Regular Health Care Research Articles

Tooth wear and oral-health-related quality of life in dentate adults

ObjectivesThis study estimated the extent to which tooth wear, adjusted for (oral) health risk indicators, impacts adversely on the Oral-Health-Related Quality of Life (OHRQoL) of dentate adults. Methods: A cross-sectional study was conducted and had a convenience sample of 570 adults ≥18 years old with at least one bilateral molar occlusal contact. Participants answered a self-applied questionnaire (ICC=0.71) consisting of four domains: socio-demographics, oral care attendance, (oral) health conditions and lifestyle, complaints and oral-health-related quality of life (OHIP-14). Tooth wear was clinically assessed using the Basic Erosive Wear Examination index by two examiners, whose inter-examiner reliability were k=0.76-0.80. Results: The outcome was a high score on the OHRQoL (median split ≥ 7). The prevalence of tooth wear was 75.0%. Only 30.2% of adults reported impacts on at least 1 performance parameter affected ‘fairly often’ or ‘very often’. The hierarchical logistic regression showed that participants 35−54 years old (OR=2.1), who were ever prevented from regular oral health care due to costs of care (OR=3.6), who ingested acidic beverages ≥ daily (OR=1.7), who had tooth sensitivity (OR= 2.9) and those having the impression that their teeth have changed appearance (OR= 5.9) were significantly more likely to report lower OHRQoL than their counterparts. The severity of tooth wear was not significant when considering moderate and severe cases together. Conclusions: Although the prevalence of tooth wear was high, its severity and impact on OHRQoL were limited. However, distal and proximal indicators for tooth wear were mediators for impaired OHRQoL and treatment needs. Clinical significancePrevalence and severity of tooth wear had limited impact on OHRQoL in adults. Distal and proximal indicators for tooth wear were mediators for impaired OHRQoL. The understanding of these relationships offers an opportunity to assess in depth the treatment needs and quality of life of patients affected by tooth wear.

Chronic diseases and multi-morbidity in persons experiencing homelessness: results from a cross-sectional study conducted at three humanitarian clinics in Germany in 2020

BackgroundPersons experiencing homelessness (PEH) suffer a high burden of chronic diseases and multi-morbidity, yet face significant barriers in accessing healthcare services. These health inequalities were further aggravated during the COVID-19 pandemic. While there is a lack of comprehensive health data on PEH, even less is known about populations experiencing housing exclusion, a hidden form of homelessness. This study examines and compares chronic diseases and multi-morbidity in PEH, persons experiencing housing exclusion, and persons with secure housing who lacked access to regular healthcare services in the wake of the COVID-19 pandemic in Germany.MethodsStudy participants were adults who sought medical care at clinics of the humanitarian organisation “Ärzte der Welt” in Munich, Hamburg and Berlin in 2020. The patients were categorised into three housing groups according to the ETHOS classification of homelessness and housing exclusion. Socio-demographic characteristics, self-rated health, chronic diseases and multi-morbidity were described in each group. Logistic regression analysis was used to identify socio-demographic factors associated with higher odds of chronic diseases and multi-morbidity in each housing group.ResultsOf the 695 study participants, 333 experienced homelessness, 292 experienced housing exclusion and 70 had secure housing. 92.3% of all patients had either no or limited health coverage, and 96.7% were below the poverty line. Males and EU/EEA citizens were highly represented among PEH (74.2% and 56.8% respectively). PEH had lower self-rated health (47.8%, p = 0.04), and a higher prevalence of psychiatric illness (20.9%, p = 0.04). In adjusted analyses, belonging to the age group 35–49 and ≥ 50 years were associated with greater odds of chronic disease (AOR = 2.33, 95% CI = 1.68–3.24; AOR = 3.57, 95% CI = 2.55–5.01, respectively) while being ≥ 50 years old was associated with multi-morbidity (AOR = 2.01, 95% CI = 1.21, 3.33). Of the 18 participants tested for SARS-COV-2, 15 were PEH, 1 of whom tested positive.ConclusionsHousing status was not an independent risk factor for chronic disease and multi-morbidity in our study population. However, PEH reported poorer self-rated and psychiatric health. Strategies to improve access to healthcare services amongst persons experiencing homelessness and housing exclusion are needed in Germany.

Health Information Seeking From an Intelligent Web-Based Symptom Checker: Cross-sectional Questionnaire Study

BackgroundThe ever-growing amount of health information available on the web is increasing the demand for tools providing personalized and actionable health information. Such tools include symptom checkers that provide users with a potential diagnosis after responding to a set of probes about their symptoms. Although the potential for their utility is great, little is known about such tools’ actual use and effects.ObjectiveWe aimed to understand who uses a web-based artificial intelligence–powered symptom checker and its purposes, how they evaluate the experience of the web-based interview and quality of the information, what they intend to do with the recommendation, and predictors of future use.MethodsCross-sectional survey of web-based health information seekers following the completion of a symptom checker visit (N=2437). Measures of comprehensibility, confidence, usefulness, health-related anxiety, empowerment, and intention to use in the future were assessed. ANOVAs and the Wilcoxon rank sum test examined mean outcome differences in racial, ethnic, and sex groups. The relationship between perceptions of the symptom checker and intention to follow recommended actions was assessed using multilevel logistic regression.ResultsBuoy users were well-educated (1384/1704, 81.22% college or higher), primarily White (1227/1693, 72.47%), and female (2069/2437, 84.89%). Most had insurance (1449/1630, 88.89%), a regular health care provider (1307/1709, 76.48%), and reported good health (1000/1703, 58.72%). Three types of symptoms—pain (855/2437, 35.08%), gynecological issues (293/2437, 12.02%), and masses or lumps (204/2437, 8.37%)—accounted for almost half (1352/2437, 55.48%) of site visits. Buoy’s top three primary recommendations split across less-serious triage categories: primary care physician in 2 weeks (754/2141, 35.22%), self-treatment (452/2141, 21.11%), and primary care in 1 to 2 days (373/2141, 17.42%). Common diagnoses were musculoskeletal (303/2437, 12.43%), gynecological (304/2437, 12.47%) and skin conditions (297/2437, 12.19%), and infectious diseases (300/2437, 12.31%). Users generally reported high confidence in Buoy, found it useful and easy to understand, and said that Buoy made them feel less anxious and more empowered to seek medical help. Users for whom Buoy recommended “Waiting/Watching” or “Self-Treatment” had strongest intentions to comply, whereas those advised to seek primary care had weaker intentions. Compared with White users, Latino and Black users had significantly more confidence in Buoy (P<.05), and the former also found it significantly more useful (P<.05). Latino (odds ratio 1.96, 95% CI 1.22-3.25) and Black (odds ratio 2.37, 95% CI 1.57-3.66) users also had stronger intentions to discuss recommendations with a provider than White users.ConclusionsResults demonstrate the potential utility of a web-based health information tool to empower people to seek care and reduce health-related anxiety. However, despite encouraging results suggesting the tool may fulfill unmet health information needs among women and Black and Latino adults, analyses of the user base illustrate persistent second-level digital divide effects.

The Value of Vaccines in Maintaining Health System Capacity in England

ObjectivesIn situations of excess demand for healthcare, treating one patient means losing the opportunity to treat another. Therefore, each decision bears an opportunity cost. Nevertheless, when assessing the value of health technologies, these opportunity costs are not always fully considered. We present a pragmatic approach for conceptualizing vaccines’ health system capacity value when considering opportunity costs. MethodsOur approach proxies opportunity costs through the net monetary benefit forgone as scarce healthcare resources are used to treat a vaccine-preventable disease instead of a patient from the waiting list. We apply this approach to cost the resource “hospital beds” for 3 different scenarios of excess demand. Empirically, we estimate the opportunity costs saved for 4 selected vaccination programs from the national schedule in England during a hypothetical scenario of long-lasting excess demand induced by the pandemic. ResultsThe opportunity cost avoided through vaccination rises with excess demand for treatment. When treating an acute vaccine-preventable outcome is a suboptimal choice compared with treating elective patients, preventing a vaccine-preventable disease from blocking a hospital bed generates opportunity cost savings of approximately twice the direct costs saved by avoiding vaccine-preventable hospitalizations. ConclusionsPolicy makers should be aware that, in addition to preventing the outcome of interest, vaccines and other preventative health technologies deliver value in maintaining regular healthcare services and clearing the pent-up demand from the pandemic. Therefore, health system capacity value should be a key-value element in health technology assessment. Existing and potential future vaccination programs deliver more value than hitherto quantified.

Equitable City in an Aging Society: Public Transportation-Based Primary Care Accessibility in Seoul, Korea

The development of an equitable city has been the primary goal of recent urban planning. Whereas previous urban planning has addressed problems caused by urbanization and population growth, current urban planning must closely consider demographic changes such as an aging society. An aging population, characterized by an increased need for regular healthcare and a growing reliance on public transport, can pose a major challenge to equitable cities. Thus, it is necessary to scrutinize the medical and public transportation links in urban planning strategies to create a more equitable city in an aging society. This study analyzed primary care accessibility for older adults using public transportation in Seoul and considered whether it is socially and economically equitable. Primary care accessibility was derived using the modified 2SFCA model and the Seoul Public Transportation API and social equity was analyzed using the concentration index and concentration curve. The results showed that primary care accessibility of the elderly is related to public transportation mobility, medical facilities and the distribution of elderly populations, revealing both social and economic inequality. This analysis suggests the need for integrated urban planning for an equitable city in an aging society, with implications for efficient resource distribution.

Analyzing delay in referral of pregnant women and children under five years old during the COVID-19 pandemic: Fars Province, Iran

The researchers assessed the delay in referral of pregnant women and children under five years old during the COVID-19 pandemic that they require regular healthcare. This cross-sectional study was conducted in 2021 in Fars, Iran. A total of 591 households with pregnant women and children under five years old were recruited, then having delay and the number of their delays in regular visits during the COVID-19 outbreak was asked. A total of 153 children under five years old (51.7%) and 93 pregnant women (31.5%) reported delays in referral. In children, higher age and referral to the family physician and private clinic, and in pregnant women, higher gestational age and pregnancy rank and having health problems (e.g., preeclampsia in the current pregnancy) significantly enhanced the number of delays. Due to the vulnerability of these groups, it is necessary to consider active care for them as a priority at the primary care level.

Call to Action

Low quality healthcare services can hinder economic and social development, result in premature death and disability, and waste human capital. To compound pre-pandemic healthcare access and equity issues, the quality of care that is delivered in low, lower-middle, as well as in high-income OECD countries can be uneven, poorly funded, and without adherence to standardization. COVID-19 has highlighted the importance of high-quality healthcare, while exacerbating many challenges. How services are delivered and the underlying guidance or standards that support the delivery of high-quality care are not necessarily a part of the regular healthcare reform dialog. This position paper introduces a new standard, ISO CD 7101, that seeks to address problems and offer solutions for the quality of healthcare delivered globally. This paper describes the need for such a standard, its history, advantages, and how it answers the global call to action set forth by the OECD, the World Bank, and the World Health Organization.

Online Guided Self-help Cognitive Behavioral Therapy With Exposure to Anxiety and Problem Solving in Type 1 Diabetes Mellitus: Case Study.

BackgroundType 1 diabetes mellitus (T1DM) is dependent on self-care to avoid short- and long-term complications. There are several problem areas in diabetes that could be addressed by psychological interventions, such as suboptimal problem-solving strategies and fear of hypoglycemia. There is empirical support for a few psychological interventions, most often cognitive behavioral therapy, with various treatment aims. However, these interventions are largely unavailable in regular diabetes health care. Online guided self-help cognitive behavioral therapy could help achieve greater outreach.ObjectiveWe tested a manualized treatment in the early stage for further development, with the long-term aim to increase access to care. The purpose of this report was to show the potential of this newly developed online intervention by describing 2 illustrative cases.MethodsAn online guided self-help cognitive behavioral therapy protocol featuring problem solving and exposure was developed. The treatment was administered from a secure online platform and lasted for 8 weeks. Case 1 was a male participant. He had a number of diabetes-related complications and was worried about his future. He reported that he had a general idea that he needed to change his lifestyle but found it difficult to get started. Case 2 was a female participant. She had fear of hypoglycemia and unhelpful avoidance behaviors. She kept her blood glucose levels unhealthily high in order to prevent hypoglycemic episodes. Furthermore, she avoided contact with diabetes health care.ResultsThe 2 participants showed clinically significant improvements in their most relevant problem areas. In case 1, the participant’s blood glucose levels reduced, and he was able to establish healthy routines, such as increase physical exercise and decrease overeating. In case 2, the participant’s fear of hypoglycemia greatly decreased, and she was able to confront many of her avoided situations and increase necessary visits to her diabetes clinic. Treatment satisfaction was high, and no adverse events were reported.ConclusionsIt is possible to deliver a cognitive behavioral therapy intervention aimed at problem areas in diabetes online. Problem solving appears to help with problems in everyday routines and lifestyle choices. Exposure to aversive stimuli appears to be a plausible intervention specifically aimed at the fear of hypoglycemia. Larger and controlled studies are needed.

Association of Remote Technology Use and Other Decentralization Tools With Patient Likelihood to Enroll in Cancer Clinical Trials

Logistical challenges such as travel time and distance to a clinical trial site can be a barrier to patient participation. The association of remote technology use and other decentralization tools that can reduce these barriers with likelihood to enroll in cancer trials is not well understood. To assess the association of remote technology and other decentralization tools used to reduce participation-related time and travel with the likelihood to enroll in cancer clinical trials. Between July 6 and September 8, 2021, a 41-question, cross-sectional, internet-based survey was administered to patients with cancer and survivors of cancer in the US who had been diagnosed with or treated for cancer in the past 7 years. Increase in self-reported likelihood to enroll in cancer clinical trials that use remote technology and other decentralization tools to decrease the need for travel to the trial site. There were 1183 survey respondents, with a mean (SD) age of 58.2 (12.5) years. Respondents self-reported their gender, race and ethnicity, cancer type, and treatment status. Of the 1183 respondents, 848 (72%) were female, 296 (25%) were male, 8 (1%) were other/nonbinary, and 31 (3%) declined to answer. With regard to race, 28 respondents (3%) were American Indian or Alaska Native, 25 (2%) were Asian, 234 (20%) were Black or African American, 20 (2%) were Native Hawaiian or Other Pacific Islander, 825 (70%) were White, and 51 (4%) declined to answer. With regard to ethnicity, 115 respondents (10%) were Hispanic, Latino/Latina, or of Spanish origin, whereas 1017 (86%) were not and 51 (4%) declined to answer. Regarding cancer type and treatment status, 483 respondents (41%) either had or had survived breast cancer and 325 (28%) were being treated for cancer during the survey period. Individuals older than 55 years were more likely to say that they would only participate in trials no farther from their home than their regular care health care practitioner compared with younger respondents (26% vs 16%, respectively; P = .02). Higher-income earners (ie, those in households earning >$125 000/y) were significantly more likely than lower-income earners (ie, those in households earning <$70 000/y) to say they would participate in trials requiring additional effort (62% vs 41%, respectively; P = .03). If given the opportunity to enroll in a cancer clinical trial that required travel farther than their regular care, a majority of respondents (range, 60%-85%) indicated that they would be more likely to participate if the trial used remote technology and other tools to decrease the need for travel to a trial site. In this cross-sectional study, the survey findings suggest that cancer clinical trials leveraging remote technology and decentralization tools to reduce patient time and travel burden associated with participation may increase the patient consent rate.

Health Risk Behavior of Adolescents with Sickle Cell Disease in Nigeria

Background: The advances in medical practice have increased the average life expectancy of people living with sickle cell disease (SCD) to 54 years. The high prevalence rates of SCD in Nigeria therefore highlights the need for research that will support overall disease management. Objective: To determine the health risk behavior (HRB) of adolescents with sickle cell disease in Nigeria. Materials and methods: In a cross-sectional descriptive survey using purposive sampling method, 122 adolescents with SCD attending sickle cell clubs in Ogun State, Nigeria were selected for the study. A 58-item questionnaire adapted from the Youth Risk Behavior Survey (YRBS) instrument developed by Centre for Disease Control and Prevention (CDC) was used to collect data from the adolescents. Results: The mean age of the respondents was 15.7 ± 2.3 years, there were more females (58.2%) than males (41.2%). Majority were from a monogamous family setting and average to large family size (≥3siblings) (63% and 76% respectively) and only 6% of the parents had no formal education. The mean ages at first sexual intercourse, cigarette smoking and alcohol use were 16 ± 5.7, 15.7 ± 0.7, and 14.9 ± 1.9 years respectively. One-fifth (21.3%) have had sex and half (50%) of them have had sex by the age of 17. Over one-tenth (13.9%) had smoked cigarette while 14.8% had taken alcohol. Adolescents from monogamous family background were more likely to be involved in substance abuse (χ2: 4.99; P=0.008) and exposed to sexual activities (χ2: 10.9; P=0.004) than those from polygamous or single parent family. Conclusion: It was concluded that adolescents with SCD are involved in HRB and may be dependent on family characteristics. It is recommended that regular health care of chronically ill adolescents should include screening and counselling for HRBs.

Treatment of hepatitis delta and HIV infection.

Hepatitis delta virus (HDV) is a defective agent that only infects individuals with hepatitis B virus (HBV). Around 5-10% of chronic hepatitis B patients worldwide are superinfected with HDV, which means 15-25 million people. Hepatitis delta is the most severe of all chronic viral hepatitis, leading to cirrhosis, liver cancer and/or transplantation in most patients. Despite it, many HDV patients remain undiagnosed. The only treatment available until recently was peginterferon alfa, with poor results and significant side effects. The recent approval of bulevirtide, a lipopeptide that blocks HBV/HDV entry, has revolutionized the field. Another drug, lonafarnib, already approved to treat progeria, is expected to be available soon as HDV therapy. Since there is no cell reservoir for the HDV RNA genome, hypothetically viral clearance could be achieved if complete blocking of viral replication occurs for a minimum time frame. This is what happens in hepatitis C using direct-acting antivirals, with the achievement of cure in nearly all treated patients. We envision the cure of hepatitis delta using combination antiviral therapy. Given that sexual and parenteral transmission routes are the most frequent for the acquisition of HBV and HDV, shared with HIV infection and HBV/HDV and HIV coinfection. The clinical outcome of hepatitis delta is worst in the HIV setting, with more frequent liver complications. Since most persons infected with HIV are on regular health care follow-up, we propose that HIV-HDV patients should be prioritized for moving forward new and potentially curative treatments for hepatitis delta.

Factors influencing treatment adherence in hypertension and HIV management in South Africa: A comparative literature review.

Hypertension (HTN) is the most significant risk factor for cardiovascular disease (CVD) in South Africa (SA), with one in three people over the age of 25 suffering from HTN. Whilst human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are the leading causes of death in South Africa, CVD is in the top 10 causes of death, demonstrating the importance of detecting and controlling blood pressure early on. This study aimed to review adherence factors to antihypertensive medication and antiretroviral therapy (ART) and evaluate the resulting factors influencing adherence discrepancies within the South African population. A comprehensive literature review was carried out. PubMed, ScienceDirect, Cochrane and Embase were searched for English publications between 2000 and 2021. A total of 50 articles covering quantitative and qualitative studies were included. Many studies identified poor adherence levels to antihypertensive treatment, reaching a substandard adherence rate of 41.9%, whilst most studies on the HIV-positive population reported good levels of adherence, with adherence rates of more than 90%. Being of the male gender, advanced age, low socioeconomic status and a low level of education were associated with unsatisfactory adherence rates in both groups. Within the HIV group, more participants had better knowledge concerning the extent of their disease and its required treatments. The results present substandard adherence levels to antihypertensives compared with antiretroviral (ARV) adherence, despite the influence of more non-adherence factors in the HIV group. The authors recommend better adherence counselling for patients with HTN during every clinic visit, regular healthcare worker training and the implementation of ART adherence programmes in patients with hypertension.

Factors Affecting Physicians' Credibility on Twitter When Sharing Health Information: Online Experimental Study.

Largely absent from research on how users appraise the credibility of professionals as sources for the information they find on social media is work investigating factors shaping credibility within a specific profession, such as physicians. We address debates about how physicians can show their credibility on social media depending on whether they employ a formal or casual appearance in their profile picture. Using prominence-interpretation theory, we posit that formal appearance will affect perceived credibility based on users' social context-specifically, whether they have a regular health care provider. For this experiment, we recruited 205 social media users using Amazon Mechanical Turk. We asked participants if they had a regular health care provider and then randomly assigned them to read 1 of 3 Twitter posts that varied only in the profile picture of the physician offering health advice. Next, we tasked participants with assessing the credibility of the physician and their likelihood of engaging with the tweet and the physician on Twitter. We used path analysis to assess whether participants having a regular health care provider impacted how the profile picture affected their ratings of the physician's credibility and their likelihood to engage with the tweet and physician on Twitter. We found that the profile picture of a physician posting health advice in either formal or casual attire did not elicit significant differences in credibility, with ratings comparable to those having no profile image. Among participants assigned the formal appearance condition, those with a regular provider rated the physician higher on a credibility than those without, which led to stronger intentions to engage with the tweet and physician. The findings add to existing research by showing how the social context of information seeking on social media shapes the credibility of a given professional. Practical implications for professionals engaging with the public on social media and combating false information include moving past debates about casual versus formal appearances and toward identifying ways to segment audiences based on factors like their backgrounds (eg, experiences with health care providers).

Evaluation of a Collaborative Care Program for Patients With Treatment-Resistant Schizophrenia: Protocol for a Multiple Case Study.

BackgroundApproximately one-third of all patients with schizophrenia are treatment resistant. Worldwide, undertreatment with clozapine and other effective treatment options exist for people with treatment-resistant schizophrenia (TRS). In this respect, it appears that regular health care models do not optimally fit this patient group. The Collaborative Care (CC) model has proven to be effective for patients with severe mental illness, both in primary care and in specialized mental health care facilities. The key principles of the CC model are that both patients and informal caregivers are part of the treatment team, that a structured treatment plan is put in place with planned evaluations by the team, and that the treatment approach is multidisciplinary in nature and uses evidence-based interventions. We developed a tailored CC program for patients with TRS.ObjectiveIn this paper, we provide an overview of the research design for a potential study that seeks to gain insight into both the process of implementation and the preliminary effects of the CC program for patients with TRS. Moreover, we aim to gain insight into the experiences of professionals, patients, and informal caregivers with the program.MethodsThis study will be underpinned by a multiple case study design (N=20) that uses a mixed methods approach. These case studies will focus on an Early Psychosis Intervention Team and 2 Flexible Assertive Community treatment teams in the Netherlands. Data will be collected from patient records as well as through questionnaires, individual interviews, and focus groups. Patient recruitment commenced from October 2020.ResultsRecruitment of participants commenced from October 2020, with the aim of enrolling 20 patients over 2 years. Data collection will be completed by the end of 2023, and the results will be published once all data are available for reporting.ConclusionsThe research design, framed within the process of developing and testing innovative interventions, is discussed in line with the aims of the study. The limitations in clinical practice and specific consequences of this study are explained.International Registered Report Identifier (IRRID)DERR1-10.2196/35336

RELATIONSHIP BETWEEN PSYCHOSOCIAL HEALTH AND DRUG USE AMONG STREET CHILDREN IN STAREHE SUB-COUNTY, NAIROBI COUNTY KENYA

Life in the streets is not easy. It has immense negative effects on the psychosocial health of street children which could result in substance use. This study set out to examine the relationship between psycho-social health and drug use among street children in Starehe Sub-County, Nairobi County Kenya. This study was based on the Problem Behaviour Theory (PBT). This study adopts the correlational research design. Data were collected from 100 street children. These were sampled using cluster and simple random sampling techniques from a target population of 30,000 in the Starehe Sub-County of Nairobi County. In addition, data was collected from purposively sampled four officials from the Starehe Children’s Office, eight officials of NGO/FBO operating in the sub-county, 1 sub-county administrator, and 4 ward administrators from the Sub-County. The qualitative data collected using questionnaires were analyzed using descriptive statistics like mean, percentage, and frequencies, as well as inferential statistics such as Pearson correlation and regression analysis. The findings obtained were presented using charts and tables. The qualitative data collected using interviews were analyzed thematically. The findings were then presented in prose. The findings show that psychosocial health affected drug use among street children. Pearson correlation showed that there was a significant relationship between drug use and psychosocial health, r=0.503. The findings show that the measures put in place to enhance the mental health of street children made had significant influences on their drug use. There is also a need to provide street children with homes to reduce exposure to stressful conditions that could lead to mental health problems. Regular free mental healthcare clinics should also be availed for all street children. Raising awareness and sensitizing the street children on the negative implications of drugs is also important. There is a need to strengthen behaviour counseling, support groups, and sober social networks for street children. The government and non-governmental organizations should come up with programs for supporting access to counseling services. Some of the street children should also be trained to prop up their abilities to offer peer counseling services to their colleagues.

Use of Digital Health Technology for Seeking Health Information Among Older Family Caregivers.

There is little research on the relationship between digital health technology use and health services, self-efficacy, health status, and health information seeking behavior among older family caregivers. We conducted a secondary analysis of the US Health Information National Data and found that older family caregivers with a regular healthcare provider are more likely to use digital health technology, which increases their confidence in obtaining health information (β=0.075, z=2.015, p<0.044).

The Impact of the COVID-19 Pandemic on Bladder Cancer Care in the Netherlands.

The COVID-19 pandemic has disrupted regular health care with potential consequences for non-COVID diseases like cancer. To ensure continuity of oncological care, guidelines were temporarily adapted. To evaluate the impact of the COVID-19 outbreak on bladder cancer care in the Netherlands. The number of bladder cancer (BC) diagnoses per month during 2020-2021 was compared to 2018-2019 based on preliminary data from the Netherlands Cancer Registry (NCR). Additionally, detailed data were retrieved from the NCR for the cohort diagnosed between March 1st-May 31st 2020 (first COVID wave) and 2018-2019 (reference cohort). BC diagnoses, changes in age and stage at diagnosis, and time to first-line treatment were compared between both periods. Changes in treatment were evaluated using logistic regression. During the first COVID wave (week 9-22), the number of BC diagnoses decreased by 14%, corresponding with approximately 300 diagnoses, but increased again in the second half of 2020. The decline was most pronounced from week 13 onwards in patients≥70 years and patients with non-muscle invasive BC. Patients with muscle-invasive disease were less likely to undergo a radical cystectomy (RC) in week 17-22 (OR = 0.62, 95% CI = 0.40-0.97). Shortly after the start of the outbreak, use of neoadjuvant chemotherapy decreased from 34% to 25% but this (non-significant) effect disappeared at the end of April. During the first wave, 5% more RCs were performed compared to previous years. Time from diagnosis to RC became 6 days shorter. Overall, a 7% reduction in RCs was observed in 2020. The number of BC diagnoses decreased steeply by 14% during the first COVID wave but increased again to pre-COVID levels by the end of 2020 (i.e. 600 diagnoses/month). Treatment-related changes remained limited and followed the adapted guidelines. Surgical volume was not compromised during the first wave. Altogether, the impact of the first COVID-19 outbreak on bladder cancer care in the Netherlands appears to be less pronounced than was reported for other solid tumors, both in the Netherlands and abroad. However, its impact on bladder cancer stage shift and long-term outcomes, as well as later pandemic waves remain so far unexamined.

Maternal Thyroid Function and Birth Weight in Twins.

ContextThyroid hormones are associated with birth weight in singleton pregnancy. Twin pregnancies need more thyroid hormones to maintain the normal growth and development of the fetuses compared with single pregnancy.ObjectiveWe aimed to investigate the association of thyroid hormones and birth weight in twins.MethodsThis was a retrospective cohort study in a Chinese population. Pregnant women who received regular antenatal health care and delivered live-born twins from 2014 to 2019 were included (n = 1626). Linear mixed model with restricted cubic splines and logistic regression models were used to estimate the association of thyroid hormones with birth weight and birth weight discordance in twins.ResultsWe observed that both thyrotropin (TSH) and free thyroxine (FT4) were not associated with birth weight in twins overall, while when stratifying on fetal sex or chorionicity, there were nonlinear association between FT4 levels and birth weight in boys (Pnonlinear < .001) and in dichorionic (DC) twins (Pnonlinear = 0.03). Women with levels of FT4 lower than the 10th percentile had a higher risk of birth weight discordance in their offspring than women with normal FT4 levels (range, 2.5 to 97.5 percentiles) (odds ratio = 1.58; 95% CI, 1.05-2.33).ConclusionOur study suggests there was an association of FT4, but not TSH, with birth weight and birth weight discordance varied by sex and chorionicity. These findings could have implications for obstetricians to be aware of the importance of FT4 levels in preventing birth weight discordance in twin pregnancy.

Various Factors that are Causing Difference in Prevalence of Coronary Risk Factors among Siblings.

Coronary artery disease (CAD) is one of the predominant types of cardiovascular disease (CVD). The aim of present study was to study various factors that are causing difference in prevalence of coronary risk factors among siblings. This cross-sectional study was conducted in Dayanand Medical College and Hospital, among the healthy individuals (not known CAD) attending regular health care outpatient department (OPD) and their siblings over a period of 1½ years. All individuals coming for regular health checkup (not known CAD) of age more than 30 years or above and their siblings (with or without known CAD). This was a cross-sectional study, conducted among 100 pairs of healthy siblings (not known cases of CAD) who came for health checkup at health center of Dayanand Medical College and Hospital, a tertiary care hospital in North India. Prevalence of obesity was more in siblings living in urban area than their counter siblings living in rural area, but it was statistically insignificant. Six had impaired fasting blood sugar (FBS) and two were diabetic. Among their siblings living in urban area, 21 were nondiabetic, 10 had impaired FBS, and seven were diabetic. This correlation was statistically significant with p-value of 0.02. Among the CAD negative, out of 23 subjects, two subjects (9.0%) had heavy stress level, while remaining four subjects (17.0%) and 17 subjects (74.0%) had light and moderate stress levels, respectively. Among the CAD negative, out of 23 subjects, 10 subjects (43.0%) had high stress level, while remaining zero subject (0%) and 13 subjects (57.0%) had light and moderate stress levels, respectively. Significant results were obtained while comparing the CAD findings of subjects divided on the basis of stress level. In our study, among siblings (CAD positive and CAD negative), significant results were obtained for residence, socioeconomic class, physical activity, stress levels, smoking, waist-to-hip ratio (WHR), and diabetes, that is, all these factors have correlation in increasing CAD among siblings.

Health Status and Access to Healthcare for Uninsured Migrants in Germany: A Qualitative Study on the Involvement of Public Authorities in Nine Cities

Non-governmental organisations (NGOs) regularly report data on their work with uninsured migrants (UM) within a (so-called) parallel health care system. The role and involvement of public authorities therein have yet been underrepresented in research. Our aim was to gain a better understanding of public authorities’ role in the parallel health care system and their view of the health situation of UM. We conducted qualitative semi-structured interviews with 12 experts recruited by purposive sampling from local public health authorities (LPHAs), state-level public health authorities (SPHAs), and social services offices (SSO) in nine cities, recorded, transcribed, and subjected the data to qualitative content analysis. LPHAs are more often directly involved in providing medical services, while SSOs and SPHAs function as gatekeepers for access to social benefits, including health insurance, and in grant-funded projects. NGOs keep substituting for the lack of access to regular health care from public institutions, but even in settings with extended services, public authorities and NGOs have not been able to provide sufficient care through the parallel health care system: Experts report gaps in the provision of health care with respect to the depth and height of coverage, due to the fragmentation of services and (ostensible) resource scarcity. Our study highlights the necessity for universal access to regular health care to overcome the fragmentation of services and improve access to needed health care for UM in Germany.