Telephone Interviews Research Articles

Barriers to Cardiac Rehabilitation Enrollment and Secondary Prevention Adherence in Patients with Coronary Heart Disease Following Percutaneous Coronary Intervention: A Cross-sectional Survey.

This study aimed to evaluate adherence to secondary prevention measures and to identify barriers to cardiac rehabilitation enrolment among patients with coronary heart disease after percutaneous coronary intervention. An observational cross-sectional survey was conducted through computer-assisted telephone interviews to assess recently treated percutaneous coronary intervention patients at the Prince Sultan Cardiac Center in Saudi Arabia. Out of 104 surveyed patients with coronary heart disease, 85 (82%) were male, with an average age of 59.5 years. The obesity rate was 28% (n = 29), with a high prevalence of comorbidities: 82 (79%), 63 (61%), and 62 (60%) patients had hyperlipidemia, diabetes, and hypertension, respectively. Despite high medication compliance (97%), adherence to secondary prevention measures was low (21%). Adherence to physical exercise and weight monitoring for fluid body build-up was notably poor at 35% and 9%, respectively. Only 11 (10.6%) patients were referred for cardiac rehabilitation, of whom only four (36.4%) attended. Significant barriers such as a lack of staff contact, insufficient physician support, and distance to cardiac rehabilitation facilities were particularly noted by 69% of rural patients. This study underscores the significant cardiac risk factors and low adherence to secondary prevention measures among post revascularization patients with coronary heart disease in Saudi Arabia. Low referral and other organizational barriers, as well as the travel distance to hospital-based cardiac rehabilitation, hinder program enrolment. To improve cardiac rehabilitation accessibility, it is crucial to revise the discharge plans, implement automated referral systems, expand the services across all regions, and utilize alternative delivery models.

Autoimmune and infectious encephalitis: development of a discriminative tool for early diagnosis and initiation of therapy.

Encephalitis originates from diverse autoimmune and infectious etiologies. Diagnostic challenges arise due to the spectrum of presentation and the frequent absence of specific biomarkers. This study aimed to comprehensively characterize and differentiate autoimmune encephalitis (AE) from infectious encephalitis (IE) in adults, and disentangle clinical, paraclinical, and therapeutic differences. A cohort study spanning 10years was conducted across three Austrian tertiary care hospitals. Inclusion criteria comprised adults with probable or definite encephalitis. Demographics, clinical features, technical findings, treatment modalities, and outcomes were collected from the electronic patient files. A follow-up was performed via telephone interviews and clinical visits. Of 149 patients, 17% had AE, 73% IE, and 10% encephalitis of unknown etiology. Significant differences between AE and IE included the prevalence of acute symptomatic seizures (AE: 85% vs. IE: 20%, p < 0.001), fever (8% vs. 72%, p < 0.001), headache (15% vs. 61%, p < 0.001), and focal neurological deficits (56% vs. 23%, p = 0.004), respectively. Paraclinical differences comprised lower CSF pleocytosis in AE compared to IE (median 6 cells/µl vs. 125 cells/µl, p < 0.001). Epileptic discharges on EEG and MRI lesions were more prevalent in AE than IE (50% vs. 14%, p < 0.001; 50% vs. 28%, p = 0.037). The modified Rankin Scale scores at discharge and last follow-up (median duration 2304days, IQR 1433-3274) indicated favorable outcomes in both groups. This comprehensive analysis provides insights into the epidemiology, clinical, paraclinical, and therapeutic aspects and the outcomes of AE and IE in adults. We developed a diagnostic tool that facilitates early differentiation between AE and IE, aiding in timely therapeutic decision-making.

Applicability of a digital health application for cancer patients: a qualitative non-participation analysis

BackgroundThe use of digital health applications (German acronym DiGA) for comprehensive patient care is increasing rapidly. Patients with non-organic insomnia can be prescribed an application to manage insomnia. Due to the high prevalence of insomnia in patients with cancer, we were interested in the effect of it and what barriers need to be overcome for its use. The focus of existing studies on acceptance and benefits prompted us to emphasise the analysis of barriers and thus to formulate possible solutions.MethodsTo analyse the barriers of use, the study population (patients with self-reported tiredness or sleep disturbance via validated instruments and cancer disease) was divided into 3 groups. In groups 1 (patients who refused to participate in advance) and 2 (patients who refused a prescription), short close-ended questionnaires were used for non-response assessment by treating oncologists. Problem-centred guidelines were used for the telephone interviews with group 3 (patients who did not provide information on DiGA use). Alternatively, group 3 was invited to complete and return the close-ended questionnaire. A quantitative analysis of the non-response reasons was conducted using SPSS in groups 1 and 2, while MAXQDA was used for the qualitative data in group 3.ResultsPatients refused to participate at several stages of our study. Quantitative data are available for groups 1 and 2. In the largest group 1, 62% of patients refused to participate due to non-subjective sleep disturbance (177 out of 189 patients) during recruitment by treating oncologists, despite high scores on the screening tool. In the small group 2 (11 out of 15), the most common reasons for withdrawal documented by the oncologists were loss of interest and deteriorating health. The problem-centred qualitative interviews with group 3 (17 patients) revealed that some of them used the prescribed DiGA, despite not being included in the main study and being categorized as lost to follow-up.ConclusionAnalysis of barriers to DiGA use showed that reducing administrative barriers and providing digital and personal support can increase acceptance of the use of DiGAs among cancer patients. Additionally, screening tools can act as a door opener to further communication regarding DiGAs.Trial registrationGerman Register of Clinical Trials DRKS00034198, registration date: 7/05/24 (retrospectively registered).

Home and workforce reintegration one year after thrombectomy in acute stroke patients.

Endovascular thrombectomy (EVT) combined with intravenous thrombolysis is the current standard treatment for acute large-vessel occlusion stroke. Beyond clear clinical benefits in the acute and post-acute phases, comprehensive evaluations of long-term outcomes, including home and workforce reintegration, remain limited. This study aimed to assess home and workforce reintegration 1 year post-EVT in a cohort of acute stroke patients and explore their association with health-related quality of life (HRQoL). We conducted a prospective observational study of 404 patients undergoing EVT at a tertiary university medical center between October 2019 and December 2021. Patients' functional outcomes were evaluated using the modified Rankin Scale (mRS), and HRQoL was assessed via the European Quality of Life Five Dimension Scale (EQ-5D). Data on occupational and living status were collected through standardized telephone interviews at 3- and 12-months post-treatment. Of 357 patients with 12-month follow-up data, 33.6% had a favorable outcome (mRS 0-2). Among stroke survivors, the rate of home reintegration without nursing care was 42.1%, and workforce reintegration among previously employed patients was 43.3% at 12 months. Both outcomes were significantly associated with improved HRQoL. Lower neurological deficits and younger age were predictive of successful home and workforce reintegration. One year post-EVT, approximately 40%-50% of acute stroke patients successfully reintegrate into home and work settings. These findings underscore the need for ongoing support tailored to improving long-term reintegration and quality of life for stroke survivors. The data supporting the findings of the study are available from the corresponding author upon reasonable request and in accordance to European data privacy obligations.

Inquérito telefónico sobre a utilização de medicina herbal em Portugal e aferição da validade científica dos usos reportados

Introduction: Portugal has a long tradition of plants and herbal preparations for medicinal purposes (herbal medicines - HMs), but few studies on their use today. The professions of phytotherapy have recently been regulated, enabling more efficacy and safety. Objectives: 1) assess the use of HMs in Portugal, including attitudes, behaviors, sources of information, acquisition methods and role of HMs in health management, and identify the most used plants and targeted conditions. 2) evaluate them according to scientific evidence. Material and methods: a structured telephone interview. Scientific validity was assessed using the monographs of European Medicines Agency (EMA) and systematic reviews. Results: in this sample of 272 individuals, HMs are considered mainly for prevention or minor health problems. Family knowledge is the main information source and supermarkets/herb shops the main places of purchase, infusions being the preferred form. Two cases of mild adverse effects were reported. Most targeted conditions are flu, cold, cough, digestive discomfort and insomnia. The most used plants are: eucalyptus, elderberry, thyme, lemon, peppermint, echinacea, lemon balm, chamomile, valerian and passionflower. Conclusions: HM is mainly used for mild pathologies and chronic conditions. Its uses are mostly supported by scientific evidence. More attention to HMs from the medical community is important, in collaboration with phytotherapy and naturopathy professionals.

Latine Immigrant Perspectives on Trust of Clinical Research.

Introduction: Medical mistrust impedes minority group participation in research, but there are few studies assessing determinants of Latine immigrants' trust in the clinical research enterprise. This qualitative study explored Latine immigrants' perspectives of clinical research. Methods: We conducted telephonic interviews with 20 Latine immigrants receiving care at a Federally Qualified Health Center in Los Angeles, California. Interviews were conducted between December 2021 and April 2022, and resultant data were coded using thematic analysis. Results: Six main themes emerged across two domains. First, trust was influenced by perceptions of the investigators' intentions. These perceptions were primarily based on (1) adequacy of information provided about the research, (2) perceived intent of investigators to respect their humanity, and (3) opportunities to share personal experiences. Second, trust was influenced by perceptions of the study's potential impact, including (4) risk of adverse outcomes, including health risks and risk of immigration status exposure, (5) perceived personal benefits, and (6) perceived community-level benefits. Conclusion: Researchers can build trust and promote participation among Latine immigrants by effectively communicating study objectives, risk mitigation efforts, and personal and community benefits. Enhancing the trustworthiness of clinical research can increase the relevance of scientific findings, representing one pathway to achieving health equity.

Patterns of complementary feeding introduction and associated factors in a cohort of Brazilian infants

BackgroundUnderstanding the timing of food introduction in infants is essential for promoting optimal complementary feeding practices. However, existing studies often rely on cross-sectional data, limiting the ability to capture age-specific patterns. We aimed to describe food introduction during the first year of life by identifying patterns related to age at food introduction and associated factors in a cohort of Brazilian infants.MethodsData were collected through standardized questionnaires administered to mothers via face-to-face interviews during the infant’s first month of life and at 3, 6, 9, and 12 months of age. Additionally, two telephone interviews were conducted at 2 and 4 months of age. Information regarding food intake was assessed using a list of 48 foods, with two key aspects recorded: whether the food was introduced (yes/no) and the age at introduction. To define food introduction patterns, we employed k-means cluster analysis. Hierarchical Poisson multiple regression was employed to examine the associations between sociodemographic, biological, and healthcare factors and patterns of food introduction.ResultsThree distinct patterns were identified and named according to their main characteristics: Pattern 1 – “Low Infant Formula and Timely CF Introduction”; Pattern 2 – “High Infant Formula and Early CF Introduction”; and Pattern 3 – “High Infant Formula and Later Ultra-processed Food Introduction”. Breastfeeding at six months showed a positive association with Pattern 1 (PR = 1.40; 95% CI = 1.10–1.80), while bottle use at four months was negatively associated with Pattern 1 (PR = 0.68; 95% CI = 0.53–0.87). No variables studied exhibited an association with Pattern 2. For Pattern 3, higher prevalences were observed among children whose mothers were aged < 20 years (PR = 1.54; 95% CI = 1.13–2.01) or > 34 years (PR = 1.42; 95% CI = 1.04–1.93). Not receiving guidance on the recommended duration of breastfeeding and complementary feeding during prenatal care was associated with a higher prevalence of children in this pattern (PR = 1.35; 95% CI = 1.01–1.80).ConclusionsWe identified three distinct patterns of age at food introduction in the study population, although none perfectly aligned with Brazilian or WHO dietary recommendations. These findings underscore the need for targeted interventions to promote timely and healthy complementary feeding practices in Brazilian infants.

Prognosis of Nonconcurrent Bilateral Achilles Tendon Rupture Is Worse Than Unilateral Achilles Tendon Rupture: Patient-Reported Outcomes at Minimum 2-Year Follow-up.

Approximately 5%-7% of patients who have had Achilles tendon rupture (ATR) suffer from contralateral ATR. However, no studies have evaluated the clinical outcomes of contralateral ATR in patients with an existing ATR. Therefore, in this study, we aimed to investigate patient-reported ankle function and activity levels in patients with nonconcurrent bilateral ATR. We retrospectively reviewed the data of 222 patients with an acute ATR who presented at our 2 institutions between 2005 and 2017. All patients had a minimum 2-year follow-up period, with no other major injuries to the ankle joint. Of these patients, 17 patients had nonconcurrent bilateral ATR. Patient-reported outcomes were assessed by telephone interview, using the Achilles tendon Total Rupture Score (ATRS), the ankle activity score, and a patient satisfaction questionnaire. Telephonic interviews were conducted by 2 authors, using a prepared script to minimize bias owing to individual interviewers. The mean age of the patients was 45.1 ± 9.8 years, and 89% were men. Patients with nonconcurrent bilateral ATR had significantly lower values in terms of ATRS, ankle activity score, and satisfaction with current activity level, compared to patients who had unilateral ATR (p < 0.001, p = 0.027, and p = 0.012, respectively). Patients with nonconcurrent bilateral ATR had poorer ankle function, activity levels, and satisfaction than those with unilateral ATR in terms of patient-reported outcome measures with an intermediate-term result and a 2-year minimum follow-up period. These results emphasize the importance of the impact of contralateral injury on the prognosis of patients with ATR and the need for efforts to prevent contralateral rupture.

A review of Peyronie's disease insurance coverage.

Peyronie's disease (PD) is a fibroproliferative disorder that causes an abnormal curve of the penis resulting in pain, discomfort, and erectile dysfunction with management options including correctional surgery, penile external/internal devices, shock wave therapy (SWT), intralesional Verapamil (IV), and collagenase Clostridium histolyticum injections. To investigate the insurance coverage of these treatment options. The authors performed a cross-sectional analysis of the top US insurance policies for coverage of PD. Companies were chosen based on their market share and enrollment. Their policies were identified through a Web-based search and telephone interviews, and the companies' medical necessity criteria were defined. The online policies were then re-examined for interval change 3 years later. There are significant discrepancies for in coverage for the different modalities of Peyronie's treatment. Of the 100 companies examined, only 54% of companies had a policy that directly addressed the treatment coverage for PD. The most covered treatment was CCH injections with 37 companies providing unanimous coverage (n = 37, 100%). Within this category, all companies required a palpable plaque as a requirement. Additionally, external/internal devices were unanimous covered by 18 companies (n = 18, 100%). Surgical treatment was covered by eight companies with six companies denying coverage (n = 8 vs. n = 6, 57.1% vs. 42.9%). IV was covered by two companies. The least covered treatment option was SWT which was universally denied by 19 companies (n = 19, 100%). Insurance coverage of PD should be aligned with current medical literature to better increase access to care. This study is limited by the updated policies of insurance companies and future applicability. Additionally, this study assumes that a written policy will provide coverage and may overestimate the actual extent of coverage. Finally, this study only addressed some of the common treatment options of PD and did not expand on all possible treatment options. Differing rates for modalities of treatment may present a barrier for patients to receive individualized and adequate treatment for PD.

Mediterranean Diet adherence, physical activity level, and quality of life in patients affected by thyroid diseases: Comparison between pre- and post-lockdown assessment

Background: SARS-CoV-2 pandemic resulted in lifestyle change of world’s population because of the measures adopted by governments to contain the virus spread. Design and Methods: This study examined whether lockdown impacted anthropometric indices, Mediterranean Diet (MD) adherence, Physical Activity Level (PAL), and Quality of Life (SF-12) in a cohort of 116 patients (96 F, aged 57.2 ± 13.1 years) affected by thyroid disorders. Before lockdown, data were collected during the endocrinological examination; after lockdown they were collected through a tele-phone interview (via video call). Results: Data revealed an overweight condition in 59% of patients, with no significant differences between the two observations (BMI values: 26.5 ± 4.9 vs 26.6 ± 4.9 kg/m2), whereas waist circumference values significantly increased over time (93.3 ± 12.6 vs 94.4 ± 12.5 cm; p = 0.003). Moreover, a lower adherence to the MD (PREDIMED score: 7.3 ± 1.8 vs 7.0 ± 1.8; p = 0.003) and a significant increase of sitting time (6.4 ± 3.2 h/die vs 9.0 ± 4.2; p &lt; 0.001) were observed. A not significant decrease in PAL, which revealed a sedentary condition in pre- and post-lockdown (648 and 562 METs/week respectively), was found. The SF-12 score did not show relevant changes between the two observations. Conclusion: Our study highlights that patients with thyroid diseases are often sedentary and exhibit a high prevalence of over-weight, underscoring the need for a systematic anthropometric evaluation and, at times, lifestyle interventions.

Neuropsychiatric symptoms of patients two years after experiencing severe COVID-19: A mixed observational study

BackgroundThe impact of SARS-CoV-2 infection (COVID-19) on mental health has not been extensively studied in the medium and long term. This study assessed how clinical, biological, and social factors affect mental health in patients who recovered from severe COVID-19. The evaluation was done 90 days after hospital discharge and followed up at 12 and 24 months. MethodsA retrospective-prospective cohort mixed observational study was conducted on patients over 18 years of age who required hospitalization in Internal Medicine or ICU for severe COVID-19 pneumonia during 2020 and 2021. Demographic information, clinical variables, and data for the scales were obtained from electronic medical records and telephone interviews. For comparisons of the different variables in each clinical variable (insomnia, depression, anxiety), the Student's t-test for independent samples has been used (normal distribution); otherwise, the Mann–Whitney test will be used. All tests and intervals will be performed with a confidence level of 95. Fisher's exact or Pearson's Chi-square test has been used as appropriate for qualitative variables. Results201 patients were recruited. 37.3% presented insomnia, 22.4% anxiety, and 21.4% depressive symptoms. A direct association was established between female sex and depressive symptoms. Psychotropic history, fatigue, and C-reactive protein levels (CRP) were correlated with depression. Anosmia and ageusia, CRP, cognitive symptoms, and dyspnea predicted insomnia. Sex, orotracheal intubation (OTI), pain, fatigue, mental health history, and academic level were independent predictors of anxiety. High percentages of depressive, anxiety, and insomnia symptoms were detected in the second month after discharge and persisted at 12 and 24 months. The fatigue variable maintained a significant relationship with depressive symptoms at 2, 12 and 24 months. A possible limitation could be recall bias in retrospective data collection. ConclusionsThis is a novel study to follow up on mental health for two years in patients with severe COVID-19. Clinical, biological, and psychosocial variables could be predictors of depressive symptoms, anxiety, and insomnia. The psychiatric symptoms persisted throughout the 2-year follow-up. These findings are critical for the follow-up of these patients and open the possibility of further studies in the medium and long term.

SHARE Corona Surveys: study profile

At the onset of the COVID-19 pandemic, the Survey of Health, Ageing, and Retirement in Europe (SHARE) was in a unique position to respond to the need for high quality survey data on people’s changing living situations. Implemented as two telephone interviews in the summer of 2020 and 2021 in 27 European countries and Israel, the SHARE Corona Surveys present a great advantage by their integration into the longitudinal, multidisciplinary and ex-ante harmonised design of the SHARE study. This allows researchers to trace changes from the pre-pandemic period, through the different stages of the pandemic, and the post-pandemic situation. This article lays out the research aims and how the two Corona Surveys fit in the general design of SHARE. It presents the main design features of the SHARE Corona Surveys following the survey life cycle. It starts with information on procurement, contracting, funding, ethics, and data protection and sampling, followed by information on instrument design, translations, questionnaire content and interviewer training. Last, fieldwork, panel care and data processing are described. Focused on topics of health behaviour, health care, economics and social relationships, the balanced panel sample of the two SHARE Corona Surveys comprises more than 48,000 interviews and provides valuable information on how the 50+ population coped with the COVID-19 pandemic. The experience of implementing the SHARE Corona Surveys also offers insights into use of agile project management methods for large survey infrastructures and moving towards a multi-mode design in an ongoing panel data collection project.

Secondary School Athletic Trainers' Experiences Managing Workplace Organizational-Professional Conflict.

Athletic trainers (ATs) face organizational-professional conflict (OPC), often surrounding return-to-sport decisions. To prioritize patient safety and establish a healthy work environment, OPC must be mitigated, yet few researchers have determined how ATs manage conflicts with stakeholders. To explore ATs' experiences with OPC in the secondary school setting. Qualitative study. Telephone interviews. Sixteen ATs (9 females, 7 males; age = 43 ± 11 years; years certified = 17 ± 9; years in their current positions = 9 ± 6). We digitally recorded telephone interviews and had them professionally transcribed. Data saturation guided recruitment efforts and was met. To ensure rigor and trustworthiness of the data, we completed basic member checks along with multiple-analyst triangulation. We analyzed the qualitative data using an interpretive phenomenological approach. Four themes emerged effective communication, professional relationships, stakeholder education, and professional experience. Participants used effective communication described as frequent, open, and direct, during interactions with stakeholders to manage OPC. Organizational-professional conflict was reduced when ATs built professional relationships with stakeholders centered on trust and respect. Participants used stakeholder education as a primary strategy for managing OPC by educating stakeholders about prognosis and return-to-sport timelines postinjury and providing rationale for decisions made. Additionally, years of experience served as a mitigating factor of conflict, in that as ATs gained experience and confidence, they perceived less OPC. Participants suggested various interpersonal relationship development strategies that can be implemented to manage OPC, especially when starting a new position or building rapport with stakeholders. Specifically, educating various stakeholders on reasons for clinical decisions via effective communication and developing strong professional relationships built on mutual respect assisted in avoiding OPC. Since professional experience appears to alleviate conflict, OPC management strategies should be taught during professional preparation and used early during transition to autonomous practice.

Long-Term Prognostic Value of Adipocytokines in Patients with Acute Coronary Syndrome: An 8-Year Clinical Prospective Cohort Study.

To elucidate the predictive values of adipocytokines in patients with acute coronary syndrome (ACS). Overall, 297 patients with ACS were consecutively enrolled in this prospective cohort study between June 2015 and July 2017 and completed follow-up with a median follow-up time of 6.5 years. For consistency, the last visit date was June 20, 2023. Serum levels of retinol-binding protein-4 (RBP4), interleukin-1β (IL-1β), monocyte chemoattractant protein 1(MCP-1), adrenomedullin (ADM), netrin 1 (NTN 1), and omentin were measured using enzyme-linked immunosorbent assay. Follow-up data were collected during clinical visits or through telephone interviews at 1, 3, 6, 12 months, and annually. The primary endpoint was defined as major adverse cardiovascular events (MACEs), including all-cause mortality, rehospitalization for percutaneous coronary intervention, and severe angina requiring rehospitalization. All biomarkers displayed a good diagnostic ability of MACEs. The Kaplan-Meier curve showed that the cumulative survival rates of high level of RBP4, IL-1β, and MCP-1 and low level of the ADM, NTN1, and omentin had lower cumulative survival rates (Log rank tests: all p<0.05). After adjustment in the Cox hazard proportional model, the results were RBP4 ≥ 6.87 ng/mL, hazard ratio (HR)=2.512, p=0.003; IL-1β≥ 58.95 pg/mL, HR=3.809, p<0.001; MCP-1 ≥ 401.75 pg/mL, HR=4.047, p<0.001; ADM≤120.01 ng/mL, HR=3.930, p=0.008; NTN1 ≤63.7 pg/mL, HR=3.345, p=0.007; omentin ≤ 4.54 ng/mL, HR=2.830, p=0.004. P-values for interaction were > 0.05 in the sex, age, and dyslipidemia subgroups. Pro-inflammation adipocytokines RBP4, IL-1β, and MCP-1 increased and anti-inflammation biomarkers ADM, NTN1, and omentin decreased were independently associated with a higher risk of MACEs in patients with ACS.

Formulation of adult food-protein–induced enterocolitis syndrome diagnostic scoring system differentiating from immediate-type food allergy

BackgroundAdult food-protein–induced enterocolitis syndrome (FPIES) has recently been recognized, and there are no international diagnostic criteria for this disease. Differentiating adult FPIES from immediate-type food allergy reactions and providing specific treatment for each in an emergency are important, but methods have not been developed. ObjectiveTo develop a diagnostic scoring system for adult FPIES by comparing it with an immediate-type food allergy (IgE-mediated food allergy [IgE-FA]). MethodsThis retrospective cohort study of food-avoidant adults based on the diagnostic criteria for adult FPIES reported by Gonzalez et al was conducted through telephone interviews. We compared the clinical profiles of the patients with FPIES and IgE-FA. Adult FPIES-associated factors were extracted using multivariate analysis, and a diagnostic scoring system was developed based on odds ratios. ResultsA total of 48 (16.7%) of 288 adults with food allergies were diagnosed with FPIES; of these, 240 (83.3%) had IgE-FA. Seafood was the most common cause of FPIES in adults (68.8%). Multivariate analysis identified an age of onset older than 26 years, more than 10 episodes, a longer latency period, cold sweat, abdominal distention, and vomiting as adult FPIES-associated factors. An adult FPIES diagnostic scoring system was developed using odds ratios with a high area under the curve (0.978), 100% sensitivity, and 87.0% specificity. ConclusionClinical profiles and an adult FPIES diagnostic scoring system were developed for the first time. This scoring system can be useful in differentiating adult FPIES and IgE-FA when treating food-related acute reactions.

Association of dietary insulinemic potential with disease severity and symptoms in patients with COVID-19

AimCOVID-19 has threatened people's lives in world. Studies showed that level of insulin is related to function of immune system and level of inflammation in body. In this study we aimed to evaluate the association between dietary insulinemic potential and level of inflammatory biomarkers, severity and symptoms of COVID-19. MethodsParticipants of this cross-sectional study were 684 people who recovered from COVID-19. Dietary intake of participants was assessed using 168-item food frequency questionnaire during telephone interview, then dietary insulinemic index and load (DII and DIL) calculated for each participants. Data related to study outcomes, include levels of inflammatory biomarkers, disease symptoms, lung infection, saturation of peripheral oxygen, Respiratory Rate, need for respiratory support, duration of disease, hospitalization, recovery from disease and need for respiratory support and score of life satisfaction were collected through an interview with participants and review of their medical records. ResultsAfter controlling for confounders, participants in the highest quartile of DIL had a significantly higher risk of severe COVID-19 (OR: 2.66, 95% CI: 1.01–7.04, Ptrend=0.035), risk of hospitalization (OR: 3.44, 95% CI: 2.27-7.64, Ptrend>0.001), fever (OR: 2.91, 95% CI: 8.08–1.05, Ptrend=0.042), chills (OR: 4.68, 95% CI: 1.77–12.37, Ptrend=0.002) and lower risk of weakness (OR: 0.28, 95% CI: 0.10–0.74, Ptrend=0.012) and myalgia (OR:0.26, CI: 0.10–0.45, Ptrend=0.006) compared to the lowest quartile. In addition our findings showed a significant positive association between DII and risk of fever (OR: 1.71 95% CI: 2.84–1.03, Ptrend=0.049). Our finding failed to find a significand association between DII and risk of sever COVID-19 and hospitalization. Moreover we did not find significant association between DII/DIL and duration of disease, other symptoms and outcomes. ConclusionsOur findings showed that higher DIL was associated with greater risk of sever COVID-19 and hospitalization. More detailed cohort studies are needed to confirm the findings.

Effect of oncology provider conversations on patients’ vaccination decision-making: Patient perspectives at a safety-net system.

266 Background: Low immunization rates among adults are associated with worse outcomes, particularly among immunocompromised individuals, such as those diagnosed with a cancer. To better understand vaccination communication and decision-making experiences among adult cancer patients treated at a safety-net system, we conducted structured interviews to: (1) explore patients’ perceptions of their oncology providers’ role in adult immunization, and (2) understand the potential factors that underlie patients’ hesitancy to receive vaccines. Methods: Parkland Health is the safety-net system for Dallas County, providing care for a primarily minority and un-/under-insured population. Cancer patients who had previously deferred or declined immunization participated in either in-person or telephone interviews in their preferred language (English/Spanish), using a structured 8-question interview guide. Questions centered on oncology providers’ role, vaccine hesitancy, and vaccine decision-making. Interviews averaged 12 minutes and were recorded for transcription. Aggregated interview responses were coded by question and interpreted through content analysis which noted frequency (i.e., times concept stated) and extensiveness (i.e., repetition across questions). Results: Thirteen patients were interviewed – 7 in English, 6 in Spanish. Patient’s perceived their oncology providers as highly important to their vaccination decision-making as they were: (1) more likely to get a vaccine if it is recommended by their provider (P2: Well, if the doctor hadn’t told me I wouldn’t have gotten vaccinated ; P3: If they didn’t recommend it, I would not get it ; P12: If they recommend it, it's worth looking into or thinking about ), and (2) identified their oncology provider as a preferred means for learning about vaccines (P8: Asking the doctor or the doctor communicating with us patients about a vaccine... in my personal opinion, I would say, go ahead and vaccinate me ). Patient-identified reasons for hesitancy included concerns about side effects (P2: “several people told me that is why we got cancer” ), fear of needles, previous negative experiences, and preference for alternative medicine approaches. Conclusions: Results from this preliminary study suggest that while patients may not initiate vaccination conversations with their oncology providers, they do identify their providers as influential in their decision-making. Oncology providers may not consider immunization as their primary responsibility but can be a primary source for effective vaccine communication in conjunction with the oncology care team. Findings from our patient interviews informed interventions in a quality improvement project to increase immunization uptake among cancer patients at our safety-net system.

Gujarati translation and adherence testing of Stretching and Strengthening of Rheumatoid Arthritis of the Hand (SARAH)

ABSTRACT Context: Stretching and strengthening for rheumatoid arthritis of the hand (SARAH) is a progressive and individually designed recommended treatment exercise program. Aims: The aim was to translate the SARAH hand exercise program into Gujarati and assess the adherence rate, usefulness, and understanding of the Gujarati SARAH exercise program. Methods and Materials: Mixed-method qualitative study was conducted among 25 participants at the outpatient departments of Institute Nadiad and Niruj Rheumatology Clinic, Gujarat, and via professional contact, a telephonic semi-structured interview was conducted among 13 participants using an interview guide, and interviews were audio-recorded following transcription verbatim. Overall adherence rates of 25 participants to a 12-week exercise program were determined using the cross-sectional method. Statistical Analysis Used: IBM SPSS software version 23.0 was used for analyzing quantitative data, and NVivo Plus version 11 was used for qualitative data. Results: The adherence rate was 97.22%. Participants completed all 72 sessions (n = 7) with an adherence rate of 100%. The least number of sessions completed was 25 (n = 2), with an adherence rate of 34% due to a lack of interest in exercising on a daily basis. Qualitative findings showed that the booklet is understandable, useful, and beneficial in terms of reducing symptoms and improving activities of daily life as well as occupational work. Conclusion: The translated strengthening and stretching for rheumatoid arthritis in the hand exercise booklet is effective and beneficial to patients who exercise at home. Participants can self-track their exercise by using dairy, which eliminates travel costs and attendance at clinic sessions.

Community and academic allergists’ perspectives on integrating biologics into food allergy care: A qualitative study

BackgroundBiologics are an important area of research and development, including for treatment of food allergy (FA). However, how allergists perceive the risks and benefits of biologics to treat FA remains largely unknown. ObjectiveTo explore how US-based allergists perceive the use of biologics in FA treatment. MethodsUsing a combination of purposive and snowball sampling, providers were recruited through direct solicitation by email to participate in a telephone or Zoom interview about their perceptions of the risks and benefits of current and future FA treatment options. Interviews were transcribed, deidentified, and coded to conduct a thematic analysis. ResultsWe conducted 60 interviews with providers from 34 states working either in community practice (53.3%) or academic medical centers (46.7%). Our sample was primarily non-Hispanic White (60.0%) and men (56.7%). The plurality was in their 40s (41.7%). Our findings clustered in the following 4 main themes: (1) perceived benefits of biologics, (2) ideal use of biologics, (3) concerns about biologics, and (4) biologics as the perceived future of FA. Community and academic providers had largely similar views, but academic providers more often emphasized the benefits of biologics, and community providers were, on the whole, more supportive of using biologics as an adjunct to oral immunotherapy rather than as monotherapy. ConclusionThis study indicates that providers hold mixed views about the use of biologics to treat FA. However, most were enthusiastic about prescribing biologics for FA while also being highly concerned about the cost to patients and the health care system.

Understanding the impact of COVID-19 on women’s access to and experiences of contraceptive services in England: a qualitative study

BackgroundThe COVID-19 pandemic response prompted rapid changes to how contraceptive services were delivered in England. Our aim was to examine women’s experiences of accessing contraceptive services since March 2020 and...