Difficulty Of Access Research Articles

Development and evaluation of an interactive information system in technical assistance and rural extension

The state of Espírito Santo has a wide diversification of rural activities, such as family agribusinesses and activities related to rural tourism. However, diagnosing the rural zone presents some challenges, such as the difficulty of access and location, long distances, and excessive costs, combined with the scarcity of human and financial resources inherent to public services. In this sense, it is necessary to restructure the communication and technical assistance and rural extension model established by public institutions to reinforce the trend towards the use of Information and Communication Technology (ICT) tools and the implementation of concepts such as e-government (e-Gov). In this context, we propose an interactive computational tool, focusing on diagnosing, planning, and addressing the different current demands the rural sector presents. To achieve this, we have developed a consulting and data analysis system that also employs artificial intelligence concepts, aiming to increase the efficiency and quality of public services in rural areas. The proposed system is called Agrolegal Ater Digital and includes functionalities such as registration, diagnosis, virtual library, event registration, news, and funding opportunities. The objective is to facilitate access to information for rural entrepreneurs regarding the public services offered and to increase the speed of communication with public agents. The results obtained through the conducted diagnoses are promising, with good acceptance from the test group regarding the proposed tool and the use of information technology in addressing requests in rural areas.

Latine perspectives on the impact of family, perceptions of medication, health systems, incarceration, and housing on accessing opioid agonist therapy: A thematic analysis

IntroductionOpioid-related overdose deaths rates among Latine individuals are increasing rapidly and, in Massachusetts, have exceeded rates among non-Hispanic White individuals. Yet Latine individuals are less likely to receive opioid agonist therapies (OAT) methadone and buprenorphine, which have been demonstrated to prevent opioid deaths. Amid climbing Latine overdose rates, we lack qualitative data from Spanish-speaking people who use opioids about their views on and access to OAT. In this paper, we sought to assess variables affecting Latine individuals' initiation of OAT. MethodsWe conducted 21 semi-structured interviews – half in Spanish – with Latine-identifying individuals recruited from four locations–three residential treatment sites and one city shelter–in Boston offering services to people who use drugs. We utilized thematic analysis to identify barriers and facilitators to starting and continuing OAT. ResultsThe following themes – which cut across individual-, interpersonal-, and systems-level variables – emerged as core considerations shaping Latine participants' OAT engagement: (1) family, (2) medication desirability and accessibility, (3) health care resources, (4) housing stability, and (5) incarceration. First, family members were prominent interpersonal influences on participants' treatment decisions. For some participants, family introduced participants to opioids at young ages and later supported them in recovery. Second, engagement with OAT was shaped by individual-level opinions on the medications as well as by systems-level experiences with trying to access the medications. Participants identified benefits and drawbacks of methadone versus buprenorphine, with greater access difficulties for methadone. Third, the health care setting in Boston provided notable systems-level facilitators to OAT access, including outreach workers, Medicaid, and Spanish-speaking providers. Fourth, housing instability impeded some from accessing OAT while motivating others to initiate the medications. Finally, incarceration created systems-level barriers to OAT engagement. Most participants had been incarcerated in jail or prison but did not have access to OAT during incarceration or during their transition back to the community. ConclusionsApproaches to increase OAT engagement among Latine individuals should consider integrating family into recovery pathways, tailoring information in Spanish, developing bilingual/bicultural staffing, ensuring supportive insurance coverage systems, addressing housing needs, and making OAT available for individuals involved in the legal system.

Exploring perspectives on how to improve psychological treatment for women from minoritised ethnic communities: A qualitative study with service users.

Women are disproportionately impacted by depression and anxiety disorders and in particular, women from minoritised ethnic communities experience inequalities in access to outcomes of psychological treatment for these disorders. Better understanding from the views of service users about the factors that impact their access to, and experiences of care could help to optimise treatment for these groups. This study explored experiences of treatment and gathered suggestions about treatment improvement, from the perspectives of women currently using psychological therapy services. Semi-structured interviews were conducted with 12 female NHS Talking Therapies for anxiety and depression (NHSTTad) service users from minoritised ethnic communities. Data were analysed using thematic analysis. Four high-order themes were identified: (1) cultural identity and experiences of mental health and treatment, (2) challenges associated with treatment, (3) facilitators of good treatment experiences and outcomes and (4) improvements for women from minoritised ethnic communities. Findings showed that cultural sensitivity and awareness are important to minoritised ethnic women receiving therapy. Challenges included access difficulties and limitations of treatment options offered, alongside personal challenges of engaging in therapy. Facilitators of good treatment experiences and outcomes included flexibility on the part of the service, as well as therapist-related factors such as identity characteristics (age, gender and culture of therapist), a good therapeutic relationship and the therapist's ability to deliver person-centred care. Improvements included ensuring care is culturally sensitive, reducing waiting times or providing better support for people on waiting lists, providing a flexible service that takes individual needs into account, increasing workforce diversity and reaching out to underserved communities. Many of the suggested improvements are generalisable to underserved minoritised ethnic groups, regardless of gender and could be applied to other psychological therapies services other than NHSTTad.

Multi-level information fusion enhanced by scene constraint: Key to improve autonomous positioning accuracy in urban underground pipeline using MEMS inertial sensors

Accurate positioning inside confined urban underground pipelines is challenging due to the lack of geo-reference and the difficulty of access for geodetic apparatus. Micro-electromechanical system (MEMS) inertial navigation systems (INS) have become the mainstream positioning approach but face challenges in maintaining accuracy over a long time period because aiding for INS is limited. We propose a factor graph optimization (FGO) architecture for aided INS inside pipes, which enhances positioning accuracy by involving information fusion from three levels: measurements from physical sensors, motion constraints, and scene constraints. We achieved autonomous positioning using a typical industrial-grade MEMS inertial measurement unit within a 1700 m pipeline, with positioning accuracy of up to 1.0 m horizontally and 0.5 m vertically. Results demonstrate that the accuracy in horizontal and vertical directions improved by at least 45% and 26%, respectively, using FGO compared with traditional Kalman filtering methods.

Let’s measure it: An approach of high-resolution estimates of bottom fixed net fishing effort at national level

Fisheries are one of the most important food sources for human consumption whilst being amongst the most impacting and extractive activities happening within the marine environment, which makes it imperative to properly manage this activity. To improve fisheries management, the precise quantification of fishing effort is of the outmost importance. Yet, present methods for effort estimation, especially at broad scales, are hampered by difficulties in data access and usually rely on coarse effort metrics or on costly data collection for quantifying fishing effort with higher resolution. In the present work, we propose an approach of high-resolution fishing effort estimates of net fishing, as length of nets operated by a given fleet, at the national level. It relies on sampling of effort, derived from classified and easy to access vessel tracking data – AIS, and fishery dependent data – logbook and landings data. The proposed methodology combines trip-based effort estimates, derived from AIS data, as a foundation to extrapolate the total fishing effort, through the number of fishing trips linked to official landings and logbook data. It is estimated that in the years from 2014 to 2020 an average of 180 200 km of static nets (gillnets and trammel nets), which corresponds to approximately 4.5 and 210 times the lengths of the equator and the Portuguese Atlantic coastline respectively, are used in Portuguese mainland waters each year, by a fleet of slightly more than 100 vessels. The presented methodology allows to quantify and study the variation of the nominal fishing effort, at country level, with a higher resolution than what is usually used and at very low cost. We argue that such methodologies need to be developed and explored in order to have better and more comprehensive estimates of fishing effort which will contribute and improve the sustainable management of fisheries and the marine environment.

Research Progress of Assessment Tools for Peripheral Venous Access Difficulties in Children

Research Progress of Assessment Tools for Peripheral Venous Access Difficulties in Children

Luminescence dating of the MIS 6 glaciation of the Pamir mountains (Central Asia)

The Pamir Mountains are one of the highest mountain systems in the world; they act as sources of fresh water for the main rivers of Central Asia: the Amudaria and Syrdaria. Throughout the Quaternary, the Pamirs played a major role in controlling atmospheric circulation and land-surface processes, and provided great volumes of terrigenous sediments for transport by large rivers to the depressions in the Aral and Caspian regions. These ultimately provided broad aeolian cover in the sandy deserts, and finer dust for the widely distributed loess-palaeosol sequences. The glaciation history of this highly dynamic region provides an important basis for understanding climate change, sediment source and landscape evolution in Central Asia during the Quaternary. The question of the number, distribution, extent and timing of Pleistocene glaciations in the Pamir is debated. One of the main obstacles to research, together with difficulties of access and severity of current climate, is the varying degree of preservation of traces of previous glaciations in the western and eastern Pamir. As a result of a geological survey, we for the first time identified a thick lacustrine deposit at high altitudes in a tributary of the Panj – the valley of the Sary-Shitharv River – this records the damming of the Panj River valley by a large glacier. Luminescence measurements were undertaken to obtain the age of the Sary-Shitharv glacially-dammed lake. As often in mountain catchments the quartz OSL signal was unsuitable for dose estimation, and so the chronology of the Sary-Shitharv section is based entirely on post-IR IRSL signals from K-rich feldspar. We used pIRIR50,290 and pIRIR200,290 protocols and obtained indistinguishable ages from both protocols. Given the high sedimentation rates deduced from the structure of lacustrine deposits, the entire sequence must have been accumulated rather quickly, over a period of no more than a few thousand years. The average age over the whole series of dates is 165 ± 11 ka. This places the existence of the glacially-dammed lake at Sary-Shitharv in late MIS 6, a result that fits well with the general course of the glacial history of the Pamirs.

Diabetes mellitus in sub-saharan Africa during the COVID-19 pandemic: A scoping review.

The COVID-19 pandemic impacted the healthcare and outcomes of individuals with various chronic diseases. However, there is a paucity of data on the impact of the COVID-19 pandemic on diabetes mellitus (DM) in low-resource settings. To address this, we conducted a scoping review to explore the literature published on diabetes-related COVID-19 outcomes and care during the COVID-19 pandemic in countries of sub-Saharan Africa. We applied our search strategy to PubMed, Web of Science, CINAHL, African Index Medicus, Google Scholar, Cochrane Library, Scopus, Science Direct, ERIC and Embase to obtain relevant articles published from January 2020 to March 2023. Two independent reviewers were involved in screening the retrieved articles. Data from eligible articles were extracted from quantitative, qualitative and mixed-methods studies. Quantitative evidence was summarised using descriptive statistics, while a thematic framework was used to identify and categorise themes from qualitative evidence. We found 42 of the retrieved 360 articles eligible, mainly from South Africa, Ethiopia and Ghana (73.4%). The incidence of DM among COVID-19 cases was 13.7/1,000 person-days observation. COVID-19 was associated with increased odds of death (OR 1.30-9.0, 95% CI), hospitalisation (OR 3.30-3.73: 95% CI), and severity (OR: 1.30-4.05, 95% CI) in persons with DM. Challenges in caring for DM during the pandemic were inadequate patient self-management, difficulties in healthcare access, and inadequate healthcare resources. The COVID-19 pandemic was characterised by a high incidence of DM in persons infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and high COVID-19-associated mortality, severity, and hospitalisation among people persons with DM. The pandemic also created difficulties in DM self-management and worsened the quality of DM care services. Policymakers should devise preventive and management strategies for DM during emerging and re-emerging infectious disease epidemics and outbreaks, given that such occurrences are increasingly frequent in the region.

Social network of families involved in child neglect: building a multidimensional perspective.

Neglect is one of the most frequently reported forms of violence against children and adolescents, although it has rarely been explored in national studies. In this light, the present study aimed to analyze the personal social network of families involved in negligence against children and adolescents. This work takes a qualitative approach, anchored in the Paradigm of Complexity, conducted with twenty families involved in negligence against children and adolescents in a municipality in the countryside of the state of São Paulo, Brazil. Data collection took place through minimal maps of the personal social network and semi-structured interviews in January 2021. The networks were limited, with little to no interaction among the different services and sectors, and were predominantly homogeneous. Because they have many weakened ties, they are relatively unsupportive, pointing out difficulties in access to work, education, and health. Due to the characteristics of the network, the complexity of the phenomenon of neglect was identified, in which elements condition and perpetuate experiences of absence and fragility. Interprofessional and intersectoral views and actions are requested and recommended.

U.S. primary care physician perceptions on barriers to providing guideline-driven care for UTI and recurrent UTI: a qualitative study

BackgroundUrinary tract infections (UTI) affect almost two-thirds of all women during their lives and many experience recurrent infections. There are evidence-based guidelines from multiple international societies for evaluation and treatment; however, recent claims-based analyses have demonstrated that adherence to these guidelines is poor. This study seeks to understand the barriers experienced by U.S. primary care providers (PCPs) to providing guideline-based care for UTI and recurrent UTI (rUTI).MethodsSemi-structured interviews of 18 PCPs, recruited from the greater Los Angeles area, examined real-world clinical management of UTI/rUTI episodes, decisions to refer to subspecialty care, and resources guiding counseling and management. Grounded theory methodology served to analyze interview transcripts and identify preliminary and major themes.ResultsParticipants expressed the desire to obtain urine cultures for each cystitis episode, but felt pressured to make compromises by patient demands or barriers to care. PCPs had lower thresholds to empirical treatment if patients had a history of rUTIs, were elderly, or declined evaluation. Laboratory data was minimally utilized in clinical decision-making: urinalyses were infrequently considered when interpreting culture data. PCPs treated a broad set of urologic and non-urologic symptoms as UTI, even with negative cultures. PCPs did not feel comfortable initiating UTI prophylaxis, instead seeking specialist evaluation for anatomic causes. They were unaware of management guidelines, typically utilizing UpToDate® as their primary resource. Few evidence-based UTI prevention interventions were recommended by providers.ConclusionsLow availability of succinct and clear professional guidelines are substantial barriers to appropriate UTI/rUTI care. Poor useability of clinical guidance documents results in substantial confusion about the role of preventative measures and additional diagnostic testing. Difficulties in patient access to care providers lead to expectations for presumptive treatment. Future studies are needed to determine if improved educational materials for providers and/or management algorithms can improve guideline concordance of UTI management.

Understanding sexual health service access for gay, bisexual and other men who have sex with men in Ireland during the COVID-19 crisis: Findings from the EMERGE survey.

In the Republic of Ireland, the COVID-19 crisis led to sexual health service closures while clinical staff were redeployed to the pandemic response. Gay, bisexual and other men who have sex with men (gbMSM) face pre-existing sexual health inequalities which may have been exacerbated. The aim of this study is to understand sexual health service accessibility for gbMSM in Ireland during the COVID-19 crisis. EMERGE recruited 980 gbMSM in Ireland (June-July 2021) to an anonymous online survey investigating well-being and service access through geo-location sexual networking apps (Grindr/Growlr), social media (Facebook/Instagram/Twitter) and collaborators. We fit multiple regression models reporting odds ratios (ORs) to understand how demographic and behavioural characteristics (age, sexual orientation, HIV testing history/status, region of residence, region of birth and education) were associated with ability to access services. Of the respondents, 410 gbMSM accessed sexual health services with some or no difficulty and 176 attempted but were unable to access services during the COVID-19 crisis. A further 382 gbMSM did not attempt to access services and were excluded from this sample and analysis. Baseline: mean age 35.4 years, 88% gay, 83% previously tested for HIV, 69% Dublin-based, 71% born in Ireland and 74% with high level of education. In multiple regression, gbMSM aged 56+ years (aOR = 0.38, 95%CI:0.16, 0.88), not previously tested for HIV (aOR = 0.46, 95%CI:0.23, 0.93) and with medium and low education (aOR = 0.55 95%CI:0.35, 0.85) had lowest odds of successfully accessing services. GbMSM with HIV were most likely to be able to access services successfully (aOR = 2.68 95%CI:1.83, 6.08). Most disrupted services were: STI testing, HIV testing and PrEP. Service access difficulties were found to largely map onto pre-existing sexual health inequalities for gbMSM. Future service development efforts should prioritise (re)engaging older gbMSM, those who have not previously tested for HIV and those without high levels of education.

The effects of previous abdominal surgery and the utilisation of modified access techniques on the operative difficulty and outcomes of laparoscopic cholecystectomy and bile duct exploration

BackgroundEarly reports suggested that previous abdominal surgery was a relative contraindication to laparoscopic cholecystectomy (LC) on account of difficulty and potential access complications. This study analyses different types/systems of previous surgery and locations of scars and how they affect access difficulties. As modified access techniques to minimise risk of complications are under-reported the study details and evaluates them.MethodProspectively collected data from consecutive LC and common bile duct explorations (LCBDE) performed by a single surgeon over 30 years was analysed. Previous abdominal surgery was documented and peri-operative outcomes were compared with patients who had no previous surgery using Chi-squared analysis.ResultsOf 5916 LC and LCBDE, 1846 patients (31.2%) had previous abdominal surgery. The median age was 60 years. Those with previous surgery required more frequent duodenal (RR 1.07; p = 0.023), hepatic flexure (RR 1.11; p = 0.043) and distal adhesiolysis (RR 3.57; p < 0.001) and had more access related bowel injuries (0.4% vs. 0.0%; p < 0.001). Previous upper gastrointestinal and biliary surgery had the highest rates of adhesiolysis (76.3%), difficult cystic pedicles (58.8%), fundus-first approach (7.2%), difficulty grades (64.9% Grades 3–5) and utilisation of abdominal drains (71.1%). Previous open surgery resulted in longer operative time compared to previous laparoscopic procedures (65vs.55 min; p < 0.001), increased difficulty of pedicle dissection (42.4% vs. 36.0%; p < 0.05) and required more duodenal, hepatic flexure and distant adhesiolysis (p < 0.05) and fundus-first dissection (4% vs 2%; p < 0.05). Epigastric and supraumbilical access and access through umbilical and other hernias were used in 163 patients (8.8%) with no bowel complications.ConclusionThe risks of access and adhesiolysis in patients with previous abdominal scars undergoing biliary surgery are dependent on the nature of previous surgery. Previous open, upper gastrointestinal and biliary surgery carried the most significant risks. Modified access techniques can be adopted to safely mitigate these risks.Graphical abstract

Subgrade Feasibility Analysis for Tourist Access Roads in Senggani Gorge, Tulungagung Using Laboratory CBR Testing

Highways have an important role in the economic and tourism sectors, providing easy accessibility and accelerating regional growth. Senggani Gorge, a tourist attraction in Nglurup Hamlet, Sentang District, Tulungagung Regency, is the main attraction with the charm of waterfalls and natural coffee plantations in the highlands. However, accessibility constraints arise because the path to the tourist attraction is still slippery and bumpy clay. Clay soil conditions pose access difficulties, so more research is needed to understand the potential use of clay soil as a base layer of road pavement. This study focused on a research system that involved soil sampling on the access road to Senggani Gorge. Experimental methods were used to evaluate the effect of using clay subgrades on such tourist road access. The laboratory CBR test was conducted to test the strength of clay subgrade in road pavement construction, with the main aim to determine the impact of its use on tourist access to Senggani Gorge in Tulungagung. The results showed the percentage of CBR in collision variations 10, 25, and 56, as well as a comparison with research in Nglurup Hamlet which reached a CBR value of 27%. These findings are expected to provide a dimension of comparison and generalization of results, broadening understanding of the use of clay soils as road construction materials in various locations.

The Non-Accessible Ureter: Can History, Gender, Age, BMI, Radiology and Stone Size Predict the Requirement of Pre-Stenting in Narrow Ureters

Abstract: Background: The difficulty in access to the ureter during stone removal surgery enhances the chances of redo-surgery, DJ stenting, and associated complications, this failure leads to mistrust in the doctor-patient relationship. Objective: This study aims to provide a comprehensive evaluation of the incidence &amp; management of narrow ureters after failure to negotiate retrograde access of rigid or flexible Ureteroscope (6/7.5 Fr ). Materials and Methods: This is a Prospective, cross-sectional study, conducted at the urology department of Tabba Kidney Institute, from June 2022 to June 2023. The minimum required sample size was 250. Patients aged between &gt; 18 to &lt;60 diagnosed with Unilateral and bilateral ureteric stones and hydronephrosis without ureteric stone obstruction were included in the study. SPSS 22 was used to analyze the data, the chi-square test was applied, with p-value &lt;0.05 as significant. Result: The overall mean age of the study population was estimated as 40.71 ± 12 years, while gender distribution indicated 138 (55.2%) male and 112 (44.8%) female patients. Group distribution identified 172 (68.8%) patients with negotiable ureter (Group A), while 78 (31.2%) with non-negotiable ureter (Group B). Conclusion: We conclude that in our population there is a higher incidence of narrow ureters, as compared to other studies which are not accessible even using the same dilatation technique, so it is safe to counsel the patients pre-operatively about the possibility of the narrow ureter and need for pre-stenting. Tabba Ureter Accessibility (TUA) score can be used as a tool to predict the possibility of a narrow ureter. Keywords: Narrow ureter, Ureteric stone, DJ stent, Ureterorenoscope, Dehydration, Hematuria.

User satisfaction regarding regional health polyclinics services in Bahia, Brazil

The Regional Health Polyclinics (RHPs) are a recent initiative, and there are still no evaluative research on them. This study aims to assess the satisfaction of RHP users in Bahia. A quantitative and qualitative survey was conducted, employing three strategies: questionnaires, semi-structured interviews with users and managers, and observation by researchers. The data were analyzed using descriptive analysis and content analysis. The majority of respondents (89.7%) were very satisfied with the services. The performance of professionals generated high satisfaction (98.3%). In interviews, the dimension of access was identified as the primary core of meaning, with mentions of difficulties in access, associated with the high demand from municipal users for specialists. The results can help managers improve the quality of services offered.

'We know the lack of services': Service lead's perspective of enablers and barriers to hearing assessment for children in metropolitan, regional and rural Australia: A qualitative study.

To explore potential enablers and barriers to accessing paediatric hearing assessment from the perspective of Australian service leads, extending previous studies on this topic from the perspectives of two other stakeholder groups - parents and speech pathologists. This qualitative study, expanding upon previous mixed-methods studies, applied a pragmatism paradigm. The study was undertaken online via Zoom and included participants who were service leads of organisations that offer hearing assessment in metropolitan, regional, rural and remote parts of Australia. Eight Australian service leads participated in semi-structured interviews. Barriers identified were similar to barriers in previous studies. Three main themes were identified. First, children with hearing loss in Australia are well identified at birth. The second theme focused on the reduced and inconsistent hearing assessment services available after this age. Finally, service leads discussed the importance of embracing technology to solve service access difficulties. Consultation with key stakeholders, to consider the needs of different communities within Australia, will be crucial when identifying new service delivery options.

Aminopyridines in the development of drug candidates against protozoan neglected tropical diseases.

Neglected tropical diseases (NTDs) pose a major threat in tropical zones for impoverished populations. Difficulty of access, adverse effects or low efficacy limit the use of current therapeutic options. Therefore, development of new drugs against NTDs is a necessity. Compounds containing an aminopyridine (AP) moiety are of great interest for the design of new anti-NTD drugs due to their intrinsic properties compared with their closest chemical structures. Currently, over 40 compounds with an AP moiety are on the market, but none is used against NTDs despite active research on APs. The aim of this review is to present the medicinal chemistry work carried out with these scaffolds, against protozoan NTDs: Trypanosoma cruzi, Trypanosoma brucei or Leishmania spp.

Factors Associated with Women’s Contraceptive Use and Access to Contraceptive Methods During the COVID-19 Pandemic

Background: Due to the pandemic, the use of contraceptive methods in women was restricted, and many of them even faced problems such as abortion and unplanned pregnancy because they could not access the contraceptive methods. Objective: This study aimed to determine women’s use of modern contraceptive methods during the COVID-19 pandemic and to examine the predictors of access to modern contraceptives. Method: Women (n=502) aged 18-49, fertile and using any contraceptive methods were included in the study. Data were collected via an online survey. The use and access to contraceptives during the pandemic were analyzed with descriptive statistics. Multiple regression analysis, odds ratios (OR), and 95% confidence intervals were calculated to investigate contraception access difficulties and change predictors. Results: The results of this study indicate that 64.9% of the participants were utilizing modern contraceptive methods, while 23.5% were concerned about obtaining contraceptives during the pandemic. Furthermore, 6% of the women experienced difficulty accessing contraceptives during this period, and 6.2% altered their contraceptive methods. The primary predictor of women’s difficulty in accessing contraceptives during the pandemic was the absence of access to the method prior to the pandemic in a similar manner (OR:40.0 95%CI=12.3-129.9; p=.001). Additionally, It was also found that women who changed their methods during the pandemic had 4.47 times more difficulty in accessing the new method. Conclusion: Having experienced an unintended pregnancy before the pandemic and fear of 48 becoming pregnant during the pandemic were found to be important determinants of the contraceptive change. This study shows evidence that the pandemic has affected contraceptive access. In this regard, planning initiatives to increase access to contraception services is recommended.

Rural ambulatory care pharmacists providing in-clinic and home visit services improve adherence to long-acting injectable antipsychotics.

Patients with schizophrenia often experience symptoms such as poor insight and disorganized thought, which limit their ability to seek and receive care consistently. In rural settings, systemic factors, including limited resources and transportation, further contribute to difficulties in health care access. Long-acting injectable antipsychotics (LAIs) can improve medication adherence and reduce hospitalizations from relapse. Opportunities exist for pharmacists to provide individualized care and improved health care access. The pilot service took place in ambulatory care clinics and home care settings. Pharmacists performed weekly reviews of patients with active orders for LAIs, coordinated care with nonadherent patients, and offered follow-up appointments in the Patient Centered Medical Home (PCMH). For patients unable to be reached, outreach pharmacists provided psychiatric assessment and LAI medication administration at home visits. There were 10 patients with LAI prescriptions in the past year selected for review. The period reviewed was 90 days before and after start of service. Pharmacist interventions resulted in 4 patients reestablished with care who were previously lost to follow-up. The percentage of days covered by LAI fills increased from an average 26% to 67% of days covered (P = .06). Total emergency room visits related to mental health episodes decreased from 11 to 2 visits (P = .03). Four patients who did not have metabolic lab monitoring in more than 1 year received lab monitoring as indicated. PCMH pharmacy services, including home visits by outreach pharmacists, may improve access and bridge care gaps for patients on LAIs by providing community-based services in addition to traditional clinic-based care.

A Study of the Role of Mass Media in the Development of Society in Sudan: A Case Study

Abstract: The broad communications assumes a vital part in shaping social orders around the world, impacting social standards, spreading data, and encouraging financial turn of events. In Sudan, a country with a rich social legacy and a background marked by political unrest, the job of broad communications turns out to be considerably more critical. This theoretical digs into the diverse commitments of broad communications to the advancement of Sudanese society. Broad communications fills in as an imperative stage for data scattering, offering residents admittance to news, current issues, and instructive substance (Adam, A. (2018). In a different and geologically scattered country like Sudan, where ignorance rates stay high and admittance to formal training is restricted, broad communications overcomes any barrier in information dispersal. Through papers, radio, TV, and progressively advanced stages, residents gain consciousness of public arrangements, formative drives, wellbeing efforts, and socio-widespread developments. Writers and media specialists frequently assume an essential part in uncovering debasement, unfairness, and common liberties infringement, in this way considering specialists responsible and driving cultural advancement. The job of broad communications in Sudan isn't without challenges. Restriction, government control, and administrative limitations frequently thwart media opportunity and pluralism, smothering the variety of perspectives and hindering the media's capacity to satisfy its formative job successfully (Khalil, A. M. (2017). Moreover. In any case, tending to the difficulties of media opportunity, access, and pluralism is basic to bridling the maximum capacity of broad communications in driving feasible turn of events and cultural advancement in Sudan.