Private Patients Research Articles

Enhanced Brain Tumor Detection and Privacy Preserving Using Federated Learning

Brain cancers pose significant difficulties for both diagnosis and treatment, underscoring the necessity for precise and private-protecting detection techniques. Federated learning is used to solve this, allowing several healthcare facilities to work together to train detection models without jeopardizing patient privacy. This paper presents an approach called federated learning that may be used to improve brain tumor identification while protecting patient privacy. Brain tumors are dangerous medical disorders that need to be accurately diagnosed in order to be effectively treated. However, sharing private patient information is a common practice in traditional medical data analysis methodologies, which raises privacy issues. Federated learning helps with this by enabling cooperative training of a common model amongst several hospitals or institutions without requiring the exchange of raw data. This method protects patient privacy by having each institution train the model using its own local data and only sharing model updates. We show through trials that our method is efficient in reliably identifying brain tumors while upholding privacy norms, presenting a viable option for improving medical diagnosis without jeopardizing patient privacy.

Effect of insurance type on Management of Vancouver B Periprosthetic Fractures: length of stay, discharge destination and cost implications.

To assess the effect of private versus public insurance on hospital length of stay, discharge destination, and costs in managing Vancouver B periprosthetic femoral fractures (PFF). A retrospective cohort study of PFF patients operatively managed at five public trauma centers. The primary outcome was hospital length of stay. Secondary outcomes included discharge destination and costs related to implants and hospital beds. The study included 195 PFF cases (133 public, 62 private). Private patients had lower ASA scores (2.8 versus 3.1, P = 0.006) and were more likely to come from independent residences (87% versus 74%, P = 0.045). Private patients spent 8 fewer days in the hospital (12 ± 8 versus 20 ± 19 days, P < 0.001) and were more often discharged to rehabilitation (74% versus 48%, P = 0.003). Public hospital costs were higher for public patients ($37 456 versus $25 324, P = 0.005), largely due to longer stays. Implant costs were similar between private and public patients, but patients that underwent revision surgeries increased costs significantly compared to patients that underwent open reduction and internal fixation alone ($6257 versus $3511, P < 0.001). Private insurance was linked to shorter hospital stays and increased discharge to rehabilitation. Public PPF patients incur an average cost of $37 456 for public hospitals, compared to $25 324 for private patients. Delays in public patient rehabilitation access may prolong hospital stays, suggesting a need for alternative care pathways, such as PPF tailored home-based rehabilitation and support programs.

Disparities in neurosurgical care: Using length of stay to evaluate efficiency of care in New York City hospitals

Objective: We sought to analyze public and private hospital patient cohorts in New York City (NYC) to assess differences in hospital access and outcomes from 2009-2022.Methods: Inpatient neurosurgical discharges, as determined by APR-DRG codes, from 2009-2022 were aggregated for seven NYC hospitals, four private and three public, via the Statewide Planning and Research Cooperative System (SPARCS). Statistical analyses (Z-tests) were performed in Python.Results: 325,351 patients were identified, 223,361 private and 101,990 public. Private hospitals had lower high-severity to low-severity and higher high-mortality to low-mortality risk ratios relative to public hospitals (p &lt; .001). Public hospitals treated a higher proportion of stroke and trauma (p &lt; .001). Average length of stay (LOS) was shorter at private hospitals compared to public (5.3 vs. 7.1 days, p &lt; .001). Statistical significance remained when stratifying for illness severity and elective versus non-elective surgery status. Interestingly, cranial trauma cases were associated with a longer LOS in private hospitals relative to public (7.9 vs. 5.7 days, p &lt; .001).Conclusions: While many factors influence outcomes in private versus public hospitals, LOS can mark the efficiency of care. LOS was shorter at private hospitals in all instances except with cranial trauma. Care efficiency is important for hospital reimbursement, which can directly impact available resources for patient care. These findings emphasize the need to further analyze patient accessibility to neurosurgical care at private hospitals and the resources necessary to support neurosurgical practices within public hospitals.

Analysis of Conflict and Challenges in the Hospital Environment that Impact the Patient’s Exercise of Private Autonomy

Objective: This article aims to investigate conflict and the challenges present in the hospital environment, seeking to understand its possible impacts on the construction of the patient's private autonomy. Theoretical Framework: The theoretical framework is based on the idea that conflict is inherent to human relationships and, therefore, its elimination is not sought, but rather its transformation. Thus, a view of conflict is presented that goes beyond the traditional negative view, highlighting its positive potential, based mainly on the ideas of authors such as Morton Deutsch and John Nash. Method: Using the theoretical, legal-descriptive methodology, mediation will be presented as a potential method for dealing with conflicts between doctors and patients. Results and Discussion: The results obtained in the research are presented throughout the text, mainly through examples, which will also reinforce the understanding of the topic and its relevance, since this subject is valuable for raising reflections on how such conflicts can be dealt with cooperatively, ensuring greater respect for the self-determination of those involved. Research Implications: The research covers theoretical and practical contributions that can promote the application of mediation in the medical-hospital context, as a viable means of treating and resolving conflicts between doctors, patients and their families. The insertion of mediation in this environment seeks to create a more collaborative and humanized space, where the parties involved can dialogue in a transparent and respectful manner, with the objective of finding solutions that meet the interests of all, preserving both the rights of patients and the autonomy and responsibility of health professionals. Originality/Value: The work provides relevant data for thinking critically and reflexively about the most appropriate methods for treating and resolving conflicts between doctors and patients, in order to contribute to the preservation of the patient's private autonomy, especially in cases of decision-making in ongoing health treatments.

Fair Satisfaction due to Violations of Patients' Rights in Healthcare

This article explores and presents the meaning of the award of just satisfaction for breaches of patients' rights that interfere with fundamental human rights and the personal integrity of the individual in the field of healthcare. The research is based on well-established methods of legal science, using historical, normative-dogmatic, comparative, axiological and sociological methods. This article reveals and presents a view on the normative regulation of the field of scientific study and points out the shortcomings of the regulation of the judicial protection of rights in health care in the Republic of Slovenia. The study concludes that the interference with a patient's right protected by law results in an interference with the patient's private life, which is why the court should mitigate the ongoing violation and its consequences without undue delay. The patient should be able to seek judicial protection of his or her rights in the healthcare system within the national system through the establishment of an institute of just satisfaction under Article 41 The European Convention on Human Rights (ECHR). The instrument of just satisfaction, as provided for by the ECHR and developed by The European Court of Human Rights (ECtHR), should be used as an important remedy in cases of violation of a patient's rights where no other immediate judicial remedy is available. It remains open to debate for which violations of patients' rights just satisfaction should be granted and in what procedure in order to ensure its swift effect. Keywords: Just satisfaction; non-pecuniary damage; criteria for non-business liability; exceptional circumstances; mitigation of the harmful consequences

Examining Impact of Insurance Type on Genetic Testing in Pediatric Neurology

ObjectiveStudies that examine the impact of insurance type on the ease of obtaining genetic testing are scarce. Therefore, we aim to analyze how different types of insurance influence the time taken to obtain genetic test results among pediatric neurology patients. MethodsThis was a retrospective cohort study from Dayton Children’s Hospital. Patients who had at least one neurologic genetic result found in the electronic medical record from 01/01/2014 to 03/01/2023 were included in the study. Variables collected include demographics, health insurance data, and genetic testing results. Results141 patients were included. Most patients were male (51.8%), white (78.0%), and not Hispanic/Latino (96.5%). The mean age at time of genetic testing was 7.9 years. Most patients had Medicaid as their primary insurance (60.3%) as compared to private insurance (39.7%). 215 genetic reports were examined (137 Medicaid charts and 78 private insurance charts). There was no statistically significant difference from mean time lapse between test order date to results date for Medicaid patients (27.3 days) versus private insurance (31.5 days, p=0.40). Molecular genetics testing and epilepsy gene panel order were the most common tests ordered for both Medicaid (86.1%, 37.2%) and private insurance (88.5%, 39.7%, respectively). ConclusionsThe mean time between test order date to results date was comparable between private and Medicaid insured patients. Our results suggest that there is no significant difference for time to result between pediatric neurology patients who carry public versus private insurance for genetic testing.

Extended length of stay in an Australian private psychiatric hospital: an observational study of patient, clinical, and treatment characteristics

BackgroundPatient extended length of stay has been scarcely studied in Australian inpatient psychiatric units (IPUs). Previous research has focused on public IPUs, however, private IPUs also care for a large proportion of people with mental illness.ObjectivesThis study aimed to identify patient, clinical, and treatment characteristics associated with ELOS within a private IPU and compare these characteristics with those of public IPUs. It is hypothesised that patients with ELOS will have complex characteristics such as high unemployment status, multiple psychiatric diagnoses and physical health comorbidities.MethodThis cross-sectional study examined characteristics of ELOS in a private Australian IPU between 1st July 2018 and 30th July 2019. A retrospective patient file audit collected characteristics of ELOS patients.ResultsOf the 54 ELOS patients (M = 42.52 years [18.62]) admitted, the average LOS was 55.04 days (SD = 4.4 days). Most patients were female (77.8%), single (44.4%) and their income status was unemployed (25.9%), employed (24.1%) and pensioner (22.2%). The most prevalent psychiatric diagnoses were major depressive disorder (29.6%), eating disorder (24.1%), alcohol or substance use disorder (7.4%), and complex post-traumatic stress disorder (7.4%) respectively.ConclusionThis study highlights patient, clinical, and treatment characteristics prevalent among private inpatients with ELOS. Future research should examine whether these are distinct from admissions that are not prolonged, with the aim to identify and reduce ELOS, and improve patient recovery, hospital flow and capacity.

Factors associated with electroconvulsive therapy treatment for adults with serious psychiatric conditions in Australia.

To identify factors associated with receiving electroconvulsive therapy (ECT) for serious psychiatric conditions. Retrospective observational study using hospital administrative data linked with death registrations and outpatient mental health data in New South Wales (NSW), Australia. The cohort included patients admitted with a primary psychiatric diagnosis between 2013 and 2022. The outcome measure was receipt of ECT. Of 94,950 patients, 3465 (3.6%) received ECT. The likelihood of receiving ECT was higher in older (hazard ratio [HR] = 1.03), female (HR = 1.24) patients. Compared to depression, patients with schizophrenia/schizoaffective disorder (HR = 0.79), schizophrenia-related disorders (HR = 0.37), mania (HR = 0.64) and other mood disorders (HR = 0.45) had lower odds of receiving ECT. Patients with depression and one other serious psychiatric condition had higher odds of receiving ECT than depression alone. Bipolar disorder likelihood of ECT did not differ from depression. A higher number of mental health outpatient visits in the prior year and an involuntary index admission with depression were also associated with receiving ECT. Likelihood of receiving ECT increased with year of admission (HR = 1.32), private patient status (HR = 2.06), higher socioeconomic status (HR = 1.09) and being married (HR = 1.25). ECT use for depression and bipolar disorder in NSW aligns with clinical national guidelines. Patients with schizophrenia/schizoaffective, schizophrenia-related disorders, mania and other mood disorders had lower likelihood of ECT than depression, despite ECT being recommended by clinical guidelines for these diagnoses. Variations in ECT were strongly associated with healthcare access, with private patients twice as likely to receive ECT than their public counterparts, suggesting a need to explore ECT accessibility.

Primary care physicians’ experiences of video and online chat consultations: a qualitative descriptive study

Objectives To explore the perceptions and views of remote consultations and patient care of primary care physicians (PCPs) who work remotely regularly and have experience performing remote consultations. Design A qualitative study using thematic analysis. Setting Four online focus group interviews with 17 PCPs, working with one private health care provider, with public and private primary care patients. Subjects PCPs who had performed video or online chat consultations with primary care patients for at least 6 months. Main outcome measurements PCPs’ perceptions and views working remotely in online chat and video consultations. Results Two main themes describing how PCPs perceived remote consultations emerged: 1) remote consultations have an impact on the way physicians work, and 2) remote consultations have an impact on the service system and patients. The subthemes of the first main theme included the physicians’ new way of working, impacts on physicians’ well-being, and impacts on communication and physician competences. The subthemes for the second main theme were the importance of smoothness of services for the patients, patient suitability, and technical liabilities. Conclusion Remote consultations provide PCPs with a new way of working that could improve work-life balance. However, it is important to maintain sufficient clinical competence through versatile work. Digital consultations can make contacting healthcare smoother and easier for patients if the patient selection is performed carefully. Online chat seems suitable for singular contacts and simple issues, but remote consultations could be used to sustain continuity of care.

Intelligent Threat Detection And Response Systems For Safeguarding Cloud-Hosted Electronic Health Records From Cyber Attacks

As more people use cloud-based electronic health record (EHR) systems, they make healthcare better, but they also make it easier for cybercriminals to attack. This article describes a system that uses artificial intelligence (AI) and machine learning (ML) to intelligently watch cloud-hosted EHR environments for bad behaviour, find cyberattacks, and automatically take the right steps to stop them. Using supervised machine learning models that have been trained on known threat indicators, the suggested framework constantly looks at log and system data. As soon as an attack is found, established containment and mitigation steps are carried out naturally to lower the harm. The test results show that the framework can correctly identify common EHR attack methods like ransomware and data theft, as well as quickly and effectively protect private patient data

Refractive errors and the uniform patient fee scheme at a public hospital in South Africa

Background: Uniform Patient Fee Scheme (UPFS) refers to the healthcare subsidy levels provided by public hospitals in South Africa. Such subsidies indirectly reflect socio-economic factors and thus potentially might impact upon distributions of refractive error.Aim: To investigate refractive errors based on the UPFS-classified records of patients consulted at an Optometry Clinic between January 2018 and December 2019. This will provide frequencies and other measures, possibly providing preliminary estimates of prevalences for the wider population for the region concerned.Setting: The study was conducted at Sekororo Hospital in Limpopo province.Methods: Data for UPFS and refractive errors (via subjective refraction) were collected retrospectively based on the archived clinical records. Statistics and Data Analysis (Stata) software was used to analyse data.Results: For H0 in the right eyes means (± s.d.) for myopia, hyperopia, and astigmatism were −2.04 ± 2.60, 1.38 ± 1.72, and −1.07 ± 0.64, respectively. For H0 (left eyes): Myopia (−2.04 ± 2.09), hyperopia (1.47 ± 1.73), and astigmatism (−1.04 ± 0.64). For H1 (right eyes): Myopia (−1.79 ± 1.50), hyperopia (1.06 ± 0.72), and astigmatism (−1.14 ± 0.81). For H1 (left eyes): myopia (−1.71 ± 1.46), hyperopia (1.24 ± 0.91), and astigmatism (−1.71 ± 0.74). (No records were found for H2, H3, or private patients.)Conclusion: Hyperopia and astigmatism were the most common in H0 records while myopia was the most common in H1.Contribution: Various authorities and others in South Africa might use this data and results for National Health Insurance planning policies and implementation purposes.

Adherence to low back pain clinical guidelines in Australian hospital emergency departments: A public and private comparison

Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in emergency department settings. Whether adherence differs between public and private settings is unknown. A retrospective audit of two Australian emergency departments matched 86 private patients to 86 public patients by age ( ± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Management GAS was lower in private patients compared to public patients (d [95 %CI]: −0.67 [−0.98, −0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95 %CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95 %CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95 %CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95 %CI]: 2.2 [1.2, 4.2], P = 0.013). Differences exist in public and private hospital emergency department guideline adherence. Exploring barriers and facilitators underpinning these differences will assist in guiding future implementation science approaches.

Utilising an Allied Health Practitioner Capability Audit and Confidence Survey to Identify Implications for Telehealth Safety and Risk-A Chronicle of a Health Service Improvement Activity.

Whilst the benefits of telehealth were identified during the COVID-19 pandemic, we noted barriers to its use at a vital time. Through a health service improvement approach, we sought to increase allied health professional capability in telehealth, but we also sought to understand if there were risks associated with its use. We designed and implemented tools to evaluate allied health professional competence and confidence in using telehealth with private and public patients in a metropolitan teaching hospital setting. With an emphasis on technology capability, we undertook audits over three consecutive years (2020 to 2022) of allied health professional telehealth occasions of service reporting on compliance with the audit criteria and investigating staff confidence in undertaking telehealth sessions using a co-designed survey. The audit tool and confidence survey results were used to identify risk factors to telehealth service delivery using a Modified Health Failure Modes, Effects Analysis. Although confidence levels were relatively high among staff, confidence in managing safety factors and technology risks associated with telehealth were not initially verified by the audit findings. Remedial efforts resulted in service improvements in many identified risk factors, yet technology performance and its troubleshooting remained a primary variable in the ability of staff to comply with the requirements of the real-time audits. Health workers using telehealth should have training to engage safely and effectively in telehealth care and the technology.

The Use of Insulin Pen Needles: The Italian Society of Metabolism, Diabetes, and Obesity (SIMDO) Consensus

A correct injection technique is essential in order to ensure the effectiveness of insulin and to achieve good metabolic control, and the use of suitable needles is fundamental. Today, technological evolution has transformed insulin needles into innovative tools able to guarantee an effective and safe administration of insulin, to reduce local complications, such as lipodystrophies that are an obstacle to the effectiveness of the treatment itself, and to minimize the pain of the injection, a crucial factor in the acceptance of therapy and for compliance. The steering committee of the scientific society SIMDO has commissioned the scientific committee and some members of the board to draw up an official SIMDO point of view/consensus on the use of insulin needles. In this way, a group that has combined the experience gained in their field of expertise—diabetologists operating in the public and private sectors, nurses, psychologists, and patients—was set up. The aim is to give indications regarding insulin injection techniques, combining themes such as technology innovation, education in self-management, and psychological support for the patient into a unified approach based on the priority area of patient quality of life. The document will provide operational recommendations that integrate the directions regarding the standards of care for diabetes resulting from the most recent scientific acquisitions with the concept of quality at 360°, as it emerged from the point of view of all the operators involved, but with the patient’s interests as a central focal point.

Factors Influencing Patient Satisfaction with Nursing Services in the Private Inpatient Health

Factors Influencing Patient Satisfaction with Nursing Services in the Private Inpatient Health

Achieving trifecta outcomes in robotic-assisted partial nephrectomy within a fellowship training centre.

To assess the robotic-assisted partial nephrectomy (RAPN) trifecta rate within a fellowship program. Patients undergoing RAPN 01/01/2010-01/07/2023 were enrolled from a prospectively maintained database. All cases were performed jointly with surgical fellows, except when privately insured. Patients were excluded if they were converted to open or radical nephrectomy. The primary outcome was achieving the 'trifecta' of negative surgical margins, no complications < 30 days post-operatively and warm ischaemia time (WIT) < 25 min. The secondary outcomes were factors associated with trifecta success. Ethics approval was obtained.In the enrolment period, 355 patients underwent intended RAPN, of whom seven were excluded due to conversion to conversion to radical nephrectomy (6 patients) or conversion to open (one). Amongst the 348 eligible patients, median age was 60 years, 115 (33%) were female and 19 were private patients. WIT was < 25 min for 324/337 patients (96%), surgical margins were negative in 325 (93%), 294 (84%) were complication-free at 30 days and 301/320 (94%) had a < 30% decline in estimated glomerular filtration rate at 3-6 months postoperatively. Subsequently, trifecta outcomes were achieved in 253/337 (75%) patients. Comparing with patients without those with trifecta success were similar in all thirteen measured patients and tumour factors. In a teaching hospital, with a fellowship training programme, trifecta outcome is achievable for most RAPN patients, and at a rate comparable to international standards. Fellowship centres should monitor their outcomes to ensure high patient outcomes are maintained alongside training requirements.

Is pay for performance promoting inverse inequality in Irish general practice?

In 2020, the Chronic Disease Management (CDM) programme was introduced in Ireland. This programme resources GPs to review public (GMS) patients, diagnosed with eight named chronic diseases, twice yearly according to a structured protocol. This pay for performance initiative has been widely adopted by GPs. However, it is hypothesised that private patients (PPs) receive a poorer standard of care, as they may be reluctant to attend due to the cost involved. To assess whether the management of eight chronic diseases named in the CDM programme is to the same standard among both PPs and GMS patients. A retrospective audit of GP practices in the Midwest of Ireland. Data relating to 25 GMS patients and 25 PPs, matched by age, gender, and clinical condition, is collected from each practice. Patients have at least 1 of the eight named chronic diseases. Parameters include vaccination status (influenza, pneumococcal, COVID); body mass index; blood pressure; smoking status; renal function; HbA1c; lipid profile; brain natriuretic peptide (BNP) in patients with heart failure; and lung function tests in patients with COPD or asthma. COVID vaccination status acts as a control because it is freely available for both PPs and GMS patients. Preliminary results from 2 GP practices show large consistent disparities in management between PPs and GMS patients in most parameters. Limiting Pay for Performance to the care of GMS patients only, based on age or income, promotes inverse inequality. We argue that CDM care should be offered to all patients.

Disparities in the prevalence of anxiety and major depressive disorder in patients with lung cancer and the associated risk factors: A retrospective analysis.

e22544 Background: Cancer is a leading cause of mortality and has been associated with an increasing prevalence of psychological disorders. Previous studies indicate that approximately 1 in 8 individuals diagnosed with lung cancer also experience symptoms of depression. Our study aimed to assess the disparities in the prevalence and association of Anxiety and Major depressive disorder (MDD) in lung cancer patients. Methods: Using the National Inpatient Sample 2017-2020, we identified lung cancer patients with regional and advanced metastatic disease. They were divided into two groups - with and without concomitant Anxiety and MDD. Baseline demographic characteristics were analyzed to assess disparities in prevalence, and multivariate logistic regression was used to evaluate the association of Anxiety and MDD in these patients. Results: A total of 461975 patients had lung cancer, and 25780(5%) had concurrent diagnoses of Anxiety and MDD. The anxiety + MDD group had 70% females and 30% males (p &lt; 0.001).Females had an increased likelihood of MDD + Anxiety (OR = 2.36 (2.21-2.52); p &lt; 0.001). Compared to younger patients, older patients were less likely to have MDD + Anxiety ( &gt; 65: OR = 0.45(0.25-0.81); p = 0.008). Compared to the white population, patients of other races had a decreased likelihood of MDD + Anxiety (Black: OR = 0.41( 0.36-0.47), p &lt; 0.001; Hispanic: OR = 0.65( 0.55-0.77), p &lt; 0.001; Other races OR = 0.60(0.48-0.76), p &lt; 0.001). Private insurance and patients without insurance were less likely to have MDD + Anxiety (OR = 0.74(0.67-0.81) and OR = 0.56(0.44-0.71), p &lt; 0.001, respectively). Patients admitted to teaching and large hospitals had an increased likelihood of MDD + Anxiety compared to smaller and nonteaching hospitals (OR = 1.13(1.03-1.24), p = 0.006 and OR = 1.14(1.03-1.25), p = 0.007, respectively). Patients with Hyperlipidemia, Hypertension, COPD, and Obesity were more likely to have MDD + Anxiety (OR = 1.39(1.30-1.48), p &lt; 0.001; OR = 1.11(1.03-1.18), p = 0.002; OR = 1.29(1.21-1.38), p &lt; 0.001 and OR = 1.33(1.22-1.45), p &lt; 0.001 respectively). In contrast, patients with Diabetes had a decreased likelihood of concomitant Anxiety + Depression (OR = 0.92(0.85-0.99), p = 0.04). Lung cancer patients with concurrent Anxiety + MDD had a higher total cost of hospitalization. (+$ 2611(66-5156); p = 0.04). Conclusions: Female lung cancer patients and white individuals had an increased risk of anxiety and depression. Patients with private insurance had decreased risk, and those admitted to larger and teaching hospitals had increased association with these psychological disorders. Devising comprehensive strategies to effectively control underlying psychiatric conditions is crucial for improving outcomes in lung cancer patients, aiming to enhance quality of life and prolong life expectancy.

Assessment of Outer and Middle Ear Pathologies in Lilongwe, Malawi.

Outer and middle ear pathologies are known to disproportionately affect low-income countries but data is limited. We aim to quantify the prevalence rate of patients presenting with middle/outer ear pathologies at ABC Hearing Clinic and Training Centre in Lilongwe, Malawi. Audiological consultations (adult and paediatric) from 2018-2020 were reviewed for outer and middle ear pathologies. Secondary outcomes included patient type (private vs. community) compared to otoscopy findings, tympanometry findings, need for follow up, and follow up compliance. Out of 1576 patients reviewed, the proportion of abnormal cases' was 98.2%, with 41.4% being unilateral and 57.4% bilateral. Eighty-three percent presented with outer/middle ear pathologies. 68% of those presented with a pathology often associated with some degree of conductive hearing loss (occluding wax, perforation, discharge, Type B/Type C tympanogram). Average age was 29 + 0.527 years; 41.6% private and 58.2% community patients. Cerumen impaction was most common finding (51%). Higher rates of otoscopic abnormalities and type B tympanograms were noted in community vs. private patient (~40% vs. ~30%; ~70% vs. ~30%). Adherence to follow up was higher for community vs. private patients (29% vs. 17%); ~70% reported subjective improvement upon follow up. The majority required multiple interventions on follow up. Secondary follow up was recommended in 64.8%. A significant disease burden of outer and middle ear pathologies was identified. Further research is required to understand the disease burden and promote health policy.

Private vs. public emergency visits for mental health due to heat: An indirect socioeconomic assessment of heat vulnerability and healthcare access, in Curitiba, Brazil

Few studies have explored the influence of socioeconomic status (SES) on the heat vulnerability of mental health (MH) patients. As individual socioeconomic data was unavailable, we aimed to fill this gap by using the healthcare system type as a proxy for SES. Brazilian national statistics indicate that public patients have lower SES than private. Therefore, we compared the risk of emergency department visits (EDVs) for MH between patients from both healthcare types. EDVs for MH disorders from all nine public (101,452 visits) and one large private facility (154,954) in Curitiba were assessed (2017–2021). Daily mean temperature was gathered and weighed from 3 stations. Distributed-lag non-linear model with quasi-Poisson (maximum 10-lags) was used to assess the risk. We stratified by private and public, age, and gender under moderate and extreme heat. Additionally, we calculated the attributable fraction (AF), which translates individual risks into population-representative burdens – especially useful for public policies. Random-effects meta-regression pooled the risk estimates between healthcare systems. Public patients showed significant risks immediately as temperatures started to increase. Their cumulative relative risk (RR) of MH-EDV was 7.5 % higher than the private patients (Q-Test 26.2 %) under moderate heat, suggesting their particular heat vulnerability. Differently, private patients showed significant risks only under extreme heat, when their RR became 4.3 % higher than public (Q-Test 6.2 %). These findings suggest that private patients have a relatively greater adaptation capacity to heat. However, when faced with extreme heat, their current adaptation means were potentially insufficient, so they needed and could access healthcare freely, unlike their public counterparts. MH patients would benefit from measures to reduce heat vulnerability and access barriers, increasing equity between the healthcare systems in Brazil. AF of EDVs due to extreme heat was 0.33 % (95%CI 0.16;0.50) for the total sample (859 EDVs). This corroborates that such broad population-level policies are urgently needed as climate change progresses.