Regular Appointments Research Articles

HIV-1 treatment failure among population taking Antiretroviral Therapy in Ethiopia

Background: Treatment failure (TF) among patients receiving antiretroviral therapy (ART) against human immunodeficiency virus (HIV) impacts on treatment outcome and is becoming a public health concern globally. However, magnitude of TF and factors leading to it are poorly defined in the context of Ethiopia. Thus, the aim of this study was to determine the magnitude of TF and assess its determinants among HIV-infected patients on ART in Ethiopia. Methods: A prospective and retrospective study was conducted from March 2016 to 2017. Retrospective clinical and laboratory data were captured from patients’ medical record. Socio-demographics and explanatory variables of participants were collected using pre-tested structured questionnaire and study participants were followed for additional 6 month after baseline viral load has been done to classify virologic failure (VF). Multiple logistic regression was conducted to assess risk factors associated with TF. Statistical significance was set at P-value less than 0.05. Results: A total of 9,284 adults taking ART from a nationally representative 63 health facilities were included in the study. Viral Load Suppression (VLS) (VL1000 copies/ml at baseline of the study were re-suppressed after six months of enhanced adherence and counseling, leading TF among population on ART in Ethiopia to be 983 (11%). Immunologic and clinical failure was significantly improved from 21.5% and 16.5% at ART initiation to 576 (6.2%) and 470 (5.0%) at baseline of the study, respectively. Medication adherence, disclosure of HIV status, missed appointment to ART, history of ART exposure prior to initiation, residency and marital status had significant association with TF. Conclusions: The high level of VLS (88.1%) could explain the success of ART program in Ethiopia towards achieving the UNAIDS global target on viral suppression. TF among population taking ART in Ethiopia is still a public health concern, since 11% of virally failed population is maintained on failed first-line regimen. However, a significant improvement on immunologic and clinical outcome after ART initiation was maintained. Close follow-up of medication adherence, ensuring disclosure of HIV status, regular appointment follow-up to ART could significantly improve the treatment outcome of population on ART in Ethiopia.

A register-based observational cohort study on persistent frequent users of emergency services in a Finnish emergency clinic

BackgroundThe focus of emergency room (ER) treatment is on acute medical crises, but frequent users of ER services often present with various needs. The objectives of this study were to obtain information on persistent frequent ER service users and to determine reasons for their ER service use. We also sought to determine whether psychiatric diagnoses or ongoing use of psychiatric or substance use disorder treatment services were associated with persistent frequent ER visits.MethodsA cohort (n = 138) of persistent frequent ER service users with a total of 2585 ER visits during a two-year-period was identified. A content analysis was performed for 10% of these visits. Register data including International Classification of Primary Care 2 (ICPC-2) –codes and diagnoses were analyzed and multivariable models were created in order to determine whether psychiatric diagnoses and psychosocial reasons for ER service use were associated with the number of ER visits after adjusting for covariates.ResultsPatients who were younger, had a psychiatric diagnosis and engaged in ongoing psychiatric and other health services, had more ER visits than those who were not. Having a psychiatric diagnosis was associated with the frequency of ER visits in the multivariable models after adjusting for age, gender and ongoing use of psychiatric or substance use disorder treatment services. Reasons for ER-service use according to ICPC-2 –codes were inadequately documented.ConclusionsPatients with psychiatric diagnoses are overrepresented in this cohort of persistent frequent ER service users. More efficient treatments paths are needed for patients to have their medical needs met through regular appointments.

Mexico's Prospera Program and Indigenous Women's Reproductive Rights.

In this study, I examine Indigenous women's autonomy and reproductive rights within Mexico's Prospera program. Prospera gave women living in poverty bimonthly cash stipends for complying with requirements argued to improve the health and welfare of their families, including attending regular appointments at the clinic. Although hailed as successful, Mexico's new administration recently eliminated the health care component, citing various abuses. Some policy experts argue that these claims are unfounded and have questioned how Mexico will now address the health care needs of marginalized populations. Drawing on more than 2 years of fieldwork (2012-2014) in a Mayan community in Chiapas, I present evidence of abusive practices related to reproductive health care based on direct observations and audio-recordings of clinical interactions and program operations in IMSS-Prospera. Furthermore, I show how the reproductive habitus that supported these actions was shaped by long-standing institutional habits and sociocultural factors that need to be directly addressed in present reforms.

Aging is independently associated with an increasing normal respiratory rate among an older adult population in a clinical setting: A cross-sectional study.

Clinical prediction scores for older patients are inaccurate, partially because they do not account for the effects of aging on the respiratory rate. The principal aim of the present study was to assess the effects of aging on the normal respiratory rate in older patients in a clinical setting. We recruited 634 participants aged >59 years to <100 years who presented to our hospital (Iwakuni Municipal Miwa Hospital, for regular appointments without any new symptoms. We assessed the relationship between age and respiratory rate using Pearson's correlation coefficient and the Jonckheere-Terpstra test. We carried out multiple linear regression analysis, with sex, age, blood pressure, heart rate and 14 comorbidities as dependent variables, and respiratory rate as the independent variable. The mean ± standard deviation respiratory rate for all for all participants was 16.1 ± 4.28. The mean ± standard deviation respiratory rates for individuals aged in their 60s, 70s, 80s and 90s were 14.8 ± 4.28, 15.5 ± 3.62, 16.37 ± 4.48 and 17.1 ± 4.45, respectively. Pearson's correlation coefficient between age and respiratory rate was 0.17 (95% confidence interval 0.10-0.25). The Jonckheere-Terpstra test and multiple linear regression analysis showed a significant positive trend between age group and respiratory rate (P < 0.001). Although the correlation coefficient between age and respiratory rate was low (R = 0.17), aging was a statistically significant factor in determining the normal respiratory rate in older patients. Furthermore, the respiratory rate increased with age. Geriatr Gerontol Int 2019; 19: 1179-1183.

Patient Portal Usage and Outcomes Among Adult Patients with Uncontrolled Asthma

Patient-clinician communication, essential for favorable asthma outcomes, increasingly relies on information technology including the electronic heath record-based patient portal. For patients with chronic disease living in low-income neighborhoods, the benefits of portal communication remain unclear. To describe portal activities and association with 12-month outcomes among low-income patients with asthma formally trained in portal use. In a longitudinal observational study within a randomized controlled trial, 301 adults with uncontrolled asthma were taught 7 portal tasks: reviewing upcoming appointments, scheduling appointments, reviewing medications, locating laboratory results, locating immunization records, requesting refills, and messaging. Half the patients were randomized to receive up to 4 home visits by community health workers. Patients' portal use by activities, rate of usage over time, frequency of appointments with asthma physicians, and asthma control and quality of life were assessed over time and estimated as of 12 months from randomization. Fewer than 60% of patients used the portal independently. Among users, more than half used less than 1 episode per calendar quarter. The most frequent activities were reading messages and viewing laboratory results and least sending messages and making appointments. Higher rates of portal use were not associated with keeping regular appointments during follow-up, better asthma control, or higher quality of life at 12-month postintervention. Patients with uncontrolled asthma used the portal irregularly if at all, despite in-person training. Usage was not associated with regular appointments or with clinical outcomes. Patient portals need modification to accommodate low-income patients with uncontrolled asthma.

P6368Blood pressure control in a registry of clinical practice, PINNACLE-BRAZIL REGISTRY

Abstract Introduction The prevalence of hypertension is estimated to be nearly 50% among Brazilian adults. Achieving an adequate control of this CVD risk factor is challenging but truly relevant on a public health perspective, as this is the top-ranking cause of all deaths globally. Purpose We aimed to describe crude and simple metrics of blood pressure management (including its control), as based on current guideline-derived recommendations, after one year of the clinical practice registry Methods Patients with documented Hypertension were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. The main goal of the PINNACLE program is to improve the quality of care in “real world” clinical practice. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated Results Currently, PINNACLE-Brazil has enrolled 7598 patients, with 87% of diagnosed hypertension. Percentage of patients with a diagnosis of hypertension who had a blood pressure measurement &lt;140/90 mmHg was 47.9% (baseline) and 57.3% (follow-up). Percentage of patients who had a blood pressure &lt;140/90 mm Hg, or who had a blood pressure ≥140/90 mm Hg and were prescribed ≥2 antihypertensive medications were 67.1% on baseline and 71.2% after 1 year. Conclusion The preliminary data of PINNACLE Registry in Brazil shows that a significant proportion of hypertensive patients (nearly half) have not presented with adequate control of blood pressure levels and, moreover, a large proportion have not been treated with recommended combination of 02 or more antihypertensive medications to reach targeted BP levels the quality of care was improving after 01 year of registry. Acknowledgement/Funding ACC Foundation

P6444Cardiovascular secondary prevention setting and lipid controlu, update data from PINNACLE BRAZIL REGISTRY

Abstract Introduction Lipid control is highly effective and improves clinical outcomes in coronary artery disease (CAD) patients, thus is one of the pillars of the cardiovascular secondary prevention. Purpose The aim of this preliminary analysis was to describe the lipid management in CAD patients in Brazil after one year of the clinical practice registry. Methods Patients with documented CAD were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated Results Currently, PINNACLE-Brazil enrolled individuals, with 2234 (29.4%) patients with CAD. Prescription of statin therapy was identified in 85.6% baseline and 78.3% follow-up. CAD patients with LDL-c &lt;100 mg/dL were 47.3% baseline and 38.5% follow-up and at least one lipid profile assessment occurred in 60.9% baseline and 51.2% follow-up. CAD patients who have an LDL-c result &lt;100 mg/dL, or &gt;100 mg/dL with a documented plan to achieve LDL-c &lt;100 mg/dL, were 48.1% (baseline) and 38.5% (follow-up). Conclusion The preliminary results of PINNACLE-Brazil show that, despite the relatively high prescription rate of statin therapy, LDL-c targeted level for CVD secondary prevention has not been achieved in the majority of patients after 01 year of follow-up. Nationwide knowledge translation initiatives are needed to improve the CVD burden in Brazil Acknowledgement/Funding ACC Foundation

P04 Co-designing a comparative randomised controlled clinical trial of corticosteroid regimens with children, young people and parents living with juvenile idiopathic arthritis

Abstract Background Previous research has identified the need for a randomised controlled trial (RCT) evaluating the most appropriate corticosteroid induction regimen to be used for children and young people (CYP) with juvenile idiopathic arthritis (JIA). A recent qualitative study found that parents and CYP understood trial concepts and were able to identify potential flaws in a proposed RCT. This confirms the need to involve parents and CYP in co-designing RCTs to best meet the needs of future trial participants. We aimed to co-design components of an RCT of corticosteroid regimens with CYP and parents living with JIA. Methods A focus group was conducted with CYP with JIA and parents as part of a wider consensus and discussion group meeting within the Steroid Induction Regimen for Juvenile Idiopathic Arthritis (SIRJIA) study in December 2018. The discussion focused on two components of the RCT design: i) Discussing the most appropriate treatment protocols; and ii) Addressing practicalities associated with an RCT. Results Two RCT protocol options, chosen through an online survey by a clear majority out of a possible eight protocols, were discussed and critiqued: i) Protocol A (intravenous vs intraarticular corticosteroid delivery); and ii) Protocol B (intravenous vs intraarticular vs intramuscular vs oral corticosteroid delivery). Several issues pertaining to both protocols were raised, related to the influence of age and past experience, routes of administration and concerns over randomisation. Participants emphasised the importance of clinicians/researchers discussing all of the potential risks with them. Participants also wanted enough information to make an informed choice. Participants emphasised the usefulness of combining trial visits with regular follow-up appointments to minimise the burden of taking part in an RCT and had a preference for their usual hospital being the site they visited. Some participants remarked that videos could be a useful way of conveying information beyond traditional participant information sheets. Some also felt that awareness of research opportunities is not equally accessible to them either, depending on where they lived in the country. Participants would want to be kept regularly updated about the progress of the RCT and felt that incentives were a good way of keeping people engaged, although some were apprehensive about hearing negative treatment results. With regards to dissemination, participants felt that study results should be readily available to them in an accessible format, should they wish to view them. Conclusion CYP and parents have a considerable amount of knowledge and experience which can shape the design of RCTs. With adequate support, complex concepts such as treatment protocols can be discussed and critiqued. Involving CYP and parents at the design stage of an RCT has been shown to eliminate some potential challenges in the future. Conflicts of Interest The authors declare no conflicts of interest.

Reflections on the SSAG2018 conference: focus, formats, and impacts

ABSTRACT Academic conferences are a regular appointment in many academic calendars worldwide. It serves several purposes, some of which are for networking, dissemination of research and adult training. For many years, the Society of South African Geographers has used the traditional conference format for their annual student and biennial academic conferences as a means of (partially) fulfiling their constitutional objectives. However, in the age of environmental change and increasing social challenges, there might be a need to rethink conferences – both in their purpose and cost. Significant costs are incurred on both the hosting institution and the attending delegates’ part. Further, the environmental impact of these conferences is substantial, and it begs justification for the efficiency of conference impacts and outputs. Using the most recent SSAG conference, SSAG2018, this paper reflects on the current conference format and questions the environmental and social impact. In light of this, recommendations are made to future conference organizers to increase the environmental consciousness and widen the social impact. It serves as a starting point for continued documentation and discussion of SSAG conference activities.

Pilot implementation of newborn hearing screening programme at four hospitals in southern Thailand.

ObjectiveTo determine the effectiveness and benefit of a universal newborn hearing screening programme at four different hospitals in southern Thailand, between January and July 2017.MethodsOne screener per hospital recorded demographic data of all newborns and their exposure to risk of hearing loss, and evaluated their hearing by transient otoacoustic emission technology. Those who demonstrated bilateral moderate to profound hearing loss at both a first and second screening were referred for diagnostic assessment. Those with confirmed hearing loss received treatment and regular follow-up appointments, and their speech development was assessed at 1 year of age. We determined effectiveness by comparing our achieved coverage and proportion of follow-up and referrals with benchmarks set by the American Academy of Pediatrics (≥ 95%, ≥ 95% and ≤ 4%, respectively), and determined benefit by calculating the composite language scores of hearing-impaired infants who received early intervention.FindingsWe screened 6140 eligible newborns, and achieved a screening coverage of 95.4% (5859/6140), lost 25.7% (63/245) and 22.0% (9/41) to follow-up at the second screening and diagnostic assessment stages, respectively, and obtained an overall proportion of referrals of 0.7% (41/6140). Twelve infants were confirmed as having hearing loss and received early intervention; nine (75%) demonstrated normal speech development by their first birthday. Our universal hearing screening yielded a prevalence of sensorineural hearing loss of less than 0.1% (3/6140).ConclusionAlthough ineffective by American Academy of Pediatrics standards, we demonstrated the benefit of early intervention in infants diagnosed with hearing loss.

Advance care planning in progressive neurological diseases: lessons from ALS

BackgroundThere is increasing awareness of the need for an integrated palliative care approach in chronic progressive neurological diseases. Advance care planning (ACP) is an integral part of this approach. As a systematically organized and ongoing communication process about patients’ values, goals and preferences regarding medical care during serious and chronic illness, ACP aims to involve patients in decision-making before they become cognitively and communicatively incapable. However, it remains underutilized in daily neurological practice except for speciality clinics such as ALS centers. Our aim was to study ACP in the tertiary ALS center Amsterdam and to investigate patients’ reflections on it. Subsequently we used this knowledge to formulate recommendations for integration of ACP in the care of patients with other chronic progressive neurological diseases.MethodsNon-participating observations of all appointments of patients with amyotrophic lateral sclerosis (ALS) or progressive muscular atrophy (PMA) with the treating physician, in various stages of disease, during 6 consecutive months, followed by single in-depth interviews, and an inductive analysis.ResultsTwenty-eight Dutch patients participated, varying in age, gender, disease onset and severity of physical decline. ACP started directly when the diagnosis was given, by means of a general outlook on the future with progressive disability and immediate introduction to a customized multidisciplinary team. During follow-up ACP was realized by regular appointments in which monitoring of the patient’s status and clear communication strategies formed the basis of tailor-made discussions on treatment options. Patients accepted this policy as careful professional guidance.ConclusionsACP is a professional communication process throughout the whole course of progressive disease. It is feasible to integrate ACP into follow-up of patients with ALS and PMA from diagnosis onwards. Supported by recent literature, we argue that such a well-structured approach would also enhance the quality of care and life of patients with other chronic progressive neurological diseases.

STUDY OF INTERACTIVE LEARNING SPREADS WITHIN EDUCATIONAL ESTABLISHMENTS

Learning takes place in spaces that are not limited to the classroom, as it is a process that occurs everywhere within the educationalfacility, from the classroom to the corridors, roads, etc. Learning spaces within educational facilities are classified into formaland informal learning spaces. The official learning space is the space that is used according to regular official appointments, andthese spaces vary to include classes, lecture halls, laboratories, ceremonies ... etc. There are several factors that affect the designof formal learning spaces, including: The development in pedagogy: The pedagogy has witnessed a shift towards active learningand cooperative learning, as well as a variety of teaching methods According to the need of the academic subject, which resultsin arranging the semester according to the method of teaching followed. New students' qualities and habits: Understandingstudents ’characteristics and habits helps in designing and developing learning spaces. There are five important features for newstudents that must be taken care of and taken into account: digital, mobile, independence, social, and participatory. Rapiddevelopment in educational communication technology: It means all digital technological devices, means, software and media andnon-digital technologies that are integrated into the learning process, and education technologies can be divided into threecategories: virtual technologies, installed devices, And mobile devices. The trend towards the human being at the center of design:through concern for some features, among which are health (and includes: physical comfort Good lighting - acoustics - indoor airquality), stimulation (through attention to sensory cues - contact with nature, shapes various color), adaptation (through flexibility- sufficient space - portable display - communication of various information. Informal learning space is a space inside theeducational facility that allows students to practice and discuss academic work without committing to deadlines Official. Thespaces that represent informal learning spaces are varied and include outdoor space, corridors, lobbies and lounges, coffee shop,and library. There are factors that affect the success of informal learning spaces, including: Spaces are compatible with the needsof learners. Striking a balance between society and isolation. Stimulus. Availability of technology and ease of contact withinformation. Adaptation

Adherence to Medical Appointments Among Living Kidney Donors After Donation Under a Monitored Approach and Long-term Clinical Outcomes: A Brazilian Single-center Cohort Study

BackgroundThere is little information about living donor long-term follow-up among Brazilian living donors. The aim of this study was to evaluate the main outcomes among living donors and to measure their adherence to regular medical appointments. MethodsThis is a Brazilian single-center cohort study that included 397 living donors with 87.1 months of follow-up and measured adherence to clinical appointments. Before 2010, the appointments were scheduled only spontaneously; after that an approach was structured to check the returns of donors, who were monitored actively. We also evaluated long-term outcomes such as survival and chronic kidney disease development and, secondarily, the incidences of hypertension, diabetes mellitus (DM), and dyslipidemia after donation. ResultsThe donors' adherence to annual clinical appointments was 75.8% (54.7% of them presenting annual regularity). Before 2010 the adherence was lower than 40%; 10-year cumulative incidences of hypertension, DM, and dyslipidemia were 20.4%, 5.7%, and 23.5%, respectively. The crude mortality was 1% and 10-year donor survival was 98.5%. The incidence of chronic kidney disease 5 years after donation was 19%, with 16.4% of patients staged in 3a and 2.6% in 3b. ConclusionA structured approach to check donor returns to long-term clinical appointments has doubled the adherence to visits returns (compared to historical data). We identified lower incidence of arterial hypertension and DM among donors as compared with the incidence of arterial hypertension and DM in the Brazilian general population, but the 5-year chronic kidney disease incidence was considered high, taking into consideration data that have been published in the last years.

A Nurse-Led Self-Management Support Intervention (ZENN) for Kidney Transplant Recipients Using Intervention Mapping: Protocol for a Mixed-Methods Feasibility Study.

BackgroundOptimal self-management in kidney transplant recipients is essential for patient and graft survival, reducing comorbidity and health care costs while improving the quality of life. However, there are few effective interventions aimed at providing self-management support after kidney transplantation.ObjectiveThis study aims to systematically develop a nurse-led, self-management (support) intervention for kidney transplant recipients.MethodsThe Intervention Mapping protocol was used to develop an intervention that incorporates kidney transplant recipients’ and nurses’ needs, and theories as well as evidence-based methods. The needs of recipients and nurses were assessed by reviewing the literature, conducting focus groups, individual interviews, and observations (step 1). Based on the needs assessment, Self-Regulation Theory, and the “5A’s” model, change objectives were formulated (step 2). Evidence-based methods to achieve these objectives were selected and subsequently translated into practical implementation strategies (step 3). Then, program materials and protocols were developed accordingly (step 4). The implementation to test the feasibility and acceptability was scheduled for 2015-2017 (step 5). The last step of Intervention Mapping, evaluation of the intervention, falls outside the scope of this paper (step 6).ResultsThe intervention was developed to optimize self-management (support) after kidney transplantation and targeted both kidney transplant recipients and nurse practitioners who delivered the intervention. The intervention was clustered into four 15-minute sessions that were combined with regular appointments at the outpatient clinic. Nurses received a training syllabus and were trained in communication techniques based on the principles of Solution-Focused Brief Therapy and Motivational Interviewing; this entailed guiding the patients to generate their own goals and solutions and focus on strengths and successes. Kidney transplant recipients were encouraged to assess self-management challenges using the Self-Management Web and subsequently develop specific goals, action plans, and pursuit skills to solve these challenges.ConclusionsThe Intervention Mapping protocol provided a rigorous framework to systematically develop a self-management intervention in which nurses and kidney transplant recipients’ needs, evidence-based methods, and theories were integrated.International Registered Report Identifier (IRRID)DERR1-10.2196/11856

Sex education in Poland – Cross-sectional study over 20,020 Polish women evaluating knowledge of reproductive health issues and contraceptive methods

Introduction: Sex education is an important issue of public health. The knowledge of physiology of menstrual cycle establishes a background for women's reproductive health and conscious family planning. Awareness of cervical cancer screening and regular medical appointments allow the detection of the disease at an early stage.

Brief assessment of depression: Psychometric properties of the Portuguese version of the Patient Health Questionnaire (PHQ-9)

Background: The lack of knowledge regarding psychometric characteristics of brief scales for assessing the severity of symptoms of depression for the Portuguese population limits the ability of health professionals to signal clinically relevant situations, as well as the implementation of alternative forms of mental health care. The Patient Health Questionnaire (PHQ-9) is a scale whose usefulness in various professional contexts has been amply demonstrated by research. However, some of its psychometric qualities remain unknown for the Portuguese version.Goals: The main objective of this study was to analyse the validity of the factorial structure and the psychometric characteristics of the PHQ-9 in two different clinical Portuguese contexts, namely in primary health care units and in a university clinic, also reflecting the similarities and differences found regarding the factorial structures.Methods: The first study was carried out with 153 patients (83.66% females), with a mean age of 46.10 years (SD = 16.79), from eight health units of primary health care (non-probabilistic sampling). All participants underwent an initial screening for the detection of symptoms of depression and suicidal ideation, within the context of a regular family medicine appointment or nursing visit. Participants who scored positively for one of these symptoms were invited to participate in the study. The PHQ-9 and the Work and Social Adjustment Scale (WSAS) were used and exploratory and semi-confirmatory factor analyses of the PHQ-9 were performed. In the second study, 106 adults (70.78% females) participated in a psychological counselling session at a university clinic, with a mean age of 32.47 years (SD = 11.01), also constituting a non-probabilistic sample. As instruments, the PHQ-9, the Beck-II Depression Inventory and the State-Trait Anxiety Inventory were used, which participants completed before the beginning of the psychological treatment. As in the first study, exploratory and semi-confirmatory factor analyses of the PHQ-9 were conducted. Results: The results of the two studies revealed a factorial structure consisting of three factors. In the first study, the three factors were: (1) depressed mood and anhedonia; (2) self-devaluation and suicidal ideation; and (3) fatigue, psychomotor agitation/retardation, and changes in appetite, sleep problems or difficulty in concentration. In the second study, the three factors that were found were: (1) sleep problems and fatigue; (2) changes in appetite and difficulty in concentration, psychomotor agitation/retardation, and suicidal ideation; and (3) depressed mood, anhedonia, and self-devaluation. The factorial structure found in both studies revealed a good fit. The PHQ-9 also presented good internal consistency, convergent validity and criterion validity in both studies. The cut-off point of 9 emerged as an indicator of major depression.Discussion: The results of this study enhance the use of this scale in different contexts of health care provision in Portugal, since it was possible to determine the cut-off point for the detection of cases with major depression, as well as the criteria for delimiting severity degrees of depression-related symptomatology.Keywords: PHQ-9, Depression, Psychometric qualities, Primary health care, University clinic

Receipt of a survivorship care plan and self-reported health behaviors among cancer survivors

Our study aims to determine whether receipt of a written survivorship care plan (SCP) is associated with five self-reported health behaviors known to be correlated with positive long-term outcomes for cancer survivors: (1) attending a recent medical appointment, (2) exercise in the past month, (3) non-smoking status, (4) mammography in the past 2years, and (5) up-to-date colorectal cancer screening. In this secondary data analysis, we used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) cancer survivorship module for 1855 off-treatment cancer survivors. Multivariable logistic regression accounting for complex survey design was used to examine the association between SCP receipt and each of the five preventive health behaviors. Overall, 37% (669/1855) of survivors reported receiving a written survivorship care plan. In the logistic regression models adjusted for sociodemographic and disease-related factors, SCP receipt was associated with having a recent medical appointment (OR (95% CI) 2.81 (1.27-6.22)), exercise in the past month (1.78 (1.20-2.63)), non-smoking status (2.27 (1.26-4.12)), and up-to-date mammography (2.25 (1.30-3.88)). Receipt of a survivorship care plan was not associated with colorectal cancer screening (1.2 (0.73-2.03)). This study provides preliminary evidence that SCPs may be helpful in promoting health behaviors among cancer survivors, including attending a regular medical appointment, mammography screening, exercise, and abstinence from smoking. Additionally, the low rates of SCP provision highlight an important missed opportunity and area for intervention. Providing survivors with SCPs may help to increase important health behaviors.

Cross-sectional research conducted in the Netherlands to identify relationships among the actual level of patient-centred care, the care gap (ideal vs actual care delivery) and satisfaction with care

ObjectiveThis study aimed to identify relationships among the actual level of patient-centred care (PCC), the care gap (ideal level of PCC vs actual care delivery) and satisfaction with care.DesignThis study...

Nonorganic Hearing Loss: A Case Profile

AbstractAdults and children exhibit nonorganic hearing loss (NOHL). In children, NOHL can be due to several underlying factors. Issues of this kind if not treated on time may become risky for the child’s well-being if the underlying cause of NOHL is psychosocial and emotional. In most of the clinical settings attention is less drawn toward diagnosis and management of the root cause of NOHL. In this present article, we present the audiological profile of a 7-year-old girl with NOHL. The patient came to the department with the compliant of difficulty in hearing. Immittance results showed no abnormalities; however, reliable pure tone results could not be obtained. Subjective tests revealed bilateral hearing loss and objective assessment indicated a normal hearing. On the second visit, audiometric tests were repeated which showed normal hearing. After exclusion of neurological pathology and psychological consultation, the diagnosis of NOHL was stated and the girl was scheduled for regular appointments with a psychologist. In addition, literature on the causative factors related to NOHL has also been discussed in the present article.

Validating the Vietnamese version of wearing – Off 19 questionnaire for patients with Parkinson's disease

BackgroundOne of the most common complication of the progression of Parkinson's disease (PD) is the wearing off phenomenon. A validated Vietnamese version of Wearing off 19 (WO19) questionnaire is necessary to optimize the Vietnamese PD treatment. ObjectivesThis study was undertaken to determine the quality attribute of the questionnaire as a tool for early detection of wearing off (WO) in Vietnamese population with PD. We also sought the relationship between the WO phenomenon and factors concerning the clinical condition and course of the disease. Subjects and methodsThis is an observational, cross-sectional study. Patients diagnosed with PD under dopaminergic treatment came to University Medical Center Ho Chi Minh city for a regular appointment were sequentially asked to complete the Vietnamese WO19 questionnaire. A neurologist specialized in movement disorders assessed the patient and determined whether he had experienced wearing off or not. The questionnaire results were then compared to the clinical opinion of the expert which is considered the gold standard for diagnosing wearing off. The reliability of the questionnaire is evaluated by Cronbach'α and Cohen’s kappa coefficient. The validity is measured by the sensitivity and the specificity of the instrument compared to the gold standard. The multivariate logistic regression analysis is used to learn the relations of associated factors and wearing off phenomenon. Results98 patients with the mean age 59.12 ± 10.99 have joined our study; 58.2% are male; and the mean disease duration is 6.32 years. The Vietnamese version of the WO19 questionnaire has a good reliability (Cronbach'α = 0.778) and the agreement with the expert assessment (the diagnostic accuracy) is at a substantial level (Kappa value = 0.618). The sensitivity and specificity of the questionnaire resulted 89.28% and 71.43% respectively. The multivariate logistic regression analysis revealed a long disease duration (≥6 years) (OR: 16.96; 95% CI: 2.17–132.57; p = 0.007), a high daily levodopa dosage (≥400 mg/day) (OR: 6.31; 95% CI: 1.36–29.23; p = 0.019) and high score of MDS-UPDRS part IV (≥4) (OR: 15.36; 95% CI: 2.13–110.58; p = 0.007) were independent predictive factors for wearing off in Vietnamese PD patients. ConclusionsVietnamese – WO19 is a reliable and effective tool which should be used in clinical practice for early detecting PD patients with wearing off.