Analyze of factors and prognosis of eyes lost to follow-up in retinal vein occlusive disease patients receiving anti-vascular endothelial growth factor therapy.

BACKGROUND: Patients with macular edema (ME) secondary to retinal vein occlusion (RVO) who received at least one intravitreal injection of anti-vascular endothelial growth factor therapy (VEGF) and lost to follow-up (LTFU) for more than six months were analyzed to investigate the factors contributing to the LTFU and the prognosis. METHOD: This was a retrospective, single-center study to analyze the causes and prognosis of LTFU over six months in RVO-ME patients treated with intravitreal anti-VEGF injections at our institution from January 2019 to August 2022 and to collect patients' baseline characteristics along with the number of injections before LTFU, primary disease, best corrected visual acuity (BCVA) before LTFU and after return visit, central macular thickness (CMT), months before LTFU and after LTFU, reasons for LTFU, and complications, to analyze the factors affecting visual outcome at a return visit. RESULTS: This study included 125 patients with LTFU; 103 remained LTFU after six months, and 22 returned after LTFU. The common reason for LTFU was "no improvement in vision" (34.4%), followed by "transport inconvenience" (22.4%), 16 patients (12.8%) were unwilling to visit the clinic, 15 patients (12.0%) had already elected to seek treatment elsewhere, 12 patients (9.6%) were not seen in time due to the 2019-nCov epidemic, and 11 patients (8.8%) cannot do it due to financial reasons. The number of injections before LTFU was a risk factor for LTFU (P < 0.05). LogMAR at the initial visit (P < 0.001), CMT at the initial visit (P < 0.05), CMT before the LTFU (P < 0.001), and CMT after the return visit (P < 0.05) were influential factors for logMAR at the return visit. CONCLUSION: Most RVO-ME patients were LTFU after anti-VEGF therapy. Long-term LTFU is greatly detrimental to the visual quality of patients; thus, the management of RVO-ME patients in follow-up should be considered.

Strategies to Aid Successful Transition of Adolescents with Congenital Heart Disease: A Systematic Review.

The majority of patients born with congenital heart disease (CHD) need lifelong surveillance with serial clinical attendance and examinations. However, loss of follow-up (namely no documented follow-up for 3 years or more) is a recognised common problem since it is often related to remarkable worsening in the health of CHD patients with increased morbidity and mortality. Transitioning from paediatric to adult care has proven to be the most vulnerable point in the care of these subjects. As such, a systematic review was carried out to ask the following questions: What is the percentage of loss of follow-up worldwide? Are there regional fluctuations in the percentage? Is there a link between loss of follow-up and the complexity of CHD? What strategies should be employed to lower the risk of discontinuity in care? The most recent worldwide averaged loss of follow-up is 26.1%, with significant fluctuations across continents and countries. This percentage is even higher (31.9%) when one includes all untraceable patients, presuming that they are not having any cardiac follow-up. The highest discontinuity of care was reported in the USA and in patients with simple CHD. Planning the rules of transition seems to be one of the most reliable tools to minimise the number of CHD patients who are lost in transition. Recalling patients, with general practitioners who are crucial in readdressing half of the lost to follow-up CHD patients to adult CHD specialists, and a good relationship between paediatric cardiologists and the adult CHD team are two other valuable strategies in aiding successful transition.

Regional Swedish study found that one in seven coeliac patients experienced loss of follow up during childhood.

AIM: To examine the clinical follow up of paediatric coeliac disease and the rate of loss of follow up during childhood, for which data are scarce. METHODS: In a cohort of coeliac children diagnosed in 2013-2018 in Gothenburg, Sweden, we retrospectively explored the follow-up practice of paediatric coeliac disease until June 2021. We used medical records from hospital-based paediatric gastroenterology and general paediatric outpatient clinics, laboratory records, and questionnaires. Loss of follow up was defined no coeliac disease-related follow up or tissue transglutaminase test over the past 2 years of study enrolment. RESULTS: We included 162 children (58% girls) aged 7.8-18.2 years (average 12.7). Most participants (76%) were followed at general paediatric outpatient clinics rather than hospital-based clinics. After 2.3-8.8 (average 5.3) years since diagnosis, 23 patients (14%; 95% confidence interval, 9%-21%) had been lost to follow up. Patients with loss of follow up were more often boys (61% versus 39%, p = 0.08), with a somewhat longer average disease duration of 5.8 versus 5.2 years (p = 0.11). There were no between-group differences in socio-economic characteristics and patient-reported experience measures of coeliac disease care. CONCLUSION: One in seven coeliac patients may experience loss of follow up during childhood.

Can non-responding mask or mimic drug effects on pregnancy outcome? Evaluation of case characteristics based on the national Embryotox cohort.

Women and their health care provider (HCP) often seek advice for drug safety in pregnancy at Teratology Information Services (TIS). In turn, TIS ask for details of drug exposure and pregnancy outcome. These data constitute a valuable basis for research on prenatal drug risks in many countries. Non-response to follow-up questionnaires, however, may cause biased study results. To assess the potential of non-response bias, this study based on the German Embryotox cohort compares maternal and HCP characteristics of responders and non-responders. Change in loss of follow-up rates over time is investigated using logistic regression. From 2010 until the end of 2020, 48,410 pregnant women and/or their HCP consented to participation in follow-up. Of these, 25.0 % did not return follow-up questionnaires. Loss rates were similar for patients and HCP but increased over time. Participants from semi-dense populated areas had a smaller loss rate (20.4 %) than those from rural (28.4 %) or urban areas (25.6 %). Responding women were older than non-responders, had a lower BMI, a more positive attitude towards pregnancy, a higher educational level, a lower number of previous pregnancies, smoked less, and indicated alcohol consumption more but social drugs less often. Non-response bias cannot be ruled out in studies based on observational data on drug use in pregnancy as those collected by TIS. However, differences between the complete and lost-to follow-up cohort do not suggest a particularly high or low risk profile for one of the cohorts that might substantially confound study results or even mask or mimic potential drug toxicity.

The negative impact of COVID-19 pandemic on age-related macular degeneration patients treated with intravitreal bevacizumab injections.

PURPOSE: COVID-19 emerged in the end of 2019 and was declared a worldwide pandemic shortly after. Social distancing and lockdowns resulted in lower compliance in intravitreal injections and office visits. We aimed to assess clinical outcomes among patients who missed these visits compared to those who arrived as planned. METHODS: Patients who missed or were late to office visits or intravitreal injections were defined as non-adherent and were compared to adherent patients. Our main outcomes were the need for subsequent injections, mean change in best-corrected visual acuity (BCVA), and central macular thickness (CMT). RESULTS: This study included 77 patients (24 adherent and 53 non-adherent). The mean BCVA remained stable during the study period for the adherent group (p = 0.159) and worsened in the non-adherent group (p < 0.001). Changes in CMT and maximum thickness were not significant for either group. A higher proportion of patients in the non-adherent group needed subsequent intravitreal injections (49% vs 20%, p = 0.014). CONCLUSION: The findings demonstrate the negative implications of the COVID-19 pandemic and the effect of deferring bevacizumab injections among individuals with age-related macular degeneration. This emphasizes the importance of a scheduled follow-up, also during a pandemic.

Lost but not missing: factors associated with loss of follow-up in a paediatric cardiology clinic.

BACKGROUND: Loss of follow-up is a barrier to providing adequate care to paediatric cardiac patients. The purpose of this study was to determine variables associated with loss of appropriate paediatric cardiology follow-up, including potentially modifiable factors. We hypothesised having earlier recommend follow-up intervals was associated with less likelihood of loss of follow-up. METHODS: We performed a retrospective cohort study of patients >5 years old seen in a large, outpatient paediatric practice from 2013 to 2016. Subjects were considered to be lost to follow-up if they did not have a subsequent outpatient encounter by 6 months after their recommend follow-up time interval. RESULTS: Of the 8940 eligible patients, 45.9% were lost to follow-up. Recommended follow-up interval of 1 year was associated with less loss of follow-up (41.4%) as compared to 2-year intervals (51.6%) and 3 years (55.7%) (p < 0.001 for both). Other significant predictors of loss of follow-up included less severe heart disease, older age, and non-Hispanic Black race/ethnicity. Sex and payor type were not significant predictors. In the stratified analyses by severity of disease and age, longer recommended follow-up time was associated with greater loss of follow-up among all severity and age categories. CONCLUSIONS: Almost half of the patients in our cohort did not return to clinic within the recommended timeline. Shorter follow-up time was associated with less loss of follow-up among all categories of disease severity and age groups. Recommending shorter follow-up intervals may be one initiative for paediatric cardiologists to improve rates of follow-up.

Characteristics of patients with adult congenital heart disease treated by non-specialized doctors: The potential loss of follow-up.

BACKGROUND: In the treatment of adult congenital heart disease (ACHD), the transfer of patients from pediatric cardiologists to ACHD cardiologists is of relevance. However, little is known about the clinical courses of ACHD patients that have been referred by non-CHD-specialized doctors (n-CSDs). METHODS: This retrospective cohort study included 230 patients (average age: 37 ± 15.2 years, male: 97) who were referred to a single specialized ACHD center between April 2016 and July 2019. We compared the characteristics and clinical courses between patients referred by n-CSDs and those referred by CHD-specialized-doctors (CSDs). RESULTS: Overall, 121 (53%) patients were referred by n-CSDs. Among them, 91 (75%) patients were referred by adult cardiologists. Univariate analysis showed that the patients referred by n-CSDs were older than those referred by CSDs (41.6 ± 16.3 vs. 32.0 ± 12.0 years, p < 0.01), were more likely to have simple CHD, and less likely to have severe CHD (27.0% vs. 12.8% and 16.5% vs. 40.4%, respectively, p < 0.01). Patients referred by n-CSDs were also more likely to have a history of loss of follow-up (16.5% vs. 3.7%, p < 0.01) and to require invasive treatments after referral, including cardiac surgeries and transcatheter interventions (47.9% vs. 26.6 %, p < 0.01). Notably, unintended invasive treatments that were not designated by the referring doctors were more frequently required in patients with moderate complexity referred by n-CSDs (50.0% vs. 23.3%, p = 0.02). CONCLUSIONS: Patients with moderate CHD complexity referred by n-CSDs are more likely to require unintended invasive treatments. Referrals to specialized ACHD centers may be most beneficial for these patients.

Follow-up of squamous atypia's and the evaluation of the conducts according to the recommendations of the Ministry of Health / Seguimento das atipias escamosas e avaliação das condutas segundo as recomendações do Ministério da Saúde

ABSTRACT Introduction: Cervical cancer is considered a public health problem, ranking fourth among the most common types of cancer worldwide. Objective: The present study aimed to gather information on the follow-up, and to verify adherence to the management recommended by the Brazilian Ministry of Health (MH) of women with cervical cytopathological results of atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H), as well as to evaluate the quality of cytopathology tests of the laboratory that provides services to the Brazilian Unified Health System (SUS). Methods: Cervical cytopathology results of squamous atypia were researched between the years 2016 and 2017 in standardized requirements from the MH. The performance of the laboratory that carried out the cytopathology tests were analyzed using indexes recommended in the Internal Quality Monitoring (IQM) of the MH [Quality Management Manual (QMM)]. Results: 42,478 cytopathology tests were evaluated, 893 of these presented ASC-US results, and 199 ASC-H results. In women with ASC-US results, 73.2% repeated the cytopathology test, of which 18.7% remained the altered result, and 81.3% were negative for malignancy. Following the recommendation of the MH, 81.9% of women repeated the test outside the recommended period. In women with ASC-H, 51.8% underwent histopathological examination as recommended by the MH, of which 73.8% were altered. Conclusion: According to the MH Guidelines, most (81.9%) women with ASC-US repeated the cytopathology test

RESUMEN Introducción: El cáncer de cuello uterino se considera un problema de salud pública y ocupa el cuarto lugar entre los tipos de cáncer más comunes en todo el mundo. Objetivo: El presente estudio tuvo como objetivo recabar información sobre el seguimiento y verificar la adherencia al manejo recomendado por el Ministerio de Salud de Brasil (MS) de mujeres con resultados de la citopatología de cuello uterino de células escamosas atípicas de significado indeterminado (ASC-US) y células escamosas atípicas, no se descarta una lesión intraepitelial escamosa de alto grado (ASC-H), así como evaluar la calidad de las pruebas de citopatología del laboratorio que presta servicios al Sistema Único de Salud (SUS). Métodos: Se investigaron resultados de citopatología cervical de las atipias escamosas entre los años 2016 y 2017 en requisitos estandarizados del MS. El desempeño del laboratorio que realizó las pruebas de citopatología se analizó utilizando los índices recomendados en el Control de Calidad Interno (CCI) del MS [Manual de Control de Calidad (MCC)]. Resultados: Se evaluaron 42.478 pruebas de citopatología, de estos 893 presentaron resultados ASC-US y 199 resultados ASC-H. De las mujeres con resultados ASC-US, el 73,2% repitió la prueba de citopatología, de los cuales el 18,7% siguió siendo el resultado alterado y el 81,3% tuvo resultado negativo para malignidad. Siguiendo la recomendación del MS, el 81,9% de las mujeres repitieron la prueba fuera del plazo recomendado. En las mujeres con ASC-H, el 51,8% se sometió a examen histopatológico según lo recomendado por el MS, de los cuales el 73,8% estaban alterados. Conclusión: De acuerdo con las directrices MS, la mayoría (81,9%) de las mujeres con ASC-US repitieron la prueba de citopatología fuera del período recomendado y el 48,2% de las pacientes con ASC-H no se sometieron a la prueba de histopatología. El laboratorio presentó todos los indicadores MCC recomendados por el MS.

RESUMO Introdução: O câncer cervical é considerado um problema de saúde pública e ocupa o quarto lugar entre os tipos de câncer mais frequentes em todo o mundo. Objetivo: Este trabalho se propôs a levantar as informações do seguimento e verificar a adesão às condutas preconizadas pelo Ministério da Saúde (MS) das mulheres com resultado citopatológico cervical de células escamosas atípicas de significado indeterminado (ASC-US) e células escamosas atípicas não podendo afastar lesão de alto grau (ASC-H), bem como avaliar a qualidade dos exames citopatológicos do laboratório prestador de serviço ao Sistema Único de Saúde (SUS). Métodos: Resultados citopatológicos cervicais de atipias escamosas foram pesquisados entre 2016 e 2017 nas requisições padronizadas do MS. O desempenho do laboratório que realizou os exames citopatológicos foi analisado por meio dos índices recomendados no monitoramento interno da qualidade (MIQ) do MS [Manual de Gestão da Qualidade (MGQ)]. Resultados: Foram avaliados 42.478 exames citopatológicos; destes, 893 apresentaram resultado de ASC-US e 199, de ASC-H. Das mulheres com ASC-US, 73,2% repetiram o exame citopatológico; 18,7% permaneceram com exame citopatológico alterado e 81,3% tiveram resultado negativo para malignidade. Seguindo a recomendação do MS, 81,9% das mulheres repetiram o exame fora do período preconizado. Das mulheres com ASC-H, 51,8% realizaram o exame histopatológico conforme orientação do MS; 73,8% deles estavam alterados. Conclusão: Segundo as diretrizes do MS, a maioria das mulheres com ASC-US (81,9%) repetiram o exame citopatológico fora do período recomendado, e 48,2% das pacientes com ASC-H não realizaram o exame histopatológico.

The impact of WeChat app-based education and rehabilitation program on anxiety, depression, quality of life, loss of follow-up and survival in non-small cell lung cancer patients who underwent surgical resection.

PURPOSE: We aimed to explore whether WeChat app-based education and rehabilitation program (WERP) affected anxiety, depression, quality of life (QoL), loss of follow-up and survival profiles in non-small cell lung cancer (NSCLC) patients after undergoing surgical resection. METHODS: 200 NSCLC patients who underwent surgical resection were randomly allocated to WERP group or control group at a 1:1 ratio and underwent a 12-month interventional stage and 48-month non-interventional follow-up stage. Anxiety and depression were evaluated by Hospital Anxiety and Depression Scale (HADS), and QoL was assessed by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30). Loss of follow-up and survival data were also evaluated. RESULTS: After the 12-month intervention (M12), HADS-anxiety score (5.00 ± 2.84 vs. 6.69 ± 4.01) and anxiety rate (19.0% vs. 41.0%) were lower in WERP group compared with control group; meanwhile, HADS-depression score (5.22 ± 2.77 vs. 6.55 ± 3.42) and depression rate (20.0% vs. 36.0%) were decreased in WERP group compared with the control group. Regarding QoL at M12, the QLQ-C30 global health status score (74.44 ± 12.06 vs. 70.26 ± 17.29) and functional score (77.15 ± 15.00 vs. 71.40 ± 17.02) were higher, while QLQ-C30 symptom score was similar (27.29 ± 11.72 vs. 27.86 ± 12.69) in WERP group compared with the control group. Besides, both the 12-month loss to follow-up (3.0% vs 10.0%) and 60-month loss to follow-up (10.0% vs 20.0%) were less in WERP group than the control group. However, limited survival benefit of WERP was observed compared with the control group. CONCLUSIONS: WERP is an effective way to improve well-being and quality of life in NSCLC patients after undergoing surgical resection.

The crossover design for migraine preventives: an analyses of four randomized placebo-controlled trials.

AIMS: To evaluate the crossover design in migraine preventive treatment trials by assessing dropout rate, and potential period and carryover effect in four placebo-controlled randomized controlled trials (RCTs). METHODS: In order to increase statistical power, the study combined data from four different RCTs performed from 1998 to 2015 at St. Olavs Hospital, Norway. Among 264 randomized patients, 120 received placebo treatment before and 144 after active treatment. RESULTS: Only 26 (10%) dropped out during the follow-up period of 30-48 weeks, the majority (n = 19) in the first 12 weeks. No period effect was found, since the treatment sequence did not influence the responder rate after placebo treatment, being respectively for migraine 30.5% vs. 27.4% (p = 0.59) and for headache 25.0% vs. 24.8% (p = 0.97, Chi-square test) when placebo occurred early or late. Furthermore, no carryover effect was identified, since the treatment sequence did not influence the treatment effect (difference between placebo and active treatment). There was no significant difference between those who received active treatment first and those who received placebo first with respect to change in number of days per 4 week of headache (- 0.9 vs. -1.3, p = 0.46) and migraine (- 1.2 vs. -0.9, p = 0.35, Student's t-test). CONCLUSIONS: Summary data from four crossover trials evaluating preventive treatment in adult migraine showed that few dropped out after the first period. No period or carryover effect was found. RCT studies with crossover design can be recommended as an efficient and cost-saving way to evaluate potential new preventive medicines for migraine in adults.

Características de mulheres vítimas de violência sexual e abandono de seguimento de tratamento ambulatorial / Characteristics of women victims of sexual violence and abandonment of ambulatorial treatment follow-up

Resumo Introdução A violência sexual afeta vários segmentos da sociedade e requer ação urgente. As mulheres são as principais vítimas desta injúria, que pode gerar inúmeras implicações. Assim, o papel dos serviços de saúde é essencial para o enfrentamento deste problema e garantia de maior adesão ao tratamento ambulatorial. Objetivo Objetivou-se analisar as características de mulheres vítimas de violência sexual e abandono de seguimento de tratamento ambulatorial. Método Estudo descritivo, analítico retrospectivo, quantitativo, de 161 prontuários de mulheres atendidas em um serviço de referência de violência sexual em Goiânia- G0, em 2015. Resultados A maioria das mulheres eram adultas (65,8%), residentes em Goiânia (55,3%), empregadas (50,3%), concluintes do ensino médio (30,4%), solteiras (55,3%), pardas (44,1%), heterossexuais (74,5%), sem deficiência (85,1%). Verificou- se uma associação entre o abandono de seguimento ambulatorial com o recebimento de profilaxia DSTs (p<0,001), imunoglobulina para hepatite B (p=0,002), contracepção de emergência (p=0,010), início do esquema de antirretrovirais (p=0,003) e abandono do seguimento após a primeira consulta (p <0,001). Houve significância entre vítimas gestantes e a conclusão do tratamento (p <0,001). Conclusão Conclui-se que, ao se conhecer os fatores relacionados à não adesão ao seguimento ambulatorial, novas estratégias poderão ser desenvolvidas pelos serviços especializados.

Abstract Background Sexual violence affects several segments of society and requires urgent action. Women are the main victims of this injury, that can generate countless implications. Thus, the role of health services is essential for coping with this problem and ensuring greater adherense to outpatient treatment. Objective The aim of this study was to analyze the characteristics of women victims of sexual violence and abandonment of ambulatorial treatment follow-up. Method This is a descriptive, retrospective analytical, quantitative study of 161 women's medical records attended at a referral service for sexual violence in Goiânia-GO, in 2015. Results Most women were adults (65.8%), residents in Goiânia (55.3%), employed (50.3%), high school graduates (30.4%), single (55,3%), browns (44.1%), heterosexuals (74.5%), without disabilities (85.1%). There was an association between the abandonment of ambulatorial follow-up and receipt of prophylaxis STD (p<0.001), immunoglobulin for hepatitis B (p=0.002), emergency contraception (p=0.010), initiate the antiretroviral regimen (p=0.003) and abandonment of follow-up after the first visit (p <0.001). There was significant between pregnant women victims and the completion of treatment (p <0.001). Conclusion It is concluded that when knowing the factors related to non-adherence for ambulatorial follow-up, new strategies should be developed by specialized services.

Predictors of loss of follow-up in a prospective registry: which patients drop out 12 months after lumbar spine surgery?

BACKGROUND CONTEXT: Long-term patient-reported outcomes (PROMs) are essential in clinical practice and research. Prospective trials and registries often struggle with high rates of loss of follow-up (LOFU), which may bias their findings. Little is known on risk factors for PROM nonresponse, especially for digitally mailed questionnaires. PURPOSE: To elucidate which patients are at high risk for LOFU by identifying associated predictors. STUDY DESIGN: Analysis of a prospective registry. PATIENT SAMPLE: Patients that underwent surgery for degenerative lumbar disease were included. OUTCOME MEASURES: Rate of PROM follow-up response at 12 months postoperatively. METHODS: Preoperatively and at 12 months postoperatively, patients were asked to complete a range of PROM questionnaires using a web-based tool. All patients who successfully completed their baseline questionnaire were included. Patients were not actively reminded upon nonresponse. Univariate and independent predictors of LOFU at 12 months were identified. RESULTS: We included 1,456 patients, of which 861 (59%) were lost to follow-up at 12 months. Univariately, lower age, American Society of Anesthesiologists (ASA) class 1, smoking, lack of prior surgery, higher pain scores and functional disability, and lower quality-of-life were associated with LOFU (all p<.05). Only lower age (OR: 0.98, p=.001), smoking (OR: 1.46, p=.019), lack of prior surgery (OR: 0.59, p=.019), and spondylolisthesis (OR: 0.47, p=.024) independently predicted LOFU. CONCLUSIONS: In a prospective registry of lumbar spine surgery patients based on web-based outcome capturing, younger age, active smoking status, lack of prior surgery, and nonspondylolisthesis surgery were independent predictors of loss of follow-up. In the future, it may become possible to preoperatively identify patients at high-risk for study dropout. As the implementation of prospective registries and the use of automated follow-up methods are on the rise, it is crucial to ensure efficiency and reduce bias of the methods on which all clinical research is based on.

Factors associated with inadequate follow-up of children with congenital syphilis / Fatores associados ao seguimento não adequado de crianças com sífilis congênita

ABSTRACT OBJECTIVE To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.

RESUMO OBJETIVO Analisar fatores associados ao seguimento ambulatorial não adequado de crianças notificadas com sífilis congênita. MÉTODOS Estudo de coorte não concorrente, realizado em unidades de atenção primária e três maternidades de referência de Fortaleza (Ceará). Os dados foram coletados de setembro de 2013 a setembro de 2016 nas fichas de notificação e nos prontuários médicos de internamento e de seguimento ambulatorial, e apresentados considerando o seguimento adequado e não adequado. Foram consideradas adequadamente seguidas as crianças que compareceram à unidade de atenção primária ou ao ambulatório de referência no período recomendado pelo Ministério da Saúde e realizaram os exames preconizados. Utilizou-se os testes qui-quadrado de Pearson e exato de Fisher na análise comparativa. O risco estimado de não seguimento adequado foi verificado por regressão logística simples e múltipla. RESULTADOS Foram notificadas 460 crianças com sífilis congênita, das quais 332 (72,2%) retornaram para pelo menos uma consulta e fizeram parte do estudo. Compareceram à unidade primária de saúde 287 (86,4%) crianças; entretanto, não havia referência à sífilis congênita em 236 (71,1%) prontuários e não foram encontradas informações acerca da solicitação do exame venereal disease research laboratory (VDRL) em 264 (79,5%). Houve não adesão às consultas subsequentes por parte de 272 (81,9%) indivíduos. As seguintes variáveis apresentaram associação estatisticamente significativa com o seguimento não adequado das crianças: estado civil das genitoras, número de consultas no pré-natal, número de gestações, hemograma e radiografia de ossos longos. CONCLUSÕES A maioria das crianças notificadas com sífilis congênita comparecem à atenção primária para seguimento, porém os serviços não atendem às recomendações do Ministério da Saúde para o seguimento adequado.

[Factors associated with lost of follow-up of men who have sex with men in a gay bathhouse cohort study in Tianjin, 2012-2015].

Objective: To understand the rate of follow-up lost in men who have sex with men (MSM) in a gay bathhouse cohort study in Tianjin and the associated factors. Methods: The open cohort study in gay bathhouse was launched in 2012 in Tianjin, and the MSM for baseline survey were recruited from January to June 2012, while the follow up was carried out every six months. A questionnaire survey and HIV test were conducted in the study. The MSM who were HIV negative in the baseline survey in 2012 were used for follow up lost analysis. Univariate and multivariate logistic regression analysis were conducted to identify the factors associated with the lost of follow-up. Results: A total of 658 gay bathhouse patrons were recruited in the baseline survey, at the end of 42-month follow-up period, 173 of them dropped out (26.3%). Multivariate analysis showed that the MSM who were local residents (OR=0.552, 95%CI: 0.377-0.808), in Han ethnic group (OR=0.197, 95% CI: 0.066-0.593), having received HIV test in the last year (OR=0.481, 95% CI: 0.326-0.710), were male sex workers (OR=0.127, 95% CI: 0.028-0.585), and believed to be at high risk for HIV infection (OR=0.285, 95% CI: 0.125-0.647). They were more likely to receive follow-up but the MSM who were aged ≥35 years (OR=1.891, 95%CI: 1.022-3.500) were more likely to be lost in the follow-up. Conclusion: The lost rate of follow-up in MSM in the gay bathhouse cohort was high in Tianjin. Age, household registration, history of HIV test, the awareness of the risk to be infected with HIV and commercial homosex were factors associated with the follow-up rate in the MSM. It is necessary to conduct similar cohort study in targeted population on the basis of findings of this study.

Factors associated with lost of follow-up of men who have sex with men in a gay bathhouse cohort study in Tianjin, 2012-2015 / 中华流行病学杂志

Objective To understand the rate of follow-up lost in men who have sex with men (MSM) in a gay bathhouse cohort study in Tianjin and the associated factors.Methods The open cohort study in gay bathhouse was launched in 2012 in Tianjin,and the MSM for baseline survey were recruited from January to June 2012,while the follow up was carried out every six months.A questionnaire survey and HIV test were conducted in the study.The MSM who were HIV negative in the baseline survey in 2012 were used for follow up lost analysis.Univariate and multivariate logistic regression analysis were conducted to identify the factors associated with the lost of follow-up.Results A total of 658 gay bathhouse patrons were recruited in the baseline survey,at the end of 42-month follow-up period,173 of them dropped out (26.3％).Multivariate analysis showed that the MSM who were local residents (OR=0.552,95％CI:0.377-0.808),in Han ethnic group (OR=0.197,95％CI:0.066-0.593),having received HIV test in the last year (OR=0.481,95％CI:0.326-0.710),were male sex workers (OR=0.127,95％CI:0.028-0.585),and believed to be at high risk for HIV infection (OR=0.285,95％ CI:0.125-0.647).They were more likely to receive follow-up but the MSM who were aged ≥35 years (OR=1.891,95％CI:1.022-3.500) were more likely to be lost in the follow-up.Conclusion The lost rate of follow-up in MSM in the gay bathhouse cohort was high in Tianjin.Age,household registration,history of HIV test,the awareness of the risk to be infected with HIV and commercial homosex were factors associated with the follow-up rate in the MSM.It is necessary to conduct similar cohort study in targeted population on the basis of findings of this study.

Factors associated with lost of follow-up of men who have sex with men in a gay bathhouse cohort study in Tianjin, 2012-2015 / 中华流行病学杂志

Objective To understand the rate of follow-up lost in men who have sex with men (MSM) in a gay bathhouse cohort study in Tianjin and the associated factors.Methods The open cohort study in gay bathhouse was launched in 2012 in Tianjin,and the MSM for baseline survey were recruited from January to June 2012,while the follow up was carried out every six months.A questionnaire survey and HIV test were conducted in the study.The MSM who were HIV negative in the baseline survey in 2012 were used for follow up lost analysis.Univariate and multivariate logistic regression analysis were conducted to identify the factors associated with the lost of follow-up.Results A total of 658 gay bathhouse patrons were recruited in the baseline survey,at the end of 42-month follow-up period,173 of them dropped out (26.3％).Multivariate analysis showed that the MSM who were local residents (OR=0.552,95％CI:0.377-0.808),in Han ethnic group (OR=0.197,95％CI:0.066-0.593),having received HIV test in the last year (OR=0.481,95％CI:0.326-0.710),were male sex workers (OR=0.127,95％CI:0.028-0.585),and believed to be at high risk for HIV infection (OR=0.285,95％ CI:0.125-0.647).They were more likely to receive follow-up but the MSM who were aged ≥35 years (OR=1.891,95％CI:1.022-3.500) were more likely to be lost in the follow-up.Conclusion The lost rate of follow-up in MSM in the gay bathhouse cohort was high in Tianjin.Age,household registration,history of HIV test,the awareness of the risk to be infected with HIV and commercial homosex were factors associated with the follow-up rate in the MSM.It is necessary to conduct similar cohort study in targeted population on the basis of findings of this study.

Patient-reported outcome measures unbiased by loss of follow-up. Single-center study based on DaneSpine, the Danish spine surgery registry.

PURPOSE: The purpose of this study is to determine if there are any demographic and reporting differences between patients who respond and those who refuse to respond to postal questionnaires from the Danish national spine database, DaneSpine. METHODS: DaneSpine collects patient-reported data, completed before surgery and at 3 months, and at 1, 2, 5, and 10 years postoperatively. The database was launched at the Center for Spine Surgery and Research at Lillebaelt Hospital on June 1st, 2010. We performed a 1-year follow-up on non-responders during a 6-month period between the 1st of August 2013 until the 31st of January 2014 using a structured phone interview to collect patient-reported outcomes, some health information and reasons for non-response. RESULTS: Of the 506 patients who were 1-year post-operative, three did not have baseline data and six had died before the 1-year follow-up. Twenty-four patients had a second spine surgery and were re-enrolled in the database. These cases had not reached the 1-year follow-up period for the second spine surgery and were excluded from the analysis. Thus, 473 patients had reached 1-year follow-up. Of these, 57 (12 %) did not respond to postal questionnaires. A structured phone interview was performed on these 57 non-responders. Non-responders were in general, a decade younger than responders, a greater proportion were males and smokers. Apart from EQ-5D, there was no difference in patient satisfaction, improvement in back pain or leg pain between the responders and non-responders. CONCLUSIONS: Missing data from 12 % of patients do not seem to bias conclusions that can be drawn from the DaneSpine database at the Center for Spine Surgery and Research at Lillebaelt Hospital.

[Factors determining irregular attendance to follow-up visits among human immunodeficiency virus patients: results of the hospital survey of patients infected with human immunodeficiency virus]. / Determinantes de la asistencia irregular a consulta médica en pacientes con infección por el virus de la inmunodeficiencia humana: resultados de la Encuesta Hospitalaria de pacientes con el virus de la inmunodeficiencia humana, 2002-2012.

INTRODUCTION: To describe the occurrence of non-regular attendance to follow-up visits among HIV patients and to analyze the determining factors. METHODS: One-day survey carried out annually (2002-2012) in public hospitals. Epidemiological, clinical and behavioral data are collected in all HIV-infected inpatients and outpatients receiving HIV-related care on the day of the survey. "Non-regular attendance to a follow-up visit" was defined as sporadic attendance to the medical appointments, according to the judgment of the attending physician. Descriptive and bivariate analyses were performed, and factors associated to non-regular attendance to follow-up visits were estimated using logistic regression. RESULTS: A total of 7,304 subjects were included, of whom 13.7% did not attend medical appointments regularly. Factors directly associated with non-regular attendance were: age between 25-49 years; birth in Sub-Saharan Africa or Latin-America; low educational level; being homeless or in prison; living alone or in closed institutions; being unemployed or retired; being an intravenous drug user; not using a condom at last sexual encounter, and injecting drugs in the last 30 days. Conversely, HIV diagnosis within the last year and being men who have sex with men were factors inversely associated with non-regular attendance to follow-up visits. CONCLUSION: In spite of health care beings free of charge for everyone in Spain, social factors can act as barriers to regular attendance to medical appointments, which, in turn, can endanger treatment effectiveness in some population groups. This should be taken into account when planning HIV policies in Spain.