Seeking Medical Care Research Articles

Health inequalities of LGBT persons in Switzerland – Results from the first national LGBT health study

Abstract Background Internationally, there is evidence that lesbian, gay, bisexual and transgender persons (LGBT persons) have poorer health outcomes than the heterosexual or cisgender population. In addition, LGBT populations face more frequent and unique healthcare access barriers. Barriers to healthcare among LGBT persons in Switzerland remained undocumented until recently, when the Swiss Federal Council mandated a report describing the health and healthcare access of LGBT persons, and related health inequalities. Methods Two data sets were included in analyses: (1) two waves of the representative Swiss Health Survey (SHS 2012, 2017) n = 29,793, ages 16 to 74, including 858 LGB persons, and (2) data from a non-representative national online survey (May to July 2021), including 1,542 LGB cisgender and 522 transgender persons, ages 15 to 81. Data were analyzed using descriptive and inferential statistics (e.g. binary logistic regression), controlling for potential confounding factors (e.g. year of study, age), using the Health Equity Promotion Model as a conceptual framework. Results The most significant areas of health inequalities across the groups of interest were mental health, experienced discrimination and violence, healthcare access barriers, substance use, and sexual health. For example, LGB persons experienced significantly higher rates of depression (16.0% vs. 7.4%; p<.001) and suicide attempts (11.0% vs. 3.3%; p<.001) compared to the heterosexual population. Additionally, LGB persons abstained from seeking medical care significantly more often than heterosexual persons (16.2% vs. 6.9%, respectively) due to a lack of trust in the healthcare system. Conclusions Besides targeted action in the identified (health) areas, a Health in All Policies Approach is needed to improve the lives and health of LGBT people in Switzerland by diminishing stigmatization and discrimination, and by implementing LGBT inclusive and specific protocols in healthcare and other settings.

Perceptions, Definitions, and Therapeutic Interventions for Occasional Constipation: A Rome Working Group Consensus Document

Functional constipation is the most common of the disorders of gut-brain interaction, affecting approximately 12% of the world population. Although classically considered a chronic condition, many individuals experience shorter yet repetitive bouts of constipation representing a different clinical entity. There has been increased interest in this latter disorder, which has recently been classified as occasional constipation. This Rome Foundation working group document reflects the consensus of an international team of specialists who summarized currently available research to provide a working definition of and treatment algorithm for occasional constipation. The recommendations herein are based on current evidence, accounting for gaps in the literature as well as international variance in definitions and health seeking behaviors for constipation. The committee members reviewed the scientific literature, focusing specifically on occasional constipation, with the understanding that as a new entity, a paucity of data would be available. We used Rome IV research and clinical definitions to establish the framework for our definition of occasional constipation. Where possible, treatment recommendations were determined on the basis of the earliest extractable data from functional constipation studies, focusing on positive results within the first 2 weeks of treatment. We used the Delphi method to create consensus with 100% agreement between the authors. An evidence-based review of the literature resulted in the definition of occasional constipation as follows: "individuals who experience the presence of at least 1 functional constipation symptom, in the absence of alarm signs or symptoms, occurring at irregular and infrequent intervals, which is bothersome enough to induce a patient to seek medical management." Medical management whether seeking medical care or self-treatment was left to the individual's discretion, and we did not include time anchors because these thresholds require further investigation. Polyethylene glycol and stimulant laxatives are recommended as first-line interventions, whereas magnesium-containing compounds are suggested in individuals failing to respond to these therapies. There are insufficient data to make recommendations for using fiber or stool softeners. Prescription laxatives should be reserved for individuals with chronic constipation. Occasional constipation is a unique clinical entity characterized by infrequent but recurrent symptoms. Data are limited because consensus definitions have been lacking. Establishing a standardized definition and therapeutic recommendations provides a framework for future studies focusing on epidemiologic and symptoms-based outcomes. Further studies are needed to confirm and refine these recommendations.

Обращаемость детей в медицинские организации, как критерий медицинской активности родителей.

An important component of the lifestyle of the population is medical activity, which plays a significant role in maintaining and strengthening the health of not only the adult population, but also children. Purpose of the study: evaluation of the influence of the social characteristics of families in the Chechen Republic on the appeal of children to medical organizations. Materials and methods. The collections “The incidence of the Russian child population (0–14 years old) with a diagnosis established for the first time in life” of the Federal State Budgetary Educational Institution of Central Research Institute of Health and Human Health for 2017–2021 were analyzed. A subjective assessment of children’s referral to medical organizations was carried out on the basis of the results of a survey of 536 parents, which was carried out using the «Questionnaire of the parents of a child under the age of 7 years» in 2021 in 9 districts of the Chechen Republic. Mathematical data processing was carried out using spreadsheets of the MS Office‑2016 software package (Word, Excel) and the StatSoft-Statistica 10.0 statistical software package. Results. Primary morbidity, according to the data on the appealability of the children’s population of the Chechen Republic, is 3.7 times lower than the national average. The number of children in the family, the education of the parents and the financial situation of the family influence the number of children in the family. In families with 5 or more children, parents are less medically active in terms of seeking medical care than in families with 1–2 children and 3–4 children (p<0.05). Families where the mother or father have an incomplete secondary education compared to families where the father or mother has a complete secondary or higher education, including incomplete higher education, parents are significantly more likely to show less medical activity (p<0.01). Families where the funds for the normal material support of the child are not fully enough or not enough at all, more often do not seek medical help or seek medical help only in case of a serious illness of the child, compared with financially secure families (p <0.01). The medical activity of parents is not affected by the age of the parents, family residence in the city or countryside, whether the child is organized or not, and he is also brought up in a family where mothers work or are housewives (p> 0.05). Conclusion. One of the most significant subjective reasons for low attendance to medical organizations in the event of a child’s illness is the low medical activity of parents, which largely depends on the social characteristics of the family. Families with 5 children or more, families where one of the parents has an incomplete secondary education, and families with a low financial situation are more likely to show poor medical care. Scope of the results. Development of organizational measures aimed at improving the quality and availability of medical care in organizations of the children’s healthcare system.

Prevalence of Hemorrhoids and Their Risk Factors Among the Adult Population in Jazan, Saudi Arabia.

Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They can be either internal, external, or internoexternal, according to their position in relation to the dentate line. They can cause significant financial burdens and personal discomfort. However, the typical symptoms of hemorrhoids include bleeding, pain, skin irritation, fecal leakage, prolapse, mucus secretion, and developing a thrombosed hernia. Nonetheless, research has shown that individuals with and without hemorrhoids equally report these symptoms. This study aims to investigate the prevalence of hemorrhoids and their risk factors among adult subjects in Jazan, Saudi Arabia. This investigation was a cross-sectional study targeting adults diagnosed with hemorrhoids in the Jazan region. Data collection was performed via a self-administered questionnaire to measure sociodemographic data of the participants, lifestyle factors associated with hemorrhoids, clinical presentations of the disease, and Rome IV criteria for diagnosis of functional constipation. The chi-squared test was used to assess the frequency of hemorrhoid symptoms according to the participants' sociodemographic and lifestyle characteristics. In the current study, which recruited 361 participants, 59% (216 individuals) reported experiencing at least one symptom of hemorrhoids. The majority of the sample were females (60%), Saudis (96%), and living in urban areas (59%)and had a university education (77.3%). The most common risk factors identified were lack of regular physical activity (83%), prolonged sitting during office work (51%), and consuming food with saturated fat (50%). A total of 44% (159 participants) had a family history of hemorrhoids, and 40% reported suffering from constipation three times or more per week. Only 34% (123 participants) had been diagnosed with hemorrhoids by a physician. Interestingly, the majority of participants (57%) preferred using home remedies instead of seeking medical care from a healthcare professional. When assessing factors associated with experiencing a minimum of six hemorrhoid symptoms per month, age, lifestyle factors, family history of hemorrhoids, and defecation practices were found to be significantly correlated with a higher occurrence of symptoms (with a p-value of less than 0.05). The current study identified a high prevalence of hemorrhoid symptoms and their risk factors among the adult population in the Jazan region of Saudi Arabia. The findings suggest a need to increase the awareness of the public about hemorrhoids risk factors and the importance of seeking healthcare at an early stage of the disease.

Burn injury characteristics and outcomes among pediatric and adult patients admitted to Ministry of National Guard Health Affairs (MNGHA) hospitals in Saudi Arabia

ObjectiveThis study aims to describe the characteristics and outcomes of burn injuries in pediatric and adult patients admitted to Ministry of National Guard Health Affairs (MNGHA) hospitals in Saudi Arabia. MethodsA multicenter retrospective cohort study was conducted between 2015 and 2021 in five hospitals run by the MNGHA inSaudi Arabia. The study included 555 patients who were admitted to the hospital with burns, and data were collected from an institutional trauma registry on various aspects such as sociodemographic variables, burn clinical characteristics and burn outcomes. The differences in epidemiological data, general characteristics, and outcomes of burn patients with ≤18 and >18 years of age among Saudi hospitalized patients. The associations between patient characteristics and burn outcomes were assessed using multivariable logistic regression. ResultsMost of the participants representing 66.1% males and females 33.9%. Flame and contact were the most common causes of burn injuries, accounting for 43.6% and 43.2% of cases, respectively; followed by chemical (6.7%), then electrical (5.4%), and friction (1.1%). The study revealed that pediatric were the most frequently admitted age group for burn injuries with most cases occurring at home (57%). Pediatric patients had a higher percentage of hot fluid injuries, accounting for 77.5 % of cases (P = 0.00). Flame injuries were more prevalent in adults, accounting for 65.3% of cases (P < 0.05). The study reported that there were significant associations between age, gender, % TBSA, body region affected, and inhalation injury with admission to the ICU in patients with burn injuries. Relative to patients with third degree burns, first and second-degree burns were associated with a lower likelihood of mortality (OR 0.13, 95% CI: 0.03,0.51, p = 0.00). ConclusionThe study’s findings can be utilized to aid in the implementation of different prevention programs and allocate appropriate resources for treatment to reduce the incidence and morbidity of burn injuries. It is essential to continue educating the public on fire safety in the home environment. This can help raise awareness, promote household safety precautions, and encourage early medical care seeking.

HEALTH CARE SEEKING AND INFERTILITY-A CROSS SECTIONAL COMPARATIVE STUDY AMONGST FEMALES OF DYAL VILLAGE LAHORE

Background: Female infertility ends up in long term health implications especially in Pakistan where combined family system and social set-up pressurizes the newly married couple for child bearing. But proper diagnosis and effective management is only possible through health care seeking.&#x0D; Objective: To assess the actual magnitude of different types of infertility and its associated health care seeking amongst females of Dyal Village Lahore. Methodology: This cross sectional comparative study was conducted in rural female population of Dyal Village Lahore. The sample size was118 and data collection was done through Simple Random Sampling. Data was gathered using Personal Self-Concept Questionnaire containing information related to socio demographic, economic, female medical, family , gynecological and Health Care seeking history. Results: Out of 118 only 42 (35.59%) had Primary infertility. only 24.58% had Menorrhagia, 40.68% had Oligomenorrhea and 22.88% experienced Dysmenorrhea. Only 7% reported male factor. Majority females had ovulatory problems 38.3 % and 11.8 % with tubal blockage 9.7 % reported uterine problems. Only 68(57.63%) visited hospitals, 67 (56.78%) seeked medical treatment and 48(40.68) had both medical and surgical interventions. Surprisingly 29(24.58%) had received Instrumentation and medication by Dai and 10 (8.47) had medication following relatives advice. Study has also shown a significant relation with higher educational and economical status. Conclusion: The higher Primary infertility levels and trends of seeking health care services other than professional experts especially from Dai is alarming. Future research study can be focused for determining the predictors of such health care services for infertility. Key Words: Infertility, Primary Infertility, Secondary infertility and Health Care Seeking,

Recurrent urethral obstruction secondary to large vulval inclusion cyst: a remote complication of female genital mutilation: a case report

BackgroundFemale genital mutilation/cutting (FGM/C) is a major public health problem, particularly in developing countries.Case presentationThe authors reported a case of 48-year old multiparous woman presented to Kassala Hospital, east Sudan, with recurrent urine retention resulting from urethral obstruction, which was caused by large vulval inclusion cyst. A traditional birth attendant circumcised her when she was 5 year old. Five years before her presentation the patient observed a painless swelling in her vulva, which was gradually increasing in size. She presented to the hospital with urine retention seeking medical care. Local examination showed a large cystic swelling originating in the circumcision line and covering the introitus. A diagnosis of inclusion cyst at the site of circumcision was made. The cyst was large enough causing bladder outlet obstruction and when the patient advised to tilt it away from the urethral orifice she passed urine without difficulties. The cyst was surgically removed by dissection along the lines of cleavage, which measured 10 × 9.2 cm and weighed 1.2 kg.ConclusionThis case report indicates that FGM is a serious public health problem and there should an urgent intervention such as planned health education campaigns to end FGM practice.

PERSONAL ANXIETY AS A CAUSE OF CVD AMONG YOUNG POPULATION

Introduction: The past decade has seen an increased research interest in anxiety disorders, in large part due to greater recognition of their burden and consequences associated with an untreated disease. Untreated anxiety is associated with significant personal and societal costs associated with frequent visits to primary and emergency care, reduced work productivity, unemployment, and deteriorating social relationships. Purpose: to study the relationship between personal anxiety (PT) and self-determination of health among young people Materials and methods: a study was conducted in 2013-2016. sampling of the population of Novosibirsk. A total of 975 persons were examined, of which 43.7% were men. A test was used to determine LT in the modification of Yu.L. Khanin. Results: 57% of men with a high level of anxiety (HUT) considered themselves not quite healthy, while with a low level of anxiety (LAT) 27%. Among females experiencing excessive anxiety, in 65% of cases they assumed poor health, while women who feel safe are 2 times less. Over-anxious young people were 2 times more likely to express complaints related to health. Moreover, excessive anxiety prevented them from taking full care of maintaining their health, both young men and women believed. Expressed anxiety also manifested itself in obsessive thoughts in the near future to get a serious illness, which was more pronounced in women. Young men were more distrustful in communicating with medical specialists and believed that they could trust only after rigorous checks. Only 14% of men who were excessively anxious felt confidence in self-checking their health, assuming that they could completely rely only on their feelings of health or ill health. However, VUT did not prevent positive emotions from interacting with medical staff, according to the men's responses. Conclusion: personal anxiety contributes to low self-esteem of the state of one's own health. On the other hand, anxiety may be associated with a delay, irregular or inconsistent seeking of medical care.

НЕ ИШЕМИЧЕСКИЕ ФЕНОТИПЫ ПАЦИЕНТОВ С ОСТРОЙ БОЛЬЮ В ГРУДИ ПО ДАННЫМ СТРЕСС-ЭХОКАРДИОГРАФИИ С ФИЗИЧЕСКОЙ НАГРУЗКОЙ

INTRODUCTION Acute chest pain is one of the most common caus­es for emergency medical care seeking. In some cases, it is considered as a manifestation of acute coronary syndrome (ACS). However, in patients with normal cardiac troponin (cTn) levels and a normal or non­diagnostic electrocardiogram (ECG) (non-ST eleva­tion ACS (NSTE-ACS) low-risk patients), the inci­dence of stenotic coronary atherosclerosis is not high. Stress echocardiography in this category of patients is indicated for ischemia visualization. Analysis of heart rhythm, ECG changes, systemic and intra­cardiac hemodynamics, in addition to assessing lo­cal contractility, allows us to identify other patholog­ical responses to stress. It is already known that their comprehensive assessment has predictive potential for long-term adverse events in patients with chron­ic coronary syndrome. THE AIM To identify non-ischemic phenotypes in low-risk patients with non-ST elevation acute coronary syn­drome. MATERIAL AND METHODS A single-center, prospective, continuous study included 70 patients aged 54 (45; 63) years (60% men) hospitalized in the department of the region­al vascular center in 2022—2023 with acute chest pain, normal or non-diagnostic ECG, normal cTn level, low (&lt; 3 %) GRACE risk and no restrictions for exercise stress echocardiography. The patients had not previously verified coronary heart disease (which was an inclusion criterion) and had no wall motion abnormality at rest. Stress echocardiography on a horizontal bicycle ergometer was performed in the first 2 (0; 3) days of the hospital period. The tests were carried out in the absence of rhythm­slowing therapy. The results of tests completed ear­ly for subjective reasons (muscle fatigue, failure) were not included in further analysis. To determine patient phenotypes based on stress echocardiogra­phy data, pathological responses to stress in the form of dichotomous variables were used to perform clus­ter analysis. The final group consisted of 50 of a non­ischemic phenotype — those who did not belong to the cluster, which was characterized by the high­est frequencies of wall motion abnormality, ST seg­ment depression &gt; 1 mm, and angina. To determine the potential significance of the identified pheno­types, the cardiac performance reserve (P/m) was ad­ditionally determined as the difference in P/m val­ues, calculated using the formula 0,222 - CO - APBmean LVM where CO — cardiac output; APBmean — mean arterial blood pressure; LVM — left ventricular mass), at peak load and at rest. RESULTS Four patient phenotypes were identified that dif­fered statistically significantly (p &lt; 0.05) in terms of exercise tolerance, volumetric contractile reserve and heart rate reserve. Type 1 (n = 17) was character­ized by a high frequency of combined decreases in all 3 indicators; type 2 (n = 11) — by the decreased ex­ercise tolerance and heart rate reserve, normal con­tractile reserve; type 3 (n = 11) — by normal exercise tolerance and heart rate reserve, but decreased con­tractile reserve; type 4 (n = 11) — by normal exer­cise tolerance, contractile reserve and heart rate re­serve. The decrease in contractile reserve (types 1 and 3) was consistent with a statistically significant lower increase in left ventricular ejection fraction at peak exercise (5 (2; 7) vs. 12 (8; 13), respective­ly; p &lt; 0.001) and P/m reserve (1.0 (0.6; 1.4) versus 1.3 (1.1; 1.6), respectively; p = 0.010). Patients with decreased contractile reserve were statistically signif­ icantly older (60 (48; 68) vs. 47 (43; 54) years, re­spectively; p = 0.003). Type 4 included predominant­ly men (91 %). For type 2, no statistically significant differences in the clinical and demographic data of pa­tients were identified. CONCLUSION In the structure of patients with low-risk pa­tients with NSTE-ACS, the phenotypes are identi­fied that are determined by a decrease in exercise tol­erance, contractile deficiency and chronotropic re­serve. Phenotypes are characterized by different levels of P/m reserve and may differ in the frequency of ad­verse events in the long-term period, and a decrease in contractile and heart rate reserve can be considered as potential targets for personalized therapy, however, in the diagnostic algorithm for ACS this remains a top­ic for further research.

Barriers to Seeking Medical Care Among Youth Victims of Sexual Violence

PurposeYouth victims of sexual violence often experience physical health problems but are unlikely to receive medical care. However, victims' reasons for not accessing medical care have been understudied. We examined barriers to seeking medical care among youth victims who contacted the National Sexual Assault Online Hotline. MethodsWe used archival data about one-on-one chat sessions with youth victims between June 2018 and February 2020. Hotline staff described victims' reasons for not accessing medical care via an online assessment. We coded and qualitatively examined these reasons using data about 520 victims with physical health concerns who had not received medical care. ResultsVictims' barriers were rooted in individual beliefs and contextual realities reflected in three categories: (1) perception that medical care was not needed, (2) anticipated consequences of seeking medical care, and (3) inability to physically access medical care. Victims who perceived care as unnecessary did not understand the health implications of abuse or minimized their need for care. Anticipated consequences included privacy and control over disclosure, stigmatization, retaliation from the perpetrator, family disruptions, and retraumatizing medical treatment. Victims unable to physically access care were uncertain how to access care independently, lacked social support, or were prevented from care by the perpetrator. DiscussionMedical treatment can ameliorate acute health concerns and increase safety, but youth victims perceived numerous barriers to care. Several barriers implied unintended consequences of child maltreatment policies, including mandatory reporting. Trauma-informed policy and practice are critical for improving victims' access to medical care and other support services.

Self-Reported Injuries in Indoor Gym-Based Rock Climbers: A Retrospective Study of Predictors of Prolonged Injury and Seeking Medical Care.

Indoor climbing injuries are often related to overuse, and climbers choose between self-management and seeing a medical practitioner. This study evaluated predictors of prolonged injury and seeking medical care for indoor climbing injuries. A convenience sample of adult climbers from 5 gyms in New York City was interviewed about injuries over the past 3 y, because of which they stopped climbing for at least a week or saw a medical practitioner. In total, 122 of 284 (43%) participants had at least 1 injury, for a total of 158 injuries. Fifty (32%) were prolonged, lasting at least 12 wk. Predictors of prolonged injury included older age (odds ratio [OR], 2.28, per 10-y increase; 95% CI, 1.31-3.96), hours per week spent climbing (OR, 1.14, per 1-h increase; 95% CI, 1.06-1.24), climbing difficulty (OR, 2.19, per difficulty group increase; 95% CI, 1.31-3.66), and years of climbing experience (OR, 3.99, per 5-y increase; 95% CI, 1.61-9.84). Only 38% of injuries were seen by a medical practitioner. Predictors of seeking care included prolonged injury (OR, 3.04; 95% CI, 1.39-6.64) and rope climbing preference (OR, 1.98; 95% CI, 1.02-3.82). The most common theme for seeking care was serious pain or interference with climbing or daily activities. Despite prolonged injuries being common, especially in older, more experienced, and higher-level climbers, only a third of climbers with injuries seek medical care. Outside of injuries causing minimal pain or limitation, those who self-managed reported receiving advice from other climbers or online research as a prominent reason for that choice.

Current practice and recommendations for managing transgender patient data in clinical laboratories in the United Kingdom and Republic of Ireland.

Transgender people may avoid seeking medical care due to previous negative experiences and fear of discrimination. Clinical laboratories can contribute to a poor patient experience and clinical outcome when the design and functionality of laboratory information management systems (LIMS) do not consider the needs of transgender patients. This survey aimed to capture current practices in United Kingdom and Republic of Ireland clinical laboratories concerning how transgender patient data and test requests are managed throughout the total testing process. An anonymous survey was distributed to clinical laboratory professionals in November 2021. Thirty-three questions covered how gender variables are recorded for transgender patients and used to inform gender-specific calculations, test access, and reference intervals (RIs). Of the 66 respondents, 70% were based in laboratories in England, with a majority of laboratories having ISO 15189 accreditation and processing 1000-10,000 blood samples daily. Eighty-five percent stated that their LIMS had a single field recording sex or gender information. Forty-three percent did not limit test access based on gender, but 68% did not append RIs for patients with unknown or indeterminate gender. This survey was the first to quantify how clinical laboratories manage sex and gender information and report results for transgender and non-binary patients, and details several key recommendations based on the survey responses.

Assessment of Cancer Patients' Relatives' Knowledge, Perception, and Attitude Toward Cancer.

Background Assessment of cancer patients' relatives' knowledge, perception, and attitude regarding cancer. To spread awareness aboutoral cancer in areas with a high prevalence of cancer, aid in its prevention, and accelerate the treatment to facilitate early-stage disease elimination and improve prognosis. Material and methods A cross-sectional study conducted at a hospital was done, where 23 questions were posed to the relatives of the patients admitted to the hospital. The questions were formulated to assess the knowledge of relatives regarding cancer, their perception, and their attitude toward the decision-making and treatment protocols. The questions also included information about the patient's habits andassociated problems with it. A total of 400 relatives participated in the study, where all participants were adequately informed beforehand, and their written consent was taken before proceeding with the questions. All the questions were formulated in the native language that they could easily understand. Result The study found that participants had limited knowledge about the causes, treatment, prevention, and recurrence of oral cancer. Additionally, the family members were unsupportive of therapy anddelayed seeking medical care. Conclusion It is crucial to raise awareness about oral cancer and inform individuals about available treatments, government programs, and counseling services to aid them in decision-making.

Factors affecting patient and public perceptions of the adoption of electronic health record sharing: A Hong Kong study

Background and ObjectivesThe disclosure of personal health information in electronic health records (eHR) highlights privacy and security concerns that are complicated by the digitization and interoperability of health records. Hong Kong’s Electronic Health Record Sharing System (eHRSS), introduced in March 2016, enables eHR sharing among public and private health services upon the consent of patients. Based on a September 2021 survey, this study examined the specific context of Hong Kong, patient and public perceptions on the security and privacy of eHR sharing, correlation of trust with personal privacy and security concerns, and how perceptions affect health care-related decisions. MethodsUsing a random sample of householders aged 45–70 years, the study conducted a questionnaire survey on respondents’ awareness, perceived benefits, and obstacles to participating in the eHRSS, and the impact of their perceptions on health care-related decisions. A focus group discussion with 13 participants further explored views on the security of Hong Kong’s eHRSS and their readiness to support the system. ResultsThe study analyzed data from 400 responses. The findings showed a low degree of awareness of the eHRSS. Privacy and security concerns were impeding factors in the sharing of information; half of the respondents reported being concerned over their personal health information being part of the eHRSS. The majority (86.9%) expressed conditional support for the sharing of information. Despite their concerns on security and privacy, 66.5% and 77.9%, respectively, would not withhold information nor postpone the seeking of medical care based on those concerns. Participants in the focus group expressed concerns regarding eHRSS registration, data leaks, information accuracy, and the potential prejudice that may result in discrimination and inequality in health care provision. ConclusionsSatisfaction with the health care services played a role in the trust reposed in the Hospital Authority and health care providers and institutions. Security and privacy were decisive factors in respodents’ refusal to seek care from physicians who had violated their privacy. Respondents expressed greater interest in sharing their information if measures were in place for anonymization and punishing data misuse. Ensuring rights of control toward information sharing would inspire greater confidence among patients.

Female patients delay seeking medical care with alcohol-associated acute pancreatitis

Background/Objective: Alcohol consumption is increasing in women, who more frequently report abdominal symptoms compared to men. We aimed to examine differences in presentation of acute pancreatitis [AP] in male and female patients hospitalized with alcohol-associated AP. MethodsWe analyzed 138 patients enrolled in an ongoing case-crossover study of alcohol-associated AP conducted across 5 medical centers in the U.S. Patients meeting the Revised Atlanta Classification of AP and who scored 3 or higher on the AUDIT-C instrument were invited to participate in the study and were interviewed while hospitalized with AP. Sex differences in the timing and type of pancreas-associated pain, alcohol consumption, clinical presentation, and quality of life were examined by Chi-squared tests, Wilcoxon rank sum tests and t-tests. ResultsFemale patients reported significantly longer interval from onset of pain to deciding to seek medical attention (median 40 h, interquartile range [IQR] 14, 74) as compared to males (14 h, IQR 4, 50; p = 0.005). While male patients were more likely to have been admitted to the intensive care unit [ICU] (21%) as compared to female patients (7%; p = 0.04), the incidence of SIRS or severe AP did not differ by sex. Quality of life measures as reported through the PROMIS-29 instrument were equally suboptimal in both sexes. Anxiety disorders were diagnosed more frequently among females (61%) than in males (41%, p = 0.009). ConclusionIn a large case series of alcohol-associated AP, we found that female patients delayed seeking medical care compared to males. However, there were no differences in the type, location and intensity of abdominal pain.

Impact of the COVID-19 Pandemic on the Severity and Early Postoperative Outcomes of Acute Appendicitis.

Background The coronavirus disease 2019 (COVID-19) pandemic caused changes in surgical practice. For acute appendicitis (AA), measures to control the pandemic might hinder patients from seeking medical care timely, resulting in increasing severity, postoperative complications, and mortality. This study aimed to investigate whether the COVID-19 pandemic had a negative impact on the severity and postoperative outcomes of patients with AA. Methodology We retrospectively reviewed medical records of AA patients treated operatively at Nhan Dan Gia Dinh Hospital hospital from June 1st to September 30th in three consecutive years: pre-pandemic (2019)/Group 1,minor waves (2020)/Group 2, and major wave (2021)/Group 3 (2021). Data were collected focusing on the duration of symptoms, severity of AA, time from admission to operation,postoperative complications, and mortality. Results There were 1,055 patients, including 452 patients in Group 1, 409 in Group 2, and 194 in Group 3. The overall number of patients decreased mainly in non-complicated AA. The percentages of hospital admission after 24 hours gradually increased (20.8%, 27.9%, and 43.8%, p < 0.05). The percentages of complicated AA in Group 2 and Group 3 were statistically higher than in Group 1 (39% and 55% vs. 31%, p < 0.05). Waiting time for operation increased to five hours during the major wave. Laparoscopic appendectomy was performed in 98-99% of AA patients during the pandemic, with an early postoperative complication rate of 5-9% and a mortality rate of 0.2-1%. Conclusions Although the percentages of hospital admission after 24 hours and complicated AA increased, laparoscopic appendectomy was still feasible and effective and should be maintained as the standard management for AA during the COVID-19 pandemic.

Prevalence of Voice Disorders in the United States: A National Survey.

The prevalence of voice disorders has not been explored in the context of recent trends in voice use, including voice assistant technology and increased use of teleconferencing for remote work. The objective of this research is (1) to determine the prevalence of voice disorders in the adult population of the United States, and (2) to understand the association of voice disorders with demographic and voice use factors, including vocal demands, and use of teleconferencing and voice assistant technology. A survey pertaining to voice disorders and voice use was developed and administered to a representative sample of US population. Demographics and information related to risk factors for voice disturbance, including high vocal demands, teleconferencing, and voice-assistant use were also analyzed. A total of 1522 responses were included. Of these, 20.6% reported having had a voice disorder at some point in their life. This rate was higher in employed respondents, singers, and teachers (all p < 0.0001) and was notably higher in those who used teleconferencing technology and voice assistant technology (both p < 0.0001). Approximately 60% of this subset reported seeking medical care for their voice, 12.6% reported a current voice disorder, and 9.5% reported a voice problem that had recurred multiple times. Approximately 1 in 5 Americans surveyed has had a voice disorder. Risk factors for voice disorders include use of teleconferencing technology, voice assistant use, and occupational factors. 3 Laryngoscope, 134:347-352, 2024.

Doctors' experiences when treating doctor-patients: a scoping review.

To work effectively, doctors need to look after themselves. They often delay seeking medical care for a range of reasons. Once they do, there is evidence that the doctors treating them ('treating doctors') can struggle to provide optimal care. To examine existing literature on what is currently known about experiences for treating doctors, in particular GPs, when their patient is also a doctor. A scoping review of articles written in English. Using the JBI methodological framework for scoping reviews, five databases (MEDLINE, PsycINFO, CINAHL [Cumulative Index to Nursing & Allied Health], Google Scholar, and Scopus) were searched from the database start date until 31 December 2022. Qualitative and quantitative studies reporting the treating doctor's experience, guidelines for treating doctors, expert opinion articles, and editorials were included. Grey literature was considered, searching the first 10 pages of two Google searches. Forty-eight articles from eight countries met inclusion criteria, of which 12 were research studies. The main areas of focus were as follows: affective responses, which included anxiety about being criticised, concern about upsetting the doctor-patient, and discomfort regarding the acknowledgement that doctors get sick; relational factors, which included boundary issues, over-identifying with the doctor-patient, treating them as a colleague rather than a patient, and role ambiguity; confidentiality, which incorporated both affective and relational aspects; and influence of medical culture and socialisation on dynamics between treating doctor and doctor-patient. These findings have been distilled into a list of key suggestions for the treating doctor. Doctors can find treating doctor-patients anxiety-provoking and challenging. The sources of this discomfort are multifaceted, and more empirical research is needed to better understand and address the complex relationship between treating doctor and doctor-patient.

Epilepsi ve Aile Hekimliği

Family physicians are specialist physicians trained in line with the principles of the discipline. Essentially, they are personal physicians responsible for providing comprehensive and ongoing service to every individual seeking medical care, regardless of age, gender, or condition. Being able to manage the first contact with patients by dealing with unselected problems, deal with all health conditions, provide coordinated service with other staff and other specialists in primary care, provide effective and appropriate healthcare delivery and use of healthcare services, make appropriate services within the healthcare system accessible to the patient, advocate for the patient includes the ability to be Family physicians are also the first point of contact for patients with epilepsy. In addition, being in contact with the people registered to them when they are healthy or their illness is stable, being easily accessible, having the chance to see the patients in their own environment/home are advantages that family physicians can use in the care of patients with epilepsy. Therefore, family physicians should be able to recognize and manage a patient with epilepsy and deal with all health problems.

Psychological status and coping measures of individuals living with chronic obstructive pulmonary diseases

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and imparts substantial economic burden on individuals and health systems. Anxiety and depression were almost three times more common in COPD patients compared to the participants from the general population. Objectives: To assess the psychological status and coping measures of individuals living with chronic obstructive pulmonary diseases. Methods: Analytical cross-sectional research was conducted in medical outpatient department of Kathmandu Medical College Teaching Hospital from 2019 Nov 20 to 2020 May 20 after institutional ethical clearance. Total 185 individuals diagnosed with chronic obstructive pulmonary disease seeking medical care were included in the study by using purposive sampling. Data collection was done through face-to-face interview technique using Hopkins Symptoms Checklist-10 and Brief Cope inventory. The collected data were analysed using SPSS software version 20. Results: Based on a cut-off value of ?1.85 of Hopkins symptoms checklist-10, almost all (180, 97.3%) patients had mental distress. Frequently used approach coping subscales by the patients were emotional support (82, 44.2%), religion (81, 42%), planning (80, 41.8%), and active coping (80, 41.7%). Similarly, mostly used avoidance coping were: denial (80, 41.8%), venting (79, 41.1%), and self-blame (78, 40.6%). Conclusion: Almost all patients living with chronic obstructive pulmonary diseases had predicted mental distress and they were using both approach and avoidance coping measures.