Previous Visit Research Articles

Knowledge and attitudes towards electroconvulsive therapy for psychiatric conditions in a single-center Jordanian hospital: a cross-sectional study

BackgroundKnowledge and attitude toward electroconvulsive therapy (ECT) play crucial roles in determining the acceptance of ECT as a viable and effective treatment option.ResultsThis study involved 400 participants (57.3% female), aged 18–25 years (36.8%) and predominantly single (49.8%), with a bachelor’s degree or higher (78.8%). Only 1.8% had undergone ECT before. While 32.0% relied on social media for ECT information, only 9.5% had a family history of psychiatric illness, and 5.8% had previous psychiatric visits. Knowledge about ECT was moderate (4.51 ± 1.76). Attitudes were less favorable (2.45 ± 2.47), with concerns about ECT as punishment or inhumane treatment. Public stigma towards mental illness was moderate (mean score: 17.77 ± 6.89), with some disagreement on stereotypes. Significant differences were observed in the knowledge scale based on residing governorates and sources of information (p = 0.003 and < 0.001, respectively). Additionally, significant differences in the attitude scale were reported for sources of information (p = 0.002), and significant differences in public stigma were found among age groups (p = 0.023). Spearman’s correlation revealed moderate positive associations between knowledge and attitudes (0.314, p < 0.001) and weak positive associations between knowledge and public stigma (0.185, p < 0.001).ConclusionPatients with stigma and poor knowledge of ECT may affect their choice in undergoing or advising family members to take on ECT if medically prescribed.

Infants show negative changes in affect and physiology when re-experiencing a stressor, its context, and a positive event 24-h later.

Exposure to early life stress shapes further development, affects later stress reactivity, and mental health outcomes. Despite the central role of early experiences, there is little understanding of how these rapidly forgotten events gain their influence. An infant's ability to cope with everyday stressors is founded on successful co-regulation through mother-infant interaction. A significant disruption of this interaction through the Face-to-Face Still-Face paradigm elicits a well-documented behavioral and physiological stress response in infants. What has yet to be explored is whether infants show regulatory adaptions when encountering the situation over again. To fill this gap, 80 mother-infant dyads were observed in the lab on two consecutive days. Infants in the experimental condition (n=40) were exposed to a double Still-Face paradigm on day one. Infants in the control group (n=40) completed time-matched episodes of typical play during their first visit. Mother-infant dyads from both groups returned to the lab 24h later and participated in the double Still-Face paradigm. Changes in behavior (positive and negative affect), physiology (heart rate), and salivary cortisol, compared to day one and between groups, were evaluated and used to infer adaption to the previous experienced laboratory visit. Infants in the experimental condition showed a significant decrease in positive affect (p=0.016) and an increase in heart rate (p<0.001) on day two, compared to controls, even during baseline measures and a neutral first play episode. Infants in the control condition showed a significant decrease in affect (p=0.05) and non-significant increase in heart rate on day two when first encountering the Still-Face paradigm. Infants in the experimental condition showed significant higher heart rate on day two compared to the control group (p=0.046). Infants in the experimental condition also exhibited a marginally significant increase in salivary cortisol on day two, compared to day one (p=0.054). The change in infant heart rate was independent of maternal heart rate which did not differ between day one and day two, or between groups. Findings suggest that a previous stressful experience may elicit a behavioral and physiological adaption in infants 24h later. Our results suggest that even a short, acute stressful event can elicit a lasting stress response in infants 24h later. The effect we observed was specific to the context of the stressful event, not just the stressor. More precisely, the effect "spilled over" from the stressful experience on day one into the baseline measure of day two, usually a neutral experience. The results could have implications for further research on how stressful experiences may shape the stress response.

“Do You Yourself Have Any Idea What is Going On?”: Invitations for Lay Diagnosis in Dutch Primary Care Physiotherapy

ABSTRACT Lay perspectives are important in the recovery of patients with nonspecific pain as they influence levels of pain and patients’ pain experiences. Although previous interactional research has focused on patients’ unsolicited attempts to share their perspectives, health professions also employ specific techniques to solicit them. Physiotherapists are recommended to assess lay perspectives and include them in treatment. One way to do so is through invitations for lay diagnosis (this paper). However, little is known about how lay perspectives are constructed through these invitations and how physiotherapists follow up on them. In this study, physiotherapy intakes were analyzed using conversation analysis. We found that invitations for lay diagnosis are frequently embedded in previous health care visits or patients’ knowledge gathering activities. Patients often express low epistemic status when they construct their lay perspectives and engage in lay diagnostic activity in response to these invitations. Additionally, physiotherapists’ responses in the third position, such as follow-up questions, may influence the further development of patients’ lay perspectives. These invitations provide patients an opportunity to share their views on their health issues, but also create an interactional challenge due to the reversal of usual epistemic dynamics. The study highlights the complexity of doing lay diagnosis, which can include diagnoses or explanations of varying specificity. The specificity and elaboration of these perspectives are influenced by the physiotherapists’ subsequent responses. We provide recommendations for healthcare professionals to facilitate lay diagnosis, and our findings contribute to the discussion around patient empowerment, shared decision making, and patient centered care.

The materiality of home visits at the margins of community care before, during and after the COVID-19 pandemic

ABSTRACT The emergence of COVID-19 led to restrictions in face-to-face interaction and an increase in remote contact, creating challenges, in particular for social services in which home visits are integral. This longitudinal study concentrates on one such service: community care among vulnerable adults, which aims to safeguard their housing and living in the community. Based on a re-analysis of 120 home visits before the pandemic, we demonstrate the significance of materiality in the visits, which manifest as home-space talk and body work. We then analyse data from two focus group interviews with workers to determine what happened to this materiality during and after the pandemic. During the pandemic, home visits were carried out (1) in the usual face-to-face manner in home spaces, (2) as visits in homes without the service users present, (3) as short visits on the doorsteps of homes, (4) as outdoor (home) visits and (5) contacts via phone calls and instant messaging applications. Carrying out home visits as usual or in a manner that enabled face-to-face contact or workers’ presence in homes signal the importance of materiality as well as the workers’ return to previous home visit practices after the acute phase of the pandemic.

Assessing Dental Anxiety Among Children In A Dental Clinic Waiting Room: An Observational Study

Background: Dental anxiety among children can significantly impact their overall oral health and well-being. This study aims to assess the levels of dental anxiety among children age 7 to 12 in a dental clinic waiting room using the Modified Dental Anxiety Scale (MDAS). The aims of this observational study were to evaluate the impact of the dental waiting room and previous dental visits on dental anxiety among children aged 7 to 12 who were waiting for their treatment. Materials &amp; Methodology: A total of 234 children aged 7 to 12 years were included in the study, and their dental anxiety levels were assessed using the MDAS. The scale, comprising a questionnaire of five items related to dental anxiety, was administered to each participant in the dental clinic waiting room. Result : Results shows Females exhibited a significantly higher median MDAS score compared to males and the extraction of tooth Procedure had a significantly higher MDAS score than those receiving restoration or scaling. Conclusion: This observational study provides insights into the prevalence and factors associated with dental anxiety among children in a dental clinic waiting room. Understanding the levels of dental anxiety in this age group is crucial for developing targeted interventions and strategies to alleviate anxiety and promote positive dental experiences

Sociodemographic and Clinical Correlates of Uncontrolled Hypertension in Patients on Treatment for Hypertension in a Family Practice in Southwest Nigeria

Abstract Context: Hypertension causes cardiovascular morbidities globally, particularly in Africa. Hypertension is a disease that is difficult to manage, and there are reports of suboptimal control in hypertensive patients despite clinic attendance. This study sought to characterize the profile of outpatients with uncontrolled hypertension while on treatment. Materials and Methods: There was a purposive consecutive sampling of 78 registered hypertensive patients diagnosed at least six months before recruitment and having clinic blood pressures at ≥ 140/90 mmHg in at least two previous consecutive clinic visits in an outpatient clinic. Their sociodemographic and clinical variables were collected using a semi-structured questionnaire, which incorporated the Hillbone Compliance to High Blood Pressure Scale. Results: There were 52 (66.7%) females and 26 (33.3%) males. The mean age was 54.3 years ± 11.48. The mean blood Pressure (BP) at initial contact was 143.92/89 mmHg. About 40.3% of participants were obese. Most 71.4% of the patients were adherent to prescribed medications. There were no significant socio-demographic factors associated with uncontrolled hypertension after multiple linear regression analysis. There was a significant positive linear correlation between poorer medication adherence and higher diastolic blood pressure r = 2.57, P = 0.024. Conclusion: Physicians ought to recognize the pattern of uncontrolled blood pressure in patients despite treatment and institute an appropriate intervention.

Parental acceptance of dental treatment with SDF in children with CP.

This study aims to evaluate parental acceptance of dental treatment with silver diamine fluoride (SDF) in children with cerebral palsy (CP). The present study is a case-control study with 80 children in the age range of 6-11 years. Group I consisted of children diagnosed with CP and Group II consisted of children without any Special Health Care Needs and systemic conditions. Preoperative and postoperative behavior assessment was done using Frankl's behavior Rating Scale. 38 % SDF application was done in any one primary molar with occlusal dentinal caries. A well-designed validated structured questionnaire with 10 questions was developed to assess the parental acceptance of dental treatment with SDF. The questionnaire comprised 10 close-ended questions with subdivisions on socio-demographic details, the reason for the previous and current dental visit, and acceptance of dental treatment with SDF. The data were analyzed using SPSS (version 26, IBM, Chicago, USA). Continuous variables were expressed as mean±standard deviation (M±SD). Categorical variables were expressed as frequency (n) and percentage (%). The chi-square test was used for qualitative analysis. The level of significance was set at 5%. The number of children showing positive behavior on Frankl's behavior Rating Scale increased from 55% to 70% after dental treatment with SDF and this difference was statistically significant in Group I (p-value<0.001). 87.5% of parents in Group I had accepted the discoloration caused after dental treatment with SDF compared to 80% in Group II. In Group I, 95% of parents agreed strongly, while in Group II, 82.5% agreed strongly that SDF can be done on un-cooperative and special health care needs children. This difference in agreement seen between parents of Group I and Group II was found to be statistically significant (p-value=0.02). Also, the acceptance of SDF was found to be higher in parents who were educationally more qualified in Group I. This difference in the acceptance level of SDF seen based on the educational status of parents was statistically significant (p-value<0.001). Parental acceptance of SDF for dental treatment was higher in Group I (children with CP) as a greater number of parents accepted dental treatment despite discoloration with the modality being noninvasive and less time-consuming. Improved behavior rating was observed among children in both groups after dental treatment with SDF.

Immune Marker and C-Reactive Protein Dynamics and Their Prognostic Implications in Modulated Electro-Hyperthermia Treatment in Advanced Pancreatic Cancer: A Retrospective Analysis

Background: Previous research has suggested that modulated electro-hyperthermia (mEHT) can be used to induce anti-tumor immune effects and to extend patient survival. The use of mEHT in advanced pancreatic cancer is beneficial; however, its immune-mediating effects were never investigated. Methods: A retrospective observational study was conducted. Leukocyte counts, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and granulocyte-to-lymphocyte ratio (GLR) were measured at baseline, midpoint, and after mEHT treatment. Results: A total of 73 mEHT treated pancreatic cancer patients were included. The time elapsed between tumor diagnosis and the first mEHT treatment was 4.40 ± 5.70 months. While no change could be observed between the baseline and the first follow-up visits, the total white blood cell (WBC), neutrophil, and granulocyte count, CRP, NLR, and GLR were significantly higher at the second follow-up compared to both previous visits. Higher levels of the latter parameters following the last mEHT treatment were signaling significantly poor prognostic signs, and so were their longitudinal changes. Conclusions: After the initiation of mEHT, immune markers stabilize with the treatment, but this positive effect is eroded over time by progressive disease. Monitoring the changes in these markers and the occurrence of their increase is a prognostic marker of shorter survival.

How does the metaverse transform festival tourism? A Cognitive-Affective Personality System (CAPS) theory

ABSTRACT This study aims to investigate how metaverse scenes influence users’ metaverse flow experiences and their level of satisfaction, ultimately leading to electronic word-of-mouth in the context of the Guangfu Temple Fair. The partial least squares method was used to explore the conceptual model using 625 valid survey data points collected during the metaverse festival. The empirical results indicate that the metaverse scene has a substantial effect on visitors’ metaverse flow experience. Previous visits serve as key moderators in the relationship between the metaverse flow experience and user satisfaction with the metaverse environment pertaining to the festival.

6728 Bilateral Adrenal Hemorrhage: Cause Or Consequence?

Abstract Disclosure: M.N. Rayan: None. R. Horner: None. A. Valenciaga: None. L.E. Ryan: None. Introduction: Before the advent of the CT scan, bilateral adrenal hemorrhage was primarily discovered post-mortem in patients who had succumbed to sepsis, burns, or anticoagulant therapy. Today, non-traumatic hemorrhage is recognized as an infrequent, yet potentially lethal diagnosis causing clinical deterioration in acutely ill patients. Clinical Case: Our patient is a 64-year-old-male with a medical history of Myelodysplastic Syndrome initially presented to an external ED with abdominal pain. CT abdomen revealed hepatomegaly, splenomegaly, and new bilateral adrenal masses—absent in an MRI conducted a year earlier. He was treated conservatively and subsequently discharged. Two weeks later, he returned to the hospital with severe right sided flank pain. His hemoglobin and platelet counts dropped from 11.5 g/dL and 309 K/uL during the previous ED visit to 7.7 g/dL and 80 K/uL, respectively. Additionally, his PT/INR, PTT, fibrinogen, and D-Dimer levels were elevated. A repeat CT scan indicated a significant enlargement of the right adrenal mass, raising suspicion of adrenal hemorrhage. He was appropriately transfused, and a BM biopsy was performed to evaluate for acute transformation of underlying MDS. Cortisol levels were monitored daily for adrenal insufficiency. A complicated hospital course ensued marked by worsening anemia, thrombocytopenia, and coagulopathy, accompanied by high fevers and new-onset atrial fibrillation. Mixing studies showed absence of a factor inhibitor ruling out acquired forms of Hemophilia. Infectious workup including fungal and viral serologies returned negative. A PET scan revealed several small hypermetabolic hypodense liver lesions, and hypermetabolic activity diffusely in the spleen, and adrenal glands leading to suspicion of metastasis. Results of the BM biopsy returned revealing hypercellularity, with aggregates of hemosiderin-laden macrophages replacing the bone marrow space with associated necrosis. Worsening abdominal pain with hematochezia prompted an endoscopy, confirming a diagnosis of metastatic melanoma. Concurrently, seizure activity and altered mentation led to a head CT, revealing new metastatic lesions that confirmed the rapid progression of the disease. Subsequently, the patient was transitioned to comfort care and passed away. Clinical Lesson: It is crucial to review the various causes of adrenal hemorrhage, understand the challenges associated with interpreting adrenal imaging, emphasize the need to monitor adrenal function, and consider the occasional necessity for tissue sampling. In this clinical scenario, metastases with hemorrhage were the most likely etiology. The causes of adrenal hemorrhage are not always apparent; in this presentation, the consequence of the underlying disease state ultimately led to the initial presenting symptom of abdominal pain. Presentation: 6/2/2024

Morph-SSL: Self-Supervision With Longitudinal Morphing for Forecasting AMD Progression From OCT Volumes.

The lack of reliable biomarkers makes predicting the conversion from intermediate to neovascular age-related macular degeneration (iAMD, nAMD) a challenging task. We develop a Deep Learning (DL) model to predict the future risk of conversion of an eye from iAMD to nAMD from its current OCT scan. Although eye clinics generate vast amounts of longitudinal OCT scans to monitor AMD progression, only a small subset can be manually labeled for supervised DL. To address this issue, we propose Morph-SSL, a novel Self-supervised Learning (SSL) method for longitudinal data. It uses pairs of unlabelled OCT scans from different visits and involves morphing the scan from the previous visit to the next. The Decoder predicts the transformation for morphing and ensures a smooth feature manifold that can generate intermediate scans between visits through linear interpolation. Next, the Morph-SSL trained features are input to a Classifier which is trained in a supervised manner to model the cumulative probability distribution of the time to conversion with a sigmoidal function. Morph-SSL was trained on unlabelled scans of 399 eyes (3570 visits). The Classifier was evaluated with a five-fold cross-validation on 2418 scans from 343 eyes with clinical labels of the conversion date. The Morph-SSL features achieved an AUC of 0.779 in predicting the conversion to nAMD within the next 6 months, outperforming the same network when trained end-to-end from scratch or pre-trained with popular SSL methods. Automated prediction of the future risk of nAMD onset can enable timely treatment and individualized AMD management.

Determinants of Intentions to Revisit the Host Country after a Sports Event: Evidence from the International Attendees of the 2018 Asian Games

The 2018 Jakarta-Palembang Asian Games is the most significant event in Asian Games history regarding contested sports, participating nations, and athletes. This study identifies the long-term benefits of the event to the host country, focusing on the international attendees’ propensity to revisit Indonesia after the event. We administered a survey throughout the two weeks of the event, yielding usable responses from 1,914 international attendees, including athletes, officials, journalists, committees, and spectators. We use the survey results to describe attendees’ evaluation of the event and Indonesia as the host country. Further, this study also estimates a multinomial logistic regression to identify the association between tourist characteristics and their intention to revisit Indonesia beyond the event. The results show that providing information and communication technology, transportation arrangement, culture, and hosting cities positively correlate with the propensity to return. In contrast, the previous visit to Indonesia has the opposite effect. International respondents mainly express their desire to revisit Indonesia on a long-stay plan. Lastly, we also discuss the academic and practical implications of our findings.

Evaluation of Children's Drawings as a Measure of Dental Anxiety Before and After Oral Health Education.

Drawing is an effective tool for evaluating dental anxiety and communicating with children. The aim of this study was to evaluate children's drawings as a measure of dental anxiety with two different assessment methods and their possible relationship with age, gender, and previous dental visits before and after education. A total of 129 children aged 4-6 years old were requested to draw a picture of the dentist and dental office perception before and after a 20-minute dental education at selected Kindergartens. Drawings were evaluated according to Child Drawing: Hospital (CD: H) and Massoni methodologies. The difference in drawing groups between before and after oral health education was found to be statistically significant which meant children had less anxiety after education (P = 0.001). A statistical difference was observed in the scores before and after the education in the group of children who had previous dental visits and those who did not (P = 0.001). Statistically significant differences were observed in both groups of children who had previous dental visits and those who did not (P = 0.002). Oral health education at younger ages is effective in overcoming dental anxiety and improving the positivity of dental perception. Drawing is a suitable assessment tool for learning about the child's notions and feelings.

Oral anticoagulants and cognitive disease progression in atrial fibrillation

Abstract Background Atrial fibrillation (AF) is associated with cognitive decline and dementia. Use of oral anticoagulant (OAC) medications has been reported to offer a lower risk of dementia, but whether differences exist in risk of cognitive decline between types of OAC agents is unclear. Purpose We explored whether the progression from normal cognition to mild cognitive impairment (MCI) or MCI to dementia differs between adults with AF on warfarin versus non-Vitamin K inhibitors (NOACs) in the National Alzheimer’s Coordinating Center (NACC) clinical case series. Methods Data freeze/extraction of NACC data (N= 48,605) took place June 2023. The presence of AF was derived using both clinician-reported health information and self-reported medical history. Subjects with AF who reported use of OACs, had normal cognition and no history of stroke at baseline, and had at least one follow-up visit were included. OAC usage was calculated based on follow-up time and reported OAC use in previous visits. Continuation ratio models (with subject-specific random intercepts) were used to examine the association between OAC type and cognitive diagnosis controlling for cognitive diagnosis from previous visit. Interactions with sex were examined in all models. Results Among 1,475 eligible participants, 478 reported taking OACs including either warfarin (N=396) or NOACs (N=82) at baseline (mean age 79 years, 51% females, 84% White). Individuals on NOACs were either on dabigatran (N=24, 29%) or rivaroxaban (N=58, 71%). The median follow-up time was 4 (interquartile range 2-7) years. About 63% continued using either warfarin or NOACs, 44% switched from warfarin to NOACs, and 2% switched from NOACs to warfarin. After adjusting for age, sex, education, race, hypertension, diabetes, hyperlipidemia, smoking history, and depression in the past two years, no significant association was found between OAC type and cognitive decline (p=0.14). Conclusions In this study of older patients with AF on OACs, we found similar risks of cognitive decline between those on NOACs or warfarin. Future studies should consider effects of patient age, provider prescribing practices, and OAC adherence on this risk.

DBScope as a versatile computational toolbox for the visualization and analysis of sensing data from deep brain stimulation

Different neurostimulators for deep brain stimulation (DBS) come already with the ability to chronically sense local field potentials during stimulation. This invaluable new data has the potential to increase our understanding of disease-related brain activity patterns, their temporal evolution, and their modulation in response to therapies. It also gives the opportunity to unveil new electrophysiological biomarkers and ultimately bring adaptive stimulation therapies closer to clinical practice. Unfortunately, there are still very limited options on how to visualize, analyze, and exploit the full potential of the sensing data from these new DBS neurostimulators. To answer this need, we developed a free open-source toolbox, named DBScope, that imports data from neurostimulation devices and can be operated in two ways: via user interface and programmatically, as a library of functions. In this way, it can be used by both clinicians during clinical sessions (for instance, to visually inspect data from the current or previous in-clinic visits), and by researchers in their research pipelines (e.g., for pre-processing, feature extraction and biomarker search). All in all, the DBScope toolbox is set to facilitate the clinical decision-making process and the identification of clinically relevant biomarkers. The toolbox is already being used in clinical and research environments, and it is freely available to download at GitHub (where it is also fully documented).

Prior emergency medical services utilization is a risk factor for in-hospital death among patients with substance misuse: a retrospective cohort study

BackgroundSubstance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse.MethodsWe conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status.ResultsAmong 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 – 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events.ConclusionsIndividuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.

Early detection of pediatric health risks using maternal and child health data

Machine learning (ML)-driven diagnosis systems are particularly relevant in pediatrics given the well-documented impact of early-life health conditions on later-life outcomes. Yet, early identification of diseases and their subsequent impact on length of hospital stay for this age group has so far remained uncharacterized, likely because access to relevant health data is severely limited. Thanks to a confidential data use agreement with the California Department of Health Care Access and Information, we introduce Ped-BERT: a state-of-the-art deep learning model that accurately predicts the likelihood of 100+ conditions and the length of stay in a pediatric patient’s next medical visit. We link mother-specific pre- and postnatal period health information to pediatric patient hospital discharge and emergency room visits. Our data set comprises 513.9K mother–baby pairs and contains medical diagnosis codes, length of stay, as well as temporal and spatial pediatric patient characteristics, such as age and residency zip code at the time of visit. Following the popular bidirectional encoder representations from the transformers (BERT) approach, we pre-train Ped-BERT via the masked language modeling objective to learn embedding features for the diagnosis codes contained in our data. We then continue to fine-tune our model to accurately predict primary diagnosis outcomes and length of stay for a pediatric patient’s next visit, given the history of previous visits and, optionally, the mother’s pre- and postnatal health information. We find that Ped-BERT generally outperforms contemporary and state-of-the-art classifiers when trained with minimum features. We also find that incorporating mother health attributes leads to significant improvements in model performance overall and across all patient subgroups in our data. Our most successful Ped-BERT model configuration achieves an area under the receiver operator curve (ROC AUC) of 0.927 and an average precision score (APS) of 0.408 for the diagnosis prediction task, and a ROC AUC of 0.855 and APS of 0.815 for the length of hospital stay task. Further, we examine Ped-BERT’s fairness by determining whether prediction errors are evenly distributed across various subgroups of mother–baby demographics and health characteristics, or if certain subgroups exhibit a higher susceptibility to prediction errors.

Discrepancy between global- and disease-specific outcome measures following lumbar spine surgery.

The aim of this study was to assess the correlation between patient-perceived changes in health and commonly utilized patient-reported outcome measures (PROMs) in lumbar spine surgery. This was a retrospective review of prospectively collected data on consecutive patients who underwent lumbar microdiscectomy, lumbar decompression, or lumbar fusion at a single academic institution from 2017 to 2023. Correlation between the global rating of change (GRC) questionnaire, a 5-item Likert scale (much better, slightly better, about the same, slightly worse, and much worse), and PROMs (Oswestry Disability Index, visual analog scale for back and leg pain, 12-Item Short Form Health Survey Physical Component Summary and Mental Component Summary, and PROMIS physical function) was assessed using Spearman's rank correlation coefficients. A total of 1871 patients (397 microdiscectomies, 965 decompressions, and 509 fusions) were included. A majority of patients in each group rated their lumbar condition as much better at each postoperative time point compared with preoperatively and reported improved health status at each postoperative time point compared with the previous follow-up visit. Statistically significant but weak to moderate correlations were found between GRC and change in PROM scores from the preoperative time point. Correlation between GRC and change in PROM scores from the prior visit showed some statistically significant correlations, but the strengths ranged from very weak to weak. A majority of patients undergoing lumbar microdiscectomy, decompression, or fusion endorsed notable improvements in health status in the early postoperative period and continued to improve at late follow-up. However, commonly used PROMs demonstrated very weak to moderate correlations with patient-perceived changes in overall lumbar spine-related health status as determined by GRC. Therefore, currently used PROMs may not be as sensitive at detecting these changes or may not be adequately reflecting changes in health conditions that are meaningful to patients undergoing lumbar spine surgery.

Dental caries status and related factors among 12-year-old Somali school children in Hargeisa.

There is little data on the oral health conditions of Somali children. The aim was to assess the dental caries status and related risk factors of 12-aged children in primary schools in Hargeisa, Somaliland. A school-based survey was conducted in Hargeisa in December 2022. Using 2-stage cluster sampling, 405 children (12-aged) were randomly selected from 16 primary schools. Data collection involved WHO structured interviewer-administered questionnaire and clinical examinations. The DMFT index was measured according to WHO criteria, and accordingly, the mean for the significant caries index (SiC) was calculated. The association between the DMFT and the relevant variables was analysed using negative binomial regression in STATA. The overall prevalence of dental caries was found to be 62.7%, with a mean DMFT of 1.7 and a SiC score of 3.7. Non-public school pupils showed significantly higher prevalence of dental caries and mean DMFT compared to public school counterparts (68.5% vs. 58.6%) and (1.91 vs. 1.48), respectively. Merely 14.7% of the participants utilized dental care services in the previous year. The multivariable analysis showed a significant positive association of the DMFT outcome with attending a non-public school (95% CI 1.16-2.12) and having many previous dental visits (95% CI 1.22-2.83). In the adjusted model, fathers of low education had children with better dental caries status (lower mean DMFT) than their well-educated counterparts. The mean DMFT was not significantly influenced by the factors sex, location, educational attainment (school class of the participants) and frequency of teeth cleaning. Although the overall mean DMFT of school children in Hargeisa could be regarded low, the high levels of untreated caries especially in the one-third most affected are a cause for concern. Children enrolled in non-public schools formed the high-risk group. Preventive oral public health programs targeting Somali school children are recommended.

Water, sanitation and hygiene insecurity predict abscess incidence among people who inject drugs in a binational US–Mexico metropolitan area: A longitudinal cohort study

IntroductionPeople who inject drugs (PWID) are at high risk of developing injection-related infections, including abscesses. Access to water, sanitation, and hygiene (WASH) are key human rights and services; yet these services have been underexplored as predictors of abscesses among PWID. MethodsLongitudinal analysis was employed among a cohort of PWID to determine if WASH insecurity (lack of access) was associated with abscess incidence in the Tijuana, Mexico and San Diego, United States metropolitan area during 24-months of follow-up survey data from 2020 to 2023. We calculated abscess prevalence at baseline and tracked the incidence of new abscesses among individuals without an abscess during the previous visit. Time dependent Cox regression modeling was employed with variance clustered by participant to characterize the relationship between WASH insecurity and abscess incidence. ResultsAt baseline, hand hygiene insecurity, bathing insecurity in the previous six months and open defecation in the last week, were reported by 60 %, 54 % and 38 % of participants, respectively; 21 % reported an abscess in the last six months. The incidence of abscesses was 24.4 (95 %CI: 21.1–27.6) per 100 person-years. After adjusting for covariates, the hazard of developing an abscess remained significantly elevated among individuals using non-improved (with risk of contamination) water sources (e.g., surface water) for preparing drugs (adjusted HR [adjHR]: 1.49 [95 %CI: 1.01–2.21], experiencing bathing insecurity (adjHR: 1.59 [95 %CI: 1.12–2.24]) and open defecation (adjHR: 1.65 [95 %CI: 1.16–2.35]). ConclusionsPWID in the Tijuana-San Diego metropolitan area reported facing high rates of insecurity accessing WASH services. Abscess incidence was higher (four to nine times) than observed rate among PWID cohorts in other settings. Access to continuously available toilet facilities, bathing infrastructure, and safe water sources for preparing drugs for injection could prevent abscesses among PWID. Accessible WASH infrastructure should be ensured among PWID communities and promoted as a key component of harm reduction infrastructure.