Catholic Hospital Affiliation and Postpartum Contraceptive Care and Subsequent Deliveries.

Importance: In recent years, the number of Catholic hospitals has grown, raising concerns about access to contraception. The association between living in an area in which the closest hospital is Catholic and the probability of postpartum contraception and subsequent deliveries is unknown. Objective: To assess whether living in an area in which the closest hospital was Catholic was associated with the probability of postpartum contraception and subsequent deliveries. Design, Setting, and Participants: This cohort study used data from the Healthcare Cost and Utilization Project's State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases for 11 states (California, Florida, Georgia, Missouri, Nebraska, Nevada, New York, South Carolina, Tennessee, Vermont, and Wisconsin). Female patients with a delivery from 2016 to 2019 who lived within 20 miles of a nonfederal acute care hospital were included, with patients followed up for 1 to 3 years. Coarsened exact matching was used to match patients based on the county-level percentage of the population affiliated with Catholic churches and urbanicity, and the zip code-level number of hospitals within 5 and 20 miles, median household income, and percentage of the population by race and ethnicity. Data were analyzed from April 2022 to November 2023. Exposures: Residence in a zip code in which the closest hospital was Catholic. Main Outcomes and Measures: Probabilities of delivery at a Catholic hospital, surgical sterilization within 1 year of delivery, receipt of long-acting reversible contraception at delivery, and subsequent delivery within 3 years. Results: The sample consisted of 4 101 443 deliveries (1 301 792 after matching), with 14.5% of patients living in exposed zip codes (ie, where the closest hospital was Catholic). Living in exposed zip codes was associated with a 21.26-percentage point (pp) increase in the probability of delivery at a Catholic hospital (95% CI, 19.50 to 23.02 pp; 237.3% relative to the mean in unexposed zip codes; P < .001). Additionally, comparing exposed vs unexposed zip codes, the probability of surgical sterilization at delivery decreased by 0.95 pp (95% CI, -1.14 to -0.76 pp; P < .001) and the probability of sterilization in the year after discharge further decreased by 0.21 pp (95% CI, -0.29 to -0.13; P < .001). Subsequent deliveries within 3 years increased 0.47 pp (95% CI, -0.03 to 0.97 pp; 2.3% relative to the mean in unexposed zip codes; P = .07). Conclusions and Relevance: This cohort study finds that living in a zip code in which the closest hospital was Catholic was associated with a modest decrease in the probability of postpartum surgical sterilizations and a modest increase in the probability of subsequent deliveries.

The introduction of a paediatric ENT and anaesthesia skills course in Kilimanjaro Christian Medical Centre hospital, (KCMC), Moshi, Tanzania.

Human factors and a safe operating theatre environment are of paramount importance, wherever surgery is undertaken. The majority of patients in sub-Saharan Africa do not yet have access to safe surgery. The Paediatric ENT Skills and Airway Course introduced and evaluated here was designed to improve outcomes and safety in a typical East African environment. The lectures, tutorials and practicals covered technical and non-technical skills. Responses from pre- and post-course questionnaires were evaluated as an initial surrogate for effectiveness of this course. The latter showed improvement in all taught skills and found universal recommendation. The course had been established to try to minimise morbidity and mortality after paediatric surgery at our institution, KCMC. We encouraged team co-operation in the care of patients, and recommend other centres consider similar courses building on human factors for safer operating theatre working practices.

O Grace Memorial Hospital e a Missão Presbiteriana norte-americana no Brasil: fontes para a história da assistência à saúde, 1955-1971 / Grace Memorial Hospital and the American Presbyterian Mission in Brazil: sources for the history of healthcare, 1955-1971

Resumo Apresenta aspectos da história e do acervo documental do Grace Memorial Hospital, instituição criada em 1926 na antiga cidade de Ponte Nova, atual Wagner, na Chapada Diamantina (BA), pelo médico e missionário presbiteriano norte-americano Walter Welcome Wood. O corpus documental está sob guarda da Universidade do Estado da Bahia, campus II, Alagoinhas, desde o encerramento definitivo das atividades do hospital, e constitui-se em fonte de pesquisa para diferentes áreas de estudo, especialmente para a história da assistência à saúde no Brasil. Os documentos auxiliam as análises sobre a incidência de doenças, tratamentos médicos e outros cuidados com a saúde em uma população que não tinha acesso a outras instituições que atuassem nesse âmbito.

Abstract The paper presents aspects of the history and archives of Grace Memorial Hospital, founded in 1926 in the former town of Ponte Nova, now Wagner, in the Chapada Diamantina region of Bahia state, Brazil, by the American Presbyterian missionary and doctor Walter Welcome Wood. The documents in question have been kept at the Universidade do Estado da Bahia, campus II, Alagoinhas, since the hospital closed down definitively. They constitute a source of research for different areas of scholarship, especially the history of healthcare in Brazil. The documents are used in analyses of the incidence of diseases, medical treatments, and other care given to a population that had no access to other institutions working in this area.

[Establishment of a trauma surgical department at the Diospi Suyana missionary hospital in Curahuasi, Peru]. / Aufbau einer unfallchirurgischen Abteilung am Missionsspital Diospi Suyana in Curahuasi, Peru.

The confusingly structured and in many areas corrupt health system in Peru even today provides only a fragmentary and insufficient medical treatment especially for the indigenous population (mainly Quechua Indians). Since October 2007 the Diospi Suyana missionary hospital in Curahuasi (State of Apurímac) has provided an affordable medical treatment at a high level mainly for these indigenous people of Peru; however, so far the hospital could only insufficiently meet the traumatological needs of the region. The establishment of a surgical trauma department aims to meet those needs but is also encumbered by special problems and challenges. Some patients, for example only present at the hospital after the fractures have already incorrectly healed, sometimes many weeks or even months after the trauma either due to a long journey through the country to different hospitals where treatment was not possible or they could not pay for the treatment and sometimes because of inadequate prior treatment, for example by traditional healers. Cultural and infrastructural particularities of the country must be included in the process of choosing the right method of treatment.

Circumventing 'free care' and 'shouting louder': using a health systems approach to study eye health system sustainability in government and mission facilities of north-west Tanzania.

BACKGROUND: Little is known about the contributions of faith-based organisations (FBOs) to health systems in Africa. In the specialist area of eye health, international and domestic Christian FBOs have been important contributors as service providers and donors, but they are also commonly critiqued as having developed eye health systems parallel to government structures which are unsustainable. METHODS: In this study, we use a health systems approach (quarterly interviews, a participatory sustainability analysis exercise and a social network analysis) to describe the strategies used by eye care practitioners in four hospitals of north-west Tanzania to navigate the government, church mission and donor rules that govern eye services delivery there. RESULTS: Practitioners in this region felt eye care was systemically neglected by government and therefore was 'all under the NGOs', but support from international donors was also precarious. Practitioners therefore adopted four main strategies to improve the sustainability of their services: (1) maintain 'sustainability funds' to retain financial autonomy over income; (2) avoid granting government user fee exemptions to elderly patients who are the majority of service users; (3) expand or contract outreach services as financial circumstances change; and (4) access peer support for problem-solving and advocacy. Mission-based eye teams had greater freedom to increase their income from user fees by not implementing government policies for 'free care'. Teams in all hospitals, however, found similar strategies to manage their programmes even when their management structures were unique, suggesting the importance of informal rules shared through a peer network in governing eye care in this pluralistic health system. CONCLUSIONS: Health systems research can generate new evidence on the social dynamics that cross public and private sectors within a local health system. In this area of Tanzania, Christian FBOs' investments are important, not only in terms of the population health outcomes achieved by teams they support, but also in the diversity of organisational models they contribute to in the wider eye health system, which facilitates innovation.

Prevalence of undiagnosed dysglycemia in an emergency department observation unit.

BACKGROUND: The proposed 2015 US Preventive Services Task Force guidelines recommend diabetes screening for individuals ≥45 years or demonstrating other risk factors for dysglycemia. Still, many patients with dysglycemia remain undiagnosed, and opportunities for early intervention are lost. METHODS: To test novel approaches for diagnosis using the haemoglobin A1c (HbA1c ) test, we screened adult patients who were admitted to an observation unit from the emergency department with no known history of pre-diabetes or diabetes. RESULTS: Of 256 subjects, 9% were newly diagnosed with diabetes and 52% were newly diagnosed with pre-diabetes. Of those aged 18-29 years, 33% were newly diagnosed with dysglycemia, while 55% of those aged 30-44 years and 70% of those aged ≥45 years were newly diagnosed with dysglycemia. CONCLUSIONS: Our results suggest that regardless of age, a large proportion of patients in the emergency department observation unit have undiagnosed dysglycemia, an important finding given the large number of observation admissions. Copyright © 2015 John Wiley & Sons, Ltd.

Dignity's transgender bias case could signal more religious freedom clashes.

Legal disputes over coverage of transgender-related care may become a source of tension for Catholic health systems and other employees.

[A development of Byzantine Christian charities during the 4(th)-7(th) centuries and the birth of the hospital].

This study aims to examine the beginning and the development of Christian Charities during the 4(th)-6(th) centuries which would eventually result in the birth of the hospital in modern sense in the first half of the 7(th) century. For this purpose, I looked carefully into various primary sources concerning the early Christian institutions for the poor and the sick. Above all, it's proper to note that the first xenodocheion where hospitality was combined with a systematic caring, is concerned with the Trinitarian debate of the 4(th) century. In 356, Eustathios, one of the leaders of homoiousios group, established xenodocheion to care for the sick and the lepers in Sebaste of Armenia, whereas his opponent Aetios, doctor and leader of the heteroousios party, was reckoned to have combined the medical treatment with his clerical activities. Then, Basil of Caesarea, disciple of Eustathios of Sebaste, also founded in 372 a magnificent benevolent complex named 'Basileias' after its founder. I scrupulously analysed several contemporary materials mentioning the charitable institution of Caesarea which was called alternatively katagogia, ptochotropheion, xenodocheion. John Chrysostome also founded several nosokomeia in Constantinople at the end of the 4(th) century and the beginning of the 5(th) century. Apparently, the contemporary sources mention that doctors existed for these Charities, but there is no sufficient proof that these 'Christian Hospitals,' Basileias or nosokomeia of Constantinople were hospitals in modern sense. Imperial constitutions began to mention ptochotropheion, xenodocheion and orphanotropheion since the second half of the 5(th) century and then some Justinian laws evoked nosokomium, brephotrophia, gerontocomia. These laws reveal that 'Christian Hospitals' were well clarified and deeply rooted in Byzantine society already in these periods. And then, new benevolent institutions emerged in the 6(th) century: nosokomeia for a specific class and lochokomeia for maternity. In addition, one of the important functions of Sampson Xenon was, according to Novel 59, to hold a funeral service for the people of Constantinople. Nevertheless, there is no sufficient literary material that could demonstrate the existence of a hospital in modern sense. The first hospital where outpatient service, hospitalization and surgery were confirmed was Sampson Xenon in the first half of the 7th century, figured in the tale of Stephanos of the The Miracles of St. Artemios. Why was the early Byzantine literary so reticent as to write the medical activities in the Christian Charities? It's because Christian innovation didn't rest on the medical treatment but caring for the poor and the sick, depending on the word of Mt. 25.35-36. In this meaning, I'd like to say that the Early Byzantine history of Christian Charities or 'Christian Hospitals' consists of only a footnote of the verse.

Santa Casa de Misericórdia e as políticas higienistas em Belém do Pará no final do século XIX / Santa Casa de Misericórdia and hygienist policies in Belém do Pará in the late nineteenth century

O artigo analisa a relação entre as políticas higienistas que vigoraram na cidade de Belém ao final do século XIX e a expansão das atividades da Santa Casa de Misericórdia do Pará. Considerada uma das primeiras instituições hospitalares da então Província do Grão-Pará, a Irmandade, além de seu hospital próprio, administrou diversos outros estabelecimentos de saúde na capital. O estudo de seu deslocamento físico permite o "desenho" de três núcleos da Saúde em Belém: Pioneiro, de Expansão e da Santa Casa, que reforçam os vetores de crescimento da cidade. A expansão de suas atividades se configura como ampliação da Misericórdia para atender os desvalidos e enfermos, que precede a instauração de um sistema de saúde pública no Pará.

The article analyzes the relationship between hygienist policies in effect in Belém in the late nineteenth century and the expansion of activities of the Santa Casa de Misericórdia do Pará. Considered one of the first hospital institutions in the former Grão-Pará Province, in addition to its own hospital, the Brotherhood administered several other health facilities in the capital, and the study of its physical displacement made it possible to "map" three health centers in Belém: Pioneer, Expansion and the Santa Casa, which reinforce the growth vectors of the city. The expansion of its activities is configured as the expansion of the Santa Casa de Misericórdia to serve the underprivileged and sick, preceding the establishment of a public health system in Pará.

Temozolomide in the treatment of newly diagnosed diffuse brainstem glioma in children: a broken promise?

BACKGROUND: The purpose of this study was to assess the efficacy and toxicity of radiotherapy (RT) with concurrent temozolomide (TMZ) chemotherapy followed by adjuvant TMZ in children with diffuse intrinsic pontine glioma (DIPG). METHODS: Patients younger than 18 years with newly diagnosed DIPG were enrolled. Children were treated with focal RT along with concurrent daily TMZ. Four weeks after completing the initial RT-TMZ schedule, adjuvant TMZ was given every 28 days up to 12 cycles or progression disease. RESULTS: Fifteen children with a median age of 9 years were enrolled. Fourteenth out of the 15 patients completed the chemoradiotherapy. The toxicity associated with TMZ was primarily haematopoietic. At a median follow-up of 15 months 13 children had died and 2 children were alive with progressive disease. No patient experienced complete response (CR). The median time to progression was 7.15 months. CONCLUSION: Chemoradiotherapy with TMZ followed by adjuvant TMZ did not improve the poor prognosis associated with DIPG in children.

Costs of eye care services: prospective study from a faith-based hospital in Zambia.

PURPOSE: To estimate the mean costs of cataract surgery and refractive error correction at a faith-based eye hospital in Zambia. METHODS: Out-of-pocket expenses for user fees, drugs and transport were collected from 90 patient interviews; 47 received cataract surgery and 43 refractive error correction. Overhead and diagnosis-specific costs were determined from micro-costing of the hospital. Costs per patient were calculated as the sum of out-of-pocket expenses and hospital costs, excluding user fees to avoid double counting. RESULTS: From the perspective of the hospital, overhead costs amounted to US$31 per consultation and diagnosis-specific costs were US$57 for cataract surgery and US$36 for refractive error correction. When including out-of-pocket expenses, mean total costs amounted to US$128 (95% confidence interval [CI] US$96--168) per cataract surgery and US$86 (95% CI US$67--118) per refractive error correction. Costs of providing services corresponded well with the user fee levels established by the hospital. CONCLUSION: This is the first paper to report on the costs of eye care services in an African setting. The methods used could be replicated in other countries and for other types of visual impairments. These estimates are crucial for determining resources needed to meet global goals for elimination of avoidable blindness.

As Santas Casas da Misericórdia do Distrito de Lisboa e sua contribuição para a História da Enfermagem em Portugal / The Holy House of Mercy in the district of Lisbon and the contributions for the History of Nursing in Portugal

Embora tenham surgido algumas investigações sobre a História da Enfermagem em Portugal, estamos apenas numa fase inicial de um caminho a percorrer. As Misericórdias em Portugal foram responsáveis pela gestão da maioria dos hospitais, desde o século XVI ao XX e possuem um enorme acervo documental para a compreensão das funções dos enfermeiros nessas instituições. Quisemos identificar a importância das Misericórdias do Distrito de Lisboa para a construção da História da Enfermagem em Portugal, assim como enumerar o principal acervo documental em cada Misericórdia. Esta viagem pelas Misericórdias do Distrito de Lisboa permitiu-nos constatar a existência de um enorme acervo documental, quer em relação aos seus compromissos, quer em relação aos regulamentos dos hospitais. Quer nos primeiros, mas principalmente nos segundos, encontramos um conjunto de funções para os enfermeiros, que nos levam á possibilidade da construção de uma História da Enfermagem nesse hospital e nessa localidade.Teremos à nossa disposição as Misericórdias de Lisboa, Cascais, Sintra e Ericeira, com uma organização arquivista, enquanto as restantes nos levam a uma procura mais desenvolvida.

Tubal ligation in Catholic hospitals: a qualitative study of ob-gyns' experiences.

OBJECTIVE: Tubal sterilization remains one of the most commonly requested contraceptive methods in the United States. Catholic hospital policy prohibits all sterilizations, but this ban is not uniformly enforced. We conducted this study to assess obstetrician-gynecologists' beliefs and experiences with tubal ligation in Catholic hospitals. STUDY DESIGN: We interviewed 31 obstetrician-gynecologists geographically dispersed throughout the US who responded to a national survey and agreed to be contacted for a follow-up interview or who were referred by colleagues from the survey sample. Twenty-seven had experienced working in a Catholic hospital. Interviews were open ended and guided by a semistructured instrument. Transcripts were thematically analyzed. RESULTS: Obstetrician-gynecologists disagreed with strict prohibition of sterilizations, especially when denying a tubal ligation placed the patient at increased medical risk. Cesarean delivery in Catholic hospitals raised frustration for obstetrician-gynecologists when the hospital prohibited a simultaneous tubal ligation and, thus, sent the patient for an unnecessary subsequent surgery. Obstetrician-gynecologists described some hospitals allowing tubal ligations in limited circumstances, but these workarounds were vulnerable to changes in enforcement. Some obstetrician-gynecologists reported that Catholic policy posed greater barriers for low-income patients and those with insurance restrictions. CONCLUSION: Obstetrician-gynecologists working in Catholic hospitals in this study did not share the Church's beliefs on sterilization. Research to understand patients' experiences and knowledge of their sterilization options is warranted in order to promote women's autonomy and minimize risk of harm. IMPLICATIONS STATEMENT: Tubal sterilization, even when medically indicated or in conjunction with cesarean delivery, is severely restricted for women delivering in Catholic hospitals. For women whose only access to hospital care is at a Catholic institution, religious policies can prevent them from receiving a desired sterilization and place them at risk for future undesired pregnancy.

Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise.

Communicating openly and honestly with patients and families about unexpected medical events-a policy known as full disclosure-improves outcomes for patients and providers. Although many certification and licensing organizations have declared full disclosure to be imperative, the adoption of and adherence to a full disclosure protocol is not common practice in most clinical settings. We conducted a case study of Ascension Health's implementation of a full disclosure protocol at five labor and delivery demonstration sites. Twenty-seven months after implementation, the rate of full disclosure had increased by 221 percent. Practitioners saw insurers' acceptance of the full disclosure protocol, consistent and ongoing leadership by local practitioners and hospitals, the establishment of a well-trained local investigation and disclosure team, and disclosure training for practitioners as key catalysts for change. Lessons learned from this multisite initiative can inform liability insurers and guide providers who are committed to ensuring that full disclosure becomes the only response to unexpected medical events.

The presence of anti-HLA donor-specific antibodies in lung allograft recipients does not correlate with C4d immunofluorescence in transbronchial biopsy specimens.

CONTEXT: C4d immunofluorescence (IF) is a surrogate for development of donor-specific antibodies (DSAs) against human leukocyte antigen (HLA) class I and II antigens in kidney and heart biopsy specimens for monitoring of antibody-mediated (humoral) allograft rejection (AMR). Use of C4d IF in monitoring of lung allografts has shown conflicting results. OBJECTIVE: To determine if C4d IF can be used as a reliable marker for AMR and if it correlates with the presence of DSAs and histologic findings on biopsy. DESIGN: All transbronchial biopsies in lung allograft recipients, performed at our institution in a 3-year period, were reviewed. A cohort of 92 patients with 110 corresponding biopsies met the inclusion criteria of (1) having a resulted DSA within 2 weeks of biopsy and (2) having C4d immunofluorescence studies performed and confirmed. RESULTS: Twenty-nine patients (31.5%) were positive for DSAs and 63 patients (68.5%) did not develop DSAs. Positive C4d capillary IF was seen in 18 of 110 total biopsy specimens (16.4%). Eight of these biopsy samples were from patients positive for DSAs and 10 were from patients negative for DSAs. The correlation coefficient between the presence of DSAs and C4d IF was 0.1628 (P = .09). CONCLUSIONS: A significant proportion of DSA-positive patients had negative C4d IF results and frequently have no histologic changes on biopsy specimens. DSA-negative patients can be positive for C4d and may show the same histologic changes as reported for DSA-positive patients. Diagnosis of AMR in lung may require a collaborative approach combining clinical data, DSA status, and histology.

Immunoparesis and monoclonal gammopathy of undetermined significance are disassociated in advanced age.

Immunoparesis and a skewed serum free light chain (FLC) ratio are indicators of immune dysfunction predictive of progression from monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM). Previous studies have reported increased prevalence of MGUS by age, but no study has examined the relationship between immunoparesis and abnormal FLC ratios in the elderly. We screened 453 older adults (median age, 80 years; range, 65-96) to characterize the patterns of immunoparesis and abnormal FLC ratio in relation to MGUS. We defined MGUS in 4.4% of the subjects; the prevalence was 12.5% among individuals of >90 years. In MGUS (vs. non-MGUS) cases, immunoparesis and abnormal FLC ratios were detected in 70.0% (vs. 49.0%; P = 0.07) and 50.0% (vs. 12.9%; P = 0.0001), respectively. Based on small numbers, MGUS patients with abnormal FLC ratio were borderline (P = 0.07) more likely to have immunoparesis. Overall, the prevalence of immunoparesis varied in a nonlinear fashion, with lowest frequencies in the youngest and oldest groups. Our observed disassociation between MGUS prevalence and impaired immunoglobulin production suggests that separate mechanisms are involved in the development of MGUS and immunoparesis in advanced age. These findings emphasize the need for molecularly defined methods to characterize myeloma precursor states and better predict progression to MM.

The journey to zero central catheter-associated bloodstream infections: culture change in an intensive care unit.

A process change with the goal of decreasing and ultimately eliminating bloodstream infections associated with central catheters in critical care patients was implemented at Riverside Methodist Hospital. This process of implementation resulted in a culture change in the hospital's medical surgical intensive care unit. Keys to success included a multidisciplinary team approach, support from persons with a stake in the process, and provision of continuous feedback. The lessons learned in this journey at Riverside Methodist Hospital can help caregivers at other hospitals decrease the occurrence of these life-threatening infections.