Routine Check-up Research Articles

Veränderungen in der Bereitstellung und Inanspruchnahme der Gesundheitsversorgung in deutschen Hausarztpraxen während der COVID-19-Pandemie – eine Befragung von Patient*innen in drei Bundesländern

IntroductionDuring the COVID-19 pandemic general practitioners (GP) practice teams were temporally confronted with major challenges which were accompanied by changes in practice organization and service provision. So far, little has been known about the views of patients who visited the GP practice for other than COVID-related reasons with regard to provision and use of GP services, the adjustments in the practice and the work of the practice team members. MethodsThe patient survey is a sub-study of the mixed-methods study VeCo-Praxis (GP healthcare for patients not suffering from COVID during the Corona pandemic) of the research practice network RESPoNsE (Research Practice Network East), which was conducted in the federal states of Berlin, Brandenburg and Thuringia. The questionnaire-based survey was carried out among patients who visited their GP practice in November 2022. The topics covered in the survey were developed by two focus groups consisting of 13 members of the RESPoNsE patient advisory board. The questionnaire was developed and piloted in a participatory approach with the RESPoNsE Patient Advisory Board. The results were analyzed descriptively using SPSS and discussed with the advisory board. Results1,405 questionnaires from 37 practices were analyzed. 97% of respondents felt that the treatment they received at their GP practice during the COVID-19 pandemic was good. For the vast majority, appointments and acute consultations, prescriptions, laboratory tests, discussions of diagnostic results, routine follow-up check-ups and health checks were available to a sufficient extent. From the patients’ perspective, the practices have successfully adapted to the challenges caused by COVID-19. Overall, the patients’ trust in and their appreciation of the work of the practice staff have increased since the pandemic. Patients stated that GP practices should continue hygiene procedures, such as wearing a mask or keeping physical distance, in the future. DiscussionDespite multiple reports of a significant decline in both provision and utilization of standard care in GP practices during the pandemic, our survey showed that the majority of patients felt that they received adequate GP care and were highly satisfied. The results should be interpreted against the background of possible selection bias. ConclusionIn this survey, GP patients were predominantly appreciative of GP care during the COVID-19 pandemic. The patients’ assessment of the provision and use of GP services during the pandemic complements the corresponding perspective of GPs and medical practice assistants.

Association between estimated glucose disposal rate and subclinical coronary atherosclerosis

Background and aimsThe estimated glucose disposal rate (eGDR) is an easily accessible clinical parameter for assessing insulin resistance in patients with diabetes mellitus. In this study, we aimed to investigate the link between eGDR and subclinical coronary atherosclerosis in an asymptomatic middle-aged Korean population. Methods and resultsThis study involved 4004 subjects who underwent routine health checkups with coronary multidetector computed tomography (MDCT) at Asan Medical Center from 2007 to 2011, among whom 913 had a follow-up analysis through 2014. The eGDR was calculated using: 21.16 − (0.09 ∗ waist circumference [cm]) − (3.41 ∗ hypertension) − (0.55 ∗ glycated hemoglobin [%]). Patients were categorized into three groups according to the tertiles of eGDR. Subclinical coronary atherosclerosis was defined by significant coronary stenosis (≥50%), presence of plaques, coronary artery calcification (CAC) score, and its progression. As a result, a lower eGDR level was associated with higher prevalence of significant coronary stenosis, plaques, moderate to severe CAC, and CAC progression. Compared to other markers or risk scores, eGDR was superior to other biomarkers of insulin resistance but did not provide additional information beyond classic cardiovascular risk models like the Framingham Risk Score and Pooled Cohort Equations. ConclusionDecreased eGDR values were significantly associated with higher subclinical coronary atherosclerosis burdens in an asymptomatic middle-aged Korean population. However, its clinical implications remain uncertain due to its weaker performance compared to established cardiovascular risk models.

Unmet needs for long-term services and supports and associations with health outcomes

BackgroundThe availability of population-level data on unmet needs for long-term services and supports (LTSS) is limited at state and national levels. Data on unmet LTSS needs can improve our understanding of disparities and relationships with health outcomes. Objective1) Explore differences in unmet LTSS needs by socio-demographic characteristics, including age, sex, race/ethnicity, metropolitan status, sexual orientation, and socio-economic status; and 2) Examine associations between unmet LTSS needs and health/preventative healthcare outcomes. MethodsWe used the 2021 Behavioral Risk Factor Surveillance System (BRFSS) core survey and state-added LTSS questions to analyze a sample of adults with LTSS needs in Texas (N = 1232). We compared socio-demographic characteristics between adults with and without unmet LTSS needs. We conducted modified-Poisson regressions to estimate unadjusted and adjusted risk ratios (with 95 % confidence intervals) for each health/preventative healthcare outcome among adults with unmet LTSS needs. Health outcomes included health status, healthy days-physical health, healthy days-mental health, suicide ideation, and multiple chronic conditions. Preventative healthcare outcomes included routine check-up and flu vaccine. ResultsAmong adults with LTSS needs, those with unmet LTSS needs were statistically significantly more likely to be younger (age<65), female, higher educational attainment, and non-straight sexual orientation. After controlling for socio-demographic variables, having unmet needs for LTSS was significantly associated with poorer physical and mental health outcomes and suicide ideation. ConclusionsImproved data collection on unmet needs LTSS can assist policymakers, particularly at the state level in guiding reforms to reduce disparities in access to home and community-based services (HCBS) and improve health outcomes.

Increasing public awareness through routine health checks for residents of RT 21 Kelurahan 13 Ulu, Palembang

Health check-ups are one of the efforts to detect abnormalities in the body that should be performed routinely with the aim of prevention and early treatment. The purpose of this activity is to increase public knowledge about the importance of health check-ups. With increased public awareness of the importance of health check-ups, their desire to undergo health checks also increases, allowing for earlier disease identification. The method used involves counseling with leaflet media and community health check-ups. Based on health screenings conducted in Kelurahan 13 Ulu RT 021 RW 005, Seberang Ulu II District, Palembang City, the results indicated an increase in knowledge, understanding, and public awareness regarding regular health checks. This is expected to encourage a change in community behavior towards routine health check-ups, leading to earlier disease detection and prevention of more serious illnesses.

Policy Evaluation Of Minimum Service Standards For Hypertension Health Services At Mabelopura Health Center

Hypertension is a chronic medical condition in which arterial blood pressure increases, causing the heart to work harder. At Puskesmas Mabelopura, hypertension has not yet reached the Minimum Service Standard (MSS) target with an achievement of only 68.61% of the 95% target. This study evaluated the SPM policy on hypertension services at the Mabelopura Health Center using a descriptive qualitative method with informants from Key Informants and Triangulated Informants. The results showed that the implementation of SPM Hypertension only reached 68.61% of the 95% target, indicating that the target has not been achieved. Health services are in accordance with SPM standards but not optimal, due to differences in central target data with Puskesmas data and limited human resources. The low number of community visits for hypertension screening, due to the community's lack of perceived importance of routine control, was also a major factor. This study concluded that to achieve SPM targets, intensive efforts are needed from Puskesmas Mabelopura and the Health Office of Palu City to establish better communication with Pusdasten and increase community awareness of the importance of routine check-ups. Thus, it is expected that Puskesmas Mabelopura can be more effective in achieving SPM targets and improving the quality of life of people with hypertension in the area.

EXPLORING THE DENTAL HEALTH BELIEFS AND PRACTICES OF COLLEGE STUDENTS IN RELATION TO SCALING AND ROUTINE DENTAL CHECK-UPS AND ITS ASSOCIATION WITH SOCIODEMOGRAPHIC FACTORS IN DISTRICT MANSEHRA KPK

Background: Maintaining good oral hygiene practice and receiving routine dental check -up are crucial for preventingdental diseases. Dental scaling is a common dental procedure that involves removing the calculus and other debris fromthe teeth.Objective: This study aimed to explore the dental health beliefs and practices of college students in District Mansehraregarding scaling and routine dental checkups and identify the sociodemographic factors that influence dental healthbehaviors.Methodology: A cross-sectional survey was conducted among 200 college students including females and males inDistrict Mansehra, and data was collected using a self-administered questionnaire. Descriptive statistics is used toanalyze the data through SPSS .Result: Only 37% of college students adhere to regular dental checkups every six months, and a mere 16.5%express a positive attitude towards dental scaling. Notably, there are no statistically significant differences in dentalcheck-up rates between genders (P = 0.210), housing arrangements (own vs. rented, P = 0.494), or education levels(P = 0.598). Similarly, there is no significant variance in attitudes towards scaling based on gender (P = 0.116),urban/rural residence (P = 0.459), housing status (P = 0.531), or education level (P = 0.295). Overall, the studyunderscores the unsatisfactory dental care habits among college students and suggests a widespread negative perceptionof routine dental check-ups and scaling.Conclusion: The findings of the study provide valuable insights into the oral health needs of this population andinform the development of culturally appropriate oral health promotion programs.Keywords: Dental Health beliefs and Practice, Routine Dental Check-up, Sociodemographic factors.

THE RELATIONSHIP OF LOW BIRTH WEIGHT WITH STUNTING INCIDENTS IN ACEH IN 2022

Background: Stunting is a failure in growth and development experienced by children due to insufficient nutritional intake, infectious diseases over a long period of time which is characterized by length or height that is not appropriate for their age. Stunting is still a major health problem in Aceh Province because its prevalence is still high and is ranked 5th nationally. Objective: to determine the determinants of stunting in toddlers in Aceh Province. Research method: Descriptive quantitative research with a cross sectional design with a sample size of 16865 toddlers obtained from total sampling based on inclusion and exclusion criteria. The data used is 2022 SSGI data belonging to the Ministry of Health's BKPK. The independent variables in this study include Early Breastfeeding Initiation (IMD), completeness of immunization, ISPA, diarrhea, ownership of health insurance, ownership of KIA books, drinking water facilities, ownership of toilets, mother's education, gender of toddler, birth weight, number of families, and regional classification. Data analysis includes univariate and bivariate using chii square and multivariate using multiple logistic regression. Results: The prevalence of stunting in children aged 0 – 59 months is 31.7% in Aceh Province in 2022. Bivariate results are low birth weight (p=0.033). Conclusion: the high prevalence of stunting in Aceh Province in 2022 is caused by multiple and interrelated factors, both specific and sensitive. To reduce the stunting rate, preventive and promotive measures need to be taken early on.by carrying out routine check-ups during pregnancy and consuming a variety of foods. Short birth length babies need to receive growth and development monitoring, additional food and nutrition and health Information Communication and Education (KIE) interventions for mothers of toddlers.

Evaluation of Insulin Prescribing Patterns and Associated Burden among Ambulatory Diabetic Patients in Islamabad/Rawalpindi

Background: Diabetes Mellitus (DM) is a significant global health challenge, particularly in developing countries where it is prevalent and associated with high morbidity and mortality due to poor management and adherence to therapy. In Islamabad/Rawalpindi, the management of DM is compromised by gaps in knowledge and adherence regarding insulin use, which is crucial for effective disease control. Objective: This study aims to assess the patterns of insulin usage, adherence to therapy, and the impact of educational status on insulin management among patients with diabetes in Islamabad/Rawalpindi. Methods: A cross-sectional, descriptive, survey-based study was conducted from February to May 2023 among 240 ambulatory diabetic patients. Data were collected using structured questionnaires covering demographics, insulin usage patterns, adherence behaviors, and diabetes management knowledge. Statistical analysis was performed using SPSS version 25, employing descriptive statistics and Chi-Square tests to explore associations between variables. Results: The majority of participants (52.5%) were over 40 years old, with 55% having type 2 diabetes. Insulin pens were used by 47.1% of the participants, while 50% used syringes. Approximately 66.3% of the participants were also taking oral anti-diabetic medications. About 63.7% regularly attended routine checkups, 88.3% knew how to inject insulin, and 90.8% were aware of the timing for insulin injections. Educational interventions showed a significant impact on adherence and knowledge, with 77.5% demonstrating an understanding of diabetes. Conclusion: The study highlights the need for improved diabetes education and access to advanced insulin delivery methods to enhance adherence and management of diabetes in Islamabad/Rawalpindi. Emphasizing patient education on insulin use could lead to better disease outcomes and quality of life for diabetic patients in the region.

Burden and factors influencing intestinal parasitic infections among food handlers in Gondar City, Northwest Ethiopia.

Intestinal parasitic infections pose significant global health challenges, particularly in developing countries. Asymptomatic infections often present a considerable burden with food handlers serving as potential carriers. In Ethiopia, the prevalence of these parasites varies across regions, and accurate data in the study area is lacking. Therefore, this study aimed to investigate the prevalence of intestinal parasites among food handlers working in hotels and restaurants in Gondar City, Northwest Ethiopia. A cross-sectional study collected stool samples from food handlers alongside a structured questionnaire gathering socio-demographic and hygiene practice information. Stool specimens were screened for intestinal parasites using direct wet mount and formol-ether concentration techniques. The collected data were checked for completeness, entered into EpiData software version 3.1, and exported to SPSS version 20 for analysis. A multivariable logistic regression analysis was deemed statistically significant if the p-value was less than 0.05. A total of 257 food handlers working in hotels and restaurants in Gondar City participated in the study. Of these, 33.5% (86/257) were found positive for one or more intestinal parasites, with a 95% confidence interval (CI) of 28.0-39.5%. The study identified nine types of intestinal parasites, with E. histolytica/dispar (8.2%, 21/257) and Ascaris lumbricoides (6.6%, 17/257) being the predominant parasites, followed by hookworm (3.5%, 9/257) and S. mansoni (2.3%, 6/257). The prevalence of mixed infections was 9.3% (24/257). A significant association was observed between intestinal parasitic infection and the educational level of food handlers. In this study, a high prevalence of intestinal parasites was detected indicating poor hygiene practices of the food handlers at the study site. Even the prevalence of mixed infections was high. Regular training, strict adherence to personal hygiene and food-handling practices, and routine inspections and medical checkups for food handlers are crucial.

An age-related nomogram for antral follicle count: an observational study of 3821 women

Research questionTo investigate the relationship between antral follicle count (AFC) and chronological age and establish expected values for AFC. DesignThis is a retrospective cohort study at a specialist gynaecological ultrasound centre in London. Women presenting to a gynaecology diagnostic unit for investigation of symptoms or routine check-up, and undergoing transvaginal ultrasound examinations, between the 1st of January 2017 and 22nd of September 2022. ResultsWe analysed 8821 data entries from 7573 women. We estimated the relationship between AFC and age to develop an AFC nomogram independent of the stage in the menstrual cycle. The AFC corresponding to the 10th, 25th, 50th, 75th and 90th centiles for each patient and age group have been calculated. Both nomogram and condition specific populations displayed a gaussian relationship between AFC and age. For the nomogram population, a peak median AFC of 30, was observed between the age groups of 21 -23. The AFC distribution of the previous cystectomy group was found to be statistically different in comparison to the nomogram population(P<0.0001). However, the same did not hold true for those on hormonal contraception (P=0.43). ConclusionsWe provide an AFC nomogram reporting median and interquartile values for AFC by chronological age across the reproductive years. This is a useful tool for providing counselling for those undergoing ovarian reserve assessments taken any time in the menstrual cycle including for those on hormonal contraceptives or previous cystectomy.

Differences in shared decision-making and prostate cancer screening by sexual orientation and race/ethnicity.

10525 Background: There are well-documented disparities among racial and sexual minorities in prostate cancer screening uptake and shared-decision making (SDM) conversations. However, it is unclear how racial/ethnic identity and sexual orientation interact to affect prostate-specific antigen (PSA) testing uptake. Methods: Data came from the 2018-2022 Behavioral Risk Factor Surveillance Survey (BRFSS). Outcomes were survey responses to questions about engagement in SDM and PSA testing uptake. The sample included 88,365 heterosexual (HS) men and 2,562 sexual minority (SM) men ages 55 to 69. Data were stratified by race/ethnicity and survey-weighted logistic regression models analyzed the association between sexual orientation and outcomes. Models controlled for age, relationship status, education, household income, insurance status, having a usual source of care, and region. Results: White SM men were more likely to have discussed disadvantages of PSA testing with their healthcare provider [odds ratio (OR)=1.407; p&lt;0.001] and to have undergone PSA testing [OR=1.320; p&lt;0.001] compared to White HS men. Asian SM men were more likely to have had discussions about PSA testing [OR=4.470; p&lt;0.05]; to have discussed advantages [OR=4.596; p&lt;0.05]; to have been recommended PSA testing [OR=4.836; p&lt;0.05] and to have undergone PSA testing [OR=4.401; p&lt;0.001] compared to Asian HS men. Black SM men were more likely to undergo screening because of an issue or a reason besides routine screening [OR=1.073, p&lt;0.05] compared with Black HS men. Hispanic SM men were more likely to have undergone screening as part of a routine checkup [OR=4.2, p&lt;0.001] compared with Hispanic HS men. There were no sexual orientation differences in PSA screening or SDM among American Indian or Native Alaskans. Conclusions: Differences in PSA testing uptake and SDM by sexual orientation vary by race/ethnicity. Further research is needed to study the factors affecting PSA testing uptake and SDM among sexual minority men of different racial/ethnic groups. [Table: see text]

Analysis of glycemia during olaparib therapy in patients with ovarian cancer.

e17559 Background: Olaparib (poly(ADP-ribose) polymerase inhibitor) is a relatively new anticancer drug and some of its metabolic side effects, such as its effect on blood glucose, are not yet well defined. The aim of the study was a retrospective analysis to investigate olaparib-induced changes in glucose levels in patients with ovarian cancer (OC). Methods: The study was conducted on 32 OC patients with normoglycemia (3.9–5.5 mmol/l) confirmed before olaparib treatment. The fasting glucose (FG) levels were estimated after I (one month), II (two months), and III (three months) courses of olaparib treatment. The severity of hyperglycemia was graded according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Results: During treatment with olaparib, grade 1 hyperglycemia was found in 18 patients (56.2%), therefore hemoglobin A1C level measurement was recommended. The number of patients with impaired fasting glucose (5.6–6.9 mmol/l), characteristic of a pre-diabetic state, was 17 (53.1%), while glycemia indicative of diabetes (≥7.0 mmol/l) were found in 1 patient (3.1%). The statistically significant increase in glycemia was observed after I course of treatment (p&lt; 0.0001), then after the second (p=0.0003), and III course (p=0.0025). Conclusions: During olaparib therapy, hyperglycemia was observed in 56.2% of the analyzed OC patients, implying the need for glycemic monitoring during monthly routine check-ups to implement effective behavioral and therapeutic management.

Hepatitis E virus in children and adolescents living in an urban environment in central Argentina: An explorative study

In Argentina, circulation of hepatitis E virus (HEV) genotype 3 has been described, producing sporadic cases of acute and chronic hepatitis. Limited information is available regarding HEV infection in children, so we aimed to investigate this virus in a pediatric population from the country. Serum samples from Argentine children (0–18 years old) (n = 213) were studied for IgG anti-HEV, IgM anti-HEV and RNA-HEV: 202 samples belonged to individuals attending health-care centers for routine check-ups, and 11 samples from patients with acute hepatitis of unknown etiology. Seropositivity for IgG anti-HEV was 1.49 % (3/202). One sample from an 18-years-old female patient with acute hepatitis tested positive for IgM anti-HEV detection, negative for IgG anti-HEV and RNA-HEV, but also positive for IgM anti-EBV. The HEV prevalence was low and showed circulation among children in central Argentina.

Fuzzy rule based classifier model for evidence based clinical decision support systems

Clinicians benefit from the use of artificial intelligence and machine learning techniques applied to health data within health records, which identify commonalities between them. It enables them to get evidence-based support in recommending shared treatment paths for undiagnosed health records. The collective inference from these patterns, drawn from an array of health records, further enhances the capacity to mine essential features, supporting public health experts in their management of population health conditions. This paper presents a novel mapping tool model designed to analyze electronic health records and provide healthcare providers with evidence-based decision support. The work focuses on the analysis of health records from hospital databases, encompassing parameters extracted from routine health checkups. By scrutinizing patterns within examined health records, healthcare providers can seamlessly align with newer health records for diagnosis and treatment recommendations. Core to this approach is the integration of a fuzzy rule-based classifier system within the proposed system. This incorporation facilitates the processing of health records, extracting pertinent features to augment decision-making with the support of knowledge bases. The model architecture provides flexibility and customizability, enabling easy configuration of the system to accurately map new health records to the examined dataset. Additionally, the model utilizes a specially developed distance-measure technique tailored for the proposed fuzzy-based system. Results showcase satisfying performance and robust discriminant capability for accurate recommendations. The alignment of outcomes with expert evaluations underscores the model's efficacy and attainment of benchmarks.

Lateral Epicondylalgia and Thoracic Kyphosis: A Study on Young Athletes.

The etiology of lateral epicondylalgia (LE) remains unclear, although it has been linked to various factors. Recent theories suggest a potential connection between LE and impairments in the kinetic chain. In our study, we aimed to investigate the association between another factor influencing kinetic chain impairment, specifically an increased angle of thoracic kyphosis, and the presence of initial signs of LE in young athletes. This study employed an observational, case-control design. The participants underwent examination during a routine preventive checkup conducted by a sports physician at Novi Sad Healthcare Center, Sports Medicine Center. One hundred young athletes aged 10 to 15 years were included in the study. Half of the participants reported pain in the lateral aspect of the elbow during maximal hand grip, while the remaining athletes served as controls and did not experience any pain. Thoracic kyphosis inclination angles were measured using a digital inclinometer. Pain was assessed using the pressure pain threshold at a specific point associated with lateral epicondylalgia, measured by a digital algometer. Participants exhibiting initial signs of LE displayed significantly different angles of anteroposterior curvatures of the spine compared with the control group. Moreover, the angle of thoracic kyphosis was significantly associated with pain in the lateral aspect of the elbow. Our findings confirm an association between initial signs of lateral epicondylalgia and the grade of thoracic kyphosis in young athletes.

Biological variation of 16 biochemical analytes estimated from a large clinicopathologic database of dogs and cats.

Biochemical measurements are commonly evaluated using population-based reference intervals; however, there is a growing trend toward reassessing results with within-subject variation (CVI). We aimed to estimate the CVI of 16 biochemical analytes using a large database of dogs and cats, which refers to the results of routine health checkups. Pairs of sequential results for 16 analytes were extracted from a database of adult patients. The second result was divided by the first result to produce the ratio of sequential results (rr), and the frequency distribution of rr was plotted. From the plots, the coefficient of variation (CVrr) was calculated. Analytical variation (CVA) was calculated using quality control data, and CVI was estimated as follows: . Estimated CVI was compared with previously reported CVI using the Bland-Altman plot analysis. From the database, 9078 data points from 3610 dogs and 3743 data points from 1473 cats were extracted, with 5468 data pairs for dogs and 2270 for cats. Sampling intervals ranged from 10 to 1970 days (median 366) for dogs and 23 to 1862 days (median 365) for cats. Bland-Altman analysis showed most CVI plots fell within the limits of agreement; however, positive fixed biases were observed in both dogs and cats. Our study introduces a novel approach of estimating CVI using routine health checkup data in dogs and cats. Despite biases, our method holds promise for clinical application in assessing the significance of measurement result differences.

Prevalence and Associated Factors of Depression Symptoms Among Aquaculture Workers in Hai Phong, Vietnam: A Cross-Sectional Study

Objective: This study aimed to determine the prevalence and factors associated with depression symptoms among aquaculture workers in Hai Phong, Vietnam. Material and Methods: The study involved 1,220 aquaculture workers in coastal and offshore areas of Hai Phong, Vietnam; from March 2022 to September 2022. It was a cross-sectional descriptive epidemiological study, utilizing direct interviews with aquaculture workers to identify depression symptoms and associated factors. The Depression-Anxiety- Stress Scale (DASS 21) was used to assess depression symptoms. Results: The prevalence of depression symptoms among aquaculture workers was 28.7%, with 20.9% experiencing mild depression, 6.3% moderate depression and 1.5% severe depression. Several factors were associated with depression symptoms; including gender (OR=2.03; 95% CI 1.56-2.63), being single or divorced (OR=1.44; 95% CI 1.04-1.99), age ≥60 (OR=1.63; 95% CI 1.05-2.55) compared to those under 40, chronic illnesses (OR=3.16; 95% CI 2.43-4.11), poor sleep quality (OR=2.84; 95% CI 2.13-3.79), alcohol abuse (OR=1.36; 95% CI 1.06-1.75), and irregular physical exercise (OR=2.09; 95% CI 1.62-2.70). Conclusion: Depression disorder is a mental health concern among aquaculture workers. To alleviate depression symptoms, workers should consider lifestyle adjustments, incorporate regular physical exercise, and undergo routine health check-ups for timely counseling and treatment.

Predicting adverse cardiac remodeling following ST-elevation myocardial infarction through the assessment of endothelin-1 levels

Abstract Adverse cardiac remodeling refers to a complex set of molecular, cellular, and interstitial changes. Cardiac remodeling is linked to an unfavorable prognosis due to its correlation with ventricular dysfunction and the occurrence of malignant arrhythmias. Endothelin-1 is a powerful vasoconstrictor that acts at the level of smooth muscle cells of the vascular wall. In patients with ST-elevation acute myocardial infarction (STEMI), increased circulating endothelin-1 is associated with left ventricular systolic dysfunction and major complication during the in-patient period. The purpose of the study is to evaluate the role of Endothelin-1 as a possible predictor of pathological remodeling six months after STEMI event. Materials and methods 162 patients with STEMI were initially enrolled into the study according to inclusion criteria (percutaneous coronary intervention performed first 12 hours after the event, age of participants 18 years and above). Blood samples for biomarker analysis were collected at admission (endothelin-1, cardiac troponin I). At the end of six months, patients came to the site for a routine check-up including echocardiography with strain. One year after the event, the patients were contacted to collect information about a primary composite endpoint. The primary endpoint was a combination of all-cause death, new incident of myocardial infarction, ischemic stroke or transient ischemic attack, heart failure decompensation with or without hospitalization, hospitalization due to any cardiovascular disease deterioration. All these were defined as a single study outcome. Secondary outcomes, measured as the change from baseline to 6 months in left ventricle (LV) end-diastolic volume &amp;gt;10% and / or LV end-systolic volume &amp;gt;10%. 9% of study subjects reached the primary study outcome. Results the study cohort was stratified into two groups: those with high and low endothelin levels, determined by the median of 2.75 pg/ml. In the group of endothelin above 2.75 pg/ml, a statistically significant increase in end-diastolic volume of the LV (p = 0.002), end-diastolic dimension (p = 0.015), left atrium size (p = 0.008), and indicators of diastolic dysfunction (p =0.024) and LV myocardial mass (p=0.015) 6 months after the event. The ROC analysis revealed that endothelin has prognostic potential for LV remodeling. The cut-off was less than 2,97 pg/ml (sensitivity - 83%, specificity - 62%, area under curve (AUC) 0,70, 95% confident interval (CI) 0,516 – 0,847, p=0,03). Logistic regression analysis was employed to assess the potential of the Endothelin-1 biomarker as a predictor for LV remodeling. Endothelin showed properties of predicting adverse cardiac remodeling (CI 95% 0.696 - 0.956, AUC - 0.861, χ2=9.03 p=0.43). Conclusion measuring the Endothelin-1 level can enable the implementation of appropriate medical interventions in STEMI patients with an unfavorable cardiac remodeling prognosis, helping to prevent the development of heart failure.

#842 Validation of the excessive salt intake screening questionnaire in CKD patients

Abstract Background and Aims Excessive salt intake is implicated in the progression of hypertension, chronic kidney disease (CKD), diabetic nephropathy, cardiovascular diseases, cerebrovascular diseases, and increased mortality. In Japan, average salt consumption surpasses the levels recommended by national guidelines and the WHO. However, individuals seldom have the chance to gauge their salt intake accurately. This study aimed to validate a screening tool initially developed by Sasaki et al. to identify individuals with excessive salt intake using health check-up data from Asahi City, Chiba Prefecture, Japan. Method This study was conducted as a part of the Cities Changing Diabetes (CCD). CCD is Novo Nordisk's commitment to drive action against type 2 diabetes and obesity in cities globally. It is a partnership program to accelerate the prevention of diabetes and obesity by addressing the systemic change in urban environments. Participants of this study were drawn from specific health examinations in Asahi City. Consent was obtained, and dialysis patients were excluded. Spot urine samples were analyzed for sodium and creatinine to estimate daily salt intake via Tanaka's formula. The screening tool incorporated risk factors such as age, gender, Body Mass Index (obesity), hypertension (use of antihypertensive drugs), frequency of soup intake, saltiness of home-cooked meals compared to restaurants, efforts to reduce salt intake, and frequency of dining out. The primary outcome was excessive salt intake, defined as an intake exceeding one standard deviation above the mean. Discrimination was assessed using the Area Under the Curve (AUC), while calibration was evaluated with a calibration plot and the Hosmer-Lemeshow test. Results Of the 1532 CKD participants, the mean age was 76.3 years, with males comprising 46%. The average daily salt intake was 9.3 g (SD: 2.39), and the estimated Glomerular Filtration Rate (GFR) was 50.6 ml/min/1.73 m² (SD: 14.5). The distribution of CKD stages included 1198 stage 3a, 285 stage 3b, 43 stage 4, and 5 stage 5 patients. The AUC of screening tool was 0.65 (95% CI: 0.61 to 0.69), and its calibration slope (with an intercept) was 0.98 (95% CI: 0.72 to 1.25). The Hosmer-Lemeshow test yielded a p-value of 0.626. Conclusion The predictive capability of the existing model for excessive salt intake was limited in the CKD population, which may suggest a need for a screening method distinct from that used in the general population. Factors such as changes in sodium excretion due to reduced renal function and the effects of diuretics should also be considered when interpreting these results. Integrating this questionnaire into routine health check-ups could enhance dietary monitoring and intervention, potentially attenuating the progression of CKD and its associated complications. There remains scope for further refinement of the tool's accuracy by incorporating additional predictors.

Racial and ethnic disparities in healthcare utilization among children in U.S. foster care: Recommendations to challenge the status quo based on a scoping review

Prior work has examined racial and ethnic disparities in the access to and utilization of healthcare services. However, evidence across studies is mixed, making it challenging to precisely identify where the racial and ethnic disparities in healthcare utilization are amongst children in foster care, and which race and ethnicity groups are most impacted by such disparities. As such, the purpose of the current study was to conduct a scoping review to synthesize evidence on the topic of racial and ethnic disparities in the physical and mental or behavioral healthcare utilization for children in the U.S. foster care system (PROSPERO ID: CRD42021272072). Comprehensive literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 414 studies identified, 23 met inclusion criteria: peer-reviewed journal article, published between 1991 and 2023, written in English, examined healthcare access or utilization of children in the U.S. foster care system as outcomes, included and disaggregated results by children’s race and ethnicity, conducted quantitative analysis, and was observational in study design. In the physical healthcare utilization domain, Black children were less likely to utilize routine and preventative check-ups and more likely to utilize medical services for treating chronic illnesses such as asthma, compared to White children. In the mental or behavioral healthcare utilization domain, Black and Hispanic/Latine children were less likely to utilize both inpatient and outpatient mental health services, compared to White children. Furthermore, notable variations were observed by specific service types and continuity of services over time. Implications include additional research and education about racial and ethnic disparities in healthcare utilization amongst children in foster care, as well as implementing regulations and oversights that mandate racial equity in the child welfare and healthcare service pathways.