Clinics In City Research Articles

Trust factors and their impact on patients satisfaction of private clinics in city of Ramadi - Iraq

The target of the research to identify the trust factors represented by (communication, competence, Service Quality) and its impact on the satisfaction of patients private medical clinics in the city of Ramadi, and for the purpose of achieving research objectives and reaching answers to questions (study problem), the Researchersadopted the analytical descriptive approach, a questionnaire was designed as a key tool for collecting preliminary data, and using the method (method) random sample, distributed (384) questionnaire forms to patients reviewing private medical clinics in the city, Of these, 368 were recovered, of which 11 were not eligible (invalid), bringing the number of questionnaires valid for statistical analysis (357) to 357, i.e. a response rate (93%) of recovered questionnaires, and the data analysis and statistically processed by the program (SPSS.V.26) as well as the statistical program (AMOS.V.26) , the most prominent findings of the research were the existence of a correlation and a positive effect with statistical significance between the factors Trust and patient satisfaction In addition, the results showed that the level of Trust of patients through their factors in the private medical clinics researched was at a (medium) level, as the contact came first and then solved the Competence second and the Service Quality iii, as well as the level of patient satisfaction with the medical services provided by the clinics in general was (average), and in the light of those results the Researchersmade a set of recommendations that could help medical clinic staff to enhance and increase the level of Trust of patients with them and strengthen them which reflects positively on the satisfaction of the patients and the permanence and prosperity of their relationship.

A multi-objective location-routing model for dental waste considering environmental factors.

Nowadays, the amounts of infectious medical waste (IMW) have surged considerably so waste management has become a critical emergency in many developing countries. However, most large medical waste generation centers (MWGC) are equipped with treatment facilities, small MWGC faces the waste management problem. It reveals the significance of having a proper program for small health centers. This is an indisputable difficulty that governments bordered because it imposes great costs on societies, also the environmental problems caused by improper treatment are irreparable. To attend to all the essential aspects of the problem, this paper recommended a location-routing model with four objective functions to minimize the total costs, environmental pollution, the risk imposed on the population around disposal sites, and the total violation from the expected arrival time. Considering a multi-period problem with a maximum acceptable delay plays a key role to connect the assumptions to the real-world problem. In addition, for solving mathematical models based on case studies, the role of uncertainty is undeniable. The demand for dental waste treatment is not definite and is changed based on the different conditions thus fuzzy chance-constrained programming is proposed for this problem to tackle the uncertainty. The revised multi-choice goal programming method is considered to solve the model and a real case study for dental clinics in Babol city of Iran is investigated to illustrate the validation of the proposed model. The results indicate that the solution method can create a balance between four objective functions. Finally, sensitivity analyses are performed for some parameters to analyze the behavior of the objective functions.

Efficacy and safety of regdanvimab in patients with mild/moderate COVID-19 and high risk of progression of the disease: a retrospective study in a short-term stay unit

The use of virus-neutralizing monoclonal antibodies is an effective method of etiotropic therapy for SARS-CoV-2 in patients of high-risk groups of severe COVID-19. Regdanvimab is a single-component monoclonal antibodies immunoglobulin G1, whose mechanism of action is aimed at binding SARS-CoV-2 virus at the RBD site of the spike protein S1 domain. In the Russian Federation, regdanvimab is approved for emergency administration in COVID-19 for adult patients not requiring respiratory therapy who are at high risk of developing a severe course of the disease. To evaluate the efficacy and safety of therapy with regdanvimab in patients with mild/moderate COVID-19 in a short-term hospital unit. Virus-neutralizing therapy with regdanvimab was performed at the short-term hospital unit of the Moscow City Clinic. An open retrospective observational single-center study included 92 adult patients with mild/moderate coronavirus infection. All patients had comorbid chronic diseases and belonged to the high-risk group for the development of a severe COVID-19. age 18 to 75 years; presence of a verified diagnosis of COVID-19 of mild/moderate COVID-19, polymerase chain reaction (PCR) confirmed; one or more chronic diseases; first 7 days from the onset of the first symptoms of COVID-19 (including day 7). need for oxygen support. Clinical efficacy was assessed according to the World Health Organization Сlinical Progression Scale and supplemented with laboratory markers at baseline and in dynamics, as well as with monitoring of virus elimination by PCR. Calculations were performed using the statistical computing environment R 4.1.3 (R Foundation for Statistical Computing, Austria). For quantitative indices the median (1; 3 quartiles) was indicated. For binomial signs we calculated 95% confidence intervals according to Wilson's method. Time interval analysis was performed according to the KaplanMeier method. The significance level was determined at p0.05. A significant decrease in the severity of clinical manifestations according to the World Health Organization Clinical Progression Scale was noted by patients by day 4 after regdanvimab administration. All 92 patients in the cohort were discharged from the hospital l on average on day 5 after regdanvimab administration and on day 9 of the disease. On day 4 after drug administration 82% of patients was being PCR negative. No adverse events related to the administration of regdanvimab were reported during the study. In real clinical practice, the efficacy and safety of regdanvimab in patients at high risk of severe COVID-19 was confirmed once again, with a positive clinical result observed in a mixed cohort by the causative agent omicron and delta strain.

Perception and practice of breastfeeding in public in Poland.

BackgroundThe aim of the study was to get to know polish women’s opinions and experiences regarding breastfeeding in public.Material and methodsA one-time 11-question survey aimed at women during lactation or breastfeeding in the past who completed a paper questionnaire or online questionnaire on the website (www.laktacja.pl). The study was conducted electronically from 1 September 2019 to 31 March 2020 in Maternity and Neonatal Departments, primary health-care clinics in various Polish cities. Data from 700 questionnaires were statistically analysed with the use of Pearson’s chi-squared test of independency or Fisher’s exacts test when applicable (small cell counts).Results90% of the surveyed women expressed the opinion that it should be possible to breastfeed in public, and 78% of women have had such an experience. Most often it was their own cars, a room for a mother and child, a hall or just a place available when there was a need to feed the child (e.g., a bench, cafe, toilet). About 10% of women faced criticism while breastfeeding in a public place, and 8.6% of women have never breastfed the child out of the house due to the lack of proper place and conditions, embarrassment and no sympathy from other people.ConclusionTaking into account the benefits of long-term breastfeeding and the comfort of breastfeeding women, their children and the environment, it is necessary to create dedicated places for breastfeeding in public places.

Quality of life profile of methadone maintenance treatment patients in Ho Chi Minh City, Vietnam

ABSTRACT Aim To determine the health-related quality of life (HRQoL) of methadone maintenance treatment patients in Ho Chi Minh City, Vietnam. Subject and Methods A cross-sectional study was conducted in 967 patients being treated at two methadone clinics in Ho Chi Minh City, in 2018. Patient’s HRQoL was estimated using the EQ-5D-5L and Visual analogue scale (VAS). Tobit regressions were used to identify factors related to patient’s HRQoL. Results Overall, the mean EQ-5D-5L utility and EQ-VAS indexes were 0.96 (SD = 0.12) and 75.8 (SD=15.5), respectively. Higher EQ-5D-5L score were found in single patients, and have a higher monthly income, while patients aged under 30 years old, have full-time employment, and have higher education were associated with a higher EQ-VAS score. HIV was associated with lower scores of both EQ-5D-5L and EQ-VAS (□ = -0.07 (95%CI: -0.13; -0.01), and □ = -7.10 (95%CI: -9.23; -4.98), respectively). Conclusion HRQoL measurement provides valuable information for the policymaker to adopt suitable decisions on opioid dependence treatment. The finding shows education, employment, and socioeconomic status are the related elements with higher HRQoL, which suggested that the policymakers and physicians should pay more attention to these aspects while working on treatment plans for drug users.

10-year clinical records of adults seeking individual therapy in a non-profit centre in the West Bank, and factors associated with premature discontinuation: a quantitative study

BackgroundFormal help-seeking behaviour and premature termination of therapy is influenced by several factors, including access to mental health services, cultural beliefs about mental health and illness, gender, and socioeconomic status. Current local and regional studies have focused on formal help-seeking attitudes of university students or on utilisation of psychiatric services. This study sheds light on actual formal help-seeking behaviours of adults attending a non-profit counselling centre in Palestine by use of both client and therapist reports. MethodsThe sample consisted of 1068 clinical records belonging to clients aged 18 years and older, who approached the Palestinian Counseling Center for individual therapy between 2008 and 2018 in three different locations in the West Bank. The Birzeit University Ethical Committee approved the study and granted a waiver for obtaining consent owing to the use of an anonymous secondary dataset. 12 quantitative variables describing clients’ demographic information and data on therapy and dropout were analysed using binary logistic regression. One qualitative variable describing patients’ subjective reports about their symptoms was analysed using thematic analysis with an inter-rater reliability of 65%. Findings70·3% of clients (750 of 1067) were women, 44·1% (471) were married, and 42·2% (450) had never married. The mean age was 30·4 years (SD 9·7). 42·3% of clients (280 of 661) had a BA degree or higher and 60·5% (633 of 1045) reported their economic status to be above average. 45·2% (457 of 1011) were working, 25·4% (257) were housewives, and the rest (297) were students or unemployed. 56·7% of clients (587 of 1036) were from cities and 38·6% (400) from rural areas. A large proportion of clients approached the Palestinian Counseling Center on their own (39·9%, 411 of 1030), and others were referred by friends (19·2%, 198) and doctors (19·0%, 196). The qualitative data show that the most common complaints reported by clients were relational problems (51·6%, 297 of 575) and anxiety (33·6%, 193). The most frequent diagnoses made by clinicians were anxiety disorders (20·9%, 196 of 939), personality disorders (20·7%, 194), depressive disorders (19·2%, 180), and other conditions with a clinical focus (18·2%, 171). The average number of sessions was 23·1 (SD 20·9), and the rate of premature discontinuation was 39·4% (392 of 994). Clients with very low education (illiterate or primary education level) were 4·1 times (95% CI 1·09–15·48) as likely as clients with a BA degree or higher to discontinue therapy prematurely (p=0·036). Clients that approached the centre on their own were 56·6% (95% CI 0·24–0·8) less likely to discontinue prematurely than those referred by institutions or professionals (p=0·008). InterpretationThe predominance of women and clients with higher education and economic status is consistent with previous findings. These groups tend to have better access or more positive attitudes, or both, to therapy use. Furthermore, previous studies reported a similar dropout rate and a link between lower education and premature discontinuation. The percentage of clients diagnosed with personality disorders and the percentage of married clients was higher than predicted. The main limitation of the study is the location of the Palestinian Counselling Center clinics in cities, and the fee that clients pay (calculated based on their financial ability), affect access to therapy, utilisation, and discontinuation. Analysing the clinical records of other Palestinian centres and institutions is necessary to understand whether the patterns reported by this study are generalisable to the Palestinian population. FundingNone.

Rapid Uptake of Testing for Chlamydia, Gonorrhea, and HIV From an Online Platform, April-October 2020.

The Baltimore City Health Department (Baltimore, MD) promoted IWantTheKit for chlamydia, gonorrhea, and HIV testing to city residents and clinic patients when COVID-19 restricted in-person clinic services. From April to October 2020, monthly online IWantTheKit orders increased by 645%. A high prevalence of chlamydia and gonorrhea was detected, and 96% of users who tested positive for chlamydia and gonorrhea were successfully contacted for treatment. Uptake by Baltimore City Health Department priority populations and excellent treatment linkage demonstrated how a public health-academic partnership successfully addressed a service gap during the pandemic. (Am J Public Health. 2022;112(7):985-989. https://doi.org/10.2105/AJPH.2022.306835).

Serum Mannose Level and Its Association in Women with Polycystic Ovarian Syndrome: a Case Control Study of Al-Najaf City / 2020

Background: Polycystic ovarian syndrome is a common public health issue around the world. Insulin resistance and glucose intolerance play important role in the etiology of polycystic ovarian syndrome and the serum mannose is incorporated in metabolism of glucose. Aim of study: Determination of the association between serum mannose level and polycystic ovarian syndrome. Patients and Methods: A case control study enrolled eighty eight women were divided as forty four women with polycystic ovarian syndrome and forty four women without polycystic ovarian syndrome presented to outpatient clinic at Fertility Center/Al Sader Medical City and outpatient clinic of Al- Zahraa Teaching Hospital in Najaf city-Iraq during the period from 1st of February till 31st of December, 2020. Results: The mean Serum Mannose level of women with polycystic ovarian syndrome 7.37 was significantly higher than mean serum mannose of controls 1.32 (p<0.001). Cutoff serum mannose level of 1.98 had acceptable validity results (90.9% sensitivity, 90.9% specificity, 94% PPV, 90.5% NPV and 90% accuracy). The means of serum level testosterone and luteinizing hormones were significantly higher among women with polycystic ovarian syndrome, while mean follicular stimulating hormone level was significantly lower among women with polycystic ovarian syndrome. Conclusions: The serum mannose level is significantly increased in women with polycystic ovarian syndrome which may indicate its possible role in the pathophysiology of polycystic ovarian syndrome.

Parents' Adherence to Childhood Screening Tests and Referrals: A Retrospective Cohort Study with Randomized Sampling.

Routine timely examinations of well-child health are important for achieving children’s good health outcomes. Nevertheless, there is evidence of low compliance with well-child visit recommendations. The aim of the study was to examine potential factors associated with parents’ nonadherence to routine childhood screening tests and their acting on further referrals following unusual findings. A retrospective cohort study was conducted among 14,348 children born in 2016–2017 and registered at mother–child health clinics in a large city in Israel. A sample of 844 children was randomly selected. Screening tests at the age of two months and nine months were examined. A multiple logistic regression examined potential factors associated with nonadherence to screening tests and to further referral for evaluation. Lower adherence to screening tests was found among parents of nine-month-old children, but adherence was higher for nurses’ screening tests than for those of physicians. Children born in a complex delivery process, older mothers with a higher number of children, and Israeli citizens were at risk of not undergoing screening tests. Fewer children in the family and initial physician’s findings were the only explanation for acting to referrals. In order to promote children’s health outcomes and public health, health policymakers should conduct campaigns to convince parents of the importance of screening tests and of adherence to referrals with the aim of ensuring their children’s wellbeing throughout the life cycle.

Comparison between immune-chromatography (ICT) and ELISA techniques for detection of anti-HAV antibodies among patients suspected to be infected with Hepatitis A virus (HAV)

Infection with Hepatitis A virus (HAV) is a significant cause of acute hepatitis, posing an important public health problem worldwide. This study aimed to compare the efficiency of the immune-chromatography test and the enzyme-linked immunosorbent assay (ELISA) in detecting infection with hepatitis A virus (HAV). For this purpose, 5 ml of blood was collected from 176 patients (92 males and 84 females) who attended the virology unit at Kirkuk General Hospital and the serological examination unit at the pediatric hospital, as well as private clinics in Kirkuk city for the presence of clinical signs or complaint directed towards infection doubt with hepatitis A virus (HAV), during the period between March 2020 and December 2021. The seropositive rate of anti –Hepatitis A immunoglobulin M antibody was 46(26.13%) of total patients of the study, while the ratio of the seronegative of HAV was 90(51.13%). The percentage of false-positive and false-negative results by immune-chromatography (ICT) was 34(19.38%) and 6(3.4%). These findings suggest that the fast test (ICT) is not a suitable screening test for detecting specific antibodies to the hepatitis A virus due to the high frequency of false-negative results caused by the test's low sensitivity and negative predictive value. This emphasizes employing ELISA or PCR methods to confirm hepatitis A virus diagnosis in public hospitals. Although ICTs are cheap, they alone are not useful in diagnosing and deciding treatment for patients infected with Hepatitis A virus, so it is recommended to use the ELISA test to confirm the diagnosis of infection and identify the Hepatitis A virus in public hospitals, healthcare units and blood transfusion centers. Keywords. Hepatitis A virus, Seroprevalence, immuno-chromatographic test, ELISA test, IgM

Prevalence of urolithiasis in Sarawak and associated risk factors: An ultrasonagraphy-based cross-sectional study.

The aim of this research is to study the prevalence of urolithiasis among the population of Sarawak Malaysia and the associated risk factors. A survey was conducted among individuals aged ≥18 years age in three primary health care clinics in the main cities of Sarawak from March 2019 to March 2020. Participants underwent face-to-face interview using a predesigned and standardised questionnaire. Details on demographic data, comorbidities, dietary variables and lifestyle were collected. Ultrasonographic examination of the kidney, ureter and bladder was performed followed by blood and urine sampling. Prevalence was defined as the proportion of participants with kidney stones, and univariate logistic regression was used to estimate the associated factors. A total of 1087 participants (486 male, 601 female) completed the questionnaire. Ultrasonographic examination and laboratory investigation were carried out, with an overall response rate of 98.8%. The prevalence of ultrasonographic proven urolithiasis in the sample studied was 4.04%. The mean age of patients with urolithiasis was 50.05 (SD 14.6, range 18-89), and the male to female ratio was 1.2: 1. Univariate analysis showed that odd ratio of personal history of urolithiasis (0.16, p:0.00), salty food intake (0.39, p:0.02), family history of urolithiasis (0.39, p:0.01), and hypertension (1.77, p:0.04) was significantly associated with a greater risk of urolithiasis. The prevalence of urolithiasis in this study population is 4.04%. It affects males and females equally; 61.4% are in the age group of 25-64 years. Hypertension, high salt diet, personal history of urolithiasis and family history of urolithiasis are significant risk factors.

The Knowledge and Reasons for Wet Vupping in Haziran Among People Referred to Cupping Clinics in Mashhad and Birjand Cities, Iran

Objective Cupping is one of the preventive and treatment methods in traditional Iranian medicine, which has two types, dry and wet cupping. The important point is that cupping should be done at the appropriate time and place and by the qualified people to have the most beneficial effects. This study aims to investigate the reasons for wet cupping therapy in Haziran, and the people’s knowledge of the cupping principles. Methods This descriptive cross-sectional study was conducted in 2019 in Mashhad and Birjand cities during the last days of June. Finally, 400 eligible samples participated in this study who were selected using a convenience sampling method. The collected data were analyzed in SPSS v. 16 software. Results Of 400 participants, 392 completed the questionnaires; 62.8% (n=246) were male, 75.1% (n=292) were married. 40.3% (n=154) had a university education, and 77.7% (n=289) had moderate socio-economic status. 82.2% (n=53) of the women were housewives; 6.6% (n=26) of participants had an underlying disease, 40.8% (n=119) had a history of cupping two times or more in a year, and 42.7% (n=132) had moderate satisfaction with cupping therapy. The most common reason for cupping was the “maintenance of health” (73.9%, n= 272) followed by “disease treatment”. Regarding the people’s knowledge of the principles of cupping, it was found that more than half of participants had correct information about the best season (spring) for cupping (81.5%, n=255), satiety during cupping (74.4%, n=210), the best time for having bath after cupping (after 24 hours) (79.7%, n=240), what to eat after cupping (Honey syrup) (64.7%, n=189) and complications of cupping (69.3%, n=185), but their knowledge was not desirable in other areas such as the best hours of day for cupping (46.9%, n=130), the best day of the week for cupping (21.3%, n=62), and the best days of month for cupping (35.6%, n=86). Conclusion Due to the high popularity of wet cupping in Haziran in Iran, and considering the people’s low knowledge of the proper principles and conditions of cupping (such as the time of cupping), it is necessary to inform the community through the media and use specialists in traditional medicine to monitor proper cupping and observance of its principles in the cupping clinics.

Assessment of factors associated with depression and anxiety among pwMS in Saudi Arabia

BackgroundMultiple sclerosis (MS) is an inflammatory chronic disease that is characterized by an increased prevalence of adverse mental health outcomes in patients with MS (pwMS). The main aim of this study is to investigate the factors of depression and anxiety in pwMS in the Kingdom of Saudi Arabia (KSA).Materials and methodsThis is a cross-sectional study conducted in KSA during the period from March to June 2020. Participants were recruited from the Neuroimmunology clinics in King Fahad Medical City (KFMC) and King Saud University medical city (KSUMC)in Riyadh City, KSA. The Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety. Fatigue Severity Scale (FSS) was used to measure fatigue in pwMS. A simple random sampling technique was utilized to select participants and the data were analyzed using SPSS v.24.0.ResultsA total of 529 participants participated in this study with a response rate of 53.1%. The prevalences of anxiety and depression were 35.3% and 19.7%, respectively. The findings also revealed that depression was more likely to be significantly affected by being male, low education, unemployment, physical inactivity, and fatigue but the anxiety was significantly affected by region, unemployment, short duration since last MS relapse, physical inactivity, and fatigue.ConclusionAnxiety and depression are not uncommon in pwMS. Given their impact on the lives of affected patients, early detection and management of these symptoms and their associated factors are crucial.

Hands‐on navigators a key component of community care initiative in NYC

A $5 million federal grant is allowing a New York City clinic to apply lessons learned from the COVID‐19 pandemic to a new program emphasizing early intervention for mental health problems. Targeting a diverse and underserved community in Brooklyn, the Enhanced Treatment and Recovery (EnTRy) program is relying heavily on teams of care navigators to ease patient access to services.

Orthodontic Patients’ Knowledge and Understanding of Orthodontic Retainers: A cross sectional study

Objectives: To assess the dental patients’ knowledge and understanding of orthodontic retainers, and to evaluate the level of knowledge in relation to different predefined variables such as gender, onset of treatment and education level.
 Materials and Methods: This is a cross sectional questionnaire-based study involving patients undergoing active orthodontic treatment. A validated and piloted questionnaire was distributed around five orthodontic clinics in Benghazi city. The paper questionnaire consisted of four sections with 20 questions covering basic demographic data, the knowledge and understanding of orthodontic retainers, and finally the mode of information provision. Descriptive statistics were carried out for frequency and proportions. In addition, the relationship between the variables was analysed using Chi-Square and Fisher exact test. A simple thematic analysis was conducted for the open-ended questions.
 Results: The response rate was 95%. A total of 295 questionnaires were self-completed and collected from the five centres. The age range was between 16 - 53 years (mean age 24.3). Around 83.4% of patients were aware that they will require a set of orthodontic retainers at the end of treatment. However, only half of the patients knew what type of retainers they will require (56.9%). Regarding the understanding of retention and relapse, around 71.2% of patients understood why retainers are needed and 60% recognize what will happen if they didn't wear their retainers. However, only 34% of the respondents understand what ‘’orthodontic relapse’’ means. No association was found between the onset of treatment, age and gender and the patients’ level of knowledge and understanding of orthodontic retainers. Nevertheless, the level of education was the only variable shown to be associated with the level of patients’ understanding. 
 Conclusions: The level of knowledge and understanding regarding orthodontic retainers was suboptimal among Libyan orthodontic patients. The reported lack of knowledge could potentially influence the amount of compliance with wearing orthodontic retainers. Postgraduate students and professionals seem to be more attentive to instructions and maintaining their teeth in place.

Neisseria gonorrhoeae infection in female sex workers in an STI clinic in Nairobi, Kenya.

BackgroundGonorrhea caused by Neisseria gonorrhoeae is the second most prevalent curable sexually transmitted infection worldwide. Female Sex Workers (FSWs) are at a higher risk of contracting gonorrhea due to their risky sexual behaviors like inconsistent condom use and multiple sexual partners. We determined the prevalence and risk factors associated with gonorrhea and its antimicrobial susceptibility pattern among symptomatic FSWs attending Sexual Workers Outreach Program (SWOP) city clinic in Nairobi, Kenya.MethodsUsing convenience sampling, we recruited 379 female sex workers from SWOP City clinic in Nairobi County. We administered a semi-structured questionnaire to collect data on socio-demographics and behavioral risk factors associated with gonorrhea. We also conducted three focus groups. Two endocervical swabs were collected from each participant by the attending physician for the laboratory identification of Neisseria gonorrhoeae. An antimicrobial susceptibility test was performed using the disc diffusion method.ResultsTwenty-four out of 379 (6.3%) participants tested positive for gonorrhea by PCR. The significant risk factors associated with gonorrhea were having multiple sexual partners in the previous two weeks, primary education, and being in the age group of 38–49 years (p < 0.05).From the qualitative data, sex work disclosure, and difficulty in engaging protected sex with their partner, and unprotected sex with their clients due to more money from the client, PREP, and alcohol use made the female sex workers vulnerable to gonorrhea exposure and or risky sexual behavior. The culture-positive sample result yielded complete (100%) resistance to all the antimicrobials used.ConclusionNeisseria gonorrhoeae infection is prevalent among symptomatic FSWs in Nairobi. Multiple sexual partners, being in age group 38–49 years and having primary education were the factors associated with gonorrhea among the study participants. Based on our identification of a highly resistant isolate, we strongly recommend increasing capacity for culture-based diagnosis and susceptibility testing.

Bridging the gap: online availability of gynecological care for lesbian, gay, bisexual, transgender, and questioning communities

To analyze online visibility of LGBTQ, specifically, transgender gynecologic health services on obstetrics and gynecology clinic websites and correlate visibility with geographic location. The term “Obstetrics and Gynecology Clinic [state name of interest]” was used to locate gynecologic clinics’ websites on Google Maps (GM) between May 2021 and August 2021. The first 40 GM results of the states’ North and South regions were analyzed. Data points collected included zip code, practice size, hysterectomy offered, mention of LGBTQ services, and academic affiliation. Clinics without websites were excluded. Clinic zip code was used to extract data on income, ethnic distribution, and population size from the US Census Public Data. Chi-square test of independence cross examined association between each variable and LGBTQ visibility on clinic websites. 818 Ob/Gyn clinics were found through GM search. 82 providers (10%) explicitly advertised LGBTQ care provided on their website. Cities were classified by population >250,000(n=159) and population <250,000(n=659), 20.1% vs 7.6% mentioned ability to provide LGBTQ inclusive care (p < 0.001). Clinics affiliated with an academic institution were 3 times more likely to advertise LGBTQ services than clinics not affiliated with an academic institution (9% vs 31.6%, p < 0.001). Analysis of ethnic distribution found clinics in cities with majority Caucasian vs non-Caucasian population showed no significant difference in transgender care visibility (9.3% vs 12.4%, p =0.202). Comparing median household income as greater than or less than national average, no difference was noted in advertised services for LGBTQ populations (9.8% vs 10.1%, p= 0.874). Larger clinics, defined as having 6 or more providers, were twice as likely to list LGBTQ services available than smaller clinics, 5 or less providers, (15.1% vs 6.3%, p<0.001). Clinics that specifically mention hysterectomy services were not more likely to mention LGBTQ services than those that don’t mention hysterectomy services (8.1% vs 11.6%, p=0.104). Of the five geographical regions of the US, the Southeast had a significantly lower incidence of clinics that advertised LGBTQ services when compared to the West and Northeast (p < 0.001). Online visibility of LGBTQ health services in OB/GYN are low, with less than 10% of clinics advertising LGBTQ services. Clinics in cities with a large population, associated with an academic institute, or considered a large clinic are more likely to advertise for such services. These findings demonstrate disparity in access to LGBTQ healthcare, specifically transgendered patients seeking gynecological services. Further efforts should be made to increase inclusivity in promoting LGBTQ services on Obstetrics and Gynecology clinics' websites as many patients use the internet as a tool to locate a suitable physician.

The Predictive Role of Vitamin D Deficiency in Urinary Tract Infection at Reproductive Age in Women

BACKGROUND: Urinary tract infections (UTIs) are common health infections in pregnant women with high complications. Many of the worldwide population suffer from vitamin D deficiency (VDD) due to insufficient exposure to sunlight. The relationship between VDD and UTI and giving vitamin D supplementation contributes to preventing UTI. AIM: The present study aims to find the effect of VDD and UTIs in women of reproductive age as risk factors during pregnancy. METHODS: The samples were collected from May 2020 to February 2021 from gynecology clinic outpatients and private clinics in Basrah city. A 104 sample was collected from females of reproductive age between 15 and 45 years divided into three age groups suffering recurrent UTI and VDD. RESULTS: Of 104 women who followed up with UTIs during the study period, the deficiency of vitamin D levels in women was 62.5%. The levels of deficiency were significantly higher in the age group 25-34y is 71.1%, followed by 15-24y is 63.2%, and 35-45 y is 50% with mean 24 ± 6.8 years. In addition, the results showed the vitamin D levels at an insufficient level (30.8%) higher in the age group 35-45 y is 42.9% with a mean of 10 ± 1.2. Furthermore, the results showed that the vitamin D levels at an insufficient level (30.8%) higher in the age group 35–45 years are 42.9% with a mean of 10 ± 1.2. CONCLUSION: Our current study revealed that there is a clear correlation between women who suffer from VDD and UTIs, whether severe or frequent infection at reproductive age and this affects their fertility and pregnancy. In addition, the study concluded that adolescent girls and young women are the most vulnerable to VDD and UTIs.

High visit-to-visit cholesterol variability predicts new-onset heart failure and adverse cardiovascular events: a retrospective population-based cohort study

Abstract Funding Acknowledgements Type of funding sources: None. Background Hyperlipidaemia is associated with adverse cardiovascular outcomes. However, the long-term prognostic value of visit-to-visit cholesterol variability is less certain, particularly regarding the risks of new-onset heart failure (HF). We investigated the associations between visit-to-visit cholesterol variability and adverse cardiovascular events. Methods This was a retrospective cohort study of patients attending family medicine clinics in a Chinese city during 2000-2003 with follow-up until 2019. Patients with at least three sets of blood cholesterol (low-density (LDL-C) and high-density (HDL-C) lipoprotein cholesterol, and total cholesterol) levels available at different visits were included. Patients with prior HF, myocardial infarction (MI), use of HF medications, and pregnancy were excluded. Visit-to-visit variability was calculated using standard deviation and coefficient of variation (CV). The primary outcome was new-onset HF. The secondary outcomes were cardiovascular mortality, and myocardial infarction. Multivariable Cox regression with adjustments for significant baseline predictors of outcomes were used to evaluate the association between cholesterol variability and the outcomes. Results A total of 5662 patients were included (2152 males; mean age 63.3 ± 12.4 years). The mean follow-up period was 15.3 ± 4.6 years. Lower mean HDL-C and total cholesterol predicted new-onset HF and MI, while higher mean LDL-C and total cholesterol and lower HDL-C predicted cardiovascular mortality (Table 1). Cholesterol variability was a significant predictor of the outcomes (Table 1). Higher variability of HDL-C (hazard ratio (HR) for CV: 14.202 [6.524, 30.916], p &amp;lt; 0.0001; Figure 1A) and total cholesterol (HR for CV: 10.340 [4.582, 23.336], p &amp;lt; 0.0001; Figure 1B) predicted new-onset HF. These also predicted MI (HR for CV: 40.738 [14.412, 115.150], p &amp;lt; 0.0001, and 34.285 [11.450, 102.660], p &amp;lt; 0.0001, respectively), as did higher variability of LDL-C (HR for CV: 3.798 [1.903, 7.578], p = 0.0002). Lower variability of LDL-C (HR for CV: 0.234 [0.104, 0.526], p &amp;lt; 0.0001) predicted cardiovascular mortality. This was probably driven by the association between cardiovascular mortality and higher mean LDL-C. Variability of HDL-C and total cholesterol did not predict cardiovascular mortality Conclusion Higher visit-to-visit cholesterol variability was associated with significantly increased long-term risks of new-onset HF and adverse cardiovascular events. Variability of different types of cholesterol had varying prognostic values, with HDL-C showing particular importance for new-onset HF. Visit-to-visit cholesterol variability may be a clinically relevant and important tool for HF and general cardiovascular risk stratification. Abstract Figure 1 Abstract Table 1

Analysis of the Effect of Quality, Service Price and Satisfaction on Patients and Their Impact on Visits to Exclusive Dental Clinics in South Jakarta

The low rate of repeat visits in exclusive dental clinics is an interesting problem to study. From the available data, as well as interviews with several owners of exclusive dental clinics in cities of Jakarta, Surabaya, Samarinda and Banjarmasin in Indonesia as well as from the initial observations at exclusive dental clinics in South Jakarta, we found that the rate of repeat visits for existing patients was much lower than for new patients. From previous studies, it was also found that patient visits to the dental clinic were very low. This was influenced by the low level of patient satisfaction with the dental clinic. Their article mentions that retaining existing patients who make repeat visits at health clinics is about five times more profitable than serving new patients. This study aims to determine the effect of quality, service price and patient satisfaction on patient loyalty which influences patients to make repeat visits to exclusive dental clinics in South Jakarta, Indonesia. The subjects of this study were patients who had made at least two visits to the same exclusive dental clinics in South Jakarta, as well as patients who had previously visited other exclusive dental clinics. In this study, the approach used is a quantitative approach, and the type of data used in this study uses quantitative data in the form of questionnaire tabulations and qualitative data in the form of the research object general observations. We collect primary data through respondents' answers to questionnaires and secondary data sources through information on the population of DKI Jakarta Selatan and the characteristics of the middle-upper economic community.