Risk factors for the accuracy of the initial diagnosis of malaria cases in China: a decision-tree modelling approach

Background Early accurate diagnosis and risk assessment for malaria are crucial for improving patients’ terminal prognosis and preventing them from progressing to a severe or critical stage. This study aims to describe the accuracy of the initial diagnosis of malaria cases with different characteristics and the factors that affect the accuracy in the context of the agenda for a world free of malaria. Methods A retrospective study was conducted on 494 patients admitted to hospitals with a diagnosis of malaria from January 2014 through December 2016. Descriptive statistics were calculated, and decision tree analysis was performed to predict the probability of patients who may be misdiagnosed. Results Of the 494 patients included in this study, the proportions of patients seeking care in county-level, prefecture-level and provincial-level hospitals were 27.5% (n = 136), 26.3% (n = 130) and 8.3% (n = 41), respectively; the proportions of patients seeking care in clinic, township health centre and Centres for Disease Control and Prevention were 25.9% (n = 128), 4.1% (n = 20), and 7.9% (n = 39), respectively. Nearly 60% of malaria patients were misdiagnosed on their first visit, and 18.8% had complications. The median time from onset to the first visit was 2 days (IQR: 0-3 days), and the median time from the first visit to diagnosis was 3 days (IQR: 0–4 days). The decision tree classification of malaria patients being misdiagnosed consisted of six categorical variables: healthcare facilities for the initial diagnosis, time interval between onset and initial diagnosis, region, residence type, insurance status, and age. Conclusions Insufficient diagnostic capacity of healthcare facilities with lower administrative levels for the first visit was the most important risk factor in misdiagnosing patients. To reduce diagnostic errors, clinicians, government decision-makers and communities should consider strengthening the primary care facilities, the time interval between onset and initial diagnosis, residence type, and health insurance status.

Bleeding Disorder Data Registry Reveals Racial/Ethnic Disparities That Could Significantly Impact Patient Journey

Background: Community Voices in Research (CVR) is the National Hemophilia Foundation's community-powered registry designed to provide researchers with a firsthand, 360-degree view of what it means to live with an inherited bleeding disorder (IBD) by providing insight on a wide range of areas previously not evaluated or under-evaluated in this population. Since 2019, information has been collected from those with an IBD as well as their immediate family members/caregivers. Previous QOL data-collection efforts have been narrow in scope or duration and/or relied on HCP-reported data. The self-reported, confidential, de-identified aggregate CVR data are used to improve clinical outcomes and quality of life for people with IBDs and identify research questions important to the community. Methods : Participants complete an enrollment survey followed by the baseline then annual surveys. Additional surveys focused on specific areas of interest are issued periodically. Participants provide demographic data including race, ethnicity, level of education, household income, employment, and health-insurance status. External researchers of various collaborations may apply for access to the de-identified, aggregate data, launch individual surveys, or invite participants to virtual advisory panels. All research findings are communicated to its participants through a personalized CVR dashboard. Results : White/Caucasians make up 86.9% of registrants; (11.3%) include Black/African American; Asian; South Asian; Alaska Native; American Indian; Middle Eastern; and Native Hawaiian/Pacific Islander and any combination of those who identify as white/Caucasian plus another race; 1.8% indicated that their race was unknown or that they preferred not to answer. Ethnicity was reported as Hispanic/Latino(a) (51%), not Hispanic/Latino(a) (46.6%), and unknown/prefer not to answer (2.4%). Demographic data reveal significant disparities between white/Caucasian/non-Hispanic (WCNH) and other CVR participants in key social determinants of health, including education level, household income, employment, and health-insurance status. Tables 1-4 provide a detailed breakdown. Education: The majority of WCNH participants (64.2%) reported having college/graduate/professional-level education, while among others, most (59.4%) reported having a trade/vocational school-level education. Annual household income: The majority of WCNHs participants (57.5%) reported earnings between $50K-$149K. In contrast, the large majority (71.2%) of others reported earning $35K-$49K annually. For WCNHs participants, the midpoint of income range divided by number of people in the household was more than double that of other participants ($31,249 vs. $14,166). Employment: Significant differences between the groups in employment were seen. WCNH participants were more likely to be employed full-time (58.6%), disabled (30%), retired (30%), homemaker (15.7%), or a student (11.4%). Other participants were more likely to be employed part-time (32.5%) or unemployed (51.3%), or able to work but were unemployed (75.2%). Health insurance: A particularly stark disparity was noted in health-insurance type. Among WCNHs, 50.1% reported insurance through an employer or union, while only 15.8% of others fit this category. Among others, the majority (76.9%) reported enrollment in Medicaid or other public income-based insurance (vs. 13% of WCNHs). Conclusions: The demographic disparities between WCNHs and other participants in the CVR are critical and emphasize the need to focus on correlations between known social determinants of health and self-reported health outcomes and quality-of-life information. It is well known that education level and type of insurance, for example, can have a significantly negative impact on factors such as access to treatments and healthcare and medication adherence. CVR recruitment efforts must focus on enrolling racially and ethnically diverse participants to better understand their patient journey. This will enable the characterization of the links between racial/ethnic disparities and differences in access to care, quality of life, and related issues in the IBD community, and tailor education and advocacy efforts. As CVR data are extracted to answer a host of research questions, ensuring the inclusion of demographic disparities will benefit all members of the IBD community. Figure 1 Figure 1. Disclosures Witkop: Teralmmune, Inc.: Consultancy. Valentino: Spark: Ended employment in the past 24 months.

SP2.1.13Does Health Insurance Status Affect Patient Outcome After Emergency Surgery?

Aim Under the Australian Medicare Scheme, Australian residents are covered for many hospital-related costs. Patients with private insurance presenting with appendicitis can elect to be admitted as a private patient. Despite the stereotypes, little is known on whether the patients’ health cover actually affect clinical outcomes. This study aims to compare the differences in patient outcomes between public and private patients after undergoing operative management for appendicitis. Methods A multi-centre prospectively collected health service database of all appendicectomies performed over a 16-month period was reviewed. In particular, patient demographics, type of operation, primary surgeon, complications and mortality rates were analysed. Results Of the total of 652 patients who underwent an appendicectomy, 203 patients were private, 444 patients were public, and 5 were overseas patients. During the post-operative period, public patients had higher rates of representation to the Emergency Department (ED) for post-operative symptoms (public 12.8% vs private 4.4%, p 0.0007, two-tailed chi square test). In comparison, the rate of post-operative complications with Clavien-Dindo (CD) score ≥ 2 is similar in both groups (p = 0.18, public 4.5% vs private 2%). There were no mortalities recorded for both groups. Conclusion Public patients have higher representation rates to the emergency department after an appendicectomy however post-operative outcomes are similar in both groups in our health system. The difference in complication rates were not significant with both groups recording low complication rates of under 5%.

Women’s Media Use and Preferences of Media-Based Interventions on Lifestyle-Related Risk Factors in Gynecological and Obstetric Care: A Cross-Sectional Multi-Center Study in Germany

This study aimed to investigate factors affecting (1) women’s media use regarding health-related behaviors during pregnancy and lactation, (2) women’s preferences for media format, and (3) the content of media-based interventions on lifestyle-related risk factors during pregnancy and lactation. A cross-sectional observational multi-center study of pregnant and lactating women and women of childbearing age was carried out in 14 randomly selected obstetric and gynecologic care settings in the 12 most populated cities in Baden-Wuerttemberg, South-West Germany. Data from 219 surveyed women showed that older women, pregnant women, and lactating women have a higher probability of using media during pregnancy and lactation, respectively. The majority of women preferred a combination of analog and digital media-based interventions in gynecological (46.9%) and obstetric (47.1%) care settings and at home (73.0%). Women would like to see information brochures and flyers on health-related behaviors during pregnancy and lactation for use in gynecological and obstetric care settings, and for media use at home, they would like to have books. The probability of preferring the favored media formats in gynecological and obstetric care settings and at home were associated with pregnancy status, relationship status, socioeconomic status (SES), ethnicity, and health insurance status. About 80% of the surveyed women preferred media content regarding recommendations for a healthy lifestyle and healthy behavior during pregnancy and lactation. All of the independent variables were associated with the probability of preferring a specific media content. The SES was found to play a major role in the probability of preferring a specific media content, followed by pregnancy status, ethnicity, and health insurance status. The results from our study provide a basis for tailored preventive interventions in gynecological and obstetric care settings and for use at home. The results imply that a woman can be reached before conception, during pregnancy, or during lactation with preventive measures tailored to their requirements; however, acceptance may vary across personal attributes, such as SES, ethnicity, and others.

Efficient Management Strategy of Malaria Patients in China: A Decision-Tree Modelling Approach

Background: Early accurate diagnosis and risk assessment for malaria are crucial for improving patients’ terminal prognosis, and preventing them from progressing to severe or critical state. This study aims to describe the accuracy of the initial diagnosis of malaria cases with different characteristics, as well as the factors that affect the accuracy in the context of the agenda for a world free of malaria.Methods: A retrospective study was conducted on 494 patients admitted to hospitals with a diagnosis of malaria from January 2014 through December 2016. Descriptive statistics were calculated and decision tree analysis was performed to predict the probability of patients who may be misdiagnosed.Results: Of the 494 patients included in this study, the proportions of patients seeking care in county-level, prefecture-level, and provincial-level hospitals were 27.5% (n=136), 26.3% (n=130), and 8.3% (n=41), respectively; the proportions of patients seeking care in clinic, township health center, and Centers for Disease Control and Prevention were 25.9% (n=128), 4.1% (n=20), and 7.9% (n=39), respectively. Nearly 60% of malaria patients were misdiagnosed on their first visit, and 18.8% of patients had complications. The median time from onset to the first visit was 2 days (IQR: 0 - 3 days), and the median time from the first visit to diagnosis was 3 days (IQR: 0 - 4 days). The decision tree classification of malaria patients being misdiagnosed consisted of six categorical variables: healthcare facilities for the initial diagnosis, time interval between onset and initial diagnosis, region, residence type, insurance status, and age.Conclusion: Insufficient diagnostic capacity of healthcare facilities with lower administrative levels for the first visit was the most important risk factor in misdiagnosing patients. Researchers and clinicians should consider strengthening the primary care facilities, time interval between onset and initial diagnosis, administrated residence, and health insurance status to reduce diagnostic errors.

Sociodemographic Determinants of Nonadherence to Depression and Anxiety Medication among Individuals Experiencing Homelessness

Psychiatric medication nonadherence continues to be a leading cause of poor health outcomes for individuals experiencing homelessness. Identifying the sociodemographic factors that contribute to medication nonadherence may help guide strategies to care for and support this group. This study examined 200 adults with depression diagnoses and active anti-depressant prescriptions (Mage = 43.98 ± 12.08, 59.4% Caucasian, 58.5% male, 70% uninsured, 89.5% unemployed) and 181 adults with anxiety diagnoses and active anti-anxiety prescriptions (Mage = 43.45 ± 11.02, 54.4% Caucasian, 57.5% male, 66.3% uninsured, 88.9% unemployed) recruited from six homeless-serving agencies in Oklahoma City. Self-reported sociodemographic variables included: age, sex, race/ethnicity, education, monthly income, employment status, and health insurance status. Adjusted logistic regression analyses revealed that employed (OR = 4.022, CI0.95: 1.244–13.004) and insured (OR = 2.923, CI0.95: 1.225–6.973) participants had greater odds of depression medication nonadherence. For anxiety, being employed (OR = 3.573, CI0.95: 1.160–11.010) was associated with greater odds of anxiety medication nonadherence, whereas having depression and anxiety diagnostic comorbidity (OR = 0.333, CI0.95: 0.137–0.810) was associated with lower odds of anxiety medication nonadherence. Interventions aimed at facilitating accessible prescription acquisition or otherwise reducing barriers to prescription medications for employed adults, including those with health insurance, may benefit adherence, but more research is needed. Future studies would benefit from using a qualitative approach to better delineate nuanced barriers to psychiatric medication adherence.

Self-Reported Reasons for the Non-Use of Hearing Aids Among Hispanic Adults With Hearing Loss

Purpose To examine the self-reported reasons for the non-use of hearing aids among Mexican–American Hispanic adults who have hearing loss. Method A total of 122 Hispanic adults with hearing loss, who did not currently or previously use a hearing aid, participated in this study. Participants completed a comprehensive hearing health questionnaire and the Hearing Handicap Inventory Screening Questionnaire to examine the possible reasons for the non-use of hearing aids. Results Self-reported hearing loss, hearing handicap score, and health insurance status were the best predictors of an individual's willingness to use hearing aids to treat their hearing loss. The primary reasons cited for the non-use of hearing aids among Hispanics with hearing loss was the belief that their hearing impairment was not severe enough to warrant using a hearing aid and that hearing aids were unaffordable. Conclusions Greater public health education regarding the deleterious effects of untreated hearing loss and the positive impact of amplification on cognitive, social, and psychological health may be warranted to improve the usage rates of hearing aids in Hispanic adults.