Public Health Care Research Articles

Optimizing Maternal Healthcare Access: A Mixed Method Study on Dual Utilization of Public and Private Antenatal Care Services in Puducherry, India

Abstract Background: Access to antenatal care (ANC) services has improved. However, it is also noted that some antenatal women seek multiple healthcare services. Exploring this practice will identify gaps in service provision and pave the path toward improving the quality of services. Objective: This study aimed to measure the concurrent use of public and private healthcare services for various components of ANC and understand the reasons for the dual utilization. Methodology: This explanatory mixed-method study enrolled 177 mothers residing in Puducherry, who had given birth in the last three years. A pretested, semi-structured questionnaire was administered, and six key informant interviews were conducted. Integration was performed in the interpretation stage, and a joint display was used to depict the results. We adopted the Donabedian model during the analysis and organized the codes under these major themes[1] Access;[2] Delivery of the Services;[3] and Quality of Care. Result: Most pregnant women (81.9%, 95% CI = 75.2%–86.8%) sought care from both public and private healthcare facilities, however, they preferred public facilities for delivery (74.6%, 95% CI = 67.6%–80.4%). The qualitative analysis revealed three major themes[1] Access;[2] Delivery of the Services;[3] and Quality of Care. Primary reasons for opting for private facilities included perceived superior ANC quality, organized care evident in scheduled appointments, reduced waiting time, frequent ultrasounds, personalized medication, and enhanced rapport with family. Women also believed that visits to government facilities are essential to avail the monetary benefits and have a seamless admission during delivery. They felt that government hospitals perform fewer cesarean sections. Conclusion: Strengthening public-private partnerships could enhance antenatal care utilization, benefiting pregnant women and streamlining healthcare delivery.

Contextualizing guidelines for the health system of Cyprus: Experiences and lessons learnt

AbstractBackgroundCyprus is undergoing a major health reform with the recent establishment of the General Healthcare System (GHS). The GHS offers equal healthcare access through one primary insurer (Health Insurance Organization [HIO]) and benefits from a wide collaborative network of public and private healthcare providers. However, unwanted variation in practice makes this transition challenging. Healthcare guidelines could decrease these variations in practice, but Cyprus lacks the capacity to develop them de novo. Through a collaboration with the National Institute for Health and Care Excellence (NICE) in the United Kingdom, the contextualization of NICE guidelines and the derivation of local quality indicators are carried out. This study presents the methodology and experience of contextualizing the first three NICE guidelines and deriving associated quality indicators in Cyprus.MethodsHIO managed the guideline contextualization with the support of a Guidelines Secretariat. For each guideline, a local topic expert committee (TEC) was recruited. Through a series of meetings, followed by public consultation, each TEC made contextual changes to the guideline and derived relevant quality indicators. During this process, NICE assured quality by overseeing several elements of the contextualization procedure such as TEC membership, proposed changes and justification and derived quality indicators.ResultsBetween 2022 and 2024, three NICE guidelines, NG196 on Atrial fibrillation (AF), NG230 on Thyroid cancer (TC) and NG203 on Chronic kidney disease (CKD), were contextualized through the modification of several individual guideline recommendations (21/79 [26.6%] in AF, 37/67 [55.2%] in TC and 62/217 [28.6%] in CKD). In parallel, NICE quality indicators were screened for applicability and feasibility in Cyprus while additional indicators were developed if required.ConclusionIn a country with limited experience in guideline development, a supervised and systematic process supported by an established organization ensures quality, is less resource intensive and builds capability for the sustainability of the process.

Hospital supply and infant mortality: Evidence from Islamic political representation in Turkey

We investigate the impact of healthcare facility supply on infant mortality by exploiting a change in local governments in Turkey as a quasi-exogenous shock to local hospital supply. Using a regression discontinuity design, we find a significant decline in infant mortality in municipalities where an Islamic mayor was barely elected. Exploring potential channels, we document a significant increase in the number and size of hospitals and health clinics in treated municipalities. Moreover, children in these municipalities are more likely to be born in government facilities, receive treatment for cough and fever, benefit from a greater number of childhood vaccinations, and have more prenatal care visits before birth. Our findings highlight that investments in public healthcare facilities in disadvantaged areas can have substantial effects on the survival of infants.

Enhancing life satisfaction among individuals receiving methadone treatment: The contribution of childhood experiences, personal variables, and therapeutic alliance with the social worker

Abstract This study examines life satisfaction in individuals receiving methadone treatment (MT) at a public healthcare clinic in Israel, using an ecological perspective to assess multiple influencing factors. A total of 180 participants completed surveys on childhood parenting styles, sense of belonging, self-esteem, and therapeutic alliance with the social worker in the healthcare setting. High sense belonging and self-esteem, as well as a strong therapeutic alliance, were positively correlated with life satisfaction. Conversely, non-adaptive parenting styles were related to lower life satisfaction. Therapeutic alliance mediated the associations between self-esteem and sense of belonging to life satisfaction, underscoring the critical role social workers play in enhancing well-being. The importance of potential strategies to enhance life satisfaction and integration into society for individuals in MT within health and social care environments is discussed.

Factors associated with program implementation competencies used to improve health service development capacity of public health nurses: a nationwide survey of prefectures and cities with public health centers

Objectives Public health nurses (PHNs) are necessary in introducing evidence-based health programs to address various health challenges. This study aimed to identify the factors related to PHNs' ability to implement programs across different career-level groups.Methods A self-administered questionnaire was administered to PHNs working in prefectures or cities with public health centers. PHNs were categorized into three career-level groups based on their seniority and position; novice with ≥ 5 years of experience, no-position with ≥ 6 years of experience without a position, and with-position with ≥ 6 years of experience holding a position. Simple regression analysis was conducted using the Implementation Degree Assessment Sheet (Okamoto et al., 2022; IDAS) score as the dependent variable and experience in developing new projects, learning experiences, horizontal development exposure, and PHNs' competency scale scores as independent variables. Stepwise multiple regression analysis was conducted with the IDAS score as the dependent variable and statistically significant variables in the simple regression analysis as the independent variables. The competency measurement scales used were the Professional Development Scale (PDS), Reflective Practice Skill Scale (RPS), and Research Utilization Competency Scale (RUC).Results We obtained 702 out of 966 valid responses (72.7%). The overall mean IDAS scores was 115.7; 107.6 for novice PHNs, 111.3 for no-position PHNs, and 119.6 for with-position PHNs. Multiple regression analysis revealed that RPS and PDS scores contributed to novice and with-position PHNs' abilities. Additionally, "recognition of the importance of horizontal development: agree" significantly influenced novice PHNs' ability, whereas RUC score contributed to with-position PHNs' ability. RUC scores and recognition of the current implementation of horizontal development significantly contributed to the ability of No-position PHNs.Conclusion For improving PHNs' program implementation abilities, novice PHNs should focus on reflective practices, improve professional knowledge and skills, acquire knowledge and competence in program implementation, and improve understanding of its importance. Moreover, no-position PHNs must collect, examine, and use information, such as recent research findings. With-position PHNs must continuously improve their skills and apply them comprehensively in management and program implementation. These findings underscore the importance of tailored program implementation training for each career level, providing opportunities to reflect on practice and one's own activities, and assessing the level of mastery.

A socio-ecological model of the management of leprosy reactions in Indonesia and India using the experiences of affected individuals, family members and healthcare providers

BackgroundLeprosy reactions (LR) are immune-mediated complications of leprosy that may be associated with severe and irreversible nerve damage. Non-medical aspects, such as financing, service provision, and healthcare resources in the management of LR are generally overlooked as studies tend to concentrate on clinical features and treatment. Barriers to accessing care and services are a major cause of suboptimal care for people with leprosy. This study aims to explore the barriers to and facilitators of high-quality care and management of LR in two leprosy-endemic countries with different health care models – Indonesia and India – and identify areas for improvement.MethodsA socio-ecological model was adopted. Data were obtained from 66 interviews with individuals who experienced LR and were seeking care at the two study sites. In addition, immediate family members of individuals with LR and healthcare workers attending to people with leprosy participated in seven focus group discussions (FGDs).ResultsThis study highlights the significant impact of public health insurance regulations and uptake at the macrosystem level on the provision of healthcare services, clinical decision-making, care expenditure, and the psychological well-being of individuals with LR in Indonesia and India. Lack of specialized health professionals and communication challenges were identified in both study populations. Indonesian participants encounter additional challenges due to a fragmented information system and drug shortages. This study identifies key facilitators in providing high-quality care for LR-affected individuals, including financial assistance, availability of corticosteroid alternatives, timely provision of care, and counselling. It found that the high coverage of public health insurance cards in the Indonesian model has increased access to care among individuals affected by LR, despite the challenges. Conversely, the Indian model of care offers treatment subsidies. The advantage of the Indonesian model is its ability to provide wider access to high-quality care, whereas the Indian model focuses on those in most need. This study emphasizes the importance of addressing these challenges through improved communication strategies, education aimed at the affected individuals, and accessible medical care. Furthermore, variations in care-seeking behaviour and self-care practices were observed in both sites, underscoring the need for culturally sensitive and comprehensive approaches to the management of LR.ConclusionThe study findings demonstrate that the factors identified at the four systemic levels are interrelated and have an impact on the access, acceptability, and management of LR services. Despite its accessibility and wider coverage of public health insurance, the integrated service model in Indonesia faces challenges associated with complex regulations and the availability of medication. India’s care model offers intensive, specialised care but has difficulties in ensuring sufficient health personnel, resources, and public health insurance coverage. These findings highlight the need to address these challenges to ensure timely, effective, and comprehensive care for individuals with LR.

PSYCHOEDUCATION TO PREVENT SMARTPHONE ADDICTION THROUGH COMMUNITY BASED INTERVENTION

The prevalence of problematic smartphone usage has become a widespread concern. Excessive smartphone use can develop into an addiction if prompt intervention is not implemented. In order to effectively engage a broader demographic, health cadres play a crucial role in disseminating information to parents regarding strategies for mitigating smartphone addiction in children. The study aimed to examine the effect of psychoeducational interventions to prevent smartphone addiction among children in health cadres. The study employed a quasi-experimental, one-group pre-test and post-test design. The questionnaire comprised ten questions with a reliability coefficient of 0.60. Twenty health cadres from Public Health Center X in Malang were selected as participants. A series of six sessions were done to provide psychoeducation to prevent smartphone addiction. The findings revealed a discernible disparity between the scores obtained before the intervention's implementation and those obtained after completion. The t-test analysis revealed a statistically significant difference between the pre-test and post-test scores, as shown by a significance level of p < 0.001 and a t-value of -9.787. This finding suggests that the intervention increased the knowledge of the health cadres.

Top‐Down Assembly of Photosensitizable Flexible Wood Dressing with Synergistic Effect of Anti‐Infection and Moisture Management

AbstractInfected wound repair stands as a formidable global issue, posing significant threats to public health and medical care. Biopolymer‐based dressings represent a natural and biocompatible candidate greatly conductive to wound healing. However, the low productivity and high price, coupled with the widespread lack of antibacterial activities, vitally restrict their clinical applications. Herein, a simple yet efficient top‐down assembly strategy is reported to fabricate aggregation‐induced emission photosensitizer (AIE‐PS) functionalized flexible wood (AIE/FW) dressing with synergistic photodynamic therapy and moisture management to accelerate the healing of infected wounds. On account of its superior bactericidal effectiveness and appropriate moisture management, along with superb flexibility and excellent biocompatibility, the proposed AIE/FW can effectively prevent wound infection and alleviate inflammatory response, thereby dramatically boosting the infected wound recovery. It is anticipated that the scalable, sustainable, and cost‐effective AIE/FW offers a promising pathway to overcome global wound care challenges.

Concordance of Australian state and territory government guidelines for classifying the healthiness of foods in public settings.

To investigate the concordance between Australian government guidelines for classifying the healthiness of foods across various public settings. Commonly available products in Australian food service settings across 8 food categories were classified according to each of the 17 Australian state and territory food classification guidelines applying to public schools, workplaces, and healthcare settings. Product nutrition information was retrieved from online sources. The level of concordance between each pair of guidelines was determined by the proportion of products rated at the same level of healthiness. Australia. No human participants. Approximately half (56%) of the 967 food and drink products assessed were classified as the same level of healthiness across all 15 'traffic light'-based systems. Within each setting type (e.g., schools), pairwise concordance in product classifications between guidelines ranged from 74% to 100%. 'Vegetables' (100%) and 'sweet snacks and desserts' (78%) had the highest concordance across guidelines while 'cold ready-to-eat foods' (0%) and 'savoury snacks' (23%) had the lowest concordance. In addition to differences in classification criteria, discrepancies between guidelines arose from different approaches to grouping of products. The largest proportion of discrepancies (58%) were attributed to whether products were classified as 'Red' (least healthy) or 'Amber' (moderately healthy). Results indicate only moderate concordance between all guidelines. National coordination to create evidence-based consistency between guidelines would help provide clarity for food businesses, which are often national, on how to better support community health through product development and reformulation.

An Integrative approach in the management of Uncontrolled type 2 Diabetes Mellitus w.s.r. to Sthula Madhumeha: A Case Report

Introduction: Diabetes is a disease of worldwide importance and a major public healthcare concern owing to its associated morbidity. Clinically Type 2 DM resembles Madhumeha with prevalence in India was 9.6% in 2021.This case report describes an integrated approach for the treatment of uncontrolled diabetes mellitus. Main clinical Findings: A 58-year-old male patient complained of polyurea, polyphagia, polydipsia, tingling, and severe burning in all 4 limbs, fatigue, and constipation. Investigations shows FBSL level of 247mg/dl, PPBSL 415mg/dl, and HbA1C 8.9%, BMI 28.6kg /m2. Diagnosis: Sthula-Madhumeha (Type 2 Diabetes Mellitus). Interventions: Treatment includes, Panchatiktapanchaprasutika Basti for consecutive 15 days (Kalbasti Krama), local therapy, oral medications and lifestyle modifications. Outcome: Patient showed marked reduction in FBSL reduced to 82mg/dl PPBSL to 184mg/dl, and HbA1c to 6.8% after 3 months. Patient exhibited significant results in clinical signs and symptoms. Conclusions: It can be concluded that Ayurvedic intervention can be a complimentary treatment in uncontrolled DM.

Health experience for pregnant stay-behind women in rural India: A study on NFHS-5 survey data

ABSTRACT This is a descriptive study based on National Family Health Survey- Round 5 (2020–21) dataset, comparing two groups of Indian women: “stay-behind pregnant women” and “women who are living with their husbands.” We applied z-test analyzing health status and healthcare access between the two groups. The result shows both health status (DMean Hemoglobin = −2.02, p = .002; DMean Sys BP = −2.48, p = .001; DMean Dias BP = −1.53, p = .003; DAnemic = 0.04, p = .006) and healthcare access (DAccess to public healthcare = −4.6 percent, p = .005; DAccess to private healthcare = 10.4 percent, p = .002, DOthers = −9.3 percent, p = .001) are significantly lower among “stay-behind pregnant women.” The intake of nutritious food among stay-behind pregnant women is relatively low (DPulses = −7.9 percent, p = .003; DVeg = −3.4 percent, p = .002; DFruits = −5.5 percent, 0.005; DEggs = −3.8 percent, p = .004; DMeat = −3.4 percent, p = .002) which contributes to their poor health status. Overall, it is concluded that the health status and healthcare access of “stay-behind pregnant women” are poorer than others. Future studies can explore the role of empowerment of “stay-behind pregnant women” in ensuring their better health and healthcare access.

Birth philosophy and experience based on birth place: an ethnographic study in Indonesia

Background/Aims A woman's childbearing philosophy and the birth environment's paradigm will affect her experience of birth. This ethnographic study aimed to explore the interaction between birth philosophy, place of birth and birth experience. Methods Interviews were held with 16 postpartum women at hospitals and public health centres, conducted at 1 week and 42 days postpartum. Observations were also taken on implementation of birth in both settings. Data were analysed thematically. Results Participants viewed birth as a medical problem that required assistance from healthcare professionals. The health system supported technocratic childbirth, particularly as a result of the referral system, which eliminated midwives' role in providing a natural birth. Conclusions The healthcare system should prioritise women's comfort during birth. Women should be given information about natural birth during antenatal care, and healthcare professionals should avoid behaviour that encourages women to give birth technocratically. Implications for practice Private midwives need the opportunity to provide independent services, and midwives need training on women-centred care. Birth planning could be used to increase women's capacity and authority over their bodies.

A Bibliometric Analysis of Healthcare Intervention-Related Studies Reporting Patient and Public Involvement and Engagement

Background/Objectives: Patient and public involvement and engagement (PPIE) has gained global recognition as an innovative healthcare research practice. PPIE engages end-users throughout the research process, improving intervention effectiveness, resource efficiency, and user satisfaction. Despite its increasing inclusion in studies, comprehensive bibliometric reviews of healthcare intervention-related studies reporting PPIE are scarce. This study aims to conduct a bibliometric analysis of healthcare intervention-related studies reporting PPIE in recent decades to identify key worldwide bibliometric features, themes, and trends. Methods: The analysis includes 10,624 relevant English articles published in the Web of Science (WoS) Core Collection up to 26 November 2024. Search terms were selected based on PPIE conceptualization, interventional types, and related healthcare terms. Using WoS descriptive analysis and CiteSpace, we examined bibliometric features and identified major international themes and trends. Results: There has been a significant increase in the number of healthcare intervention-related studies reporting PPIE over the past five years, especially from the United States and the United Kingdom, with a recent rise in Asia. However, cross-national collaboration remains limited. Key research themes identified include “community participation”, “health equity”, “coronary heart disease”, “web-based patient empowerment”, “mental illness”, and “obesity prevention”, with growing interest in “mobile health” and “digital health”. Conclusions: This study provides a comprehensive and up-to-date overview of the bibliometric characteristics and evolving trends in healthcare intervention-related studies reporting PPIE. It highlights global regions with limited PPIE implementation, suggests pathways for further development, and identifies key research themes. The study offers researchers and practitioners valuable insights into tracking PPIE trends in healthcare interventions and fostering collaborations on evidence-based PPIE studies with leading scholars and institutions worldwide. Additionally, the findings drive innovations aimed at improving patient and public healthcare outcomes.

Who bears the distance cost of public primary healthcare? Hypertension among the elderly in rural India.

Hypertension is one of the most prevalent NCDs in the world. Its prevalence is especially high among the elderly, a demographic group on the rise in low and middle income countries. Extant medical literature calls for early detection to prevent aggravation of problems when old. In this paper, we investigate whether diagnosis of hypertension among adults aged 45 and above, is correlated with geographic access to primary public healthcare services, after accounting for a rich set of potentially confounding covariates. Our study focuses on rural India where access to public primary health services is especially poor but hypertension rates are high. Using the first wave of the Longitudinal Ageing Survey of India (LASI) 2017-19, we find that hypertensive adults belonging to poor households, face a distance cost of public primary health facilities and are 8 percent less likely to be aware of their hypertension when Primary Health Centres are 10km away. Since almost 10 percent of villages in India are at least 10km away from PHCs, this exclusionary effect is significant. Our analysis suggests that even though public primary facilities are poorly staffed and managed in India, and private care is popular, geographical expansion of public primary facilities can still play an active role in NCDs and public primary health financing should take heed of the need for such expansion.

Dual Clinical Practice (DCP) policy to improve the retention of human resources for health in Rwanda: a mid-term review using a cross-sectional and retrospective study design

BackgroundDespite the high demand for public services globally, ensuring the quality of services provided by public health facilities is challenging. Poor remuneration of public sector health care providers (HCPs) drives their migration to private health facilities. The Dual Clinical Practice (DCP) Policy in Rwanda represents a strategic initiative aimed at retaining healthcare professionals in public health facilities, allowing them to engage in private practice concurrently. This study assesses the implementation challenges and identifies opportunities for potential reformulation of DCP schemes.MethodsThis study employed a mixed methods approach, incorporating both cross-sectional and retrospective designs across six Rwandan public hospitals. Quantitative and qualitative data were collected through key informant interviews (KIIs) and joint interviews (JIs), as well as through the analysis of health facility records obtained from the Health Management Information System (HMIS) and the Electronic Medical Record (EMR). Qualitative data were analyzed using Atlas.ti software, while quantitative data were analyzed using Microsoft Excel.ResultsThe study involved participants from six Rwandan hospitals, including 20 healthcare providers and 32 patients. Qualitative results revealed that a substantial majority of health care providers supported the DCP policy, with a high patient satisfaction rate of 81% regarding DCP services. However, challenges emerged, including limited awareness of the policy and difficulties in tracking DCP engagements. Quantitative data from the HMIS and EMR indicated an increase in patient enrollment across most facilities, with DCP outpatient visits accounting for a significant percentage of total visits in some hospitals. While the DCP contributed positively to hospital revenues, concerns about the sustainability of the scheme and the adequacy of health care remuneration were highlighted, calling for a review of DCP policy involving stakeholders beyond the Ministry of Health.ConclusionThis study found that the DCP policy in Rwanda positively impacted healthcare provider retention, patient satisfaction, and hospital revenues. Providers expressed strong support for the policy, and patient satisfaction was high, with 81% of patients reporting positive experiences with DCP services. The scheme contributed to increased patient enrollment and hospital revenue, particularly in urban facilities. However, challenges, such as limited awareness of the policy among healthcare providers and difficulties in tracking DCP engagements, were noted. Additionally, concerns about the sustainability of the DCP and the adequacy of healthcare remuneration highlighted the need for policy revisions. To address these challenges, a collaborative approach involving stakeholders such as tax authorities, hospital administrations, and health insurance companies is necessary. Additionally, our study highlights the critical role of investments in physical infrastructure to support the long-term success of DCP. Enhancing infrastructure would not only ensure better healthcare quality but also support the retention of providers in both urban and rural settings.

Access to Disability-related Healthcare among People with Visual Disability in India: Evidence from a National Sample Survey

Abstract Background: Despite progress, there are still gaps and inequalities in achieving universal health coverage (UHC), particularly among marginalized populations such as people with visual disability (VD). This study aimed to evaluate access to disability-related healthcare among people with VD in India. Methods: Data from the Survey of Persons with Disabilities in India, the 76th round of the National Sample Survey (NSS), which was conducted between July 2018 and December 2018, were used in this study. Binomial logistic regression was used to find the association between access to disability-related healthcare and sociodemographic characteristics. Results: The prevalence of VD in the general population was 0.23%. About 15% of people with VD did not have access to healthcare for disability. Access was lower in the older age group (Adjusted Odds Ratio (AOR) =0.68) than in the younger age group, females (AOR = 0.89), persons with low literacy (AOR = 0.72), low consumption expenditure (AOR = 0.60), and people belonging to the scheduled tribes (STs) (AOR = 0.57). Affordability was the leading reason for poor accessibility. About 55% of people with VD had zero out-of-pocket expenditure (OOPE), 35.8% had monthly OOPE below INR 1000, and 1.3% had monthly OOPE INR >5000. Conclusion: The study found gaps in access to healthcare in people with VD in India. This population is falling behind in the core elements of UHC, i.e. affordability and inequality. India should adopt a comprehensive strategy that includes age-specific interventions, improved rural access, measures for socioeconomic equity, gender sensitivity, and expanded public health insurance coverage and social security schemes for people with VD.

Impact of Funding Source on Long-Term Outcomes in Prostate Cancer: Analysis of a Large Public Database From Sao Paulo, Brazil

PURPOSE We investigated the impact of the funding source (public v private) on the overall survival (OS) of men with prostate cancer in Brazil. METHODS We retrospectively analyzed patients with prostate cancer from a large hospital registry from the state of São Paulo, Brazil. Patients age 50-99 years diagnosed with prostate acinar adenocarcinoma or adenocarcinoma not otherwise specified (NOS) between January 2014 and December 2017 were eligible. Demographic and clinical features were analyzed alongside the funding source. On the basis of clinical characteristics at diagnosis (lymph node status, distant metastasis, prostate-specific antigen [PSA], and Gleason score), patients were categorized into low-risk, intermediate-risk, high-risk, and metastatic groups. RESULTS Of 25,009 patients analyzed, 85% had a public funding source. These patients were slightly older, had greater proportion of adenocarcinoma NOS, and higher PSA levels and risk category. There was a significant difference in OS favoring patients with a private funding source ( P < .0001). The estimated OS rates at 5 years were 76.2% (95% CI, 75.6 to 76.9) and 86.9% (95% CI, 85 to 88.7) for the public and private groups, respectively ( P < .0001). The funding source was significantly associated with OS independent of age, educational level, and receipt of any treatment in the intermediate-risk (hazard ratio [HR], 2.28 [95% CI, 1.58 to 3.30]; P < .001) and high-risk (HR, 1.36 [95% CI, 1.02 to 1.80]; P = .04) groups, but not in the low-risk (HR, 0.85 [95% CI, 0.60 to 1.21]; P = .38) or metastatic groups (HR, 0.84 [95% CI, 0.64 to 1.11]; P = .23). CONCLUSION The worse OS observed for patients with prostate cancer with a public source of funding underscores the need for actions directed to improve the standards of public health care in Brazil.

Real-world cost-effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft loss.

A new induction therapy strategy of a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG) showed a lower incidence of acute rejection. The objective of this study was to use real-world data to determine the incremental cost-effectiveness ratio (ICER) of r-ATG induction for the prevention of acute rejection (AR) in the first year following kidney transplantation and for kidney graft survival over 1, 4, and 10 years of post-transplantation from the perspective of the national public healthcare system. A Markov state transition model was developed utilizing real-world data extracted from medical invoices from a single center. The study population consisted of adults at low immunological risk undergoing their initial transplantation and received kidneys from either living or deceased donors. The intervention of r-ATG induction was compared to no induction. The clinical outcomes considered for this analysis were acute rejection, cytomegalovirus infection/disease, death, graft loss, and retransplantation. The cost-effectiveness analysis in the first year revealed that the r-ATG group was more cost-effective, with an ICER of US$ 399.96 per avoided AR episode, an effectiveness gain of 0.01 year in graft survival and a total incremental cost of US$ 147.50. The 4- and 10-year analyses revealed an effectiveness gain of 0.06 and 0.16 years in graft survival in the r-ATG induction group, and a total incremental cost of US$ -321.68 and US$ -2,440.62, respectively. The single 3 mg/kg dose of r-ATG is cost-effective in preventing acute rejection episodes and dominant in the long term of transplantation, conferring survival gain.

Evidence-Based Umbrella Review of Non-Invasive Neuromodulation in Chronic Neuropathic Pain.

Non-invasive neuromodulation techniques (NIN), such as transcranial Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS), have been extensively researched for their potential to alleviate pain by reversing neuroplastic changes associated with neuropathic pain (NP), a prevalent and complex condition. However, treating NP remains challenging due to the numerous variables involved, such as different techniques, dosages and aetiologies. It is necessary to provide insights for clinicians and public healthcare managers to support clinical decision-making. This umbrella review aims to consolidate existing evidence on the effectiveness of various NIN in managing chronic NP. A systematic search was conducted in the PubMed/MEDLINE database, including meta-analyses of controlled trials comparing NIN techniques with sham interventions for NP treatment. The quality of included studies was assessed using the AMSTAR-2 tool and the GRADE system, with effect sizes adjusted to the standard mean difference (SMD). The review included 22 meta-analyses comprising 8151 participants from 214 controlled trials. The most investigated NIN techniques were tDCS and rTMS, with primary targets being the motor cortex and dorsolateral prefrontal cortex. The findings suggest that excitatory protocols, particularly high-frequency rTMS and anodal tDCS, are effective in reducing pain intensity in individuals with NP. However, the overall quality of evidence was rated low, primarily due to heterogeneity among studies and small sample sizes. NIN techniques show promise in managing NP, with potential benefits in pain reduction. However, further high-quality research is needed to establish optimal protocols and long-term effects. This paper consolidates the evidence regarding non-invasive neuromodulation for the treatment of neuropathic pain, including differentiating the most effective techniques based on the aetiology of pain, and provides clinicians with easy access to this critical information. It also highlights key aspects that require further research in the field of non-invasive neuromodulation and neuropathic pain.

Feasibility and acceptability of genomic newborn screening in the Australian public healthcare system: BabyScreen+ pilot study

Feasibility and acceptability of genomic newborn screening in the Australian public healthcare system: BabyScreen+ pilot study