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INTRODUCTION: Clinic absenteeism promotes higher waiting lists for medical procedures and public resources waste. OBJECTIVES: The present work aimed to identify the reasons for clinic absenteeism from each cycle of the antineoplastic chemotherapy treatment, as well as to determine the socio-demographic, clinical and treatment profiles of this population. METHODS: This observational prospective work evaluated pediatric and adult patients which missed their chemotherapy cycle between May and October 2023 in a Cancer Center located in Rio de Janeiro, Brazil. Clinic absenteeism rate was calculated, and socio-demographic profile was described. Reasons for absenteeism, treatment protocol and most used drugs were also identified. RESULTS: This work analyzed data from 69 patients, the majority above 60 years old. Approximately 60% were male, 33.3% had little to no education and 63.8% lived outside the center city. Absenteeism average monthly rate was 1.73% for adults and 0.87% for children. The most related non-attendance reasons were patient feeling too ill to attend their chemotherapy session, failure to remember the cycle day and lack of means of transportation. Most prevalent neoplasms were from the digestive tract (46%). Fluorouracil, irinotecan, oxaliplatin and gemcitabine were the most discarded drugs due to absenteeism. CONCLUSIONS: Older patients and the ones residing far away from the Center tend to miss the scheduled chemotherapy cycles. However, most reasons for absenteeism could be avoided by confirmation calls or text messages. These procedures implementation could lead to a lower absenteeism rate and less resource waste.

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RESUMEN La inasistencia a citas dentales es un problema relevante en la atención sanitaria debido a las consecuencias negativas que implica. El presente artículo tiene como objetivo revisar las causas de la inasistencia y las estrategias implementadas para su prevención a nivel internacional. Los factores socioeconómicos, culturales, geográficos y demográficos son identificados como las principales causas del ausentismo. Se ha observado una relación inversamente proporcional entre el nivel socioeconómico y el ausentismo, donde aquellos pacientes con mayores recursos tienden a tener una menor inasistencia. El factor socioeconómico y cultural, junto con la educación en salud oral, influyen en la preocupación y la frecuencia de los controles dentales. Se han propuesto diversas soluciones, como el recordatorio telefónico o mediante mensajes de texto (SMS), aunque su efectividad puede variar debido a la familiaridad y el acceso de los pacientes a la tecnología. Se requiere abordar este problema de manera integral y considerar diferentes enfoques para reducir la inasistencia a citas dentales.

ABSTRACT Non-attendance at dental appointments is a relevant problem in health care due to the negative consequences it entails. This article aims to review the causes of nonattendance and the strategies implemented for its prevention at the international level. Socioeconomic, cultural, geographic, and demographic factors are identified as the main causes of absenteeism. An inversely proportional relationship has been observed between socioeconomic status and absenteeism, with those patients with greater resources tending to have lower absenteeism. Socioeconomic and cultural factors, together with oral health education, influence the concern and frequency of dental checkups. Various solutions have been proposed, such as telephone or SMS reminders, although their effectiveness may vary due to patient familiarity and access to technology. There is a need to address this problem comprehensively and consider different approaches to reduce missed dental appointments.

RESUMO A não comparência às consultas de medicina dentária é um problema relevante nos cuidados de saúde pelas consequências negativas que acarreta. Este artigo tem como objetivo rever as causas do absentismo e as estratégias implementadas para a sua prevenção a nível internacional. Os fatores socioeconómicos, culturais, geográficos e demográficos são identificados como as principais causas do absentismo. Foi observada uma relação inversamente proporcional entre o estatuto socioeconómico e o absentismo, sendo que os doentes com mais recursos tendem a ter menos absentismo. Os fatores socioeconómicos e culturais, juntamente com a educação para a saúde oral, influenciam a preocupação e a frequência das consultas dentárias. Têm sido propostas várias soluções, como lembretes por telefone ou SMS, embora a sua eficácia possa variar devido à familiaridade do paciente e ao acesso à tecnologia. É necessário abordar este problema de forma abrangente e considerar diferentes abordagens para reduzir a não comparência às consultas dentárias.

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INTRODUCTION: Nonattendance is a critical problem that affects health care worldwide. Our aim was to build and validate predictive models of nonattendance in all outpatients appointments, general practitioners, and clinical and surgical specialties. METHODS: A cohort study of adult patients, who had scheduled outpatient appointments for General Practitioners, Clinical and Surgical specialties, was conducted between January 2015 and December 2016, at the Italian Hospital of Buenos Aires. We evaluated potential predictors grouped in baseline patient characteristics, characteristics of the appointment scheduling process, patient history, characteristics of the appointment, and comorbidities. Patients were divided between those who attended their appointments, and those who did not. We generated predictive models for nonattendance for all appointments and the three subgroups. RESULTS: Of 2,526,549 appointments included, 703,449 were missed (27.8%). The predictive model for all appointments contains 30 variables, with an area under the ROC (AUROC) curve of 0.71, calibration-in-the-large (CITL) of 0.046, and calibration slope of 1.03 in the validation cohort. For General Practitioners the model has 28 variables (AUROC of 0.72, CITL of 0.053, and calibration slope of 1.01). For clinical subspecialties, the model has 23 variables (AUROC of 0.71, CITL of 0.039, and calibration slope of 1), and for surgical specialties, the model has 22 variables (AUROC of 0.70, CITL of 0.023, and calibration slope of 1.01). CONCLUSION: We build robust predictive models of nonattendance with adequate precision and calibration for each of the subgroups.

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INTRODUCTION: Outpatient appointment nonattendance (NA) represents a public health problem, increasing the risk of unfavorable health-related outcomes. Although NA is significant among older adults, little is known regarding its correlates. This study aimed to identify the correlates (including several domains from the geriatric assessment) of single and repeated NA episodes in a geriatric medicine outpatient clinic, in general and in the context of specific comorbidities. METHODS: This is a cross-sectional study including data from 3,034 older adults aged ≥60 years with ≥1 scheduled appointments between January 1, 2016, and December 31, 2016. Appointment characteristics as well as sociodemographic, geographical, and environmental information were obtained. Univariate and multivariate multinomial regression analyses were carried out. RESULTS: The mean age was 81.8 years (SD 7.19). Over a third (37.4%) of participants missed one scheduled appointment, and 14.4% missed ≥2. Participants with a history of stroke (OR 1.336, p = 0.041) and those with a greater number of scheduled appointments during the study time frame (OR 1.182, p < 0.001) were more likely to miss one appointment, while those with Parkinson's disease (OR 0.346, p < 0.001), other pulmonary diseases (OR 0.686, p = 0.008), and better functioning for activities of daily living (ADL) (OR 0.883, p < 0.001) were less likely to do so. High socioeconomic level (OR 2.235, p < 0.001), not having a partner (OR 1.410, p = 0.006), a history of fractures (OR 1.492, p = 0.031), and a greater number of scheduled appointments (OR 1.668, p < 0.001) increased the risk of repeated NA, while osteoarthritis (OR 0.599, p = 0.001) and hypertension (OR 0.680, p = 0.002) decreased it. In specific comorbidity populations (hypertension, type 2 diabetes mellitus, and cancer), better ADL functioning protected from a single NA, while better mobility functioning protected from repeated NA in older patients with hypertension and cancer. DISCUSSION/CONCLUSION: Identifying geriatric factors linked to an increased probability of NA may allow one to anticipate its likelihood and lead to the design and implementation of preventive strategies and to an optimization of the use of available health resources. The impact of these factors on adherence to clinical visits requires further investigation.

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A suspensão das aulas presenciais em virtude da pandemia de Covid- 19 atingiu todos os sistemas de ensino e, a partir de então, algumas instituições têm adotado as chamadas atividades pedagógicas não presenciais (APNP). O objetivo deste artigo foi analisar, a partir da Psicologia Histórico-Cultural, as mediações relacionadas às APNP no contexto do distanciamento social. Problematizamos o uso dos termos ensino e aula, pois ambos configuram atividades relacionais, dialéticas e dialógicas, experiências coletivas que se materializam no encontro. Realizamos um caminho de análise tendo a categoria mediação como escopo para pensar os processos de aprender e ensinar. Tecemos considerações sobre o lugar da escola na contemporaneidade e sobre o conjunto de relações que permeiam o trabalho com o conhecimento, inclusive na sua forma remota. Apontamos algumas pistas para avaliar este momento em que instituições de ensino adotaram as APNP e apresentamos implicações e perspectivas sobre o retorno à situação presencial.

The suspension of in-person classes due to the Covid-19 pandemic affected all education systems and, since then, some institutions have adopted the so-called non-attendance pedagogical activities (NAPA). The aim of this article was to analyze, from the Historical-Cultural Psychology, the mediations related to NAPA in the context of social distancing. We problematize the use of the terms teaching and class, as both configure relational, dialectical and dialogic activities, collective experiences that materialize in the encounter. We carried out an analysis path having the mediation category as a scope to think about the processes of learning and teaching. We make considerations about the place of the school in contemporaneity and about the set of relationships that permeate the work with knowledge, even in its remote form. We point out some clues to assess this moment when educational institutions adopted NAPA and present implications and perspectives on the return to the presential situation.

Suspender las clases presenciales debido a la pandemia de Covid-19 afectó a todos los sistemas educativos y, desde entonces, algunas instituciones Adoptaron las actividades pedagógicas no presenciales (APNP). El objetivo de este artículo fue analizar, desde la Psicología Histórico-Cultural, las mediaciones relacionadas con APNP contextualizada por la distancia social. Problematizamos el uso de los términos enseñanza y clase, porque ambos configuran actividades relacionales, dialécticas y dialógicas, experiencias colectivas que se materializan en el encuentro. Realizamos una ruta de análisis con la categoría de mediación como ámbito para pensar sobre los procesos de aprendizaje y enseñanza. Hacemos consideraciones sobre el lugar de la escuela en los tiempos contemporáneos y el conjunto de relaciones que impregnan el trabajo con el conocimiento, incluso en su forma remota. Señalamos pistas para evaluar este momento cuando las instituciones educativas adoptaron el APNP y presentan implicaciones y perspectivas sobre el regreso a la situación presencial.

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BACKGROUND: In patients with epilepsy, regular follow-up is vital for adequate seizure control, antiseizure drugs' (ASDs) side effects, psychiatric comorbidities, and planning for epilepsy surgery. Non-attendance creates barriers to adequate patient care, inefficient allocation of resources, loss of income, and unnecessary emergency department visits due to lack of seizure control. This study aimed to determine the causes and sociodemographic characteristics of the non-attendant population at the Epilepsy Clinic. METHODS: A prospective and observational study was carried out on patients treated at the Epilepsy Clinic of the National Institute of Neurology and Neurosurgery (NINN) in Mexico from August 2015 to June 2016. A phone interview was made with all those patients who did not attend the epilepsy consultation. This call incorporated ad hoc questions to meet the objectives of this study. RESULTS: During the study period, 1299 patients had an appointment at the epilepsy clinic, where 233 (17.9%) patients missed their consultation, 123 (52.8%) were male, mean age was 35.9 ±â€¯14.42 years. The most frequent cause of non-attendance was forgetfulness of the appointment in 62 patients (26.6%). Two patients died; no patient was reported to have experienced SUDEP. Non-attendant patients showed statistically significant overall prevalence of psychiatric comorbidities (41.6%), particularly depression, anxiety, and interictal psychosis. CONCLUSION: Information on non-attendance at various specialist consultations is scarce, and to our knowledge, this is the first study to address non-attendance in patients with epilepsy in Latin America. Improving hospital protocols to reduce non-attendance can increase patient adherence to follow-up, ultimately improving the quality of care in the epilepsy clinic.

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O objetivo deste estudo foi testar o impacto de um lembrete por mensagem de texto eletrônica, via WhatsApp®, sobre a taxa de absenteísmo nas consultas de subespecialidades pediátricas. Este estudo aleatorizado foi composto por um grupo controle e um experimental. Os participantes do grupo experimental receberam um aviso por WhatsApp® lembrando a data da consulta. Foram incluídos no estudo todos os usuários agendados (primeira vez e retornos) para consultas de subespecialidades pediátricas. Para as análises foi calculado os percentuais e realizou-se o teste Qui-quadrado de associação. Um total de 998 participantes foram incluídos para análise. A maioria dos participantes era do sexo masculino (59 porcent). A taxa de absenteísmo no grupo experimental foi de 24 porcent e no grupo controle, 25,5 porcent, representando uma diferença de 1,5 porcent (p= 0,580). A taxa de absenteísmo era particularmente mais alta para consultas agendadas na segunda-feira, com 30 porcent (p= 0,009). Globalmente, o uso de lembretes por mensagens de texto em estudos com diferentes populações reduz a taxa de absenteísmo. No entanto, nossas descobertas sugerem que o envio de mensagens de texto via WhatsApp® como lembretes de consulta não é uma ferramenta eficaz na redução do absenteísmo de subespecialidades pediátricas(AU)

El objetivo de este estudio fue evaluar el impacto de un recordatorio a través de un mensaje de texto por WhatsApp® sobre la tasa de absentismo en las consultas de subespecialidades pediátricas. Este estudio aleatorizado fue compuesto por un grupo control y un grupo experimental. Los participantes del grupo experimental recibieron un recordatorio a través de WhatsApp® que rememoraba la fecha de la consulta. Todas las consultas programadas de la subespecialidad pediátrica, tanto las realizadas por primera vez como las siguientes, fueron incluidas en el estudio. Para el análisis fueron calculados los porcentajes mediante la prueba chi-cuadrado. Fueron incluidos 998 participantes en el análisis, de los cuales la mayoría eran hombres (59 por ciento). La tasa de absentismo del grupo experimental fue de 24 por ciento, mientras la del grupo control fue de 25,5 por ciento, lo que representa una diferencia del 1,5 por ciento (p= 0,580). La tasa de absentismo fue del 30 por ciento (p= 0,009), lo que resultó particularmente alta para las consultas programadas para los lunes. Generalmente los estudios que utilizaron mensajes de texto en diferentes poblaciones, como recordatorio, redujeron la tasa de absentismo de las consultas. Sin embargo, nuestros resultados sugieren que enviar mensajes de texto a través del WhatsApp® como recordatorio de consultas médicas no es una herramienta efectiva para reducir el absentismo en las subespecialidades pediátricas(AU)

The purpose of the study was to evaluate the impact of WhatsApp® text messaging reminders on the rate of non-attendance to pediatric specialty consultation. Randomized examination was conducted of a control group and an experimental group. Participants in the experimental group received a WhatsApp® reminder of the appointment date. All the appointments scheduled for the pediatric subspecialty were included, i.e. first-time appointments as well as those following. Data analysis was based on percentage estimation by the chi-square test. A total 998 participants were included in the analysis, most of whom were men (59 percent). The non-attendance rate was 24 percent in the experimental group and 25.5 percent in the control group, for a difference of 1.5 percent (p= 0.580). The non-attendance rate was 30 percent (p= 0.009), particularly high for appointments scheduled for Mondays. In general terms, studies using text messaging as reminders in different populations reduced the rate of non-attendance to consultation. However, our results suggest that sending WhatsApp® text messages as reminders of medical appointments is not an effective tool to reduce non-attendance to pediatric consultation(AU)

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BACKGROUND: Non-attendance to scheduled medical appointments in outpatient clinics is a problem that affects patient health and health-care systems. OBJECTIVE: Evaluate association of non-attendance to scheduled appointments in outpatient clinics and Emergency Department (ED) visits, hospitalizations and mortality. METHODS: Retrospective cohort study of outpatients enrolled in 2015 to 2016 in the Hospital Italiano de Buenos Aires HMO with over five scheduled appointments. Individual non-attendance proportion was obtained by dividing missed over scheduled appointment numbers in the 365 days prior to index date. Outcomes were evaluated with a Cox proportional-hazards or Fine and Gray model for competing risks. We adjusted by several variables. RESULTS: Sixty-five thousand two hundred sixty-five adults were included. Mean age was 63.6 years (SD 18.16), 29.9% male. Outpatients had average 10.18 (SD 5.59) appointments. Non-attendance the year before the index appointment had a median of 20%. A 10% increase in non-attendance was significantly associated with ED visits (asHR 1.19; 95%CI 1.08-1.32, P < .001) and all-cause mortality (aHR 7.57; 95%CI 4.88-11.73, P < .001). In the matched subcohort analysis we observed a crude significant association of non-attendance with ED visits (P < .001) and all-cause mortality (P < .001). DISCUSSION: Our findings show non-attendance could be a marker of health events that lead to emergency department evaluations and/or death.

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INTRODUCTION: Nonattendance at scheduled outpatient appointments for primary care is a major health care problem worldwide. Our aim was to estimate the prevalence of nonattendance at scheduled appointments for outpatients seeking primary care, to identify associated factors and build a model that predicts nonattendance at scheduled appointments. METHODS: A cohort study of adult patients, who had a scheduled outpatient appointment for primary care, was conducted between January 2010 and July 2011, at the Italian Hospital of Buenos Aires. We evaluated the history and characteristics of these patients, and their scheduling and attendance at appointments. Patients were divided into two groups: those who attended their scheduled appointments, and those who did not. We estimated the odds ratios (OR) and corresponding 95% confidence intervals (95% CI), and generated a predictive model for nonattendance, with logistic regression, using factors associated with lack of attendance, and those considered clinically relevant. Alternative models were compared using Akaike's Information Criterion. A generation cohort and a validation cohort were assigned randomly. RESULTS: Of 113,716 appointments included in the study, 25,687 were missed (22.7%; 95% CI: 22.34%-22.83%). We found a statistically significant association between nonattendance and age (OR: 0.99; 95% CI: 0.99-0.99), number of issues in the personal health record (OR: 0.98; 95% CI: 0.98-0.99), time between the request for and date of appointment (OR: 1; 95% CI: 1-1), history of nonattendance (OR: 1.07; 95% CI: 1.07-1.07), appointment scheduled later than 4 pm (OR: 1.30; 95% CI: 1.24-1.35), and specific days of the week (OR: 1.00; 95% CI: 1.06-1.1). The predictive model for nonattendance included characteristics of the patient requesting the appointment, the appointment request, and the actual appointment date. The area under the receiver operating characteristic curve of the predictive model in the generation cohort was 0.892 (95% CI: 0.890-0.894). CONCLUSION: Evidence related to patient characteristics, and the identification of appointments with a higher likelihood of nonattendance, should promote guided strategies to reduce the rate of nonattendance, as well as to future research on this topic. The use of predictive models could further guide management strategies to reduce the rate of nonattendance.

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O objetivo deste estudo retrospectivo foi levantar taxas de desistência e abandono do atendimento em uma clínica-escola de psicologia infantil e identificar fatores de risco sócio-demográficos, clínicos e familiares para ambos os desfechos. Dados de 258 crianças foram obtidos nos prontuários. Desistiram do atendimento logo após a entrevista inicial 16 por cento das famílias. Entre as famílias não desistentes, 49 por cento interromperam o atendimento antes da alta. Foram comparados, quanto aos fatores de risco, os grupos desistente e não desistente. Além disso, no grupo não desistente, os subgrupos abandono (clientes que compareceram ao menos uma vez antes de interromperem o tratamento) e alta clínica (clientes que persistiram até o final do atendimento) também foram comparados. Famílias desistentes apresentaram mais crianças nas séries iniciais, com menos problemas de comportamento. O abandono foi associado a menor recurso cognitivo e menor idade da criança, pai mais jovem e maior exposição da família a estresse psicossocial.

This retrospective study aimed at investigating the rates of treatment nonattendance and dropout at a university-affiliated child guidance clinic and identifying socio demographic, clinical and family risk factors that contribute to them. We obtained archival data of 258 children. Sixteen percent of the families did not return after their intake interview. Among families that returned, forty-nine percent dropped out of treatment. Groups were compared with respect to risk factors for self-termination: nonattenders (clients who did not return after intake) versus attenders (clients who returned); dropouts (clients that attended at least one session before interrupting treatment) versus completers (clients that persisted until treatment conclusion). Children from nonnattender families attended earlier school grades and had less behavior problems. Children in the dropout group had lower scores in intelligence assessment, their fathers were younger and their families were more exposed to psychosocial stress, as compared to completers.

El objetivo fue buscar tasas de retirada y abandono del tratamiento en una clínica-escuela de psicología para niños y identificar factores de riesgo demográficos, clínicos y ambientales para ambos los desenlaces. Se utilizaron datos de archivo de 258 niños. No llegaran a iniciar el tratamiento en seguida a la primera entrevista 16 por ciento de las familias. Entre las que retornaran, 49 por ciento terminaran el tratamiento prematuramente. Se compararan las familias que no regresaran después de la entrevista inicial con las familias que retornaran. Las familias que abandonaran el tratamiento empezado fueran comparadas con las que persistieran hasta el fin. En las familias que no iniciaran en tratamiento los niños tenían menos problemas de conducta y cursaban años iniciales en la escuela. En las familias que abandonaran, los niños eran más jóvenes, tuvieran peor desempeño en test cognitivo, el estatus educativo de los padres era menor y la familia estaba más expuesta a estrés psicosocial.

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O objetivo deste estudo retrospectivo foi levantar taxas de desistência e abandono do atendimento em uma clínica-escola de psicologia infantil e identificar fatores de risco sócio-demográficos, clínicos e familiares para ambos os desfechos. Dados de 258 crianças foram obtidos nos prontuários. Desistiram do atendimento logo após a entrevista inicial 16 por cento das famílias. Entre as famílias não desistentes, 49 por cento interromperam o atendimento antes da alta. Foram comparados, quanto aos fatores de risco, os grupos desistente e não desistente. Além disso, no grupo não desistente, os subgrupos abandono (clientes que compareceram ao menos uma vez antes de interromperem o tratamento) e alta clínica (clientes que persistiram até o final do atendimento) também foram comparados. Famílias desistentes apresentaram mais crianças nas séries iniciais, com menos problemas de comportamento. O abandono foi associado a menor recurso cognitivo e menor idade da criança, pai mais jovem e maior exposição da família a estresse psicossocial.(AU)

This retrospective study aimed at investigating the rates of treatment nonattendance and dropout at a university-affiliated child guidance clinic and identifying socio demographic, clinical and family risk factors that contribute to them. We obtained archival data of 258 children. Sixteen percent of the families did not return after their intake interview. Among families that returned, forty-nine percent dropped out of treatment. Groups were compared with respect to risk factors for self-termination: nonattenders (clients who did not return after intake) versus attenders (clients who returned); dropouts (clients that attended at least one session before interrupting treatment) versus completers (clients that persisted until treatment conclusion). Children from nonnattender families attended earlier school grades and had less behavior problems. Children in the dropout group had lower scores in intelligence assessment, their fathers were younger and their families were more exposed to psychosocial stress, as compared to completers.(AU)

El objetivo fue buscar tasas de retirada y abandono del tratamiento en una clínica-escuela de psicología para niños y identificar factores de riesgo demográficos, clínicos y ambientales para ambos los desenlaces. Se utilizaron datos de archivo de 258 niños. No llegaran a iniciar el tratamiento en seguida a la primera entrevista 16 por ciento de las familias. Entre las que retornaran, 49 por ciento terminaran el tratamiento prematuramente. Se compararan las familias que no regresaran después de la entrevista inicial con las familias que retornaran. Las familias que abandonaran el tratamiento empezado fueran comparadas con las que persistieran hasta el fin. En las familias que no iniciaran en tratamiento los niños tenían menos problemas de conducta y cursaban años iniciales en la escuela. En las familias que abandonaran, los niños eran más jóvenes, tuvieran peor desempeño en test cognitivo, el estatus educativo de los padres era menor y la familia estaba más expuesta a estrés psicosocial.(AU)

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