Free Medication Research Articles

Use of nanoparticles in animal models for prostate cancer treatment: a systematic review.

To conduct a systematic review of nanoparticles' use in the treatment of prostate cancer in animals. A systematic review was conducted in the databases PubMed, Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Library, and EMBASE, and the descriptors were chosen based on terms indexed in Health Sciences Descriptors (DeCS)/Medical Subject Headings (MESH), which are: nanoparticles, nanomedicine, and prostate cancer. The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID CRD42021271008. A total of 3,897 articles was chosen; after reading the inclusion and exclusion criteria, six scientific articles with themes involving nanoparticles carrying medications were reached. Among the nanoparticles found, there were carboxymethylcellulose polymer, micellar casein nanoparticles, liquid crystal nanoparticles, serum albumin nanoparticles, and poly(ethylene glycol)-block-polylactide (mPEG-PLA) conjugated nanoparticles encapsulating cabazitaxel, docetaxel, and flutamide, which were nanoparticles used to treat prostate cancer in animals. Through using nanoparticles to encapsulate medications for treating prostate cancer in animals, studies show a decrease in weight and tumor reduction, with nanoparticles resulting in greater survival time than free medications. The improved permeability and retention effect of nanoparticles in the bloodstream contribute to their effectiveness.

Impact of pharmacist intervention to improve medication access for patients with diabetes

BackgroundDespite newer guideline-recommended antidiabetic agents demonstrating a reduction of disease burden and improved health outcomes, high drug cost and restrictive insurance coverage limit public access. To address this issue, many manufacturers offer free medication through manufacturer patient assistance programs. ObjectivesThis study aimed to determine the impact of pharmacist intervention using manufacturer patient assistance programs in individuals who are uninsured or enrolled in Medicare Part D prescription drug plan and to evaluate the impact of pharmacist utilization in meeting diabetic quality measures set forth by accountable care organizations (ACOs). MethodsThis single-center, retrospective cohort study evaluated 171 participants enrolled into a manufacturer patient assistance program owing to pharmacist intervention compared with 171 participants receiving usual care. The primary outcome was the change in glycosylated hemoglobin (A1c) between groups. Secondary outcomes included the impact of pharmacist management on change in weight, change in blood pressure, and the number of participants meeting ACO quality measures. ResultsThe average change in A1c in the intervention group was –2.5% compared with an average A1c reduction of –1.3% in the control group (95% CI –2.11 to –1.67, P < 0.001). The average change in weight of the intervention group was –4.01 kg, whereas the control group had an average weight reduction of –1.4 kg from baseline (95% CI –3.95 to –1.61, P < 0.05). The body mass index (BMI) of the intervention group was a value of 1.4 kg/m2 lower whereas the BMI of the control group was 0.6 kg/m2 lower than at baseline (95% CI –1.38 to –0.61, P < 0.05). ConclusionParticipants who were enrolled in a manufacturer patient assistance program by a pharmacist and were followed for diabetes care management experienced greater A1c lowering and weight loss than participants receiving usual care.

1403. Facilitators and barriers to latent tuberculosis infection diagnosis and care in Massachusetts: a convergent mixed methods study of clinicians

Abstract Background Understanding barriers and facilitators to latent tuberculosis infection (LTBI) diagnosis and care is needed to successfully treat children/adolescents with LTBI in the US. We explored physicians’ perspectives on pediatric LTBI diagnosis and care, and strategies to improve care. Methods We conducted a convergent mixed methods study with physicians in Massachusetts. Participants were purposefully sampled from primary care clinics (n=10), clinics seeing immunocompromised patients (n=2), and TB clinics (n=2). Physicians participated in individual qualitative semi-structured interviews exploring experience and comfort with LTBI care, and perceived barriers and facilitators to care. We used applied thematic analysis to analyze transcripts. Participants completed surveys to assess comfort with LTBI care and volume of LTBI patients in their care. Results Of the 25 physicians invited, 14 participated. Most participants reported “medium” or “high” comfort with current LTBI guidelines; volume of LTBI care varied by physician type (Table 1). Analysis revealed perceived barriers (Figure 1) at four steps of care: 1) identification of risk and testing for LTBI (e.g., family/patient risk perception, physician knowledge gaps), 2) completion of referral after a positive test (e.g., communication barriers), 3) treatment acceptance and initiation (e.g., lack of social support), and 4) treatment adherence and completion (e.g., adolescents’ emerging autonomy). Facilitators such as protocolized screening, counseling strategies, free medication, and telehealth (Figure 2) overcame some barriers. Important emergent themes included: 1) COVID-19 has induced rapid positive and negative changes in LTBI care in primary care clinics; 2) immigrant adolescents are uniquely at risk for disengagement due to lack of social support; and 3) physicians and clinics are ill-equipped to provide TB care for patients’ close contacts, despite knowledge of need for care. Table 1.Volume of patients by clinician type (N=13 respondents)Figure 1.Barriers to LTBI diagnosis and care.Figure 2.Facilitators of LTBI care. Conclusion Lack of perceived risk, family and clinic resource constraints, and accessibility challenges hindered LTBI care; protocolized screening, telehealth, and free medications were among the facilitators that overcame some but not all barriers. These results will inform improvement of LTBI care within and between clinics. Disclosures Jessica Haberer, MD, MS, Merck: Advisor/Consultant|Natera: Stocks/Bonds.

Peningkatan Pengetahuan Buruh Tani Akan Bahaya Pestisida dan Penggunaan Alat Pelindung Diri Yang Benar Melalui Penyuluhan

Farm labor is one of the main livelihoods in Indonesia. Farmers' activities on agricultural land are never separated from the use of pesticides, although basically pesticides are not only harmful to plant pests but also pose a potential hazard to farm workers as pesticide users. Various types of pesticides circulating and used in Indonesia include the type of organophosphate. Jam because of its affordable price, organophosphates have good effectiveness in controlling plant pests. This ability is comparable to the dangers of organophosphates for health. Various studies have proven that organophosphate pesticides and other pesticides can cause both acute and chronic health problems. Health problems can range from mild to severe symptoms resulting in disability or death. Pesticides intoxication can actually be prevented. One of the prevention efforts that can be done is the use of good and correct Personal Protective Equipment (PPE). Farmers actually know about the potential dangers of pesticides and the importance of using PPE when spraying pesticides. However, most farm workers do not use standard PPE and do not know how to use the correct PPE. They choose to use simple PPE that they make themselves, for example using t-shirts as head coverings and face masks instead of using hats, goggles and masks as face and head protection. These measures are, of course, non-standard and cannot provide perfect protection. The community service that is carried out has the target of farm workers who live in Gayasan Village, Jenggawah District, Jember Regency. This community service activity uses counseling methods and training on the proper and correct use of PPE, accompanied by the implementation of free health checks and medication for farm laborers and the surrounding community. Measurement of the level of knowledge is measured using a questionnaire and then compared between before and after counseling. The results obtained are an increase in the knowledge of farm workers about the dangers of pesticides and the use of good and standard PPE.

Old is the new young: A paradox for glaucoma patients

AbstractOlder/mature glaucoma patients are increasingly active these days and it is a myth that glaucoma patients are all passive and sedentary. Glaucoma does not only occur in the elderly, but even those glaucoma patients who are mature are working longer and staying more active. So perceptions of the ‘normal’ glaucoma patient need to be adjusted. Quality of life is increasingly important as older patients still feel young inside and want to enjoy their daily lives and interests and treatment must therefore be effective, but also tolerable so that patients' QoL is not limited by side effects. These patients have high expectations, but at the same time, this older population has a higher incidence of ocular and systemic comorbidities which can pose challenges. For instance, to start with ocular comorbidities it is well known that glaucoma patients have a higher risk of suffering from ocular surface disease and that the prevalence of ocular surface disease increases with increasing age. In this context therapeutic choices should be focused at lowering the intraocular pressure while preserving as much as possible the health of ocular surface for example by using preservative‐free medications to minimize ocular side‐effects. We know from published studies and from clinical experience that ocular surface disease shows improvements after switching from preserved to preservative free topical medications. Since glaucoma prevalence increases with age the prevalence of age‐related ocular comorbidities increases as well such as in the case of macular degeneration with additional deterioration of vision and increased impact on quality of life.Important to keep in mind that also systemic comorbidities that may particularly impact older patients, and the effect this might have on treatment (e.g. impairment in fine motor skills that can impact their ability of self‐administering the drops).Additionally, more mature patients may experience increased prevalence of systemic comorbidities such as cardiovascular or pulmonary ones limiting the therapeutic choices. More challenges to diagnosing and monitoring the disease might be posed by increased difficulties in performing psychophysical tests such as visual field testing.In this scenario it has to be highlighted the importance of communication to assess patients' level of comprehension and ability to cooperate with treatment and monitoring schedule.

Effect of free medicine distribution on ability to make ends meet: post hoc quantitative subgroup analysis and qualitative thematic analysis

ObjectivesOut-of-pocket medication costs can contribute to financial insecurity and many Canadians have trouble affording medicines. This study aimed to determine if the effect of eliminating out-of-pocket medication costs on individual’s...

Challenges faced by parents of screen-detected children with Cystic Fibrosis: The ICOS study

Abstract Background Informal care is an essential component of overall care for patients, particularly those with chronic illnesses such as Cystic Fibrosis (CF). This study aims to assess the level of caregiving burden faced by parents/caregivers of children with CF (CwCF) recruited to the Irish Comparative Outcomes Study of CF (ICOS), a historical cohort study of CwCF. In July 2011, a new-born screening programme began in Ireland. Methods The study population includes the parents of screen-detected CwCF born between July 2011-2021. The Challenge of Living with CF-Short Form is a new, validated 15-item tool that evaluates the caregiving burden faced by parents from the child’s diagnosis until early adolescence. Comparisons based on the age of screen-detected CwCF were conducted. SPSS was used for analysis. Results 69 parents of screen-detected CwCF responded. Fifty percent of parents of older children (aged 4-12+ years) and 35% of the parents of toddlers (0-3 years) faced moderate-high level difficulties in managing the extra expenses required for the care of their CwCF, despite all children receiving free clinical care, prescriptions and medications. A significantly greater proportion of the parents of older children than younger children experienced constant problems in managing daily oral medication routines (37% vs 13%; P = 0.039), nebulised medication routines (67.5% vs 21.4%; P = 0.003), and physiotherapy routines (57.8% vs 31.8%; P = 0.046) Conclusions Using the novel Challenge of living with Cystic Fibrosis-Short Form questionnaire, our findings suggest that the caregiving burden is higher for parents of older CwCF. Expenses incurred by parents of a child with a serious chronic medical condition go beyond medical care and treatment expenses. Key messages • The challenge of living with Cystic Fibrosis-Short Form is being used for the first time in a population setting. • The caregiving burden was more pronounced in the parents of older CwCF.

International Research and Philanthropy

International Research and Philanthropy

P138 A decade of cat-transmitted sporotrichosis (CTS) in a tertiary hospital from Curitiba, southern Brazil (2011-21)

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesThis study aims to report the evolution of cat-transmitted sporotrichosis (CTS) and map the distribution of these cases within a tertiary hospital in Curitiba (state capital of Paraná, in southern Brazil).MethodsWe reviewed the medical records of 175 patients seen in a hospital service over a period of 10 years (2011-21). Proven CTS consists of patients that had clinical manifestations after contact with sick cats, microbiological, and/or histopathological evidence of sporotrichosis. CTS was considered probable when patients had clinical signs associated with contact with sick cats that had a microbiological diagnosis of sporotrichosis made by a veterinarian. The confirmed cases in culture were submitted to molecular identification performed by sequencing the locus of calmodulin (CAL), determined by the set of primers 1 (5′-GAR TWC AAG GAG GCC TTC TC-3′) and CL2A (5′-TTTT TTG CAT CAT GAG TTG GAC-3 ′). The study was approved by the local Research Ethics Committee. Data analysis was performed using Statistical software for Windows (Version 8.0, StatSoft InC., Tulsa, OK, USA).ResultsThe diagnosis of proven sporotrichosis was established in 57 patients (32.6%) and the probable diagnosis was verified in 118 patients (67.4%). Among all 175 patients, 171 (98.3%) cases were reported as zoonotic transmission and only 4 (1,7%) as sapronotic (classical pathway). Molecular identification was performed in 35 isolates and in 97.0% (n = 34) of them, Sporothrix brasiliensis was the main etiological agent identified (Fig. 1). Most cases of sporotrichosis were diagnosed between 2019 to 2021 (n = 105, 60%). The incidence rate increased from 0.27 cases/100.000 patients in 2011 to 30.4 cases/100.000 patients in 2021 (until July) and was observed geographic expansion of human cases of CTS in Curitiba in the last decade (accumulated cases 2011-12, 2011-16, and 2011-21 July) (Fig. 2). Prevalence rate was 4.97 cases per 100 000 patients. The majority of the patients were from Curitiba (n = 145, 82.9%). Women were the most affected (63.4% women vs 36.6% men) with the average age of 40 years old (1-87 years old). A total of 12% (n = 21) of the patients were under 18 years old. The prevalence of CTS in patients at high risk of occupational exposure to the disease was 9.7% (n = 17), 9 being veterinarians, 5 veterinary students, 3 pet house workers, and 2 gardeners. The main clinical manifestation was lymphocutaneous (n = 114, 65.1%), followed by fixed cutaneous (n = 43, 24.6%), ocular (n = 13, 7.4%), and mixed forms (n = 5, 2.9%).ConclusionCTS is a public health issue that is aggravated due to the lack of national control programs, unknown prevalence of the disease, lack of knowledge of the population, and health professionals about the epidemic. Besides that, there are difficulties in handling sick cats, lack of diagnosis of human and veterinary cases, and poor access to free medication. In 2011, the first case of CTS was identified in Curitiba, Paraná, Brazil. In 10 years, there has been a significant increase in the number of new cases. Those evidence indicate the continuous dispersion of the disease out of epidemiological control.

Tanshinone IIA loaded bioactive nanoemulsion for alleviation of lipopolysaccharide induced acute lung injury via inhibition of endothelial glycocalyx shedding

Acute lung injury (ALI) and its more serious form; acute respiratory distress syndrome are major causes of COVID-19 related mortality. Finding new therapeutic targets for ALI is thus of great interest. This work aimed to prepare a biocompatible nanoformulation for effective pulmonary delivery of the herbal drug; tanshinone-IIA (TSIIA) for ALI management. A nanoemulsion (NE) formulation based on bioactive natural ingredients; rhamnolipid biosurfactant and tea-tree oil, was developed using a simple ultrasonication technique, optimized by varying oil concentration and surfactant:oil ratio. The selected TSIIA-NE formulation showed 105.7 nm diameter and a PDI ∼ 0.3. EE exceeded 98 % with biphasic sustained drug release and good stability over 3-months. In-vivo efficacy was evaluated in lipopolysaccharide (LPS)-induced ALI model. TSIIA-NE (30 µg/kg) was administered once intratracheally 2 h after LPS instillation. Evaluation was performed 7days post-treatment. Pulmonary function assessment, inflammatory, oxidative stress and glycocalyx shedding markers analysis in addition to histopathological examination of lung tissue were performed. When compared to untreated rats, in-vivo efficacy study demonstrated 1.4 and 1.9-fold increases in tidal volume and minute respiratory volume, respectively, with 32 % drop in wet/dry lung weight ratio and improved levels of arterial blood gases. Lung histopathology and biochemical analysis of different biomarkers in tissue homogenate and bronchoalveolar lavage fluid indicated that treatment may ameliorate LPS‐induced ALI symptoms thorough anti‐oxidative, anti‐inflammatory effects and inhibition of glycocalyx degradation. TSIIA-NE efficacy was superior to free medication and blank-NE. The enhanced efficacy of TSIIA bioactive nanoemulsion significantly suggests the pharmacotherapeutic potential of bioactive TSIIA-NE as a promising nanoplatform for ALI.

Long term evaluation of a multidisciplinary trigeminal neuralgia service

BackgroundTrigeminal neuralgia is an episodic severe neuralgic pain and can be managed both medically and surgically. If possible, this should be directed by a Multidisciplinary Team (MDT) of specialised surgeons, physicians, dentists, psychologists and specialist nurses with access to all treatment modalities, which enables patients to make an informed decision about their future management.ObjectiveThe aim of this study was to review the outcomes of patients managed by an MDT clinic, in a single institute over an eleven-year period.MethodsA prospective database was used to identify patients with trigeminal neuralgia or its variants who had attended a joint MDT clinic. The electronic notes were examined for demographics, onset and duration of trigeminal neuralgia, medications history, pain scores and details of surgical procedures if any by two independent assessors.ResultsThree hundred thirty-four patients attended the MDT between 2008–2019. Forty-nine of them had surgery before being referred to the service and were included but analysed as a subgroup. Of the remaining patients, 54% opted to have surgery following the MDT either immediately or at a later date. At the last reported visit 55% of patients who opted to have surgery were pain free and off medications, compared to 15.5% of medically managed patients. Surgical complications were mostly attributable to numbness and in the majority of cases this was temporary. All patients who were not pain free, had complications after surgery or opted to remain on medical therapy were followed up in a facial pain clinic which has access to pain physicians, clinical nurse specialists and a tailored pain management program. Regular patient related outcome measures are collected to evaluate outcomes.ConclusionAn MDT clinic offers an opportunity for shared decision making with patients deciding on their personal care pathway which is valued by patients. Not all patients opt for surgery, and some continue to attend a multidisciplinary follow up program. Providing a full range of services including psychological support, improves outcomes.

A case report of the first hereditary transthyretin cardiac amyloidosis diagnosed in Vietnam

Amyloid cardiomyopathy is a cardiovascular disease characterized by infiltration of amyloid into the heart muscle and other organs in the body, triggering impaired function of the heart and other organs. There are three main subtypes of amyloidosis including primary or AL amyloidosis, secondary or AA amyloidosis and hereditary or familial amyloidosis. Hereditary amyloidosis is less common, caused by an autosomal-dominant mutation most frequently in the transthyretin gene and has a more favorable prognosis.1,3 In this paper, we will be looking into a rare case of hereditary transthyretin amyloid disease with a genetic mutation (mutant TransThyRetin Amyloidosis - ATTRm), the first to be reported in Vietnam. That is a 47-year-old Vietnamese man with various clinical manifestations, including gastrointestinal disturbances (diarrhea, watery stool), periorbital purpura, macroglossia, autonomic neuropathy (dizziness, orthostatic hypotension, limb numbness, faint), and cardiovascular symptoms (dyspnea, leg edema, severe heart arrhythmias). The patient has a notable family history of many members appeared to have shown signs of the same disease and passed on without a diagnosis. A multimodality team in hematology, nuclear medicine, genetics, dermatology, and cardiology was assigned to the patient. We concluded that the patient was suffering from a form of ATTRm with a different genetic mutation from the common gene mutation in the world. Our patient is currently enrolled in a research program with a pharmaceutical manufacturer providing specific treatment and free medication. He is responding well to treatment and has shown signs of improvement.

Cost-effectiveness of Implementing Smoking Cessation Interventions for Patients With Cancer

Guidelines recommend cancer care clinicians offer smoking cessation treatment. Cost analyses will help stakeholders understand and plan for implementation of cessation programs. To estimate the incremental cost per quit (ICQ) of adopting an intensive smoking cessation intervention among patients undergoing treatment at cancer care clinics, from a clinic perspective. This economic evaluation, a secondary analysis of the Smokefree Support Study (conducted 2013-2018; completed 2021), used microcosting methods and sensitivity analyses to estimate the ICQ of the interventions. Participants included patients undergoing treatment for a broad range of solid tumors and lymphomas who reported current smoking and were receiving care at cancer care clinics within 2 academic medical centers. Intensive smoking cessation treatment (up to 11 counseling sessions with free medications), standard of care (up to 4 counseling sessions with medication advice), or usual care (referral to the state quitline). Total costs, component-specific costs, and the ICQ of the intensive smoking cessation treatment relative to both standard of care (comparator in the parent randomized trial) and usual care (a common comparator outside this trial) were calculated. Overall and post hoc site-specific estimates are provided. Because usual care was not included in the parent trial, sensitivity analyses were conducted to assess how assumptions about usual care quit rates affected study outcomes (ie, base case [from a published smoking cessation trial among patients with thoracic cancer], best case, and conservative case scenarios). The per-patient costs of offering intensive smoking cessation treatment, standard of care, and usual care were $1989, $1482, and $0, respectively. For intensive treatment, the dominant costs were treatment (35%), staff supervision (26%), and patient enrollment (24%). Relative to standard of care, intensive treatment had an overall ICQ of $3906, and one site had an ICQ of $2892. Relative to usual care, intensive treatment had an ICQ of $9866 overall (base case), although at one site, the ICQ was $5408 (base case) and $3786 (best case). In this economic evaluation study, implementation of an intensive smoking cessation treatment intervention was moderately to highly cost-effective, depending on existing smoking cessation services in place.

Attitudes, practices, and determinants of community care-seeking behaviours for fever/malaria episodes in the context of the implementation of multiple first-line therapies for uncomplicated malaria in the health district of Kaya, Burkina Faso

BackgroundMalaria case management relies on World Health Organization (WHO)-recommended artemisinin-based combination therapy (ACT), and a continuous understanding of local community knowledge, attitudes, and practices may be a great support for the success of malaria disease control efforts. In this context, this study aimed to identify potential facilitators or barriers at the community level to inform a health district-wide implementation of multiple first-line therapies (MFT) as a new strategy for uncomplicated malaria case management.MethodsA community-based cross-sectional study using a mixed-method design was carried out from November 2018 to February 2019, in the health district (HD) of Kaya in Burkina Faso. Quantitative data were collected using a standardized questionnaire from 1394 individuals who had fever/malaria episodes four weeks prior to the survey. In addition, 23 focus group discussions (FGDs) were conducted targeting various segments of the community. Logistic regression models were used to assess the predictors of community care-seeking behaviours.ResultsOverall, 98% (1366/1394) of study participants sought advice or treatment, and 66.5% did so within 24 h of fever onset. 76.4% of participants preferred to seek treatment from health centres as the first recourse to care, 5.8% were treated at home with remaining drug stock, and 2.3% preferred traditional healers. Artemether-lumefantrine (AL) was by far the most used anti-malarial drug (98.2%); reported adherence to the 3-day treatment regimen was 84.3%. Multivariate analysis identified less than 5 km distance travelled for care (AOR = 2.7; 95% CI 2.1–3.7) and education/schooling (AOR = 1.8; 95% CI 1.3–2.5) as determinants of prompt care-seeking for fever. Geographical proximity (AOR = 1.5, 95% CI 1.2–2.1), having a child under five (AOR = 4.6, 95% CI 3.2–6.7), being pregnant (AOR = 6.5, 95% CI 1.9–22.5), and living in an urban area (AOR = 2.8, 95% CI 1.8–4.2) were significant predictors for visiting health centres. The FGDs showed that participants had good knowledge about malaria symptoms, prevention tools, and effective treatment. Behaviour change regarding malaria treatment and free medication for children under five were the main reasons for participants to seek care at health centres.ConclusionsThe study showed appropriate knowledge about malaria and positive community care-seeking behaviour at health centres for fever/malaria episodes. This could potentially facilitate the implementation of a MFT pilot programme in the district.ClinicalTrials.gov Identifier: NCT04265573.

Lost2PrEP: Understanding Reasons for Pre-Exposure Prophylaxis and Sexual Health Care Disengagement Among Men Who Have Sex with Men Attending a Sexual Health Clinic at a Large Urban Academic Medical Center in New York City.

Pre-exposure prophylaxis (PrEP) prevents HIV, but low rates of retention in care limit its effectiveness. We conducted a prospective survey-based study to investigate reasons for PrEP disengagement among men who have sex with men attending a sexual health clinic at a large urban academic medical center in New York City who were lost to follow up; surveys asked about current PrEP status, reasons for disengagement, attitudes toward PrEP, substance use, sexual practices, and behavioral/social determinants of health. Outreach attempts were made to 634 patients; majority of eligible participants were unable to be contacted (59%). Among those who agreed to participate (n = 175), 21% asked to re-establish care. Among those who completed the questionnaire (n = 86), 36% were taking PrEP. The most common reasons for PrEP discontinuation were cost/lack of insurance coverage (31%), decreased HIV risk perception (29%), and side effects (16%). Among those with decreased perception of risk, 62% were less sexually active, 38% were no longer engaging in anal sex, and 31% were using condoms for prevention. Participants reported that free medication (60%), having a sexual partner recommend PrEP (13%), and being able to receive PrEP from a primary care provider (13%) would encourage restarting PrEP. Findings were limited by low response rate (12% of eligible subjects completed the survey) and lack of Spanish-language questionnaires. Understanding reasons for loss-to-PrEP follow-up is essential for HIV prevention. Many people lost to follow up still desired PrEP, underscoring the importance of outreach, benefits navigators, and expansion of PrEP into primary care settings.

SOCIAL ROLES OF FAMILY MEMBERS AND EFFECTIVENESS OF DIABETES MANAGEMENT OF PATIENTS SEEKING CARE AT ST. MARY’S MISSION HOSPITAL, NAIROBI

Purpose: Diabetes is one of the non-communicable diseases (NCDs) of great global public health and development concern. This NCD has adverse effects on the social well-being of patients, their households, and the whole society. The overall objective of this study was to determine the relationship between social roles of family members and effectiveness of diabetes management of patients seeking care at St. Mary’s Mission Hospital, Nairobi.&#x0D; Methodology: This study drew on descriptive study design, involving quantitative and qualitative methods, particularly closed and open questions. The sample size was 269 respondents included in the study through purposive and convenient sampling. These sampling techniques were preferred in this research since data was gathered from the respondents during their visit to the hospital. The researcher collected data through interviewer-administered questionnaires containing both open and closed questions. Qualitative data was grouped, coded, and categorized, picking on cross-cutting issues, then compiled, analysed, and interpreted accordingly. Quantitative data was coded then entered into Statistical Package for Social Sciences (SPSS) version 22 for windows. SPSS was used to run frequency distributions and cross-tabulations for analysis and interpretation, and Microsoft Excel was used for graphical presentation.&#x0D; Findings: The study established that diabetes management is costly and not affordable to many patients. Hence, it affects the social well-being of the patients and their families.&#x0D; Unique Contribution to Theory and Practice: The study recommends free or affordable and available medication for diabetes patients, and continuous awareness programs for patients, family members and the community across all Counties to address the effects of diabetes management on the patients, families, and the Nation. This would contribute to the social well-being of the patients and their families and the Nation's economic development.

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Effectiveness of a Workplace-Based, Multicomponent Hypertension Management Program in Real-World Practice: A Propensity-Matched Analysis.

Limited studies had investigated the potential benefits of workplace-based hypertension management programs on long-term blood pressure (BP) control and health outcomes. This study used the propensity score matching to examine the effectiveness of a workplace-based hypertension management program on BP control and risks of major adverse cardiovascular events and all-cause mortality. Within the Kailuan study, a workplace-based hypertension management program was initiated in 2009 among men with hypertension, which included regular BP measuring (twice a month), free antihypertensive medications, and individualized health consultation. Participants were followed until loss to follow-up, death, or December 31, 2019. Among 17 724 male hypertensives aged 18 to 60 years, 6400 participated in the program. The propensity score matching yielded 6120 participants in the management group and 6120 participants in the control group. Both systolic and diastolic BPs were significantly lower in the management group than in the control group over follow-up, and the mean between-group difference at the 10th year was -7.83 (95% CI, -9.06 to -6.62) mm Hg for systolic BP and -4.72 (95% CI, -5.46 to -3.97) mm Hg for diastolic BP. Participants in the program were more likely to achieve BP control (odds ratio, 1.70 [95% CI, 1.41-2.06]) and had significantly lower risks of major adverse cardiovascular events (hazard ratio, 0.83 [95% CI, 0.72-0.94]) and all-cause mortality (hazard ratio, 0.71 [95% CI, 0.58-0.86]), compared with those who were not in the program. A workplace-based hypertension management program was related to reduced BP levels and lower risks of major adverse cardiovascular events and mortality in Chinese men with hypertension.

A Judicialização da Saúde no Ordenamento Jurídico Brasileiro no Contexto da Pandemia COVID-19

A saúde está inserida no rol dos direitos sociais fundamentais, configurando um sustentáculo para a própria vida, condição sine qua non para a dignidade. A Constituição Federal de 1988 (CF/88) determina que a saúde é um direito de todos, motivo pelo qual o Sistema Único de Saúde (SUS) deve atender toda a coletividade. No atual contexto da pandemia COVID-19 há esforços no mundo inteiro para salvar vidas. Diante da precariedade do sistema público de saúde, aliada ao insuficiente fornecimento de medicamentos gratuitos, tratamentos médicos, procedimentos cirúrgicos, transferência hospitalar e acesso a Unidades de Tratamento Intensivo – UTIs, surge o nascimento do fenômeno “judicialização da saúde”, para determinar que o ente público cumpra com determinada prestação na área da saúde. O presente artigo tem como objetivo geral discorrer acerca dos aspectos inerentes à saúde no Brasil, destacando as mais novas decisões sob a ótica dos tribunais superiores no contexto da pandemia COVID-19, verificando os resultados de tais decisões e as contribuições que elas trazem para uma nova visão na busca do bem-estar social. Buscam-se políticas públicas voltadas para a prevenção da doença, no intuito de se alcançar um direito à saúde mais justo e universal. Para tanto, é empregada a metodologia do tipo exploratória, de cunho qualitativo, com análise jurisprudencial conjugada com revisão bibliográfica.

Assessment of a psychiatric intervention at community level for people who inject drugs in a low-middle income country: the DRIVE-Mind cohort study in Hai Phong, Viet Nam

SummaryBackgroundAccess to psychiatric care for people who inject drugs (PWID) is limited/absent and stigmatized in most low-middle-income countries (LMICs). Innovative interventions are needed. We aimed to describe and assess the impact of a community-based psychiatric intervention among PWID in Hai Phong, VietnamMethodsIn a cohort study with one year psychiatric follow-up, PWID diagnosed with a psychotic disorder, a major depressive episode, or suicide risk, were recruited from the wider Drug-Related Infections in ViEtnam (DRIVE) project in the city of Hai Phong. The community-based psychiatric intervention included specialized follow-up (free consultations with psychiatrists, free medication, referral to mental health department for hospitalization when necessary) and support from community-based organisations (case management, harm reduction, administrative support, linkage to HIV care, methadone maintenance treatment and mental health support). The main outcome was reduction/remission of symptoms. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention.FindingsAmong the 1212 participants screened from March to May 2019, 271 met the inclusion criteria, 233 (86.3%) accepted the intervention and 170 completed the follow-up (72.9%). At inclusion, 80.6% were diagnosed with current depression, 44.7% with psychotic disorder and 42.4% with suicide risk. After a one-year follow-up, these proportions dropped to 15.9%, 21.8%, and 22.9% respectively. Quality-of-life and perceived stigma related to mental health were also significantly improved, while drug use decreased only marginally.InterpretationCommunity-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Similar interventions should be implemented and evaluated in other, different LMICs.Funding: This work was supported by grants from NIDA (US) (#DA041978) and ANRS (France) (#13353). The funding agencies had no role in designing the research, data analyses, or preparation of the report.