Need For Treatment Research Articles

The Unmet Treatment Need for Eating Disorders: What Has Changed in More Than 10 Years? An Updated Systematic Review and Meta-Analysis.

A minority of individuals with eating disorders seek help from health professionals qualified to provide eating disorder care. This review assessed the proportion of individuals with eating disorders who had sought help or received treatment, as an update to an earlier review conducted more than a decade ago. Three databases were searched for studies that: (1) included a community sample of help-seekers and non-help seekers, (2) used a standardized eating disorder screening instrument, and (3) assessed the percentage of participants who had sought help specifically for eating disorder concerns. Of 972 articles, 21 studies met inclusion criteria, representing 37,423 participants. The pooled proportion reporting help-seeking from any source (e.g., helpline, support groups, chat rooms as well as health professionals) was 30% and the pooled proportion reporting formal treatment seeking from health professionals (e.g., psychologist) specifically for eating disorder concerns was 32%. However, there was evidence of publication bias across studies. These rates suggest little to no improvement in the unmet need for treatment since the last review with studies continuing to focus on white adult women. Help-seeking rates among other populations remain unclear and there is an urgent need to understand reasons for overall low help-seeking rates. Clear definitions and measures of help-seeking with appropriate distinctions between sources of help are needed to improve our understanding of help-seeking pathways and identify solutions to facilitate help-seeking. Better visibility of health professionals qualified to provide safe and effective eating disorder care could help reduce the substantial treatment gap.

Continuous peripheral nerve blocks for burn management: a retrospective study of outcomes and complications in 281 burn patients.

There is scarce literature regarding the use of continuous peripheral nerve blocks in acute burn patients, who may be at higher risk for catheter-related complications, including infection. We sought to describe our center's experience and infection rate with continuous perineural catheters in the setting of pain management for patients suffering from burns. A retrospective observational study was performed including all patients admitted to an American Burn Association-verified regional burn center between January 2018 and July 2023 who received a continuous peripheral nerve block for an acute burn injury. There were 281 patients in the study cohort who received 484 perineural catheters. The cohort was 52% men with a median age of 39 years (IQR 30-55). A catheter-associated infection, defined as a clinical diagnosis by the treating physicians requiring the need for treatment with antibiotics or surgical debridement, was identified in six perineural catheters (1.2%, 95% CI 0% to 2.2%) involving six different patients (2.1%, 95% CI 0% to 3.8%). The median total body surface area burned was 5% (IQR 2-9%) and 20% of patients had full-thickness burns. The most commonly used catheters were infraclavicular (49%), popliteal sciatic (29%), femoral (19%), and adductor canal (17%). One-third (33%) of patients did not require operating room debridement as the block provided sufficient analgesia for bedside debridement. The median duration of catheter use was 6 days (IQR 4-8). There were no documented cases of nerve injury or toxicity, vascular injury, or local anesthetic systemic toxicity. In our practice, continuous perineural catheters in the setting of acute burns are associated with an infection rate comparable to other surgical populations.

Carotid artery stenosis: diagnosis and guidelines for management

In carotid artery stenosis, the carotid arteries become blocked by fatty cholesterol deposits. Older individuals with high cardiovascular risk are disproportionately susceptible to this condition, for which risk factors include smoking, high cholesterol, male sex, and older age. When the vascular endothelium is damaged by the above-mentioned causes, low-density lipoproteins invade the inside of the endothelium and undergo an oxidation process. Monocytes infiltrate the endothelium in response to oxidized low-density lipoproteins and transform into lipid-laden macrophages, thereby activating inflammatory responses. As this inflammatory reaction progresses further, various decomposing enzymes are secreted, causing the atherosclerotic plaque to rupture and various thrombogenic materials to be secreted into the blood, resulting in the formation of blood clots and vascular stenosis or occlusion. This can cause symptoms ranging from mild, such as blurred-vision, to severe, such as life-threatening stroke. Carotid artery stenosis accounts for approximately 10% of all strokes. Therefore, early diagnosis and appropriate management are very important. When choosing between medical and surgical treatment, it is necessary to consider various factors, such as patient characteristics, symptoms, risk factors, and imaging results. In this review, we discuss the pathophysiology of carotid artery stenosis, risk factors, and the importance of prompt diagnosis and treatment. In particular, we focus on how to determine the need for treatment and select management methods for each individual patient.

Emergency department visits, inpatient hospitalizations, and non-fatal and fatal drug overdoses during COVID-19 among Veterans with opioid use disorder.

The COVID-19 pandemic had dramatic adverse impacts on people with opioid use disorder (OUD), as evidenced by significant disruptions to care and unprecedented increases in drug overdoses. In this study, we evaluated the impacts of COVID-19 on utilization of emergency and inpatient care, and fatal and non-fatal overdoses among veterans with OUD. We used Veterans Health Administration (VHA) electronic medical record and mortality data to compare emergency department (ED) visits, inpatient hospitalizations, and fatal and non-fatal overdoses between a pandemic-exposed cohort of veterans with OUD observed both pre- and post-pandemic onset (n = 53,803; observed January 2019-March 2021) to a matched pre-pandemic control group (n = 53,803; observed October 2017-December 2019). Compared to pre-pandemic trends, there were significant decreases in the odds of ED and inpatient admissions and total number of ED and inpatient admissions during COVID-19. There was a significant decrease in the odds of having a recorded non-fatal overdose. The odds of overdose death increased during the pandemic compared to pre-pandemic trends. We observed significant decreases in the utilization of ED and inpatient care services, and fewer non-fatal overdoses, post-pandemic onset. Healthcare disruptions limiting access to emergency and inpatient care could account for the lower number of recorded non-fatal overdoses, potentially reflecting an underestimate of risk. In contrast, fatal overdoses increased during the pandemic compared to pre-pandemic trends. Lower utilization of emergency and inpatient care, and higher rates of fatal overdoses during the pandemic, suggest an exacerbation of unmet treatment need post-pandemic onset.

An Insight into the Structure-Activity Relationship of Benzimidazole and Pyrazole Derivatives as Anticancer Agents.

Cancer is a leading cause of death worldwide, driving the urgent need for new and effective treatments. Benzimidazole and pyrazole derivatives have gained attention for their potential as anticancer agents due to their diverse biological activities. The development of resistance in cancer cells, toxicity concerns, and inconsistent efficacy across different types of cancer are a few of the challenges. To overcome these challenges, optimisation of these nuclei using the structure-activity relationships is necessary. This review aimed to examine various benzimidazole, pyrazole, and their hybrid derivatives by focusing on their structure-activity relationships (SAR) as anticancer agents. Results of the most potent and least potent benzimidazole, pyrazole compounds, and their hybrid derivatives published by researchers were compiled. The findings of different researchers working on benzimidazole and pyrazole nuclei were reviewed and analysed for different targets and cell lines. Moreover, substitutions on different positions of pyrazole, benzimidazole, and their hybrid were summarised to derive an optimised pharmacophore. Based on our analysis of existing studies, we anticipate that this review will guide researchers in creating potent pyrazole, benzimidazole, and hybrid derivatives crucial for combating cancer effectively. Structure-Activity Relationship (SAR) studies can help in developing pyrazolebenzimidazole hybrids that are more powerful and selective in targeting specific aspects of cancer.

Virtual screening and lead optimization of Desmostachya bipinnata-derived FGFR inhibitors for oral squamous cell carcinoma management

BackgroundOral cancer remains a major global health challenge with limited therapeutic options, highlighting the need for novel treatments. Phytochemicals derived from Desmostachya bipinnata (Db), a plant used in traditional Chinese medicine for its anti-inflammatory and analgesic properties, have demonstrated potential anti-cancer effects. However, their mechanisms of action, particularly in targeting Fibroblast Growth Factor Receptor (FGFR) in oral cancer, are not well characterized. ObjectiveThis study aimed to leverage in-silico drug design methodologies to identify bioactive compounds from Db with potential FGFR-inhibiting activity for the treatment of oral cancer. MethodologyAn MTT assay was conducted using KB cell lines to evaluate cytotoxic effects, while thirty-eight phytochemicals from Db were screened through in silico approaches for their pharmacokinetics, toxicity, and drug-likeness. Molecular docking studies were performed to assess binding affinities to the FGFR protein. The biological activity and toxicity of the compounds were predicted to prioritize candidates for further investigation. ResultsFourteen compounds were identified as promising candidates based on their drug-like properties, favourable pharmacokinetic profiles, significant FGFR binding affinities, and predicted anti-cancer activity. These compounds also demonstrated potential for oral bioavailability and central nervous system penetration, supporting their candidacy for further drug development. Notably, the traditional use of Desmostachya bipinnata in TCM emphasizes its role in enhancing overall vitality and immune function, which may synergize with the identified FGFR-inhibiting properties in the context of oral cancer treatment ConclusionThe phytochemicals from Desmostachya bipinnata exhibit significant potential as FGFR-targeted therapeutic agents for oral cancer. Further experimental validation and optimization of these lead compounds could contribute to the development of novel, effective treatments for oral cancer and related conditions

A study of CPITN score in Periodontics Clinic Patients, RSGM Airlangga University, 2022

Background: Approximately 90% of the global population suffers from periodontal disesase, characterizes by bleeding gums, pain, and bad breath. The impact of this disease is diverse, ranging from tooth loss, disruption of aesthetics and confidence, to influencing individual nutritional status. The disease can be caused by damage of the periodontal tissues. Therefore, the Community Periodontal Index of Treatment Needs (CPITN) is highly essential for assessing the extend of issues in periodontal tissues, including evaluating oral and dental health problems in patients. This assessment can aid in the treatment and prevention of periodontal disease. Material and Methods: This research is a descriptive study. The population consists of all patients who visited the periodontology clinic at the Faculty of Dentistry, Airlangga University, in the year 2022. The sample was taken using a total sampling technique, involving secondary data obtained from the periodontal status cards of patients, specifically focusing on the examination data related to the condition of periodontal tissues based on the Community Periodontal Index of Treatment Needs (CPITN). Conclusion: The CPITN scores vary between gender and age groups of the patients. Therefore, bivariate research is needed to analyze the relationship of these parameters with the CPITN scores of periodontology patients.

Control of Helminth Infections in Captive Herbivores: An Overview of Experience

There are numerous challenges associated with helminth control in captive animals. The aim of the present paper is to provide an overview of the research on deworming of captive herbivorous mammals, the associated problems and the solutions sought, in order to derive recommendations for practice in the relevant institutions. The research was conducted by searching electronic internet databases and following the bibliographies in the published articles. The articles found are presented in summarized form. Most of the results relate to herbivores of the family Bovidae, followed by the families Cervidae, Equidae, Elephantidae, Camelidae and Giraffidae. Systematic data are presented on the types of anthelmintics used, dosages and application regimens for different animal species. Anthelmintics were administered at doses similar to or even higher than those used in farm animals, with no evidence of side effects. Treatment results often depended on the animal and parasite species. Incomplete cure, reinfection, and resistance to anthelmintics were the most common problems in the field. Based on the literature reviewed, the optimal prevention measures include the following: quarantine of newly arrived animals; daily or as intensive as possible cleaning of droppings; regular change of substrate in the enclosures; and monitoring of possible infections and their qualitative and quantitative composition (monthly or at least every two months). For treatments and monitoring effectiveness, recommendations include the following: individual assessment of the need for treatment; selective choice of anthelmintics; post-treatment examination between the 10th and 14th day after deworming; carrying out a group treatment after a preliminary drug effect test; conducting mass deworming only in case of a significant increase in fecal egg counts, highly pathogenic helminth species and a deterioration in the condition of the animals. In the future, more attention should be paid to new approaches such as biological control by saprophytic fungi or natural compounds as an alternative to anthelmintics. This would help minimize the use of anthelmintics, protect refugia and allow animals to remain healthy by maintaining a balance with the low levels of parasites present.

Specific symptom change associated with ecological momentary assessments of intrusive trauma memories

As the global prevalence of exposure to traumatic events rises, there is a growing need for accessible and scalable treatments for trauma-related disorders like posttraumatic stress disorder (PTSD). Intrusive reexperiencing symptoms, such as trauma-related intrusive memories (TR-IMs), are central to PTSD and a target of gold-standard treatments that are effective but resource-intensive. This study examined whether completing a brief ecological momentary assessment (EMA) protocol assessing the occurrence and phenomenology of TR-IMs was associated with decreases in intrusion symptom severity. Trauma-exposed adults (N = 139) experiencing at least 2 TR-IMs per week related to a DSM-5 criterion A traumatic event completed a 2-week EMA protocol. During this period, they reported on 18 sensory-perceptual and affective qualities of their TR-IMs three times per day and on posttraumatic stress symptom severity at day’s end. Longitudinal symptom measurements were entered into linear mixed-effects models to test the effect of Time on symptom severity. Over the 2-week protocol, intrusion symptom severity decreased, while other symptom cluster scores did not change. Within the intrusion symptoms, this effect was specific to TR-IMs and emotional reactivity to trauma reminders, and was not moderated by survey completion rate, total PTSD symptom severity, ongoing treatment, or time since trauma. This study was quasi-experimental and lacked a control group, therefore no definitive conclusions about clinical utility can be made. Nonetheless, these findings provide preliminary proof-of-principle and warrant future clinical trials assessing the clinical efficacy of EMAs of intrusive trauma memories as a scalable treatment option targeting intrusive memory symptoms.

Study of some physicochemical and bacteriological characteristics of drinking water in three selected rural communities in Wamba, Nasarawa State, Nigeria.

Access to safe drinking water remains a challenge in rural Nigeria. This study was carried out to determine physicochemical and bacteriological characteristics of drinking water in three rural communities in Wamba, Nasarawa State. A cross-sectional survey was conducted, 5 water samples were in respective cases collected from stream, well and borehole sources. Standard techniques were used for physicochemical analysis. Total viable counts, Total Staphylococcal counts, Total coliforms & Feacal coliforms in the samples were obtained using pour plate method, growth on Mannitol salt agar, growth on MacConkey agar and Eosin Methylene Blue agar respectively. Stream Water had higher values for physicochemical parameters. Stream water exhibited the highest bacterial counts, followed by well and borehole water. The Bacteria isolated were Escherichia coli, Staphylococcus aureus, Pseudomonas spp, Klebsiella spp, Proteus spp and Salmonella spp. The acid lability attributes of the isolates were determined using Nutrient Agar buffered with (4-(2- Hydroxyethyl)-1- piperazineethanesulfonic acid) and Lipase activity was assessed using Trypticase soy agar supplemented with 1% Tween 80. Statistical analysis was performed using SPSS-PC statistical package, with a p-value of < 0.05 it was considered statistically significant. These findings indicate contamination of drinking water sources, posing health risk to consumers and it shows the need for water treatment, monitoring & public health education in rural communities.

Special Needs in Substance Use Treatment for Women Who Use Drugs: Social and Mental Health Factors

Women who receive substance use treatment have a particular classification of sensitivity to European drugs and drug use (according to the EMCDDA). The average level of women’s treatment is lower than men’s across Europe, while women’s abandonment is higher than men’s. The purpose of this study was to examine the factors associated with problems for women who use drugs, analyzing several psychological and social factors (gender, substance use, mental health, source of economic support, legal status, and abuse). Methodology: This was a quantitative study. Data on 2179 people receiving rehabilitation treatment were obtained from the EuropASI survey. The dependent variables in this study were (1) a patient’s known history of addiction and mental illness; (2) primary drug use; (3) drug use in their lifetime and the past month; (4) mood in their lifetime and the past month, physical condition, and sexual abuse history; (5) mental illness in their lifetime and the past month (including suicide attempts); (6) legal status in their lifetime and the past month; (7) and source of income in the past month and (8) and the number of patients. The factor of gender was taken as a dichotomous variable (male–female). The confidence interval used was 95%. Results: In summary, we found that women had consumed more alcohol, used more drugs, and suffered more from depression, anxiety, and suicidal ideation than men, both during their lifetimes and in the past month. In addition, women were more likely than men to be stigmatized for prostitution because their financial support came mainly from colleagues, friends, and family, as well as from prostitution. Finally, women had experienced more violence (emotional, physical, and sexual) during their lifetimes and in the last month than men. Conclusion: There appears to be a need to develop a comprehensive treatment network for addictive behaviors from a multifactorial perspective, including harm reduction, psychosocial support, and recovery programs; furthermore, targeting specific groups with special needs, such as women, especially those with mental health problems, women with alcoholism, and abused women, it also seems important to develop adaptive recovery programs within addictive behavior treatment networks.

Gastrointestinal helminths of Cattle slaughtered at Gwagwalada abattoir, federal capital territory, Nigeria

Gastrointestinal parasites are widespread in cattle worldwide, causing both clinical and sub-clinical infections that can lead to significant financial losses. This study investigated the prevalence of gastrointestinal helminths infection in cattle slaughtered in the abattoir at Gwagwalada area council, federal capital territory, Nigeria. A total of 120 faecal samples were collected and analysed by flotation and sedimentation methods. The results revealed an overall prevalence of 26.67%. The helminths identified were Toxocara sp (5.00%), Schistosoma sp (10.83%), and Fasciola sp (10.83%). These findings were compared to existing studies, with variations attributed to differences in climatic conditions, management practices, and seasonal factors. Age, breed, and sex-specific analyses revealed significant differences in infection rates. While no helminth infection was found in young adult cattle (1≤3 years), a 31.37% prevalence was recorded in older adult cattle (≥3 years). Among the breeds examined, Sokoto Gudali showed the highest prevalence (100%), followed by White Fulani (26.42%) and Red Fulani (16.67%). A significant breed-related difference (p = 0.0001) was recorded. Additionally, male cattle exhibited a higher prevalence (31.37%) compared to (0.00%) in females. The study highlighted the impact of geographical, ecological, and environmental factors on helminths infection, as well as the need for strategic anthelmintic treatment, improved livestock management, and educational programs to control these infections. Regular monitoring and selective breeding may further contribute to long-term infection control in cattle populations.

Assessment of drinking-water quality in Indigenous Communities of Santa Victoria Este, Argentina

Santa Victoria Este is in the north-east region of Argentina. Historically, socio-economic marginalization and poor governmental assistance have resulted in one of the poorest regions of the country. Over 60% of its population is estimated to belong to indigenous communities. Access to water is mainly through community wells, often lacking adequate infrastructure. With the main objective of empowering indigenous communities in relation to access to safe water, we: 1) established a local laboratory with capacity to analyze microbiological and physical and chemical parameters of water and transfer capabilities to the local community to ensure long-term monitoring; 2) assessed the water quality in 34 communal wells. Results (physical, chemical, metals, and microbiological parameters) show that 70.6% of the groundwater supplies are not safe for human consumption as they exceed the limits established by Argentinian regulation. Microbiological contamination was consistently found in water storage systems (tanks), highlighting the imperative need of water treatment and maintenance. A long-term monitoring program, which includes physicochemical and microbiological parameters, is crucial to ensure the quality of water in these communities and to take appropriate decisions and measures.

Treatment Preferences in Acute Psychosis: A Comparison of Patient and Staff Perspectives on Symptom Prioritization and Biopsychosocial Interventions.

Patients with acute psychosis are often confronted with the prejudice that they refuse all treatment due to lack of insight. This study examined and compared the aims and preferences for treatment of patients with acute psychosis and of psychiatric inpatient staff. A total of 142 inpatients being treated for a psychotic disorder on either a locked or an open ward indicated which of a range of symptoms they want to be treated and which of various biopsychosocial treatment options they would like to receive. Staff members from the same wards reported which psychiatric symptoms they deemed relevant in the treatment of psychosis and which treatment options should be offered. Patients assigned the highest treatment need to neurocognitive symptoms, followed by affective and positive symptoms. In contrast, staff assigned the highest treatment need to positive symptoms, followed by neurocognitive and affective symptoms. Patients and staff on open wards expressed more treatment needs overall than did patients and staff on locked wards. Patients' desire for treatment differed across treatment types. In comparing patients on locked versus open wards, patients on open wards expressed higher approval of medication than patients on locked wards. Even patients with highly acute psychosis being treated on locked psychiatric wards endorsed treatment. Treatment preferences of this group deviated markedly in some instances from staffs' preferences. Considering their specific needs may contribute to increasing patient self-efficacy, and improving adherence to treatment.

Modulating the organization of medical care and early diagnosis of prostate cancer

Aim. To analyze the existing system of medical care organization and timely diagnostics for prostate cancer (PC).Materials and Methods. The study utilized data from official statistics to analyze the system of medical care organization and the diagnostic methods applied for prostate cancer at different stages.Results. In the country, medical care for patients with prostate cancer is organized into three levels. The first level involves family physicians, urologists, and oncologists in oncology clinics, where access to modern diagnostic facilities is limited. The second level provides advanced diagnostic services through regional oncology centers and major urology departments. The third level offers specialized care at the National Cancer Research Center (NCRC) and select urology clinics. Based on the experience of other countries, it is recommended to improve the system of medical care for prostate cancer by establishing four stages of care. The proposed model takes into account the real situation, emphasizing the need for prevention, timely diagnosis, and effective treatment in accordance with clinical protocols, as well as the coordinated use of human and technological resources from oncology, urology, and morphological services at all stages.Conclusions. The proposed model for organizing medical care, based on evidence-based practices, aims to improve early detection of prostate cancer, enhance the clinical effectiveness of treatment, and optimize the use of resources.

Factors influencing surgical treatment of De Quervain's tendinopathy: A retrospective cross-sectional observational study

BackgroundThe literature surrounding how different patient, sociodemographic, and anatomical factors influence surgical treatment of De Quervain's tendinopathy (DQT) is limited. PurposeWe hypothesised that different patient, anatomical, or sociodemographic factors influence the management of DQT with regard to non-operative vs. surgical management. MethodsThis retrospective cross-sectional study reviewed 155 cases of patients with DQT seen over a 10 year period. Patient-specific factors included age, gender, hand affected, dominant hand, steroid injection given and mean number of injections. Sociodemographic factors included ethnicity, employment, and deprivation, were measured using deprivation quintiles through The Index of Multiple Deprivation. Anatomical factors included the presence of subcompartmentalization, number of APL and EPB tendon slips, tendon thickening, exudative tenosynovitis, hypervascularization, and the presence of a sheath ganglion Patients were categorized into either non-operative or surgical cohort. Bivariate analysis was used to compare factors between the cohorts, and significant factors (p < 0.05) were included in the logistic regression model, used to predict factors influencing surgical management. ResultsBivariate analysis detected a significant difference in the mean number of steroids given between the non-operative and surgical cohort (p = 0.001) patient factors. For sociodemographic factors, a significant difference was found between deprivation quintiles (p = 0.02). From the anatomical factors, the surgical cohort had more patients with multiple APL tendon slips (p = 0.02) and the presence of a tendon ganglion sheath ganglion (p = 0.02). For patient and sociodemographic factors, logistic regression identified that the number of steroids (per patient) and being in deprivation quintile 4 were associated with surgical treatment. For anatomical factors, multiple APL tendon slips and the presence of a tendon sheath ganglion were associated with the surgical treatment. ConclusionThis study suggests that several factors are associated with the need for surgical treatment of DQT, including the number of steroid injections received, social deprivation, and anatomical factors, such as the presence of multiple tendon slips and a tendon sheath ganglion. Our findings add to the growing body of literature exploring factors that may influence treatment pathways for patients with DQT.

When toxicity is not just from gluten: a systematic review on financial toxicity and celiac disease

Abstract Background With an incidence of up to ∼2% globally, Celiac Disease (CD) is probably one of the most life-long common chronic conditions. Although ‘Financial toxicity’ (FT) has been mainly linked to oncology, significant financial burdens have been described across all healthcare domains, even in CD and to the unexpected economic effort resulting from illness and the need for treatments. This study aimed to investigate the potential relationship between CD and FT. Methods A systematic literature review was performed according to the PRISMA Statement 2020 guidelines. The search query queried the following databases: PubMed, Scopus, CINAHL and APA PsycInfo. No time and study design limits were included. Results 105 articles were found, and 25 were included in the review. The main results revealed that CD impacts physical health and imposes a significant financial burden on patients and their families. FT in CD is primarily due to the high costs of diagnosis, lifestyle changes, and expenses for gluten-free foods. Several studies highlighted the scarce adherence to the therapeutic diet due to the cost of food and poor acceptance of CD. Furthermore, since 2007, there has been increased attention to the difficulty of finding gluten-free products and their expensive fees. All these aspects, even for low-income countries, were faced differently globally, as documented by the heterogeneity of government subsidy policies highlighting the health inequity. Conclusions Considering the prevalence, a comprehensive health assessment with a global health approach should consider clinical, social, and economic aspects. This regard could improve the quality of life for CD patients and ensure fair and personalised access to care, regardless of their geographical location or financial situation. This review has highlighted the fragmentation of resources available internationally, underlining the relevance from a public health point of view. Key messages • Celiac Disease is one of the most common life-long disorders, and financial toxicity is an aspect that should be taken into account also from a public health point of view to ensure health equity. • The gluten-free diet represents an important therapeutic choice in CD; the related expensive fees could increase scarce adherence and worse health outcomes.

Who took care of patients with diabetes during the COVID-19-pandemic? A registry-based study

Abstract Background The rise of people with chronic diseases strains our healthcare system. Chronic disease management programs (CDMP) provide accessible care for patients with a chronic disease, aiming to prevent further development of the disease and avoid the need for (more costly and severe) hospital treatments. During the COVID-19 pandemic, CDMP provided at general practices (GP) for diabetic patients were downscaled. It remains unknown whether this downsizing led to increased care in other healthcare settings. We examined the changes in healthcare utilization by Dutch diabetic patients in 2020 and 2021 compared to 2019 regarding; 1) CDMP consultations, 2) hospital care for diabetes and 3) regular GP care. Methods In this retrospective observational study, data from electronic health records of GPs, participating in Nivel Primary Care Database, of 15,247 Dutch diabetic patients who were enrolled in CDMP, were linked to hospital claims data. Differences in healthcare utilization in 2020 and 2021 compared to 2019 were assessed quarterly using regression analyses. Results Results show that CDMP care was notably lower in 2020 and 2021, compared to 2019 (-35%). From Q1 2021 onwards, patients received more hospital care for diabetes (+13%) and regular GP care increased from Q3 2020 onwards (+14%). Compared to 2019, reduced CDMP contacts in 2020 were significantly associated (p = 0.001) with increased regular GP care in 2021. In the short-term, decreased CDMP in the first half of 2021 was significantly associated with increased regular GP care (p = 0.033) and hospital care (p = 0.037) in the second half of 2021. Conclusions Temporarily downscaling CDMP care during the COVID-19-pandemic was associated with increased hospital and regular GP care for diabetic patients. These findings contribute to making informed decisions regarding measures during future pandemics. Key messages • Chronic disease management programs at GPs appear to be effective in preventing disease exacerbations, and may help prevent (expensive) utilization of hospital care. • This research prompts further investigation into the desirability of CDMPs among patients, GPs, hospitals and policymakers, crucial for assessing undesirable healthcare shifts in diabetic patients.

Comparative insights into type non-A non-B vs type B acute aortic syndromes and their blood pressure management: a monocentric, retrospective, 11-year study

Abstract Background Acute aortic syndromes (AAS) are classified either as type A, if the ascending aorta is involved, or as type B, if only the descending aorta is; AAS affecting the aortic arch, alone or in combination with the descending aorta, have recently been classified as type non-A-non-B (NANB). Few and discordant data are available about the differences between type B and type NANB AAS, especially in terms of presentation, management and prognosis. Little evidence also exists about the effects of blood pressure (BP) management, peaks and variability on in-hospital outcomes in such context. In particular, the largest international AAS registry suggests a comparable course and prognosis, while a recent meta-analysis indicates a poorer clinical outcome with higher rate of complications, need of invasive treatment and mortality in the case of type NANB AAS. Methods We conducted a monocentric, observational, analytical, retrospective registry study including all patients ≥ 18 years old admitted to our tertiary referral hospital with a diagnosis of type B or type NANB AAS from January 2011 to December 2021. Epidemiological, clinical, operative and outcome data were analyzed by comparing type B and type NANB AAS patients. We also focused on systolic and diastolic BP, in terms of both peak values as well as BP variability (BPV); BPV was defined as the difference between the peak and the through value on a certain day. Blood pressure variables were analyzed in relationship with mortality and the failure of an initial conservative management. Results 274 type B and 44 type NANB AAS patients were enrolled. The only significant differences between the two groups were a higher rate of pre-operative complications in type NANB patients (p=0.002) resulting in a higher rate of invasive management (p=0.005), particularly as failure of an initial conservative strategy (p=0.018). However, comparable rates of post-operative complications and in-hospital mortality (overall 7%) were observed. In the overall population, lower limb ischemia, ST segment depression, and post-operative visceral ischemia were associated with higher in-hospital mortality. Peri-aortic effusion was independently associated with failure of conservative management, whereas diagnosis of intramural hematoma (as opposed to other subtypes of AAS) appeared to be protective. Among all BP variables (including anti-hypertensive treatment intensity and daily systolic or diastolic BP peaks and variability), only peak systolic BP on day 5 was found to be non-independently associated with a higher risk of in-hospital mortality and failure of an initially conservative strategy. Conclusions In our study type NANB AAS were more often complicated and treated invasively than type B AAS, while having the same rates of post-operative complications and overall mortality. BP peaks had only a minor effect on outcomes, while BPV and BP management intensity did not have any significant impact.OutcomesBlood Pressure

Health services consumption and barriers in the health care of persons of Roma origin in Bulgaria

Abstract Introduction Persons of Roma origin often face serious inequities concerning their state of health and their access to good quality health services. The aim of the study is to analyze the health services consumption and barriers in the health care of persons of Roma origin in Bulgaria. Methods The cross-sectional study was conducted and a semi-structured face to face interview were applied in 2022. Adult citizens of Roma origin were covered as follows: residents of Knezha - a total of 59 people and households from the towns of Knezha and Kotel - 18 families (50 persons). The cities are representative of settlements of medium size with separate neighborhoods of Roma origin. Data processing was performed by SPSS v.24. Results Over two thirds of the covered persons of Roma origin do not have health insurance. In each household an average of 1.8 uninsured people was found, but in some of the families almost all of the elderly members are not insured. Due to lack of health insurance in 14% of the households were reported a refusal to provide health care by general practitioners (GPs) and specialists in out-hospital care. 82.1% of Roma women have never had a mammography and 71.4% a smear test. In 83.3% of the households required direct payment for the provision of health services, which corresponds to the high share of informal payments in health care in Bulgaria (34 % in 2023), but among the Roma population this share is significantly higher. The households have to pay for specialized out-hospital care (66.6%), GPs (22.2%), and for emergency assistance (5,6%). 44.4% of the families have used the services of emergency care in the last one year. While in one third of the families an adult member was hospitalized in 27.8% of them there is a need for hospital treatment, which is unrealized. Conclusions The Roma population in Bulgaria is characterized by an unfavorable health profile and the health services provided to the persons of Roma origin are inadequate to their needs. Key messages • Persons of Roma origin in Bulgaria often face serious inequities concerning their state of health and their access to good quality health services. • Improving the socioeconomic status of people of Roma origin will increase their opportunities for health insurance and going to improve their access to health services.