Direct Health Research Articles

Recreational substance use among international travellers.

Drug tourism reflects the expanding illicit drug market, posing health risks in unfamiliar travel settings. Existing knowledge specifically addressing substance use among international travellers is sparse and has not been reviewed to date. This review aimed to describe the recreational substance abuse in international travellers. A literature search was conducted on PubMed, Google Scholar and Scopus using keywords related to recreational substances and international travellers. A total of 11 021 articles were reviewed, charted and summarized for the evidence on prevalence, patterns and characteristics of substance abuse and their health- and non-health-related problems on international travellers. A total of 58 articles were included. Most were cross-sectional studies and review articles. In total, 20 articles addressed the prevalence of substance abuse in travellers, 33 looked at characteristics and patterns of substance abuse in travellers and 39 investigated the health- and non-health-related problems from substance abuse. Estimated prevalence of recreational substances abuse varied from 0.7% to 55.0%. Rates of substances abuse were 9.45-34.5% for cannabis, 20.4-35.9% for alcohol intoxication, 2.82-40.5% for MDMA, 2-22.2% for cocaine, 2-15% for psychedelic agents and 2% for methamphetamine. The prevalence varied according to travellers' characteristics and travel destinations. Direct health problems included neuropsychiatric problems. Indirect problems included accident and unintentional injuries, crime and violence, risky sexual behaviours and sexual violence and blood-borne infections. Non-health-related problems included air rage, deportation and violation of local laws. Substance abuse among international travellers is an underestimated problem that requires intervention. These findings emphasize the importance of addressing this issue to mitigate both health and well-being problems among travellers whilst promoting safer and more responsible travel experiences. In the context of travel health practices, practitioners should counsel travellers whose itineraries may include substance abuse, informing them about associated risks and consequences.

Economic burden of chronic obstructive pulmonary disease in Morocco: a cost of illness study.

Chronic obstructive pulmonary disease (COPD) carries an important economic burden worldwide. However, the cost of this disease in Morocco is not well explored. This study aimed to estimate the economic cost associated with COPD in Morocco and identify its determinants. A cost of illness, prevalence-based study using a bottom-up approach method, including COPD patients, was carried out in 2021-2022. The cost was estimated from a societal perspective, and the time horizon was 1 year. Data collection was performed using a questionnaire including socio-demographic, clinical data, and utilization of health care resources in 2019: hospitalization, medical tests, medications, and medical visits. Direct health cost (DHC) was estimated by multiplying the use of health services by the official prices (unit costs) published by the National Agency for Health Insurance. The indirect cost (IC) represented by labor productivity losses was calculated using the human capital method. Costs were compared according to different socio-demographic and clinical factors. We included 159 patients; 82.4% were men, 80.4% were current or former smokers, and 78.7% were categorized as "high-risk" groups (grades C-D). The DHC was estimated at $1816.6 per patient per year. Pharmaceutical and hospitalization costs represented the highest part of the total DHC (42.5% and 22.1%, respectively). The IC was estimated at $709.5±1081.3 per patient per year. DHC increased with increasing disease severity and with the number of severe exacerbations (p<0.001). Current and former smokers were more costly to the healthcare system than nonsmokers (p=0.029). IC also increased with the number of severe exacerbations (p=0.003). In this study, we showed that COPD in Morocco generates important costs for the health system, mainly related to smoking and the severity of the disease. It is therefore important to strengthen tobacco control measures in our country.

Too hot to thrive: a qualitative inquiry of community perspectives on the effect of high ambient temperature on postpartum women and neonates in Kilifi, Kenya

ObjectiveTo understand community perspectives on the effects of high ambient temperature on the health and wellbeing of neonates, and impacts on post-partum women and infant care in Kilifi.DesignQualitative study using key informant interviews, in-depth interviews and focus group discussions with pregnant and postpartum women (n = 22), mothers-in-law (n = 19), male spouses (n = 20), community health volunteers (CHVs) (n = 22) and stakeholders from health and government ministries (n = 16).SettingsWe conducted our research in Kilifi County in Kenya’s Coast Province. The area is largely rural and during summer, air temperatures can reach 37˚C and rarely go below 23˚C.Data analysisData were analyzed in NVivo 12, using both inductive and deductive approaches.ResultsHigh ambient temperature is perceived by community members to have direct and indirect health pathways in pregnancy and postpartum periods, including on the neonates. The direct impacts include injuries on the neonate’s skin and in the mouth, leading to discomfort and affecting breastfeeding and sleeping. Participants described babies as “having no peace”. Heat effects were perceived to be amplified by indoor air pollution and heat from indoor cooking fires. Community members believed that exclusive breastfeeding was not practical in conditions of extreme heat because it lowered breast milk production, which was, in turn, linked to a low scarcity of food and time spend by mothers away from their neonates performing household chores. Kangaroo Mother Care (KMC) was also negatively affected. Participants reported that postpartum women took longer to heal in the heat, were exhausted most of the time and tended not to attend postnatal care.ConclusionsHigh ambient temperatures affect postpartum women and their neonates through direct and indirect pathways. Discomfort makes it difficult for the mother to care for the baby. Multi-sectoral policies and programs are required to mitigate the negative impacts of high ambient temperatures on maternal and neonatal health in rural Kilifi and similar settings.

Assessment of strategic healthcare purchasing and financial autonomy in Tanzania: the case of results-based financing and health basket fund.

Low-and middle-income countries (LMICs) are implementing health financing reforms toward Universal Health Coverage (UHC). In Tanzania direct health facility financing of health basket funds (DHFF-HBF) scheme was introduced in 2017/18, while the results-based financing (RBF) scheme was introduced in 2016. The DHFF-HBF involves a direct transfer of pooled donor funds (Health Basket Funds, HBF) from the central government to public primary healthcare-PHC (including a few selected non-public PHC with a service agreement) facilities bank accounts, while the RBF involves paying providers based on pre-defined performance indicators or targets in PHC facilities. We consider whether these two reforms align with strategic healthcare purchasing principles by describing and comparing their purchasing arrangements and associated financial autonomy. We used document review and qualitative methods. Key policy documents and articles related to strategic purchasing and financial autonomy were reviewed. In-depth interviews were conducted with health managers and providers (n = 31) from 25 public facilities, health managers (n = 4) in the Mwanza region (implementing DHFF-HBF and RBF), and national-level stakeholders (n = 2). In this paper, we describe and compare DHFF-HBF and RBF in terms of four functions of strategic purchasing (benefit specification, contracting, payment method, and performance monitoring), but also compare the degree of purchaser-provider split and financial autonomy. Interviews were recorded, transcribed verbatim, and analyzed using a thematic framework approach. The RBF paid facilities based on 17 health services and 18 groups of quality indicators, whilst the DHFF-HBF payment accounts for performance on two quality indicators, six service indicators, distance from district headquarters, and population catchment size. Both schemes purchased services from PHC facilities (dispensaries, health centers, and district hospitals). RBF uses a fee-for-service payment adjusted by the quality of care score method adjusted by quality of care score, while the DHFF-HBF scheme uses a formula-based capitation payment method with adjustors. Unlike DHFF-HBF which relies on an annual general auditing process, the RBF involved more detailed and intensive performance monitoring including data before verification prior to payment across all facilities on a quarterly basis. RBF scheme had a clear purchaser-provider split arrangement compared to a partial arrangement under the DHFF-HBF scheme. Study participants reported that the RBF scheme provided more autonomy on spending facility funds, while the DHFF-HBF scheme was less flexible due to a budget ceiling on specific spending items. Both RBF and DHFF-HBF considered most of the strategic healthcare purchasing principles, but further efforts are needed to strengthen the alignment towards UHC. This may include further strengthening the data verification process and spending autonomy for DHFF-HBF, although it is important to contain costs associated with verification and ensuring public financial management around spending autonomy.

Electric Cable Insulator Damage Monitoring by Lasso Regression

Since the discovery of electricity, electric cables have become ubiquitous in human constructions, from machines to buildings. Insulators play a crucial role in ensuring the proper functioning of these cables, so it is important to monitor their possible damage, which can be caused by environmental contamination, severe temperature variations, and electrical and mechanical stress. While shunt conductance is a direct health indicator of cable insulation, measuring the cable average shunt conductance is not sufficient for the detection of localized insulator damage, since localized conductance variations are diluted over a long cable length in such measurements. The objective of this paper is to assess the feasibility of reflectometry techniques for the monitoring of insulator damage in electric cables. To this end, the estimation of localized conductance variations is investigated based on electrical measurements made at one end of a cable. To avoid estimating a large number of discretized conductance values along a long cable, the proposed method relies on sparse regression, which automatically focuses on localized conductance variations at unknown positions caused by accidental insulator damage. In order to efficiently apply sparse regression techniques, the telegrapher’s equations describing electric wave propagation in cables are transformed through several steps into a simple linear regression form. Then, Lasso (Least Absolute Shrinkage and Selection Operator) regression is applied to process the voltage and current data collected at a single end of the monitored cable. Numerical simulations show the potential of this method for fast estimation of localized shunt conductance variations.

Direct diabetes-related healthcare expenditures in Slovenia: recent evolution and future projections based on population-level data

ABSTRACT Objective The burden of diabetes on individuals, healthcare systems, and society must be explored to improve and sustain diabetes care. With this aim, we estimated both past and future diabetes-related direct health expenditures in Slovenia. Methods Analysis of expenditures from the healthcare payer perspective during the 2019–2022 period was based on individual patient data on expenditures for seven groups of diabetes-related medical conditions from the population-level database of the Health Insurance Institute of Slovenia. Expenditure projections were prepared using the European Commission’s methodology for budgetary projections. Results In the 2019–2022 period, average annual diabetes-related expenditures equaled €174.1 million (€1,108 per patient), with their average annual growth rate reaching 12.5%. Expenditures due to inpatient care (33%) and drugs used in diabetes (24%) had the highest shares. More than half of the expenditures were due to complications of diabetes. The diabetes-related expenditures as a share of GDP are projected to increase by 19.2% from 2019 to 2030, with slower yet continued growth up to 2050. Conclusions Diabetes-related expenditures in Slovenia continue to rise. By focusing on the prevention and optimal management of diabetes, its impact on the healthcare system could be reduced significantly, given the magnitude of expenditures attributed to complications.

Garbage consumption by Arctic terrestrial predators in one of the most pristine land areas on Earth

Garbage may cause substantial environmental perturbations, in part because of its consumption by wildlife. Such consumption may have direct health implications for animals and may also influence trophic relationships. Even in pristine Arctic ecosystems, wildlife feeding in marine environments consume garbage in the form of plastic debris transported by ocean currents. We show that Arctic wildlife in pristine terrestrial environments may also ingest garbage or food items derived from abandoned camp sites. We found the remains of a chocolate wrapper and a milk powder bag in two Arctic fox (Vulpes lagopus) scats and a piece of cloth in an Arctic wolf (Canis lupus arctos) scat collected near Nares Strait, northern Greenland, one of the most pristine terrestrial wilderness regions on Earth. Found on Washington Land and associated with long-abandoned camp sites, these three scats were among 657 Arctic fox scats and 92 wolf scats collected as part of a larger study. Our study demonstrates that these two highly opportunistic predators managed to consume garbage despite the almost complete lack of human activity in this High-Arctic region. Our results highlight that abandoned anthropogenic material in the High Arctic may function as a source of garbage for local terrestrial wildlife over extended time periods, and that garbage consumption may become a potential issue if human activity in remote Arctic regions increases.

Photocatalytic Self-cleaning Eco-Friendly Paint: A Unique Approach for Efficient Indoor Air Pollutant Removal and Surface Disinfection

Improving of air quality, particularly the removal of indoor-air pollutants with direct environmental and health implications, remains a significant challenge in modern society. We, herein, present a novel approach using photocatalytic eco-friendly paint to effectively eliminate indoor air pollutants and disinfect surfaces. Ultra Small Porous Nitrogen-doped Titanium dioxide (USPNT), which has been successfully incorporated into the paint by different coating techniques. The UPSNT photocatalyst was synthesized via probe sonication coupled sol-gel technique, resulting in anatase phase with a high surface area of 83m²/g. The efficiency of the UPSNT-coated paint in removing air pollutant like p-xylene under simulated indoor illumination is considered. In additional, it showed the capability to disinfect pathogens like E. coli, remove surface dirt, such as organic dyes, confirming its self-cleaning properties. This will lead to develop a direct eco-friendly paint by formulating USPNT directly with suitable binders promotes the durability of indoor and outdoor air quality as well as reducing “sick building syndrome’’.

Digital health literacy and associated factors among health professionals during the outbreak of corona virus pandemic in Ethiopia: A systematic review and meta-analysis.

The COVID-19 pandemic had a significant impact on healthcare delivery worldwide. Digital tools emerged as a preferred solution for maintaining healthcare services during this crisis. This study aimed to assess the magnitude of digital health literacy among healthcare professionals in Ethiopia in 2020-2023. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Articles published from 2020 to 2023 were reviewed using various electronic databases such as Medline, PubMed, and Cochrane Library, CINAHL, HINARI, Science Direct, Google Scholar, and Global Health. Meta-analysis was performed using STATA 17, and publication bias and heterogeneity were assessed. Six studies involving a total of 2739 participants were included in the analysis. The pooled level of high digital health literacy among health professionals in Ethiopia during the pandemic was found to be 56.0% (95% CI: 55, 58). Several factors were identified as significant contributors to high digital health literacy, including internet use (AOR = 2.72, 95% CI: 1.86, 3.98), perceived ease of use (AOR = 2.79, 95% CI: 1.83, 4.25), favorable attitude (AOR = 2.49, 95% CI: 1.61, 3.85), perceived usefulness (AOR = 2.29, 95% CI: 1.65, 3.18), information-communication-technology training (AOR = 6.09, 95% CI: 1.83, 24.27), and educational level (AOR = 3.60, 95% CI: 2.96, 4.37). The study findings revealed a moderate level of high digital health literacy among Ethiopian health professionals. Factors such as internet use, favorable attitude, and information-communication-technology training were associated with high-level digital health literacy. To enhance digital health literacy, it is crucial to provide timely training and improve internet access for healthcare professionals. Additionally, promoting the perception of digital tools as useful and supporting evidence-based decision-making can further improve digital health literacy. Comprehensive information-communication-technology training programs should be implemented to equip healthcare professionals with necessary skills to effectively combat outbreaks like the COVID-19 pandemic.

Analysis of the Work Environment and Occupational Health, Safety (K3) in the Carton Box Packaging Industry Using the Fault Tree Analysis (FTA) Method (Case Study of Pt. Carton Box Manufacturing Bekasi Regency)

The cardboard box packaging industry is a form of innovation in paper-based packaging products which includes outer protective packaging for food, automotive and other finished products, PT. Cikarang Cardboard Box Manufacturing is a multi-national company that operates in the field of manufacturing paper-based packaging sourced from paper recycling processing, so that in its operations it still pays attention to environmental aspects for the continuation of the next generation. As a provider of large-scale cardboard packaging, the company certainly has business ethics and occupational health and safety (K3) regulations that must be adhered to by all employees and guests who visit it, however there are still cases of work accidents that occur every year, the measurement of the level of work accident cases is based on data obtained based on direct observation, Therefore, work health and safety (K3) analysis research was carried out using the Fault Tree Analysis (FTA) method. From the analysis carried out by researchers, it was found that the cause of work accidents that occurred was due to employee understanding, bad habits that occurred (unsafe action). and the work environment is in an unsafe condition. So the solution to this problem is that it is hoped that the company can tighten K3 regulations in the company environment in order to improve company performance and reduce the number of work accidents that occur in the company environment.

Analytic optimization of Plasmodium falciparum marker gene haplotype recovery from amplicon deep sequencing of complex mixtures.

Molecular epidemiologic studies of malaria parasites and other pathogens commonly employ amplicon deep sequencing (AmpSeq) of marker genes derived from dried blood spots (DBS) to answer public health questions related to topics such as transmission and drug resistance. As these methods are increasingly employed to inform direct public health action, it is important to rigorously evaluate the risk of false positive and false negative haplotypes derived from clinically-relevant sample types. We performed a control experiment evaluating haplotype recovery from AmpSeq of 5 marker genes (ama1, csp, msp7, sera2, and trap) from DBS containing mixtures of DNA from 1 to 10 known P. falciparum reference strains across 3 parasite densities in triplicate (n = 270 samples). While false positive haplotypes were present across all parasite densities and mixtures, we optimized censoring criteria to remove 83% (148/179) of false positives while removing only 8% (67/859) of true positives. Post-censoring, the median pairwise Jaccard distance between replicates was 0.83. We failed to recover 35% (477/1365) of haplotypes expected to be present in the sample. Haplotypes were more likely to be missed in low-density samples with <1.5 genomes/μL (OR: 3.88, CI: 1.82-8.27, vs. high-density samples with ≥75 genomes/μL) and in samples with lower read depth (OR per 10,000 reads: 0.61, CI: 0.54-0.69). Furthermore, minority haplotypes within a sample were more likely to be missed than dominant haplotypes (OR per 0.01 increase in proportion: 0.96, CI: 0.96-0.97). Finally, in clinical samples the percent concordance across markers for multiplicity of infection ranged from 40%-80%. Taken together, our observations indicate that, with sufficient read depth, the majority of haplotypes can be successfully recovered from DBS while limiting the false positive rate.

Catering for Mental Health and Stress Coping Mechanisms amongst Eleven- To -Fourteen-Year-Old Learners in Privately Owned Schools of Imbizo District in Bulawayo

This paper sought to assess the extent to which privately owned schools offer stress coping mechanisms and mental health awareness to learners who are preteenagers. There is often a misconception that children do not experience stress, however, literature review revealed that children do in fact experience stress. Children’s stressors may be different from those of adults and children’s ways of experiencing and describing what is happening to them may also be different in comparison to adults. Mixed research methods were used in the study issuing questionnaires which had both open and closed ended questionnaires and conducting interviews. The close ended questions allowed for frequencies of responses to be calculated, thus this brought in a quantitative element of research. The interviews/interview guides provided a deeper understanding of how schools offer coping. An interpretive paradigm was used to explain how learners experience stress and what schools are doing to ensure that their learners mental health and stress levels are being catered for. The target population was learners who are pre-teenagers, learning in Imbizo District. The sample method employed was simple random sampling, which meant all schools and their learners within the Imbizo District, had an equal chance of being selected. Ethical considerations of confidentiality, informed consent and anonymity were paramount during this study. The findings of the study revealed that there is a need for stress coping mechanisms and raising mental health awareness amongst learners. Two schools however, have introduced clubs, thus offering learners a stress coping mechanism. The research study recommended that schools direct mental health awareness campaigns to parents and teachers. There is also the recommendation to staff develop teachers and administrators on skills of identifying and accommodating learners who are going through stress or have mental health issues so as to provide the learners with the needed assistance at an early stage.

Equity Lens on Canada's COVID-19 Response: Review of the Literature.

A growing literature has documented how the secondary effects of the COVID-19 pandemic have compounded socioeconomic vulnerabilities already present in society, particularly across social categories such as gender, race, class, and socioeconomic status. Such effects demonstrate how pandemic response policies act as structural determinants of health to influence not only direct health outcomes but also intermediary outcomes, such as access to education or income. This review aims to scope research that analyzes pandemic response policies in Canada from an equity perspective, to identify common themes, recommendations, and gaps. Fourteen studies were thematically analyzed, the majority being qualitative policy document analysis, applying critical frameworks and focused on effects on select priority populations. Analysis of economic and labour policies indicates a lack of consideration for the specific needs of priority populations, and those engaged in precarious, informal, and essential labour. Analysis of social policies illustrate the wide-ranging effects of school and service closures, particularly on women and children. Furthermore, these policies lacked consideration of populations marginalized during the pandemic, include older adults and their caregivers, as well as lack of consideration of the diversity of Indigenous communities. Recommendations proposed in this review call for developing policy responses that address persistent social and economic inequities, pandemic response policies tailored to the needs of priority populations and more meaningful consultation during policy development. The limited number of studies suggests there is still much scope for research recognizing policies as structural determinants of health inequities, including research which takes an intersectional approach.

Perfil das doenças cardiovasculares e atuação fisioterapeutica em um serviço de emergência hospitalar

Abstract Introduction Cardiovascular disease (CVD) is the lead-ing cause of death globally, with a high proportion of hospitalizations and costs. In view of this, it is essential to understand the main CVDs in patients admitted to hospital emergency services and the role of physiotherapists, in order to plan and direct health services, and to denote participation and encourage specific physiotherapy training in the context of tertiary care. Objective To outline the profile of cardiovascular emergencies and to evaluate physiotherapy in adult patients in the emergency department of a hospital in the interior of the state of São Paulo. Methods This was an observational study which analyzed 1,256 on-call records over a period of eight months. The data collected included age, gender, cardiovascular diagnostic hypothesis and physiotherapy treatment carried out. Results A total of 75 patients with cardiovascular emergencies were included, the most prevalent of which were: heart failure (n = 21), acute coronary syndrome (n = 14), acute myocardial infarction (n = 13), bradyarrhythmia (n = 6) and hypertensive crisis (n = 5). Regarding physiotherapeutic actions and their applications, the most frequent were invasive mechanical ventilation management (n = 34), lung re-expansion maneuvers (n = 17), orotracheal intubation assistance (n = 17), non-invasive mechanical ventilation (n = 14), bronchial hygiene maneuvers (n = 12), kinesiotherapy (n = 10) and sedation (n = 10). Conclusion Heart failure and acute coronary syndrome were the cardiovascular diseases that caused the most admissions to the hospital emergency department and that the procedures with an emphasis on the respiratory system were the most applied.

Navigating the nutritional paradox: The impact of sustainable development targets on childhood wasting and overweight prevalence.

In 2015, the United Nations member states endorsed the 2030 Agenda for Sustainable Development to chart a path towards a better future for all. Childhood malnutrition, particularly wasting, remains a critical global health challenge, disproportionately affecting children under five in low- and middle-income countries. This study evaluates the impact of achieving selected Sustainable Development Goal (SDG) targets on reducing childhood malnutrition, with a specific focus on wasting and overweight. Utilizing multi-country DHS datasets, this study analyzed data from 138,782 children under five across 27 countries, nested within 13,788 neighborhoods. We simulated the predicted prevalence of wasting and overweight as selected SDG-related health inputs and determinant indicators reached their target values. Our findings reveal a baseline prevalence of 6.3% for wasting and 4.3% for overweight among the children studied. Progress towards the SDGs can potentially decrease wasting prevalence by a quarter (25%), translating to a reduction from 6.3% to 4.7%. This significant reduction in wasting is more pronounced in rural areas (29%) than in urban settings (7%). Conversely, a 14% increase in overweight prevalence was observed, with rural areas experiencing a higher rise (15%) than urban areas (13%). The study also highlighted variations in access to safe sanitation, improved water sources, healthcare services, income, maternal employment, and education levels, underscoring the complex interplay between these factors and malnutrition outcomes. Notably, the reduction in wasting prevalence was mainly attributable to input determinants rather than direct health inputs, suggesting the importance of broader socioeconomic factors in combating malnutrition. Achieving SDG targets presents a significant opportunity to mitigate wasting, particularly in rural communities. However, the uneven distribution of improvements underscores the need for targeted interventions in less affected areas. The concurrent rise in overweight prevalence, points to the emerging challenge of addressing the dual burden of malnutrition. This necessitates integrated, multi-sectoral strategies considering the diverse health determinants and nutritional status.

How Physicians Should Respond to Climate Change.

Urgent warnings about the existential threat of climate change are coming from leaders in nearly every sector of society, including virtually all climate scientists, notable heads of civil governments around the globe, the world's top religious leaders, prestigious medical journals, as well as principals of the largest financial firms. Surveys show that the majority of U.S. physicians in several specialties are caring for patients who are experiencing direct health harms due to climate change. In public platforms, physicians are expressing their awareness that this public health crisis places everyone at risk, but many people are at greater risk, including children, pregnant women, people with chronic health conditions, elders, and those who experience environmental injustice or live in harm's way. Physicians should respond to this crisis with meaningful activities performed within the context of their current roles. The role of medical care provider is the best known role. But, throughout their careers, physicians have ongoing responsibilities as educators of colleagues, trainees, and patients. They are influential employees of medical institutions, trusted experts who exercise civic responsibility, and sources of guidance for public policymakers. Physicians and other health professionals, individually and through their organizations, also work to influence our societal response to the challenge of climate change. The first annual Lancet Journal Countdown Report in 2016 tracking health indicators of climate change stated that climate change had the potential to wipe out all public health gains of the last half century, but it also presents a tremendous opportunity to save lives and improve health. All physicians should work toward the latter outcome.

Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis.

This study aimed to determine the direct costs of pediatric tracheostomy care within a health care system. Prospective analysis. Academic children's hospital. Costs associated with caring for pediatric tracheostomy patients under 18 years were analyzed between 2015 and 2021. Direct costs were calculated using the Medicare/Medicaid charges-to-costs ratio for various visit types. Costs were estimated using generalized linear equations, accounting for confounders. A total of 297 children underwent tracheostomy at a median age of 0.94 years. The median follow-up was 2.5 years, resulting in 13,966 visits (mean = 41). The total cost was $321 million. The initial admission accounted for 72% ($231 million) of costs while other inpatient admissions added 24% ($78 million). Emergency department, observation, and outpatient visits comprised 4% of costs. The length of stay (LOS) was the primary cost driver for inpatient visits. Each additional hospital day increased costs by roughly $1195, and each extra admission added about $130,223 after adjusting for confounders. Respiratory failure and infections were the primary reasons for 67% of subsequent admissions. Pediatric tracheostomy care generated over $300 million in direct costs over 5 years. Inpatient stays constituted 96% of these costs, with the LOSbeing a major factor. To reduce direct health expenditures for these patients, the focus should be on minimizing admissions.

Direct health implications of e-cigarette use: a systematic scoping review with evidence assessment.

E-cigarettes are often marketed as a less harmful alternative to traditional tobacco cigarettes. Despite their popularity, the evidence regarding their effects on human health remains unclear and is filled with complexities. This systematic review aims to elucidate the direct effects of electronic cigarette use on human health, carefully distinguishing between the specific characteristics of the populations studied. Adhering to the PRISMA guidelines, we conducted a comprehensive search in PubMed/Medline, Web of Science, Scopus, and Google Scholar databases without date restrictions, including articles in both Spanish and English. This approach enabled the identification and analysis of primary studies to understand the direct effect of electronic cigarettes on human health. A total of 33 studies were included that evaluated cardiovascular, pulmonary, renal, weight and fertility effects. Only five studies analyzed e-cigarettes in healthy populations and seven studies compared healthy individuals against smokers. The effects evaluated on smokers or former tobacco smokers were apparently positive, however, among healthy individuals, increased heart rate, mean arterial pressure, oxidative stress, alteration of respiratory epithelial cells and increased airflow resistance were found. Smokers or former smokers who switch to e-cigarettes may reduce their exposure to carcinogens and lower their risk of developing severe health issues associated with conventional smoking. However, in healthy individuals who have never smoked traditional cigarettes, the use of e-cigarettes introduces several cardiovascular and respiratory adverse effects. These findings suggest that while e-cigarettes can be a strategic harm reduction tool for smokers, they are not a safe option for non-smokers.

The effectiveness of topical gel formulation extract Centella asiatica and Curcuma domestica to fading striae gravidarum

Background: The incidence of striae gravidarum in Indonesia is 95%, and 79.7% are primigravida. Striae gravidarum is not a direct physical health risk but is associated with body image and decreased self-confidence. Curcuma domestica contains curcumin and vitamin C, which can stimulate the synthesis of type IV collagen. In contrast, the Centella asiatica plant contains triterpenoids and saponins, which can stimulate the synthesis of type I collagen, which helps regenerate skin cells and improve skin elasticity. However, it is necessary to see the effectiveness of the two herbs, Centella asiatica and Curcuma domestica, in fading striae gravidarum. Purpose: To prove the effectiveness of topical gel formulation extract Centella asiatica and Curcuma domestica for fading of striae gravidarum.Methods: This is a quasi-experimental study with a pretest-posttest control group design. The sample consisted of 32 primigravida pregnant women divided into two groups: the intervention group was given a combination of Curcuma domestica and Centella asiatica gel at a dose of 5 mg twice a day for 14 days, and the control group was given a mineral oil gel at a quantity of 5 mg twice a day for 14 days—measurement of striae gravidarum using Davey score. The statistical test used the Friedman and Wilcoxon test.Results: The average fading of striae gravidarum in the intervention group was more significant than in the control group, 11.44±4.131 to 4±3.033 vs.12.19±5.788 to 8.56±4.320 treatment on the 14th day. The analysis results showed that the topical gel formulation of Centella asiatica and Curcuma domestica was more effective in fading striae gravidarum than the placebo gel (p&lt;0.001).Conclusion: Administering topical gel containing 12% Centella asiatica extract and a 10% Curcuma domestica dose of 5 mg twice a day for 14 days affected the fading of striae gravidarum.

A Collective Impact approach to improving the physical health of people living with mental illness.

Introduction: Eighty percent of people living with mental illness have a co-existing physical health condition. Yet due to ‘diagnostic overshadowing’ (where the presenting problem overshadows all other concerns and risks), stigma and systemic discrimination, the rate of screening and treatment for mortality-related chronic health conditions in this part of our community is low. Consequently, as a group, people living with mental illness have poor health and have a 13 - 23 year reduced life expectancy. This pattern of poor health and reduced life-expectancy has been consistently reported in research studies across the world for more than 20 years.&#x0D; Aims, Objectives, Theory or Methods: The aim of this paper is to show how the countries of Australia, France, New Zealand and England have applied the collective impact approach to address the issue of the poor health and reduced life-expectancy of people living with mental illness. A collective approach seeks to coordinate organisations to reduce duplication and amplify impact. Co-chaired by consumers and with an emphasis on consumer-led initiatives, a collective impact approach seeks to coalesce multiple agencies/stakeholders through a common goal to address complex personal and system challenges. &#x0D; Highlights or Results or Key Findings: Although each country has adopted a collective impact approach, the way this has been implemented in different contexts has been quite different. The paper compares and contrasts approaches to ‘developing a shared agenda’, ‘mutually reinforcing activities’, and facilitating coordination. Common to each of these collective impact core elements is the need for a strategic approach to communication. This presentation will challenge the collective impact theory of ‘continuous communication’ using examples of the communication strategies from each country.&#x0D; Further, this paper will present how each country measures progress and seeks to demonstrate public value. This is a particularly important issue for intermediary organisations who do not provide direct health care services.&#x0D; Finally, it will highlight how by networking and working together internationally, these countries have successfully initiated reform in policy, and practice changes in areas such as cardiovascular disease management and vaccination for people living with mental illness.&#x0D; &#x0D; Conclusions: Collective impact appears to be an effective way to mobilise diverse organisations and amplify actions converting policy to practice. There is scope to apply a collective impact approach flexibly to different service system contects. Consistent across systems is the need for a backbone team to drive change and maintain momentum. &#x0D; Implications for applicability/transferability, sustainability, and limitations: The processes and methods of a collective impact approach can be applied to a range of health scenarios to facilitate enhanced integration and collaboration. However, sustainability requires a backbone team and providing ongoing evidence of impact and success.&#x0D;