Refusal Rate Research Articles

KardioNet Digital - a structured care model involving digital tools for intersectoral communication and a patient-focused strategy for treatment of heart failure

Abstract Introduction Inefficiencies and discontinuities in care at the interfaces within Germany's healthcare system, especially between acute and outpatient care, present significant challenges in managing patients with heart failure (HF). The management complexity of HF has increased with the advent of new digital tools, though patient acceptance of these tools remains contentious. The prevention of loss of diagnostic and therapeutic information for this complex disease is crucial for cross-sectoral communication (hospital - office-based cardiologist - general practitioner) and quality of care. Purpose Our goal was to examine the impact of digital app-supported coordination of HF management across different healthcare providers from hospital discharge to the ambulatory sector and to assess patients' acceptance of a structured care program. A patient-focused digital strategy, supported by a Heart Failure Nurse (HFN), aimed to facilitate structured follow-up and patient empowerment, focusing on patient-reported outcomes and experiences (refer to Table 1). Results Out of 401 patients screened during their hospital stay for HF, only 57 (14.9% male, 12.6% female) participated in the KardioNet Digital (KND) program. NYHA classifications were I (3.5%), II (49.1%), III (40.4%), and IV (7.1%); Diagnoses included CMP (26, 45.6%), CAD (19, 33.3%), valvular HF (8, 14.0%), and others (4, 7.0%). The mean age was 55.03 years, with a notable difference in participation based on age (≥70 years: 9.5% male, 33.3% female; <70 years: 90.5% male, 66.7% female). Age was a significant determinant of program participation. Patients who regularly used the app benefited from several features: A total of 35 alerts (17 patients) were triggered for reasons such as bodyweight increase (2kg or more) and device-induced alerts (i.e. false shock delivery, 3x slow-VT, Syncope), leading the HFN to contact the patients. This early intervention prevented rehospitalization due to decompensation of heart failure in 11 patients (64.7%) and addressed device-related alarms for organizing an emergency hospital visit by HFN. Despite substantial incentives, such as support from an HFN and expedited appointments with specialists for follow-up therapy, refusal rates were high (refer to Table 2). Conclusion A structured, digitally supported cross-sectoral care model for heart failure patients can potentially improve care coordination and outcomes. However, the success of such programs critically depends on patient willingness and the seamless integration into existing healthcare structures. Despite valuable incentives, we observed low acceptance of the program. Even among motivated participants (14.1%), there is a significant need for substantial support and education on digital literacy for the widespread implementation of digital tools in real-world settings for the treatment of heart failure.Workflow of structured digital supportReasons for Declining Participation

Screen time and social media exposure in children and adolescents - the landscape

Abstract Dr. Cecilia Elias is a Public Health Consultant, collaborating with the Infant, Youth, Sexual and Reproductive Health Division at the Health Directorate General, in Lisbon, Portugal. Following on from John’s introduction, Cecilia will dig deeper into the impacts of the omnipresence of social media and phones in modern society. She will provide an overview of the harms and benefits for today’s youth. She will highlight data for example on impaired development of language, cognitive and social skills from screen exposure at young ages, and increased rates of depression, anxiety, self-harm, and school refusal among adolescents with problematic social media usage, including examples of significant outcomes. Exposure to disturbing and harmful content on social media platforms like TikTok and Instagram will be covered also.

Sampling Strategies for Assessing Male Clients of Female Sex Workers in Public Health Research: A Compilation of Global Evidence.

Clients of Female Sex Workers (FSWs) are major bridge population in HIV transmission. Any research among them remains challenging because they are hidden within society. The objective of this review was tocompile the global evidence on different sampling strategies used to access male clients of female sex workers for research purpose, the challenges faced during the sampling process andpossible sources of bias. Original articles and reports published globally in last 10years, in English language and those with full text freely available online were included in this scoping review. A comprehensive search was carried out among the electronic peer-reviewed literature database (Pubmed and Web of Science) using a pre-designed peer reviewed search strategy. Narrative synthesis was applied out across all such articles. A total of 36 articles were finally included in this review. The common sampling techniques used include convenience sampling, referral by FSWs/ pimp/brothel manager/clients, time location cluster sampling, use of virtual network, anonymous telephone survey, referred by clinicians of STI clinic etc. Overall response rate varied between 35 and 90%. Major challenges in participant recruitment included non-response, feasibility issue specially to cater non-brothel-based clients, safety issue for investigators, over-representation of clients with lower socio-economic status, higher refusal rate for known HIV positive clients to provide biological sample etc. As different sampling techniques have comparable response rate, it can be recommended that a pilot study should be carried out in local context to finalise appropriate participant recruitment technique for a given population.

Factors affecting parental refusal of lumbar puncture in Iraqi children in COVID-19 era: a cross-sectional study.

To assess the frequency and causes of parental lumbar puncture refusal for their children. The cross-sectional study was conducted at the Central Child Teaching Hospital, Baghdad, Iraq, from October 1, 2021, to April 1, 2022, and comprised children aged at least >1 month at the emergency department who had been advised to undergo lumbar puncture. Data from the mother of the child was collected using an interviewbased questionnaire, exploring. demographic characteristics, the cause of lumbar puncture refusal, as well as knowledge of the advantages and risks of lumbar puncture. Data was analysed using SPSS 26. There were 128 children with a mean age of 3.9±2.1 years (range: 1-120 months). The parents of 18(14%) patients refused the procedure, and the most frequent reason was fear of paralysis 12(67%). Refusal was significantly associated with mother's age, parents' levels of education, and parents' knowledge of the risks of lumbar puncture (p<0.05). Raising public awareness and parents' educational level regarding the necessity and safety of lumbar puncture procedure is vital to decrease the refusal rate and ensure a better health outcome.

“When selling anything to an audience, visible publicity is key:” experiences, barriers, and enablers to participate in a COVID-19 study in Malawi

BackgroundMany studies in infectious diseases struggle to recruit participants. The SARS-CoV-2 infection, transmission dynamics, and household impact in Malawi (SCATHIM) study reported a refusal rate of 57.2%. Adequate publicity can lead to more people participating in studies. This study explored the reasons for participating in the SCATHIM study.MethodsA descriptive qualitative study informed by the theory of reasoned action was conducted in Blantyre between January 2022 and March 2022 to assess factors that influence participation in a COVID-19 study among 10 index cases, 10 caregivers, 10 study decliners, and 5 research staff. The data were collected via in-depth interview guides, audio recorded, transcribed, managed via NVIVO and analysed via a thematic approach.ResultsThe factors that motivated participation in the study included one’s knowledge of COVID-19; potential access to medical services, including free COVID-19 tests for members of the household; financial reimbursements; and the ability to contribute scientific knowledge. The barriers to participation included minimal publicity of the study amidst a novel condition, perceived stigma and discrimination, perceived invasion of privacy, discomfort with the testing procedures, and suboptimal financial reimbursements.ConclusionEffective publicity and outreach strategies have the potential to decrease refusal rates in study participation, especially if a condition is novel. Studies on infectious diseases should address stigma and discrimination to promote participation and ensure participant safety.

55 Establishing grain-based modified protocols for re-feeding malnourished horses

Abstract Increased feed costs, forage availability, and the increasing number of malnourished horses present major challenges to the equine industry. The goal of this project was to test an adapted refeeding protocol using Bermuda hay and two commercial grain products in severely malnourished horses. So, an 8-wk study from January to March 2023 was conducted to evaluate the effects of Total Equine in the refeeding of 10 emaciated horses. Horses were previously destined for slaughter and purchased from an auction with an average body condition score (BCS) of 2.01 (S.D. ± 0.69), then quarantined for 30 d before starting the study following recommended biosecurity protocols. During quarantine, horses were evaluated by a veterinarian and received treatment as needed, vaccinations, deworming, and mares were pregnancy checked. All horses were provided with ad libitum Bermuda hay and water. Upon completion of the quarantine period, horses were blocked into two groups based on age, BCS, pregnancy status, and gender and randomly assigned to a diet. The Control (Ctrl) diet consisted of a commercial grain diet recommended and used by five local West Texas horse rescue groups and the Treatment (Trt) diet consisted of Total Equine. Both diets included ad libitum access to water and Bermuda hay (TDN 56.5) offered twice daily in port-a-grazer tubs to control waste and the amount was adjusted daily to maintain a 3% refusal rate. Grain was offered at a rate of 0.005% BW + 227 kg per the manufacturer’s suggestion, divided into 2 equal feedings with amounts adjusted weekly. Individual horses were weighed weekly using an electronic scale and BCS was evaluated at wk 0, 4, and 8. All horses were allowed a 1-h turnout in a dry-pen per day for 6 d each week. Blood samples were collected at wk 0, 4, and 8 for analysis. Health parameters were measured weekly throughout the study. Samples (grain, hay, hay orts) were collected twice weekly for DM, NDF, ADF, EE, CP, and Ash analysis. Data was analyzed using Proc Mixed in SAS. Overall, there was no significant difference between DMI by diet (Ctrl 8.74 kg/d and Trt 9.44 kg/d). However, a tendency for increased ADG (P = 0.06) for the Trt diet (Ctrl 0.20 kg/d &amp; Trt 1.34 kg/d) was noted. Efficiency calculated as (ADG/DMI) was significantly improved (P = 0.04) indicating an improvement in the efficiency of BW gain for the Trt diet compared with the Ctrl. Improved BW gain and efficiency of gain are of interest when rehabilitating malnourished horses. The establishment of accessible modified feeding protocols may improve efficiency and reduce the cost involved in the rehabilitation of malnourished horses and would be a step forward for the equine industry.

56 Establishing grain-based modified protocols for the nutritional and physical reconditioning of malnourished horses

Abstract From April to June 2023, we conducted a study to evaluate the effects of Total Equine containing Ascophyllum nodosum seaweed and chelated minerals on the continued recovery and reconditioning of 10 horses. Horses were used on a preceding 8-wk study and given a 21-d, 24-h turnout, with ad libitum access to Bermuda hay washout period between trials. Once the washout was complete horses were randomly assigned to one of three diets: Control (Ctrl) - a commercial grain product and Bermuda hay (n = 3); Treatment (Trt) - Total Equine and Bermuda hay (n = 4); and Grain only (Grn) - Total Equine without Bermuda hay (n = 3); for 8 wk with ad libitum access to water. For Ctrl and Trt diets we offered hay twice a day in port-a-gazer tubs to control waste, adjusted daily for a 3% refusal rate, and orts were collected twice a day. Individuals were weighed weekly, and their body condition score (BCS) was evaluated during the standardization period, wk 4 and wk 8. Grain was offered at a rate of 0.005% BW + 227 kg and divided into 2 equal feedings for Ctrl and Trt diets, while for the Grn diet horses were offered up to 9.07 kg of grain divided into 3 daily feedings, with grain amounts adjusted weekly based on BW. For physical reconditioning, horses were exercised 5 d/wk with a Priefert hot walker, increased in duration and intensity from wk 1 to 8. We collected samples of grain, hay, and orts for DM, NDF, ADF, EE, CP, and ash analysis. Blood samples were collected at wk 0, 4, and 8 for analysis. Baseline health parameters as rectal temperature, heart, and respiratory rate were measured weekly throughout the study to evaluate possible detrimental effects of the trial. Data were analyzed using Proc Mixed procedures in SAS. Investigation into Dry matter intake (DMI) between the Ctrl and Trt cohorts revealed no significant difference. However, significant differences (P ≤ 0.05) were observed in Overall DMI (grain + hay) among Grn and other diet pairs. Significant average daily gain (ADG) and Efficiency (EFF) observations in wk 1, 4, and 6 (P ≤ 0.05) suggest that Total Equine grain had better overall performance in both groups during the first 6 wk of the trial compared with the Ctrl grain. Our results demonstrate the successful outcome of a modified, grain-based protocol in nutritional and physical reconditioning of a cohort of malnourished horses. Further evaluation of larger populations is still needed.

A prospective registry study of the epidemiology and management of childhood cancer in the Gambia-The first year experience.

Globally, over 180,000 children develop cancers yearly, with about 80% residing in low- or middle-income countries where cancer-associated mortality is also high. In The Gambia, cumulative incidence rate of 27.6 childhood cancers/million population was reported between 2002 and 2011. The current study appraised newly-established pediatric oncological services in The Gambia. In this prospective registry study, children with cancer who presented at the pediatric units, Edward Francis Small Teaching Hospital, Banjul, between November 2022 and October 2023 were assessed. Data on sociodemographic variables, mode of admission and presentation, tumor type, diagnostic methods, and challenges such as laboratory support, treatment, use of blood/blood products; and eventual outcome were analyzed. The median (interquartile range, IQR) age at presentation of the 44 children was 36.0 (22.3-117.0) months. Wilms tumor was the most common tumor 12 (27.3%); followed by leukemia 11 (25.0%); germ cell tumor 8 (18.2%); lymphoma 6 (13.6%); retinoblastoma 4 (9.1%); rhabdomyosarcoma 2 (4.5%) and one central nervous system tumor (2.3%). The median(IQR) duration of symptoms before presentation was 48 (21-90) days, presentation to diagnosis 7.5 (3-20.8) days, and first symptom to diagnosis 62.5 (32-126.8) days. Treatment refusal and abandonment rates were 20.5% and 13.6%, respectively. Families of 93.8% of children could not procure cytotoxic drugs due to nonavailability, high cost, or both. Adequate laboratory monitoring was only available in 6.8%, and none had platelet concentrate transfusion or radiotherapy. The nine (20.5%) who completed treatment are currently being followed up, 10(22.7%) are still receiving chemotherapy, while 2(4.5%) were referred. Eight (18.2%) died, predominantly from metastasis (75%) and severe drug toxicities (25%). Late presentation and diagnosis, poverty, unavailability of drugs, suboptimal or lack of laboratory testing, blood product, adjuvant medications, and psychosocial supports contributed to high treatment refusal, abandonment, and mortality. These daunting challenges can be ameliorated with regular community sensitization, frequent cancer auditing, and strong political will.

Long-term effects of an alcohol prevention program at licensed premises: a Swedish 20-year follow-up study.

In 1996, a multicomponent community-based alcohol prevention program in Responsible Beverage Service (RBS) targeting licensed premises was developed by STAD (Stockholm Prevents Alcohol and Drug Problems) and implemented in Stockholm, Sweden. The program consists of community mobilization and collaboration, training, and enforcement. Early evaluations have shown a significant increase in the refusal rates of alcohol service to intoxicated patrons, from 5% in 1996 to 70% in 2001, and a 29% decrease in the frequency of police-reported violence. A cost-effectiveness analysis showed a cost-saving ratio of 1:39. The program was institutionalized by a collaborative steering group consisting of community stakeholders. This study aimed to evaluate the long-term effects over 20 years of the RBS program. The indicator chosen was the rate of alcohol overserving to obviously intoxicated patrons at licensed premises in Stockholm. A 20-year follow-up study was conducted using the same procedure as the baseline and previous follow-ups. Professional male actors (pseudopatrons) were trained by an expert panel to enact a standardized scene of obvious alcohol-intoxication. In 2016, 146 licensed premises located in the central part of Stockholm were randomly selected and visited. A review of program implementation from its initiation 1996 was conducted, examining critical events, including commitment from key actors in the community, training of bar staff, and enforcement. At the 20-year follow-up, pseudopatrons were refused alcohol service in 76.7% of the attempts, which was at the same level (70%) as in the follow-up in 2001, thus indicating sustained effects of the RBS program. Compared with previous follow-ups, serving staff used more active intervention techniques in 2016 toward intoxicated patrons, such as refusing to take the order (56.9% in 2016 vs. 42.0% in 2001), and fewer passive techniques, such as ignoring patrons (6.5% in 2016 vs. 15.5% in 1999) or contacting a colleague (4.1% in 2016 vs. 25% in 2001). The sustained long-term effects of the RBS program are unique and can be explained by the high level of institutionalization of the multicomponent program, which is still ongoing in Stockholm. These findings can inform the dissemination of the program to other countries and settings.

Evaluate a comprehensive geriatric assessment service framework targeting frail older people who had high risk of requiring long-term care services in Japan: a community-based pilot study

BackgroundFrailty has become a key concern in an aging population. A comprehensive geriatric assessment (CGA) service framework was developed and evaluated aiming to target and connect frail older adults who are at high risk of requiring long-term care services.MethodsA community-based pilot study was conducted in fiscal year 2016 and 2017 in Kure city, Hiroshima, Japan. Participants aged 65 and over living in Kure city, and 393 persons were extracted from the Kihon Check List (KCL) responses. Among the eligible individuals, 101 consented to participate and received CGA and referred to services based on individual health needs. The efficacy was evaluated by referral rate of services, continuity of the service usage, evaluation of participant’s health condition and the quality of life (QoL) after the 6-month follow-up.ResultsNinety-nine (98.0%) participants needed support for the instrumental activity of daily living, 97 (96.0%) were categorized as locomotive syndrome, and 64 (63.4%) had a depressive tendency. Afterward, 60 participants (59.4%) subsequently accepted the referral services, however, 34 (33.7%) used the services and the remaining 26 (25.7%) did not use the services. The health condition improvements in the service-uses group were statistically significant (p < 0.001), however, QoL score did not change between the baseline and 6th -month.ConclusionKCL extracted high-risks older people, and CGA revealed related diseases and health conditions. However, the high refusal rate of referral services indicates a necessity to modify the service framework such as by collaborating with community general support centers, which could increase the efficacy of service framework.

657 Transplant Ureteric Stent Removal Using Isiris® in an Outpatient Setting

Abstract Aim The risk of urological complications following kidney transplantation is reduced by the intraoperative insertion of ureteric stents. Transplant ureteric stent removal (TUSR) has traditionally been performed in theatre using flexible cystoscopy. Isiris® is a single-use flexible cystoscope. The aim is to analyse the acceptability, efficacy, and cost-effectiveness of Isiris®, for TUSR in a ward/outpatient setting. Method A retrospective analysis of a contemporaneously maintained database at a high-volume kidney transplant centre from January 2021 to June 2022. Data collected included clinico-demographic, operative and stent removal details including time to removal (gold-standard within 6 weeks) and refusal rates. A cost analysis was also performed based on equipment costs and NHS tariffs. TUSR was performed using Isiris® in outpatient ANP-led clinics or on wards by surgical middle grades or ANPs. Results 345 patients were included in analysis with a median age of 54 (19-81). 99.13% were single ureteric anastamoses with 348 stents removed in total. The M:F ratio was 1.32:1. 98.85% of stents were removed using Isiris®, with a 1.15% refusal rate. 86.34% (n=297) were removed in clinic. Median dwell-time was 34 days, IQR 17.25 (25.75-43). 73.84% of stent removal was within 6 weeks. There were savings of £545.00 per stent removal, including expenses for failed Isiris TUSR, with overall savings of £154,021.20 and 86 theatre sessions freed for other activity. Conclusions Isiris® was acceptable and effective for TUSR. Savings were demonstrated compared to TUSR in theatre. Outpatient/ward TUSR reduces demand for theatre time, freeing theatres for other elective activities.

Kish grid vs birthday procedures: survey refusal rates by the type of within-household selection procedure in the European Social Survey

Two approaches to within-household selection of target respondents dominate cross-national surveys of the general population: the Kish grid and birthday procedures. The Kish grid is a rigorous probabilistic approach expected to produce higher-quality samples. However, its requirement to construct a complete household register is intrusive and may increase refusals. Conversely, birthday procedures, which do not require a household roster, may result in fewer refusals at the cost of lower sample quality. Our paper examines the impact of within-household selection procedures on refusal rates based on a methodological inventory of 120 national surveys from nine rounds of the European Social Survey (2002–2018). Controlling for the implementation of incentives for respondents, the experience of the interviewer teams and the country’s level of economic development, we find that surveys using the Kish grid have higher refusal rates before or during the selection process compared to surveys involving birthday procedures, suggesting that the use of the Kish grid is perceived as more intrusive for household members than birthday procedures. However, we find no significant difference between the two selection procedures regarding respondent refusals and total refusals.

Vaccine Hesitancy in HIV Patients Following the COVID-19 Pandemics

Introduction: The prevalence of vaccine hesitancy has been on the rise for several years in the United States leading up to the Covid19 pandemic. During the pandemic, there was controversy and media attention surrounding the effectiveness and safety of the Covid19 vaccine, with many individuals, including patients with HIV, refusing vaccination, despite evidence of its benefit. There are further concerns that patients with HIV are reluctant to receive additional vaccines that existed prior to the Covid19 pandemic. In this study, we evaluated the rate of refusal of non-Covid19 vaccines in the pre- and post-period after release of the Covid19 vaccine. Methods: We measured and compared the number of vaccines offered and refused at each visit over the total number of visits for 195 patients with HIV during a pre-Covid (approximately 18 months before the release of the Pfizer vaccine to the public on August 23, 2021) and post-Covid period (approximately 18 months after the previously mentioned date). The vaccines studied included the following: tetanus, pneumococcal, shingles, hepatitis A/B, and influenza. The data was collected using hospital records from Athena and Cerner, as well as Michigan State Records. Data was analyzed using descriptive statistics and the Wilcoxon signed ranks test. The Mann-Whitney U test, Kruskal-Wallis test and Pearson’s correlation were performed for the Covid19 vaccine statistics. In all statistical tests, a p-value less than 0.05 was taken to indicate statistical significance. Results: Collectively, there were more refusals in the period after release of the Covid19 vaccine for non-Covid19 vaccines. This was also the case for all individual vaccines, except Hepatitis A. There was an overall statistically significant difference (p &lt;0.001) in the distribution of vaccine refusals between the pre-Covid19 and post-Covid19 period. This was observed for the Pneumococcal (p=0.026), Hepatitis B (p=0.035), and Shingles vaccine (p &lt;0.001) respectively. The Covid19 vaccine was more likely to be refused in female patients (p=0.005), non-white patients (p=0.02), and younger patients (p=0.04, r= -0.21). Discussion/Conclusion: This study provides evidence that there is an increase in non-Covid19 vaccine hesitancy following the release of the Covid19 vaccine in patients with HIV at Ascension St. John Hospital. Given the small size of the study population and this study being an initial evaluation, more will need to be performed. This is to further test these findings in other regions of the United States.

Some psychometric properties of the school refusal assessment scale–revised: Parent and child version in Tanzanian context

Considering the increase in primary and secondary school dropout rates worldwide, it is necessary to identify the underlying causes, particularly in places with high school refusal rates, such as Tanzania. Today, only a limited number of studies can explain, through valid and reliable measurements, why students in Tanzania refuse to attend school. The current study used confirmatory factor analysis techniques to investigate some psychometric properties of the child’s and parent’s versions of the School Refusal Assessment Scale–Revised (SRAS–R) in the Tanzanian population. Since previous studies found significant associations between the parent–child relationship and the risk of school refusal, we included the associations between the SRAS–R scales and measures of psychological control (parent ratings) and parent–child communication (child ratings) as external validity criteria. We collected data from five public primary schools, including 502 grades three to seven children with their parents (N = 465) in Ruvuma, Tanzania. Confirmatory factor analyses revealed that the four–factor model (avoidance of stimuli provoking negative affectivity, escape from aversive social situations, attention seeking, and tangible rewards) showed a good fit for both the parent and child versions of the SRAS–R. In line with expectations, we found a negative association between parent–child communication and school refusal and positive associations between the parent version of the SRAS–R subscales and the psychological control scale. The findings of this study support the use of this measurement in an African context and Tanzania specifically. The discussion stresses the appropriateness of Western cultural instruments in the African context.

Voice Disorder Prevalence and Vocal Health Characteristics in Children

Voice disorders impede communication and limit quality of life for many children. However, research demonstrating the prevalence of pediatric voice problems and associated voice use patterns is scarce. This investigation examined the prevalence of voice problems and vocal health characteristics of school-aged children. To examine the prevalence of voice problems in school-aged children throughout the US with reference to lifestyle, demographic characteristics, and voice use patterns. This study used a cross-sectional design to survey a probability sample of caregivers of children aged 4 to 12 years living throughout the US in 2023. Caregivers were surveyed regarding their children's voice use, voice symptoms, voice problems, extracurricular activities, and demographic information. Caregivers also competed the Pediatric Voice-Related Quality of Life questionnaire. The Fisher exact test, χ2 tests, and logistic regression were used to compare children with and without voice problems. Overall, 6293 panelists were invited to complete screening questions for the survey, and 1789 individuals were screened for eligibility between March and April 2023. Of these, 1175 parents (65.7%) completed the survey. Twenty-one (1.8%) were excluded for a combination of either high refusal rates (n = 16), speeding (n = 2), or straight lining (n = 12). The final number of participants included in analysis was 1154 caregivers of children aged 4 to 12 years (559 female children [48.4%]; 595 male children [51.6%]; mean [SD] age, 8.02 [2.49] years). The prevalence of voice problems in children was 6.7% (n = 78), and the lifetime prevalence was 12% (n = 138). Benign vocal fold lesions was the most common diagnosis underlying voice complaints, and other causes included respiratory illness, allergies, autism-related voice issues, and other neurological conditions. Risk factors for pediatric voice problems included being male (odds ratio [OR], 1.47; 95% CI, 1.0-2.1), having more than 4 individuals living in the household (OR, 2.30; 95% CI, 1.2-4.4), poor speech intelligibility (OR, 2.26; 95% CI, 1.2-4.3), maternal history of voice problems (OR, 4.54; 95% CI, 1.2-16.4), participating in online gaming (OR, 1.56; 95% CI, 1.0-2.3), and secondhand smoke exposure (OR, 1.7; 95% CI, 1.1-2.6). Voice use-related risk factors included frequent talking, coughing, throat clearing, tantrums/crying, and vocal strain. Voice problems were associated with substantially detracted quality of life as measured by the Pediatric Voice-Related Quality of Life questionnaire, limited social/extracurricular interactions, increased school absences, and negative attention from adults. The results of this survey study suggest that pediatric voice problems are relatively common and detract from quality of life. Specific environmental and behaviorial factors are associated with increased risk for voice disorders.

Response Rates by Condom Use Measurement Type Among Sexually Active Young Black Men Who Have Sex with Women.

Measuring condom use accurately is important to understanding sexual behaviors; however, there is still no consensus on the gold standard of condom use measurement. In this study, authors aimed to investigate if non-response rates were higher when absolute or relative frequency condom use questions were utilized. This study used Check It study data of Black men who have sex with women, ages 15-26 in New Orleans, LA. All men underwent a survey of sexual behavior, which included questions on condom use. From January 2017 to August 2019, participants were asked for the number of sex acts during which they had used a condom (absolute frequency question), and after August 2019 until March 2020, this was changed to response options of "Never", "Sometimes" or "Always" (relative frequency question). Participants could refuse to answer the question; the rate of refusal was tabulated by question type to determine if non-response rates differed. There were 1907 participants included in the study, with data on 2957 partnerships. Of those asked the relative frequency question, 92.7% responded compared to 86.1% who were asked the absolute frequency. In GEE modeling, those asked the relative frequency question had 2.42 (95% C.I. 1.42, 4.13, p < 0.001) greater odds of response than those asked the absolute frequency question. Relative frequency questions may be more likely to elicit a response, in research among this population.

Comparative analysis of laparoscopic nissen fundoplication and rossetti modification in gastroesophageal reflux disease: A focus on life quality enhancement

ObjectiveThis study aims to investigate the focus of surgical treatment of gastroesophageal reflux disease (GERD) on enhancing life quality beyond symptom relief. The comparison involves laparoscopic Nissen fundoplication and Rossetti modification techniques. MethodsPatients intolerant to or experiencing relapse after medical therapy underwent either standard Nissen procedure (Group 1, n=61) or Rossetti modification (Group 2, n=42). A disease-specific quality of life questionnaire for GERD was utilized for evaluating life quality preoperatively and 2 years postoperatively. Symptom scores and patient satisfaction were also assessed. ResultsPreoperatively, groups were similar in symptom duration, hiatal hernia presence, and DeMeester scores (p=0.127, p=0.427, and 0.584, respectively). Both groups exhibited a statistically significant increase in life quality postoperatively (p<0.001), with no significant intergroup difference. Symptoms decreased after both surgeries, except for dysphagia and bloating. Bloating significantly increased in both groups after surgery (p=0.018 and p=0.017, respectively), and dysphagia increased significantly only in Group 2 (p=0.007). The surgery refusal rate was significantly higher in Group 2 for similar preoperative symptoms (p=0.040). ConclusionDespite increased life quality scores, the combination of increased dysphagia and bloating in patients undergoing Rossetti modification resulted in a decreased satisfaction rate.

Assessment of fever screening at airports in detecting domestic passengers infected with SARS-CoV-2, 2020–2022, Okinawa prefecture, Japan

BackgroundWhile airport screening measures for COVID-19 infected passengers at international airports worldwide have been greatly relaxed, observational studies evaluating fever screening alone at airports remain scarce. The purpose of this study is to retrospectively assess the effectiveness of fever screening at airports in preventing the influx of COVID-19 infected persons.MethodsWe conducted a retrospective epidemiological analysis of fever screening implemented at 9 airports in Okinawa Prefecture from May 2020 to March 2022. The number of passengers covered during the same period was 9,003,616 arriving at 9 airports in Okinawa Prefecture and 5,712,983 departing passengers at Naha Airport. The capture rate was defined as the proportion of reported COVID-19 cases who would have passed through airport screening to the number of suspected cases through fever screening at the airport, and this calculation used passengers arriving at Naha Airport and surveillance data collected by Okinawa Prefecture between May 2020 and March 2021.ResultsFrom May 2020 to March 2021, 4.09 million people were reported to pass through airports in Okinawa. During the same period, at least 122 people with COVID-19 infection arrived at the airports in Okinawa, but only a 10 suspected cases were detected; therefore, the capture rate is estimated to be up to 8.2% (95% CI: 4.00-14.56%). Our result of a fever screening rate is 0.0002% (95%CI: 0.0003–0.0006%) (10 suspected cases /2,971,198 arriving passengers). The refusal rate of passengers detected by thermography who did not respond to temperature measurements was 0.70% (95% CI: 0.19–1.78%) (4 passengers/572 passengers).ConclusionsThis study revealed that airport screening based on thermography alone missed over 90% of COVID-19 infected cases, indicating that thermography screening may be ineffective as a border control measure. The fact that only 10 febrile cases were detected after screening approximately 3 million passengers suggests the need to introduce measures targeting asymptomatic infections, especially with long incubation periods. Therefore, other countermeasures, e.g. preboarding RT-PCR testing, are highly recommended during an epidemic satisfying World Health Organization (WHO) Public Health Emergency of International Concern (PHEIC) criteria with pathogen characteristics similar or exceeding SARS-CoV-2, especially when traveling to rural cities with limited medical resources.

A protocol to determine the acceptability and feasibility of a pilot intervention emergency department virtual observation unit fall prevention program

BackgroundAs a third of all community dwellers aged 65+ fall each year, falls are common reasons for older adults to present to an Emergency Department (ED). Although EDs should assess patients’ multifactorial fall risks to prevent future fall-related injuries, this frequently does not occur. We describe our protocol to determine the feasibility, acceptability, and safety of a pilot ED Virtual Observation Unit (VOU) Falls program.MethodsTo ensure standardized conduct and reporting, the Standard Protocol Items for Intervention Trials (SPIRIT) guidelines will be used. The VOU is a program where patients are sent home from the ED but are part of a virtual observation unit in that they can call on-call ED physicians while they are being treated for conditions such as cellulitis, congestive heart failure, or pneumonia. A paramedic conducts daily visits with the patient and facilitates a telemedicine consult with an ED physician. VOU nursing staff conduct daily assessments of patients via telemedicine. The ED VOU Falls program is one of the VOU pathways and is a multi-component fall prevention program for fall patients who present after an ED visit. The paramedic conducts a home safety evaluation, a Timed Up and Go Test (TUG). During the VOU visit, the ED physician conducts a telemedicine visit, while the paramedic is visiting the home, to review patients' fall-risk-increasing drugs and their TUG test. We will determine feasibility by calculating rates of patient enrollment refusal, and adherence to fall-risk prevention recommendations using information from 3-month follow-up telephone calls, as well as qualitative interviews with the paramedics. We will determine the acceptability of the ED VOU Falls program based on patient and provider surveys using a Likert scale. We will ask VOU nursing staff to report any safety issues encountered while the patient is in the ED VOU Falls program (e.g., tripping hazards). We will use the chi-square test or Fisher’s exact test for categorical variables, Student’s t-test for continuous variables, and Mann-Whitney for nonparametric data. We will review interview transcripts and generate codes. Codes will then be extracted and organized into concepts to generate an overall theme following grounded theory methods. This is a pilot study; hence, results cannot be extrapolated. However, a definite trial would be the next step in the future to determine if such a program could be implemented as part of fall prevention interventions.DiscussionThis study will provide insights into the feasibility and acceptability of a novel ED VOU Falls program with the aim of ultimately decreasing falls. In the future, such a program could be implemented as part of fall prevention interventions.

Mapping sedentary behaviour (MAPS-B) in winter and spring using wearable sensors, indoor positioning systems, and diaries in older adults who are pre-frail and frail: A feasibility longitudinal study.

Older adults who are frail are likely to be sedentary. Prior interventions to reduce sedentary time in older adults have not been effective as there is little research about the context of sedentary behaviour (posture, location, purpose, social environment). Moreover, there is limited evidence on feasible measures to assess context of sedentary behaviour in older adults. The aim of our study was to determine the feasibility of measuring context of sedentary behaviour in older adults with pre-frailty or frailty using a combination of objective and self-report measures. We defined "feasibility process" using recruitment (20 participants within two-months), retention (85%), and refusal (20%) rates and "feasibility resource" if the measures capture context and can be linked (e.g., sitting-kitchen-eating-alone) and are all participants willing to use the measures. Context was assessed using a wearable sensor to assess posture, a smart home monitoring system for location, and an electronic or hard-copy diary for purpose and social context over three days in winter and spring. We approached 80 potential individuals, and 58 expressed interest; of the 58 individuals, 37 did not enroll due to lack of interest or medical mistrust (64% refusal). We recruited 21 older adults (72±7.3 years, 13 females, 13 frail) within two months and experienced two dropouts due to medical mistrust or worsening health (90% retention). The wearable sensor, indoor positioning system, and electronic diary accurately captured one domain of context, but the hard copy was often not completed with enough detail, so it was challenging to link it to the other devices. Although not all participants were willing to use the wearable sensor, indoor positioning system, or electronic diary, we were able to triage the measures of those who did. The use of wearable sensors and electronic diaries may be a feasible method to assess context of sedentary behaviour, but more research is needed with device-based measures in diverse groups.