Previous Consultation Research Articles

Assesment of anxiety and depression in pregnant women in home care management

This study aims to identify factors associated with depressive and anxious symptomatology in pregnant women hospitalized during the antepartum period in home care management (Hospitalisation à domicile). This is a quantitative, single-center, observational, and descriptive study that included all French-speaking women hospitalized in the HAD of AP-HP between September 2022 and February 2023. Anxious and depressive symptoms were assessed using the self-administered HADS (Hospital Anxiety and Depression Scale) questionnaire. Analyses were conducted according to two distinct groups, comparing patients with an anxiety or depression scores below 8 on the HADS to those with a score of 8 or above (the threshold set on the questionnaire corresponding to intermediate symptomatology). A second questionnaire created for the study detailed maternal history, pregnancy experience, and lifestyle. A total of sixty-four women were included from September 20, 2022, to February 15, 2023. Eighteen women (28%) evaluated had anxious symptomatology and thirteen women (20%) had depressive symptomatology. Factors significantly associated with anxiety were poor pregnancy experience (p = 0.04), the need for psychological follow-up during pregnancy (p<0,01), country of birth (p = 0.022), as well as psychiatric history such as previous consultations with a mental health specialist (p = 0.015) and previous psychotropic treatment (p = 0.028). Additionally, a history of violence (respectively, p = 0.034 and p<0.01) and the women's belief that a consultation with a psychologist would benefit them were also associated with anxious and depressive symptomatology (respectively, p<0,01 and p <0.01) Conclusion: Our results highlight the importance and necessity of enhancing the screening and prevention of various mental disorders during pregnancy. It would be interesting to implement organized screening for anxiety, similar to depression, in pregnant women hospitalized at home and for the entire obstetric population.

Development and Validation of an Index to Measure and Quantify Pet-Related Barriers to Healthcare Access and Utilization

ABSTRACT Issues such as inadequate transportation, language barriers, being uninsured, and living in geographic locations with poor service availability can prevent people from accessing necessary healthcare. In addition, approximately 60% of the US population has pets, which can also create barriers to healthcare that are related to pet caregiving responsibilities and concerns about pet welfare, particularly when they have inadequate social and economic resources. This study introduces a new index to measure pet-related barriers to healthcare: the Pet-Related Barriers to Healthcare Index (PRBH). We first describe the development of the index based on previous literature and expert consultation. Next, we evaluate the psychometric properties of the index in a sample of 219 pet-owning people with HIV in Florida. We use three validation approaches: (1) confirmatory factor analysis to test the hypothesized two-factor structure of the PRBH measure and to compare the fit of this model with alternative models, (2) assessment of construct validity for the PRBH factors with validated measures of commitment to pets, comfort derived from pets, and social support from people, and (3) latent class analysis to identify underlying patterns of endorsement of items. Additionally, we assessed differences in index scores by sociodemographic characteristics. Our results indicate that: (1) a modified 2-factor model that split items based on item phrasing fit the data best: one factor measured previously experienced barriers, while the other factor measured anticipated future barriers. This factor structure was further supported by the results of the latent class analysis. (2) Poorer social support from people was associated with higher endorsement of both factors. And (3) Twenty percent of the participants were characterized by high endorsement of the index items. The use of the PRBH in research and clinical settings is an important step in standardizing the quantification of this construct, identifying populations most at risk for pet-related barriers to their healthcare, and moving toward systematized support services for those groups and their animal companions.

Risk factors for non-isolation of patients admitted for pulmonary tuberculosis in a high-incidence department: a single-centre retrospective study

Pulmonary tuberculosis (PT) is an airborne disease, justifying the identification of suspect patients on admission, and their hospitalization in individual rooms with the implementation of Airborne Supplementary Precautions (ASP). The aim of this study was to identify, in a high-prevalence hospital, the frequency of non-isolated PT and the factors associated with the delay in implementing ASP.This was a retrospective observational study, including patients with at least one Mycobacterium tuberculosis-positive specimen. Patient demographic and clinical data, as well as data related to the mode of admission, were collected. Univariate and multivariate statistical analyses were performed.During the study period, 256 patients were included. Among them 134 (52.3%) had PT. These included 100 (75%) men, median age 39, 70% foreign-born. Among these patients, 46 (34%) were isolated beyond the 24th hour of admission. The average time to implement ASP was 4.3 days, and 7 patients (5.2%) were not isolated throughout their stay. Three classes of factors were associated by multivariate analysis with isolation. Previous consultation with a general practitioner was protective whereas admission through emergency department was not. Presence of so-called cardinal clinical signs and a suggestive chest X-ray were protective factors. Finally, European patients were less frequently isolated.In our study, 34% of patients admitted with PT were not isolated on admission. The risk of non-isolation was 3 times higher in cases of admission via the emergency department, and European patients were less well isolated. The presence of cardinal signs and prior consultation with a general practitioner were associated with a higher frequency of isolation.

What Do Travelers Know about Traveler's Diarrhea? Impact of a Pre-Travel Consultation in the Lisbon Area, Portugal.

Traveler's diarrhea (TD) is one of the most common travel-related health problems, largely interfering with planned activities and potentially contributing to antimicrobial resistance. This study aimed to characterize the knowledge about TD among pre-travel consultation users of one Portuguese travel clinic and determine the impact of the consultation on knowledge levels. Using a quasi-experimental, separate-sample pretest-posttest design, participants were randomly assigned to two groups: control/pre-consultation group (CG) or experimental/post-consultation group (EG). An anonymous self-administered questionnaire was used. A total of 470 participants were analyzed (227 CG; 243 EG). The EG/post-consultation group showed significant improvement in knowledge, with correct answers increasing from 63% to 75% (p < 0.001). However, knowledge gaps persisted: over 50% were unaware of TD's self-limited nature, 30% did not recognize loperamide as a symptom reliever, and 36% believed all travelers should take antibiotics to prevent TD. The educational level and previous travel outside Europe influenced baseline knowledge; previous travel medicine consultations and information on TD improved knowledge in both groups and made it easier to acquire knowledge on the subject. Thus, a pre-travel consultation effectively increased travelers' TD knowledge. However, post-consultation knowledge levels remained suboptimal, indicating the need for targeted interventions to increase travelers' literacy and optimize pre-travel consultations.

Methodology for selecting potential CO2 sinks in Macaronesia: The case of Gran Canaria

Carbon dioxide (CO2) accounts for 80% of the greenhouse gas emissions in the atmosphere. One of the several ways to mitigate CO2 emissions is through afforestation, which prevents catastrophic environmental consequences. The mean average emission per tourist in the Canary Islands on their way to the islands is 0.48 Tn. Like most urban cities, the island of Gran Canaria faces the problem of CO2 emissions due to anthropogenic and human activities. Vegetation coverage significantly influences the distribution of temperature. The correlation between Land Surface Temperature (LST) and Normalized Difference Vegetation Index (NDVI) of Gran Canaria, using satellite images from Landsat 8 and Sentinel-2, revealed a strong inverse relationship within all land use types, with an R2 value of 0.39. Land suitability analysis is a prerequisite for optimum utilization of available land resources. This study developed a suitability map for afforestation based on land use land cover, topographic, meteorologic, and socio-economic factors. Eight factors, including distance from settlements, land use, distance from the road, distance from water, elevation, slope, precipitation, and temperature, were employed according to previous studies, expert consultation, and land suitability mapping experience. After the criteria decision and data acquisition, maps of each criterion were created and transformed using the Suitability Modeler of ArcGIS Pro. The current study results show that 87% of the total area is suitable for afforestation and reforestation projects in Gran Canaria. Instead of using reactive methods to lessen the effects, the study recommends a proactive approach to climate adaptation through nature-based solutions. The study is part of an umbrella project of the Canary Islands and Spain in general, which considers the contributions of local and institutional stakeholders at different stages of the project. The next stage will be to design a forest afforestation and reforestation project, considering the kind of tree species needed, the methods required to implement it, and the management guidelines about the initial years of installation and growth of the new trees. The most crucial technical choice is which forest species to choose, as it will determine the success of the reforestation effort. The new revegetated space's ability to sequester carbon dioxide will primarily rely on the productivity of the land used for forest reforestation, the species chosen, and the introduced planting density.

Pharmacies Counselling of Patients in the Era of Antifungal Resistance.

Tinea pedis is one of the most prevalent superficial fungal infections. Initial antifungal treatment is often acquired over-the-counter (OTC) without previous consultation with a physician. Lately, increasing antifungal terbinafine resistance has been documented in Denmark and globally and it is therefore of interest to assess how Danish pharmacies advise customers with tinea pedis. One hundred Danish pharmacies were randomly selected and an employee interviewed from each. A structured question guide was followed, with the possibility to add further comments. Interviews of 94 pharmacies were conducted. Six pharmacies never replied. Terbinafine as standard dose or cutaneous solution terbinafine one time application (Lamisil Once (R)) were recommended by 99% of the pharmacy employees as first-line treatment. The customer was advised to seek medical attention when tinea pedis was recurring (93%), or when treatment duration was > 2 weeks (77%). The majority (88%) of the pharmacy employees had no knowledge about antifungal resistance. Only few pharmacy employees were aware of the current problem of antifungal resistance and the majority advised costumers to initiate treatment using OTC topical terbinafine. The problem of emerging antifungal resistance requires attention in order to provide customers with tinea pedis effective treatment and prevent further societal spread of resistance to antifungals.

Cost burden for healthcare and patients related to the unawareness towards laryngopharyngeal reflux.

To investigate the impact of physician unawareness towards laryngopharyngeal reflux (LPR) on healthcare costs. Patients with a confirmed LPR diagnosis were consecutively recruited from Belgian Hospitals. Demographics and clinical outcomes (impedance-pH testing features, reflux symptom score, and reflux sign assessment) were extracted. The past consultations and additional examinations dedicated to the investigation of laryngopharyngeal symptoms and findings without suspicion of LPR were collected. The estimated costs of consultations and procedures were those indicated in the National Health Insurance Institute's Charges for 2022. Part was reimbursed by the social security system, and the rest was paid by patients. Seventy-six patients were recruited. Seventeen patients (22.4%) had no previous consultation or additional examination for their LPR-symptoms. The estimated mean (standard deviation) costs related to the unawareness of LPR for the healthcare system and patient, were 310.06 ± 370.49 €, and 54.05 ± 46.28 €, respectively. The highest estimated costs were related to gastroenterology consultations and procedures, which did not lead to a confirmation of LPR diagnosis. The total estimated cost for the Belgian healthcare system and patients (11,590,000 million), could range from 359 359 540 € to 1 078 078 620 €; and 62 643 950 € to 187 931 850 €, respectively. The estimated costs related to gastroenterology practice of patients with severe disease were significantly higher than patients with mild disease. The unawareness of practitioners toward LPR leads to significant costs for healthcare system and patients. The teaching and awareness towards LPR need to be improved in medical schools and clinical practice.

Determinants of Duration of Untreated Psychosis in Patients with Schizophrenia in Indonesia

Background: The duration of untreated psychosis (DUP) is a crucial factor influencing the prognosis of schizophrenia, affecting long-term outcomes and treatment efficacy. Despite its importance, there is a paucity of research on the determinants of DUP in Indonesian patients with schizophrenia, highlighting the need for a focused investigation within this specific context. This study aims to identify the determinants of DUP among patients with schizophrenia in Indonesia. Methods: A cross-sectional study was conducted involving patients with schizophrenia admitted to a referral psychiatric hospital in Indonesia. Data were collected using guided interviews and observations through structured questionnaires. Additionally, socio-demographic information was gathered. Results: A multiple linear regression analysis revealed that previous consultations with traditional healers (β = 21, 95% CI = 11.4 - 30.6, p = 0.001) and religious healers (β = 16.7, 95% CI = 8.2 - 25.2, p = 0.0001) were independently predicting the longer DUP. Conclusions:Treatment-seeking behavior is significantly influencing the DUP in patients with schizophrenia. Efforts should focus on improving health literacy to encourage earlier mental health treatment-seeking.

Recognition of overweight and obesity by patients and medical practitioners and their practices related to weight reduction; a cross-sectional study

Introduction: Accurate perception of weight by overweight/obese patients and the acknowledgment of their excess weight by medical practitioners are pivotal in managing obesity. This study aims to assess knowledge, perception and practices related to weight reduction among overweight/obese patients and the recognition of their overweight status and interventions by medical practitioners.Methods: This descriptive cross-sectional study interviewed 317 overweight/ obese patients during their first visits to general medical clinics at the University Hospital of Kotelawala Defence University. A structured questionnaire assessed their demographic characteristics, comorbidity, knowledge, perception and practices related to weight reduction. Recognition and management of overweight/ obesity by medical practitioners were evaluated through recall of previous six-month consultations and review of medical records.Results: Among the study participants, 163 (51.4%) were obese and 154 (48.6%) were overweight. Only 63 (19.9%) patients knew the meaning of BMI, and 306 (96.5%) could not define the ideal BMI for a Sri Lankan adult. Less than half (45.4%) considered overweight/obesity a medical problem. Body weight misperception observed among 92 (59.7%) overweight and 150 (92.0%) obese participants. Of the 267 participants who reported being evaluated by another medical practitioner in the previous six months, 102 (38.2%) were told the diagnosis of overweight/obesity. However, weight status was documented only in seven (2.6%) patient records. Nonetheless, 110 (41.2%) patients had received weight reduction advice during previous consultations, and 68 (61.8%) had attempted to lose weight.Conclusions: Low comprehension of the term BMI and misperception of body weight among the studied population is concerning. Patients who received weight reduction advice from medical practitioners were more inclined to lose weight. However, acknowledgment and intervention of the excess weight status of overweight /obese patients by medical practitioners were largely inadequate.

Hybrid care potential of teledermatology: The importance of linking digital and physical practice and acceptance of online services: A cross-sectional study.

Telemedicine, with Teledermatology, has become a central component of modern medicine. Its importance, especially during the COVID-19 pandemic, underlines its potential to optimize access for dermatological needs. The study aims to assess the potential of teledermatology, understand the importance of linking digital and physical practices, and analyze the adoption of online services based on participants' demographic and experiential factors. This cross-sectional survey was conducted among users of the telemedicine platform from July 2022 to March 2023. The platform ("OnlineDoctor") allows users to contact dermatologists for remote dermatological consultations. The survey included questions about the participants' dermatological concerns, their reasons for using teledermatology, their satisfaction with the recommendations and their willingness to continue using telemedicine in the future. Data was collected via the RedCap online platform. Descriptive statistics and regression analyses were carried out. Overall, 1141 people participated in the study (mean age 44.0 years [SD 14.6], 61.4% women). Results showed that 52.7% of participants with skin conditions had not consulted a dermatologist in the previous year. Shorter waiting times and the lack of face-to-face appointments were the main reasons for using the online platform. In total, 77.6% (n = 885) of participants indicated they would use teledermatology as their first choice if they had an upcoming skin condition. Age, gender, and satisfaction with previous consultations impacted the use of teledermatology as the first choice for future skin conditions. Teledermatology is characterized by various benefits, including reduced waiting times and improved accessibility to treatment. Nevertheless, the study underscores the importance of a hybrid care approach with direct interaction with the physician. Teledermatology can be transformative in meeting dermatologic needs, mainly when traditional face-to-face consultation is limited. A deep understanding of user preferences and widespread adoption of digital services can pave the way for the successful adoption of teledermatology platforms, improving healthcare accessibility and efficiency.

A context-driven approach through stakeholder engagement to introduce a digital emergency obstetric and newborn care register into routine obstetric health care services in Bangladesh.

Emergency obstetric and newborn care (EmONC) in Bangladesh focusses on maternal health, whereby it addresses childbirth and postpartum complications to ensure women's health and well-being. It was transitioned to a digital platform to overcome challenges with the paper-based EmONC register and we conducted implementation research to assess the outcome. Here we outline the stakeholder engagement process integral to the implementation research process. We adopted a four-step stakeholder engagement model based on the identification, sensitisation, involvement, and engagement of stakeholders. The approach was informed by previous experience, desk reviews, and expert consultations to ensure comprehensive engagement with stakeholders at multiple levels. Led by the Maternal Health Programme of the Government of Bangladesh, we involved high-power and high-interest stakeholders in developing a joint action plan for digitisation of the paper-based EmONC register. Finally, we demonstrated this digital EmONC register in real-life settings to stakeholders at different levels. The successful demonstration process fostered government ownership and collaboration with multiple stakeholders, while laying the foundation for scalability and sustainability. Nevertheless, our experience highlighted that the stakeholder engagement process is context-driven, time-consuming, resource-intensive, iterative, and dynamic, and it requires involving stakeholders with varied expertise. Effective strategic planning, facilitation, and the allocation of sufficient time and resources are essential components for successful stakeholder engagement. Our experience demonstrates the potential of adopting the 'identification, sensitisation, involvement, and engagement' stakeholder engagement model. Success in implementing this model in diverse settings depends on leveraging knowledge gained during implementation, maintaining robust communication with stakeholders, and harnessing the patience and determination of the facilitating organisation.

Exploratory Factor Analysis of Influences on Social Integration and Religious Practice Among Catholic Students: Evidence from Hanoi- Vietnam

The study contributes to the existing knowledge by introducing how various factors determine religious commitment and practices among Catholic students in Hanoi, Vietnam, an under-studied region in academic literature. In this gap, the research study investigates the impact of social support networks, cultural identity, educational environment, and social integration on the students’ religiosity. The study method is justified, as the researcher employed a well-constructed questionnaire based on previous literature and expert consultations. Thus, the collected data from a stratified random sample of 200 university students in Hanoi over 2020-2022 was analyzed through Structural Equation Modelling (SEM). The study's findings show a positive relationship between social support networks, cultural identity, educational environment, and the dependent variable of religious commitment to the students. Moreover, there is a positive relationship between the dependent and independent variables, as noted in the first significant correlation. These results help bridge the gap and provide practical implications for educators and religious leaders in approaching Vietnamese youth. This can assist their overall spiritual health and help them engage effectively in religious and educational practices in Vietnamese society.

The use of FreeStyle libre improves glycaemic control along with reducing diabetes burden and hospital admissions in a socially deprived Northwest English population.

This retrospective study aimed to use mixed (qualitative and quantitative) methods to evaluate the role of FSL in reducing hospital admissions due to all causes, HbA1c, and reported hypoglycaemic episodes in people with diabetes living in a socially deprived region of Northwest England. Data were collected retrospectively from previous consultations, which coincided with the 6th -week, 6th -month and annual review including blood tests, hospital admissions due to any cause and reported hypoglycaemia. Also, FSL assessment and satisfaction semi-structured questionnaire was done to assess the impact of FSL on diabetes management and quality of life. Mixed-effects models were used to assess glycaemic control and reductions in hospital admissions and reported hypoglycaemic episodes. Just 127 patients met the inclusion criteria. A multivariate linear mixed model method that analyses HbA1c data longitudinally revealed mean differences (mmol/mol) between baseline and post-FSL measurements, estimated by restricted maximum likelihood method (REML) of 9.64 (six weeks), 7.68 (six months) and 7.58 (annual review); all with a corresponding p-value of < 0.0001. For DKA patients, the bootstrap method revealed a significant reduction in mean HbA1c of 25.5, 95% confidence interval (CI) [8.8, 42.6] mmol/mol. It is demonstrated that FSL use for one year resulted in 59% reduction in hospital admissions and 46% reduction in reported hypoglycaemic episodes. The use of FSL resulted in statistically significant reductions in hospital admissions, HbA1c and reported hypoglycaemic episodes among diabetics in a socially deprived Northwest region of England. These outcomes show a direct association with a higher questionnaire score. The online version contains supplementary material available at 10.1007/s40200-024-01424-4.

Evaluation of Awareness and Perception of Clear Aligner Orthodontic Treatment Among Students of Hawler Medical University.

Background and Objectives: The growing emphasis on appearance has led to an increased interest in orthodontic treatment among adults, particularly those who are highly self-conscious about their looks. Clear Aligner Therapy, a nearly invisible and effective method for aligning teeth, represents the latest generation of aesthetic orthodontic treatments. This study aims to assess the awareness and perception of Clear Aligner Therapy among students at Hawler Medical University. Materials and Method: A cross-sectional study was conducted using an online questionnaire comprising four sections: demographics, general dental and orthodontic awareness, knowledge of Clear Aligner Therapy and Fixed Orthodontic Therapy, and optional comments and questions. Results: A total of 383 participants, with an average age of 20.54 years, completed the questionnaire. The majority (89.6%) were Kurds and 63.2% females. Among the participants, 68.2% had visited a dentist as needed, 72.3% had family members with malocclusions, 41% had sought orthodontic consultation. Additionally, 86.2% were familiar with Fixed Orthodontic Therapy, 63.2% had heard of Clear Aligners, 30.5% had undergone orthodontic treatment, and 8.5% individuals had received Clear Aligner Therapy. Conclusion: The knowledge level of Hawler Medical University students regarding Clear Aligner Therapy was determined to be moderate. Despite the fact that they possessed a general understanding of its characteristics and application, their involvement in the treatment and its procedures was limited. Previous orthodontic treatments recipients', satisfaction with their smile, overall concern about teeth, previous orthodontic consultation, and knowledge of Fixed Orthodontic Therapy all notably demonstrated significant associations with the awareness of Clear Aligner Therapy. Keywords: Clear Aligner, Orthodontic treatment, Esthetic treatment, Awareness, Perception, Hawler Medical University.

A Penny for Your Thoughts: Athletes’ and Trainee Sport Psychologists’ Internal Dialogue During Consultations

The purpose of this study was to explore the internal dialogue of trainee sport psychologists (TSPs) and athletes immediately following athlete–practitioner consultations. TSPs (four male and three female, age 22–32 years) and athletes (four male, three female, age 19–29 years) completed a thought-listing procedure twice, while watching video recordings of their previous consultations. The thought-listing procedure involved participants’ pausing the video to record the in-session internal dialogue they had experienced during the consultation. Participants’ responses were categorized into six dimensions: time, place, focus, locus, orientation, and mode. TSPs’ and athletes’ retrospective accounts provided evidence that their in-session internal dialogue was (a) present focused, (b) about in-session material, (c) about the athletes or themselves, (d) about internal and external events, (e) professional (i.e., related to the session), and (f) neutral. Findings provide trainees and inexperienced practitioners with insights into the thought content of TSPs and athletes to guide their own athlete interactions.

Ayurvedic Management of Developmental Displasia of the Hip: A Case Report

Developmental dysplasia of the hip (DDH) poses a significant threat to childhood mobility and can lead to later complications, including the need for hip replacements. This article provides a comprehensive overview of DDH, covering its incidence, prevalence, risk factors, and associated pathology. It emphasizes the importance of early diagnosis and outlines various treatment modalities, ranging from non-surgical interventions like the Pavlik harness to surgical options such as open reduction and hip reconstruction. The article includes a case report of an 8-year-old female with DDH who sought Ayurvedic treatment after previous consultations offered surgery as the primary solution. The therapeutic intervention involved a combination of Koshta Shuddhi, Basti Karma, and oral medications. The results indicated a significant reduction in pain and improved mobility, demonstrating the potential efficacy of Ayurvedic approaches in managing DDH. The discussion delves into the pathophysiology of DDH, highlighting the role of Vata Dosha and emphasizing the multifaceted benefits of Ayurvedic treatments in addressing the underlying imbalances. The presented case underscores the importance of personalized care and alternative treatment options for DDH, contributing to the broader discourse on holistic healthcare and integrative medicine. In conclusion, this article provides a thorough exploration of DDH, incorporating clinical features, diagnosis, and a detailed treatment case study. It not only contributes valuable insights into the conventional management of DDH but also introduces the potential benefits of Ayurvedic interventions, opening avenues for further research and collaboration between traditional and modern medical practices.

Oncology and Palliative Care Integration Model: A Cost Analysis Study in a Brazilian Hospital Setting.

Background: In 2019, the São Paulo State Cancer Institute (ICESP) implemented a novel model integrating Oncology with Palliative Care specialists. We evaluated the impact of this model on healthcare resource utilization and costs. Methods: We analyzed data from all patients who passed away in February (1month prior to implementation) and November (8months after model implementation group) at ICESP, Brazil. Healthcare utilization data, including emergency department visits, hospital and intensive care unit admissions, chemotherapy, and radiotherapy use, were retrieved from Electronic Medical Records. Unit cost values were obtained from the administrative database. Results: A total of 198 patients who died in February and 196 in November were included in the analysis. Groups exhibited similarities in sex, age, ECOG, cancer type, previous outpatient palliative care consultations, and place of death (ward: 56.6% pre-intervention, 50% post-intervention). The mean cost per patient was US$13,226.29 pre-intervention and US$11,445.82 post-intervention (P = .007). Statistically significant differences were noted in days hospitalized in the surgical ward (227 vs 115), emergency department visits (233 vs 45), chemotherapy sessions (140 vs 26), and radiotherapy sessions (146 vs 10). Excluding outpatient treatments, the total costs for chemotherapy and radiotherapy in the last 30days of life were US$16,924.45 pre-intervention and US$7851.65 post-intervention. Reductions were more pronounced in patients with ECOG 3-4 (P = .039). Conclusion: Our data suggests that the integration model was associated with a reduction in potentially inappropriate treatments during the last month of life, leading to decreased healthcare utilization and costs.

What makes a good general practice consultation? An exploratory pilot study with people from a low socioeconomic background.

While patients from low socioeconomic (SES) backgrounds are at increased risk of developing chronic health conditions, typically managed within general practice, they report fewer positive consultation experiences with GPs than patients from higher SES groups. To our knowledge, existing research does not provide an in-depth understanding of the GP conducts that contribute to positive consultations. To identify the factors that patients from low SES backgrounds perceive as essential for creating good consultation experiences. This exploratory pilot study was performed in GP clinics in Melbourne, Australia. We used an appreciative inquiry approach, focused on positive consultation experiences, previously shown to be helpful for researching sensitive topics. Nine patients from low SES backgrounds, who reported positive consultation experiences, undertook a semi-structured qualitative interview while watching the video recording of their GP consultation. Four different GPs were captured in the recordings. Inductive thematic coding was performed by two researchers. The following four categories were developed: 1) the doctor's demeanour and how the patient was made to feel during the consultation drove their engagement; 2) an established and collaborative therapeutic relationship was of high importance to patients; 3) a doctor's therapeutic skillset was integral to patient confidence and comfort; and 4) patients appreciated verbal and non-verbal communication techniques. In each interview, the discussion about the video-recorded consultation often triggered reflections about previous consultations with the respective GP. For patients from low SES groups, positive consultation experiences were underpinned by perceived continuity of care with a specific GP who consistently showed good communication skills and key interpersonal characteristics. This research is a small step towards increasing our understanding of the experience of individuals from low SES backgrounds in primary care and the existing health inequities within this area.

Perception and Practices of Self-medication Practices among Health Science Students during the ongoing COVID-19 Pandemic in Mangalore, India.

Health science students are prone to self-medication due to easy accessibility to medicines, background medical knowledge, and their ability to diagnose illnesses. The ongoing COVID-19 pandemic has further encouraged this practice due to the fear of contracting the virus by visiting healthcare establishments. This study was conducted to assess the perception and practices of self-medication among health science students during the background of the COVID-19 pandemic. This cross-sectional study was conducted in July 2021 during the second wave of COVID-19. Data were collected using a Microsoft form circulated among students using WhatsApp or email. The mean age of the 350 participants was 20.8 ± 1.5 years. About 165(47.1%) participants had self-medicated over the past one year. The most common mode of self-medication was using previous consultation notes [121(73.3%)]. The most common reason for self-medication stated was the mild nature of the illness [131(79.4%)]. Fifteen (9.1%) participants reported changes in medication from one to another during self-medication. Sixteen (9.7%) participants increased drug dosage during self-medication. Sixteen (26.2%) out of 61 participants who self-medicated with antibiotics did not complete the course. Forty-six (27.9%) out of the 165 participants were not aware of the adverse effects of the drugs being self-medicated on most occasions. One hundred and sixty seven (47.7%) of the total participants did not feel that self-medication practices are harmful. Ninety-five (27.1%) felt that self-medication practices are acceptable during the COVID-19 pandemic. Eighty-six (90.5%) of them thought so to avoid getting COVID-19 infection by visiting healthcare establishments. In multivariable analysis, participants in the final year and those with chronic morbidities were associated with self-medication practices. Self-medication practices were present among 47.1% of participants. More than onefourth of them were not aware of the side effects of self-medicated drugs on most occasions. About 47.7% participants felt that self-medication practices are not harmful and more than one-fourth of them felt that it was acceptable during the COVID-19 pandemic. Therefore, the students need to be made aware of the harmful consequences of self-medication.

Caracterización de la gravedad del intento de suicidio en adolescentes hospitalizados en un hospital público de Chile.

Adolescent suicide has increased in the Americas. In Chile, at-tempted suicide in adolescents is a public health problem that needs an urgent solution. A quantitative, comparative and retrospective study was conducted to provide the hospital with intervention strategies and articulation with the territorial mental health network. The sociodemographic and clinical aspects of 96 records of adolescents hospitalized for attempted suicide between Janu-ary 2017 and December 2018 were reviewed, compared, and related. Two study groups were formed: Group I, 14 adolescents previously hospitalized in the Intensive Treatment Unit and Group II, 82 adolescents who did not require this unit. Gender, age, education, history of sexual abuse, diagnoses of mental disorders, co-morbidities, previous mental health consultations, and caregivers with mental disorders were studied. Descriptive statistics and odds ratios were used. In group I, with 92% male adolescents, severe depression was observed in 57% of cases, and 100% of its members suffered sexual abuse; in group II, with 91% female adolescents, 79% moderate depression was found, 85.3% ab-normal personality development and 70% of its members suffered sexual abuse. Sexual abuse explained the highest percentage of the variance (29%). It is con-cluded that the hospital must consider the distinctive characteristics of the study groups and coordinate with the territorial network of mental health the continuity of care in its interventions.