P036 IMPACT OF THE COVID-19 PANDEMIC ON HERNIA SURGERY IN A SWEDISH HEALTH-CARE REGION WITHOUT LOCKDOWN: A RETROSPECTIVE COHORT STUDY

Aim During the COVID-19 pandemic, Swedish health care centers were restructured. This was accompanied by changes in the surgical programme. The aim of this study was to determine the effects of COVID-19 on emergency and elective hernia surgeries in a Swedish health-care region. Material and Methods This was a retrospective, observational cohort study. Data from inguinal and ventral hernia surgeries were retrieved from a medical database using procedure codes from all three hospitals in Region Jönköping County from March 1, 2019 to January 31, 2021. The participants were divided into two groups: COVID-19 group (March 1, 2020 - January 31, 2021) and reference group (March 1, 2019 - January 31, 2020). The incidence rate (IR) and relative risk (RR) of operations over different time frames were analyzed. Results A total 1351 participants met the inclusion criteria. 590 were operated during the COVID-19 period and 761 during the reference period. The IR of elective operations was decreased during the COVID-19 pandemic; 146 operations/100.000 population vs 192 operations/100.000 population during the reference period. RR was 0,76 (95% CI 0.6813-0.8545, p < 0.0001). Moreover, IR of emergency operations decreased insignificantly during the COVID-19 pandemic; 17,5 operations/100.000 population vs 19,4 operations/100.000 population during the reference period. RR was 0,9 (95% CI 0.6404- 1.2649, p 0.5441). No significant variations in the emergency operations have identified when different time frames were compared. Conclusions There is no evidence to support that COVID-19 pandemic has increased emergency hernia operations during the studied period despite the significant reduction of elective operations.

Gambaran Faktor Risiko Diare pada Balita (0 - 59 Bulan) di Wilayah Kerja Puskesmas Bojongsoang pada Tahun 2019

Diare merupakan penyakit endemis di Indonesia. Angka kematian diare paling banyak pada anak usia 5 tahun ke bawah. Jawa Barat menempati posisi pertama dalam penderita balita terbanyak. Berdasar atas data Dinas Kesehatan Kabupaten Bandung, kejadian diare banyak tersebar di Kabupaten Bandung. Wilayah kerja Puskesmas Bojongsoang mengalami peningkatan kasus diare balita pada tahun 2019. Diare disebakan oleh faktor lingkungan, faktor ibu, faktor anak, dan sosiodemografi. Studi ini bertujuan mengetahui gambaran faktor risiko diare pada balita berusia 0 - 59 bulan. Metode yang digunakan adalah deskriptif observasional dengan desain cross-sectional. Responden berjumlah 43 orang, dilakukan selama bulan september 2020 menggunakan rumus perkiraan proporsi, tingkat kepercayaan 90%, margin of error 1%, dan dipilih dengan teknik purposive. Terdapat hasil sebanyak 51% (22 orang) balita non ASI eksklusif dan 93% (40 orang) balita memiliki status gizi baik. Pada faktor sosiodemografi, sebanyak 49% (21 orang) ibu dengan pendidikan terakhir SLTP/MTS. Pada faktor ibu, sebanyak 95% (41 orang) ibu memiliki pengetahuan PHBS yang baik dan 77% (33 orang) ibu memiliki sikap PHBS yang baik. Pada faktor lingkungan, sebanyak 58% (25 orang) balita memiliki sarana air bersih yang baik dan 65% (28 orang) memiliki sarana jamban yang baik. Kesimpulan yang didapat adalah masih banyak balita non ASI eksklusif. Pengetahuan dan sikap PHBS baik, tetapi banyak ibu belum terbiasa melakukan PHBS. Masih banyak sarana air secara fisik tidak layak dan jamban yang kurang baik karena belum memiliki pembuangan kotoran sesuai aturan yang dapat menyebarkan bakteri penyebab diare. Disarankan pada institut terkait agar dapat mengajak para ibu menerapkan PHBS dan memberi ASI eksklusif.Diarrhea Risk Factors in Toddlers (0-59 Months) in Bojongsoang Primary Health Care Region in 2019Diarrhea is an endemic disease in Indonesia. Diarrhea mortality rates mostly occur in toddlers. West Java occupies the first position in most toddlers who experience diarrhea. Based on the Bandung District Public Health Office data, the incidence of diarrhea in toddlers spread in the Bandung district. In 2019, it has increased in Bojongsoang Primary Health Care region. Some of the risk factors are environmental factors, maternal factors, child factors, and sociodemography. This study was conducted to discover the risk factors for diarrhea in toddlers. During September 2020 the method used was a cross-sectional descriptive observational. A sample of 43 people was calculated by estimating proportions with a credibility level of 90%, a 1% margin of error, and were selected using purposive sampling. The results are 51% (22 people) toddlers were not exclusively breastfed and 93% (40 people) had a good nutritional status. In sociodemographic, 49% (21 people) mothers attended Junior High School. In the maternal factor, 95% (41 people) mothers had good PHBS knowledge and 77% (33 people) had a good attitude. In environmental factors, 58% (25 children) toddlers have good water facilities and 65% (28 people) have good latrine facilities. The conclusion is there are still many toddlers unexclusively breastfed. Good mother’s PHBS knowledge and attitude, but did not implement. Many poor water facilities physically and poor latrines due to unproper sewage disposal that can spread bacteria that causes diarrhea. It is suggested that the primary health care should be able to encourage mothers to apply PHBS and provide exclusive breastfeeding.

POS0506 TENOSYNOVITIS HAS A HIGH SENSITIVITY FOR EARLY ACPA-POSITIVE AND ACPA-NEGATIVE RA: A LARGE CROSS-SECTIONAL MRI STUDY

Background:Clinically evident tenosynovitis can be seen in established Rheumatoid arthritis (RA). Imaging research has recently shown that tenosynovitis at small joints occurs in early RA, contributes to typical RA symptoms (including joint swelling) and is infrequent in healthy controls. Imaging-detectable tenosynovitis is often not recognizable at joint examination, hence its prevalence can therefore be underestimated.Objectives:We hypothesized that if MRI-detectable tenosynovitis is a true RA-feature, the sensitivity for RA is high, in both ACPA-positive and -negative RA, and lower in other diseases that are associated with enthesitis (such as Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA)). So far, no large MRI-study addressed these questions.Methods:Consecutive early arthritis patients (n=1211) from one health-care region underwent contrast-enhanced 1.5T MRI of hand and foot at diagnosis. MRIs were scored for synovitis and tenosynovitis by two readers blinded for clinical data. All included patients with ACPA-positive RA (n=250), ACPA-negative RA (n=282), PsA (n=88), SpA with peripheral arthritis (n=24), reactive arthritis (n=30) and self-limiting undifferentiated arthritis (UA;n=76) were studied. Sensitivity was calculated.Results:The sensitivity of tenosynovitis in RA was 85%; 88% for ACPA-positive RA and 82% for and ACPA-negative RA (p=0.19). The sensitivity for RA was significantly higher than for PsA (65%;p=0.001), SpA (53%;p<0.001), reactive arthritis (36%;p<0.001) and self-limiting UA (42%;p<0.001). The observed sensitivity of MRI-synovitis was 91% in RA and ranged 83-54% in the other groups.Conclusion:MRI-detected tenosynovitis has a high sensitivity for early ACPA-positive and ACPA-negative RA. This supports both juxta-articular (tenosynovitis) and intra-articular synovial involvement is characteristic for RA.Figure 1.Presence of tenosynovitis (in black) in wrist MCPs and MTPs, in rheumatoid arthritis, stratified for ACPA-status and compared to other diseases Legend: RA: Rheumatoïd arthritis; ACPA: anti-citrullinated protein antibodies; UA: undifferentiated arthritisDisclosure of Interests:None declared

Regional needs assessment for emergency physician audit and feedback

ABSTRACTObjectivesAudit and feedback is widely used to improve physician performance. Many data metrics are being provided to physicians, yet most of these are driven by the regulatory environment. We sought to conduct a needs assessment of audit and feedback metrics that were most useful to clinicians within our health care region.MethodsWe conducted a Web-based survey of five clinical practice sites in our region and asked that physicians rank 49 clinical practice metrics. In addition, we assessed their readiness for audit and feedback and their preferences for data confidentiality. We collected data on duration of training, gender, and site of practice (academic v. community) allowing for comparison between groups.ResultsA total of 104 emergency medicine physicians participated in the survey (52.3% response rate). There was a significant readiness for participation in audit and feedback activities. Top ranked metrics were emergency department return rates and colleague's assessment of collegiality and quality of care, which were common across all sites. Small yet significant differences were noted between genders and academic v. community practitioners.ConclusionThis study represents the first regional analysis of physician preferences for audit and feedback activities and implementation. It demonstrates that physicians are interested in audit and feedback activities and provides a roadmap for the development of a regional audit and feedback structure. It will also be used as a guiding document for regional change management.

Correlation Between an Exclusive Breast Feeding with Baby’s Nutritional Status Assessed at Primary Health Care, Region I in North Denpasar

According to data from the Basic Health Research of Indonesia (Riskesdas), exclusively breastfed babies has reached only 15.3% in 2010. While in Denpasar, its level fell from 62.2% in 2007 to 56.2% in 2008 for infants aged 0-6 months. This study aims to find out an exclusive breastfeeding given in infants, assessing infant’s nutritional status, and the correlation between an exclusive breastfeeding with infant’s nutritional status at Primary Health Care, Region I in North Denpasar. This research used a descriptive correlative method. Subjects were given exclusively breastfed for totally 45 respondents. This type of sampling using a purposive sampling. Statistical analysis was done by Chi-Square. Respondents were breastfed exclusively has higher normal nutritional status for about 51.1% compared with those whose was not given, showing only 15.6%.

O Cuidado nos CAPS numa Região de Saúde Maranhense / Care in a Psycho-social Care Centre in a Health Care Region in Maranhão, Brazil

A partir da Reforma Psiquiátrica, os Centros de Atenção Psicossocial assumiram a função de serviços substitutivos e ordenadores da rede em saúde mental. O objetivo do presente estudo foi compreender o cuidado em saúde mental e as articulações com a rede de atenção à saúde na perspectiva dos profissionais dos CAPS. Trata-se de uma pesquisa de abordagem qualitativa realizada com profissionais de CAPS em uma região de saúde do nordeste brasileiro. Foi realizado um grupo focal e utilizado um questionário estruturado. Através da Análise de Conteúdo na modalidade Temática as falas foram agrupadas em três categorias: entre o preconizado e a prática; a articulação em rede; o usuário, ora sujeito, ora doente mental. Concluiu-se que a presença do CAPS, por si só, não garante um novo modelo de atenção. Faz-se necessário apoio das gestões municipais na consolidação do cuidado em rede, pactuação de fluxo do cuidado e supervisão clínico-institucional eficiente.Palavras-chave: Reforma dos Serviços de Saúde; Desinstitucionalização; Serviços de Saúde Mental; Saúde Mental.