Government Health Policy Research Articles

THE SINGLE PILL CONCEPT LEADS TO IMPROVED PERSISTENCE OF MEDICATION, CLINICAL OUTCOMES AND REDUCED ALL‐CAUSE MORTALITY IN HYPERTENSIVE PATIENTS – RESULTS FROM THE START PROJECT

Objective: ESC/ESH guidelines for the treatment of arterial hypertension recommend to start treatment with a single pill combination (SP) of a renin–angiotensin–system (RAS) blocker with a diuretic or a calcium channel blocker to improve drug persistence, blood pressure (BP) control and to reduce cardiovascular events. Escalation should be a SP triple combination. We aimed to assess whether the SP concept is superior to identical free combinations (FC) in terms of clinical outcomes, including all-cause mortality. Design and method: This exploratory analysis of an anonymized claims dataset from patients with hypertension and cardiovascular disease captured in the database of the governmental health insurance company (German AOK PLUS) in the years 2012–2017. 57,998 Patients aged 18 years and older treated with SP or identical FC were followed up for at least 1 year. After 1:1-Propensity Score Matching (PSM) persistence (redemption of prescription with a lack > 60 days) and clinical outcomes were compared using non-parametric tests. Results: No significant differences in baseline characteristics were observed after PSM. Each group included 10,801 patients with valsartan/amlodipine, 1,026 with candesartan/amlodipine, 1,823 with amlodipine/valsartan/hydrochlorothiazide (HCT), and 15,349 with ramipril/amlodipine as SP or identical FC. Eight different clinical outcomes were compared for each combination. In 27 of 32 comparisons, significantly lower incidence rate ratios (IRR) were identified for SP, confirmed by time-to-event-analyses. In the largest group (ramipril/amlodipine, n = 15,349), a significantly lower risk for stroke (IRR = 0.75; 95% CI 0.627–0.886; p < 0.001), transitory ischemic attack (IRR = 0.69; 95% CI 0.496–0.963; p = 0.023), myocardial infarction (IRR = 0.62; 95% CI 0.493–0.784; p < 0.001), coronary artery disease (IRR = 0.58; 95% CI 0.462–0.723; p < 0.001), heart failure (IRR = 0.47; 95% CI 0.409–0.534; p < 0.001), all cause hospitalization (IRR = 0.67; 0.652–0.687; p < 0.001), cardiovascular hospitalization (IRR = 0.60; 95% CI 0.519–0.685; p < 0.001), and all-cause mortality (IRR = 0.53; 95% CI 0.463–0.596; p < 0.001) was observed for SP versus FC. Conclusions: These results strongly support the ESC/ESH guidelines recommending the use of a SP in favor of FC to improve cardiovascular outcomes including all-cause mortality.

A12 PRE-TREATMENT HLADQA1-HLADRB1 TESTING FOR THE PREVENTION OF AZATHIOPRINE-INDUCED PANCREATITIS IN INFLAMMATORY BOWEL DISEASE: A PROSPECTIVE COHORT STUDY

Abstract Background Azathioprine (AZA) therapy has a long history of use in IBD. The need to promote its safe use in this population is ensured by governmental health policy requiring IBD patients to fail low cost drugs, such as AZA, prior to approving funding for more potent biologic therapies. AZA-induced pancreatitis is an idiosyncratic and unpredictable response, occurring in up to 7% of AZA-exposed patients that can lead to patient morbidity, hospitalization, delay in effective IBD management, as well as result in substantial additional health-related costs. There are no tools in clinical practice to identify individuals at risk of AZA-induced pancreatitis. Genetic variation in the HLADQA1-HLADRB1*07:01 haplotype is strongly associated with azathioprine (AZA)-induced pancreatitis in inflammatory bowel disease (IBD). Aims To evaluate whether HLA DQA1-HLADRB1*07:01A>C pre-treatment genotype testing in an adult IBD population prior to AZA therapy to guide AZA selection would result in a lower incidence of AZA-induced pancreatitis. Methods Participants with IBD (n=599) were screened for HLADQA1-HLADRB1*07:01A>C and participants with a variant genotype were excluded from azathioprine treatment (n=271). Wildtype participants (n=328) were started on azathioprine and followed for 3 months. The incidence of pancreatitis was compared to unscreened historical controls (n=373). Results The minor allele frequency of HLADQA1-HLADRB1*07:01 was 30.4% and 30.0% in the screened and unscreened populations respectively. Up to 45.2% of participants were excluded from AZA therapy based on genotype in the HLADQA1-HLADRB1*07:01A>C screened cohort. HLADQA1-HLADRB1*07:01A>C screening resulted in an 11-fold reduction in the odds of azathioprine-induced pancreatitis (0.30% versus 3.4%, OR=0.085, 95%CI=0.011–0.651, p=0.002). Conclusions HLA DQA1-HLADRB1*07:01A>C screening substantially reduced the risk of pancreatitis during AZA treatment in patients with IBD. However, using this strategy as a tool for guiding the use of AZA therapy in IBD may eliminate a large proportion of patients from being eligible for treatment with AZA. In regions, where there is access to other IBD therapies, and given the short and long term toxicities associated with AZA, HLA DQA1-HLADRB1*07:01A>C screening may be a clinically-relevant strategy for enhancing the safe use of AZA in IBD. Additionally, cost-effectiveness analyses are needed to further solidify the utility of HLA DQA1-HLADRB1*07:01A>C-screening in IBD populations. Funding Agencies Academic Medical Organization of Southwestern Ontario Innovation Fund

Health in all policies for rural and remote health: A role for Australian local governments?

AbstractThe role of local government in improving public health has been given legislative recognition in some Australian states. There is growing evidence of the positive role this statutory recognition has given to align local government efforts with state government health policy. Health in All Policies (HiAP) is a comprehensive approach to integrating public health, promoting components into a range of traditional local policies such as those relating to housing, transport and water. While much of the work internationally in HiAP has focused on urban populations, we argue that there are opportunities for rural and remote Australian local governments to use HiAP to respond to disparities in health outcomes amongst rural and remote Australian communities. We examine the Australian experiences with HiAP, the role for local governments and the future challenges and opportunities around the use of a HiAP approach to improve community health outcomes in rural and remote Australian communities.

The Age Structure, Stringency Policy, Income, and Spread of Coronavirus Disease 2019: Evidence From 209 Countries.

This article aims at answering the following questions: (1) What is the influence of age structure on the spread of coronavirus disease 2019 (COVID-19)? (2) What can be the impact of stringency policy (policy responses to the coronavirus pandemic) on the spread of COVID-19? (3) What might be the quantitative effect of development levelincome and number of hospital beds on the number of deaths due to the COVID-19 epidemic? By employing the methodologies of generalized linear model, generalized moments method, and quantile regression models, this article reveals that the shares of median age, age 65, and age 70 and older population have significant positive impacts on the spread of COVID-19 and that the share of age 70 and older people in the population has a relatively greater influence on the spread of the pandemic. The second output of this research is the significant impact of stringency policy on diminishing COVID-19 total cases. The third finding of this paper reveals that the number of hospital beds appears to be vital in reducing the total number of COVID-19 deaths, while GDP per capita does not affect much the level of deaths of the COVID-19 pandemic. Finally, this article suggests some governmental health policies to control and decrease the spread of COVID-19.

D-App for providing geriatric aid and to collect and handle periodic health survey data

The system aims to build a health survey platform designed to collect basic health information about residents of particular area. Block chain is used to store the collected information making sure only authenticated persons can have access to crucial information. This system also provides information about government health policies or schemes that the members of a family are eligible for and can have easy access to these facilities. This system can also be used as a platform to host health survey in case of an unexpected outbreak of a disease. Machine learning algorithms may be used predict health issues like the possible occurrence of epidemics etc. The system efficiently reduces the paperwork and inefficiency of traditional door to door health surveys by enabling each family to directly feed in their information.

Does High Public Trust Amplify Compliance with Stringent COVID-19 Government Health Guidelines? A Multi-country Analysis Using Data from 102,627 Individuals.

PurposeTo examine how public trust mediates the people’s adherence to levels of stringent government health policies and to establish if these effects vary across the political regimes.MethodsThis study utilizes data from two large-scale surveys: the global behaviors and perceptions at the onset of COVID-19 pandemic and the Oxford COVID-19 Government Response Tracker (OxCGRT). Linear regression models were used to estimate the effects of public trust and strictness of restriction measures on people’s compliance level. The model accounted for individual and daily variations in country-level stringency of preventative measures. Differences in the dynamics between public trust, the stringent level of government health guidelines and policy compliance were also examined among countries based on political regimes.ResultsWe find strong evidence of the increase in compliance due to the imposition of stricter government restrictions. The examination of heterogeneous effects suggests that high public trust in government and the perception of its truthfulness double the impact of policy restrictions on public compliance. Among political regimes, higher levels of public trust significantly increase the predicted compliance as stringency level rises in authoritarian and democratic countries.ConclusionThis study highlights the importance of public trust in government and its institutions during public health emergencies such as the COVID-19 pandemic. Our results are relevant and help understand why governments need to address the risks of non-compliance among low trusting individuals to achieve the success of the containment policies.

Неопределенность французской политической жизни: Сдвиг вправо и кризис представительной демократии

This article deals with the evolution of French politics between 2017 and 2020. Using systematic surveys, which are conducted by the Center for the Study of French Political Life and in which the author is directly involved he shows that President Macron’s policies have not succeeded in dissipating a democratic crisis affecting trust in political institution. The sanitary crisis had a great impact on the political situation in the country. In France, the crisis associated with Covid-19 was manifested not in the confrontation of political forces, but in the criticism of the government by civil society and in the growth of populism. In this respect, France is very different from Germany, where there is a general public consensus, and Great Britain, where confidence in the system-forming parties remains. Populism has gained ground in French politics and explains, more than any other factor, both the distrust in the Presidency and in government health policies. The rise of left-wing and rightwing populism has not led to the disappearance of the division between left and right. A shift toward right values and State intervention can be observed in French public opinion, changing the electoral game for the 2022 presidential campaign.

RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís): history, objectives and methods.

This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.

Strengthening prevention of nutrition-related non-communicable diseases through sugar-sweetened beverages tax in Rwanda: a policy landscape analysis

ABSTRACT Background: Food and beverages high in sugar are recognized to be among the major risk factors for nutrition-related non-communicable diseases. The growing presence of ultra-processed food producers has resulted in shifts to diets that are associated with non-communicable diseases and which include sugar-sweetened beverages. Sugar-sweetened beverage taxation presents an opportunity to prevent non-communicable diseases but it comes with challenges. Objectives: To describe the policy landscape, identify and analyse the facilitators of and barriers to strengthening taxation on sugar-sweetened beverages in Rwanda. Methods: We conducted a desk-based policy analysis to assess the facilitators of and barriers to strengthening sugary beverage taxation policy. We consulted eight stakeholders to validate the findings of the desk review. Results: Non-communicable diseases are recognized as a public health challenge in Government health and non-health policy documents. However, sugar intake is not explicitly identified as a risk factor for non-communicable diseases and existing policies do not clearly aim to reduce sugar consumption. The Rwandan Government's commitment to growing the local sugar industry and the substantial economic contribution of Rwandan beverage producers are potential barriers to fiscal policies aimed at reducing sugar consumption. However, the current 39% excise tax levied on all soft drinks could support the adoption of future sugar-sweetened beverage policies. Conclusions: The landscape for strengthening a sugar-sweetened beverage tax in Rwanda is complex. The policy environment provides both facilitators of and impediments to strengthening the existing tax. A differential tax could be introduced by leveraging on the existing excise tax and linking it to the sugar content of beverages.

Strategies for financing social health insurance schemes for providing universal health care: a comparative analysis of five countries

ABSTRACT Background: Universal Health Coverage has become a political priority for many African countries yet there are clear challenges in achieving this goal. Though social health insurance is considered a mechanism for providing financial protection, less well documented in the literature is evidence from countries in Africa who are at various stages of adopting this financing strategy as a way to improve health insurance coverage for their populations. Objectives: The study investigates whether social health insurance schemes are effectively and efficiently covering all groups. The objective is to provide evidence of how these schemes have been implemented and whether the fundamental goals are met. The selected countries are Ghana, Rwanda, Tanzania, Kenya and Ethiopia. The study draws lessons from the literature about how policy tools can be used to reduce financial barriers whilst ensuring a broad geographic coverage in Africa. Methods: The study relies primarily on a review of literature, both documented and grey matter, which include key documents such as government health policy documents, strategic plans, health financing policy documents, Universal Health Coverage policy documents, published literature, unpublished documents, media reports and National Health Accounts reports. Results: The results show that each of the selected countries relies on a plurality of health insurance schemes with each targeting different groups. Additionally, many of the Social Health Insurance programs start by covering the formal sector first, with the hope of covering other groups in the informal sector at a later stage. Health insurance coverage for poor groups is very low, with targeting mechanisms to cover the poor in the form of exemptions and waivers achieving no desirable results. Conclusions: The ability for Social Health Insurance programs to cover all groups has been limited in the selected countries. Hence, relying solely on social health insurance schemes to achieve Universal Health Coverage may not be plausible in Africa. Also, highly fragmented risk pools impede efforts to widen the insurance pools and promote cross-subsidies.

A case of COVID-19 reinfection in the UK

Protective immunity following COVID-19 infection is not yet fully understood. An understanding of COVID-19 reinfection will be key in guiding government and public health policy decisions in the coming months. This report describes two distinct infective episodes of COVID-19 occurring in the same individual, at the time of writing the first published case in the UK. In April 2020 a 25-year-old UK doctor exhibited classical COVID-19 symptoms, including fevers, headaches, and fatigue. A COVID-19 nucleic acid amplification test (NAAT) at the time returned negative. However, a follow-up antibody test in May 2020 returned positive. In October 2020 the same individual exhibited coryzal symptoms and headaches. He was COVID-19 NAAT tested and found to be positive. There was exposure to high viral load prior to reinfection. Overall the second infection was symptomatically milder, with a faster recovery. This evidence for reinfection poses challenges for public health and vaccination efforts to protect against the COVID-19 pandemic.

Understanding the Drivers of Wearable Health Monitoring Technology: An Extension of the Unified Theory of Acceptance and Use of Technology

The market for wearable health monitoring technology is promising globally and in Saudi Arabia particularly. The country has a very high prevalence of chronic diseases that can be managed using wearable health monitoring technology. However, wearable devices are not fully advantageous if people do not accept them. Due to the parsimony of studies on the acceptance of wearable health monitoring technology, understanding the key drivers of using wearable health monitoring technology remains uncertain. This cross-sectional study extends the extended unified theory of acceptance and use of technology (UTAUT2) to explain the variance in the adoption intention of wearable health monitoring technology. A total of 256 responses were analyzed using the partial least squares structural equation modeling technique, in addition to the importance-performance map analysis. The results indicate that performance expectancy (PE), social influence (SI), facilitating conditions (FC), hedonic motivation (HM) and habit (HA) significantly impact users’ behavioral intention (BI) to adopt wearable health monitoring technology. The results also demonstrate that effort expectancy (EE), price value (PV), government health policy (GHP) and trust (TR) are not important. Based on the findings, this research presents a set of recommendations for decisions makers, managers and system developers in the healthcare sector to enhance the use and quality of wearable technology.

The COVID-19 Pandemic Exposes Fatal Health Inequities

As stated in the United Nations Universal Declaration of Human Rights, health is a fundamental human right. However, we find ourselves in the midst of the COVID-19 pandemic with a shortage of both human and material health resources, most of which must be sourced from the private sector. Some of the wealthiest countries—France, Italy, Spain, the United Kingdom, and the United States—have proved unable to respond rapidly. The evolution of public health over the past four decades, during which government health policies have reduced health services to commodities and objects of speculative investment, has led to the current crisis.

Prevalence of Urinary Schistosomiasis among Clients Attending Private Medical Laboratory Diagnostic Center in Karshi, Abuja, Nigeria

Urinary Schistomiasis is one of the global public health problems. A study on the prevalence of urinary Schistosomiasis was carried out among clients attending private medical laboratory center in Karshi, Abuja, Nigeria. The study was carried out among 210 clients comprised 50 males and 70 females aged 11-50years between August 2019 to February, 2020.Single urine samples were collected from the clients between 10.00hours and 14.00hours were examined for the presence of S. haematobium in eggs using centrifuged techniques. Morbidity indicators of haematuria and proteinuria was determined using reagents strips. Out of 210 subjects examined 16(7.6%) had the eggs of S. haematobium in their urine. The results show that males were more infected than the females with 4.8% and 2.8% respectively. The infection rate varied according to age group where 21-30 years age group had highest infection rate 3.3% and age 41-50years had the least prevalence rate 1.0%.The chemical analysis carried out shows that proteinuria had highest prevalence 20.5% and haematuria had 16.7%.Distribution according to marital status show that single had higher prevalence of 5.7% and married had the least 1.9%.There was no statistically significance relationship between all the variables and prevalence of urinary schistosomiasis. From the results of this study, it was concluded that schistosoma haematobium was less prevalent in this study area. Studies strongly suggest that health education on the modes of transmission be promoted and strengthened to achieved total eradication of the disease in the area. Authors recommended the inclusion of private medical laboratory into the government health policies on urinary schistosomiasis.

Estimating model-based nonnegative population marginal means in application to medical expenditures covered by different health care policies - A study on Medical Expenditure Panel Survey.

The medical care expenditure is historically an important public health issue, which greatly impacts the government's health policies as well as patients' financial and medical decisions. In population health research, we commonly discretize a numeric attribute to a few ordinal groups to examine population characteristics. Oftentimes, the population marginal mean estimation by the ANOVA approach is inflexible since it uses pre-defined grouping of the covariate. In this paper, we propose a method to estimate the population marginal mean using the B-spline-based regression in a manner of a generalized additive model as an alternative for the ANOVA. Since the medical expenditure is always nonnegative, a Bayesian approach is also implemented for the nonnegative constraint on the marginal mean estimates. The proposed method is flexible to estimate marginal means for user-specified grouping after model fitting in a post-hoc manner, a clear advantage over the ANOVA approach. We show that this method is inferentially superior to the ANOVA through theoretical investigations and an extensive Monte Carlo study. The real data analysis using Medical Expenditure Panel Survey data assisted by some visualization tools demonstrates an applicability of the proposed approach and leads us some interesting observations that may be relevant to public health discussions.

Building Community and Transforming Knowledge: Histories of Women's Health Practitioners and Community-Based Health Services in 20th-Century Alberta, Canada.

As new government health policy was created and implemented in the late 1910s and the late 1960s, women patients and health practitioners recognized gaps in the new health services and worked together to create better programs. This article brings the histories of the district nursing program (1919-43) and local birth control centres (1970-79) together to recognize women's health provision (as trained nurses or lay practitioners) as community-based and collaborative endeavours in the province of Alberta. The district nursing and birth control centre programs operated under different health policies, were influenced by different feminisms, and were situated in different Indigenous-settler relations. But the two programs, occurring half a century apart, provided space for health workers and their patients to implement change at a community level. Health practitioners in the early and late twentieth century took women's experiential knowledge seriously, and, therefore, these communities formed a new field of women's health expertise.

Commentary on Jin et al. (2020): Regulatory and allocative policies inform access to opioid agonist therapy.

Opioid agonist therapy (OAT) access is restricted by regulatory and allocative treatment policies. Oppressive social conditions inform the creation and implementation of policies and treatment systems that limit access to life-saving care. Jin et al. [1] had the difficult task of summarizing opioid agonist therapy (OAT) delivery practice indicators from around the world (n = 41 countries). They observed variation in OAT eligibility criteria (e.g. age, step-therapy), increased frequency of OAT underdosing, differences in access to unsupervised OAT dosing, variation in urine drug screen practices, and concerningly, the provision of patient information to law enforcement agencies in some jurisdictions [1]. The review, however, did not explicitly explore how broader structural elements inform OAT clinical practice and treatment system design, specifically, policy. Access to OAT is informed through an amalgamation of contemporary and historic social conditions (e.g. racism, classism, capitalism, and moralism/stigma) and how society and decision makers conceptualize addiction (e.g. moral/criminal model versus brain disease model [2]). In turn, these elements are institutionalized through regulatory and allocative treatment policies, dictating the design of treatment systems, which subsequently influences how OAT is delivered (where, when, and by whom) and who receives care. In the United States (US), OAT is regulated unlike any other pharmaceutical product. Methadone and buprenorphine administration and prescribing occur within the context of special regulatory systems. Methadone must be dispensed, often through observed daily dosing, in federally certified opioid treatment programs (OTPs) [3]. To prescribe buprenorphine, physicians must receive a special federal-waiver (i.e. the X-waiver) and are limited in the number of patients they can prescribe to [3]. In contrast, in Canada, methadone and buprenorphine may be prescribed and administered through the pharmacy system without special federal requirements [4]. This special regulatory apparatus is just one of several categories of OAT access barriers (e.g. provider, institutional, and financial among others) [5]. Furthermore, the two-tiered design of the US OAT regulatory system [6-8] propagates OAT access inequities, based on race [9, 10], class [10], and educational-demographics [11]. OTPs across the US are more likely to be located in highly segregated Black and Hispanic/Latinx neighborhoods, compared with buprenorphine, which is more readily available in highly segregated White neighborhoods [9]. In a study of office-based buprenorphine access, Black patients are less likely to receive buprenorphine (adjusted OR = 0.23; 95% CI = 0.13–0.44) as compared with White patients [10]. These findings build on the original evaluation of the buprenorphine waiver system where researchers observed differences among patients who received buprenorphine versus methadone; specifically, buprenorphine patients were more likely to be White, employed, and with some college education [11]. In addition to differences in access by OAT type, racial disparities in OAT access persist. Compared with White women, Black and Hispanic women are significantly less likely to receive any medication for OUD treatment [12]. Similarly, Black veterans receiving care in the Veterans Health Administration have lower odds of starting buprenorphine compared to White patients [13]. In addition to regulatory constraints, allocative policies inform and dictate OAT access. This is of particular importance in societies where the delivery of health care services is commodified and privatized [14]. In the US, a standardized national health insurance program or delivery system does not exist; instead, the US has a fragmented collection of governmental health insurance programs for specific sub-populations (e.g. Medicare, Medicaid, and Tricare), and for-profit and not-for-profit health insurance enterprises. A commodified health services delivery and health insurance market aims to “…optimize the market from their perspective and for their benefit” [15]. Therefore, the US economic production system informs and dictates health care service delivery, which is reflected in payer polices, and, subsequently, access to OAT [16]. Until recently (January 2020), for example, Medicare, the US federally sponsored health insurance plan for patients age 65 and above and those with disabilities, did not cover services received in an OTP [17]. Moreover, private Medicare Part D plans decreased buprenorphine coverage options from 2007 to 2018, as opioid-related overdoses were increasing [18]. Further, many Medicaid programs continue to impose buprenorphine coverage restrictions [19]. Access to OAT, in the US and internationally, is undoubtedly constrained and restricted by federal and local regulatory and allocative treatment policies. Social conditions and oppressive elements inform the creation and implementation of these policies, treatment system design, and subsequently access to care. None. Many thanks to Dr. Dennis McCarty for his comment and review of this commentary. National Institute on Drug Abuse (F30DA044700). The content of this manuscript does not represent the views of the US Government.

Perception Pertaining to Oral and Systemic Health: A Mixed Method Model

Background: Oral health is an indispensible part of general health is an often ignored by masses including health care personnel. There have been health policies launched by the government recently including oral care but to what extent the people are aware of these policies are yet to be assessed. Aim: To assess the oral health status and perception pertaining to link between oral and systemic health, Ayushman Bharath Yojana and the concept of Universal Health Coverage (UHC) amongst the people visiting the exhibition on 64th Institute Day, AIIMS, New Delhi, India. Materials and Methods: People who came to the dental booth at the exhibition over a period of 3 days from 25th September 2019 to 27th September 2019, fulfilling the inclusion criteria were included in the study. Data collection was performed through clinical examination and open ended questionnaire for the assessment of perception regarding association between oral health and systemic health, concept of Universal Health Coverage and Ayushman Bharath Yojana. Result: Mean DMFT score was found to be 2.6 ± 3.4, 41.3% had bleeding on probing, 2.8% showed dental trauma and 2% had dental fluorosis. Nearly 73.6% felt that oral health does affect general health. Majority of the study population was not aware of the concept of UHC. Around 60% participants were aware of the Ayushman Bharath Yojana. Conclusion: The study findings conclude the need to spread awareness amongst masses about government health policies and effects of oral health on general health.

Barriers and Limitations to Obstacle Diabetes Self-Management with a Focus on Nutritional Literacy: Solutions and Opportunities. Critical Review and Research Synthesis

Background: Researchers should seek applicable solutions and appropriate opportunities to solve or ravage barriers and limitations that worsen diabetes self-management and outcomes.
 Objectives: The aim of this critical review and research synthesis was to explore whether the enhancement of nutritional literacy can optimize diabetes self-management and to identify barriers and limitations that obstacle diabetes self-management and to suggest the best available solutions and opportunities that were tailored to eliminate these barriers.
 Methods: Data sources were PubMed and Medline databases. Studies were authorized if they were in English, used an observational or interventional design and were tailored based on the individual's nutritional knowledge or literacy in diabetes management among patients with diabetes. Databases were searched from February 1988 to December 2018. In order to evaluate the studies' quality, the abstracts that met PICO criteria for qualitative studies underwent dual review for data extraction. A qualitative synthesis was also conducted and the GRADE criteria were used to evaluate the quality of studies.
 Results: A structured inventory consisted of six constructs (socioeconomic determinants, cultural determinants, education, access to health care services, family structure, and thoughts and personal practices) was designed based on the barriers and limitations. As a result, 151 solutions and opportunities were proposed. Most repeated solutions that were frequently suggested to eliminate the existing barriers, were: “The access to optimal nutrition and health literacy”, “Improved health care services”, “Health policies of governments”, “Sustainable lifestyle-based healthcare system”, “Proper implementation of nutritional intervention programs”, and “Comprehensive culturally sensitive diabetes education, and care programs”.
 Conclusion: Identification and classification barriers and limitations to obstacle diabetes self-management are critical advances in accomplishing the interventions that can improve optimal diabetes outcomes, for different diabetic societies. Well-designed nutrition literacy intervention programs and preventive procedures may ameliorate the health status in diabetic population.

Decontamination methods of personal protective equipment for repeated utilization in medical/surgical settings

The COVID-19 pandemic has affected citizens and healthcare workers worldwide due to a number of important factors. The transmission of the SARS CoV-2 microorganism, the pathogen that causes COVID-19 infection, occurs through droplet and aerosol spread due to coughs and sneezes from infected patients. A panicked public began hoarding medical supplies and personal protective equipment (PPE), leaving healthcare workers to care for patients without adequate protection. A literature review was conducted to better understand the options available to hospital and healthcare system administrators as they develop necessary protocols for the conservation and possible reuse of PPE. This review is based upon the peer-reviewed studies of various scientific investigators, biotechnology researchers, governmental agency health officials, including meta-analyses, preliminary/pilot studies, and policy statements. Current findings indicate that extended usage of N95 respirators is practical since there are methods available for the decontamination/repeated use of N95 respirators. In evaluating the efficacy of such methods, the safety of healthcare workers is important in deciding which method to recommend. Available evidence supports the use of the Bioquell Hydrogen Peroxide Vapor (HPV) system for decontaminating N95 respirators. Information on other PPE will also be discussed about more specific items. Informed decisions regarding the policies of hospitals and healthcare systems must be considered, and with the safety of healthcare workers in mind, both factors influenced the recommendations made in this comprehensive review.