Effective Coverage Research Articles

Rapid Assessment of Avoidable Visual Impairment in Two Coastal Districts of Eastern India for Determining Effective Coverage: A Cross-Sectional Study.

To measure the prevalence and causes of visual impairment (VI) among the 40+ age population in two coastal districts of India and to determine the levels of effective cataract surgical coverage (eCSC) and effective refractive error coverage (eREC) in the study population. A cross-sectional study was done on 4200 people chosen using cluster sampling in two coastal districts of Odisha, an eastern state in India. A team consisting of trained optometrists and social workers conducted the ocular examination which included unaided, pinhole, and aided visual acuity assessments followed by examination of the anterior segment and lens. Overall, 3745 (89.2%) participants were examined from 60 study clusters, 30 in each district. Among those examined, 1677 (44.8%) were men, 2554 (68.2%) were educated and number? (17.8%) used distance spectacles during the survey. The prevalence of VI adjusted for age and gender was 12.77% (95% CI 11.85-13.69%). Multiple logistic regression showed that older age (OR 3.1; 95% CI 2.0-4.7) and urban residence (OR 1.2; 95% CI 1.0-1.6) were associated with VI. Being educated (OR 0.4; 95% CI 0.3-0.6) and using glasses (OR 0.3; 95% CI 0.5-0.2) were found to provide protection; therefore, resulting in lower instances of VI. Cataract (62.7%) and uncorrected refractive errors (27.1%) were the two main causes of VI. The eCSC was 35.1%, the eREC for distance was 40.0%, and the eREC for near was 35.7%. VI remains a challenge in Odisha, as the prevalence is high and the surgical coverage is poor. Nearly 90% of VI is avoidable indicating that targeted interventions are required to address this problem.

Region coverage-aware path planning for unmanned aerial vehicles: A systematic review

The use of unmanned aerial vehicles (UAVs) to carry out remote aerial surveys has become prominent in recent years. The UAV-based survey faces several operational issues, such as complicated terrain, limited UAV resources, obstacles, sensor limitations, and other environmental factors. In addition, the coverage plan includes numerous objectives, such as lowering path length, maximizing coverage, and limiting survey time, necessitating multi-objective optimization. UAVs require effective coverage path planning (CPP) to generate the ideal route. It involves determining the path which encompasses every point inside the required region under different constraints. The process automates the process of route determination for autonomous operation by considering various environmental constraints. In this paper, we explore and analyze the existing research on the various techniques used in coverage route planning for UAVs. It provides an overview of the current state-of-the-art CPP methods for UAVs. The study discusses the key challenges and requirements of CPP for UAVs and presents various approaches proposed in the literature to tackle these challenges. We explore a variety of geometric flight patterns for the area of interest having UAV deployment. It also features multi-UAV and multi-region coverage strategies, providing a new dimension to UAV-based operations. The energy consumption of UAVs during CPP is an essential factor, as it influences their flight length and mission duration. The design of the CPP algorithm is determined by the unique requirements of the UAV application, such as the size and form of the region to be mapped, the existence of obstacles, and the desired coverage resolution. Path planning strategies in a three-dimensional environment and dynamic coverage are also included in the study. Moreover, we compare the existing strategies using different performance metrics to evaluate the success of covering missions. Finally, the problems and unresolved concerns related to UAV coverage path planning are examined to provide valuable insights to the readers.

Perceived Barriers to Effective Coverage of Health and Social Services for Sexual Violence in Young Adults in Spain

Despite the increase in sexual violence (SV) amongst young people, the use of formal services is poor. Effective coverage of health services is related to a satisfactory and quality care for the people who need a specific intervention. The aim of this study is to identify the factors that influence effective coverage of SV services from the perspective of young people and professionals in Spain. A qualitative study was conducted using an inductive thematic analysis approach based on 38 semistructured interviews with young people and professionals working in SV resource services and/or youth services in Spain, from September 2020 to October 2021. A content analysis was carried out. Both the professionals and young people referred to the fact that effective coverage is limited by the factors related to SV normalization and stigma, the lack of training of professionals, and the lack of human and economic resources. Furthermore, the young interviewees perceive sexual education as more biological and not focused on SV, as well as excessive bureaucracy, medicalization of processes, and the lack of trust in resources. However, the professionals mentioned the excessive specialization of psychological recovery accompaniment programmes and the lack of specialization of judicial institutions. To conclude, both the young people and professionals identified factors that reduce effective coverage of the services related to the social construction of the problem, training, and availability of resources. The young people also perceive other factors related to care and services, while the professionals place more emphasis on factors related to the user population.

Intelligent Fault Diagnosis of an Aircraft Fuel System Using Machine Learning—A Literature Review

The fuel system, which aims to provide sufficient fuel to the engine to maintain thrust and power, is one of the most critical systems in the aircraft. However, possible degradation modes, such as leakage and blockage, can lead to component failure, affect performance, and even cause serious accidents. As an advanced maintenance strategy, Condition Based Maintenance (CBM) can provide effective coverage, by combining state-of-the-art sensors with data acquisition and analysis techniques to guide maintenance before the asset’s degradation becomes serious. Artificial Intelligence (AI), particularly machine learning (ML), has proved effective in supporting CBM, for analyzing data and generating predictions regarding the asset’s health condition, thus influencing maintenance plans. However, from an engineering perspective, the output of ML algorithms, usually in the form of data-driven neural networks, has come into question in practice, as it can be non-intuitive and lacks the ability to provide unambiguous engineering signals to maintainers, making it difficult to trust. Engineers are interested in a deterministic decision-making process and how it is being revealed; algorithms should be able to certify and convince engineers to approve recommended actions. Explainable AI (XAI) has emerged as a potential solution, providing some of the logic on how the output is derived from the input given, which may help users understand the diagnostic result of the algorithm. In order to inspire and advise data scientists and engineers who are about to develop and use AI approaches in fuel systems, this paper explores the literature of experiment, simulation, and AI-based diagnostics for the fuel system to make an informed statement as to the progress that has been made in intelligent fault diagnostics for fuel systems, emphasizing the necessity of giving unambiguous engineering signals to maintainers, as well as highlighting potential areas for future research.

Human Papilloma Virus: An Unraveled Enigma of Universal Burden of Malignancies.

HPV, or Human Papilloma Virus, has been the primary causative agent of genital warts and cervical cancer worldwide. It is a sexually transmitted infection mainly affecting women of reproductive age group, also infecting men and high-risk group individuals globally, resulting in high mortality. In recent years, HPV has also been found to be the major culprit behind anogenital cancers in both gender and oropharyngeal and colorectal cancers. Few studies have reported the incidence of HPV in breast cancers as well. For a few decades, the burden of HPV-associated malignancies has been increasing at an alarming rate due to a lack of adequate awareness, famine vaccine coverage and hesitancy. The effectiveness of currently available vaccines has been limited to prophylactic efficacy and does not prevent malignancies associated with post-exposure persistent infection. This review focuses on the current burden of HPV-associated malignancies, their causes and strategies to combat the growing prevalence of the cancers. With the advent of new technologies associated with treatment pertaining to therapeutic interventions and employing effective vaccine coverage, the burden of this disease may be reduced in the population.

Measuring adequacy of the midwifery workforce using standards of competency and scope of work: Exploring the density and distribution of midwives in three low- and middle-income countries using cross-sectional and geospatial data.

A global midwifery shortage hampers the goal of ending preventable maternal/newborn mortality and stillbirths. Whether current measures of midwifery workforce adequacy are valid is unknown. We compare two measures of density and distribution of midwifery professionals to assess their consistency, and explore how incorporating midwifery scope, competency, and the adjusting reference population impacts this critical metric. We collected a census of midwives employed in eligible facilities in our study settings, (422 in Ghana; 909 in India), assessed the number practicing within the scope of work for midwifery professionals defined in the International Labor Organization International Standard Classification of Occupations, and whether they reported possessing the ICM essential competencies for basic midwifery practice. We altered the numerator, iteratively narrowing it from a simple count to include data on scope of practice and competency and reported changes in value. We altered the denominator by calculating the number of midwives per 10,000 total population, women of reproductive age, pregnancies, and births and explored variation in the indicator. Across four districts in Ghana, density of midwives decreased from 8.59/10,000 total population when counting midwives from facility staffing rosters to 1.30/10,000 total population when including only fully competent midwives by the ICM standard. In India, no midwives met the standard, thus the midwifery density of 1.37/10,000 total population from staffing rosters reduced to 0.00 considering competency. Changing the denominator to births vastly altered subnational measures, ranging from ~1700% change in Tolon to ~8700% in Thiruvallur. Our study shows that varying underlying parameters significantly affects the value of the estimate. Factoring in competency greatly impacts the effective coverage of midwifery professionals. Disproportionate differences were noted when need was estimated based on total population versus births. Future research should compare various estimates of midwifery density to health system process and outcome measures.

Estimating the cost and cost-effectiveness of adding zinc to, and improving the performance of, Burkina Faso's mandatory wheat flour fortification programme.

Zinc is an essential micronutrient that promotes normal growth, development and immune function. In the context of persistent dietary zinc inadequacies, large-scale food fortification can help fill the gap between intake and requirements. Burkina Faso mandates wheat flour fortification with iron and folic acid. We used activity-based cost modelling to estimate the cost of adding zinc to the country's wheat flour fortification standard assuming (1) no change in compliance with the national standard, and (2) a substantial improvement in compliance. We used household food consumption data to model effective coverage, that is, the number of women of reproductive age (WRA) predicted to achieve adequate zinc density (zinc intake/1000 kcal) with the addition of fortification to diets. Without interventions, the prevalence of inadequate dietary zinc density was ~35.5%. With no change in compliance, the annual average incremental cost of adding zinc to fortified wheat flour was $10,347, which would effectively cover <1% of WRA at an incremental cost of ~$0.54/WRA effectively covered. Improving compliance added ~$300,000/year to the cost of the fortification programme without zinc; including zinc added another ~$78,000/year but only reduced inadequate intake among WRA by 3.6% at an incremental cost of ~$0.45/WRA effectively covered. Although the incremental cost of adding zinc to wheat flour is low ($0.01/wheat flour consumer/year), given low levels of wheat flour consumption, zinc fortification of wheat flour alone contributes marginally to, but will not fully close, the dietary zinc gap. Future research should explore potential contributions of zinc to a broader set of delivery vehicles.

Evaluation of effective coverage for type 2 diabetes in Mexican primary care health information systems: a retrospective registry analysis

BackgroundAs the leading cause of disability and the fourth leading cause of premature death in Mexico, type 2 diabetes (T2D) represents a serious public health concern. The incidence of diabetes has increased dramatically in recent years, and data from the Mexican National Health and Nutrition Survey (ENSANUT) indicate that many people remain undiagnosed. Persistent socioeconomic health care barriers exacerbate this situation, as T2D morbidity and mortality are worsened in vulnerable populations, such as those without social security. We evaluated the performance of public primary health centers (PHCs) in T2D medical attention through the measure of effective coverage (EC, a combined measure of health care need, use, and quality) at national, state, health jurisdiction, and municipality levels.MethodsThis retrospective analysis used blinded data recorded during 2017 in the Non-communicable Diseases National Information System (SIC) and T2D prevalence reported in 2018 ENSANUT to evaluate the EC achieved. We included individuals ≥ 20 years old without social security who did not declare the use of private health care services. Each EC component (need, use, and quality) was estimated based on the Shengelia adapted framework. The Kruskal–Wallis test was applied to evaluate the associations among EC quintiles and demographics.ResultsIn 2017, 26.5 million individuals, aged ≥ 20 years, without social security, and without the use of private health care services, were under the care of 12,086 PHCs. The national prevalence of T2D was 10.3%, equivalent to 2.6 million people living with T2D in need of primary health care. Large contrasts were seen among EC components between and within Mexican states. We found that only 37.1% of the above individuals received health services at PHCs and of them, 25.8% improved their metabolic condition. The national EC was 9.3%, and the range (by health jurisdiction) was 0.2%–38.6%, representing a large geographic disparity in EC. We found an evident disconnect among need, utilization, and quality rates across the country.ConclusionsExpansion and improvement of EC are urgently needed to address the growing number of people living with T2D in Mexico, particularly in states with vulnerable populations.

Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys

BackgroundPosttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs).MethodsSeventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage.Results12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR = .35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage.ConclusionThere is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.

Effective Coverage of Emergency Obstetric and Newborn Care Services in Africa: A Scoping Review.

This scoping review aimed to map the evidence of effective coverage (EC) of EmONC (Emergency Obstetric and Neonatal Care) services and associated factors in Africa. The review used PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) checklist to select, appraise, and report the findings. We searched four databases (PubMed, Web of Science, Google Scholar, and Scopus) and grey literature published between Jan 01, 2011 - Dec 31, 2020. The search terms included "emergency", "obstetric", "newborn", "effective coverage", and "quality" with Boolean terms, AND and OR. The review was conducted using title, abstract, and full-article screenings. The results were analyzed thematically using NVivo v12 qualitative research data analysis software. Of the 1811 searched studies, 32 met the eligibility criteria for review. The majority of the studies were from East (56.3%) and Western (28.1%) Africa. Most studies were cross-sectional, had targeted health facilities, and combined two or more data collection techniques. The thematic analysis yielded three themes: EmONC service utilization, quality of EmONC service, and factors associated with the quality of EmONC services. The review showed a scarcity of evidence and variations regarding the crude coverage, quality of care, and factors affecting the quality of EmONC services in Africa. The review reported that the utilization of EmONC services was below the WHO-recommended 100% in all studies, though some reported improvements over time. Disparities in EmONC services quality were paramount across studies and contexts. However, the methodological and analytical incongruity across studies brought difficulties in tracing and comparing the progress made in EmONC services utilizations. This scoping review protocol was first registered on the Open Science Framework (OSF) on Aug 27, 2021 (https://osf.io/khcte/).

A strategy to reduce fraction number in peripheral lung stereotactic ablative body radiotherapy

Hypo-fractionated lung Stereotactic Ablative Body Radiotherapy (SABR) has often been avoided when tumours are close to the chest wall. Our strategic objective was the reduction of fraction number, while maintaining target biological effective dose coverage without increasing chest wall toxicity (CWT) predictors. Twenty previously treated lung SABR patients were stratified into four cohorts according to distance from PTV to the chest wall, <1 cm, <0.5cm, overlapping up to 0.5cm and 1.0cm. For each patient, four plans were created; a chest wall optimised plan for 54Gy in 3 fractions, the clinical plan re-prescribed for 55Gy in 5, 48Gy in 3 and 45Gy in 3 fractions. For a PTV distance of 0.5-0.0cm, a reduction of the median (range) Dmax from 55.7 (57.5-54.1) Gy to 40.0 (37.1-42.0Gy) Gy was observed for the chest wall optimised plans. The median V30Gy decreased from 18.9 (9.7-25.6) cm3 to 3.1 (1.8-4.5) cm3. For a PTV overlap of up to 0.5cm, the Dmax reduced from 66.5 (64.1-70) Gy to 53.2 (50.6-55.1) Gy. The V30Gy decreased from 21.5 (16.5-29.5) cm3 to 14.9 (11.3-20.2) cm3. For the cohort with up to 1.0cm overlap, there was a reduction in Dmax values of 9.9Gy. The V30Gy for clinical plans, at 66.8 (18.7-188.8) cm3, decreased to 55.3 (15.5-149) cm3. When PTVs are within 0.5cm of chest wall, lung SABR dose heterogeneity can be used to reduce fraction number without increasing CWT predictors.

Design of improved four-coil structure with high uniformity and effective coverage rate

Helmholtz coils have extensive applications in biological medicine, aerospace, and other industries depending on the simple structure and miraculous magnetic field characteristics. However, the uniform zone generated by them is not appropriate for scientific experiments with large devices. Due to the limitations of Helmholtz coils in application, a novel design technique is proposed to improve the homogeneity and region of magnetic field. The main approach is to add an auxiliary coil on each side of Helmholtz coils to compensate for the magnetic field that exists farther out from the center point. To analyze the size relationship between the auxiliary coil and the main coil to obtain the best magnetic field distribution, the traditional Maclaurin expansion method and particle swarm optimization (PSO) algorithm are used to research and discuss. The magnetic field distribution and the corresponding effective coverage rate (ECR) of the improved schemes with different structural parameters are calculated under the relative deviations of 0.1%, 0.5% and 1%, respectively. The results obtained by the above optimization methods are verified by the finite element software COMSOL and specific experiments. Both optimization methods manifest that the maximum effective coverage rate can be achieved when the size of the auxiliary coil is consistent with that of the main coil. In addition, we compare the improved four-coil structure proposed in this paper with the existing four-coil square structure under the same volume. The data show that the improved structure has certain advantages in the spatial magnetic field distribution. The corresponding tri-axial coil system is established by adopting the parameters on the single axis, which can achieve a constant magnetic field in arbitrary directions by controlling the magnitude and direction of current on each axis. This provides a theoretical basis for the application of magnetic navigation technology.

POST MASS DRUG ADMINISTRATION ASSESSMENT OF COVERAGE, COMPLIANCE, AND OBSTACLES IN A LYMPHATIC FILARIASIS ENDEMIC DISTRICT OF CENTRAL INDIA.

Introduction: Lymphatic Filariasis is still a huge problem in the endemic districts as it can cause deprivation in the economic condition of the sufferer, it is linked with stigma, and shame which leads to psychological problems in the individual. The aim was to assess the coverage, compliance, and obstacles post-Mass Drug Administration (MDA) of Filariasis in the Katni District. Methods: This community-based study was conducted in selected areas of the Katni district of Madhya Pradesh. Three rural primary health centers (PHCs) and one urban PHC were selected for the study. Afterward, 30 households were randomly selected from these 4 PHCs. The MDA drive was held in late Dec 2020 in the whole katni district. As an external evaluation, this study commenced 30 days after the drive and the data were collected. Results: A total of 128 households were surveyed, and 621 people were covered. 607 were eligible for drug administration. The overall coverage rate of MDA in the study was found to be 95.88 %. The overall effective coverage rate was 88.63 %. It was 93.93 % in urban and 86.65 % in rural areas. The overall coverage compliance gap was 7.37 %. The most common reason for the non-consumption of tablets was people busy doing work i.e., 47 %. Conclusion: It would be a challenge for the district to sustain this performance in the coming rounds of MDA. Equal Sensitization of the urban and rural populations through IEC activities and proper training for drug distributors is required.

FitFun: A modelling framework for successfully capturing the functional form and noise of observed traffic flow–density–speed relationships

Measurements of the average properties of vehicular traffic are inherently noisy. The distributions of flow and speed measurements at any particular density are non-Gaussian with density-dependent variance, skewness, and kurtosis. Previous studies have failed to properly account for these complicated noise properties. In remediation, we present FitFun, a general framework for modelling any observed flow–density–speed relationship. Models specified within FitFun incorporate components for both the functional form and the noise. We define three flexible noise model components and we fit 200 different models to a high-quality sample of 10,150 observed urban flow-occupancy relationships. We compare the fits using information criteria and assess fit quality through analysis of the residuals. We find that the non-parametric Sun model for the functional form component combined with a Skew Exponential Power Type III noise component significantly outperforms all of the other models. Interestingly, we find that the city, country, road topology, and detector location have virtually no impact on model performance and fit quality, which is very convenient for model selection. The only factor of relevance from those that we studied is the effective occupancy coverage of the data. We conclude that certain models specified judiciously within FitFun can successfully capture the functional form and noise of observed flow–density–speed relationships without the need to discard data taken during non-stationary conditions. This is particularly advantageous for urban data where stationary traffic conditions are rarely observed.

District Mental Health Program: Inception, Evolution and Challenges

In 1982, National Mental Health Program (NMHP) was launched in India. In order to suffice its aim and objectives and effective coverage of mental health care, a district level program was suggested and for which NIMHANS did a pilot project in between 1985-90 and finally District Mental Health Program (DMHP) was started in Bellary district of Karnataka. Since then, the DMHP has been running in entire nation for fulfilling its aim and objectives and delivering mental health care services. In the span of almost three decades, the Program has been monitored and assessed periodically in terms of its effectiveness by keeping the vision of fulfillment of its goals. In this article we are reviewin theachievements of DMHP and how far we have reached to achieve the goals.

Generalized data-driven optimal path planning framework for uniform coverage missions using crop spraying UAVs

Unmanned aerial vehicle (UAV) based crop spraying has become a popular alternative in the field of precision agriculture. One of the key goals of UAV based spraying is achieving spray coverage that is as uniform as possible to ensure maximum spray efficacy. Most of the existing studies in the literature focus on analysing the effects of spraying parameters on the uniformity of coverage distribution using experimental studies. However, in this work, we propose a novel generalized data-driven optimal path-planning framework aimed at finding the optimal operational flight parameters (flight speed and pass widths) for a lawnmower coverage path plan to meet the specified spray coverage rate while ensuring the uniformity. The framework takes a spray distribution model as an input and computes the optimal operational parameters for the coverage path plan to minimize coverage non-uniformity without making any assumptions on the UAV type. Furthermore, we also propose a neural network structure using Gaussian kernel neurons to design the spraying model using experimental data. The neural network structure makes no assumption about the type of UAV, onboard nozzle placement, or the flight parameters. The accuracy of the modelling solution only depends on the quality of the training data. In other words, higher diversity of the training data in terms of the flight and spraying parameters would result in a modelling solution that is more representative of the spraying distribution and consequently improve the quality of the operational parameters obtained from the proposed optimization framework. In this work, we present a case study to demonstrate the use case and test the performance of the proposed framework via simulation and experiments using the DJI AGRAS-T10 drone. The results showed that the optimal pass-width solutions for low forward speeds were similar to optimizing the positioning of the nozzles on a boom sprayer to achieve uniform coverage. Whereas, at high speeds, the pass-width was comparatively higher as the spread of the effective coverage over each pass increased. A discussion contextualized in the case study is provided to highlight the salient features and limitations of the proposed framework.

Perception About Household Decision-Making Process on Obtaining Maternal Health Services Among the Employed Women of Dhaka City

Reducing maternal morbidity and mortality and ensuring maternal and new-born health have been one of the central goals of healthcare system in Bangladesh. In that connection care during and after pregnancy, especially antenatal and delivery, is critical to monitor the status of pregnancy both for mother as well as for expected new-born baby. The role of women’s decision-making in reproductive health is crucial one. This study intends to understand the role of household decision-making in obtaining maternal health services- its patterns access and reasons by using qualitative methods. The approaches are employed to explain woman’s decision-making process to utilize the service facilities. The findings of the study illustrate that decision-making processes should be understood and recognized in a wider social environment and as a multifaceted process that is closely tangled with local belief systems and social relationships. Combined knowledge of social images, women’s requirements and expectations can play an important role in confirming broader and more effective coverage of maternal healthcare, health authorities and to those in charge of maternal care services. Social Science Review, Vol. 38(2), December 2021 Page 105-116

From contact coverage to effective coverage of community care for patients with severe mental disorders: a real-world investigation from Italy. Methodology and results from the QUADIM project

IntroductionThe evaluation of healthcare pathways must be considered of fundamental importance. The quality of care provided to patients with severe mental disorders (SMD) does not correspond to the standards set by the recommendations. Therefore, measures such as the real coverage rate of psychiatric patients’ needs (contact coverage), by comparing epidemiological prevalence rates and the number of patients receiving adequate care, could be a valuable resource for implementing the transition to community mental health. However, simple assessment and reporting of rates of contact with mental healthcare potentially overestimate the full expected health benefits of services. Therefore, in addition to monitor the coverage rate achieved by the services, the evaluation of the effectiveness of the care provided (effective coverage) [De Silva et al. Int J Epidemiol 2014;43(2):341–53] is also of relevant importance.ObjectivesTo measure the gap between contact and effective coverage of mental healthcare, i.e., the effectiveness of interventions provided by services for the treatment of SMD in preventing an exacerbation of psychiatric symptoms.MethodsData were retrieved from Healthcare Utilization databases of four Italian Regions (Lombardy, Emilia-Romagna, Lazio, Sicily). 45,761 newly taken-in-care cases of depression, schizophrenia, bipolar, and personality disorder were included. A variant of the self-controlled case series method was used to estimate the incidence rate ratio (IRR) for the relationship between exposure (use of different types of mental healthcare such as pharmacotherapy, generic contacts with the outpatient service, psychosocial interventions, and psychotherapies) and relapse episodes (mental illness emergency hospital admissions).Results11,500 relapses occurred. Relapse risk was reduced (Figure) during periods covered by (i) psychotherapy for patients with depression (IRR 0.67; 95% CI, 0.49 to 0.91) and bipolar disorder (0.64; 0.29 to 0.99); (ii) psychosocial interventions for those with depression (0.74; 0.56 to 0.98), schizophrenia (0.83; 0.68 to 0.99) and bipolar disorder (0.55; 0.36 to 0.84), (iii) pharmacotherapy for those with schizophrenia (0.58; 0.49 to 0.69), and bipolar disorder (0.59; 0.44 to 0.78). Coverage with generic mental healthcare, in the absence of psychosocial/psychotherapeutic interventions, did not affect the risk of relapse.Image:ConclusionsPsychosocial interventions, psychotherapies and specific pharmacotherapies can be considered particularly effective in treating patients with bipolar, depressive, and schizophrenic disorders. This study ascertained the gap between utilization of mental healthcare and effective coverage, showing that real-world data can represent a useful resource to monitor mental healthcare paths and to assess the effectiveness of a mental health system.Disclosure of InterestNone Declared

Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal.

The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce density as one of 6 core indicators for monitoring universal access to safe, affordable surgical and anaesthesia care. Using Nepal as a case study, we explored the capacity of a generalist workforce (led by a family physician or MD general practitioner and non-physician anaesthetist) to enable effective surgical delivery through task-shifting. Using a multiple-methods approach, we retrospectively mapped essential surgical care and the enabling environment for surgery in 39 hospitals in 25 remote districts in Nepal and compared it with LCoGS indicators. All 25 districts performed surgery, 21 performed Caesarean section (CS), and 5 met at least 50% of district CS needs. Generalist surgical teams performed CS, the essential major operation at the district level, and very few laparotomies, but no operative orthopaedics. The density of specialist Surgeon/Anaesthesiologist/Obstetrician (SAO) was 0·4/100,000; that of Generalist teams (gSAO) led by a family physician (MD General Practitioners-MDGP) supported by non-physician anaesthetists was eight times higher at 3·1/100,000. gSAO presence was positively associated with a two-fold increase in CS availability. All surgical rates were well below LCoGS targets. 46% of hospitals had adequate enabling environments for surgery, 28% had functioning anaesthesia machines, and 75% had blood transfusion services. Despite very low SAO density, and often inadequate enabling environment, surgery can be done in remote districts. gSAO teams led by family physicians are providing essential surgery, with CS the commonest major operation. gSAO density is eight times higher than specialists and they can undertake more complex operations than just CS alone. These family physician-led functional teams are providing a pathway to effective surgical coverage in remote Nepal.

Acceptance of COVID-19 Vaccine and Related Factors in Iran: A Cross-sectional Study.

One of the most important strategies to control COVID-19 pandemic is vaccination. Effective vaccination coverage is necessary to control this pandemic. Therefore, in this study we investigated acceptance of COVID-19 vaccine and associated factors among Iranian population. A cross-sectional study conducted through Pors Line in South Khorasan Province of Iran. 1043 people participated in this study. Results were analyzed with SPSS software version 13. 85.2% of the participants wanted to receive the vaccine. Vaccine acceptance was higher in participants that were over 41 years old. Moreover, rate of vaccine acceptance was higher in men than women. Major concern about vaccination was fear of its side effects. Vaccine acceptance increased with increasing education level. Results of this study showed that one of the most important reasons for vaccine rejection is the fear of vaccine side effects.