Site Of Delivery Research Articles

Health Care Delivery Site- and Patient-Level Factors Associated With COVID-19 Primary Vaccine Series Completion in a National Network of Community Health Centers.

Objectives. To assess multilevel factors associated with variation in COVID-19 vaccination rates in a US network of community health centers. Methods. Using multilevel logistic regression with electronic health record data from ADVANCE (Accelerating Data Value Across a National Community Health Center Network; January 1, 2022-December 31, 2022), we assessed associations between health care delivery site-level (n = 1219) and patient-level (n = 1 864 007) characteristics and COVID-19 primary vaccine series uptake. Results. A total of 1 337 440 patients completed the COVID-19 primary vaccine series. Health care delivery site characteristics were significantly associated with lower series completion rates, including being located in non-Medicaid expansion states and isolated or rural communities and serving fewer patients. Patient characteristics associated with significantly lower likelihood of completing the vaccine series included being Black/African American or American Indian/Alaska Native (vs White), younger age, lower income, being uninsured or publicly insured (vs using private insurance), and having fewer visits. Conclusions. Both health care delivery site- and patient-level factors were significantly associated with lower COVID-19 vaccine uptake. Community health centers have been a critical resource for vaccination during the pandemic. (Am J Public Health. 2024;114(11):1242-1251. https://doi.org/10.2105/AJPH.2024.307773).

Christian Communities During Russia’s War Against Ukraine: Perception of the Churches’ Aid Involvement Through the Eyes of Poles from Lviv—A Pilot Study

The purpose of this study is to present the perceptions of Poles from Lviv regarding the aid involvement of Christian churches during Russia’s war against Ukraine. Christian churches appear privileged and effective sites of aid delivery in the narratives of respondents. However, this does not mean that they have a monopoly on aid activities. The foundation that underpins these activities is particularly evident in the categories highlighted in this article: the role of clergy in local communities (leaders), personal knowledge of society, church infrastructure, and the churches’ experience gained during the USSR’s persecution of religion. The assistance identified by respondents boils down to material and emotional support, experiencing religious practices, and involvement in direct activity on the war front. The research was based on individual in-depth interviews (IDIs), conducted in December 2023.

Cost, risk, landscape context, and potential treatments vary with biological value for conservation of declining grassland birds

AbstractSpatially explicit models are an important component of systematic conservation planning, enabling the depiction of biodiversity metrics across landscapes and objective evaluation of candidate sites for conservation delivery. However, sites considered “best” for conservation are typically viewed from the standpoint of biological value and may not be the most effective or efficient when risk of habitat loss, cost of conservation, intended conservation treatments, and overall conservation strategy are considered. We evaluated risk of habitat loss, land cost, and landscape context for geographic areas harboring most‐dense to least‐dense population quartiles for 16 species of grassland birds in the US northern Great Plains. Differences in land cost, risk of grassland conversion, and landscape context among quartiles and species indicated that a minimum‐area strategy may be inefficient and even ineffective. Priority zones for western species were generally associated with lower agricultural land cost, more protected land, and landscape characteristics associated with intact grasslands; eastern species were generally associated with higher agricultural land cost, tillage probability, grass loss, cropland, development, forest, Conservation Reserve Program grasslands, and distance to grass. Our results indicate that addressing areas outside of population cores increases conservation options and may provide substantial benefits to portions of populations that are most vulnerable to habitat loss or other stressors.

Pharmacokinetics of nano- and microcrystal formulations of low solubility compounds after intramuscular injection to mice.

The aim of this study was to investigate the pharmacokinetics (PK) of poorly soluble compounds when administered intramuscularly (i.m.) as crystalline particles of different sizes. Three uncharged compounds (griseofulvin, AZ'72, and AZ'07) with varying aqueous solubility were dosed to mice at 10 and 50mg/kg as nano- and microparticle formulations. The PK of the compounds was evaluated. The smaller particles of the drugs resulted in higher maximum plasma concentration (Cmax) and area under the plasma concentration-time profile (AUC) at 50mg/kg. There was a dose-proportional increase in AUC but less than dose dose-proportional increase in Cmax. The evaluation at 10mg/kg was more complex as increased exposure for nanoparticles was only observed for griseofulvin which has the highest solubility. In addition, there was an increase in half-life with an increase in dose. This study highlights that general expectations based on in vitro dissolution (i.e. that smaller particles dissolve faster than larger particles when surrounded by liquid) do not always translate to in vivo and demonstrates the importance of understanding the physicochemical properties of the drug, the characteristics of the formulations and the microphysiology at the delivery site.

Interventions to minimise hospital winter pressures related to discharge planning and integrated care: a rapid mapping review of UK evidence.

Winter pressures are a familiar phenomenon within the National Health Service and represent the most extreme of many regular demands placed on health and social care service provision. This review focuses on a part of the pathway that is particularly problematic: the discharge process from hospital to social care and the community. Although studies of discharge are plentiful, we identified a need to focus on identifying interventions and initiatives that are a specific response to 'winter pressures'. This mapping review focuses on interventions or initiatives in relation to hospital winter pressures in the United Kingdom with either discharge planning to increase smart discharge (both a reduction in patients waiting to be discharged and patients being discharged to the most appropriate place) and/or integrated care. We conducted a mapping review of United Kingdom evidence published 2018-22. Initially, we searched MEDLINE, Health Management Information Consortium, Social Care Online, Social Sciences Citation Index and the King's Fund Library to find relevant interventions in conjunction with winter pressures. From these interventions we created a taxonomy of intervention types and a draft map. A second broader stage of searching was then undertaken for named candidate interventions on Google Scholar (Google Inc., Mountain View, CA, USA). For each taxonomy heading, we produced a table with definitions, findings from research studies, local initiatives and systematic reviews and evidence gaps. The taxonomy developed was split into structural, changing staff behaviour, changing community provision, integrated care, targeting carers, modelling and workforce planning. The last two categories were excluded from the scope. Within the different taxonomy sections we generated a total of 41 headings. These headings were further organised into the different stages of the patient pathway: hospital avoidance, alternative delivery site, facilitated discharge and cross-cutting. The evidence for each heading was summarised in tables and evidence gaps were identified. Few initiatives identified were specifically identified as a response to winter pressures. Discharge to assess and hospital at home interventions are heavily used and well supported by the evidence but other responses, while also heavily used, were based on limited evidence. There is a lack of studies considering patient, family and provider needs when developing interventions aimed at improving delayed discharge. Additionally, there is a shortage of studies that measure the longer-term impact of interventions. Hospital avoidance and discharge planning are whole-system approaches. Considering the whole health and social care system is imperative to ensure that implementing an initiative in one setting does not just move the problem to another setting. Time limitations for completing the review constrained the period available for additional searches. This may carry implications for the completeness of the evidence base identified. Further research to consider a realist review that views approaches across the different sectors within a whole system evaluation frame. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130588) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 31. See the NIHR Funding and Awards website for further award information.

Matrix metalloproteinase-responsive hydrogels with tunable retention for on-demand therapy of inflammatory bowel disease

Therapeutic options for addressing inflammatory bowel disease (IBD) include the administration of an enema to reduce intestinal inflammation and alleviate associated symptoms. However, uncontrollable retention of enemas in the intestinal tract has posed a long-term challenge for improving their therapeutic efficacy and safety. Herein we have developed a protease-labile hydrogel system as an on-demand enema vehicle with tunable degradation and drug release rates in response to varying matrix metalloproteinase-9 (MMP-9) expression. The system, composed of three tailored hydrogel networks, is crosslinked by poly (ethylene glycol) (PEG) with 2-, 4- and 8-arms through dynamic hydrazone bonds to confer injectability and generate varying network connectivity. The retention time of the hydrogels can be tuned from 12 to 36 h in the intestine due to their different degradation behaviors induced by MMP-9. The drug-releasing rate of the hydrogels can be controlled from 0.0003 mg/h to 0.278 mg/h. In addition, injection of such hydrogels in vivo resulted in significant differences in therapeutic effects including MMP-9 consumption, colon tissue repair, reduced collagen deposition, and decreased macrophage cells, for treating a mouse model of acute colitis. Among them, GP-8/5-ASA exhibits the best performance. This study validates the effectiveness of the tailored design of hydrogel architecture in response to pathological microenvironment cues, representing a promising strategy for on-demand therapy of IBD. Statement of significanceThe uncontrollable retention of enemas at the delivery site poses a long-term challenge for improving therapeutic efficacy in IBD patients. MMP-9 is highly expressed in IBD and correlates with disease severity. Therefore, an MMP-9-responsive GP hydrogel system was developed as an enema by linking multi-armed PEG and gelatin through hydrazone bonds. This forms a dynamic hydrogel characterized by in situ gelation, injectability, enhanced bio-adhesion, biocompatibility, controlled retention time, and regulated drug release. GP hydrogels encapsulating 5-ASA significantly improved the intestinal phenotype of acute IBD and demonstrated notable therapeutic differences with increasing PEG arms. This method represents a promising on-demand IBD therapy strategy and provides insights into treating diseases of varying severities using endogenous stimulus-responsive drug delivery systems.

Enteric neural stem cell transplant restores gut motility in mice with Hirschsprung disease.

The goal of this study was to determine if transplantation of enteric neural stem cells (ENSCs) can rescue the enteric nervous system, restore gut motility, reduce colonic inflammation, and improve survival in the Ednrb-KO mouse model of Hirschsprung disease (HSCR). ENSCs were isolated from mouse intestine, expanded to form neurospheres, and microinjected into the colons of recipient Ednrb-KO mice. Transplanted ENSCs were identified in recipient colons as cell clusters in "neo-ganglia." Immunohistochemical evaluation demonstrated extensive cell migration away from the sites of cell delivery and across the muscle layers. Electrical field stimulation and optogenetics showed significantly enhanced contractile activity of aganglionic colonic smooth muscle following ENSC transplantation and confirmed functional neuromuscular integration of the transplanted ENSC-derived neurons. ENSC injection also partially restored the colonic migrating motor complex. Histological examination revealed a significant reduction in inflammation in ENSC-transplanted aganglionic recipient colon compared with that of sham-operated mice. Interestingly, mice that received cell transplant also had prolonged survival compared with controls. This study demonstrates that ENSC transplantation can improve outcomes in HSCR by restoring gut motility and reducing the severity of Hirschsprung-associated enterocolitis, the leading cause of death in human HSCR.

Maternal Death Self-Risk Perception as a Predictor of Women’s Delivery Site Preferences in Ile-Ife, Nigeria

Background: Increased uptake of health facility delivery could improve the worsening maternal mortality in low and middle-income countries. Several factors that determine women’s preferred delivery site had been reported in the literature, but none had explored women’s self-perception of maternal death as a predictor of their delivery site, hence this study. Subjects and Method: A cross-sectional study of 183 women recruited serially at the immuni­za­tion clinic of two primary health facilities in Ile-Ife, Nigeria. Data was obtained using an interviewer-administered questionnaire. Their maternal death self-risk perception score by type of delivery site was determined with a minimum and maximum obtainable score of 7 and 35. Descriptive and inferential statistical analysis was done including a simple and multiple binary logistic regression. Results: The mean age of the respondents (Mean= 29; SD= 5.26). About 130 (71.0%) of the women delivered at a health facility. The majority of the women (91.8%) were aware of maternal death, while 32 (17.5%) feared death in their last pregnancy, with a mean maternal death self-risk perception score ((Mean= 24.96; SD= 2.69) (95% CI= 24.55 to 25.33)). The higher the maternal death self-risk perception score, the greater the odds of a facility-based delivery (AOR=1.40, 95% CI=1.20 to 1.64, p<0.001). However, alongside other confounding variables, only a facility-based ANC registration (AOR= 607.52, 95% CI= 1.39 to 2.66*105, p=0.039) and women’s personal reasons (AOR=0.02; 95%CI= 0.01 to 0.51; p=0.018) significantly influenced delivering at a health facility and non-health facility respectively. Conclusion: The place of ANC registration and personal reasons such as the women’s influential decision-makers better predicted their eventual delivery site. Nonetheless, the development and standardization of maternal death self-risk perception criteria for women is encouraged.

Greenhouse Gas Emissions Due to Unnecessary Antibiotic Prescriptions for Respiratory Diagnoses

Background: Healthcare accounts for 8.5% of total US greenhouse gas emissions (GHGE), with US healthcare the main contributor. Yet little effort has been made to measure healthcare related GHGE. Specifically, GHGE related to unnecessary antibiotic prescriptions is unclear, and to our knowledge, no one has used estimates of GHGE of unnecessary antibiotics as an antibiotic stewardship tool. We aimed to measure GHGE from solid waste associated with unnecessary antibiotic prescriptions for respiratory conditions. Methods: We calculated emissions for an outpatient prescription including the plastic bottle, paper leaflet, and paper bag (photos) based on the weight of each item multiplied by US Environmental Protection Agency (EPA) GHGE factors. Emission factors depend on waste type and treatment method which we assumed to be landfilled. To estimate unnecessary antibiotic prescriptions for respiratory infections, visits from nine University of Utah Health Urgent Care Centers from 2019-2022 were electronically identified and included if they had an ICD-10-CM code for a respiratory diagnosis where antibiotics are not indicated. Waste emissions of the paper and plastic in an individual prescription were then multiplied by the number of unnecessary respiratory antibiotic prescriptions for designated time periods to arrive at total landfilled waste emissions. We used similar methods applied to published 2014 data from CDC to estimate national waste emissions due to unnecessary antibiotic prescriptions for respiratory infections. Finally, we used the EPA’s GHG Equivalencies Calculator to convert emissions into tangible GHGE for providers and patients. Results: A prescription has 32g of paper and 15g of plastic waste. Among 124,461 urgent care visits (Table 1) in 2019-2022, 18,531 (14.9%) received an antibiotic. This equates to 593 kg of paper waste and 278 kg of plastic waste leading to a total landfilled waste emissions of 0.479 MT CO2e/ton. Using the EPA GHG Equivalencies Calculator, this equates to driving an average gasoline-powered car 1,228 miles. There were 14,482,976 unnecessary antibiotic prescriptions (Table 2) in the US for respiratory infections in 2014. Our estimates suggest these prescriptions led to 375.109 CO2e/ton of GHGE, the same as driving 961,610 miles by an average gasoline-powered vehicle. Conclusion: Unnecessary antibiotic prescriptions are associated with substantial GHGE. This estimate demands further evaluation across diagnoses and care delivery sites, and most importantly action. Additionally, the large GHG contribution of unnecessary antibiotics should be used as a stewardship tool to highlight low-value care that is likely contributing to global climate change.

Comparative effects of insulin pump and injection on gestational diabetes mellitus pregnancy outcomes and serum biomarkers

BACKGROUND Insulin injection is the basic daily drug treatment for diabetic patients. AIM To evaluate the comparative impacts of continuous subcutaneous insulin infusion (CSII). METHODS Based on the treatment modality received, the patients were allocated into two cohorts: The CSII group and the multiple daily injections (MDI) group, with each cohort comprising 210 patients. Comparative assessments were made regarding serum levels of serum-secreted frizzled-related protein 5, homocysteine, and C1q/TNF-related protein 9. Furthermore, outcomes such as fasting plasma glucose, 2-hour postprandial glucose levels, pain assessment scores, and the incidence of complications were evaluated post-treatment. RESULTS The CSII group displayed notably lower fasting plasma glucose and 2-h postprandial glucose levels in comparison to the MDI group (P < 0.05). Subsequent analysis post-treatment unveiled a significantly higher percentage of patients reporting no pain in the CSII group (60.00%) in contrast to the MDI group (36.19%) (P < 0.05). Additionally, the CSII group exhibited a markedly reduced occurrence of fetal distress and premature rupture of membranes compared to the MDI group (P < 0.05). However, there were no significant variances observed in other pregnancy outcomes between the two groups (P > 0.05). A statistical analysis revealed a significant difference in the incidence of complications between the groups (χ 2 = 11.631, P = 0.001). CONCLUSION The utilization of CSII via an insulin pump, as opposed to MDI, can significantly enhance the management of insulin administration in patients with GDM by diversifying the sites of insulin delivery. This approach not only promotes optimal glycemic control but also regulates metabolic factors linked to blood sugar, reducing the likelihood of adverse pregnancy outcomes and complications. The clinical relevance and importance of CSII in GDM management highlight its wide-ranging clinical usefulness.

Creation of a complex multivariate integrated model of the oil interfield transport system

Background. In conditions of variability of external and internal factors that directly affect the loading of the existing hydrocarbon transport system, the risks arise associated with the productive capacity of the existing infrastructure and noncompliance with the requirements for the quality of delivered oil. Objective. To create a tool allowing to assess the degree of loading of existing infrastructure facilities and indicators of the commercial quality of oil at commercial delivery sites in the near and long term, the availability of which is essential for risk minimization. Materials and methods. An integrated model in combination with automation tools is an effective tool for making strategic decisions in order to develop the assets of a subsurface user company. Results. By the example of transport infrastructure, the paper describes an approach to using the gathering system model, which jointly with automation algorithms allows solving a number of strategic tasks of oil and gas producers, such as performing multivariate hydraulic calculations and monitoring oil quality in order to verify compliance with the requirements. Conclusions. An integrated model in combination with the developed automation tools is an auxiliary tool for management decision-making. The tool helps to significantly reduce the labor costs for performing calculations and primary processing of the results. The implemented approaches can be used for hydraulic calculations and monitoring of limitations of transportation networks of similar configuration.

New forms of employment: development of take-away delivery and urban–rural wage inequality

PurposeSince smartphones became ubiquitous, online grocery and food purchases through take-away delivery platforms have steadily increased in China. Nevertheless, whether the development of take-away delivery can ameliorate urban–rural wage inequality still requires further analysis. The purpose of this paper is to clarify whether this positive effect exists.Design/methodology/approachThis paper makes estimations based on city and individual levels combining the Chinese Household Income Project (CHIP) 2008, CHIP 2013, CHIP2018 survey data and the take-away delivery site data. At the city level, the Oaxaca-Blinder (O-B) decomposition method is employed to construct wage inequality index of urban and rural labors. At the individual level, this paper analyzes urban–rural wage differentials with high or low formal education level.FindingsThe rapid establishment of take-away delivery sites has resulted in an increase of 52.425 yuan on average in the annual wage of rural labors with low formal education level. When the cumulative number of sites increases by 1 unit, the annual wage inequality index decreases by 0.007 on average. Labors with the characteristics of rural household registration and low education can enjoy more dividends. Through inter-/within-industry decomposition, this paper elaborates formal education, age and cross-industry transfer as the main factors for the improvement of urban–rural wage inequality. Narrowing effect of wage differences between different groups in multiple sample slices also contributes to the mechanism analyses.Originality/valueTo the best of the author’s knowledge, this paper is the first to analyze the impact of take-away delivery development on the urban–rural wage inequality from the perspective of the establishment of take-away delivery sites. This empirical study will enrich the existing theoretical perspectives on urban–rural divide under the emergence of new forms of employment. The results indicate that new forms of employment represented by take-away delivery can not only promote economic growth, but also eliminate urban–rural inequality.

Clients’ expectations and experiences with providers of menstrual regulation: a qualitative study in Bangladesh

BackgroundMenstrual Regulation (MR) has been legal in Bangladesh since 1979 in an effort to reduce maternal mortality from unsafe abortion care. However, access to high-quality and patient-centered MR care remains a challenge. This analysis aimed to explore what clients know before going into care and the experience itself across a variety of service delivery sites where MR care is available.MethodsWe conducted 26 qualitative semi-structured interviews with MR clients who were recruited from three different service delivery sites in Dhaka, Bangladesh from January to March 2019. Interviews explored client expectations and beliefs about MR care, the experience of the care they received, and their perception of the quality of that care. We conducted a thematic content analysis using a priori and emergent codes.ResultsClients overall lacked knowledge about MR care and held fears about the damage to their bodies after receiving care. Despite their fears, roughly half the clients held positive expectations about the care they would receive. Call center clients felt the most prepared by their provider about what to expect during their MR care. During counseling sessions, providers at in-facility locations reinforced the perception of risk of future fertility as a result of MR and commonly questioned clients on their need for MR services. Some even attempted to dissuade nulliparous women from getting the care. Clients received this type of questioning throughout their time at the facilities, not just from their medical providers. The majority of clients perceived their care as good and rationalized these comments from their providers as coming from a caring place. However, a handful of clients did report bad care and negative feelings about their interactions with providers and other clinical staff.ConclusionProviders and clinical staff can play a key role in shaping the experience of clients accessing MR care. Training on accurate knowledge about the safety and effectiveness of MR, and the importance of client communication could help improve client knowledge and person-centered quality of MR care.

Quality by design (QbD) approach-based development of optimized nanocarrier to achieve quality target product profile (QTPP)-targeted lymphatic delivery

Background. Insulin, commonly used for diabetes treatment, needs better ways to improve its effectiveness and safety due to its challenges with poor permeability and stability. Various system has been developed for oral peptide delivery. The non-targeted system can prevent gastric and enzymatic degradation of peptides but cannot increase the bulk transport of peptides across the membrane. However, the non-selectivity is the limitation of the existing system. Numerous carbohydrate-binding receptors overexpressed on intestinal macrophage cells (M-cells) of gut-associated lymphoid tissue. It is the most desirable site for receptor-mediated endocytosis and lymphatic drug delivery of peptides. Objective. The prime objective of the study was to fabricate mannose ligand conjugated nanoparticles (MNPs) employing a quality-by-design approach to address permeability challenges after oral administration. Herein, the study’s secondary objective of this study is to identify the influencing factor for producing quality products. Considering this objective, the Lymphatic uptake of NPs was selected as a quality target product profile (QTPP), and a systematic study was conducted to identify the critical formulation attributes (CFAs) and critical process parameters (CPP) influencing critical quality attributes (CQAs). Mannosylated Chitosan concentrations (MCs) and TPP concentrations were identified as CFAs, and stirring speed was identified as CPP. Methods. MNPs were prepared by the inotropic gelation method and filled into the enteric-coated capsule to protect from acidic environments. The effect of CFAs and CPP on responses like particle size (X) and entrapment (Y) was observed by Box-Behnken design (BBD). ANOVA statistically evaluated the result to confirm a significant level (p < 0.05). The optimal conditions of NPs were obtained by constructing an overlay plot and determining the desirability value. HPLC and zeta-seizer analysis characterized the lyophilized NPs. Cell-line studies were performed to confirm the safety and M-cell targeting of NPs to enhance Insulin oral bioavailability. Results. The morphology of NPs was revealed by SEM. The developed NPs showed a nearly oval shape with the average size, surface potential, and % drug entrapment were 245.52 ± 3.37 nm, 22.12 ± 2.13 mV, and 76.15 ± 1.3%, respectively. MTT assay result exhibited that MNPs safe and Confocal imaging inference that NPs selectively uptake by the M-cell. Conclusion. BBD experimental design enables the effective formulation of optimized NPs. The statistical analysis estimated a clear assessment of the significance of the process and formulation variable. Cell line study confirms that NPs are safe and effectively uptake by the cell.

Investing in School Mental Health: Strategies to Wisely Spend Federal and State Funding.

In the context of the current youth mental health crisis, it is prudent to reconsider how resources are allocated to facilitate the delivery of effective and comprehensive supports and services to children and adolescents. Schools are the main delivery sites for youth mental health services. Many districts have adopted comprehensive school mental health systems (CSMHS) to provide a multitiered approach comprising mental health promotion, prevention, and intervention to students via partnerships between school and community health and behavioral health providers. COVID-19 relief funding and other new federal and state investments in school mental health have led to expansions of school mental health programming in most states. An impending federal funding cliff necessitates an examination of how to wisely invest now to achieve the greatest positive future impact on youth mental health. To capitalize on opportunities to sustain effective school mental health and maximize return on investment, states may consider four strategies: leverage cross-sector partnerships to advance school mental health policies and funding, strengthen and expand Medicaid coverage of CSMHS, establish and enhance data systems, and create state technical assistance and professional development support for CSMHS implementation through local education agencies.

Enrollment, Continuity and Factors associated with Health Insurance among Insured and Uninsured People of Pokhara Metropolitan, Kaski

Purpose: To assess SHI and its associated factor among people of Pokhara Metropolitan.&#x0D; Methodology: A comparative study using a cross-sectional design was carried out from June-December, 2018 among 184 insured and Uninsured People of Pokhara Metropolitan, Kaski using multistage sampling technique. Interview method was used using Interview schedule. Data was entered in epidata version 3 and analyzed using SPSS version 20.&#x0D; Result: Educational level (p-value 0.03) was one of the major associated factors to determining enrollment status of SHIP. Similarly home ownership (p-value 0.001) was highly associated factor with insurance status. The association of perceive health status of household with enrollment status (p-value 0.043). Knowledge about SHIP was another major associated factor (p-value 0.02) of enrollment status of SHIP in this study. The study showed that 29% of household have dropout. The major reasons for discontinuity were found as no quality of health care, crowed in service delivery site and long waiting time, inappropriate benefit package, distance to health care facility, did not use service use in last year etc.&#x0D; Conclusion: The major factors such as education, occupation, family income, household ownership, perceive health status and knowledge about social health insurance were found to be associated with enrollment of SHIP

Prenatal Diagnosis of Congenital Heart Disease: The Crucial Role of Perinatal and Delivery Planning.

Although most congenital heart defects (CHDs) are asymptomatic at birth, certain CHD lesions are at significant risk of severe hemodynamic instability and death if emergent cardiac interventions are not performed in a timely fashion. Therefore, accurate identification of at-risk fetuses and appropriate delivery resource planning according to the degree of anticipated hemodynamic instability is crucial. Fetal echocardiography has increased prenatal CHD detection in recent years due to advancements in ultrasound techniques and improved obstetrical cardiac screening protocols, enabling the prediction of newborns' hemodynamic status. This assessment can guide multidisciplinary resource planning for postnatal care, including selection of delivery site, delivery room management, and transport to a cardiac center based on CHD risk severity. This review will discuss fetal cardiovascular physiology and the circulatory changes that occur at the time of and immediately following birth, outline fetal echocardiographic findings used to risk-stratify newborns with CHDs, and outline principles for neonatal resuscitation and initial transitional care in neonates with these complex CHD lesions.

A review on topical ophthalmic drug delivery system: Reference to viscosity enhancer.

The eye is the most accessible site for topical drug delivery. Drug's ocular bioavailability is quite low when administered topically as eye drops. Viscosity enhancers are used to increase ocular bioavailability by extending the precorneal residence time of the drug at the ocular site. Cellulose, polyalcohol and polyacrylic acid are examples of hydrophilic viscosity enhancers. The addition of viscosity modifiers increases the amount of time the drug is in contact with the ocular surface. Several polysaccharides have been studied as excipients and viscosity boosters for ocular formulations, including cellulose derivatives such as chitosan (CS), xyloglucan and arabinogalactan (methylcellulose, hydroxyethylcellulose, hydroxypropylmethylcellulose (HPMC), and sodium carboxymethylcellulose). Viscosity-increasing substances reduce the surface tension, extend the corneal contact time, slow the drainage, and improve the bioavailability. Chitosan is a viscosity enhancer that was originally thought to open tight junction barrier cells in the epithelium. Chitosan thickens the medication solution and allows it to penetrate deeper. Alginate is an anionic polymer with carboxyl end groups that has the highest mucoadhesive strength and is used to improve penetration. Carboxymethylcellulose (CMC), a polysaccharide with a high molecular weight, is one of the most common viscous polymers used in artificial tears to achieve their longer ocular surface residence period. Hyaluronic acid (HA) is biocompatible and biodegradable in nature, and it is available in ocular sustained-release dose forms. A polymer known as xanthan gum is used to increase viscosity. At 0.2% concentration, carbomer forms a highly viscous gel.

Targeting the Gut: A Systematic Review of Specific Drug Nanocarriers.

The intestine is essential for the modulation of nutrient absorption and the removal of waste. Gut pathologies, such as cancer, inflammatory bowel diseases (IBD), irritable bowel syndrome (IBS), and celiac disease, which extensively impact gut functions, are thus critical for human health. Targeted drug delivery is essential to tackle these diseases, improve therapy efficacy, and minimize side effects. Recent strategies have taken advantage of both active and passive nanocarriers, which are designed to protect the drug until it reaches the correct delivery site and to modulate drug release via the use of different physical-chemical strategies. In this systematic review, we present a literature overview of the different nanocarriers used for drug delivery in a set of chronic intestinal pathologies, highlighting the rationale behind the controlled release of intestinal therapies. The overall aim is to provide the reader with useful information on the current approaches for gut targeting in novel therapeutic strategies.

Application of hydrogel microneedles in the oral cavity.

Microneedles are a transdermal drug delivery system in which the needle punctures the epithelium to deliver the drug directly to deep tissues, thus avoiding the influence of the first-pass effect of the gastrointestinal tract and minimizing the likelihood of pain induction. Hydrogel microneedles are microneedles prepared from hydrogels that have good biocompatibility, controllable mechanical properties, and controllable drug release and can be modified to achieve environmental control of drug release in vivo. The large epithelial tissue in the oral cavity is an ideal site for drug delivery via microneedles. Hydrogel microneedles can overcome mucosal hindrances to delivering drugs to deep tissues; this prevents humidity and a highly dynamic environment in the oral cavity from influencing the efficacy of the drugs and enables them to obtain better therapeutic effects. This article analyzes the materials and advantages of common hydrogel microneedles and reviews the application of hydrogel microneedles in the oral cavity.