Preventable Deaths Research Articles

Supporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trial

Abstract Background Unhealthy alcohol use, a spectrum of use inclusive of risky consumption and alcohol use disorder (AUD), is a leading cause of preventable death in the United States. Most people with unhealthy alcohol use do not receive evidence-based treatment. This four-arm factorial design randomized trial will assess whether population health management (PHM) and clinical care management (CCM) support for primary care providers (PCPs) are associated with improved AUD treatment engagement among their patients, beyond electronic health record (EHR) prompting and decision support alone. Methods PCPs from an urban safety-net hospital-based primary care clinic are randomized to one of four groups (1) EHR best practice advisory (BPA) and clinical decision support tools for unhealthy alcohol use (BPA), (2) BPA plus population health manager support, (3) BPA plus clinical care manager support, and (4) all three. All PCPs will have access to the EHR BPA and decision support tools which provide chart-based advisories and order set navigation. PCPs assigned to receive PHM support will receive quarterly panel-level feedback on AUD treatment metrics for their patients. PCPs assigned to receive CCM support will receive CCM facilitation of AUD treatment processes including medication counseling, referrals, and support through direct patient interactions. The primary outcome will be the percent of patients engaged in AUD treatment among those with a new AUD diagnosis on a PCP’s panel. Secondary outcomes include the percent of patients with a new diagnosis of AUD who (1) initiated AUD treatment, (2) were prescribed AUD medications within 90 days, and (3) numerical counts of a range of AUD health services (outpatient encounters, specialty AUD care encounters, referrals, and acute healthcare utilization) in this sample. We will assess the primary outcome and the acute healthcare utilization secondary outcomes using Medicaid claims; the remaining secondary outcomes will be assessed using EHR data. Discussion The study will evaluate how a targeted EHR innovation alone, compared with population health and care management enhancements alone or in combination, impact engagement in AUD treatment, a national quality of care measure. Findings will advance understanding of supports needed to improve systems of care for AUD in general settings. Trial registration ClinicalTrials.gov identifier/registration number (NCT number): NCT05492942

Machine Learning Prediction and Simulation of Drugs Targeting GSK-3β in Breast Cancer

Introduction and Objective: Breast cancer ranks as the second-most prevalent cause of death among women worldwide, with particularly elevated mortality rates in India. Breast cancer’s origin involves biochemical pathway alterations influenced by tumor-inducing proteins. Research has highlighted glycogen synthase kinase-3 beta (GSK-3β) as a crucial protein that regulates the expression of various genes in the cell cycle. Mutations in this protein have a significant impact on cellular development. As a consequence, it triggers aggressive subtypes of breast cancer, such as triple-negative breast cancer. So, the primary aim of this study is to identify novel chemicals targeting GSK-3β using machine learning methods, molecular modeling, and dynamic techniques. Materials and Methods: To achieve the study's objective, small molecules were screened using a Machine Learning (ML) approach, and subsequently, molecular docking and dynamic modelling investigations were conducted to explore interactions between drugs and GSK-3β. Results: The research findings highlighted a specific compound, piperidine, 4-(3,4- dichlorophenyl)-4-[4-(1H-pyrazol-4-yl) phenyl], which exhibited a superior docking score of -9.6 kcal/mol. Piperidine also formed conventional hydrogen bonds with the target protein. Furthermore, the calculated binding free energy of -12.46 kcal/mol suggested that this compound exhibited greater stability compared to commercially available drugs. Conclusion: These promising findings highlight the potential of piperidine and similar small molecules as promising candidates for targeting the tumor-inducing protein GSK-3β. Subsequent investigations, both in vitro and in vivo, will be essential to assess their effectiveness in combating breast cancer.

Prenatal diagnosis of vasa praevia in routine clinical practice: Prevention of stillbirths and impact on perinatal outcomes.

Vasa praevia (VP) is defined as the presence of unsupported fetal blood vessels in close proximity of the internal os of the cervix. There is robust evidence from observational cohort studies and meta-analysis that prenatal diagnosis of VP is associated with excellent perinatal outcomes. We have previously proposed a two-stage strategy for prenatal diagnosis that can be implemented in routine clinical practice leading to effective prenatal diagnosis and prevention of fetal and neonatal mortality and morbidity. To demonstrate the feasibility and effectiveness of a two-stage screening strategy for prenatal diagnosis of VP in routine clinical practice and to estimate the potential impact on prevention of stillbirths and perinatal deaths. This was an observational retrospective cohort study carried out at the Medway Fetal and Maternal Medicine Centre between January 2010 and June 2022. We examined the feasibility and effectiveness of this policy in terms of identification of a high-risk cohort and prenatal diagnosis of VP through routine 11-13 and 20-22weeks' ultrasound assessments based on the two-stage protocol. We also examined the impact on maternal, neonatal and perinatal outcomes in pregnancies with a confirmed diagnosis of VP. Absolute risks (95%) were calculated based on rates of events in the two groups. Logistic regression analysis was used to estimate independent contribution from maternal and pregnancy characteristics in prediction of VP. The study population of 53,648 singleton pregnancies included 45 pregnancies with VP (0.83 per 1,000 pregnancies or an incidence of 1 in 1,192 pregnancies). VP was suspected in 56 cases and were resolved in 11 cases (19.6%), thus leaving 45 pregnancies with a confirmed diagnosis of VP. The main findings that predicted VP included a low-lying placenta at 20-22weeks', placenta praevia, bilobed placenta and a velamentous cord insertion. In our study population, pregnancies with a prenatal diagnosis of VP had a livebirth rate of 100% and an intact perinatal survival rate of 97.8%. Our study demonstrates that effective prenatal diagnosis of pregnancies with VP can be achieved in routine clinical practice with good perinatal outcomes.

Impact of Perinatal Death Auditing: Outcomes of An Interventional Study on Perinatal Death Auditing in Two Districts of Karnataka State, India

Background: Perinatal death auditing is useful to identify preventable perinatal deaths and avoidable/preventable factors. Objectives: To know the impact of perinatal death audit like 1). Documentation of Care Provided 2) Changes in Infrastructure and Facilities 3). Number of perinatal deaths 4) Any other impact. Methodology: Perinatal death auditing project implemented in two districts of Karnataka state. As a Part of Intervention, Expert Panel audited the perinatal deaths and provided feedback to the hospitals where these deaths occurred. The feedback included issues identified and suggestion for prevention. Trained Medical-Social Workers conducted evaluation surveys in post-interventional period at 6th monthly intervals. They collected the filled tools from the hospitals and handed over the written feedback of the expert panel to these hospitals. It was anticipated that the process of feedback would initiate some changes in infrastructure, facilities, documentation and number of perinatal deaths. Results: Number of reported perinatal deaths decreased in Koppal District (from 325 to 301) as compared with Dakshina Kannada (from 223 to 221). Improvements in: 1]. Documentation of care provided 2] Assertion of preventability by the doctors 3] Infrastructure &facilities were observed in backward district of Koppal as compared to developed district of Dakshina Kannada. Conclusion: Perinatal Death Auditing reduces the number of perinatal deaths apart from improving documentation, assertion of preventability by doctors, infrastructure & facilities.

A Military-Civilian Training Partnership for Army Nurses.

In 2018, the U.S. Army Surgeon General created the Army Medical Department Military-Civilian Trauma Team Training (AMCT3) program to enhance the clinical proficiency of medical personnel serving on Army trauma teams called forward resuscitative surgical detachments (FRSDs). FRSDs provide resuscitative and surgical care to wounded patients in the deployed environment until they can be medically evacuated to a higher level of care. Through AMCT3, FRSD personnel work at civilian trauma centers while not deployed in order to maintain their combat casualty care competency. This article describes an innovative nursing-specific AMCT3 program model in which Army nurses serving on an FRSD are embedded within a level 1 trauma center for a 3-year assignment. The goal of the program, which was established at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee, is to improve participants' clinical proficiency and skills in preparation for the next major military conflict, with the aim of reducing preventable battlefield deaths. The VUMC Military Affairs Committee, in consultation with Army medical leaders, developed a unique 3-part model for a nursing partnership program at VUMC. This model includes separate tracks for critical care and emergency nurses. The nurses receive training in their specialty, cross-training in the opposite track, and other professional development opportunities. A critical care nurse and an emergency nurse were assigned to the program in January 2022 and September 2022, respectively. Between January 2022 and June 2023, the critical care nurse completed all the required individual critical task lists-specialty-specific clinical skills Army medical personnel must be competent in before deployment-except for 1, obtaining intra-abdominal pressure. The VUMC AMCT3 nursing partnership training model ensures that Army nurses are highly prepared to function as part of the FRSD and to provide superior combat casualty care in a resource-limited environment.

Health promotion and tobacco control: a transatlantic perspective between Brazil and Portugal

Health promotion, a concept based on the Ottawa Charter, recognizes that health is influenced by economic, social and environmental factors, as well as individual practices. The fight against smoking is one of the most challenging fronts in this context, given its direct relationship with the global burden of chronic diseases and preventable deaths. The articulation of public policies that involve multiple sectors and civil society has proved fundamental in dealing with this problem. In both Brazil and Portugal, health promotion plays a crucial role in integrating tobacco prevention and control actions, reflecting the guidelines of Canada's Population Health Promotion Model. This Canadian model highlights the intersection between health, public policies and community action, emphasizing the need for healthy environments and structural interventions that shape behaviour. The influence of this paradigm is evident in global policies, including those adopted in Brazil and Portugal. It offers a theoretical framework that guides governments to create evidence-based strategies that are sensitive to cultural and social particularities. In Brazil, the National Health Promotion Policy (Política Nacional de Promoção da Saúde, PNPS) translates these principles into concrete actions, whereas in Portugal, the National Program for the Prevention and Control of Smoking reflects a progressive normative approach, especially in relation to tobacco consumption and electronic devices. Brazil and Portugal have different histories and cultural dynamics, but they share similar challenges in tackling smoking. In Brazil, robust policies have contributed to a significant reduction in the prevalence of adult smokers, from 34.8% in 1989 to 12.6% in 2019(1). These achievements are the result of educational campaigns, tax increases and the creation of smoke-free environments. In Portugal, legislative efforts, such as the Tobacco Law (Law No. 37/2007), have significantly limited smoking in public places and restricted advertising, but the country still faces worrying rates, with 17% of the population identified as smokers in 2019(2). [...]

DEMOGRAPHIC AND SOCIOECONOMIC DETERMINANTS OF UNDER-FIVE MORBIDITY AND MORTALITY IN GOMBE STATE, NIGERIA

This paper examined the demographic and socioeconomic determinants of under-five morbidity and mortality in Gombe State. Child mortality is the probability that a child born in a specific year or period would die before reaching the age of five. Goal 3 of SDG centred on ensuring healthy lives and promoting well-being for children as well as ending preventable deaths of newborns and under-five children by 2030. The objectives of the paper are to: identify the major prevalent under-five diseases; to examine the influence of child’s demographic characteristics on under-five diseases, as well as to examine the influence of child’s mother demographic and socioeconomic determinants on under-five mortality. The paper utilized both quantitative and qualitative data to obtained information from the pool of respondents. Quantitative data such as medical records of under-five children and their mothers were generated while qualitative data was obtained using Focus Group Discussion (FGD) and In-depth interview. A cross sectional Hospital Medical Records of under-five children from 2007- 2016 was utilized. The data was analyzed using descriptive statistics such as tables and charts. Logistic regression was used for inferential statistics. The result showed that malaria fever accounted for 50% of under-five morbidity and mortality. Also, age of the child and mother’s age significantly influenced under-five morbidity and mortality. The result indicates that children that their mothers are younger are more likely to experience under -five mortality compares to more advance mothers. Likewise, educational qualification of mother was found to be significantly associated with under-five mortality. More efforts should be put in place by government at all levels and NGOs on how to curtail malaria fever. These efforts may include the provision of treated mosquito net, effective sensitization of mothers on proper usage of treated mosquito net, provision of dedicated malaria treatment facilities/units, and provision of affordable/subsidized malaria treatment.

Ending preventable newborn and child deaths

Ending preventable newborn and child deaths

Prevalence of sudden unexpected death of infants and its subcategories in low- or middle-income countries: a systematic review protocol.

Infant mortality in low or middle-income countries (LoMICs) is still triple that of high-income countries (HICs), and the high mortality burden regions are also weighed down by a triple or quadruple burden of disease such as HIV and tuberculosis; chronic illness; mental health; injury and violence; and maternal, neonatal and child mortality. Emerging data suggest that the sudden unexpected death in infancy (SUDI) burden in LoMICs is at least 10-fold that in HICs. While ending preventable deaths in the neonatal period has received some global attention, the postnatal period where SUDIs occur is a poorly understood and data-poor area in LoMICs. We propose conducting a systematic review to evaluate the burden and trends of SUDIs in LoMICs since 2004. We will systematically search PubMed, Web of Science, Scopus, African Index Medicus, EBSCOHost, Google Scholar, WHOIS and WHO database to identify studies published from July 2004 until October 2024. Two reviewers will screen titles and abstracts and select full-text articles independently for review. We will use the tool developed by the South African Medical Research Council-Burden of Disease Review Manager (BODRevMan)-to assess the risk of bias for each included study. Risk of bias will be assessed for each included study. Information on the prevalence and/or incidence of SUDI and its subcategories and case definitions will be extracted from each article. Where possible, data on prevalence, incidence and subcategories will be pooled using a random effects meta-analysis to account for variability between estimates. The I2 statistic will establish the level of heterogeneity due to variation in estimates rather than chance. Results will be presented in tables and graphs. The systematic review will be reported according to the PRISMA 2020 checklist. Ethical approval is not required as this is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. CRD42023466162.

Cost-effectiveness analysis for implementation of smoking cessation strategies at primary health care settings in Tamil Nadu.

Smoking is a major public health concern in Tamil Nadu, as it is in many parts of the world. It is a leading cause of preventable diseases and deaths, with a significant economic burden on healthcare systems and society as a whole. Recognizing the need to address this issue, the implementation of smoking cessation strategies at primary health care (PHC) settings has gained attention. Conducting a cost-effectiveness analysis in this context can help policymakers and healthcare providers make informed decisions about the allocation of resources for such interventions. To compare the cost-effectiveness of the smoking cessation of proposed strategies (PSs), PS1: enhanced counselling (EC) + nicotine replacement therapy (NRT) + bupropion tablet; PS2: behavioural intervention (BI) + NRT + promotion of bupropion sustained release (SR); PS3: EC + NRT + promotion of bupropion SR with the current strategy (BI +NRT+ Bupropion) in a population of smokers aged ≥15 years attending the PHC in Tamil Nadu. In this hypothetical cohort of 100,000 individuals using the decision tree analysis, a cost-effectiveness assessment was conducted for both proposed and existing strategies. The results were evaluated in terms of incremental cost-effectiveness ratios (ICERs) per person quitting smoking. To assess the robustness of the findings, one-way sensitivity analysis and probabilistic sensitivity analysis were performed which aims to explore and address the uncertainties associated with the outcomes. The cost of the current strategy (CS) was higher (₹359 or $4.28 million) when compared with PS1 (₹327 or $3.90 million) and PS3 (₹327 or $3.90 million) strategies. The PS2 with BI + bupropion SR + NRT was found to be more cost (₹2,720,571 or $ 32,414.76) as compared to current strategy. ICER values indicates that compared to the current strategy, the PS1 and PS3 were found to be cost-saving, whereas the PS2 was found to be cost-effective. The cost-effectiveness acceptability curve demonstrated that the PS1 and PS3 indicates 100% probability of the intervention being cost-saving. After excluding dominated interventions (PS2 and CS), the remaining strategies (PS1 and PS3) were compared. The PS3, with an incremental cost of ₹462,497 ($5,510) for 131 additional quitters, resulted in an ICER of ₹3,531 ($42) per quitter, making it a cost-effective option compared to PS1. Our study findings indicate that the need for healthcare providers and policymakers to implement PS3 with EC, NRT, Bupropion SR, as which was found to be cost-saving compared to current practices.

P-158. Knowledge of Rabies Prevention Measures for Dog Bite Incidents in the Peruvian Population: Findings from a National Survey in 2022

Abstract Background Rabies continues to be a significant global zoonotic threat. In the last two decades, Peru has reported nine dog-transmitted rabies cases, including a preventable death in 2023. This study aimed to assess public knowledge of rabies prevention post-dog bites, focusing on sociodemographic disparities to better tailor future interventions.Figure 1.Factors associated with knowledge of the Rabies Preventive Triad of the Peruvian population, ENAPRESS 2022. Methods Utilizing data from the 2022 National Survey of Budget Programs, targeting Peruvians aged 14 and older through a stratified two-stage sampling across both urban and rural areas, this cross-sectional study included 89,655 adults who completed interviews on the rabies prevention triad (wound washing, biting animal identification, and medical consultation). The "Survey" package in R facilitated data analysis, acknowledging the complex design. Poisson regression was employed to explore sociodemographic disparities in knowledge. Results Out of 89,655 participants, the majority were women (53.7%), aged 30-59 (52.2%), and lived in urban areas (81.6%). The 6.5% displayed adequate knowledge of the rabies preventive triad, 45.7% indicated they would clean their wounds, 20.9% would identify the dog involved, and 86.7% would seek medical attention at a health facility. Regression models revealed better knowledge among older adults and the elderly (adjusted prevalence ratio (aPR): 1.04; 95% confidence interval (95%CI): 1.03-1.05), females (aPR: 1.01; 95% CI: 1.00-1.02), and those with higher educational levels. Highland residents showed greater knowledge than coastal ones (aPR: 1.02; 95% CI: 1.01-1.03). Conversely, Quechua ethnicity and rural residency were negatively associated with knowledge (aPR: 0.97; 95% CI: 0.96-0.98 and aPR: 0.98; 95% CI: 0.97-0.99, respectively) (Figure 1). Conclusion Despite the high frequency of dog bites in Peru, knowledge of rabies prevention is very low. Although limited by potential recall bias and its non-causal inference capacity, the study's strengths lie in its national scope and reliable data collection. The results underscore the urgency of targeted educational campaigns and policy enhancement in high-risk areas to boost community health and rabies prevention. Disclosures All Authors: No reported disclosures

Comparative Assessment of Acute Pulmonary Effects Induced by Heat-Not-Burn Tobacco Aerosol Inhalation in a Murine Model

Tobacco smoking remains a major global health concern, causing preventable deaths and economic strain. Although new tobacco products such as heat-not-burn (HnB) are safer alternatives to traditional cigarettes, research on their associated risks remains limited. This study aimed to investigate the effects of HnB smoke exposure on the lungs compared to those of traditional cigarettes and the combined use of HnB and cigarettes using experiments with a mouse model. We quantitatively analyzed changes in the levels of 92 blood plasma proteins using the proximity extension assay method and observed significant changes in their levels in mice exposed to different smoke conditions; specifically, the levels of certain proteins, including Ccl20, Cxcl1, and Pdgfb, increased in the HnB smoke-exposed group, suggesting activation of nicotine pathways. Comparative analysis with traditional cigarette smoke-exposed mice further highlighted similarities and differences in their protein expression profiles. This study contributes to an improved understanding of the biological mechanisms underlying the harmful effects of alternative nicotine delivery systems and identifies potential biomarkers associated with the harmful effects of HnB smoke exposure. However, the precise impact of nicotine on the immune system may be influenced by various factors, necessitating further research.

Feasibility of a Mobile App-Based Cognitive-Behavioral Perinatal Skills Program: Protocol for Nonrandomized Pilot Trial.

Mental illness is one of the top causes of preventable pregnancy-related deaths in the United States. There are many barriers that interfere with the ability of perinatal individuals to access traditional mental health care. Digital health interventions, including app-based programs, have the potential to increase access to useful tools for these individuals. Although numerous mental health apps exist, there is little research on developing programs to address the unique needs of perinatal individuals. In an effort to fill this gap, a multidisciplinary team of experts in psychology, psychiatry, obstetrics, and pediatric primary care collaborated to develop the novel Perinatal Skills Program within Maya, a flexible and customizable cognitive-behavioral skills app. Maya-Perinatal Skills Program (M-PSP) uses evidence-based strategies to help individuals manage their mood and anxiety symptoms during pregnancy and post partum. This pilot study aims to assess the feasibility, acceptability, and usability of M-PSP and explore links between program use and symptoms of anxiety and low mood. This single-arm trial will recruit 50 pregnant or postpartum individuals with mild-to-moderate anxiety or mood symptoms. Participants will be recruited from a variety of public and private insurance-based psychiatry, obstetrics, and primary care clinics at a large academic medical center located in New York City. Participants will complete all sessions of M-PSP and provide feedback. Outcome measures will include qualitative and quantitative assessments of feasibility, acceptability, and usability, passively collected program usage data, and symptom measures assessing mood, anxiety, and trauma. Planned data analysis includes the use of the grounded theory approach to identify common themes in qualitative feedback, as well as an exploration of possible associations between quantitative data regarding program use and symptoms. The recruitment began on August 2023. As of October 2024, a total of 32 participants have been enrolled. The recruitment will continue until 50 participants have been enrolled. Digital health interventions, like M-PSP, have the potential to create new pathways to reach individuals struggling with their mental health. The results of this study will be the groundwork for future iterations of M-PSP in the hopes of providing an accessible and helpful tool for pregnant and postpartum individuals. ClinicalTrials.gov NCT05897619; https://classic.clinicaltrials.gov/ct2/show/NCT05897619. PRR1-10.2196/59461.

Poor quality care in healthcare settings: an overlooked epidemic

Adverse events in healthcare settings, including medical errors, healthcare-associated infections (HAIs), and surgical complications, have been a persistent challenge globally, contributing significantly to patient morbidity and mortality. Over the past decade, these events have remained prevalent despite increasing efforts to improve patient safety. This narrative literature review explores the burden of poor-quality care. It examines the trends in adverse events and associated mortalities from 2015 to 2024, highlighting the impact of these events on global health outcomes and identifying potential strategies for reducing their occurrence. Data were collected from various sources such as PubMed, Google Scholar, Scopus, and Ebscohost. The analysis revealed that ~10%−12% of hospitalized patients in high-income countries experienced adverse events annually from 2015 to 2024. Globally, the WHO estimated that 134 million adverse events occurred each year, with ~2.6 million deaths attributed to these events. Adverse events in healthcare settings remain a significant public health challenge, contributing to millions of preventable deaths annually. The persistence of these events highlights systemic issues within healthcare delivery, including inadequate safety protocols, underreporting, and workforce challenges.

Improving complex health systems and lived environments for maternal and perinatal well-being in urban sub-Saharan Africa: the UrbanBirth Collective.

While maternal mortality decreased during the Millennium Development Goals era, it remains unacceptably high, with stagnation in reductions possible due to shocks such as COVID-19. Most women in low- and middle-income countries already receive antenatal care and over half give birth in health facilities. In cities, use of health facilities for childbirth is near universal (>90%). Cities present complex challenges in ensuring pregnant women receive equitable, high-quality care. The UrbanBirth Collective is a portfolio of projects in sub-Saharan African cities seeking to address an important knowledge gap: how to adapt urban healthcare systems and lived environments to improve maternal and perinatal well-being? Its key focus is care during labour, childbirth, and the early postnatal period, when most poor maternal and perinatal outcomes occur. Our starting projects focus on harnessing open source data to examine and compare cities on the continent, including in-depth case studies of three cities: Grand Conakry (Guinea), Grand Nokoué metropolitan area (Benin), and Lubumbashi (Democratic Republic of the Congo), where we will capture and analyse three main dimensions of the dynamics: maternal health service provision; maternal healthcare use by women; and the complex, nonlinear interactions between the provision and use of care within the spatial, social, and political ecosystem of a city. By comparing these three cities, we shall propose a generalisable model which can be validated and applied in other cities in sub-Saharan Africa. The growth of cities demands increasing attention on future-proofing them with the capacity to develop, implement, and continuously adapt a coherent strategy for the provision of equitable maternal and newborn care. Our ambition is to contribute to reaching zero preventable maternal deaths in cities. To achieve these goals through understanding specific contexts and facilitating the adoption and application of research findings and recommendations, we will collaborate closely with local stakeholders, including healthcare workers, community leaders, and policymakers.

Promoting Evidence-Based Tobacco Cessation Treatment in Community Mental Health Clinics: Results of a Pilot Implementation Study: Promouvoir le traitement de sevrage tabagique fondé sur des données probantes dans les cliniques communautaires de santé mentale : résultats d'une étude pilote de mise en œuvre.

Tobacco smoking is the leading cause of preventable death among individuals with serious mental illness (SMI) but few persons with SMI are offered smoking cessation treatment. The purpose of this study was to pilot-test a multicomponent intervention to increase the delivery of evidence-based smoking cessation treatment in community mental health clinics (CMHCs). This study was carried out at five CMHCs in Maryland involving clinicians who participated in training in smoking cessation. Other implementation activities included the provision of a treatment protocol, coaching, expert consultation, and organizational strategy meetings. The primary outcome was a change in clinicians' knowledge and self-efficacy about smoking cessation. Secondary outcomes included documentation of evidence-based smoking cessation practices including assessment of smoking status and readiness to quit, and provision of smoking cessation treatment over the course of the 12-month intervention period. A total of 91 clinicians participated in the study. Data were available on 6,011 clients. Clinicians' scores on the knowledge and self-efficacy measures increased modestly over the course of the implementation period. Overall, 57% of clients had their smoking status assessed; 81% of current smokers were evaluated about their willingness to quit; 82% of those willing to quit within 90 days received behavioral counseling, and 36% were prescribed or given smoking cessation pharmacotherapy. Clinicians rated the smoking cessation program highly in terms of acceptability, appropriateness, and feasibility. Clinicians at CMHCs were engaged by and participated in training and implementation activities around smoking cessation practices which they then delivered to a substantial portion of clients in their care. The results of this study provide important data for the future planning of testing implementation strategies to scale up tobacco cessation treatment in this population in outpatient mental health settings.

Impact of the WHO safe childbirth checklist on birth attendant behavior and maternal-newborn outcomes: A systematic review and meta-analysis.

The intrapartum period is critical for reducing maternal and perinatal morbidity and mortality. The WHO's Safe Childbirth Checklist (SCC) was designed as a reminder of the most critical, evidence-based practices (EBPs) to improve quality care and reduce preventable complications and deaths. To assess the impact of SCC on birth attendant behavior and maternal and newborn health outcomes. A systematic review and meta-analysis was performed searching across five databases from 2009 to 2023. We included randomized controlled trials, quasi-experimental studies, and pre/post studies. A meta-analysis yielded a pooled estimate ofrelative risk (RR) for adherence to and effectiveness of the SCC. Of 1070 articles identified, 16 were included. Use of the SCC increased adherence to EBPs by 65% (RR 1.65; 95% confidence interval [CI]1.34-2.02). The behaviors that improved the most were danger sign counseling (RR 12.37; 95% CI 1.95-78.52; P = 0.008) and pre-eclampsia management (RR 3.43; 95% CI 1.33-8.88; P = 0.011). There was moderate evidence for stillbirth reduction (RR 0.89; 95% CI 0.80-0.99; P = 0.034). There is moderate evidence demonstrating the effectiveness of the SCC in reducing stillbirths and improving adherence to EBPs.

Healthcare Access vs. Quality Healthcare: Rethinking Healthcare Risks

ObjectivesThis narrative literature review examines the global burden of mortalities due to poor quality care compared to mortalities resulting from lack of access to healthcare, focusing on the period from 2015 to 2024.MethodsData was extracted from electronic databases such as PubMed, Google Scholar, Scopus, Ebscohost, and WHO. Relevant statistics on mortality rates due to poor quality care and lack of access to healthcare from the identified data sources were extracted. Descriptive statistics were used to summarize the mortality rates, with trends analyzed over the 10 years.ResultsThe results indicate that while progress in healthcare access has reduced mortality, the lack of corresponding improvements in care quality has led to a rising number of preventable deaths. The findings reveal a consistent decline in mortality due to lack of access. In contrast, mortality due to poor quality care has increased from 5 million in 2015 to an estimated 6 million by 2024, underscoring the persistent challenges in healthcare delivery, including medical errors, misdiagnoses, and inadequate treatment.ConclusionAddressing the dual challenges of access and quality is essential for reducing global mortality rates and achieving better health outcomes.

Updating US Public Health For Healthier Communities.

The United States faces urgent public health challenges, including high preventable death rates, pervasive health disparities, and emerging health risks, despite unprecedented medical progress. This article, part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2025 initiative, presents a vision for modernizing the US public health system to address these twenty-first-century challenges through federally supported partnerships with health care, social services, and community organizations. We identify actions to address persistent public health challenges that stem from insufficient and fragmented funding models, inadequate data infrastructure, workforce vulnerabilities, and limited public trust. Our proposals focus on four areas: enabling cross-sector collaboration, aligning financing mechanisms with accountability for population health outcomes, improving data systems, and building a ready workforce. These changes would enable significant improvements in population health outcomes and reductions in health disparities and provide a stronger foundation for a "team-based" future public health enterprise.

EVALUATING MATERNAL UNDERSTANDING OF WHO-RECOGNIZED NEONATAL DANGER SIGNS: A CROSS-SECTIONAL STUDY

Background: Neonatal mortality constitutes a significant proportion of under-five mortality worldwide, with over 2.4 million neonatal deaths reported annually. In Pakistan, the neonatal mortality rate (NMR) stands alarmingly high at 42 per 1,000 live births. Neonatal danger signs, such as fever, jaundice, and breathing difficulties, require immediate medical attention but often go unrecognized due to insufficient maternal knowledge. Socioeconomic disparities, cultural practices, and inadequate access to healthcare exacerbate the issue, delaying timely interventions and contributing to preventable neonatal deaths. Objective: The study aims to assess maternal knowledge of neonatal danger signs, identify determinants of adequate awareness, and explore barriers to timely healthcare-seeking practices. Method: A cross-sectional, community-based survey was conducted from August to December 2024 in one urban and one rural district of Sindh, targeting mothers of neonates aged 0–28 days. A structured questionnaire adapted from the WHO Safe Motherhood Toolkit was used to collect data on maternal knowledge, antenatal care (ANC) attendance, and healthcare-seeking behaviors. A multistage random sampling method ensured representativeness, with a sample size of 300 participants. Descriptive statistics and logistic regression analyses were performed using SPSS version 25 to identify key predictors of knowledge, with significance set at p<0.05. Results: Among 300 mothers, 48.5% demonstrated adequate knowledge of neonatal danger signs. Fever (75%), poor feeding (62%), and jaundice (51%) were the most recognized signs, while hypothermia (18%) and convulsions (12%) were least identified. Maternal education, urban residence, and ANC attendance significantly predicted knowledge levels. Only 57% sought timely medical care, with rural participants reporting financial constraints, transportation challenges, and reliance on traditional healers as primary barriers. Conclusion: Maternal knowledge of neonatal danger signs remains suboptimal, especially in rural areas. Targeted health education programs, improved healthcare access, and financial support mechanisms are essential to enhance neonatal survival and reduce preventable deaths.