Consent Research Articles

Predictors of In-hospital and Short-term Outcomes of Thoracic Endovascular Aortic Repair for Aortic Aneurysm and Aortic Syndrome: A Single-Center Experience

BACKGROUND: Endovascular technique has replaced open repair as primary treatment for different aortic disease indications and was associated with low perioperative mortality and acceptable short-, mid-, and long-term survival. Locally, thoracic endovascular aortic repair (TEVAR) was not widely practiced until year 2017. This study aims to determine the predictors of in-hospital and short-term outcomes of patients who underwent TEVAR for aortic aneurysm and aortic syndrome in a single center and how it compares with local and international data. METHODS: This study is a retrospective analysis of 52 adult patients who underwent TEVAR for the treatment of aortic aneurysm and aortic syndrome. Demographic and clinical data, diagnostic imaging, and procedural details were obtained via inpatient charts at the medical records section and hospital system database archiving. Outcomes at 30 days and 1 year postprocedure were obtained through telephone follow-up after attaining verbal consent. Gathered data were analyzed as to association of different variables with or without the presence of complications. Outcomes reported included in-hospital mortality rate, presence of major adverse events (MAEs), 30-day and 1-year survival rates, and rate of freedom from reintervention. RESULTS: The overall in-hospital mortality was 7.69% (n = 4/52), and complication rate was 32% (n = 20/52), with a survival rate of 92.31% and 87.76% at 30 days and 1 year, respectively. The rates of overall freedom from reintervention were 83.33% and 100% at 30 days and 1 year, respectively. The independent predictors for in-hospital mortality and development of MAEs were increasing weight (odds ratio [OR], 1.0588; 95% confidence interval [CI], 1.003–1.208), preexisting chronic kidney disease (OR, 10.33; 95% CI, 1.1069–96.462), and TEVAR with debranching done as a single procedure (OR, 3.6667; 95% CI, 1.1154–12.054), whereas an estimated glomerular filtration rate of 49.05 ± 19.25 (OR, 0.9402; 95% CI, 0.9019–0.9801) and TEVAR with debranching done as a staged procedure (OR, 0.1624; 95% CI, 0.0321–0.8225) statistically decrease the risk for development of in-hospital mortality and MAEs (P = 0.001 and P = 0.028, respectively). CONCLUSIONS: In this single-center study, indications for TEVAR were fusiform and saccular aneurysm, high-risk intramural hematoma and penetrating aortic ulcer, complicated acute type B dissection, chronic complicated type B dissection with high-risk feature, and aortic rupture. The outcome of this study shows comparable results with other international studies with an acceptable in-hospital mortality rate, complication rate, short-term survival rate, and rate freedom from reintervention at 30 days and 1 year. Increasing weight, preexisting chronic kidney disease, and TEVAR with debranching done as a single setting are independent predictors for developing in-hospital mortality and MAEs, whereas a normal estimated glomerular filtration rate and TEVAR with debranching done as a staged procedure decrease the risk; hence, careful planning and scheduling of procedure among elective and amenable cases could further reduce complication rates of future TEVAR procedures.

Knowledge and attitudes of patients in underserved communities regarding antibiotic resistance, antibiotic stewardship, and pharmacist involvement in antibiotic prescribing: A regional survey

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Despite the effectiveness of antibiotic stewardship programs (ASPs) in improving antibiotic prescribing, these are rarely implemented in clinics serving underserved communities. Our objective was to understand patients’ perspectives on the factors that can impact implementation of ASPs and integration of pharmacists in antibiotic prescribing in rural clinics. Methods We conducted a survey using both quantitative questions and an open-ended question. To participate, patients had to receive care from a clinic serving low-income or rural communities and provide verbal consent to be included in the study. We analyzed the quantitative component of the data using descriptive statistics. The Pearson correlation coefficient was used to examine the relationship between respondents’ knowledge of the prevalence of antibiotic resistance and their attitudes toward ASPs and pharmacist integration in antibiotic prescribing. Results Of the 189 respondents who completed a survey, 51.3% were female and 51.3% were Caucasian. In our analysis, over 60% of patients reported knowing their prescribed antibiotics’ names, while less than 30% possessed adequate knowledge of the indication and duration of the prescribed antibiotics. There was a positive correlation between knowledge about antibiotic resistance and being comfortable involving pharmacists in antibiotic prescribing (P < 0.01). Conclusion Many patients supported pharmacist involvement in antibiotic prescribing. Understanding patients’ perceived attitudes will facilitate patient-centered, infrastructure-supported interventions by clinicians to improve antibiotic prescribing in the community.

Protocol for an ambidirectional cohort study on long COVID and the healthcare needs, use and barriers to access health services in a large city in Southeast Brazil

IntroductionPost-COVID-19 condition, or syndrome, also known as long COVID, is an infection-associated chronic condition that can develop after a SARS-CoV-2 infection and last at least 3 months to years. Despite...

Experience, knowledge, practices and attitudes of emergency department medical staff regarding teledermatology.

The present study aimed to assess self-reported experience, knowledge, practices and attitudes of ED medical staff regarding teledermatology. Online questionnaire of ED medical staff at Prince of Wales Hospital (Sydney, Australia). Seventy-nine staff completed the questionnaire. Photographic technique and compliance with medicolegal policies were variable: 1% obtained written consent and 45.6% documented verbal consent for photography. 54.4% of respondents had concerns about the quality of their photographs. Skin photography image quality, knowledge and adherence to medicolegal policy were poor among ED medical staff. Education could reduce risk and improve outcomes.

Exploring the Link between ABO Blood Groups and Obesity among Young Adults

Objective: To explore the link between the ABO blood groups and obesity among young adults of Hyderabad district, Sind, Pakistan. Methods: This cross-sectional study was conducted from February 2021 to January 2022, and included 582 randomly selected participants, including 301 males and 281 females, aged between 18 to 40 years, from various institutions of district Hyderabad, including students, faculty members, and employee of universities, colleges, hospitals. A simple random sampling technique was used for the collection of data. Before induction, verbal consent was taken from all the participants. Data was collected by a self-structured questionnaire including sociodemographic characteristics. A brief history was taken relevant to the parameters of the study followed by measuring Body Mass Index, waist circumference, and waist-hip ratio. BMI was categorized with South Asian standards. Data collected through structured questionnaires and anthropometric parameters were analyzed by SPSS version 20.0. Results: In this study, the data of 582 participants were included out of 600 participants, as the remaining 18 could not provide complete data. The mean age in male participants was 27.83 ± 5.478 and in females was 22.27 ± 4.730. The average BMI in male participants was 25.81 ± 5.08 and in females was 24.00 ±4.90. Overall, 205 B blood group participants were found obese, which included 111 male participants and 94 female participants, followed by blood 197 group O participants, 130 A blood group participants, and 50 AB group individuals. In total, there were 536 Rh positives, and only 42 Rh negatives. Individuals with blood group B and Rh-positive status were identified at being greater risk of developing higher BMI, waist-hip ratio, and waist circumference. Conclusion: The evidence found in this study proved a positive association of the types of blood groups with BMI, waist-hip ratio, and waist circumference.

Assessing the practicality of a novel heart failure therapeutic score (QUAD Score) for drug optimisation in heart failure with a reduced ejection fraction

Abstract Introduction The 4 pillars of drug treatment for heart failure with a reduced ejection fraction (HFrEF) [Angiotensin-converting enzyme inhibitors (ACEi)/Angiotensin receptor–neprilysin inhibitors (ARNi), β-blockers (BB), Mineralocorticoid receptor antagonists (MRA), and Sodium-glucose cotransporter 2 inhibitors (SGLT2i)], are recommended by international HF guidelines to improve patient outcomes. Treatment inertia remains a challenge with non-prescription or sub-optimal dosing of these therapies. We developed a pragmatic HFrEF treatment score (QUAD score) (Figure 1) to prompt initiation and/or titration of sub-optimally dosed foundational therapies. Patients are categorized as poor (<8), good (8-14), and excellent (15-24) based on the dose and number of foundational drugs prescribed. This study aims to assess the practical utility of the QUAD score and its influence on treatment optimization. Methods Unwarned prescribing HCPs were approached consecutively in person, within clinical settings. Participants were told the questions were part of a research project and they provided verbal consent. Responses were anonymous and no patients were involved; therefore, verbal consent was considered proportionate and reasonable. HCPs were given an information sheet describing the QUAD score (Figure 1). They were then presented with 3 hypothetical clinical scenarios of haemodynamically stable and uncomplicated HFrEF patients with uncalculated poor, good and excellent QUAD scores. They were asked to calculate the QUAD score and if they proposed any changes to treatment. Time was recorded using a stopwatch and proposed changes were recorded. They were then invited to answer a series of follow-on questions. Results Between September 2023 and February 2024, there were 70 respondents. 71% (50) were doctors and 29% (20) allied HCPs. 83% (58) placed patients in the correct treatment grade in at least one scenario. 62.9% (44) did so for all three scenarios (Figure 2) with numerically more HCPs compared to doctors (80% vs 56% p=0.06).The median (IQR) time in seconds required to calculate the QUAD score for clinical scenarios 1,2 and 3 was 158 (100-234), 86 (54-122) and 83 (53-119) respectively. In response to the calculated QUAD score, 94.3% (66), recommended drug treatment optimisations. On a 5-point Likert scale (1 -poor, 5- excellent), 77.1% of participants rated the QUAD score ≥3 for ease of use, and 88.6% rated ≥3 as an incentive for treatment optimization. Conclusion We demonstrated the rapid clinical usability of the QUAD Score in a cohort of unselected prescribing HCPs, with a decremental calculation time with each presented clinical scenario. HCPs were also motivated to achieve further HF drug therapy optimization based on the calculated score. We conclude that the QUAD Score as a HFrEF drug therapy score may have a role in addressing treatment inertia however, it needs validation against clinically relevant outcomes in a larger cohort of HFrEF patients.

Partisan Impacts and Determinants for Internationalization of Ethiopian Pharmaceutical Products

<i>Background</i>: The pharmaceutical and related commodities manufacturing industry in Ethiopia is long-lived because the country is well-endowed with basic raw materials and local ownership and to some extent with machinery and technological know-how. The pharmaceutical industry, both globally and in Africa, encounters challenges in internationalizing products. In Ethiopia, challenges like regulatory complexities and limited government support hinder international market access for pharmaceutical products. This aim is to explore the barriers and understand why Ethiopian pharmaceuticals struggle to enter global markets. <i>Method</i>: The study adopted a mixed research approach, integrating qualitative and quantitative methods. It focuses on 15 pharmaceutical industries in Ethiopia, particularly those in Addis Ababa and the Oromia Special Zone, using probability and none probability sampling technique. The total study participants involved in the quantitative and qualitative studies were 373 and 15, respectively. Data collection comprises questionnaires, key informant interviews, and observation checklists, supplemented by secondary data from official and theoretical sources. Ethical considerations underscore obtaining verbal consent and ensuring confidentiality. Analysis entails descriptive statistics and qualitative synthesis, with numerical analysis conducted using STATA 14.1 software. <i>Results</i>: Out of the expected 384 study participants, 373 (97.13%) participated in our study, while the entire group of participants proposed in the qualitative study (15) also participated in this study. Key findings include resource constraints, regulatory issues, and biased perceptions against local products, hindering their global recognition. While strong political commitment and effective policy enforcement at the top government level are crucial, inadequate collaboration across government tiers undermines these efforts. Despite existing policies, inadequate implementation and procedural guidance diminish industry interest. There's uncertainty about government support for local pharmaceutical production, with persistent challenges like resource shortages and policy inconsistencies impeding progress. Perceptions vary on the effectiveness of policies promoting local production, and concerns about taxation issues impact the industry. Nevertheless, most respondents’ express confidence in the quality of domestically produced pharmaceuticals. <i>Conclusion</i>: Despite crucial government commitment, weak collaboration across levels impedes progress. Respondents note deficient policy implementation and doubt government support. Persistent issues like resource shortages persist, along with taxation concerns, despite locally produced products being perceived as equal in quality. To advance, better policy implementation, regulatory harmony, financial support, infrastructure enhancement, increased awareness, and improved collaboration are essential.

Clinico-Demographic Profile of Children Attending Pediatric Outpatient Department in Tertiary Care Center in Gandaki Province, Nepal: A Prospective, Descriptive Cross-Sectional Study

Introduction: Pediatric outpatient departments (OPDs) in tertiary care centers provide a vital connection for the early diagnosis and treatment of childhood illnesses. Understanding the clinico-demographic profile of pediatric patients attending these centers provides insight into the healthcare needs and challenges faced by children in specific regions. This study aimed to evaluate the clinico-demographic characteristics of children attending the pediatric OPD.  Methods: A prospective, descriptive cross-sectional study was conducted from April 12 to December 17, 2023 at pediatric OPD at GP Koirala National Centre for Respiratory Diseases and Hospital, Tanahun, Gandaki Province, Nepal. Data were collected from the pediatric OPD during clinical history taking and examination, including 7,020 children aged 0–14 years. Verbal consent was obtained from legal guardians for using clinical history and diagnostic data. Data on age, sex, socioeconomic status, parental education, and disease distribution were analyzed using SPSS version 23.  Results: Out of 7,020 children, 42.89% were aged 1–5 years, and 28.67% were aged 6–10 years. Males (50.7%) slightly outnumbered females (49.3%). Socioeconomic analysis showed that 57.3% of children were from low-income families. Regarding parental(either father or mother or any legal gurdian who brought child at hospital OPD) education, 31.19% had secondary education, and 28.3% had primary education. Respiratory infections (19.97%) were the most common diagnosis, followed by gastroenteritis (11%), pain abdomen (9%), and malnutrition, especially undernutrition (8%). Other notable conditions included enteric fever (7.4%) and acute conjunctivitis (7.3%).  Conclusion: The study highlights a high prevalence of respiratory and gastrointestinal conditions among children, particularly from low-income families. The findings emphasize the need for targeted healthcare interventions and improved parental education to reduce the burden of childhood illnesses in Gandaki Province.

The effect of role play prepared with video support on ethical decision-making and motivation levels of nursing students: A quasi-experimental study.

Background: Since the increasingly complex structure of health care services brings many ethical problems, it is important to use different instructional technologies in the ethical education of future nurses.Aim: The aim of this study was to determine the effect of role play prepared with video support on ethical decision-making and motivation levels of nursing students.Research design: A quasi-experimental study with pretest-posttest design.Participants and research context: The research was conducted in the Nursing Department of a University located in Istanbul, Turkey between October 15 and November 15, 2024. The sample of the research consisted of 3rd year nursing students. Data were collected using the Descriptive Characteristics Form, the Nursing Dilemma Test, and the Instructional Material Motivation Scale for Single-Use.Ethical considerations: Permission was obtained from Bezmialem Vakif University Non-Interventional Ethical Research Committee and the institution where the study was conducted for the implementation of the research. Written and verbal consent was obtained from all participants in accordance with the Helsinki Declaration.Findings: While there was no difference between the students' Ethical Dilemma Test Principled Thinking pre-test and post-test scores, their Practical Consideration (p = .005) and motivation levels (p = .037) post-test scores were found to be higher. There was a weak but significant negative correlation between academic achievement and pre-test teaching material motivation levels (r = -0.375, p = .041).Discussion: The use of different teaching methods and techniques in ethics education in nursing is important for future nurses to find more practical solutions to the ethical problems they will encounter during patient care.Conclusion: The results of the study indicate that the use of video-supported role play can be effective in teaching ethics courses in nursing education.

Incidence of Benzodiazepine Use and Misuse Among Adults in Selected Areas of Bangladesh

Background: Benzodiazepines (BDZ) are widely prescribed for anxiety and insomnia in Bangladesh, but their misuse has become a major public health concern. Objective: The aim of this study was to identify the incidence and patterns of use and misuse of BDZ in Bangladesh, and to explore the factors contributing to their misuse. Methodology: A cross-sectional study, including 368 current BDZ users, was conducted in the department of Pharmacology, Monno Medical College, Manikganj, during January, 2021 to December, 2022. The participants were selected randomly. Structured questionnaires were used to include participants’ personal information, drug use characteristics, physiological and psychological effects of drugs usage. Verbal consent was taken from each of the respondents. Results: In this study, 268(72.83%) of the participants were male, where 157(42.66%) were from the age group 31-40 years and 139(37.77%) were single. Among the study population, 51(13.86%) were students, 79(21.47%) had monthly family income above 50,000 Bangladeshi taka. Many of the participants reported that they used BDZs to relieve stress/pressure (108, 29.35%), followed by 95(25.82%) to manage insomnia, 79(21.47%) for relieving anxiety, depression and to get pleasure and others The mostly used drug was clonazepam (112, 30.43%), followed by diazepam (108, 29.35%) and others. Most of the users were influenced by friends (115, 31.25%). The common side effects of using BDZs were confusion (47, 12.77%), fatigue (45, 12.22%), drowsiness (37, 10.05%), and others. The mostly experienced withdrawal effect was headache (86, 23.28%), followed by insomnia (59, 16.25%), confusion (50, 13.48%) and others. Conclusion: BZDs were widely used in selected areas of Bangladesh with high incidence of misuse. The most common reason of misuse was self-medication. Increasing awareness program should be taken for safe and effective use of the drug. Journal of Monno Medical College December, 2023; 9 (2):68-72

Asking for Verbal Sexual Consent and Experiences of Sexual Violence and Sexual Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Adolescents' sexual consent behaviors are critical for developing healthy sexual relationships and preventing experiences of sexual violence. This report uses 2023 Youth Risk Behavior Survey data to describe prevalence of asking for sexual consent verbally at last sexual contact among U.S. high school students. Differences in prevalence of asking for sexual consent verbally by sex, age, race and ethnicity, sexual identity, sex of sexual contacts, and gender identity were examined. Differences in asking for sexual consent verbally also were examined by experiences of sexual violence and sexual behaviors. Sex-stratified logistic regression analyses were performed to determine the association between asking for sexual consent verbally with experiences of sexual violence and sexual behaviors. In addition, data were analyzed using adjusted logistic regression models controlling for age, race and ethnicity, and sexual identity. Among high school students who reported ever having sexual contact, 79.8% reported asking for sexual consent verbally at last sexual contact. A lower percentage of female students (74.5%) reported asking for sexual consent verbally than male students (84.6%). In adjusted sex-stratified analyses, female students who asked for sexual consent verbally had higher prevalence of ever having had sexual intercourse. Male students who asked for sexual consent verbally had higher prevalence of ever having had sexual intercourse and being currently sexually active. Female and male students who asked for sexual consent verbally had higher prevalence of having first sexual intercourse before age 13 and using condoms. In addition, female students who asked for sexual consent verbally during last sexual intercourse had lower prevalence of using alcohol or drugs at last sexual intercourse. Public health researchers and practitioners, health care providers, schools, and youth-serving organizations can use these findings to better understand high school students' verbal sexual consent, improve complex measurement of consent-seeking behaviors, and guide multicomponent sexual health and violence prevention efforts across various settings.

6766 Cortisol Pumps: Hospitalizations And Quality Of Life

Abstract Disclosure: A. Tiwari: None. R. Berry: None. A. Mokbel: None. A. Abotouk: None. A.R. Alrifai: None. J. Waleed: None. O. Alzohaili: None. Introduction: Oral regimens of exogenous cortisol fail to mimic physiologic levels. The discrepancy leads to complications, notably nausea, hyperglycemia, and susceptibility to infection. Finer control over cortisol delivery may be achievable with infusion pumps. While international groups have published their experiences with cortisol pumps, these studies often include less than ten patients. We share the largest, single-center cohort ever documented and the first from an American clinic. Methods: We conducted a retrospective cohort study. Through chart review, we identified all patients who received a cortisol pump at a private clinic; these pumps were originally designed to deliver insulin, but we repurposed them for patients with adrenal insufficiency. Clinic notes allowed collection of cortisol dosing pre- and post-exposure to the cortisol pump. We supplemented this information with telephone and digital surveys on the frequency of hospitalization, symptoms, and quality of life; patients provided verbal consent before participation. A Wilcoxon signed rank test and Fisher exact test evaluated significant differences between groups. Results: We identified thirty patients who received a cortisol infusion pump. Our study revealed a statistically significant decrease in hospitalization rate after exposure to a cortisol pump (n=26, mean difference = -5.94 hospitalizations per year, p=0.003), a decrease in the frequency of fatigue (n=25, p=0.0001) and a decrease in the frequency of hypotension (n=25, p=0.005). A validated, quality of life survey corroborated these findings with improvement in twenty-seven out of twenty-eight questions (n=22, p<0.05). However, we did not detect a statistically significant difference in the frequency of eighteen other symptoms nor cortisol dosing between pre- and post-exposure groups. Conclusion: Infusion pumps can better mimic physiological variations in cortisol than oral dosing regimens. We show the extent to which cortisol dosing may reduce hospitalization rate - and therefore cost - as well as improve quality of life. We hope our findings encourage the availability of infusion pumps for adrenal insufficiency, a smaller market that may not otherwise attract commercial investment for a dedicated, randomized trial. Presentation: 6/3/2024

Impact of early continuous positive airway pressure in the delivery room (DR-CPAP) on neonates < 1500 g in a low-resource setting: a protocol for a pilot feasibility and acceptability randomized controlled trial

BackgroundPreterm birth is the leading cause of childhood mortality, and respiratory distress syndrome is the predominant cause of these deaths. Early continuous positive airway pressure is effective in high-resource settings, reducing the rate of continuous positive airway pressure failure, and the need for mechanical ventilation and surfactant. However, most deaths in preterm infants occur in low-resource settings without access to mechanical ventilation or surfactant. We hypothesize that in such settings, early continuous positive airway pressure will reduce the rate of failure and therefore preterm mortality.MethodsThis is a mixed methods feasibility and acceptability, single-center pilot randomized control trial of early continuous positive airway pressure among infants with birthweight 800–1500 g. There are two parallel arms: (i) application of continuous positive airway pressure; with optional oxygen when indicated; applied in the delivery room within 15 min of birth; transitioning to bubble continuous positive airway pressure after admission to the neonatal unit if Downes Score ≥ 4 (intervention), (ii) supplementary oxygen at delivery when indicated; transitioning to bubble continuous positive airways pressure after admission to the neonatal unit if Downes Score ≥ 4 (control). A two-stage consent process (verbal consent during labor, followed by full written consent within 24 h of birth) and a low-cost third-party allocation process for randomization will be piloted.We will use focus group discussions and key informant interviews to explore the acceptability of the intervention, two-stage consent process, and trial design. We will interview healthcare workers, mothers, and caregivers of preterm infants. Feasibility will be assessed by the proportion of infants randomized within 15 min of delivery; the proportion of infants in the intervention arm receiving CPAP within 15 min of delivery; and the proportion of infants with primary and secondary outcomes measured successfully.DiscussionThis pilot trial will enhance our understanding of methods and techniques that can enable emergency neonatal research to be carried out effectively, affordably, and acceptably in low-resource settings. This mixed-methods approach will allow a comprehensive exploration of parental and healthcare worker perceptions, experiences, and acceptance of the intervention and trial design.Trial registrationThe study is registered on the Pan African Clinical Trials Registry (PACTR) PACTR202208462613789. Registered 08 August 2022. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23888.

Association between Socio-Demographic Factors and Quality of Life for Patients with Knee Osteoarthritis in Baaquba City

Background: Osteoarthritis is a degenerative joint condition causing joint dysfunction, discomfort, and limited range of motion; it may be affected by poor quality of life. Aim of the study: The study aims to investigate the association between socio-demographic factors and the quality of life for patients with knee osteoarthritis in Baquba City. Methods: A cross-sectional study at Baquba Teaching Hospital in Iraq analyzed 374 adult patients with kneeosteoarthritis, 18 or older, both sexes, and verbal consent. The researchers used a self-structured questionnaire and Dhafar M. et al.'s socioeconomic scale to assess patients' socio-demographic characteristics. Data collection involved direct interviews, and statistical significance was determined using IBM SPSS-29 software. Results: The study found that the majority of participants, particularly women, were married and lived in urban areas, with 53.2% having a family history of knee OA. A study shows that many patients with knee osteoarthritis have poor quality of life, with only 0.5% rating it as excellent. The study reveals significant differences in quality of life scores across age groups, with the 50-59 group reporting fair quality of life (40.0%) and the 60- 69 group (34.0%). The study found significant disparities in quality of life scores across different occupations, with housewives and retired individuals experiencing higher rates, while employees, married couples, and illiterate individuals reported fair quality of life. Conclusion: The study reveals that knee osteoarthritis patients are mostly overweight or obese, with retired individuals and housewives being the largest risk group. They often lack literacy and experience a low quality of life.

Microbial laden mobile phones from international conference attendees pose potential risks to public health and biosecurity

IntroductionMobile phones, contaminated with pathogenic microorganisms, have the potential to act as “trojan horses”. The microbial signatures present on their surfaces most probably vary across different geographical regions. As a result, mobile phones belonging to international conference attendees may serve as a model for global microbial dissemination, posing potential risks to public health and biosecurity. AimThis study aimed to profile the microbes present on mobile phones belonging to delegates attending an international scientific conference through use of metagenomic shotgun DNA sequencing. MethodsTwenty mobile phones, representing ten different geographical zones from around the world, were swabbed and pooled together into ten geographical-specific samples for high definition next-generation DNA sequencing. WONCA council members were invited to participate and provided verbal consent. Following DNA extraction, next generation sequencing, to a depth of approximately 10Gbp per sample, was undertaken on a v1.5 Illumina NovaSeq6000 system. Bioinformatic analysis was performed via the CosmosID platform. ResultsA total of 2204 microbial hits were accumulated across 20 mobile phones inclusive of 882 bacteria, 1229 viruses, 88 fungi and 5 protozoa. Of particular concern was the identification of 65 distinct antibiotic resistance genes and 86 virulence genes. Plant, animal and human pathogens, including ESKAPE and HACEK bacteria were found on mobile phones. Discussion/conclusionMobile phones of international attendees are contaminated with many & varied microorganisms. Further research is required to characterize the risks these devices pose for biosecurity and public health. Development of new policies which appropriately address and prevent such risks maybe warranted.

The priority of organizational improvement of preventive vector in the system of intersectoral interaction for the preservation of children’s eye health

Background. The relevance of the study is due to a need to apply a comprehensive differentiated approach to the organization of preventive diagnostic examinations and monitoring the formation of visual functions in children of various ages in the difficult conditions of hostilities on the territory of our country. Children’s health remains a strategic task for the formation of Ukraine’s defense capabilities in the future. Full vision is necessary for the formation of a physically healthy and socially adapted personality, good quality of life, learning, working capacity, both in childhood and in working age. In difficult domestic conditions and taking into account the forecast calculations of international experts, which testify to the formed trends towards the growth of ophthalmic pathology, the research on the implementation of modern organizational approaches to the formation of healthy visual functions from childhood is gaining relevance. The purpose of the study was to justify the use of systemic measures of intersectoral interaction to preserve the eye health of children. Materials and methods. The materials for the study were the results of a sociological survey of doctors who provide medical and preventive care to children at outpatient and polyclinic basis (a total of 504 questionnaires were analyzed). The procedure of filling out the questionnaires required anonymity and the prior voluntary verbal consent of the doctors to participate in the study. The research methods were sociological survey, analytical synthetic, content analysis, systemic approach and systemic analysis, medical statistical (calculation of representativeness and reliability of sociological research results). Results. The need for justified organizational improvement in the preventive approach to preserving visual functions in children has been pro­ven. The algorithm of preventive intervention, based on organizational, diagnostic, treatment and preventive measures, is primarily focused on the cooperation of family doctors, family pediatricians, pediatric ophthalmologists and secondary medical staff of medical and educational institutions when introducing modern regular medical and preventive technologies, identifying risk factors and conducting effective supervision of the formation of visual functions in children of various ages, will contribute to the early detection of possible vision disorders for the timely implementation of the necessary treatment and preventive measures. Most interviewed doctors of the outpatient polyclinic level expressed the feasibility of introducing regular systemic supervision of visual functions in preschool and school-age children in the context of implementing state preventive programs to preserve vision from childhood in Ukraine. Conclusions. The medical and social importance of preserving eye health from childhood requires organizational improvement of a preventive approach whose introduction will contribute to the early detection of risk factors, early signs and manifestations, the implementation of the necessary medical and preventive measures, timely diagnosis, correction and treatment of diseases of the eye and its accessory parts in children. The obtained results open the prospect of establishing systemic intersectoral interaction in the planning and implementation of measures of comprehensive programs to prevent the development of ophthalmic pathology among children of various ages.

An Explanation of the Psycho-Social Factors Driving Child Sexual Perpetrators Towards Sexual Abuse in Khyber Pakhtunkhwa

Child Sexual Abuse (CSA) is a severe global child rights issue. This native research finding is the first of its kind and will explore the persuading factors and pave the way for future research exploration. The study explores the psychosocial factors driving perpetrators to commit child sexual abuse. The integrated theory of sexual offending by Ward and Beech 2002 guided the research. This study used a phenomenological qualitative methodology and purposive sampling to select participants. Twenty-five child sexual perpetrators were interviewed in a private room at central jail, Peshawar, after receiving formal approval from jail authorities and verbal consent from the participants. They were allowed to withdraw from the interview at any time. Data collection involved 60 to 80-minute in-depth interviews guided by a structured protocol. Ethical standards, including verbal informed consent and ensuring anonymity and confidentiality, were strictly adhered to throughout the research process. NVIVO software was used for thematic analysis. The analysis revealed a myriad of psychosocial factors influencing perpetrators, such as childhood victimization, substance abuse, cognitive distortions, notions of masculinity, delayed marriage, sexual gratification, social isolation, and exposure to pornography. Perpetrators are often familiar faces within the child's and family's proximity, typically with no prior convictions and mostly first-time offenders. The study highlights the complex interplay of psychosocial factors that drive perpetrators to child sexual abuse.

Hepatitis C elimination: amplifying the role of primary care nurses in Australia.

Background Australia's commitment to eliminate hepatitis C by 2030 is underpinned by the mobilisation of the primary care sector. Primary care nurses are well placed to contribute to achieving elimination given their unique access to people with/at risk of hepatitis C and their person-centred approach to care delivery. This study examines the enablers to primary care nurse involvement in elimination efforts. Methods Primary care nurses involved in the care of people with/at risk of hepatitis C were recruited through two national nursing organisations. Participants provided verbal consent to participate in an electronically recorded, semi-structured interview. Interview data were transcribed verbatim, coded and analysed using a thematic analysis. Results Sixteen interviews were conducted with nurses working in general practice, community health, alcohol and other drug services, and custodial settings, with the findings framed using a social-ecological model. The study identified individual attributes, such as empathy and advocacy for clients deemed 'too hard for everyone else'. Interpersonal enablers included participants' ability to effectively communicate with clients and colleagues, and using trusted professional relationships to improve client access to care. Public policy that addressed community factors, including stigma and confidentiality, were seen as supportive. Conclusions This study identified the critical and varied role primary care nurses play in hepatitis C elimination. Effective scale up of hepatitis C care involves recognising the pivotal role of primary care nurses, which will help to create an enabling environment that supports nurses to work to their full scope of practice and enhance their contribution to the elimination response.

Trauma care supported through a global telemedicine initiative during the 2023–24 military assault on the Gaza Strip, occupied Palestinian territory: a case series

Hospitals, patients, and health-care workers are legally protected by international humanitarian law and the Geneva Convention. However, since Oct 7, 2023, the health-care system in the Gaza Strip, occupied Palestinian territory, has been under unprecedented direct military attacks by Israel, with support for patients proving to be challenging for the remaining health-care workers. Peer-to-peer telemedicine holds promise for assisting surgeons in high-risk, low-resource environments, but might be of reduced utility in extremely austere settings. We present a patient case series of traumatic injuries shared in an international telemedicine group by the surgical team at Nasser Medical Complex, also known as Nasser Hospital, the largest remaining partially functioning hospital in Gaza. WhatsApp (Meta; Menlo Park, CA, USA), a widely available and user-friendly end-to-end encrypted smartphone application, was used to facilitate consultations for weapon-inflicted injuries. All the presented patient cases were shared after obtaining verbal consent from the patients and discussed through a multidisciplinary team approach. The group was developed into a community with more than 15 specialty and injury-oriented subgroups and over 1000 members who joined through non-targeted social media outreach followed by snowball recruitment. Prospective registration and formal ethics approval in Gaza was impossible because the Ministry of Health, including the local Helsinki Committee, had suspended all operations. In June, 2024, we obtained ethics approval from the local Helsinki committee in Gaza. We present 12 select patient case studies from a pool of hundreds of patients admitted to Nasser Hospital between Jan 28 and Feb 12, 2024. Four (33%) of the 12 patients were female and eight (67%) were male, with four patients (33%) being children (younger than 18 years). The age range was between 3 years and 70 years, with a median age of 25 years. Most patients presented with penetrating injuries (11 [92%] of 12), with six patients presenting with wounds secondary to fragment injury, and five patients presenting with wounds due to gunshots. One patient presented with a direct blast injury. The site of reported injuries included head and neck areas (four [33%] of 12), abdomen (four [33%] of 12), chest (three [25%] of 12), pelvis (two [17%] of 12), and limbs (one [8%] of 12). Most patients were lost to follow-up (11 [92%] of 12) and were affected by the invasion of the hospital by the Israeli Defense Forces, which subsequently rendered the hospital non-functional. One patient died following their injury. The health-care team at the now non-functioning Nasser Hospital in southern Gaza adapted their allocation and distribution of extremely low resources and relied on smartphones for specialised telemedicine outreach purposes. This enhanced the capability of the medical teams in management of mass casualties of military assaults that few are trained to work in. Nonetheless, the options available to a health-care system that is under-staffed, under-served, and under siege, are extremely constrained, regardless of such telemedicine initiatives. None.

Acceptability of the use of health related quality of life measurements for decision-making in healthcare science in Vietnam: a qualitative study

ObjectiveThis study was conducted with the objective of exploring the usage of health-related quality of life (HRQOL) outcomes and willingness of health technology assessment (HTA) and public health stakeholders to...