Missed opportunity: low uptake of VMMC among men attending the OPD of a public health facility offering free VMMC services in Uganda.

BACKGROUND: Studies in various countries including Uganda and Kenya have shown a much lower incidence of the human immunodeficiency virus (HIV) among men that underwent voluntary medical male circumcision (VMMC) compared to uncircumcised men. Wakiso district, the district with the highest prevalence of HIV in Uganda (7%), has a very low estimated proportion of men who have undergone VMMC (30.5%). Within the district, various public health facilities provide free VMMC services. This study examined the prevalence and factors associated with the uptake of VMMC among men attending the outpatient department (OPD) of a public facility offering VMMC services. METHODS: We conducted a cross-sectional study between July to August 2021 using a sample of men attending the OPD at Kira Health Centre IV. We defined VMMC uptake as the removal of all or part of the foreskin of the penis by a trained healthcare professional. We determined factors independently associated with VMMC uptake using a modified Poisson regression analysis with robust standard errors at a 5% statistical significance level. Adjusted prevalence risk ratios (APRR) were reported as the measure of outcome. RESULTS: Overall, 389 participants were enrolled in the study. The mean age of the participants was 27.2 (standard deviation ± 9.02) years. The prevalence of VMMC uptake was 31.4% (95% Confidence Interval [CI] 26.8-36.2). In the adjusted analysis, the uptake of VMMC among men attending the OPD of Kira HC IV was less likely among married participants compared to unmarried participants (APRR 0.64, 95% CI 0.48-0.88), among participants from Western tribes (APRR 0.50, 95% CI 0.41-0.86) or Eastern tribes (APPR 0.31, 95% CI 0.13-0.72) compared to participants from the Central tribes and among participants who didn't disclose their sexual partner number compared to those that had one or no sexual partner (APRR 0.62, 95% CI 0.40-0.97). On the other hand, the prevalence of uptake of VMMC was 7 times among participants who were aware of VMMC compared to those who were not aware of VMMC (APRR 7.85 95% CI 1.07-9.80) and 2.7 times among participants who knew their HIV status compared to those that didn't know (APRR 2.75, 95% CI 1.85-4.0). Also, the uptake of VMMC was 85% more among participants who knew that Kira HC IV provided free VMMC services compared to those that didn't (APRR 1.85, 95% CI 1.85-4.08). CONCLUSION: VMMC among men attending the OPD at the largest public healthcare facility proving free VMMC services in Kira Municipality was low. The OPD may provide a quick win for improving VMMC uptake. Collaborative efforts among the administration of Kira HC IV, the Ministry of Health and VMMC implementation partners could work towards developing health-facility-based strategies that can improve VMMC awareness and uptake with emphasis on the OPD.

[The landscape of child and adolescent psychiatry and psychotherapy in Germany: structures, challenges, and developments]. / Die Versorgungslandschaft der Kinder- und Jugendpsychiatrie und -psychotherapie in Deutschland: Strukturen, Herausforderungen und Entwicklungen.

For children and adolescents in need of psychiatric and psychotherapeutic care, outpatient, day patient, and inpatient facilities are provided. A new development is called "inpatient equivalent treatment" that consists of home visits by a multiprofessional team. This paper depicts the landscape of Child and Adolescent Psychiatry (CAP) Services, covering its historical development and the structural, care policy, and financing backgrounds. Until 2014, there was free choice of private practice locations in the outpatient sector, leaving rural areas and marginalized neighborhoods partially undersupplied until today.The number of beds in the hospital sector decreased significantly between 1991 and 2004. It later rose again in favor of improved regional access and smaller units, with an additional 50% of day patient places. Inpatient equivalent treatments are equally effective, but not yet established nationwide; only a few innovative models have been negotiated. Regional networks of all social support systems, aiming for child psychiatric supply networks, are limited due to the pillarization of the social system. In conclusion, an imperative cooperation between all services of the Social Security Code and enabling true cross-sectoral services would benefit CAP patients.

Impact evaluation of long-lasting insecticidal nets distribution campaign on malaria cases reported at outpatient departments across all the regions in Ghana.

BACKGROUND: Malaria remains the biggest public health challenge globally, and Ghana is among the 15 highest burden malaria countries in the world, with 2% of global malaria cases and 3% deaths in 2019. This study sought to assess the impact of mass LLIN distribution campaign on malaria morbidity using all health facilities outpatient data across 15 regions of Ghana. METHODS: Data for this study was obtained from the DHIMS2 for health facilities providing OPD and malaria services in Ghana. This was an ecological study that employed the difference-in-difference approach to assess the change in proportion of uncomplicated confirmed malaria cases among OPDs in all types of health facilities in Ghana between 2015 and 2019 following the mass distribution campaign of LLINs in 2018. Malaria cases at the OPDs before and after the free LLIN mass distribution exercise were evaluated. RESULTS: The trend of the proportion of OPD cases that were confirmed uncomplicated malaria cases increased from 14.8% in 2015 to 18.9% in 2019 at the national level. The average proportion of malaria cases among OPDs in Ghana in 2019 reduced against the expected by - 3.76% (95% CI - 4.69 to - 2.84], p<0.001) among all cases, - 4.52% (95% CI [- 5.70 to - 3.34], p<0.001) among children under-fives years, - 4.10% (95% CI - 5.3 to 2.9], p<0.001) among female children under-five and - 5.18% (95% CI [- 6.33 to - 4.02], p<0.001) among male children under-five. The reduction on the average proportion of malaria cases among OPDs varied significantly across regions and the type of health facilities. CONCLUSION: The mass distribution of LLINs across Ghana in 2018 can be associated with reduction in the proportion of malaria cases among OPDs across health facilities in Ghana. The study recommends the biannual mass distribution campaigns especially in the high-density regions.

Outpatient facility volume, facility type, and the risk of serious colonoscopy-related adverse events in patients with comorbid conditions: a population-based study.

PURPOSE: Patients with a chronic comorbidity or multiple comorbidities are at much greater risk of serious colonoscopy-related gastrointestinal (GI) adverse events relative to patients with no comorbidity. It is important to identify outpatient facilities that can effectively and safely provide colonoscopy to complex patients. To address this need, the association between outpatient facilities' complex care volume and type (ambulatory surgery center (ASC) and hospital outpatient department (HOPD)) and the risks of serious GI adverse events in colonoscopy patients with single and multiple chronic comorbidities were examined. METHODS: Outpatient colonoscopies of 1,020,372 patients with single and multiple comorbidities were investigated, using a retrospective cohort study. Thirty-day hospitalizations due to colonic perforations and GI bleeding were examined. Ambulatory surgery and hospital discharge datasets from California, Florida, and New York for 2006-2009 were used. RESULTS: Higher complex care volume was associated with lower risks of adverse events in patients with comorbidities (OR 1.69; 95% CI [1.13, 2.54]). ASCs had higher risks of adverse events in patients with comorbidities relative to HOPDs (OR 2.85; 95% CI [2.40, 3.38]). Patients with single and multiple comorbid conditions, patients with systemic diseases, and complex patients of advanced age had higher risks of adverse events. CONCLUSIONS: Referring patients with single and multiple chronic comorbidities to facilities experienced in treating complex patients, or HOPDs, may reduce colonoscopy-related adverse events.

TestMeEast: a campaign to increase HIV testing in hospitals and to reduce late diagnosis.

Late diagnosis occurs in almost half of those diagnosed in the UK (HIV Prevention England, 2013. Retrieved June 22, 2014, from HIV Prevention England: http://www.hivpreventionengland.org.uk/Campaigns-Current/National-HIV-Testing-Week ). Testing occurs mainly in sexual health and antenatal clinics despite recommendations to test more broadly [Ellis, S., & Curtis, H. (2012). HIV diagnoses and missed opportunities. Results of the British HIV association (BHIVA) National Audit 2010. Clinical Medicine, 12(5), 430-434]. We report the findings of an HIV-testing week campaign to offer testing to those who have blood tests as part of routine care within outpatient clinics and emergency departments of six London hospitals. The campaign target was to test 500 patients a day during the 2013 National HIV Testing Week (NHTW). Clinic staff and medical students were trained to offer routine HIV testing. Linkage to care was arranged for those who tested HIV-positive. During NHTW we tested 2402 of the planned 2500 test target. 2402/4317 (55.6% 95% CI 54.1-57.1%) of those who had routine blood tests were tested for HIV. There were eight HIV-positive tests; three were new diagnoses (all linked to care). The campaign hashtag #TestMeEast achieved a total Twitter "reach" of 238, 860 and the campaign had widespread news coverage. Our campaign showed that staff and students could be trained and mobilised to do thousands of routine HIV tests during a campaign.

Italy and Argentina compared: an epidemiological study of occupational diseases.

BACKGROUND: The research presented in this paper analyses the clinic-pathological manifestations and work-related health risks identified among outpatients treated in the hospitals of Rome and Buenos Aires. MATERIALS AND METHODS: The occupational anamnestic data were collected between 2013 and 2014 through questionnaires with specific items aimed at detecting occupational diseases classified by target organ systems in outpatient clinics of cardiology, dermatology, physical medicine, ophthalmology, orthopedics, endocrinology (thyroid and gonads). An inferential statistical analysis was then carried out to evaluate the relationship between nationality, exposure to occupational risks and the prevalence and incidence of the selected pathologies. An univariate statistical analysis was performed for this purpose and, in the case of statistically significant results, a subsequent multivariate analysis was used to evaluate the incidence of occupational risk factors and nationality on the pathology diagnosed in conjunction with other confounding factors such as smoking habits and gender. The total sample consisted of 1090 subjects of both sexes. Risks were grouped into seven categories and diseases into 12 diagnostic groups. We analyzed the correlation between risks and diseases with respect to hospital outpatients and to the total sample then comparing Argentina and Italy's data. RESULTS: Analysis of data revealed a higher prevalence of hypertension and dysmetabolic disorders for DSE (Display Screen Equipment) workers both in Italy and Argentina; however, multivariate analysis showed that smoking represents a confounding factor for this association. A higher prevalence of allergic contact dermatitis (ACD) was found in the population samples of Rome and there appeared to be a correlation between eye disorders/defects and Argentine data source. CONCLUSIONS: Our study suggests the usefulness of collecting occupational anamnestic data from outpatient departments to highlight possible associations between occupational risks, lifestyles and pathologies, so as to implement the appropriate prevention strategies.

Client's satisfaction with healthcare services received at the hospital outpatients department and the primary healthcare facilities in Al-Qassim, Saudi Arabia: A review of service users' satisfaction.

OBJECTIVES: To assess the level of satisfaction expressed for services rendered in the public health sector to clients who were seen at outpatient departments (OPDs) and primary healthcare (PHC) facilities in Al-Qassim Health Cluster in Saudi Arabia. METHODS: This study used a comparative cross-sectional study design, and data were obtained as secondary data from The Patient's Experience Platform. Data analysis was carried out using Stata (version 16), and the significance level was 5%. RESULTS: In comparing the mean satisfaction in 9 domains, statistically significantly higher means for the PHC facilities than the OPDs were seen across 7 domains: patients navigating health facilities (p=0.008), nursing services (p<0.001), physicians' services (p=0.004), radiological services (p<0.001), personal issues (p=0.003), the pharmacy (p=0.005), and general experience (p=0.036). CONCLUSION: This study's findings are significant. They indicate that client satisfaction with services at PHC facilities was significantly higher than with services at hospital OPDs in Al-Qassim region. This underscores the need to improve the quality of services provided at OPDs to bring them to the same level as those provided by PHC facilities. Policymakers and implementers should, therefore, sustain efforts to make OPDs and PHC facilities more desirable for clients.

Tackling antimicrobial resistance in primary care facilities across Pakistan: Current challenges and implications for the future.

Antibiotics are gradually becoming less effective against bacteria worldwide, and this issue is of particular concern in economically-developing nations like Pakistan. We undertook a scoping review in order to review the literature on antimicrobial use, prescribing, dispensing and the challenges associated with antimicrobial resistance in primary care (PC) settings in Pakistan. Furthermore, this review aims to identify potential solutions to promote appropriate use of antimicrobials in Pakistan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist, a comprehensive scoping review was conducted to review the literature of antimicrobials used, prescribed and dispensed in PC settings in Pakistan. Google Scholar and Pub-Med were searched for the period 2000-2023. Papers were analyzed on the basis of eligibility i.e., included antimicrobial use, prescribing and dispensing practices by general population at homes, by prescribers in outpatient departments of hospitals and by pharmacists/dispensers in community pharmacies, respectively. Two researchers analyzed the articles thoroughly and disagreements were resolved through discussion with a third reviewer. Both quantitative and qualitative research studies were eligible for inclusion. Additionally, the selected papers were grouped into different themes. We identified 4070 papers out of which 46 studies satisfied our eligibility criteria. The findings revealed limited understanding of antimicrobial resistance (AMR) by physicians and community pharmacists along with inappropriate practices in prescribing and dispensing antibiotics. Moreover, a notable prevalence of self-medication with antibiotics was observed among the general population, underscoring a lack of awareness and knowledge concerning proper antibiotic usage. Given the clinical and public health implications of AMR, Pakistan must prioritize its policies in PC settings. Healthcare professionals (HCPs) need to reduce inappropriate antibiotic prescribing and dispensing, improve their understanding of the AWaRe (access, watch and reserve antibiotics) classification and guidance, monitor current usage and resistance trends, as well as implement antimicrobial stewardship (ASP) activities starting in targeted locations.

Development and influential factor analysis of pharmacy outpatient departments in 714 Chinese tertiary healthcare institutions / 中国药房

OBJECTIVE To investigate the basic situation of developing pharmacy outpatient departments in Chinese tertiary medical institutions and analyze the influencing factors. METHODS The research targeted the pharmacy outpatient department managers of hospitals and conducted a survey through Sojump in March 2023. Various independent variables were selected from the hospital’s own characteristics， the management of the pharmacy outpatient departments， and the construction of the pharmacist team for Logistic and linear regression analysis， with the aim of separately analyzing the factors influencing the establishment of pharmacy outpatient departments and the factors affecting the total number of patients served by these departments throughout the year 2022. RESULTS & CONCLUSIONS A total of 1 304 medical institutions of different levels nationwide participated in this survey， with 714 tertiary hospitals. Among the tertiary hospitals， 377 （52.80%） had established pharmacy outpatient departments， including 321 grade-A tertiary hospitals， 48 grade-B tertiary hospitals and 8 other tertiary hospitals. The 377 tertiary hospitals collectively operated 1 739 pharmacy outpatient departments， covering 19 specialized fields， with the highest proportion found in the cardiovascular field （including anticoagulation） at 16.45%. Tertiary hospitals in North China， Central China， East China and South China regions had more pharmacy outpatient departments. The establishment of pharmacy outpatient departments was found to be influenced by tertiary grade-B status （P＝0.010） and the annual outpatient volume of the hospital （P＝0.008）， although the impact was relatively small. The factors influencing the number of patients served by pharmacy outpatient departments were the annual outpatient volume of the hospital （P＝0.042） and the number of pharmacists engaged in clinical pharmacy work （P＝0.004）. The proportion of tertiary hospitals in China that have established pharmacy outpatient departments is insufficient. It is necessary to further accelerate the construction of pharmacy outpatient departments and appropriately expand the talent pool of hospital pharmacy teams based on the needs of pharmacy outpatient departments and patients， in order to meet the requirements of medical practice and patient care.