Outpatient Registry Research Articles

Design and Development of a Web-Based Registry for Outpatient Rehabilitation: A Delphi Multi-Disciplinary, Expert Consensus Study.

The goal of this research was to create a minimum data set (MDS) and design a web-based registry for outpatient rehabilitation, focusing on four disciplines: speech therapy, audiology, optometry, and physical therapy. The registry was intended to enhance assessment, guide optimal care, and provide value-based and evidence-based rehabilitation management for patients. This cross-sectional study utilized the Delphi technique at Mashhad University of Medical Sciences in northeastern Iran from 2022 to 2023. First, the PubMed, Scopus, Embase, and Web of Science databases were searched in an untimed systematic review. Additional information was gathered from websites and forms related to rehabilitation systems. Coding guidelines were derived from the International Classification of Functioning, Disability, and Health. A questionnaire containing data elements of outpatient rehabilitation was developed based on the systematic reviews. The data items were validated in two stages using the Delphi approach. Subsequently, an MDS and a web-based registry were designed for outpatient rehabilitation. The study included 25 eligible articles, 6 websites, and 24 forms to establish the rehabilitation MDS. A total of 470 information elements were extracted from the systematic review and rehabilitation registries. Through two rounds of the Delphi technique, 423 data elements were refined. The MDS was categorized into basic information and specialized information. Basic information comprised 12 subcategories of demographic details, socioeconomic information, referral information, service provider information, follow-up information, death information, history, past medical history, environmental factors, treatment measures, rehabilitation measures, and assessment of body systems; specialized information included four subcategories of optometry information, audiology information, physiotherapy information, and speech therapy information. Following the finalization of the MDS, a web-based registry for outpatient rehabilitation was created. This work offers a combined MDS that reflects the priorities and viewpoints of multidisciplinary experts for an outpatient rehabilitation registry that aids in clinical decision-making.

Precarious employment, strenuous working conditions and the long-term risk of diagnosed chronic musculoskeletal disorders

ObjectivesTo investigate the effect of precarious employment (PE) on the risk of diagnosed chronic musculoskeletal disorders (MSDs) among Swedish workers in occupations with strenuous working conditions.MethodsThis nationwide register-based cohort study...

Cryptorchidism: A 20-Year Journey of Patient Outcomes and Family Concerns – A Cohort Study at a Single Center

Background: Undescended testis (UDT), or cryptorchidism, is a prevalent pediatric condition with significant implications for fertility and malignancy risk if untreated. Affecting 1–5% of male infants, UDT is influenced by genetic, hormonal, and environmental factors. Methods: This retrospective cohort study examines 470 pediatric UDT cases treated at a single center over two decades (2004–2024) at a single pediatric surgery center - The Maternity and Child Teaching Hospital, Al Qadisiya, Iraq, focusing on surgical outcomes, fertility, long-term testicular health, and family concerns. Inclusion criteria; Patients were identified from hospital records and outpatient clinic registries confirmed diagnosis of UDT (unilateral or bilateral), availability of complete medical records, patients who underwent chromosomal analysis as part of their diagnostic workup, and underwent surgical intervention within the study timeframe at our center with at least three years of follow-up. Results: The mean age at diagnosis was 18 months, with 45% diagnosed within the first year. Unilateral UDT predominated (60%), and testicular position influenced size and outcomes. Surgical success was achieved in 90% of cases, with minor complications including wound infections (5%) and reoperations (5%). Earlier diagnosis correlated with improved fertility outcomes, with normal spermatogenesis observed in 75% of early cases but declining significantly with delayed treatment (P < 0.05). Chromosomal abnormalities, present in 9% of patients, heightened family concerns, particularly regarding fertility and psychosocial impacts. Conclusion: Family concerns evolved through stages of care, initially focusing on fertility and malignancy risks, then shifting to surgical safety and postoperative recovery. Tailored counseling and psychosocial support were integral to family satisfaction. This study underscores the importance of early diagnosis, multidisciplinary care, and culturally sensitive family engagement to optimize outcomes and enhance the quality of life for patients with UDT. Future recommendations include routine genetic screening and targeted educational initiatives to address community-specific challenges.

Self-awareness Regarding Obesity and Specific Therapy in Patients with Overweight or Obesity and Cardiovascular Diseases from Moscow Region

Objective: Despite the proven effectiveness of lifestyle interventions and specific medications in the treatment of obesity, little is known about their use in real-world practice. . Aims: To study the awareness of patients about the problem of overweight/obesity, as well as the clinical practice of non-drug and drug therapy according to the survey Material and Methods: Eligible patients were recruited from the prospective outpatient registry of patients with cardiovascular diseases. The design of the study was a cross-sectional cohort singlecentre. All of the included patients completed a specifically designed questionnaire. The study included 295 patients (mean age 66.8 ± 11.8 years) with a body mass index (BMI) of ≥ 25 kg/m2. One hundred eight (36.6%) individuals were overweight, 124 (42.2%) had first-class obesity, 42 (14.2%) had second-class obesity, and 21 (7.1%) patients had third-class obesity. Results: 252 patients (85.4%) were informed of being overweight/obese, and all of them received non-drug recommendations for the treatment of obesity. Anti-obesity medications (AOM) were recommended only to 25 (8.5%) patients: 3 – overweight, 11 – obesity class I, 6 obesity class II, and 5 – obesity class III. Twenty-one (7.1%) patients took the prescribed medications (84% adherence). The drugs were more often taken by patients with class II and III disease (40.5% and 57.1% of patients, respectively). Overweight (8.5%) and class I obesity (18.0%) patients took these drugs less often (p < 0.0001). Conclusion: The results of the survey have demonstrated good awareness of patients about their obesity/overweight and quite frequent use of non-drug obesity therapy. However, the rate of AOM prescription was extremely low.

Polycystic ovary syndrome and labor market attachment in Swedish women

Abstract Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of fertile age and is associated with several burdensome comorbidities. We use Swedish longitudinal register data to identify and compare clusters of employment trajectories among working age women, in order to investigate how PCOS affects labor market attachment. Data and Methods A cohort of 157,356 women born in 1975-1977 were followed annually between the ages of 30 and 39. Labor market states were constructed by combining detailed data on various types of earned income. PCOS was identified through national inpatient and outpatient registers. Sociodemographic covariates (civil status, region of origin, highest attained education, number of children) were measured at the age of 29 years. Sequence analysis was used to identify clusters of typical labor market trajectories. Multinomial logistic regression was employed to assess the associations between being diagnosed with PCOS and belonging to the identified clusters. Results Women with PCOS spent less time in employment and were more dependent on sickness benefits during the follow-up time than those without PCOS. Five clusters of trajectories were identified: stable employment, education into employment, labor market exclusion, continuous unstable position, long-term sickness. Compared to being in stable employment cluster, women diagnosed with PCOS were 97% more likely to experience long-term sickness (RRR (relative risk ratio): 1.97 [CI: 1.90-2.05]), and had 11% higher risk of belonging to education into employment (RRR: 1.11 [CI: 1.07-1.15]) and a 4% higher risk (RRR: 1.04 [CI: 1.00-1.09]) of experiencing labor market exclusion. The magnitude of the association increased for education into employment and labor market exclusion after adjusting for covariates. Conclusions PCOS can lead to disadvantaged labor market outcomes and better strategies are needed in order to prevent economic exclusion among women diagnosed with the condition. Key messages • PCOS leads to disadvantaged labor market outcomes. • Women with PCOS may experience economic exclusion.

Up-titration of Guideline Directed Medical Therapy (GDMT) and the occurrence of side effects in Heart Failure with reduced Ejection Fraction (HFrEF)

Abstract Background The ESC Guidelines recommend early, full-dose use of heart failure (HF) medications to enhance survival, but real-world application often faces delays and inconsistencies. Clinicians often fear side effects during up-titration to the recommended target dose (TD), i.e. hypotension, bradycardia, renal impairment, and hyperkalemia (HK). The dependency of side effects during dose escalation from the severity of HF remains unclear. Purpose This study aimed to evaluate the relationship between the occurrence of side effects during up-titration of HF medication and HF severity reflected by N-terminal pro B-type natriuretic peptide (NT-proBNP). Methods 425 patients with HFrEF and a complete data set of patient characteristics, medications and laboratory values at baseline (BL), 2 months (2M), and 6 months (6M) were included from our outpatient HF unit's prospective registry. Significant side effects were defined as: systolic blood pressure (SBP) <90mmHg, heart rate (HR) <50 beats per minute (bpm), potassium (K) >5.0mmol/l or K >5,5mmol/l and estimated glomerular filtration rate (eGFR) <30ml/min/1.73m2. Patients were categorized into three risk groups based on their NT-proBNP levels, i.e. low-risk with NT-proBNP <1000pg/ml, medium-risk with NT-proBNP 1000-2000pg/ml or high-risk with NT-proBNP >2000pg/ml. The occurrence of side effects was recorded and the development compared among the HF risk groups. Results Figure 1 shows up-titration of HF medication. Mean daily dosages of betablockers (BB), mineralocorticoid receptor antagonists (MRA) and renin-angiotensin-system inhibitors (RASi) increased significantly during follow-up (BL vs 2M and BL vs 6M, p<0.001 for all). The majority of patients received ≥50% of the recommended TDs at 6M (89% for BB, 83% for MRA, 88% for RASi and 91% for total mean TDs ≥50%), and the achieved daily dosages at 6M were largely comparable across the HF risk groups at 6M, except for RASi (p=0.030). Figure 2 depicts the side effects. Side effects developed almost exclusively at short-term within 2M except for lower SBP (Figure 2A). Newly developed side effects occurring after up-titration (2B) were even more rare and predominantly occurred within the highest NT-proBNP group. The occurrence of hypotension and bradycardia was infrequent and comparable within the HF risk groups. Renal dysfunction (at 6M p=0,041) and HK occurred predominantly in higher risk patients (HK at 2M p=0,001 and at 6M p<0,001). Conclusions Up-titration of HF medications is highly feasible, particularly in low- and medium-risk patients. Despite rare side effects such as hyperkalemia and renal impairment, up-titration remains unimpeded, especially in patients with NT-proBNP levels below 2000pg/ml. These findings emphasize the safety of up-titration in HF.

Guideline-directed medical therapy patterns in heart failure with reduced ejection fraction: the OPTIMA-HF registry

Abstract Background/Introduction European guidelines strongly recommend an optimized pharmacological treatment in patients with heart failure with reduced ejection fraction (HFrEF) with a fast introduction of the four-pillars. Purpose Aim of the Optimization of Therapy in the Italian Management of Heart Failure [OpTIMa-HF] Registry was to collect data on HF patients to describe the current Italian population of HF patients with a specific focus on HFrEF treatment adherence and prescription rates, according to the most recent European Guidelines. Methods OPTIMA-HF is an observational, cross-sectional, multicenter, real-life study conducted in two different clinical settings: HF outpatients’ clinics of Italian University Hospitals and territorial Italian Cardiology outpatients’ services, that enrolled patients with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA) and sodium glucose co-transporter II inhibitor (SGLT2i). Patient-level factors associated with medication use were examined. Results Overall, 1390 patients from 29 ambulatory cardiology practices and university hospitals were included. Mean age was 69.5 ± 11.9 years, 24% were female, and median EF was 33 (28-37). Among enrolled patients, 72.2% were prescribed ARNI, 17.1% ACEI/ARB, 95% beta-blocker, 75.5% MRA and 63% SGLT2i therapy (Figure 1). Despite high prescription rates for each single class, a still not sufficient number of patients was on treatment with all four pillars, in particular 40.4% considering the presence ARNI and 6.2%. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (31.7%), ARNI (16%), and beta-blocker (33.3%), whereas a higher proportion were receiving target doses of MRA therapy (38%), and all were receiving target dose for SGLT2i. Among patients eligible for all classes of medication, only 1.1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, MRA and SGLT2i. Prescription rates did not significantly differ between the type of center (University Hospital vs. territorial Cardiology outpatients’ services). As regards patients not on treatment with any of the four pillars, a small but still present amount of patients had no contraindications to these drugs (Figure 1). Conclusions In this contemporary outpatient HFrEF Italian registry, significant high prescription rates of the four-pillars were observed, however therapy combination rate is still not sufficient and drugs' titration need to be implemented to receive the greatest benefits from an optimized treatment. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.

Epidemiology of myasthenia gravis in Denmark, Finland and Sweden: a population-based observational study

BackgroundIncidence and prevalence rates of myasthenia gravis (MG) vary considerably across studies, and mortality risk is rarely addressed. We examined the prevalence and incidence rates, mortality and factors associated with...

A - 17 Effects of Bilingualism on Symptom Duration before Diagnosis of MCI

Abstract Objective While some studies (e.g., Bialystok et al., 2014; Brini et al., 2020) have identified a bilingual advantage in delaying age of onset for Mild Cognitive Impairment (MCI) (4.7 years) relative to monolingual individuals, inconsistencies have been attributed to immigration status and level of education, among others. The present study investigated the role of bilingualism on the age of MCI onset, symptom duration before diagnosis, and age at time of diagnosis MCI. Method Data from an outpatient neuropsychological clinic registry were examined for MCI. 177 adults ages 39–92 (monolingual = 121, bilingual = 56) were identified. Participants with Traumatic Brain Injury (TBI), acute psychosis, or dementia were excluded. Results Independent t-test showed monolingual individuals had significantly shorter duration of symptoms until diagnosis (32 months) than bilingual individuals (41 months; t (175) = −1.714, p = 0.044) despite the fact that there was no significant difference between monolingual and bilingual participants on age of symptom onset (t (175) = −0.033, p = 0.487) or age at diagnosis (t (175) = −0.456, p = 0.324). Years of education was not significant. Conclusion Bilingual patients had a longer course of symptoms before MCI diagnoses, providing support that bilingualism may aid in the preservation of cognitive function despite disease related progression associated with MCI. More detailed analysis accounting for quality of education, access to health care, socioeconomic status, immigration status, etc., is necessary to examine the complexity associated with bilingualism that may underlie the controversy around the bilingual advantage.

Prescription patterns of antibiotics and associated factors among outpatients diagnosed with respiratory tract infections in Jinja city, Uganda, June 2022–May 2023

BackgroundMost respiratory tract infections (RTIs) are viral and do not require antibiotics, yet their inappropriate prescription is common in low-income settings due to factors like inadequate diagnostic facilities. This misuse contributes to antibiotic resistance. We determined antibiotic prescription patterns and associated factors among outpatients with RTIs in Jinja City, Uganda.MethodsWe conducted a retrospective observational study that involved data abstraction of all patient records with a diagnosis of RTIs from the outpatient registers for the period of June 1, 2022, to May 31, 2023. An interviewer-administered questionnaire capturing data on prescribing practices and factors influencing antibiotic prescription was administered to drug prescribers in the health facilities where data were abstracted and who had prescribed from June 1, 2022, to May 31, 2023. We used modified Poisson regression analysis to identify factors associated with antibiotic prescription.ResultsOut of 1,669 patient records reviewed, the overall antibiotic prescription rate for respiratory tract infections (RTIs) was 79.8%. For specific RTIs, rates were 71.4% for acute bronchitis, 93.3% for acute otitis media, and 74.4% for acute upper respiratory tract infections (URTIs). Factors significantly associated with antibiotic prescription included access to Uganda Clinical Guidelines (Adjusted prevalence ratio [aPR] = 0.61, 95% CI = 0.01–0.91) and Integrated Management of Childhood Illness guidelines (aPR = 0.14, 95% CI = 0.12–0.87, P = 0.002), which reduced the likelihood of prescription. Prescribers without training on antibiotic use were more likely to prescribe antibiotics (aPR = 3.55, 95% CI = 1.92–3.98). Patients with common cold (aPR = 0.06, 95% CI = 0.04–0.20) and cough (aPR = 0.11, 95% CI = 0.09–0.91) were less likely to receive antibiotics compared to those with pneumonia.ConclusionThe study reveals a high rate of inappropriate antibiotic prescription for RTIs, highlighting challenges in adherence to treatment guidelines. This practice not only wastes national resources but also could contribute to the growing threat of antibiotic resistance. Targeted interventions, such as enforcing adherence to prescription guidelines, could improve prescription practices and reduce antibiotic misuse in this low-income setting.

Parental Report of Indoor Air Pollution Is Associated with Respiratory Morbidities in Bronchopulmonary Dysplasia

To determine the association between indoor air pollution and respiratory morbidities in children with bronchopulmonary dysplasia (BPD) recruited from the multicenter BPD Collaborative. A cross-sectional study was performed among participants <3years old in the BPD Collaborative Outpatient Registry. Indoor air pollution was defined as any reported exposure to tobacco or marijuana smoke, electronic cigarette emissions, gas stoves, and/or wood stoves. Clinical data included acute care use and chronic respiratory symptoms in the past 4weeks. A total of 1011 participants born at a mean gestational age of 26.4±2.2weeks were included. Most (66.6%) had severe BPD. More than 40% of participants were exposed to ≥1 source of indoor air pollution. The odds of reporting an emergency department visit (OR, 1.7; 95% CI, 1.18-2.45), antibiotic use (OR, 1.9; 95% CI, 1.12-3.21), or a systemic steroid course (OR, 2.18; 95% CI, 1.24-3.84) were significantly higher in participants reporting exposure to secondhand smoke (SHS) compared with those without SHS exposure. Participants reporting exposure to air pollution (not including SHS) also had a significantly greater odds (OR, 1.48; 95% CI, 1.08-2.03) of antibiotic use as well. Indoor air pollution exposure (including SHS) was not associated with chronic respiratory symptoms or rescue medication use. Exposure to indoor air pollution, especially SHS, was associated with acute respiratory morbidities, including emergency department visits, antibiotics for respiratory illnesses, and systemic steroid use.

Improving experiences of neglected tropical diseases of the skin: Mixed methods formative research for development of a complex intervention in Atwima Mponua District, Ghana.

Integrated approaches to managing co-endemic neglected tropical diseases (NTDs) of the skin within primary healthcare services are complex and require tailoring to local contexts. We describe formative research in Atwima Mponua District in Ghana's Ashanti Region designed to inform the development of a sustainable intervention to improve access to skin NTD care. We employed a convergent, parallel, mixed-methods design, collecting data from February 2021 to February 2022. We quantitatively assessed service readiness using a standardised checklist and reviewed outpatient department registers and condition-specific case records in all government health facilities in the district. Alongside a review of policy documents, we conducted 49 interviews and 7 focus group discussions with purposively selected affected persons, caregivers, community members, health workers, and policy-makers to understand skin NTD care-seeking practices and the policy landscape. Outside the district hospital, skin NTD reporting rates in the surveyed facilities were low; supply chains for skin NTD diagnostics, consumables, and medicines had gaps; and health worker knowledge of skin NTDs was limited. Affected people described fragmented care, provided mostly by hospitals (often outside the district) or traditional healers, resulting in challenges obtaining timely diagnosis and treatment and high care-seeking costs. Affected people experienced stigma, although the extent to which stigma influenced care-seeking behaviour was unclear. National actors were more optimistic than district-level actors about local resource availability for skin NTD care and were sceptical of including traditional healers in interventions. Our findings indicate that improvement of the care cascade for affected individuals to reduce the clinical, economic, and psychosocial impact of skin NTDs is likely to require a complementary set of interventions. These findings have informed the design of a strategy to support high-quality, integrated, decentralised care for skin NTDs in Atwima Mponua, which will be assessed through a multidisciplinary evaluation.

Effects of Patient-Initiated Brief Admissions on Psychiatric Care Consumption in Borderline Personality Disorder: ARegister-Based Study.

Previous studies have reported that patients with borderline personality disorder (BPD) often have negative experiences in psychiatric inpatient care. To address this issue, a novel intervention known as patient-initiated brief admission (PIBA) has been developed. PIBA offers a constructive approach to crisis management insituations of heightened anxiety, as well as during instances of self-harm and suicidal ideation. The intervention allows patients to directly contact the psychiatric ward to initiate a brief admission lasting 1-3 days. This easily accessible care option during a crisis has the potential to prevent harm to the patient and reduce the need for prolonged hospital stays. The aim of the present study is to investigate the effects of PIBA on psychiatric care consumption among patients diagnosed with BPD. This retrospective register-based study includes data from both inpatient and outpatient care registries for patients diagnosed with BPD. Data were extracted from the National Board of Health and Welfare in Sweden. The study period encompasses 2013-2020, with the PIBA intervention occurring between 2016 and 2019. The sample included 107 patients in the PIBA group and 5659 matched controls. Data were analysed using a difference-in-differences (DiD) approach through ordinary least squares (OLS) regression and ordinal logistic regression. Throughout the 3-year follow-up, both groups exhibited a reduction in the number of days of utilisation of psychiatric inpatient care services. The DiD analysis indicated an additional decrease of 1.5 days at the 6-month mark for the PIBA group (β = -1.436, SE = 1.531), expanding to 3 days fewer at the 12-month follow-up (β = -3.590, SE = 3.546), although not statistically significant. For outpatient care, the PIBA group displayed an increase in the number of visits, averaging to half a visit more every 6 months (β = 0.503, SE = 0.263) compared with the controls. Statistically significant differences were observed for two out of six measurements at the 12-month (β = 0.960, SE = 0.456) and 18-month follow-up period (β = 0.436, SE = 0.219). The PIBA group had a statistically significant lower odds of experiencing extended lengths of inpatient care days after the index date than the controls (OR 0.56, 95% CI: 0.44-0.72). In conclusion, PIBA was associated with a significant reduction in the length of individual hospital stays, but not in the overall number of inpatient care days. PIBA may be linked to a shift from longer inpatient care utilisation to outpatient care utilisation. These findings suggest that PIBA may reduce the risk of prolonged hospitalisations for patients who have access to the intervention. Future research should explore the impact of PIBA on healthcare costs and cost-effectiveness, both in relation to health care for the individual and cost-effectiveness in relation to recovery and health.

Extended Swedish Adoption Study of Adverse Stress Responses and Posttraumatic Stress Disorder

Twin studies have found that posttraumatic stress disorder (PTSD) is influenced by both genetic and environmental factors within a generation. No study has used an adoption design, which can address questions about the degree and sources of cross-generational transmission of adverse stress responses (ASRs) and PTSD. To examine whether ASRs or PTSD are transmitted from parents to offspring, and to clarify the relative importance of genes and rearing. This cohort study used nationwide Swedish registry data from parents and offspring (n = 2 194 171, born 1960-1992) of 6 types of families (intact; had not lived with biological father; had not lived with biological mother; lived with stepfather; lived with stepmother; and adoptive). Follow-up occurred on December 31, 2018, and data were analyzed from March 3, 2023, to January 16, 2024. Three sources of parent-offspring resemblance: genes plus rearing, genes only, and rearing only. Diagnoses of ASRs or PTSD were obtained from national inpatient, outpatient, and primary care medical registries. Parent-child resemblance was assessed by tetrachoric correlation. Sensitivity analyses were conducted to control for possible shared traumatic events. The study population included 2 194 171 individuals of 6 family types (1 146 703 [52.3%] male; median [range] age, 42 [20-63] years). The weighted tetrachoric correlations across family types were 0.15 (95% CI, 0.15-0.16) for genes plus rearing, 0.08 (95% CI, 0.06-0.11) for genes only, and 0.10 (95% CI, 0.07-0.12) for rearing only. Controlling for potential shared traumatic events, sensitivity analyses found that the correlation for rearing decreased, with the most conservative control (exclusion of parent-offspring dyads with onset of ASRs or PTSD within 1 year) suggesting equal correlations with genes and rearing. Diagnosis of ASRs or PTSD demonstrated cross-generational transmission, including both genetic and rearing correlations. Sensitivity analyses suggested that shared traumatic events partially accounted for the observed rearing correlations.

Neighborhood Walkability Is Associated With Lower Burden of Cardiovascular Risk Factors Among Cancer Patients

BackgroundModifiable cardiovascular risk factors constitute a significant cause of cardiovascular disease and mortality among patients with cancer. Recent studies suggest a potential link between neighborhood walkability and favorable cardiovascular risk factor profiles in the general population. ObjectivesThis study aimed to investigate whether neighborhood walkability is correlated with favorable cardiovascular risk factor profiles among patients with a history of cancer. MethodsWe conducted a cross-sectional study using data from the Houston Methodist Learning Health System Outpatient Registry (2016-2022) comprising 1,171,768 adults aged 18 years and older. Neighborhood walkability was determined using the 2019 Walk Score and divided into 4 categories. Patients with a history of cancer were identified through International Classification of Diseases-10th Revision-Clinical Modification codes (C00-C96). We examined the prevalence and association between modifiable cardiovascular risk factors (hypertension, diabetes, smoking, dyslipidemia, and obesity) and neighborhood walkability categories in cancer patients. ResultsThe study included 121,109 patients with a history of cancer; 56.7% were female patients, and 68.8% were non-Hispanic Whites, with a mean age of 67.3 years. The prevalence of modifiable cardiovascular risk factors was lower among participants residing in the most walkable neighborhoods compared with those in the least walkable neighborhoods (76.7% and 86.0%, respectively). Patients with a history of cancer living in very walkable neighborhoods were 16% less likely to have any risk factor compared with car-dependent–all errands neighborhoods (adjusted OR: 0.84, 95% CI: 0.78-0.92). Sensitivity analyses considering the timing of events yielded similar results. ConclusionsOur findings demonstrate an association between neighborhood walkability and the burden of modifiable cardiovascular risk factors among patients with a medical history of cancer. Investments in walkable neighborhoods may present a viable opportunity for mitigating the growing burden of modifiable cardiovascular risk factors among patients with a history of cancer.

Ophthalmological conditions among elderly patients attending a private eye care facility in Malawi: A retrospective study.

The elderly comprises the fastest-expanding age group globally, with the greatest increase occurring in developing countries. The elderly populace is prone to develop various ocular morbidities. To determine the distribution of ocular morbidities among the elderly population visiting a private eye care facility in Malawi. This was a retrospective cross-sectional study conducted at St. John's Hospital in Mzuzu, Malawi. We retrieved data from the hospital's ophthalmic outpatient registry from January, 2021 to December, 2021. A nonprobability census sampling technique was used to retrieve 52 elderly patients. Data analysis were done employing SPSS (v.26). This study found according to gender a larger proportion were females 27 (51.9%) compared males, who accounted for 25 (48.1%). Refractive error 21 (40.4%) was the most prevalent ocular morbidity followed by cataract 13 (25.0%), pinguecula 6 (11.5%), and glaucoma 4 (7.7%). Although clear differences exist in the distribution of ocular morbidities according to sex (p = 0.529) and age (p = 0.328), the differences are not statistically significant. The pattern of eye diseases is typical to the country. More resources should be targeting main causes of preventable blindness including refractive error and cataracts at the facility.

Homicide and Mental Disorders—Perpetrators’ Prior Contacts With Psychiatric Services

This study examines diagnosed mental health disorders among nearly 800 perpetrators of homicide in Sweden between 2005 and 2017. The analysis is based on information from in- and outpatient registers, which has been linked to crime data on homicide. The results show that four out of the 10 homicide perpetrators had been in contact with psychiatric services during the year prior to the crime. It is about seven times more common for a perpetrator of homicide, irrespective of sex, to have been in contact with psychiatric services during the year prior to the crime than it is for someone in the general population to have such contacts in the course of a calendar year. The prevalence of different psychiatric disorders among homicide perpetrators follows the same pattern as that observed in the general population although at higher levels. In both populations, substance abuse, depression, and anxiety disorders dominate. However, the overrepresentation of substance abuse—especially multi-substance abuse—and personality disorders is particularly high among the perpetrators. Perpetrators of family-related homicide had particularly frequent contacts with psychiatric services prior to the crime. Female perpetrators had been treated for psychiatric disorders more often than men, which may reflect not only actual differences in levels of psychiatric ill-health but also differences in the propensity to seek treatment.

Establishing the profile of eye diseases among elderly patients attending a tertiary hospital in Northern Malawi

Globally, there has been a dramatic increase in the geriatric population. Sadly, this populace is highly prone to develop various ocular morbidities putting pressure on the strained eye care delivery system especially in low-income countries. Hence, the aim of this study was to determine the distribution of ocular morbidities among elderly. The study was a retrospective cross-sectional study conducted at Mzuzu Central Hospital in Malawi. We retrieved data from the hospital’s Ophthalmology out-patient registry from January 2021 to December 2021. We recruited all 970 elderly patients who visited the clinic during the period of study. Data entry and analysis was done employing SPSS (v.26). More males than females had ocular morbidities. Cataract 400 (41.2%) was the most prevalent ocular morbidity followed by glaucoma 189 (19.5%), pinguecula 48 (4.9%) and allergic conjunctivitis 43 (4.4%). Anterior segment eye diseases were common 714 (73.6%). The prevalence of cataract, glaucoma, refractive error and allergic conjunctivitis was significantly associated with sex (p < 0.05). Age association was found with the prevalence of cataract, glaucoma, pinguecula, allergic conjunctivitis and corneal scar (p < 0.05). The pattern of eye diseases is endemic to the country. More resources should be targeting cataract and glaucoma among the age group.

Trajectories of Kidney Function in Heart Failure Over a 15-Year Follow-Up: Clinical Profiling and Mortality

BackgroundLimited data are available on the long-term trajectory of estimated glomerular filtration rate (eGFR) in patients with chronic heart failure. ObjectivesThe authors evaluated eGFR dynamics using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation and its prognostic significance in a real-world cohort over a 15-year follow-up. MethodsA prospective observational registry of ambulatory heart failure outpatients was conducted, with regular eGFR assessments at baseline and on a 3-month schedule for ≤15 years. Urgent kidney function assessments were excluded. Locally weighted error sum of squares curves were plotted for predefined subgroups. Multivariable longitudinal Cox regression analyses were conducted to assess associations with all-cause and cardiovascular death. ResultsA total of 2,672 patients were enrolled consecutively between August 2001 and December 2021. The average age was 66.8 ± 12.6 years, and 69.8% were men. Among 40,970 creatinine measurements, 28,634 were used for eGFR analysis, averaging 10.7 ± 8.5 per patient. Over the study period, a significant decline in eGFR was observed in the entire cohort, with a slope of −1.70 mL/min/1.73 m2 per year (95% CI: −1.75 to −1.66 mL/min/1.73 m2 per year). Older patients, those with diabetes, a preserved ejection fraction, a higher baseline eGFR, elevated hospitalization rates, and those who died during follow-up experienced more pronounced decreases in the eGFR. Moreover, the decrease in kidney function correlated independently with all-cause mortality and cardiovascular death. ConclusionsThese findings highlight the sustained decline in eGFR over 15 years in patients with heart failure, with variations based on clinical characteristics, and emphasize the importance of regular eGFR monitoring in this population.

Association Between Cardiovascular Event Type and Smoking Cessation Rates Among Outpatients With Atherosclerotic Cardiovascular Disease: Insights From the NCDR PINNACLE Registry.

It is unclear how the type of an atherosclerotic cardiovascular disease (ASCVD) event potentially influences patients' likelihood of smoking cessation. Using 2013 to 2018 data from the US based National Cardiovascular Data Registry Practice Innovation and Clinical Excellence outpatient cardiac registry, we identified patients who were current smokers at a clinic visit and followed them over time for a subsequent ASCVD event. Self-reported smoking status was assessed at each consecutive visit and used to determine smoking cessation after each interim ASCVD event (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, stroke/transient ischemic attack, peripheral artery disease). We constructed separate multivariable Cox models with nonproportional hazards to examine the association of each interim ASCVD event with smoking cessation, compared with not having an interim ASCVD event. We estimated the relative association of ASCVD event type with smoking cessation using contrast tests. Analyses were stratified by presence versus absence of ASCVD at baseline. Across 530 cardiology practices, we identified 1 933 283 current smokers (mean age 62±15, male 54%, ASCVD at baseline 50%). Among the 322 743 patients who had an interim ASCVD event and were still smoking, 41 336 (12.8%) quit smoking by their first subsequent clinic visit, which was higher among those with baseline ASCVD (13.4%) as compared with those without baseline ASCVD (11.5%). Each type of ASCVD event was associated with an increased likelihood of smoking. Patients who had an myocardial infarction, underwent coronary artery bypass graft (hazard ratio, 1.60 [95% CI, 1.55-1.65]), or had a stroke or transient ischemic attack were more likely to quit smoking as compared with those who underwent elective percutaneous coronary intervention or had a new diagnosis of peripheral artery disease (hazard ratio, 1.20 [95% CI, 1.17-1.22]). Only 13% of patients reported smoking cessation after an ASCVD event, with the type of event being associated with the likelihood of smoking cessation, prompting the need for patient-centered interventions.