usual source or for care (aOR 2.16, 95% CI 1.35-3.48). Poverty was not significantly associated with user experience or perceived quality of care in the last visit to the health facility. No differences in the associations between poverty and access to quality care were found between rural and urban settings. The results presented in this article suggest socioeconomic disparities in health care access in Lao PDR despite major national efforts to provide universal access to care. Universal health care policies may not be reaching the poor and additional targeted efforts may be needed to meet their healthcare needs.

The role of developmental factors in hypoplasia of deciduous teeth and treatment specifics in pediatric dental practice

Relevance. Congenital and systemic diseases can lead to developmental errors in the enamel organ, resulting in anomalies such as enamel hypoplasia. The high prevalence of these defects illustrates the vulnerability of teeth to changes in the intrauterine and postnatal environments. Enamel hypoplasia contributes to the development of caries and tooth wear by making enamel thinner, more retentive to dental plaque, and less resistant to acid degradation compared to normal enamel. Surfaces of the affected hard tissues are smooth and exhibit a symmetric distribution pattern. The occurrence of enamel hypoplasia in children is a significant factor in the development of caries; thus, they require comprehensive treatment and ongoing preventive care by a pediatric dentist.Purpose. To analyze the impact of factors contributing to the development of deciduous teeth hypoplasia in children, on the frequency of this condition and the specifics of its treatment by a pediatric dentist.Materials and Methods. The study involved the examination and treatment of children aged 4-12 at the Dental and Implantology Department of Kazan (Volga Region) Federal University over a 12-month period. Out of 972 children, 67 were diagnosed with systemic enamel hypoplasia. A questionnaire was developed for statistical research, and data were processed using Statistica 7.0 software Statistica 7.0 (StatSoft, США).Results. The survey revealed chronic diseases in 16.42% of mothers. During pregnancy, 68.6% of the mothers visited a dentist once, and 31.3% visited two to three times. Most mothers experienced early pregnancy toxemia—67% in the first half and 58.2% in the second half of the pregnancy. Additionally, 50.7% suffered from acute respiratory viral infections and influenza, and 25.4% had gastrointestinal diseases. Feeding practices involved breastfeeding in 68.7% of cases and artificial feeding in 31.3% (up to 3 months – 16.4%, up to 1 year – 64.1%, up to 2 years – 19.4%). Examination of the oral cavity in 67 children with systemic hypoplasia revealed a spotted form in 79.1% of cases and a purely destructive form in 20.9% of cases. Contemporary conservative dentistry emphasizes minimally invasive approaches to the treatment of such dental defects.Conclusion. The study of deciduous tooth hypoplasia in children highlighted the importance of the health status of the expectant mother and timely sanitation of the oral cavity. Particular attention should be paid to maternal infectious diseases, specifically influenza and ARVI. The findings underscore the need for preventive measures against temporary tooth hypoplasia from the onset of pregnancy planning to enhance the dental well-being of children.

Patient satisfaction with nursing care in infertility patients: A questionnaire survey.

Infertility remains a persistent global reproductive health challenge, with causative factors encompassing abnormalities in both the male and female reproductive systems. Typically, female partners seek initial consultations for infertility concerns, often within the context of routine annual well-woman check-ups. Nurses providing preventive care play a crucial role, conducting initial diagnostic assessments, and addressing certain causes of infertility. Patient satisfaction serves as a vital indicator of care quality. Identifying factors contributing to patient satisfaction with nursing services is crucial, yet research in this area has been limited. This study aimed to compare infertility patients' assessments of nurse quality and satisfaction with hospital services. The findings could offer valuable insights for healthcare providers, hospitals, and policymakers, guiding improvements in nursing care delivery and enhancing patient satisfaction in China's infertility treatment sector. By understanding patients' perspectives and experiences, healthcare providers can make necessary adjustments to improve care quality and patient outcomes. The sample included 1200 patients, and data collection utilized a self-assessment questionnaire, with percentages employed for analysis. Nurses are integral to caring for infertility patients during visits and conducting research to advance fertility care practices.