Ministry Of Health Research Articles

Characteristics of Pulmonary Tuberculosis patients with HIV in Regional General Hospital Dr Harjono Ponorogo period January 2018 – December 2022

Tuberculosis (TB) is the most common opportunistic infection in people living with HIV/AIDS in Indonesia, and HIV infection promotes Mycobacterium tuberculosis infection. In ODHIV, the probability of contracting TB is 10% per year. According to the Indonesian Ministry of Health, East Java is in second place with 71,909 cases and has the second highest number of AIDS patients and 824,000 TB cases in Indonesia. This study aims to determine the characteristics of pulmonary tuberculosis patients with HIV at DR Harjono Ponorogo Hospital for the period January 2018 - December 2022. This study applied descriptive research methodology with quantitative techniques with secondary data from medical records of pulmonary TB patients with HIV at Dr. Harjono Ponorogo Hospital for the period January 2018 - December 2022. The results showed a total sample of 130 medical records, there were several characteristics of TB patients with HIV, namely the highest age group of 30-39 years by 29.2%, more in male gender 73%. More patients had last high school education 38.5%, more treatment duration in patients who did for 9 months 61.5% and the results showed more patients with poor prognosis 56%. In conclusion, the characteristics of TB patients with HIV with the highest group at the age of 3-39 years, having male gender, more high school education, with more treatment duration of 9 months, and the results showed a poor prognosis.

The Cancer Clinical Library Database (CCLD) from the Korea-Clinical Data Utilization Network for Research Excellence (K-CURE) Project.

The common data model (CDM) has found widespread application in healthcare studies, but its utilization in cancer research has been limited. This article describes the development and implementation strategy for Cancer Clinical Library Databases (CCLDs), which are standardized cancer-specific databases established under the Korea-Clinical Data Utilization Network for Research Excellence (K-CURE) project by the Korean Ministry of Health and Welfare. Fifteen leading hospitals and fourteen academic associations in Korea are engaged in constructing CCLDs for 10 primary cancer types. For each cancer type-specific CCLD, cancer data experts determine key clinical data items essential for cancer research, standardize these items across cancer types, and create a standardized schema. Comprehensive clinical records covering diagnosis, treatment, and outcomes, with annual updates, are collected for each cancer patient in the target population, and quality control is based on six-sigma standards. To protect patient privacy, CCLDs follow stringent data security guidelines by pseudonymizing personal identification information and operating within a closed analysis environment. Researchers can apply for access to CCLD data through the K-CURE portal, which is subject to Institutional Review Board and Data Review Board approval. The CCLD is considered a pioneering standardized cancer-specific database, significantly representing Korea's cancer data. It is expected to overcome limitations of previous CDMs and provide a valuable resource for multicenter cancer research in Korea.

Continued Increase in Incidence of Kidney Cancer in Iran and its 31 Provinces

Background: Kidney cancer in adults includes malignant tumors originating from the parenchyma and pelvis and is the most lethal urogenital cancer. Available data in Iran indicate that the incidence and pattern of this cancer are changing. Objectives: Our study aimed to present an updated incidence rate of kidney cancer in Iran and its 31 provinces and their trends, and climate zones distribution of the disease. Methods: In this study, the age standard incidence rate (ASIR) of kidney cancer based on provinces, age groups, and gender has been calculated using the available data in the national cancer registration system of the Ministry of Health from 2003 to 2016. Results: Overall ASIR of kidney cancer was 1.28 per 100,000 from 2003 to 2016. ASIR of this cancer in men has increased from 0.96 in 2003 to 3.66 in 2016 and similarly, reached from 0.61 in 2003 to 2.24 in 2016 in Iran. Fars, Yazd, Tehran and Isfahan provinces had the highest ASIR in Iran. Hot climate zones are associated with a higher incidence of kidney cancer while moderate climate is linked to lower incidence rates in Iran. Conclusions: Although the incidence rate of kidney cancer in Iran and its provinces is low, the increasing trend is concerning particularly among men. Therefore, it is crucial to develop cost-effective screening tests and implement control and prevention programs in the high-incidence provinces.

A review on the crisis of antibiotic resistance and the strategies to combat resistance

Abstract The discovery of antibiotics has caused a huge impact on the history of the entire health-care system. The irrational and excessive use of antibiotics has become futile and has given rise to another serious issue known as antibiotic resistance, which is now a threat to the health-care sector. Due to this, millions of deaths are occurring worldwide every year as infections are becoming difficult to treat as a result of resistance to the antibiotics that are used to treat them. Thus, the confidence of the global health-care system is ruined. The WHO has recognized antibiotic resistance as a serious issue that needs to be addressed and has declared tackling it a high priority. Even though complete eradication of antibiotic resistance is not possible, the spread and the incidence of resistance can be reduced by taking adequate measures. Combating antimicrobial resistance is, therefore, a prime need of the and various strategies have been adopted globally. This article primarily focuses on the phenomenon of antibiotic resistance, the mechanisms of resistance, various reasons that contribute to it, and the strategies adopted to combat the global crisis. Here, we have reviewed articles on antibiotic resistance from scientific websites such as PubMed Central, NCBI, Science Direct, and Google Scholar, and the strategies have been taken from the official website of the WHO, Indian Council of Medical Research, and the guidelines issued on this by the Ministry of Health and Family Welfare Government of India and Government of Kerala.

The managers' perspectives on service providing in women's harm reduction centers during the COVID-19 pandemic: mixed method study

BackgroundThe COVID-19 pandemic posed significant challenges for managers overseeing women's harm reduction centers. This study seeks to capture managers' perspectives on the service providing in women's harm reduction centers during the COVID-19 pandemic.MethodsThis convergent mixed-method study conducted in three provinces of Iran: Tehran, Khuzestan, and Kermanshah. The study was carried out between January and May 2023. In the quantitative part, the researchers utilized reports from 10 center managers. A researcher-designed questionnaire was employed to collect data on a wide range of services and referrals provided by the centers. The qualitative part of the research involved conventional content analysis and included 12 individual interviews. Two directors from the Ministry of Health and ten managers of women’s harm reduction centers participated in the interviews. During the interpretation phase, the researchers compared the quantitative and qualitative findings to obtain a comprehensive understanding of the topic.ResultsDuring the quantitative stage of the study, it was observed that all the managers were women, with an average age of 40.7 ± 7 years. More than half of the managers had obtained a postgraduate education (n = 6, 60%), and a majority of them were married (n = 7, 70%). Additionally, 40% of the managers (n = 4) were working as contractors. During the non-COVID-19 period, there were higher coverage by centers and residents, more referrals of non-injecting drug users and sex workers, and a higher number of group counseling sessions in all three provinces compared to the COVID-19 period. The qualitative analysis revealed two primary themes: "challenges" and "capabilities."ConclusionsDuring the COVID-19 pandemic, providing some services and client referrals decreased in the centers, and center managers faced increased challenges. Many of these challenges were in the communication, executive, management, structure, education, financial, civilization, facilities, and socio-cultural sectors. Managers used their skills to manage and control these challenges. It is important to focus on these challenges and managerial capabilities to effectively handle future crises.

Clinical Efficacy And Safety of Long-Term Treatment Of Tenofovir Alafenamide Vs Tenofovir Disoproxil Fumarate for Chronic Hepatitis B in Vietnam.

Hepatitis B virus (HBV) infection is a contagious condition posing a major public health risk in various nations including Vietnam. In 2019, the Ministry of Health introduced tenofovir alafenamide (TAF) to treat patients with chronic HBV infection and reduce the long-term toxicity of tenofovir disoproxil fumarate (TDF). This study aimed to assess the effectiveness and safety of these two medications in individuals with HBeAg-positive chronic HBV. This retrospective cohort study included data collected from the medical records of patients with chronic HBV who visited the Liver Clinic at University Medical Center HCMC between 2018 and 2020. After two years of treatment, the proportion of HBeAg loss in the TAF group was twice that of the TDF group (22.4% vs. 11.2%), indicating a statistically significant difference in the probability of HBeAg loss (adjusted hazard ratio = 2.22; 95% CI 1.43 to 3.42; p < 0.01). Additionally, there was a statistically significant difference in the rate and ability of antiviral response between patients treated with TAF and TDF (65% vs. 54.5%, respectively; adjusted hazard ratio = 1.34; 95% CI 1.08 to 1.69; p < 0.01). 93.9% of patients achieved the goal of restoring ALT to normal, a higher percentage compared to the 81.2% in the TDF group, and the likelihood of achieving normal ALT levels with TAF was greater compared to those on TDF (adjusted hazard ratio = 1.67; 95% CI 1.38 to 2.01; p < 0.01). Moreover, there was a statistically significant difference in the variation in renal function between the TAF and TDF groups. Serum creatinine levels in the TAF group increased less than those in the TDF group by 0.03 mg/dL every 6 months (95% CI -0.04 to -0.01, p < 0.01), and the eGFR in the TAF group was higher than that in the TDF group every 6 months by 2.78 mL/min/1.73 m2 (95% CI 0.98 to 4.57, p < 0.01). However, there was no statistically significant difference in the likelihood of HBeAg seroconversion between chronic hepatitis B patients treated with TAF or TDF (adjusted hazard ratio = 1.79; 95% CI 0.91 to 3.53; p = 0.09), nor in the risk of adverse events between the two groups (adjusted odds ratio = 1.34; 95% CI 0.88 to 2.05; p = 0.17). Additionally, although the HBsAg concentration in the TAF group was lower than in the TDF group by an average of 0.05 log10 IU/mL every 6 months (95% CI -0.15 to 0.05), this difference also did not reach statistical significance (p = 0.35). TAF has been demonstrated to achieve some therapeutic efficacy goals and reduce nephrotoxicity better than TDF. However, no differences were found in seroconversion or adverse events between the patient groups.

Healthcare workers’ views on decentralized primary health care management in Lesotho: a qualitative study

BackgroundLesotho experienced high rates of maternal (566/100,000 live births) and under-five mortality (72.9/1000 live births). A 2013 national assessment found centralized healthcare management in Ministry of Health led to fragmented, ineffective district health team management. Launched in 2014 through collaboration between the Ministry of Health and Partners In Health, Lesotho’s Primary Health Care Reform (LPHCR) aimed to improve service quality and quantity by decentralizing healthcare management to the district level. We conducted a qualitative study to explore health workers’ perceptions regarding the effectiveness of LPHCR in enhancing the primary health care system.MethodsWe conducted 21 semi-structured key informant interviews (KII) with healthcare workers and Ministry of Health officials purposively sampled from various levels of Lesotho’s health system, including the central Ministry of Health, district health management teams, health centers, and community health worker programs in four pilot districts of the LPHCR initiative. The World Health Organization’s health systems building blocks framework was used to guide data collection and analysis. Interviews assessed health care workers’ perspectives on the impact of the LPHCR initiative on the six-health system building blocks: service delivery, health information systems, access to essential medicines, health workforce, financing, and leadership/governance. Data were analyzed using directed content analysis.ResultsParticipants described benefits of decentralization, including improved efficiency in service delivery, enhanced accountability and responsiveness, increased community participation, improved data availability, and better resource allocation. Participants highlighted how the reform resulted in more efficient procurement and distribution processes and increased recognition and status in part due to the empowerment of district health management teams. However, participants also identified limited decentralization of financial decision-making and encountered barriers to successful implementation, such as staff shortages, inadequate management of the village health worker program, and a lack of clear communication regarding autonomy in utilizing and mobilizing donor funds.ConclusionOur study findings indicate that the implementation of decentralized primary health care management in Lesotho was associated a positive impact on health system building blocks related to primary health care. However, it is crucial to address the implementation challenges identified by healthcare workers to optimize the benefits of decentralized healthcare management.

Estimation of self-funded human papillomavirus vaccine recipients from Japan's previously assumed "unvaccinated generation".

Precise vaccination data is essential to accurately estimate the effectiveness of the human papillomavirus (HPV) vaccine against HPV-related cancers. In Japan, the number of subsidized HPV vaccinations can be tracked through registries, but the number of self-funded vaccinations has not been tracked. The number of individuals who chose to receive the vaccine at their own expense, despite being ineligible for public subsidies due to their age, is unknown and has been nominally considered to be zero. Our aim is to produce a more accurate estimate of this number using recently released proprietary data. First, we estimated the total number of self-funded HPV vaccinations occurring from 2010 to 2012 using public data from the Ministry of Health, Labour and Welfare and our previously reported data on the number of HPV vaccinations eligible for public subsidy. Second, using proprietary data from the vaccine manufacturer, we calculated the distribution of self-funded vaccination shots by age. Finally, we combined these data to estimate the number of self-funded HPV vaccinations by birth fiscal year (FY) relative to a yearly reference population. We found that 78,264 individuals born in FY1993 and 58,190 born in FY1992 self-funded their vaccinations, representing 13.6% and 10.0% of the reference population, respectively. Additionally, we found that 5%-10% of individuals born from FY1986 to FY1991 self-funded their vaccinations. Our study revealed for the first time that a certain number of individuals from the "HPV unvaccinated generation," ineligible for subsidies due to age restrictions, chose to self-fund their vaccinations.

Revisions to the requirement of the Japanese clinical study data for biosimilar developments in Japan

ABSTRACT Background The ‘Questions and Answers (Q&A)’ document regarding Japanese biosimilar guideline elucidated that Japanese participant enrollment in at least one comparative clinical study was required for the marketing authorization application (MAA) of biosimilars in Japan. Research design and methods To discuss the requirement of Japanese clinical study data for biosimilar development, the trend in comparative clinical studies conducted for approved biosimilars of monoclonal antibodies and fusion proteins was analyzed, and the consistency of the results between the overall population and the Japanese population according to the publicly available information was reviewed. Results The number of comparative clinical studies enrolling Japanese participants was 25 cases, and the type and percentage were 13 (52%) and 12 (48%) cases of comparative pharmacokinetic study and comparative efficacy study, respectively. In all comparative clinical studies, consistent results between the overall population and the Japanese population were shown. Conclusions Our study indicated that Japanese participant enrollment in comparative clinical studies may not always be necessary for biosimilar development when certain conditions are satisfied. This has been described in the revised Q&A document published by the Ministry of Health, Labour and Welfare in January 2024.

High Incidence of Gastric Cancer in El Salvador: A National Multisectorial Study 2000-2014.

Gastric adenocarcinoma (GC) is the fourth leading cause of global cancer mortality, and leading infection-associated cancer. GC has significant geographic variability, with a high incidence in East Asia and mountainous regions of Latin America. In the U.S., GC represents a marked disparity with incidence rates that are 2-3 times higher in Hispanics compared to non-Hispanic whites. We conducted a national retrospective study of incident GC in El Salvador from to 2000-2014 to estimate the age-standardized incidence rate (ASIR) by using a combination of pathology and endoscopy databases. A unique multisectorial coalition was formed between the Ministry of Health (MINSAL) and ES Gastroenterology Society (AGEDES), representing public hospitals (n=5), governmental employee hospitals (ISSS, n=5), and private facilities (n=6), accounting for >95% of national endoscopy capacity. HER2 and EBV tumor status was ascertained in a representative sample during 2014-2016. 10,039 unique cases of GC were identified, 45.5% female, and mean age of 65. 21% and 9.4% were <55 and <45 years old, respectively. ASIRs (M, F) were 18.9 (95%CI;14.4-20.7) and 12.2 per 100,000 persons (95%CI;10.9-13.5), respectively, in the period 2010-2014 with all centers operational. Intestinal GC was 2.8 times more common than diffuse GC. 23.2% had partial or complete pyloric obstruction. The HER2 2+/3+ status was 16.7% and EBER positivity was 10.2%. A high incidence of gastric cancer was confirmed in El Salvador, and nearly half of patients were female. The findings have implications for cancer control in the Central America LMICs and for U.S. Latino populations.

High Incidence of Gastric Cancer in El Salvador: A National Multisectorial Study 2000-2014.

Gastric adenocarcinoma (GC) is the fourth leading cause of global cancer mortality, and leading infection-associated cancer. GC has significant geographic variability, with a high incidence in East Asia and mountainous regions of Latin America. In the U.S., GC represents a marked disparity with incidence rates that are 2-3 times higher in Hispanics compared to non-Hispanic whites. We conducted a national retrospective study of incident GC in El Salvador from to 2000-2014 to estimate the age-standardized incidence rate (ASIR) by using a combination of pathology and endoscopy databases. A unique multisectorial coalition was formed between the Ministry of Health (MINSAL) and ES Gastroenterology Society (AGEDES), representing public hospitals (n=5), governmental employee hospitals (ISSS, n=5), and private facilities (n=6), accounting for >95% of national endoscopy capacity. HER2 and EBV tumor status was ascertained in a representative sample during 2014-2016. 10,039 unique cases of GC were identified, 45.5% female, and mean age of 65. 21% and 9.4% were <55 and <45 years old, respectively. ASIRs (M, F) were 18.9 (95%CI;14.4-20.7) and 12.2 per 100,000 persons (95%CI;10.9-13.5), respectively, in the period 2010-2014 with all centers operational. Intestinal GC was 2.8 times more common than diffuse GC. 23.2% had partial or complete pyloric obstruction. The HER2 2+/3+ status was 16.7% and EBER positivity was 10.2%. A high incidence of gastric cancer was confirmed in El Salvador, and nearly half of patients were female. The findings have implications for cancer control in the Central America LMICs and for U.S. Latino populations.

Performance Power: Boosting Saudi Arabia’s Health System Disaster Readiness (2017–2023)

Introduction: The 2016 self-assessment based on joint external evaluation (JEE) identified certain gaps, which prompted the need for additional improvement. This study attempted to address an approach to enhance preparedness using the performance management system’s components focusing on related areas in the JEE tool by the International Health Regulations (IHR). Methods: This was an observational cross-sectional study including all hospitals and regional health directorates within the Ministry of Health, Saudi Arabia. Entities preparedness was calculated using the JEE tool. Moreover, the implementation of the performance management system was also assessed for Saudi Arabia from the year 2017 to 2022. Additionally, the feedback was collected using the survey from the 11 National Preparedness Index (NPI) coordinators. Results: Total readiness was found to be 52% only, which was far less than the planned value of 75%. While regarding the implementation of the performance management system, it was noted that there was a progressive increase in the implementation from 10% in the year 2017 to 81.25% in the year 2022. Considering the feedback responses of NPI coordinators, it was found that 100% of coordinators agreed that the NPI has supported enhancing Health emergency preparedness and that the follow-up and support from the NPI team played an important role in NPI score improvement. Conclusion: The analysis indicated that while there are areas of progress, Saudi Arabia is still working on strengthening fundamental public health functions and emergency preparedness. This is evident when comparing a range of indicators with those of many countries under the purview of the World Health Organization (WHO).

The utility of website-based quality improvement tools for health professionals: a systematic review.

As technology continues to advance, it is important to understand how website-based tools can support quality improvement. Website-based tools refer to resources such as toolkits that users can access and use autonomously through a dedicated website. This review examined how website-based tools can support healthcare professionals with quality improvement, including the optimal processes used to develop tools and the elements of an effective tool. A systematic search of seven databases was conducted to include articles published between January 2012 and January 2024. Articles were included if they were peer reviewed, written in English, based in health settings and reported the development or evaluation of a quality improvement website-based tool for professionals. A narrative synthesis was conducted using NVivo. Risk of bias was assessed using the Mixed Methods Appraisal Tool. All papers were independently screened and coded by two authors using a six-phase conceptual framework by Braun and Clarke. Eighteen studies met the inclusion criteria. Themes identified were tool development processes, quality improvement mechanisms and barriers and facilitators to tool usage. Digitalising existing quality improvement processes (n = 7), identifying gaps in practice (n = 6), and contributing to professional development (n = 3) were common quality improvement aims. Tools were associated with reported enhancement of accuracy and efficiency in clinical tasks, improvement in adherence to guidelines, facilitation of reflective practice and provision of tailored feedback for continuous quality improvement. Common features were educational resources (n = 7) and assisting the user to assess current practices against standards/recommendations (n = 6), which supported professionals in achieving better clinical outcomes, increased professional satisfaction and streamlined workflow in various settings. Studies reported facilitators to tool usage including relevance to practice, accessibility and facilitating multidisciplinary action, making these tools practical and time-efficient for healthcare. However, barriers such as being time consuming, irrelevant to practice, difficult to use and lack of organisational engagement were reported. Almost all tools were co-developed with stakeholders. The co-design approaches varied, reflecting different levels of stakeholder engagement and adoption of co-design methodologies. It is noted that the quality of included studies was low. These findings offer valuable insights for future development of quality improvement website-based tools in healthcare. Recommendations include ensuring tools are co-developed with healthcare professionals, focusing on practical usability and addressing common barriers to enhance engagement and effectiveness in improving healthcare quality. Randomised controlled trials are warranted to provide objective evidence of tool efficacy. This work was supported by the Prevention Research Support Program, funded by the New South Wales Ministry of Health, Australia. This review was registered with PROSPERO, no. CRD42023451346.

Analysis of the consistency of doctors’ opinions in the assessment of dermatoscopic images of actinic keratosis, Bowen’s disease, keratoacanthoma and squamous cell cancer

Background. Squamous cell skin cancer (SCSC) is the most dangerous tumor of all non-melanocytic skin neoplasms due to its aggressive course with destructive growth and frequent metastasis. Another characteristic feature of SCSC is the presence of precancerous conditions such as actinic keratosis, arsenic keratosis and PUVA-keratosis. In the gradual increase in the degree of keratinocyte dysplasia to the development of invasive forms of skin malignancies, the following continuum of diseases can be distinguished: actinic keratosis — Bowen’s disease — keratoacanthoma — SCSC. Dermatoscopic signs of each of the listed nosologies can also occur in other diseases of this chain, which can complicate diagnosis and lead to erroneous patient management tactics. Aim. To determine the consistency of dermatologists’ opinions in assessing dermatoscopic images of actinic keratosis, Bowen’s disease, keratoacanthoma and SCSC, depending on work experience. Methods. The study was conducted on the basis of the Scientific and Practical Center for the Diagnosis and Treatment of Skin Tumors of the Federal State Budgetary Educational Institution “PIMU” of the Ministry of Health of the Russian Federation. Based on the literature data, we compiled a generalized list of possible dermatoscopic signs of actinic keratosis, Bowen’s disease, keratoacanthoma, SCSC and analyzed dermatoscopic images of 85 elements of actinic keratosis, 28 — of Bowen’s disease, 10 — of keratoacanthoma and 24 — of SCSC. 10 dermatovenerologists participated in the study, half of whom (Group 1) had experience in the field of dermatoscopy for more than 4 years, and the other half (Group 2) — for less than 4 years. Results. The study reveals statistically significant deviations in the frequencies of dermatoscopic signs between the two groups of specialists when analyzing images of actinic keratosis and Bowen’s disease. Differences in the frequency of detection of keratoacanthoma and SCSC signs between specialists with more than 4 years of experience in the field of dermatoscopy and less than 4 years’ experience have not been found. Conclusion. Taking into account the average number of signs, the statistically justified result of the analysis is the inference that the average group frequencies in Group 1 and Group 2 are equal. The conclusion is that the opinions of specialists in the field of dermatoscopy are highly consistent, regardless of work experience. This indicates the high diagnostic value of the method, despite its subjective nature.

Design and Implementation of Brief Interventions to Address Noncommunicable Diseases in Uzbekistan.

In Uzbekistan, NCDs, including cardiovascular diseases, cancer, and diabetes, accounted for over 80% of mortality in 2019. In 2021, national stakeholders, in conjunction with the World Health Organization, identified brief interventions (BIs) to implement in primary health care settings to change unhealthy behaviors and reduce the burden of NCDs in the country. BIs consist of a validated set of questions to identify and measure NCD behavioral risk factors and a short conversation with patients/clients about their behavior, as well as the provision of a referral opportunity for further in-depth counseling or treatment if needed. We used a multimethod approach of document review, participatory workshops, and key informant interviews to describe how BIs were designed and implemented in Uzbekistan and generated a theory of change for its large-scale implementation. BIs in Uzbekistan targeted 4 risk factors (alcohol use, tobacco use, unhealthy diet, and physical inactivity) and entailed training clinicians on how to conduct behavioral change counseling using the 5As and 5Rs toolkit, conducting supportive supervision, and using feedback to improve service delivery. The program was collaboratively designed by multiple stakeholders across sectors, including the Ministries of Health, Higher Education, Science, and Innovations, with buy-in from key political leaders. The potential impact of the program (i.e., reducing the incidence of NCDs) was mediated by several intermediate and implementation outcomes at the individual, primary care, and community levels operating along multiple pathways. Significant health system challenges remain to the program, such as limited human resources, lack of incentives for clinicians, outdated systems and data collection processes for performance monitoring, and coordination among different relevant sectors. These and other challenges will need to be addressed to ensure the effective large-scale implementation of BIs in Uzbekistan and similar LMICs.

Design and Implementation of Brief Interventions to Address Noncommunicable Diseases in Uzbekistan.

In Uzbekistan, NCDs, including cardiovascular diseases, cancer, and diabetes, accounted for over 80% of mortality in 2019. In 2021, national stakeholders, in conjunction with the World Health Organization, identified brief interventions (BIs) to implement in primary health care settings to change unhealthy behaviors and reduce the burden of NCDs in the country. BIs consist of a validated set of questions to identify and measure NCD behavioral risk factors and a short conversation with patients/clients about their behavior, as well as the provision of a referral opportunity for further in-depth counseling or treatment if needed. We used a multimethod approach of document review, participatory workshops, and key informant interviews to describe how BIs were designed and implemented in Uzbekistan and generated a theory of change for its large-scale implementation. BIs in Uzbekistan targeted 4 risk factors (alcohol use, tobacco use, unhealthy diet, and physical inactivity) and entailed training clinicians on how to conduct behavioral change counseling using the 5As and 5Rs toolkit, conducting supportive supervision, and using feedback to improve service delivery. The program was collaboratively designed by multiple stakeholders across sectors, including the Ministries of Health, Higher Education, Science, and Innovations, with buy-in from key political leaders. The potential impact of the program (i.e., reducing the incidence of NCDs) was mediated by several intermediate and implementation outcomes at the individual, primary care, and community levels operating along multiple pathways. Significant health system challenges remain to the program, such as limited human resources, lack of incentives for clinicians, outdated systems and data collection processes for performance monitoring, and coordination among different relevant sectors. These and other challenges will need to be addressed to ensure the effective large-scale implementation of BIs in Uzbekistan and similar LMICs.

Doença Pulmonar Obstrutiva Crônica no Brasil: Análise do custo da doença

Objective: To measure the cost of Chronic Obstructive Pulmonary Disease (COPD) in Brazil to present an updated overview of the economic impact. Methods: A descriptive and retrospective analysis was carried out using macro and micro-costing techniques. It was based on information available in the Brazilian Ministry of Health’s databases, national and international guidelines for the clinical management of COPD, and the opinion of specialists. The time horizon adopted included the period from January to December 2019 and considered the direct medical costs linked to the provision of health care. Results: The analysis revealed that the costs of hospital management of COPD totaled BRL107,867,664.40. This represents 8.2% of the total costs of care related to the group of respiratory diseases in Brazil during the specified time range. In addition, it was evidenced that there is a substantial increase in the cost related to the management of the stable phase of the disease according to the severity of the condition, ranging from BRL418.50 for Stage I to BRL4,257.53 for Stage IV. Conclusion: This cost analysis and the estimated prevalence of COPD identified in Brazil demonstrate the importance of implementing effective strategies and public policies aiming to reduce risk factors associated with the disease.

Investigating war trauma, its effects, and associated risk factors on anxiety among high school students in Woldia town, northeast Ethiopia, 2022

BackgroundAnxiety symptoms are the most frequent mental health problems in the world, and it is a serious public health concern, especially among adolescents, because if left untreated, adolescent anxiety can have a number of detrimental effects, including lower academic performance, strained relationships with friends and family, substance addiction, thoughts of suicide and homicide, and trouble finding work. While this vulnerability is concerning in all situations, it is particularly critical in armed conflict areas. Ethiopia is one of the most recent war-affected countries, but to the best of our knowledge, limited studies focused on adolescents in this context. Therefore, this study assessed the experience of war trauma and its effects on anxiety symptoms among high school students in Woldia town, Ethiopia.ObjectiveWe assessed the experience of war trauma and its effects on anxiety among high school students, as well as associated risk factors, in war-affected areas in Woldia town, northeast Ethiopia.MethodsA cross-sectional study design was conducted from May 23 to June 08 2022. Data were collected from high school students in Woldia town. Bivariable and multivariable logistic regression analyses were used to identify independent factors associated with anxiety.ResultsA total of 624 out of 660 students participated in the study (94.5% response rate). The prevalence of anxiety among high school students in Woldia town was 39.7%. In the multivariable analysis, having depression (AOR = 9.24, 95% CI: 6.27, 13.64), witnessing the murder of family/friends (AOR = 1.93, 95% CI: 1.05, 3.57), being of female sex (AOR=1.59, 95% CI: 1.08, 2.36), and having a family history of mental illness (AOR=1.69, 95% CI: 1.00, 2.85) were factors significantly associated with anxiety.Conclusions and recommendationsThe prevalence of anxiety in this study was approximately two in five high school students. Therefore, we recommend that the Ministry of Education collaborate with the Ministry of Health to expand and implement mental health services in high schools to promote the wellbeing of students for the prevention of anxiety.

Dynamics of Dental Care for the Population of the Ryazan Region in COVID-19 Pandemic

INTRODUCTION: Identification of morbidity (based on requests) and the population’s need for dental care optimizes the planning and distribution of compulsory health insurance (CHI) funds between medical organizations at the regional level. However, due to a decrease in the population’s demand for medical care in the context of the new coronavirus infection (Corona Virus Disease 2019, COVID-19), the dynamics of the provision of dental care and the structure of dental morbidity taken into account in the compulsory medical insurance system, have changed. AIM: To study the structure and dynamics of the provision of dental care in the period 2018–2021 (pre-pandemic and COVID-19 pandemic period) based on the volume of dental care paid for in the compulsory medical insurance system provided to citizens of the Ryazan region (RR). MATERIALS AND METHODS: The analysis was carried out on the basis of registers of bills accepted for payment submitted by medical organizations, taking into account the results of control and expert measures. All completed cases of treatment of insured persons with dental diseases in medical organizations of the Ryazan Region for 2018–2021 were selected for study according to territorial compulsory medical insurance programs. RESULTS: In the structure of outpatient primary health care in 2021, cases of its provision in the ‘Dentistry’ profile amounted to 7.40 ± 0.10%, taking 3rd place; the total number of cases of providing medical care to patients with this pathology decreased by 5.60% compared to 2018. Despite the reduction in the volume of primary dental care, the volume of dental examinations of the population of the RR increased by 30.46%. There was also a 34.08% reduction in completed cases of treatment of chronic periodontitis (p 0.02). For the 2018–2021 period 73,049 medical and economic examinations (MEE) and 1,626 examinations of medical care quality (EMCQ) were carried out, and 1,966 violations were identified (1,316 based on the results of the MEE and 650 based on the results of the EMСQ). The vast majority of these concerned non-compliance with standards of care and clinical guidelines. CONCLUSION: The results of the study indicate a reduction in the number of cases of insured persons seeking medical care for dental diseases during the COVID-19 pandemic. Owing to the approval of Order No. 231n of the Ministry of Health of Russia of March 19, 2021, obliging medical insurance organizations to carry out control and expert measures in each medical organization in a certain amount of dental care cases accepted for payment, the number of examinations has increased, and, as a result, the identification of violations in the provision of dental care.

Obtaining and Characterization of Experimental Diagnostic Brucellosis Rabbit Sera for the Development of a National Standard for Brucellosis Serum

Relevance. The production of brucellosis diagnosticums is currently being established in the medical and veterinary practice of the Republic of Uzbekistan. However, due to the lack of a national standard serum in the country and the high cost of analog standard serums on the market, problems may arise in the production of diagnostic tools. In addition, the lack of national standard serums causes problems in quality control of commercial and local antigens, hinders the development of local drugs – brucellosis diagnostics, which reduces the effectiveness of serological diagnosis of brucellosis in humans and animals. Given the above, it becomes necessary to develop and produce a standard serum with a high level of safety, which will improve the methods of laboratory diagnosis of various forms of brucellosis in patients and animals to identify hidden foci of infection in Uzbekistan. The aim of the study is to obtain and characterize experimental standard diagnostic brucellosis rabbit sera for the development of national and industry standard serum with appropriate titers. Materials and Methods. The experiments were carried out in full compliance with the European Council Directive 2010/63/EU on compliance with ethical principles in working with laboratory animals and the experiments were carried out on the basis of the methodological manual «Methods and rules of work» approved by the Ministry of Health of the Republic of Uzbekistan in 2016 with laboratory animals in experimental microbiological and immunological studies. To obtain positive standard sera against brucellosis pathogens, 12 rabbits weighing from 2.2 kg to 4.6 kg, aged 6 to 12 months, were used. The animals were kept under identical conditions on a standard vivarium diet. For the experiment, animals adapted to the conditions of the study were selected and kept in quarantine for 21 days. The maintenance and conduct of the studies followed international rules for the humane treatment of animals. Results and Discussion. During the evaluation of the heterologic specificity of the obtained sera for 23 collection and hospital strains, a weakly positive response (+) was observed in 16.7% of cases. Rabbit sera positive for heterologic specificity were adsorbed on suspensions of inactivated microorganisms (Citrobacter spp. and Enterobacteriaceae spp.) - no significant drop in titer was observed, and cross-agglutination was eliminated. A significant increase in the total protein level was noted after the first and fourth immunizations. Before the first immunization, the total protein level was 59.57 g/l, and after the fourth immunization, it increased threefold to 157.17 g/l. There was also an increase in albumin and globulin (33.2 g/L and 26.37 g/L, respectively) to 79.37 g/L and 77.43 g/L, respectively. IgM levels remained almost unchanged, increasing 3.5-fold after the second immunization and decreasing to 0.24 mg/ml after the fourth immunization. An increase in the level of IgG after the second and third immunizations was revealed, followed by a decrease after the fourth immunization. Conclusion. The obtained national and industry standard diagnostic polyvalent brucellosis sera, as well as the developed methods of laboratory control of its quality and efficiency testing will make it possible to produce candidate standard serum samples for agglutination reaction test and detection of Brucella strains. The obtained standard serum samples will be further used for control of the produced immunobiological diagnostic preparations and provision of unified requirements to their quality. The goal was achieved – improving the serological diagnosis of brucellosis, laying the foundation for further study and standardization of serum.