Time Of First Visit Research Articles

Association between timing and number of antenatal care visits on uptake of intermittent preventive treatment for malaria during pregnancy among Malawian women

BackgroundMalaria in pregnancy is a critical public health challenge, and intermittent preventive treatment for malaria during pregnancy (IPTp) has proven to be an effective intervention. However, access to and use of malaria interventions, including IPTp, remains a considerable problem among African women. This cross-sectional study investigated factors, including antenatal care (ANC) attendance (both numbers of visits and timing of the first visit) and socio-demographics, associated with the uptake of the recommended IPTp dose among Malawian women.MethodsA nationally representative sample of women with a live birth in the 2 years preceding the survey from the Malawi Demographic Health Survey 2015–2016 dataset was analysed. Self-reported data on socio-demographics, ANC attendance and IPTp uptake were collected using a questionnaire and analysed using logistic models.ResultsOf the 6549 included women, 1981 (30.2%) took the recommended three or more IPTp doses. Despite inadequate ANC visits, early ANC initiation increased the likelihood of these women taking the recommended IPTp dose; women who initiated ANC in the first [adjusted odds ratio (aOR) = 2.24; 95% confidence interval (CI) = 1.44–3.49] and second (aOR = 2.19; 95% CI = 1.56–3.08) trimesters were more likely to take the recommended IPTp dose compared to late initiators. The effect of the number of ANC visits on IPTp uptake was significant in married women (aOR = 1.68, 95% CI = 1.42–1.98), and the timing of first ANC visit was associated with IPTp uptake only among rural women (aOR = 2.13, 95% CI = 1.54–2.95).ConclusionANC attendance is vital in IPTp uptake. The results highlight the need for health care providers to encourage women, particularly those in high-risk groups, to make frequent ANC visits and receive early ANC initiation to ensure high coverage of the recommended IPTp dose.

Abstract 211: Long-Term Participant Engagement in Weight Management Programs

Lifestyle interventions must be effective at engaging participants beyond the initial intervention period in order to be successful in reducing long-term cardiovascular risks. Unfortunately, there is a lack of evidence for improvement in long-term cardiovascular outcomes following participation in lifestyle interventions. Participant engagement has been shown to wane after the first 12 months of participation. This gradual reduction in engagement may be responsible for the limited evidence for an effect on long-term cardiovascular risk. The objective of this study is to assess patient, program and community characteristics associated with better participant engagement after 2 years in a weight management program. This is an observational study of 330,522 participants enrolled in MOVE! programs within the Veterans Healthcare Administration (VHA) from 2008 to 2013. The MOVE! program is a nationwide weight management intervention integrated into primary care within the VHA and provided free to Veterans. Participant engagement is defined as the number of MOVE! program visits per year for each participant. Engagement is assessed at 6 months, 12 months, and 24 months following the first program visit. Bivariate statistics and multivariate generalized linear models were used to assess factors associated with patient engagement at each time point. At the first MOVE! visit, the average participant age was 56.3 years old (SD=12.0) with a body mass index of 36.9 [Standard Deviation (SD)=5.4). Most participants were male (87.9 and lived in an urban area (69.7%) an average of 38.6 miles from the MOVE! program (SD=48.5). Eight percent (7.5%) of participants had a Charlson Comorbidity Index of 4 or more at the time of their first visit. Engagement decreased as time from the first visit increased. Patients had a median of 4.0 visits per year at 6 months [Interquartile Range (IQR)=2.0-8.0], 2.0 visits per year at 12 months (IQR=1.0-5.0), and 1.0 visit per year at 24 months (IQR=0.5-3.0). In adjusted models of 24-month engagement, older age (beta=0.03, p<0.01), greater body mass index (beta=0.06, p<0.01), and female gender (beta=0.46, p<0.01) were associated with better engagement. Factors predicting better engagement at each time period were similar with the exception of comorbidities. More comorbidities at the time of first visit was the only factor associated with a small improvement in 24-month engagement (beta=0.01, p=0.04) but no difference in 6-month (p=0.35) or 12-month (p=0.10) engagement. In conclusion, in this large observational study, female gender, greater BMI, older age, and more comorbidities are associated with better 24-month engagement in a weight management program. Few factors stood out as predictors of better 24-month engagement as compared to 6- and 12-month engagement.

A study of mosquito borne diseases awareness, attitude and practices among the rural population in Karnataka, India

Background: All over the world mosquito borne diseases are responsible for a large number of morbidity and mortality. A study showed that there are about 350-500 million cases of malaria annually, with the outcome of 1 million deaths. Although there are around 3500 species of mosquitoes tracked down to tropical and subtropical regions of the world only a hand full of species cause most of the vector borne diseases. The objective of this study was to study people’s awareness, attitude and practice about mosquito borne disease in rural areas of Dakshina Kannada district, Karnataka.Methods: A cross-sectional study was conducted among the residents of Manjanady, Asaigoli, and Kuthar villages during the rainy season in 2016. Through systemic random sampling a total of 200 houses were selected. After obtaining informed consent, the participants were administered a pre-tested, structured questionnaire at the time of first visit for the collection of data.Results: A large majority of subjects about 86% said that polluted water was a breeding place for mosquitoes, 89.5% thought malaria was spread by mosquitoes, 84.5% said that fever and rigor is the most common symptom, 48.5% said that the health authorities had not conducted active surveillance. Also 41.5% visit general practitioner for consulting on their health issues and 65% of the subjects used mosquito coil as a protective measure.Conclusions: Intensified efforts should be made to create public awareness and mobilize the community in the preventive measures against mosquito borne diseases.

Clinical and Histopathologic observations in a cohort of Libyan patients with Oral Lichen Planus

This study describes the clinical and histological features in a cohort of 72 Libyans with a histologically confirmed oral lichen planus (OLP) seen in the academic department of Oral Medicine & Oral Pathology of dental faculty in Benghazi in the period between 1997 and 2015.The cases were followed up clinically from the time of first visit up to periods extending from 4-14 years. In addition, serial biopsies were taken (whenever it deemed necessary) for those patients diagnosed with epithelial dysplasia to monitor its behaviour within the lesion. All the epithelial dysplastic changes were found in erosive, atrophic and bullous form, and none was detected in the white keratotic types. Only One case had undergone malignant transformation after 14 years of the first presentation. Most of the cases responded invariably to management by topical corticosteroids, however, systemic corticosteroids were used for short periods in 5 cases, while benzydamine hydrochloride proven to be beneficial for the relief of mild to moderate pain that sometimes associates with OLP.

Management of congenital talipes equino varus using Ponseti method: 3 year follow up in 166 club feet

<p class="abstract"><strong>Background:</strong> Our aim was to study the effectiveness of Ponseti method using Pirani score in children with club foot treated over the past three years at our hospital.</p><p class="abstract"><strong>Methods:</strong> We studied 111 children with 166 idiopathic club feet who were treated at our teaching hospital between period of January 2012 and January 2017.The foot deformities were assessed using Pirani score at the time of first visit and the scores were recorded with each subsequent visit, with each casting and manipulation until correction of deformity. Tenotomy was performed on all the idiopathic club feet and continued with Steenbeek foot abduction brace (FAB) and the scores were recorded with every follow up and the progress was noted. All the relevant data in terms of treatment and demographics were recorded with dates and maintained.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total of 166 feet of 111 children was treated out of which 72 were males and 39 were females. 55 children had bilateral involvement remaining were unilateral. Mean Pirani score was 5.5 (range 4-6) when the treatment was started. On an average 5.7 casts (range 3-9) were required before preforming a tenotomy. Tenotomy was performed on all the feet (100%) with idiopathic club foot. Foot abduction orthosis was given to all the patients and 108 patients (97.3%) were compliant. Mean Pirani score after three years of treatment was 0.26. Skin complications like blister formation were seen in three children during the course of the treatment. Four patients did not follow up and defaulted. Three patients had relapse or worsening of Pirani score. The recurrence or worsening of scores is thought to be due to poor compliance while using the foot abduction brace.</p><p><strong>Conclusions:</strong> Ponseti method of treatment for CTEV is very effective, simple, non-invasive and convenient with excellent outcomes over long term with no significant complications.</p>

Improving efficacy and efficiency through the implementation of a new organisational model in a Radiation Oncology Department

To evaluate a new organisational model, "process management" (PM), implemented in the Hospital Universitario Virgen de la Victoria (HUVV) compared with traditional models used in other Radiation Oncology Departments (RODs), in terms of efficacy and efficiency. The study period ranged from September 2011 to August 2012. Efficacy was assessed, comparing the number of patients attended in first consultation and treated per month, average waiting time from referral to first visit and average waiting time from first visit to treatment. Data were collected from two public hospitals in Andalusia: the HUVV and another Public Hospital in Andalusia (PHA1). Efficiency was assessed comparing the costs per patient attended in first visit and treated at HUVV in 2012 compared with those of a second Public Hospital in Andalusia (PHA2) for 2008. The number of sessions saved using hypofractionation versus classical schemes during the year 2012 in HUVV was estimated, and the money saved was calculated. In the efficacy analysis, we found significant differences in the average waiting time for first visit, start of treatment, and the number of patients seen and treated annually. After calculating the total cost generated in the ROD, the efficiency analysis showed a lower cost per patient attended in first visit (EUR 599.17) and per patient treated (EUR 783.50), with a saving of 6035 sessions using hypofractionated schemes. Process management in an ROD reduces time, both to first medical visit and to treatment initiation, allowing an optimisation of linear accelerator (LINAC) capacity.

Front loading sputum microscopy – an alternative approach for diagnosis of pulmonary tuberculosis

IntroductionUntil newer, rapid, economical tools are introduced for diagnosis of Pulmonary Tuberculosis in resource limited settings, optimization of sputum smear examination for increasing case detection remains of utmost priority. The aim of the study was to detect presumptive TB patients using Front Loading sputum microscopy and compare it with Standard method. MethodsThree sputum specimens (Spot 1- on spot at the time of first visit, Spot 2- one hour after Spot 1 and early morning-next day early morning sample) from 552TB suspect cases were collected. Zeihl Neelsen staining (spot 1, spot 2 and early morning respectively) and microscopy by Front Loading (spot 1, spot 2) and Standard method (spot 1, early morning) of sputum microscopy were done. ResultsCulture on LJ media being the gold standard, the sensitivity and specificity of the Front Loading and the Standard method of sputum microscopy were 68.65%, 94.43% and 70.14%, 93.6% respectively. The difference between two methods was not statistically significant. 91.1% patients gave preference for same day sampling process. ConclusionThe sensitivity and specificity of sputum microscopy using an early morning sample followed by another sputum one hour later from the same day appears not to be inferior to using two early morning samples on subsequent days. The Front Loading sputum microscopy can be implemented in DOTS clinic on the day of first visit of patients to health care center to increase compliance of patients with diagnostic procedure and decrease drop-outs.

Similarities in Hepatitis C Patient Profiles Over a Decade in an Urban GI Clinic

INTRODUCTION: There is considerable uncertainty with respect to predicting the liver disease status of African American (AA) patients with Hepatitis C seen in the current era of highly effective direct acting anti-virals (DAA). This uncertainty is due to the complex interplay between the identification of patients early in their disease progression by screening, the fact that many AA patients failed earlier interferon based therapy, duration of the HCV viremia in AA patients, the possible variation In disease course in AA as compared to other races, and potential early mortality of AA patients due to liver disease. Understanding the evolution of HCV infection as defined by comparing previous and current patient populations provides information relevant to both therapeutic and health costs decisions. METHODS: We selected patients from a 24 month period between 2002 and 2003 (Epoch 1; n = 414) to compare with patients seen in the same GI clinic between 2012 and 2013 (Epoch 2; n=405). Epoch 1 was the beginning of the peg-interferon and ribavirin treatment era and Epoch 2 reflects the patient population seen when DAA therapy was first available. RESULTS: Epoch 2 patients were older (59.7 vs 50.3 years) with a similar gender distribution (55% vs 59% male). Consistent with the change in clinic demographics, more AA patients were seen in Epoch 2 (89%) as compared to Epoch 1 (77%). There was no significant difference between hepatic fibrosis as assessed by APRI (1.1 vs 0.9) or FIB-4 (2.4 vs 2.6) but there was an increase in intermediate degree of fibrosis as defined by liver biopsy. The majority of Epoch 2 patients were still naive to treatment (96% Epoch 1 vs 61% Epoch 2) and a similar proportion had cirrhosis (15% Epoch 1 vs 17% Epoch 2) at the time of first visit in the different time periods. CONCLUSIONS: The patients in Epoch 2 from this urban GI referral clinic are older and the majority of them had not been treated or had not responded to treatment. This age demographic continues to reflect patients who were likely infected during the 1960’s-1980’s which is when HCV infection became widespread. Epoch 2 patients also do not have more advanced liver disease as defined either by significant fibrosis or cirrhosis as compared to Epoch 1. Possible explanations include that Epoch 2 patients’ disease was detected earlier by surveillance, progressed very slowly to advanced liver disease, or had a high mortality that resulted in a decline in patients with advanced disease. The role of access to therapy in patients not treated remains to be determined and the increased effectiveness of DAA are predicted to increase the number of AA patients seeking and accepting treatment.

MA08.11 Monitoring the Emergence of EGFR T790M ctDNA in Urine from EGFR Mutated NSCLC Patients to Predict Response to 3rd Generation Anti-EGFR TKIs

EGFR T790M mutation occurs in about half of EGFR mutated NSCLC patients with acquired EGFR-TKI resistance. It is currently unknown if switching therapy to a third generation anti-EGFR TKI based on circulating tumor DNA at first detection with urine is superior to switching therapy based on radiographic progression. Herein we demonstrate the identification of T790M in urine months before radiographic progression, patient responses when treated with an anti-EGFR third generation TKIs, clinical cutoffs that may be predictive of benefit, and a novel clinical trial to consider for treatment selection. From 2014 to 2016 a total of 42 patients with EGFR activating mutations were followed at UCSD Moores Cancer Center through multiple lines of therapy. 34 patients had serial urine collection every 4-6wks from time of first visit. Clinical progression was assessed with CT imaging performed every two months. Among the 42 patients, 35 patients had metastatic disease (6 with intrathoracic M1a disease and 29 with distant metastasis M1b). Urine volume ranged from 30-100ml. Average time from first line TKI start to urine T790M was 15.7mos (CI 9.6-25.6), time from TKI start to radiographic progression was 21.9mos (CI 10.7-27.0), and time from urine T790M to radiographic progression was 3.6mos (CI 0.9-6.8). All patients with >30 copies/105 genome equivalents (GEq) of urine T790M had response to third generation TKIs. In patients who had urine EGFR T790M from 10-30 copies/105 GEq, three serial measurements in the 10-30 range predicted response. EGFR T790M copies of less than 10 copies/105 GEq did not predict response to third generation inhibitors. EGFR T790M can be identified in urine before radiographic progression and quantitative cut-offs can be predictive of response. We are testing this prospectively in a clinical trial with serial ctDNA analyses obtained for resistance monitoring for up to 24 months on first line TKI therapy. Patients who have urine detection of T790M (>30 copies or three serial collections with 10-30 copies/105 GEq) at 12 months and before progression are randomized to second line third generation TKI therapy or continuation of the first line therapy until progression. Patients with undetectable urinary T790M or <10 copies/105 GEq will continue on the first line therapy past 12 months until progression. Overall survival, progression free survival, and time to progression will be compared between cohorts to validate the early detection of T790M by urine ctDNA and understand the impact of an early switch in therapy based on ctDNA analyses.

Characterization of Myelodysplastic Syndromes (MDS) with T-Cell Large Granular Lymphocyte Proliferations (LGL)

▪Introduction:MDS include a spectrum of hematopoietic stem cell malignancies characterized by bone marrow failure and dysplastic morphology. LGL is a clonal proliferation of cytotoxic T cells, which manifest as neutropenia, anemia, and thrombocytopenia and is associated with autoimmune disorders. LGL in association with MDS has been previously reported. However, clinicopathological features, prognostic, and predictive factors in those patients diagnosed with both LGL and MDS is not well studied.Methods:We identified patients at Moffitt Cancer Center (MCC) diagnosed with MDS who were previously tested for the presence of LGL clonal populations by peripheral blood flow cytometry at time of first visit. An LGL population was defined by the standard flow cytometry immunophenotype and clonality confirmed by T-cell receptor gamma and beta gene rearrangement.. Next Generation sequencing data was available for 151 patients. Recurrent somatic gene mutations were compared between patients with an LGL clone and those without.Results:Of the 675 patients with MDS tested for LGL in the database, 206 (30.5%) had an LGL clonal population. The mean LGL absolute cell count in the peripheral blood was 335/µL. Table-1 summarizes the baseline characteristics of the two groups.There was no difference in response to azacitidine therapy. Among 50 patients with LGL clone who received azacitidine with available data on response, the rate of hematological improvement or better (HI+) was 38%. The (HI+) was 28% among 105 patients evaluable for response without LGL clone. P .14The median overall survival (OS) was for patients with no LGL clone was 65 months (mo) compared to 46 mo (p .024). The median OS for lower risk MDS patients (low/int-1 by International Prognostic Scoring System [IPSS]) was 68 mo versus 97 mo for those with or without LGL proliferation, respectively (P .005). In higher risk MDS, there was no difference in median OS between those with or without LGL expansion, respectively (20 mo versus 16 mo, p .7). The median OS for patients with very low/ low Revised-Internatinal Prognostic Scoring System (R-IPSS) was 96 mo if LGL proliferation was detected compared to 128 mo if it was not, (p value .016). For intermediate R-IPSS the median OS was 65 mo and 41 mo with or without LGL proliferation (p .16). Finally, for high/very high R-IPSS the median OS was 18 and 16 mo with or without LGL proliferation, (p .84) In cox regression analysis the presence of an LGL clone was independently prognostic for OS after adjusting for age and R-IPSS, Hazard ratio 1.3, p = .05. Somatic gene mutation data were available for 151 patients; there was no statistically significant difference in the distribution of any mutation except IDH-2 (Table-2). The most common somatic mutations observed among patients with LGL clone were SF3B1 19%, TET-2 16%, U2AF1 13%, IDH-2 13%, RUNX-1 13%, and ASXL-1 10%. In patients without an LGL clone the most common somatic mutations were TET-2 26%, ASXL-1 20%, DNMT3A 16%, TP53 13%, SF3B1 12%.Conclusion:An LGL clone is demonstrable in approximately 30% of patients with MDS in association with advancing age. The presence of LGL proliferation was associated with worse OS in lower risk MDS pts. Although the spectrum of somatic gene mutations were similar, the presence of IDH-2 mutation and absence of DNMT3A or TP53 gene mutationscharacterized LGL+ cases. [Display omitted] [Display omitted] DisclosuresRoe:Celgene: Speakers Bureau; Alexion: Speakers Bureau; Seattle Genetics: Speakers Bureau. Sweet:Pfizer: Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Ariad: Consultancy, Speakers Bureau; Incyte Corporation: Research Funding; Karyopharm: Honoraria, Research Funding. Sokol:Seattle Genetics: Consultancy; Spectrum: Consultancy. Komrokji:Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy, Speakers Bureau; Incyte: Consultancy.

HbA1c and Age in Non-Diabetic Subjects: An Ignored Association?

Objective: Target HbA1c values given in the most National Therapeutic Guidelines for patients with diabetes and cut-off HbA1c values for diabetes diagnosis are usually not taking the age of the respective patients into account; despite the fact that an increase in HbA1c in subjects without diabetes with age is known for some time. In order to further quantify the association between age and HbA1c in non-diabetic subjects an analysis of one German register was performed. Methods: In this cross-sectional study we analyzed data from 7 699 visits of 2 921 patients without diabetes (age 46.6 y [range 18-93 y]; 69.1% women; BMI 27.6±6.4 kg/m²) who had at least one HbA1c and blood glucose measurement. Data were drawn from an electronic patient record system (EMIL™) in which data were collected between 01/1992 and 01/2014. The patients were divided in 6 age groups (< 30 years [n=1 057];>30-40 years [n=1 160];>40-50 years [n=1 693];>50-60 years [n=1 523];>60-70 years [n=1 310];>70 years [n=956]) and the HbA1c values of these groups were compared. Patients with: gestational diabetes, use of systemic glucocorticoids, malignant neoplasm, age<18 y at time of first visit and IGT were excluded. HbA1c measurements were DCCT adjusted. Results: Patients with age>70 years have a 0.47% [5.14 mmol/mol] higher HbA1c compared to those<30 years. The mean HbA1c of the age groups was:<30 4.98% [30.96 mmol/mol],>30-40 5.07% [31.99 mmol/mol],>40-50 5.17% [33.10 mmol/mol],>50-60 5.33% [34.79 mmol/mol],>60-70 5.42% [35.79 mmol/mol] and>70 years 5.45% [36.10 mmol/mol]. In a multiple linear model the regression coefficient for each year of age increase was β=0.0074 (p<0.001); thus age results in an increase of 0.074% in HbA1c per decade. Conclusion: HbA1c increases significantly with ageing in people without diabetes. The use of different cut-off values for every age range for diagnosis of diabetes should be discussed.

Adequacy of antenatal care received by Nigerian women and some related factors

Aim: This study aim was to apply a set of indicators to measure antenatal care (ANC) adequacy in Nigerian and to identify key factors associated with. adequacy of ANC utilization Methods: We used cross-sectional data from the 2008 Nigeria Demographic and Health Survey. Our study sample consist of 9604 mothers who had a live birth in the five years preceiding the survey and had at least one ANC visit. The outcome variable Adequacy of Received ANC (ARANC) score was calculated as follows; ARANC Score=Provider × (Number of visits + Timing of first visit + Content of ANC). Where utilizing skilled provider was scored 1 and utilizing unskilled provider was scored 0, the remaining ANC atributtes were given a score of 1 for adequate utilization and 0 otherwise, such that, the maximum ARANC score was 3 and the minimum was 0The SPSS Complex Sample General Lineer Model procedure was used for both bivariate and multivariate analysis to compare assosiacion between ARANC score and explanatory variables. Results: Most mothers had scores of 2 (46.2%) refering to mothers who had a skilled provider and 2 ANC attibutes adequately. Older age, low number of birth, living in urban area, high educational level, almost daily exposure to mass media, being currently employed, knowledge on modern contraceptive methods, high household wealth index and easy access to health facility were positively associated with ARANC score (p

Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes.

Repeat concussion has been associated with risk for prolonged and pronounced clinical recovery in athletes. In this study of adolescent athletes, we examined whether an additional head impact within 24 h of a sports-related concussion (SRC) is associated with higher symptom burden and prolonged clinical recovery compared with a single-injury group. Forty-two student-athletes (52% male, mean age = 14.9 years) diagnosed with an SRC in a concussion clinic were selected for this study: (1) 21 athletes who sustained an additional significant head impact within 24 h of the initial injury (additional-impact group); (2) 21 single-injury athletes, age and gender matched, who sustained only one discrete concussive blow to the head (single-injury group). Groups did not differ on initial injury characteristics or pre-injury risk factors. The effect of injury status (single- vs. additional-impact) was examined on athlete- and parent-reported symptom burden (at first clinic visit) and length of recovery (LOR). Higher symptom burden was reported by the athletes and parents in the additional-impact group at the time of first visit. The additional-impact group also had a significantly longer LOR compared with the single-injury group. These findings provide preliminary, hypothesis-generating evidence for the importance of immediate removal from play following an SRC to protect athletes from re-injury, which may worsen symptoms and prolong recovery. The retrospective study design from a specialized clinical sample points to the need for future prospective studies of the relationship between single- and additional-impact injuries on symptom burden and LOR.

Safety and efficacy of 1020 consecutive laparoscopic sleeve gastrectomies performed as a primary treatment modality for morbid obesity. A single-center experience from the metabolic and bariatric surgical accreditation quality and improvement program.

LSG is widely accepted as a definitive treatment for obesity. Due to lack of large series with long-term follow-up, disagreement remains regarding its safety and efficacy. We present a series of 1020 consecutive LSGs performed with long-term follow-up. A retrospective review of a prospectively collected database was conducted on patients who underwent LSG from January 2005 to February 2014. Data included weight, height, BMI, ideal body weight, comorbid conditions, intraoperative complications, mean length of hospital stay (LOS), early (<30days) readmission, early and late (>30days) postoperative complications, and percentage of excess weight loss (%EWL). Of the 1020 patients, 66.6% (n=679) were female, with a mean age of 38.4±16.5years. Mean BMI at the time of first visit was 43.4±5.8kg/m(2). The most common comorbid conditions identified were diabetes mellitus (89.4%), sleep apnea (86.4%), hypertension (80.3%), and hyperlipidemia (70%). Over the entire follow-up period, 57% of diabetic patients experienced significant improvement or remission. There was no mortality in this series. Early postoperative complications within 30days of surgery included leak in 0.1% (n=1), stricture in 0.1% (n=1), emesis in 23% (n=234), dehydration in 19% (n=194), prolonged ileus in 18% (183), and self-limited bleeding in 3% (n=30). Mean LOS was of 3.4±2.1days, with a 3.8% overall rate of early readmissions. Long-term morbidity was found in 3.9% of patients (n=40) and included stricture in 0.49% (n=5) and GERD in 6% (n=61). The overall 30-day mortality rate was 0%. Mean %EWL at 3months to 1, 3, 5, and 8years was 72±16.8, 86±22.3, 63±19, 61±11, and 52±9.2, respectively. This study confirms that LSG is safe and has very low rates of early and long-term complications when compared to other well-established procedures. Additionally, LSG that appears results in significant improvement of obesity-related comorbid conditions.

The serum lipid profiles of amyotrophic lateral sclerosis patients: A study from south-west China and a meta-analysis

Associations between the fasting levels of serum lipid and amyotrophic lateral sclerosis (ALS) in Chinese populations remain largely unknown. Our objective was to analyse data from a cohort of ALS patients to determine these associations. Four hundred and thirteen ALS patients and 400 age- and gender-matched healthy controls were included. Fasting serum lipid concentration of all subjects, including total cholesterol, low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C) and triglyceride (TG), were measured at the time of first visit. The revised ALS Functional Rating Scale (ALSFRS-R) was used to assess the severity of ALS. Systems Analysis by Review Manager 5 was used to evaluate differences in dyslipidaemia between ALS patients and controls. Results showed that ALS patients with higher triglyceride levels had longer survival time compared to patients with lower triglyceride levels (p < 0.05). We found a median prolonged life expectancy of 5.8 months for patients with serum triglyceride levels above the median of 127.5 mg/dl. Cox regression analysis indicated that disease duration and age were positively correlated with death, and triglyceride was positively correlated with survival. A meta-analysis indicated that there were no significant differences in mean total cholesterol, TG, LDL or the LDL/HDL ratio between patients and controls. In conclusion, high serum TG might be a protective factor for the survival of patients with ALS.

(455) - Outcomes of Telehealth Care for Lung Transplant Recipients

(455) - Outcomes of Telehealth Care for Lung Transplant Recipients

The care of pregnant women and their babies: empirical data from Umbria region.

The promotion of the concept of evidence-based health care in the field of maternity care began in the 1980s; the indicators in this field were devised to enable us to know key components of care for mothers and babies and to relate them to health outcomes. The study is based on data from the Standard Certificate of Live Birth (SCLB) forms of the Umbria region (Italy) during 2012, which merges data from each mother and her baby for a total of 7964 records. We followed the healthcare indicators recommended by World Health Organization for monitoring and evaluating maternal and child health services. We considered number of prenatal medical visits and timing of first antenatal visit such as indicators of Antenal care, and mode of delivery and place of birth by volume of deliveries such as indicators of Intrapartum care in healthcare maternal and child services. Odds ratios were calculated to indicate the likelihood of some individual and social variables across appropriate access to prenatal care. It is present an association between social disadvantage (mothers' educational level and mothers' country of birth) and inappropriate access to prenatal care, low number of prenatal medical visits (below 4) and late timing of first visit (after more than 12 gestational weeks). In Umbria there are 11 place of birth, 9 of I level and 2 of II level. Overall, 29.3% births occurred in 6 maternity units with fewer than 500 births in 2012 (in Italy is 7.3%). The average rate of cesarean section observed in the NTSV sample (Nulliparous, Terminal, Single, Vertex), was 28.2%. This value was higher than expected, especially in this class with an indication for the physiological birth. The World Health Organization recommends that the caesarean section rate should not be higher than 10% to 15%. Moreover there is a wide variability between birth centers (7.2% -41.4%). The use of mother and child prenatal care services was associated with individual characteristics of the mothers from less advantage social classes (i.e., unemployed or poorly educated); cesarean section was higher than expected, especially in the NTSV sample; we foresee an important role for application of indicators that proactively help health-care professionals to deliver the right care at the right time.

Assessing the Influence of Clinic-based Health Education on Pregnant Women's Utilization of Primary Health Care Services in Ogun State

Aims: The paper assessed the influence of clinic - based health education (C - BHE) on pregnant women’s attitude in relation to birth preparedness, complication and readiness (BP/CR) and utilization of Primary Health Care (PHC) services in Ogun State. Study Design : Quasi - experimental design was used. Primary data was collected from surveyed participants. Place and Duration of Study: Study was conducted between February and May 2013 in Ikenne, Ogun state, Nigeria. Methodology: Stratified sampling method was used to allocate 48 pregnant women, attending ante - natal care, each to experimental and control groups, making a total of 96 respondents. Structured questionnaire was used to collect data from the respondents. The women in the experimental group were exposed to two hours of health education discussion addressing pertinent maternal health issues weekly for five weeks. Data were analyzed using descriptive statistics and independent t - test. All tests were measured at p ≤0.05 level of significance. Results: Results showed that the women were between 19 and 24 years, had up to secondary education, recorded parity of 1 - 2 while timing of first visit was between 20 and 24 weeks of gestation and number of Ante - natal visits were ≥ 4. At baseline, there were no significant difference in the attitudes and desires for utilization of PHC facility for delivery for the experimental and Original Research Article

Clinical and Epidemiological Characteristics of HIV Infection/AIDS in Hospitalized Patients.

Introduction:More than three decades after recognition of acquired immunodeficiency syndrome (AIDS) in the United States, the pandemic of human immunodeficiency virus (HIV) infection has dramatically changed the global burden of disease.Aim:The main goal of this research is retrospective analysis of epidemiological and clinical characteristics of 28 HIV infected patients, who were diagnosed and treated at the Clinic for Infectious Diseases in University Clinical Center Tuzla in the period from 1996 until the end of 2013.Subjects and Methods:Retrospective analysis was performed using the medical records of 28 HIV-infected persons. Two rapid tests were used for HIV testing: OraQuick Advance test, Vikia HIV1/2, Elisa combo test, HIV RNA test. AIDS disease was determined by using the criteria from WHO.Results:Among a total of 28 HIV-infected persons, 23 (82.14%) were males and 5 (17.86%) were females, with the male: female ratio of 4,6:1. In terms of the transmission route, a large proportion of cases were infected through heterosexual contact 19 (67.86%). At the time of the first visit, 16 (57.15%) patients showed asymptomatic HIV infection, 4 (14.28%) HIV infection with symptoms other than the AIDS defining diseases, and 8 (28.57) had AIDS. At the time of first hospital visit, the CD4 + cells count ranged from 40 to 1795/µl (conducted in 19 patients), and mean value of CD4 + cells was 365,31/µl, and mean HIV RNA titer was 287 118 copies/ml³. Of 28 HIV-infected persons 39 cases of opportunistic diseases developed in 12 patients (42.9%). In terms of the frequency of opportunistic diseases, tuberculosis (12 cases, 42.9%). Among a total of 28 HIV-infected patients, 6 (21.4%) of them died.Conclusion:This study characterizes the epidemiological and clinical patterns of HIV–infected patients in Tuzla region of Bosnia and Herzegovina to accurately understand HIV infection/AIDS in our region, in the hope to contribute in the establishment of effective HIV guidelines in the Tuzla region of B&H in the future.

Predictors of Timing of First Antenatal Care Booking at Public Health Centers in Mekelle City, Northern Ethiopia

Background: Early antenatal care attendance during pregnancy is important to identify risk factors in pregnancy and to encourage women to have a skilled attendant at childbirth. But many pregnant women in sub-Saharan Africa start antenatal care attendance late, mostly in the second and third trimester. According to Ethiopian DHS 2011, Antenatal care coverage of Ethiopia is 34% and only 11% pregnant women start antenatal care timely. This indicates most pregnant mothers are not benefited from the services. Hence this study is aimed at assessing timing of first antenatal care visit and identifies factors affecting early attendance. Methods: Cross sectional descriptive study design was used. Data was collected from 410 systematically selected pregnant women who were attending antenatal care service at selected five governmental health centers of Mekelle city using pre-tested and interviewer administer structured questionnaire. SPSS version 16 was used to analyze the data. Socio demography, obstetric history and knowledge on advantage of early ANC booking and time when to start ANC were analyzed to see association with timing of antenatal care using bivarite and multivariate logistic regression analysis. Result: The proportion of respondents who made their first antenatal care within the recommended time (before or at 16 weeks of gestation) was found to be 32.7%. Multivariate analysis revealed that respondents with history of still birth, had obstetric problem for the current pregnancy, knowledge of timing of first visit and those pregnant women who had accompany to the health center for ANC visit were more likely to book ANC within the recommended time. Educational status of pregnant women and gravidity status has not significantly associated with timing of ANC booking. Conclusions: Majority of pregnant women do not practice early booking of antenatal care provided that the service is accessible. In order to improve the situation, adequate information should be provided to community.