Good Health Status Research Articles

A comparative analysis of methods of preinduction cervical ripening and induction of labor in Poland and in Germany (Part II): maternal and neonatal outcomes

The benefits and risks of delivery should always be considered before initiating preinduction cervical ripening and labor induction. Understanding the benefits and potential complications is crucial for healthcare professionals to make informed decisions and provide optimal care. The research was conducted retrospectively between January 2019 and July 2022. It involved the analysis of the medical records of 154 pregnant women staying in the Clinic of Obstetrics and Gynecology in the city of Szczecin and 150 pregnant women hospitalized in the Clinic of Obstetrics and Gynecology in the town of Schwedt/Oder in Germany. Inclusion criteria were consent to participate and the implementation of internal written protocols in line with national guidelines for labor induction. The research concerned a group of pregnant women with postdate pregnancy, calculated according to the Naegele’s rule and confirmed by the USG examination conducted in the first trimester of the pregnancy, as well as an unfavorable cervix that received less than 6 points in the Bishop score. Moreover, the pregnant patients with a low biophysical profile and an abnormal record of CTG or comorbidities were also included, as these factors determined the classification of the group above. The study did not include patients who had undergone cesarean section. The average change in evaluation of the cervix marked on the Bishop Score was higher in Germany, and it was 2.7 points, whereas in Poland, it was 1.6 points. The largest percentage of the scores on the Apgar Scale in the first, third and fifth minutes after birth was in the norm and indicated a good health condition of infants. They reached 8 to 10 points in both countries. Significantly more infants in Germany received pH from the umbilical cord within the limits of the norm. And it marks the welfare of neonates (7.20–7.45). The duration of hospitalization in Poland was shorter than in Germany. It was 3.8 days in the case when the median equalled 3. The number of days of preinduction cervical ripening and induction was similar in both countries. The levels of haemoglobin were comparable in both countries. The most common postpartum complications in Poland and Germany were first-degree perineal tears, episiotomies and anemia. Among the postpartum complications, cervical tears, revision of the uterine cavity, and episiotomy were significantly more common in Poland. First- and second-degree perineal tears were more frequent in Germany.

Use and acceptance of video consultation among adults insured by statutory health insurance provider in Germany: A nationwide online survey.

The increasing digitalization of the healthcare system makes it possible to provide medical services using digital technologies without direct patient-provider contact. This study aimed to investigate 1) the use and acceptance of video consultation and 2) factors associated with the use of video consultation. A cross-sectional online survey was conducted in February 2023. Overall, 20,000 adults insured at a statutory health insurance company in Germany (10,000 users and 10,000 non-users of video consultation) were invited by email to an online survey with 31 items. The items addressed use and acceptance of digital health services with a focus on video consultation, digital health literacy and sociodemographic characteristics. Data were analyzed using descriptive statistics and factors associated with video consultation use were assessed using binary logistic regression. Among the 1657 participants, 686 were users and 971 were non-users of video consultation. The participants were aged between 18 and 80 years (M ± SD: 44 ± 13 years), 55% were female, 59% reported a medium subjective socioeconomic status, and 69% a good to very good health status. Video consultation were predominantly used following physician recommendations (71%) as part of general medical care (50%). The main reasons for using video consultation were time saving (93%) and flexibility in terms of location (87%). Most video consultation users felt well cared-for during video consulting (93%), would use it again (95%), and would recommend it to others (93%). Factors associated with video consultation use were age from 30 to 49 years, high subjective socioeconomic status, high digital health litercay, and very poor to moderate health status. The acceptance of video consultations in this study was high. Advantages and barriers to offering video consultations from a physician perspective should be investigated to incorporate video consultations in everyday medical practice.

Eco-epidemiological Survey of Trypanosoma cruzi in Dogs from Mendoza, Argentina.

Urban domestic dog populations can provide important clues about the eco-epidemiological characteristics of Trypanosoma cruzi, the causative agent of Chagas disease (ChD). Given the limited data on ChD from the Metropolitan Area of Mendoza, Argentina, a seroprevalence survey of 327 dogs across an urban-rural gradient was conducted between April 2018 and May 2019. Seropositive cases were analyzed considering host, social, and environmental factors, subtypes (DTUs), and bloodstream parasite load. Seroprevalence of infection by T. cruzi total antigens (ELISA-H) was similar in urban (18%), interface (14%), and rural (21%) areas. Serotyping (recombinant TSSA-II antigen ELISA) revealed that 61% (37/61) of seropositive dogs carried the subtypes TcII, V and/or VI. There was no difference in the proportion of seropositive dogs versus seronegative dogs that lived with a person with ChD (9/62 = 14% vs. 35/265 = 13%, respectively). Parasite loads in seropositive dogs varied between < 0.10 and 1.18 parasite-equivalents/ml. Dogs with T. cruzi infection were in good health and nutritional condition, suggesting that they may have indeterminate or chronic stage infections. High infection rates in all areas and limited knowledge of owners about ChD and its triatomine vectors emphasize the need to intensify entomological studies, especially in urban areas, and promote vector information campaigns. This work shows that screening of dogs is a beneficial epidemiological tool to deepen studies on ChD from a One Health perspective.

Ecosystem Health Assessment in Kalimpong District (West Bengal), India Based on AHP-VORS Model

The present research paper proposes an AHP model based on integrating weight and VORS modelis used to prepare of ecosystem health conditions map in Kalimpong district of West Bengal from 1991 to 2021. In this study, LULC map is prepared based onlandsat-5 (for 1991) and also landsat-8 (for 2021)applyingArcgis 10.3.1.The district is covered by 7 types of LULCclasses such as agriculture fallow land, forest,social forestry, agriculture plantation, build up area, agriculture land and water bodies1. LULC map of 1991 and 2021 were used to prepare ESVs map based on ESVs of biomes, 1997 and 2014 to analysis of spatio-temporal dynamics in ESVs of the district.EH of the district is categorised into five classes in the period of 1991 to 2021. The output results show that about 30.05 % and 23.30 % areas under very good health condition in 1991 are predicted while the areas under very good health conditions are changed to 22.00 % and 22.00 % in 2021 as per used ecosystem services map which prepared based on global coefficient values. This work gives a valuable guide line for conducting sustainable environmental management steps for the district in future.

Did Finerenone Improve Health Status in the FINEARTS Trial?: A Critical Reevaluation of the Analysis of Patient-Reported Outcomes in Heart Failure.

Patient-reported health status is an important assessment of patients with heart failure, but current approaches have substantial methodological and analytical limitations. Changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ) are commonly presented as a measure of the effect of drugs and devices, most often as the between-group difference in population means or as the odds of showing threshold changes of 5, 10, 15, and 20 points. However, the presentation of mean differences is based on statistical assumptions that are routinely violated in most trials. The presentation of threshold changes is based on the belief that a within-patient change in KCCQ of 5 points represents a significant treatment difference across diverse populations and trial settings, but the minimal clinically meaningful difference varies substantially depending on patient characteristics, comorbidities, and trial duration and design, with most values for minimally clinically important difference for KCCQ ranging from 10 to 20 points. Furthermore, the assessment of between-group differences is highly distorted by the assignment of a large proportion of randomized patients with very good health status as having substantially improved even if they showed no change after treatment. Any responder analysis is highly sensitive to differences in variance between the 2 treatment groups and cannot account for the stability of changes in the KCCQ score. The imposition of number-to-treat presentations onto KCCQ scores further compounds the lack of interpretability of reported changes. It is therefore not surprising that trials have reported substantial discrepancies between the effect of treatment on KCCQ and on the risk of hospitalizations for heart failure. In the FINEARTS (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with HeartFailure) trial, finerenone produced an 18% reduction in the risk of hospitalizations for heart failure but yielded uninterpretable and clinically questionable changes in KCCQ, with the small possibility of a modest benefit in<2% of randomized patients. Most physicians are unaware of the critically important methodological concerns summarized in the current paper, and, therefore, may make clinical decisions that hinge on unwarranted impressions of the effects of an intervention on health status.

Considerations and Challenges for Acute Inhalation Toxicity Testing and Classification of Zinc Sulphide Under REACH.

Zinc sulphide is a widely used inorganic powder, and its production has reached quantities greater than 1000 t/year. Therefore, in accordance with OECD guideline 436, an acute inhalation test was implemented to provide more accurate data. This study is crucial for ensuring the safety of workers exposed to zinc sulphide dust and complying with regulatory requirements for REACH. Due to particle-specific properties, the maximum attainable concentration of zinc sulphide for an inhalation study was not certain. Two dry dispersion systems were used to aerosolize the zinc sulphide powder, and the generated aerosol was supplied to a nose-only inhalation exposure system. The results showed a maximum attainable concentration of 0.82 mg/L at an MMAD of 1.5 µm over a 4 h exposure. In the inhalation study, all six rats showed no specific symptoms and good health status and survived a post-exposure observation period of up to 14 days. From the results observed, the status of Not classified was derived according to CLP. Based on the experimental results, an LC50 was not determined but is considered to be higher than 0.82 mg/L (the maximum achievable aerosol concentration). These findings highlight the importance of documenting efforts to achieve aerosol conditions when concentrations required by OECD test guidelines cannot be reached.

Gut response to the dietary supplementation with sodium butyrate in broiler chickens: morphology and microbiota composition and predictive functional groups

This study investigated the effects of Na-butyrate supplementation (0 vs. 150 vs. 300 mg/kg) and the dietary fat level (7.7% vs. 6.7% in the grower diet; 8.9% vs. 7.7% in the finisher diet) in 900 broiler chickens of both sexes, out of which 108 were used to evaluate gut morphology and immune response on jejunum tissues at 14, 28, and 40 days of age, and caecal microbiota composition according to 16S rRNA gene multi-amplicon sequencing and the predictive functional bacteria groups at 40 d of age. Villi height and crypts depth changed only according to the age of chickens. Microbiota analysis revealed Firmicutes as the dominant phylum, with sex-related differences in microbial diversity indices (Simpson index, p < .05). The Na-butyrate dietary supplementation and dietary fat level affected the abundance of specific bacterial genera related with short fatty acids production, without changes in the bacterial metabolic pathways. Under the good health conditions of chickens in the present trial, Na-butyrate supplementation and the dietary fat level did not modify the overall gut equilibrium of broiler chickens.

Length-weight&amp;nbsp; relationship, condition factor, morphometric and meristic characteristics of &lt;em style="mso-bidi-font-style: normal;"&gt;Ctenopoma kingsleyae&lt;/em&gt; from Esa-Odo Reservoir, Nigeria.

Anabantid, Ctenopoma kingsleyae is a commercially important fish being captured as a food and aquarium fish. Limited literature is available on the biology of the fish. Therefore, this study investigated the length-weight relationship, condition factor, morphometric and meristic characteristics of C. kingsleyae from Esa-Odo water Reservoir, Nigeria. Fish collected (n = 90) from fishermen were subjected to morphometric measurements to the nearest length (0.1cm) and weight (0.1g) and meristic counts were recorded in the laboratory. Results revealed the fin formula of C. kingsleyae was D1xvii, D2 9-11, A1 ix, A2 10-11, P 11-13, vi/5, TLr 25-27. The b value for males, females and combined sexes were 10.014, 12.7 and 12.81 respectively, indicating positive allometric growth for all the samples. The mean condition factors, 1.95±0.02, 2.03±0.02 and 2.00±0.01 were recorded for males, females and combined sexes respectively, implying that the fish are in good health condition. The correlation coefficient (R) of 0.8925, 0.9175 and 0.9507 were recorded for males, females and combined sexes respectively, revealing a positive relationship between the weight and total length of the fish. Positive correlations were observed between the total length and each of the other morphological characteristics of the fish (p ≤ 0.05). Data generated from this study can form baseline information for the conservation, production and management of C. kingsleyae reservoirs in Nigeria.

Adherence to the Mediterranean diet in 5 Mediterranean countries: A descriptive analysis of the DELICIOUS project

Background: The Mediterranean diet is considered a healthy dietary pattern associated with substantial health benefits. While its application at global level is rather difficult due to the intricate features eradicated into the cultural heritage of populations living in countries facing the Mediterranean basin, its preservation in such areas is considered crucial to maintain a good health status of current and future generations. Objective: To assess the level of adherence to the Mediterranean diet in children and adolescents living in 5 Mediterranean countries participating in the DELICIOUS project. Methods: An online survey was conducted involving 2011 parents of children and adolescents from Spain, Italy, Lebanon, Egypt, and Portugal. The KIDMED score applied to 24-h recalls of their children's diets was used to assess the level of adherence to the Mediterranean diet and cross-references with background and lifestyle variables. Results: Children and adolescents living in Lebanon and Portugal are more adherent than their counterparts in other countries. Some specific aspects related to the Mediterranean diet were rather common, such as olive oil consumption, daily fruit and vegetable intake, as well as lifestyle habits including having breakfast and limited sweets. Others, including having a second portion of fruit and vegetable, adequate consumption of fish, nuts, and cereals (for breakfast), as well as frequent consumption of fast foods underscored substantial abandonment of certain other Mediterranean diet features. Older adolescents with inadequate sleep duration, longer screen time, and low physical activity levels, as well as children of older parents with lower educational level, lower family income, and living in rural areas had significantly lower KIDMED scores. Conclusions: This study provides important information on the current status of adherence to the Mediterranean among children and adolescents in the Mediterranean region and may help setting specific targets for nutrition interventions aiming at its promotion.

The salivary microbiome and oral health status in HBeAg-negative chronic hepatitis B

Background/purposeDysbiosis of oral microbiota has been reported in late stage of chronic hepatitis B (CHB) infection with cirrhosis. CHB is characterized by the constant virus-induced liver injury which may lead to liver cirrhosis and hepatocellular carcinoma (HCC). However, some patients show normal liver function without antiviral treatment, associating with favourable prognosis. The oral microbiota composition and oral health status in these patients is unidentified. Materials and methodsThe study focuses on the composition of oral microbiota and oral health status in individuals with CHB and HBV vaccinees as controls. The CHB patients were hepatitis B 'e' antigen (HBeAg)-negative, with or without elevated liver enzyme increase at time of sampling, The 16S rRNA high-throughput sequencing and bioinformatic analysis were applied to investigate oral bacterial diversity, and oral examination including decay-missing-filled teeth (DMFT) index, probing depth (PD) and mucosal status was performed, along with oral health questionnaire, to assess the oral health status in CHB patients and healthy controls. ResultsOur results indicate that their oral microbiome compositions are not significantly different though some have increased ALT/AST liver enzyme levels at the time of sampling, compared to the healthy control participants who are vaccinated e.g. protected from this viral disease. CHB patients here bore a good oral health status and life-style habits as comparing to healthy controls. ConclusionThese findings suggest that a health-associated salivary microflora is present in CHB without severe liver injury. Continued regular dental health and lifestyle support in liver disease patients is therefore justified.

Investigation of gut microbiota composition in humans carrying blastocystis subtypes 1 and 2 and Entamoeba hartmanni

The composition of human gut microbiota is dominated by bacteria which have been extensively studied. The role of intestinal eukaryote microorganisms like Blastocystis, however, remains under investigation. Moreover, the potential impact on gut health related to Blastocystis presence was primarily investigated in symptomatic individuals mainly from industrialized countries, and appears to be mostly beneficial to the host microbiota. Data from surveys conducted in underdeveloped countries with higher prevalence and from asymptomatic individuals could therefore be valuable. The aim of this preliminary study was to analyze the composition of the gut microbiota in relation to the protozoa Blastocystis ST1 and ST2 and Entamoeba hartmanni carriage in asymptomatic subjects living in a semi-urban area of Côte d’Ivoire to add data into the ongoing debate on the role of Blastocystis in host health. The amplification of the V3 and V4 regions of bacterial 16S rDNA genes was performed to obtain the gut microbiota composition, and differential analyses on alpha and beta diversity were performed from the phylum to genus taxonomic level. The analysis revealed that individuals positive for both protozoa exhibited higher alpha and beta diversity compared to those who tested negative. Additionally, their bacterial composition showed a reduction in Bacteroides and an increase in Prevotella 9. Relative abundances of some OTUs, particularly Faecalibacterium, observed in individuals who tested positive for protozoa, were correlated with a good state of health of the gut microbiota. Blastocystis ST1 and ST2 associated with E. hartmanni thus appeared to be related to a state of intestinal eubiosis.

Prevalence and social determinants of self-reported health status among reproductive age women in Nepal.

The self-reported health status (SRHS) is a subjective evaluation of an individual's health and has been connected to mortality and future health outcomes in numerous studies. However, the determinants of SRHS among women in Nepal remain largely unclear. In Nepal, traditional gender norms often result in women bearing greater responsibilities in terms of household chores, child-rearing, and taking care of elderly family members, all of which may potentially contribute to lower self-perceived health. Therefore, this study aims to identify the factors influencing SRHS among women in Nepal. The study utilized data from 7,442 women aged between 15 and 49 who participated in the Nepal Demographic and Health Survey (NDHS) 2022. Both univariate and multiple linear regression analyses were employed to ascertain the factors influencing self-rated health status (SRHS) among women in Nepal. Women in the age groups 15-24years (AOR: 5.14, 95% CI: 3.07-8.62) and 25-34years (AOR: 2.71, 95% CI: 1.99-3.68) were more likely to report good health status compared to older age groups. Additionally, women who were never married (AOR: 4.89, 95% CI: 3.62-5.32) or currently married (AOR: 1.46, 95% CI: 1.11-2.20) and those from wealthy families (AOR: 1.54, 95% CI: 1.07-2.21), also had a higher likelihood of reporting good health status. Other factors associated with a higher probability of reporting good health included not having a history of terminated pregnancy (AOR: 1.48, 95% CI: 1.11-1.97), having no history of genital discharge (AOR: 1.75, 95% CI: 1.29-2.38), not visiting a health facility in the last 12months (AOR: 2.03, 95% CI: 1.43-2.88), and having no genital ulcers in the previous 12months (AOR: 2.02, 95% CI: 1.24-3.28). Conversely, women with mild to severe depression and anxiety were less likely to report good health status compared to those with no depression or anxiety. This study identified several social determinants of SRHS among Nepalese women. These socioeconomic determinants of health should be included in future research and health policy activities in Nepal and other comparable contexts.

Assessment of Oral Health-related Quality of Life among Adults in Kolkata, West Bengal, India

Background: Oral diseases are thought to produce a negative impact on the quality of life of an individual. It is well-documented now a days that the patient's perception should be familiarized while evaluating oral diseases and the respective treatment measures. Hence, it is imperative to assess the oral health-related quality of life (OHRQoL) that serves to be a vital indicator of the required intervention outcomes in modern-day oral health research and practice. Aim: To assess the OHRQoL among the individuals reporting to the OPD of department of oral pathology&amp; microbiology at Kusum Devi Sunderlal Dugar Jain Dental College &amp; Hospital, Kolkata. Methodology: A cross-sectional study was performed on 600 subjects with age more than 30 years were in good physical and mental health condition. OHIP-14 was used for surveys of 7 dimensions of impact i.e. functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. Results: The mean age of the patient’s group was 44.57+12.62. Mean OHI-14 score of the surveyed population was 7.095+10.53. There was insignificant difference in mean ohip-14 score among males and females (P= 0.435). Oral health related quality of life was found to have positive correlation with age (R = 0.362; P&lt; 0.0001). Conclusion: Further research with appropriate sample size should be undertaken to emphasize on OHRQoL in the treatment procedure to facilitate in proper planning and evaluating the outcomes that is best suitable for the patient.

Progressing a river health assessment framework to tropical waters

Diverse anthropogenic activities have threatened the valuable tropical biodiversity and freshwater reserves. Despite that, there is little concern in the Brazilian legislation about the ecological integrity of aquatic ecosystems. We proposed a framework based on two joint indices, allowing the creation of a management tool. The first is the Tropical Water Healthy Index (TWHI), a river index that integrates pressures on aquatic ecosystems, their conditions, and societal/governmental response. The second is the Suitability of the Class of Use (SCU), which measures whether rivers’ conditions are in accordance with their classes of use proposed for the legal Brazilian water framework. Our results showed that most sites had good river health conditions, with the worst conditions occurring in areas with high urban occupations followed by agricultural areas. The second index indicated that few streams were poorly or incompatible with their classes of use, suggesting their classifications were based on current conditions but not future intentions. The force of these joint analyses was shown in the Melchior River stretch, which was classified as compatible with SCU, but the TWHI was critical. This is good to show that we simultaneously have a problem with the legislation and to indicate something that needs to be done quickly for managers. Therefore, we built a management model that can assess the real situation of aquatic ecosystems and define efficient management strategies, producing alerts for the decision-maker.

Five-year long-term functional and quality of life outcomes in total glossectomy survivors.

Total glossectomy is proven to be a superior treatment option for advanced tongue cancer. Despite its efficacy, the procedure is associated with profound morbidity, notably impacting Speech, swallowing, and overall quality of life. Limited therapeutic benefits and the potential for considerable morbidity render total glossectomy a subject of controversy. We performed a multidimensional quality of life evaluation of long-term (more than 5 yrs.) total glossectomy survivors. In this study, we evaluated 25 total glossectomy survivors with comprehensive functional and quality of life outcomes using objective measures (London Speech Evaluation Scale, FOIS, 100ml Water Challenge, FEES) and Patient-reported outcomes (SHI, PSS HN, EORTC QLQ 30 & HN35). EORTC QLQ 30 showed overall good global health status (M = 80 ± 20) and functional scale mean scores ranging from 87 to 91, despite issues in pain (M = 31.6 ± 31), swallowing (M = 23.3 ± 24), and Speech (26.1 ± 1). Speech outcomes revealed 80% with moderate to severe intelligibility impairment. Swallowing outcomes showed 84% requiring special food preparation, 24% exhibiting aspiration, and 72% having pharyngeal residue. Speech outcomes showed 88% having moderate-severe speech impairment, and Patient-reported speech outcomes indicated a mean SHI score of (M = 47.2 ± 42). Patients undergoing total glossectomy report favourable long-term outcomes in global health-related quality of life despite moderate to severe impairments in objective speech and swallowing evaluations. These positive patient-reported outcomes support the consideration of total glossectomy as a viable treatment option if and when required, underscoring the importance of evaluating treatment outcomes through the patient-perceived quality of life.

Necessity of Analyzing the Korea Community Health Survey Using 7 Local Government Types.

This study examined the potential of a new analytical framework for the Korea Community Health Survey (KCHS) with classification criteria for the sub-national governmental level, the degree of urbanization including an urban-rural multimodal category, and population size as a more effective tool to address local health problems and deduce practical implications. Retrospective survey data from 2023 KCHS were obtained. Frequency analyses were performed for self-rated good health status, current smoking status, and unmet medical needs as proxies for health status, as well as healthcare utilization and health behavior, utilizing individual weights to represent national community residents. We established a new classification of local governments into 7 types to facilitate regional comparisons. These local government types are presumably composed of populations showing statistically significant differences in demographic characteristics. There were evident differences in health status, health behavior, and healthcare utilization in comparisons of groups categorized by local government types. This study suggests that regional disparities can be analyzed using a new typology of local governments. This practically effective approach could be used in decision-making for community-centered health projects in terms of community health planning. Future research should conduct analyses of KCHS data that use these 7 local government types to comprehensively reflect regional characteristics.

Social determinants and oral health conditions in the elderly

Introduction: In older adults, the social determinants of health directly influence the health-disease process; oral health is no exception. Objective: Determine the behavior of social determinants and oral health conditions in older adults. Methods: A descriptive cross-sectional study was carried out on 221 individuals aged 60 years and over from office 19, La Demajagua, in June 2024. Questioning and clinical examination of the oral cavity were used, with prior informed consent of the participants and caregivers. The variables studied were: age, sex, occupation, economic well-being, family functioning, housing conditions, eating habits and oral health conditions. Results: The most represented age group was 60 to 74 years old with 72,8 %, with a predominance of males. Only 32,6 % of older adults worked and 11,8 % had good oral health conditions. 56,1 % of those examined reported not having economic well-being, and 73,8 % presented a regular oral health condition. Dysfunctional families predominated in 56,6 %, 46,2 % living in homes with regular conditions and 58,8 % with inadequate eating habits. Conclusions: The unfavorable behavior of the analyzed determinants reveals their negative influence on the oral health condition of older adults.

Edukasi Perilaku Hidup Bersih dan Sehat dan Demonstrasi Cuci Tangan pada Siswa Raudhatul Athfal Daarun Na’im, Wayame, Kota Ambon

Clean and healthy living behavior (CHLB) is an action that maintains cleanliness to achieve good health status. CHLB must be implemented as early as possible to instill awareness always to maintain personal and environmental health. School-age children are at high risk of contracting diseases originating from their environment which is strengthened by not implementing CHLB. The implementation of CHLB in schools is often not carried out consistently so it affects the health status of children. The purpose of this community service activity is to provide knowledge and understanding about the importance of implementing CHLB for school-age children. The activity was carried out at Raudhatul Athfal Daarun Na'im Wayame which is in Wayame Village, Rumah Tiga Kota Ambon. The activity was carried out through CHLB education with a lecture method in class with interesting delivery and assisted by props to see dirty palms under ultraviolet light, as well as a demonstration of the correct 6-step hand washing for students. The implementation of CHLB education and demonstration went well and participants were enthusiastic in participating in the activity until it was finished.

The indirect costs of motherhood and fatherhood: impacts on income, working hours, and perceived health across 32 European countries

Abstract Background Parenthood may affect men’s and women’s personal lives, professional careers, and well-being differently. In the last decades, structural modifications in gender norms, the labor market, and family-supporting policies have occurred, but with cross-country variations, even within European borders. This study aimed to update the estimates on the impact of parenthood on men’s and women’s income, working hours, and perceived health status, and better comprehend their variation across 32 European countries, using a longitudinal approach. Methods Data from the European Survey on Income and Living Conditions (2004-2020) were used to estimate the income variation and the likelihood of transitioning into a non-income status, less than 40 weekly hours, and less than very good health status, from one year before to one year after parenthood. Estimates were done by sex and country. Pooled effects were estimated using random effects meta-analysis. Results We found a short-term 29% income penalty for women and a 12% income premium for men after parenthood. Seventy percent of women who transitioned their status after motherhood shifted to work less than 40 hours per week while no effect was found for men. Regarding perceived health, no shifts were overall observed. A large cross-country heterogeneity was found. Conclusions Motherhood-related income penalties concurred with losses of employment and reductions of weekly working hours, while among men the income premiums were not necessarily coupled with transitions to employed status or 40 weekly working hours. The cross-country heterogeneity is, probably, multifactorial, depending on countries’ policies, norms, labor market, and social structure.

Prevention of mechanical valve thrombosis with a combination of the factor Xa inhibitor edoxaban plus aspirin in swine: intermediate results from the EdoValves project

Abstract Background Patients with an implanted mechanical heart valve (MHV) currently have a contraindication to the use of non-vitamin K antagonist oral anticoagulants (NOACs) based on the unfavorable results of the RE-ALIGN trial with dabigatran. We hypothesized that the combination of a Factor Xa inhibitor, acting upstream of thrombin generation, plus aspirin, may effectively prevent valve thrombosis, providing a much more friendly and viable alternative to vitamin K antagonists for such patients. We tested this in a swine model with a recently implanted mechanical valve prosthesis in the mitral position, combining the most unfavorable conditions promoting mechanical valve thrombosis, based on (a) the implanting position; (b) recent surgery; (c) the high thrombogenicity of the animal model. The study was approved by the Animal Ethics Committee of the University of Pisa and the Italian Ministry of Health and conducted according to Good Clinical Practices for Animal Experiments. Methods 17 farm male pigs, weighing ≈30 kg at the beginning, underwent cardiac surgery under general anesthesia and with extracorporeal circulation to receive a 25 mm or 27 mm bileaflet Corcym Bicarbon mechanical heart valve replacement in the mitral position. Pigs were given 1 mg/kg enoxaparin immediately after surgery and started with the oral daily administration of edoxaban 1 mg/kg (30 mg, then escalated to 60 mg with the animal growth) + aspirin 100 mg, both given as crushed tablets with a food pellet since the animal awakening from anesthesia. An initially planned warfarin control group was quickly abandoned because of the extreme difficulty of controlling warfarin activity. Animals were submitted to blood sampling and transthoracic echocardiography at least twice in the follow-up when uneventful for up to three months or in case of health deterioration. The autopsy was performed by a certified pathologist after each spontaneous death or procured sacrifice. Results (Figure 1): Excluding 5 peri-operative deaths, 12 animals survived surgery. Of those, 6 died within the second month: pulmonary edema occurred in 3 cases, due to prosthesis-mismatch in the growing animals; pulmonary infection occurred in 1 subject; heart failure due to valve thrombosis occurred in 2 cases. Six swine were full-term survivors in good health status up to the 3-month planned observational time. No hemorrhagic events were ever documented. Conclusion The combination of edoxaban + aspirin effectively avoided valve thrombosis events in 10 out of 12 (83%) analyzable animals and was safe from bleeding complications. The study is ongoing up to a predicted sample size of ≥20 animals. If further confirmed, these data may open the possibility of an alternative to vitamin K antagonists in humans with the fixed-dose drug combination here used, without the need for continuous anticoagulation monitoring and with expected greater safety.Figure 1