Ministry Of Health Research Articles

Physical activity promotion in Aged care: a participatory approach

Abstract Introduction Aged care facilities (ACF) constitute an increasingly important, yet challenging setting for health promotion - given it is a highly sedentary pseudo-total institution characterized by structured daily routines within a paradigm of care for residents perceived as fragile and vulnerable. A participatory approach with residents, significant others, staff, and management might be a promising pathway to address intrapersonal, sociocultural, organizational, environmental, and political determinants of physical activity in this specific context. We will present processes and results from a research project, funded by the German Ministry of Health (2019-2023), on physical activity promotion in ACFs. Methods Our co-creation approach involved residents, significant others, staff, and management from seven nursing homes in Southern Germany. Methods included 800hrs on-site observations, semi-structured interviews (n = 31), Photovoice (n = 27 participants, n = 169 photos), as well as future workshops (n = 14) for intervention co-development (n = 14) and co-evaluation workshops (n = 7). Data analysis used reflexive thematic analysis with MaxQDA20. Results Implemented interventions (n = 57) addressed individual, social, environmental, and organizational factors. Activity promotion was integrated into care concepts and mission statements, staff work descriptions, as well as informal internal routines. Of the interventions implemented, 33% were rated as more successful, 43% as successful, and 19% as less successful than anticipated. Conclusions Participation can initiate structural and cultural change towards physical activity. However, the analyses also emphasized the critical role of staff training, along with the involvement of significant others and external service providers, as essential components for achieving sustainable change. Key messages • Participatory approaches integrate physical activity into aged care, fostering cultural shifts for resident well-being. • Success requires staff training, engaging residents’ support networks, balancing empowerment with protection.

Developing a set of core items for assessing preparedness in Italy: a Delphi approach

Abstract Background Effective pandemic management relies on preparedness and several tools are available for evaluation. However, due to differences in regional healthcare organization and structures, these may not accurately evaluate Italy’s capacities. This study, part of a project funded by the Italian Ministry of Health, report on the development of an assessment tool capable of evaluating the preparedness to confront pandemics at the regional level based on the actions outlined by the Italian influenza pandemic plan. Methods A desk research was carried out for preparedness evaluation tools, consulting Public Health Agencies, and Google Scholar and Search. Tools evaluation items were extracted, associated with the Italian plan, and screened for relevance and data availability. Selected items were then subjected to a two-round Delphi procedure involving 18 stakeholders from academia, local health services, and national agencies. The agreement was assessed using a 10-point Likert scale, and defined as a mean score ≥8, and consensus as a score standard deviation (SD) ≤1.5. Items with mean score ≥ 8 and SD > 1.5 after the first round were sent to the second round. Results A total of 6 tools were included in the study, from which 303 evaluation items matched the actions of the plan. After the screening phase, 122 indicators were deemed relevant and potentially available and sent to the Delphi procedure. Eighteen (14.8%) items reached both agreement and consensus in the first round, while another fifteen (12.3%) after the second. The 33 items covered all the domains of the national plan, especially Research and Development (21.1%) and Clinical Governance (15.2%). Conclusions The development of a set of core items that are agile, relevant, and readily available was facilitated by the involvement of stakeholders from different sectors. Moreover, adherence to the Italian pandemic plan should ensure that these items are deeply integrated into the unique context of the Italian regions. Key messages • The Delphi process identified a narrow number of evaluation items with great consensus. • Consensus was searched involving stakeholders from central authorities, local units, and academia.

The importance of healthcare monitoring systems

Abstract Issue Healthcare evaluation is an important tool of governance in the health sector that reinforces its key components: evidence-based care, effectiveness, programme standards, performance monitoring, quality improvement, risk and incident management and patient-centered care. One of the evaluation systems used by the Veneto Region (north italian region of about 4.8 million inhabitants) consists of the National Outcomes Programme (PNE) developed by the Italian National Agency for Regional Healthcare Services (AGENAS) on behalf of the Health Ministry. Description The PNE is an instrument used to measure, analyze, evaluate and monitor clinical and welfare assistance performances of Italian healthcare facilities. The Veneto Region, in particular, utilizes a regional epidemiologic service to periodically monitor 21 performance indicators based on “treemap” methodology. These indicators are used to assess processes, outcomes and volumes. The data used to monitor these practices derive from the hospital discharge documentation (SDO) and tax registry information system. The aim of this monitoring system is to track any critical situation that is not in alignment with national guidelines and to improve the efficacy, efficiency, appropriateness and safety within the healthcare system. Results In the Veneto region, over the course of nearly 10 years, this method of management has led to the development of various training courses that guide clinicians to correctly document and code different diagnosis and treatments. The treemap process of analysis has also made possible various clinical audits that have provided significant policy changes regarding risk and overall health management. Lessons Having a constant view of healthcare performance has proven to be helpful not only to identify some common gaps in care given from different facilities on a national level, but also guides different regions to develop specific strategies that lead to quality improvement. Key messages • Data on healthcare quality can be used as comparative information and for quality improvement. • Continuous monitoring of specific performance indicators can help identify difficulties in healthcare facilities and create strategies for long term solutions.

9.N. Practice session: From Data to Action – Joining forces to close the inequity gap in adolescent health

Abstract Persistent adolescent health inequalities exist in Europe, necessitating interventions that address both individual and societal factors, especially those pertinent to youths in unfavourable contexts. Collaborative efforts involving cross-sectoral partnerships and adolescent engagement are crucial in identifying and mitigating these disparities. Three case studies exemplify this approach. Case study 1: Effective intervention development hinges upon the translation of epidemiological insights into tangible actions. Heiko Schmengler will discuss how individual and contextual-level data is made actionable for the development of ePro-schools, an e-health intervention to promote healthy dietary habits and physical activity amongst adolescents in socially disadvantaged settings. ePro-schools brings together stakeholders from academia, the health sector, the education system, and local communities. This collaborative approach ensures that the intervention is not only grounded in solid scientific evidence but also fits the specific cultural, social, and economic contexts of the adolescents it aims to serve. Case study 2: Adolescents are not passive consumers of interventions, but active agents who frequently understand best what they need to improve regarding their health. Lourdes Cantarero Arevalo will share innovative methodologies and best practices for involving adolescents in data collection, intervention design, and policy development processes with the final aim to empower the voices of adolescents in vulnerable situations while addressing problems that are relevant for them. Case study 3: Filipa Alves da Costa will draw attention to the health concerns of adolescents resulting from incarceration. This talk will outline the development of a policy brief derived from UN global study data, which highlights the importance of cross-sectoral collaboration in developing actions to safeguard access to high quality healthcare for adolescents within the criminal justice system. A cross-sectoral approach is critical given that criminal justice systems typically fall outside the direct oversight of health ministries. The goal is to encourage policymakers, practitioners, and advocates to consider inter-sectoral strategies to address the complex health challenges these adolescents face. Following the presentations, we will facilitate a dynamic discussion with the audience, encouraging an exchange of ideas on strategies to address adolescent health inequalities from a multilevel perspective. This discussion aims to draw on the collective expertise of participants from diverse backgrounds, including practitioners, researchers, and policymakers. This dialogue aims to identify common barriers and opportunities, fostering a collaborative approach to tackling inequalities. The goal is to emerge from the workshop with a richer understanding of effective strategies that can be leveraged to close the gap in adolescent health across Europe. Key messages • Health inequalities among adolescents must be tackled collaboratively across different sectors and with participation of adolescents. • Participants will gain valuable insights on innovative solutions and effective methodologies from the case studies to inform their own efforts in addressing adolescent health inequalities.

Analysis of risk factors for the development of major adverse cardiovascular and cerebrovascular events in patients after aortic valve replacement with myocardial revascularization

Background. Acquired aortic valve disease and coronary heart disease often occur together, and almost two thirds of patients with aortic valve stenosis have severe coronary heart disease. Given the presence of both pathologies, this cohort of patients requires an individual diagnostic and therapeutic approach. The aim of the study was to analyze risk factors for the development of major adverse cardiovascular and cerebrovascular events (MACCE) in patients after aortic valve replacement with myocardial revascularization. Materials and methods. For this study, a selection of disease histories of adult patients (over 18 years old) who underwent surgical aortic valve replacement (SAVR) together with myocardial revascularization at the State Institution “Heart Institute of the Ministry of Health of Ukraine” from 2018 to 2022 was carried out. Results. We selected 130 case histories of patients who underwent SAVR together with myocardial revascularization: the first group (n = 51) — a combination of SAVR and percutaneous coronary interventions; the second group (n = 79) — a combination of SAVR and coronary artery bypass grafting. The analysis of intraoperative data showed that the duration of cardiopulmonary bypass and aortic cross-clamping in patients of the first group was significantly lower, by 1.5 times (p = 0.0001) and 1.4 times (p = 0.0001), compared to the second group. There was no significant difference between the study groups regarding the frequency of MACCE (p = 0.589). Reliable risk factors for the development of MAССE in the early postoperative period were the evaluation of the operative risk according to the EuroSCORE II scale (odds ratio (OR) 2.13, confidence interval (CI) 1.54–4.48, p = 0.012), the history of myocardial infarction (OR 1.43, CI 1.13–2.45, p = 0.002) and right coronary artery damage (OR 1.79, CI 1.44–3.78, p = 0.021). Conclusions. Patients who underwent percutaneous coronary interventions before SAVR were characterized by a shorter duration of cardiopulmonary bypass and aortic cross-clamping, however, no significant difference in major early postoperative complications was observed between the study groups. In particular, there were no significant differences regarding the frequency of MACCE in the early postoperative period.

Hospitalisation cost for paediatric osteomyelitis and septic arthritis in New Zealand.

Hospitalisation rates for paediatric bone and joint infection (BJI) in New Zealand (NZ) are among the highest globally. This study aims to quantify hospitalisation costs of BJI in 2018-2019. National hospitalisation data from the NZ Ministry of Health was used to describe costs associated with all paediatric hospitalisations coded for osteomyelitis or septic arthritis in those aged <16 years. Data included age, ethnic group, area level deprivation, diagnosis-related-group coding, admission length and cost-weight. Readmissions up to 24 months following the initial encounter were analysed for associated costs. More than ten million dollars was spent on hospitalisation for paediatric BJI over the study period (NZ$10 819 474). There were 869 primary hospitalisations and 229 related readmissions. Median length of stay was 7.4 days (95% confidence interval 6.8-7.9). Re-admission costs were NZ$1 196 640 within 24 months following diagnosis. Higher median hospitalisation costs occurred for children residing in the most deprived versus least deprived neighbourhoods (NZ$12 126 vs. NZ$9010, P < 0.01). NZ Māori compared with non-Māori children had longer length of stay (8.4 vs. 6.3 days, P = 0.04), more complex and severe illnesses (53% vs. 17%, P < 0.01), and higher median hospitalisation costs (NZ$11 796 vs. NZ$9581, P = 0.03). Direct BJI hospitalisation costs in 2018-2019 were NZ$10 819 474 with 11% of costs due to re-admission. Direct hospitalisation costs for paediatric BJI in NZ vary by deprivation and ethnic group. Illness complexity of paediatric BJI varies by ethnic group. Interventions are needed to reduce incidence and severity of these debilitating infections.

The impact of COVID-19 restrictions on road traffic and noise pollution of the urban street, a case study from Krakow, Poland.

The study determined the impact of restrictions introduced by the Ministry of Health in connection with the COVID-19 pandemic on traffic and sound pressure levels in the university building and its immediate vicinity. Mickiewicza Street was selected for the study. It is one of the city's busiest streets, located relatively close to the old historic center, and is the main artery connecting the north and south of the city. There are residential buildings on this street, but primarily offices and institutions, as well as schools and universities. Noise near the street and in buildings located relatively close to the road can be a serious problem in places where peace is required (e.g., libraries, reading rooms, university halls). Therefore, the acoustic comfort needed in these places may be disturbed, and the perception of knowledge acquisition may be limited. The aim of the work was achieved through measurements and analysis of street traffic intensity and sound pressure levels, taking into account pandemic restrictions. Then, statistical analyses were performed, which showed significant variability in traffic intensity and sound pressure values in individual periods of the pandemic. The pandemic's beginning was mainly characterized by a significant decrease in the above data, deviating from the norm. In the pre-pandemic period, an average of 47,733 vehicles passed through the street daily, and the median sound pressure was Leq.OUT = 62.0 dBA outside the building and Leq.INS = 44.0 dBA inside. During the greatest restrictions, a period called "lockdown," the number of cars driving decreased a little to an average of 44,153 per day, but there were days with 10,000-20,000 cars passing. In turn, noise decreased to 59.9 dBA for Leq.OUT and 43.2 dBA for Leq.INS. Between the first and second waves of infections, traffic was comparable to the post-pandemic period (an average of 69,027 cars per day), and noise also increased to Leq.OUT = 64-65 dBA and close to Leq.INS = 47.5 dBA. Studies have shown that noise on Mickiewicza Street is mainly caused by traffic (correlation coefficient: r = 0.92 for Leq.OUT and r = 0.86 for Leq.INS). The sound pressure level is high outside (Leq.OUT = 63.9 dBA) but relatively low inside the building (Leq.INS = 47.0 dBA) and should not negatively affect university staff and students (Leq.WH < LWH.acc). Based on the analyses, three stages show society's approach to the COVID-19 pandemic: (1) fear of the COVID-19 pandemic; (2) relaxation after restrictions; (3) getting used to the COVID-19 pandemic. These periods did not correlate with the development of the pandemic or the number of people infected and dead.

Magnitude and predictors of obstetric complications during delivery among postpartum women in Ethiopia: evidence from PMA Ethiopia longitudinal survey

IntroductionThe majority of pregnancy-related complications were preventable. However, the magnitude of complications during pregnancy and childbirth was high in sub-Saharan Africa. There was limited evidence on the magnitude of obstetric complications during childbirth and its predictors among postpartum women in Ethiopia.Methods and materialsThe research used secondary data sources based on performance monitoring for action in Ethiopia’s second cohort longitudinal survey. It was a national survey that was conducted in three large, predominantly agrarian regions (Oromia, Amhara, and SNNP) and one urban region (Addis Ababa) of Ethiopia between 2021 and 2023. It was conducted to track pregnant women’s use of essential maternal and newborn health services. It involved the enrollment of pregnant women and tracking them at six weeks, six months, and one year after giving birth. The data collected at the beginning of the survey and six weeks after childbirth were used for the analysis. Sample weights were applied to account for differences in sample allocation and response rates across regions and urban/rural areas. Multi-collinearity and intra-cluster correlation were assessed before fitting the multilevel models to ensure the accuracy of the estimates. A multi-level logistic regression model was used to assess the magnitude and predictors for the occurrence of obstetric complications during delivery. The model fit was evaluated using Akaike’s Information Criterion and Bayesian Information Criterion. Adjusted odds ratio with its 95% confidence interval was used to measure the strength of association for this study.ResultsThe magnitude of obstetric complications during delivery was found to be 33.86% with 95% CI (31.56, 36.24. Among the obstetric complications that occurred during delivery, about 15.73%with 95% CI(14.02, 17.61) of women experienced bleeding, 4.14% with 95% CI (3.30, 5.17) had their membrane rupture but labor did not start within 24 h, 2.29% with 95% CI(1.67, 3.13) had their membrane rupture before 9 months, 3.95% with 95% CI(3.16, 4.93) had faced malpresentation or malposition of the baby, 12.70% with 95% CI (11.18, 14.39) had prolonged labor lasting more than 12 h, and 12.40% with 95% CI (10.83,14.17) had convulsions. The odds of occurrence of obstetric complication during delivery among women from severely food insecure households were 1.88 times [AOR = 1.88; 95% CI (1.22, 2.90)] more likely to occur than women from food secure households. Moreover, the odds of occurrence for obstetric complications during delivery among women who had complications during their pregnancy were 2.39 times [AOR = 2.39; 95% CI (1.81, 3.16)] more likely to occur as compared to those women who had no complication during their pregnancy. On the other hand, women’s who had 1–4 live births given before this delivery were 0.61 times [AOR = 0.61; 95% (0.43, 0.88)] less likely to develop complications as compared to those women’s who had no prior live birth.Conclusion and recommendationDelivery-related obstetric complications during delivery in Ethiopia were high. Approximately one-third of postpartum women in Ethiopia experienced obstetric complications during delivery. Based on this study, women’s from severely food insecure households, those women’s who had no prior live birth, and women’s who had complications during their pregnancy were more likely to develop delivery-related obstetric complications. Thus, policy makers and program implementers who were working on maternal and newborn health should give special attention for women’s from severely food insecure households, women’s who had no prior live births, and those women’s who encountered obstetric complications during their pregnancy to decrease the occurrence of obstetric complications during delivery. In Ethiopia, various governmental organizations, such as the Ministry of Health and the Ministry of Agriculture, are dedicated to addressing food insecurity and improving nutritional access. The country has launched several effective nutritional programs, including the Productive Safety Net Program, the Targeted Supplementary Feeding Program, and the National Nutrition Program, aimed at alleviating food insecurity and enhancing nutrition. Ongoing efforts are crucial to tackle the food insecurity experienced by women, which can help to reduce obstetric related complications of women’s during delivery. It is crucial for everyone involved in maternal and newborn health to prioritize addressing the factors that lead to obstetric complications during delivery in women in order to reach the goal of ending all preventable maternal and newborn deaths by 2030.

Designing a Human Resource Empowerment Model for Pharmacists in Pharmacies in Tehran

Background: One of the most effective strategies to gain a competitive advantage in the current business environment is to enhance the efficiency of employees within organizations. The purpose of this research was to design a human resource empowerment model for pharmacists in pharmacies in Tehran. Methods: The research's statistical population includes two qualitative and quantitative components. In the qualitative part, 35 elite pharmacists from universities, industry, and the Ministry of Health were included, while the quantitative part involved a statistical sample of 220 individuals. For data analysis, the Grandad process of Kolmogorov-Smirnov statistical tests, independent one-sample t-test, exploratory factor analysis, confirmatory factor analysis, and structural equation modeling were used. SPSS 25 and AMOS 24 software were used to analyze the research data Results: The findings showed that in the final development model of empowering pharmacists and personnel in Tehran courts, causal factors include psychological characteristics and training. The core category includes cultural and moral competence, as well as professional and technical competence. Background factors include commitment and skill. Intervening factors include moral values. Strategies include efficiency and speed. The consequences include creativity, innovation, and social responsibility.Results: The findings showed that in the final development model of empowering pharmacists and personnel in Tehran courts, causal factors include psychological characteristics and training. The core category includes cultural and moral competence, as well as professional and technical competence. Background factors include commitment and skill. Intervening factors include moral values. Strategies include efficiency and speed. The consequences include creativity, innovation, and social responsibility. Conclusion: It can be concluded that continuous training workshops should be organized for pharmacists in Tehran pharmacies to enhance their specialized knowledge. Periodic in-service courses should be provided to these individuals based on their professional activities. The organization should consider social activities and social behaviors as focal points.

Disability trends among elderly Ukrainians in war conditions: a 10-year retrospective study

AimNon-communicable diseases (NCDs) in elderly are a significant problem in Ukraine. It is expected that the ongoing war will augment this problem. The study aimed to analyze the trends of disability due to NCDs s in newly-diagnosed elderly patients between 2013 and 2023.MethodsThis retrospective study included data obtained from the official document “Report on the Causes of Disability and Indications for Medical, Professional, and Social Rehabilitation” commissioned by the Ministry of Health of Ukraine. The data on disability due to NCDs s were obtained from for 2013–2023.ResultsDuring the 2013–2021 the average number of disabled elderly patients due to NCDs per 10,000 elderly persons was significantly lower in compare with working-age. During the first year of full-scaled war the average number of disabled elderly patients due to NCDS s per 10,000 elderly persons dramatically increased by 2-fold, and in 2023 – by 2.8-fold against 2013 value (p < 0.05), while in working-age the disability rate increased significantly only in 2023 by 1.4-fold compared to the pre-war level. In 2013–2021 the main causes of disability among those related to NCDs in elderly were cardiovascular diseases, followed by cancer. In 2022 compared to the pre-war level, the indicators of disability of the elderly due to CVD increased by 1.5 times, due to cerebrovascular diseases - by 2.2 times, due to cancer - by 1.7 times, due to musculoskeletal diseases - by 2 times (p < 0.05). The most significant increase in the number of elderly people with disabilities during the full-scale war occurred due to coronary artery disease - by 55.1%, and osteoarthritis - by 83.4% from baseline in 2013. It estemated the differences in indicators of disability of elderly between regions of Ukraine, significantly higher indicators of disability of the elderly due to cardiovascular diseases, cancer, cerebrovascular diseases, musculoskeletal diseases were noted in the frontline regions.ConclusionsData on primary disability among elderly Ukrainians indicates a significant increase in NCDs-related disability during the war in compare with working population, especially in frontline regions and regions with a high concentration of displaced persons. In this structure of NCDs-related increasing disability, CVD, oncology and musculoskeletal diseases system prevailed.

Harnessing SSB tax for health and economic prosperity: A Path to sustainable growth

This study explores the implementation of sugar-sweetened beverages (SSB) excise taxes as a policy tool to address public health challenges related to excessive sugar consumption in Indonesia. With rising rates of diabetes and obesity, SSB taxes have been widely adopted globally, yielding positive outcomes such as reduced consumption and increased government revenue. This research synthesizes global evidence through a scoping review and examines how an SSB excise tax could be structured to fit Indonesia’s unique socio-economic context. The findings suggest that a tiered tax based on sugar content would be most effective in curbing consumption while encouraging the beverage industry to innovate healthier alternatives. Revenue generated from the tax, estimated to reach IDR 9.68 trillion annually, could be directed toward public health initiatives, particularly for preventing and managing non-communicable diseases. The study also recommends complementary public health campaigns to raise awareness of the risks associated with sugar consumption. Effective collaboration between the Directorate General of Taxes and the Ministry of Health is crucial for successfully implementing and monitoring the policy. The introduction of SSB excise taxes in Indonesia represents a strategic opportunity to enhance public health, generate substantial government revenue, and support long-term sustainable development.

Human papillomavirus vaccine to prevent CIN3 or worse (CIN3+): A nationwide case-control study in Japan.

An increase in cervical cancer incidence has been reported in Japan. The Ministry of Health, Labor, and Welfare of Japan has resumed the active recommendation of regular HPV vaccines in 2022. In Japan, the preventive effect of CIN3+ in the real world has not yet been demonstrated in age-adjusted cohort or case-control studies. This study aimed to estimate the effect of the HPV vaccine against CIN3+ in Japanese women. This nationwide case-control study from April 2013 to March 2020 targeted women aged 20-26 years old at the time of cervical screening. We compared HPV vaccination exposure between those with abnormal and those with normal cytology. Abnormal cytology was classified into cervical intraepithelial neoplasia (CIN)1+, CIN2+, and CIN3+. We calculated the odds ratio (OR) and 95% confidence interval (CI) of the above endpoints and vaccination exposure using the conditional logistic regression model and estimated vaccine effectiveness using the formula (1 -OR) × 100. A total of 2790 cases and 13,990 controls (one-to-five matching) were eligible in 37 municipalities in Japan. In this study, 61 CIN3 (2.2%) and 10 squamous cell carcinomas (SCC) (0.4%) were found. The OR for CIN3+ versus controls was 0.14 (95% CI, 0.03-0.75), equating to a vaccine effectiveness of 86%. Of the 10 patients who had SCC none were vaccinated. This nationwide case-control study in Japan demonstrated a substantial risk reduction in CIN3+ among women who did versus those who did not receive HPV vaccination.

Profile and Histopathological Description of Gastritis Patients

Gastritis, better known as ulcer disease, is a disorder of the abdomen that patients most often complain about and is a disease that is often found in clinics when seen from the symptoms experienced. The Indonesian Ministry of Health stated that currently, Indonesia is in fourth place as the country with the highest incidence of gastritis. Based on Basic Health Research (Riskesdas) data in 2018, gastritis is one of the 10 most common diseases in hospitalized patients in Indonesia with 30,154 cases or 4.9%. The number of gastritis cases is considered quite high because the prevalence of cases is 274,396 out of the 258,704,900 total population of Indonesia. This study aims to explore the histopathological features of the gastric mucosa and the characteristics of patients with gastritis. This study used a descriptive method with retrospective data collection from the medical record archives of the MRCCC Siloam Semanggi Hospital during the period 2022. The research sample included all m edical records of patients with gastritis who underwent an endoscopic examination. Of the 252 patients who met the inclusion criteria, 59 patients (23.4%) were diagnosed with gastritis in the age range of 41 to 50 years. More women experience gastritis than men, with 137 patients (54.4%). In terms of histopathology, 171 patients (67.9%) were diagnosed with chronic non-active gastritis. From the assessment of the corpus and antrum, it was found that 121 patients (48%) had no atrophy, 249 patients (98.8%) had no intestinal metaplasia, and 248 patients (98.4%) had no Helicobacter pylori. Therefore, it is important to carry out an early examination and endoscopic examination so that medical treatment can be carried out as soon as possible. Keywords: Stomach, Helicobacter pylori, atrophy, intestinal metaplasia

USO DA CETAMINA COMO ESCOLHA NO TRATAMENTO EM ADULTOS E IDOSOS COM DEPRESSÃO RESISTENTE AO TRATAMENTO

Introduction: Increasingly, there has been a rise in the diagnosis of depressive disorders among the elderly, making this issue alarming as it directly affects their quality of life and functional capacity. In addition to these aspects, this situation increases the risk of morbidity and mortality. Antidepressants, either alone or in combination with other medications, can be used to treat this type of depressive disorder. Currently, there are several classes of antidepressants available, but in the case of patients with mood disorders, the response to common antidepressants may be unsatisfactory. Studies indicate that a relevant alternative for treating resistant depression (RD) is the use of ketamine. Objective: To gather and analyze information on the pharmacological approach of ketamine in the treatment of resistant depression in the elderly. Methodology: Articles published in indexed journals in the Scientific Electronic Library Online (SCIELO), National Library of Medicine/NLM (MEDLINE), and National Library of Medicine/NLM (PUBMED) databases were evaluated, in addition to official sites such as the Ministry of Health of Brazil and the World Health Organization, covering the period from 2014 to 2024. Results: After completing the data collection phase, 29 relevant articles were identified for analysis of the proposed theme. Discussion: Based on the results obtained and the objectives of this review, it is possible to highlight the most relevant aspects of the topic in question. Thus, a positive response to treatment-resistant depression (TRD) was observed in patients treated with ketamine. Conclusion: The use of ketamine in patients with depressive disorders demonstrates rapid and lasting antidepressant effects, making it a viable treatment alternative.

Pattern of Family Planning in Bani-Talib village in Assiut, Egypt-cross Sectional Study

Family planning programs have emerged as one of the most successful public health interventions of the 20th century, significantly improving maternal and child health outcomes. This study aims to evaluate the prevalence and patterns of contraceptive use in Bani-Talib village, Assiut governorate, and to identify barriers to family planning method utilization. Conducted as part of a baseline survey by the Ministry of Health and Population in 2010, this cross-sectional study included all married women aged 15-49 in the village. Data were collected through structured questionnaires addressing demographic information and contraceptive practices. Ethical approval was obtained, and data were analyzed using SPSS. The mean age of participants was 30.38 years, with an illiteracy rate of 63.8% and only 4.6% employed. The prevalence of contraceptive use was 46%, with 36.9% never having used any method. The most commonly used contraceptive method was the intrauterine device (IUD) at 40.4%, followed by injectables (32%) and oral contraceptive pills (22.1%). Major barriers to contraceptive use included newly married status (34.9%), cost (24.8%), and concerns about infertility (20.2%). The findings revealed no significant differences in contraceptive use related to education, employment status, or number of children, but age was significantly associated with usage patterns. The results highlight the need for targeted interventions to address barriers to contraceptive use and increase awareness of family planning among men. Future studies should further explore family planning utilization patterns in urban versus rural settings in Egypt. Enhanced training for healthcare providers is also recommended to improve family planning service delivery in rural communities.

Trust in scientific institutions and experts during the first 2 years of the COVID-19 pandemic in Finland.

To explore variations in trust in science and scientific institutions in Finland during the COVID-19 pandemic, and the factors influencing trust in experts of a key institution in the management of the pandemic, the Finnish Institute for Health and Welfare (THL). These results are contrasted with trust in the Ministry of Social Affairs and Health. Five surveys were conducted between April 2020 and March 2022 (n=5448). The changes were tested with the chi-square test. Predictors of trust in THL and the ministry was examined with binary logistic regression. Trust in science and key scientific institutions remained consistently high throughout this period. In the early pandemic, trust in the ministry declined. The most significant explanatory factors for trust in THL and the ministry were being a supporter of some other party than the right-wing Finns Party and belonging to the age groups over 50 years. Our findings indicate that the pandemic, marked by unpredictability, did not weaken trust in science and THL, whereas trust in the ministry responsible for managing the pandemic and university experts weakened. In increasingly politically polarised societies, the impact of political sentiments on health-related perceptions and choices should be analysed more in future public health studies.

Distraction osteogenesis in the treatment of transverse malocclusions in children

Relevance. Malocclusions accounts for 37% to 89% of all maxillofacial conditions in children aged 3 to 18 across various regions of Russia. These malocclusions can present as isolated issues in a single plane or as combined anomalies across multiple planes. Jaw narrowing or underdevelopment is influenced by various endogenous and exogenous factors. The choice of treatment depends on the severity of the malocclusion. While literature indicates several effective methods for treating transverse malocclusions, some aspects remain insufficiently explored.Materials and methods. A statistical analysis was conducted on 271 patient records of individuals with transverse malocclusions who received treatment in the Department of Pediatric Maxillofacial Surgery at A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of the Russian Federation, between 2013 and 2023.Results. There was an almost equal distribution of patients by gender, with a noticeable increase in medical consultations from 2013 to 2023. The majority of surgically treated patients were between 15 and 17 years old. Isolated transverse malocclusions were significantly less common than cases combined with other pathologies, with mesial occlusion being the most frequent comorbidity.Conclusion. The findings demonstrate a significant need for surgical treatment in pediatric patients with transverse malocclusions through distraction osteogenesis. This underscores the importance of continually improving treatment methods for children, including enhancing diagnostics, refining treatment indications, optimizing distraction protocols, and adjusting treatment courses. These efforts aim to improve the quality of rehabilitation for children, ensuring better outcomes into adulthood and facilitating their social adaptation.

Core procedural skills in the MD curriculum: what students need to learn

The medical education system in Vietnam is currently undergoing a significant transformation with the support of the Ministry of Education and Training (MOET) and the Ministry of Health (MOH). Alongside this shift, the emergence of new medical schools, including VinUniversity, reflects a growing enrollment trend in undergraduate medical programs (UME). During the curriculum development phase, a crucial gap in core procedural skills among medical graduates surfaced. In response, the Medical Doctor (MD) Education team launched a project aimed at establishing a consensus-based list of essential procedural skills and identifying optimal clinical placements for skill acquisition. A cross-sectional survey, based on this list, was distributed among physicians and residents in the VINMEC Healthcare system, asking them to rate skills using the Likert scale and specify suitable clinical placements or rotations for acquisition. With 207 respondents, a consensus list of 38 core procedural skills was generated and integrated into the curriculum. This adaptable list holds promise for adoption by medical schools nationwide, fostering standardization and enhancement of medical education quality.

Multimorbidity and Multiple Disabilities: Present Status and the Roles of Rehabilitation

The world is aging, and an increasing number of countries are becoming aged or super-aged societies. Japan has already become the world’s first super-aged society, with an aging rate of 29.1% of the entire population of the country. As of 15 September 2021, there were approximately 36.40 million people aged 65 years and over. The advent of the super-aged society has increased the possibility of multimorbidity and multiple disabilities (MMDs) in the elderly population. According to a survey by the Ministry of Health, Labour and Welfare, the percentage of people with multiple disabilities of all people with physical disabilities has fluctuated between 4.0 and 7.0%, but rapidly increased to 8.9% in 2006 and 17.7% in 2016. This review aimed to establish the present status of MMDs and the rehabilitation for MMDs. In rehabilitation settings, patients with MMDs are more common than patients with a single disease or disability; however, evidence on MMD rehabilitation is insufficient. Inexperienced and unconfident medical professionals are overly cautious in providing rehabilitation; therefore, adequate rehabilitation is not provided. Furthermore, to respond to the rehabilitation needs of patients with MMDs, human resources need to be cultivated, and a scientific basis needs to be built. It is expected that MMD guidelines will soon be developed based on various case studies and surveys. In MMD rehabilitation, it is important to provide “wider, earlier, more intimate, and more connected rehabilitation”; for this, the training and cooperation of rehabilitation medical professionals is necessary.

Dr. Meena and mission maternal health: building allies in the government hospital

Research methodology The case study is based on field data, including in-depth semi-structured interviews with the main protagonist and related stakeholders of a large government hospital in Western India. After informed consent, the interviews with the stakeholders were conducted, transcribed and analyzed verbatim. In addition, secondary data from policy reports, newspaper articles and government websites was used to create the case. Since the protagonist works in the government system, her identity and other identifying information are disguised to maintain confidentiality. Case overview/synopsis The case study investigates the leadership challenges in a healthcare facility/hospital in public health. It traces the evolution of Dr Meena Sharma (Dr Meena), a leader in the government hospital ecosystem facing challenges such as infrastructural deficiencies, manpower deficit, healthcare bureaucracy and heavy patient load. This first-generation medical practitioner who transitioned from a private practice to a governmental one juggles balancing her demanding clinical practice, administrative responsibilities and teaching in the government hospital with her family responsibilities setup. However, in the wake of the upcoming LaQshya – Labour Room Quality Improvement Initiative by the Ministry of Health &amp; Family Welfare, she strives to put together and motivate her team to work toward improving the quality of care during delivery and the immediate postpartum period at her hospital. Various issues arise in the organizational leadership for a woman leader such as adopting appropriate leadership style and using appropriate motivation and communication strategies for optimal performance. Complexity academic level The case study is aimed at teaching/training a) departmental heads of public and private hospitals, b) health program managers at higher and middle-level leadership roles, c) health policymakers at various levels in the government and other organizations and d) graduate and postgraduate students of public health, hospital management/administration. In addition to this, it can also be used for general management programs to teach organizational behavior, communication and leadership courses.