Health Scenario Research Articles

Maximizing Survival in Pediatric Congenital Cardiac Surgery Using Machine Learning, Explainability, and Simulation Techniques

Background: Pediatric and congenital heart surgery (PCHS) is highly risky. Complications associated with this surgical procedure are mainly caused by the severity of the disease or the unnecessary, late, or premature execution of the procedure, which can be fatal. In this context, prognostic models are crucial to reduce the uncertainty of the decision to perform surgery; however, these models alone are insufficient to maximize the probability of success or to reverse a future scenario of patient death. Method: A new approach is proposed to reverse the prognosis of death in PCHS through the use of (1) machine learning (ML) models to predict the outcome of surgery; (2) an explainability technique (ET) to determine the impact of main risk factors; and (3) a simulation method to design health scenarios that potentially reverse a negative prognosis. Results: Accuracy levels of 96% in the prediction of mortality and survival were achieved using a dataset of 565 patients undergoing PCHS and assessing 10 risk factors. Three case studies confirmed that the ET known as LIME provides explanations that are consistent with the observed results, and the simulation of one real case managed to reverse the initial prognosis of death to one of survival. Conclusions: An innovative method that integrates ML models, ETs, and Simulation has been developed to reverse the prognosis of death in patients undergoing PCHS. The experimental results validate the relevance of this approach in medical decision-making, demonstrating its ability to reverse negative prognoses and provide a solid basis for more informed and personalized medical decisions.

Economic assessment of animal disease burden in Senegalese small ruminants

Small ruminant production in sub-Saharan Africa is limited by a range of constraints, including animal health issues. This study aimed at estimating the impact of these issues on the small ruminant production in Senegal in a holistic manner, using an approach developed by the Global Burden of Animal Diseases (GBADs) programme. The estimation focused on the mixed crop-livestock system, representing a large proportion (>60%) of the small ruminant population in the country. It was based on existing data collected via a systematic literature review, acquisition of secondary datasets from local stakeholders, and expert elicitation. A dynamic population model was used to calculate the gross margin of the sector under both the current health constraints and an ideal health state, where animals are not exposed to causes of morbidity and mortality. The difference between the current and ideal health scenarios, termed the Animal Health Loss Envelope (AHLE), provides a quantitative measure of the farm-level cost of disease in the system. The all-cause AHLE was estimated at 292 billion FCFA (468 million USD, with 95% prediction interval 216 – 366 billion FCFA) per year for 2022, for a population of 8.8 million animals. The contribution of Peste des Petits Ruminants (PPR) was modelled separately, as an example of attributing part of the AHLE to a specific disease cause. PPR was estimated to contribute 5% of the total AHLE. The animal disease burden experienced by Senegalese livestock keepers was largely due to loss in animals and production, with relatively small amounts of animal health expenditure. Implementation of this study contributed to the further development of the GBADs approach. Such estimates can support decision making at all levels, from investment decisions at the international level to local disease awareness campaigns targeting livestock keepers.

5.X.2. Improving indoor air quality: a public health challenge

Abstract Indoor air quality (IAQ) may have a profound effect on a person’s physical and mental health and well-being. The Knowledge for Indoor Air Quality and Health (K-HEALTHinAIR) project (grant no 101057693) is an interdisciplinary European research project that brings together 15 partners across 8 countries to study the sources, determinants and health outcomes related to IAQ. We aim to increase knowledge and provide input for more accurate monitoring and interventions, promoting healthy indoor air quality across several public health settings. The main aim of this workshop is to engage the public health community in the relevance of IAQ as a public health concern. We will share the innovative and new methodologies applied in the K-HEALTHinAIR project to study IAQ and health and discuss opportunities as well as challenges in this field of research to support shared learning. This workshop highlights IAQ pollutant sources and determinants, seasonal variation in IAQ, older people’s IAQ and health, and presents the project’s open access platform that is developed to share knowledge. We will zoom in on the evidence available for the sources and determinants of exposure to indoor air pollutants. This activity, a systematic review, was fundamental to identify the gaps of knowledge and guide the preparation of data collection tools. It also depicts the main pollutants present in indoor settings and the respective sources and determinants of exposure. Then, one of the 9 public health scenarios studied in the project is presented. We will focus on the first results regarding (determinants of) IAQ variation in primary schools at several locations in Poland. Next, the pilot study in older people living in senior homes in the Netherlands presents first findings of IAQ and health data in this vulnerable population. Finally, the project will deliver an open-access platform aiming to be the one-stop-shop for IAQ Knowledge. The user-profiles identified are presented. At the end, the workshop participants will be up to date on the project’s activities, its relevance for public health and the open access platform via which all output will be shared. Participants will leave with increased understanding of public health research needed to further study IAQ and its impact on health and well-being. Key messages • Indoor air quality is a public health concern impacting health and well-being, especially in vulnerable populations such as children and older people. • The K-HEALTHinAIR project is a multidisciplinary research project in which innovative methodologies are applied to increase knowledge on indoor air quality and health.

Everyday life information seeking: A systematic review with bibliometric analysis

This study presents the first comprehensive systematic review and bibliometric analysis of the Everyday Life Information Seeking (ELIS) research domain, spanning nearly three decades of academic contributions. Initiated by Savolainen’s groundbreaking study in 1995, ELIS research has significantly progressed; however, to date, no researchers have undertaken a thorough overview of this field. Employing a mixed-methods approach, this study combines systematic review techniques with bibliometric analysis, aiming to bridge this gap. The methodology includes rigorous data filtration from the Web of Science and Scopus databases, amassing a total of 345 articles published between 1995 and 2023. Findings indicate a marked increase in ELIS publications and citations, particularly after 2008, underscoring a growing interest in everyday life information seeking. Analysis identified significant contributions from the United States, Canada, the United Kingdom, Finland, and Australia. Thematic analysis unveiled three main research directions: the influence of digital technology on ELIS, information seeking in health scenarios, and diverse information needs and sources among specific user groups. Furthermore this study also proposes an integrative framework, emphasizing the importance of understanding information-seeking behaviors within the complex and diverse context of everyday life. It recognizes the necessity of incorporating various sociocultural perspectives and adapting to the continuously evolving digital environment. This framework serves as a valuable resource for scholars and practitioners dedicated to improving information services and interventions in daily life. The limitations of this study include language and database restrictions, as well as the exclusion of gray literature. Additionally, given the significant potential of integrating information seeking with technology to improve daily life, future research should focus on the foundational theoretical issue of how artificial intelligence technology is reshaping users’ ELIS behaviors.

Roadmap for rebuilding the health system and scenarios of crisis path in Gaza.

The horrific attacks on Gaza have had a profound impact on Gaza's health system, culminating in a multidimensional crisis. The deliberate destruction of vital infrastructure, such as hospitals, schools, housing, and public facilities, coupled with the deaths and injuries of medical personnel and support workers has only exacerbated the situation and further highlighted the existing gaps. This unprecedented catastrophe proves the criticality of adopting a new national inclusive integrated approach to meeting the immediate and long-term needs of the population. In this perspective, we explore the recovery roadmap features for rebuilding the health system in Gaza, specifically focusing on determining the primary challenges that might emerge, the trajectory of recovery, and the expected crisis scenarios. The existing evidence and perspectives of key stakeholders, including state and non-state health authorities in Palestine were synthesised. Despite some local and international initiatives undertaken to generate a concrete road to recovery, there remains a need for realistic, innovative, and comprehensive Marshall plans to rebuild Gaza's health system. The article draws on insights and gaps in current efforts and underscores the urgent need to address the challenges of rebuilding the health system. The authors strive to offer an inclusive and realistic path with the potential scenarios toward recovery and resilience considering the mass levels of loss and damage, and ways to move forward for building back a resilient health system in Gaza.

Viral genetics and transmission dynamics in the second wave of mpox outbreak in Portugal and forecasting public health scenarios

ABSTRACT In 2023, a second wave of the global mpox epidemic, which is mainly affecting men who have sex with men (MSM), was observed in some countries. Herein, we benefited from a large viral sequence sampling (76/121; 63%) and vast epidemiological data to characterise the re-emergence and circulation of the Monkeypox virus (MPXV) in Portugal during 2023. We also modelled transmission and forecasted public health scenarios through a compartmental susceptible-exposed-infectious-recovered (SEIR) model. Our results suggest that the 2023 mpox wave in Portugal resulted from limited introduction(s) of MPXV belonging to C.1.1 sublineage, hypothetically from Asia, followed by sustained viral transmission and potential exportation to other countries. We estimated that the contribution of the MSM high sexual activity group to mpox transmission was 120 (95% CrI: 30–3553) times higher than that of the low sexual activity group. However, among the high sexual activity group, vaccinated individuals likely contributed approximately eight times less [0.123 (95% CrI: 0.068–0.208)] than the unvaccinated ones. Vaccination was also linked to potential reduced disease severity, with a Mpox Severity Score of 6.0 in the vaccinated group compared to 7.0 in unvaccinated individuals. Scenario analysis indicated that transmission is highly sensitive to sexual behaviour, projecting that a slight increase in the MSM sub-population with high sexual activity can trigger new mpox waves. This study strongly supports that continued vaccination, targeted awareness among risk groups and routine genomic epidemiology is needed to anticipate and respond to novel MPXV threats (e.g. global dissemination of clade I viruses).

Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies. In this analysis, we use the Institute for Health Metrics and Evaluation's Future Health Scenarios platform to forecast the effects of three smoking prevalence scenarios on all-cause and cause-specific YLLs and life expectancy at birth until 2050. YLLs were computed for each scenario using the Global Burden of Disease Study 2021 reference life table and forecasts of cause-specific mortality under each scenario. The reference scenario forecasts what could occur if past smoking prevalence and other risk factor trends continue, the Tobacco Smoking Elimination as of 2023 (Elimination-2023) scenario quantifies the maximum potential future health benefits from assuming zero percent smoking prevalence from 2023 onwards, whereas the Tobacco Smoking Elimination by 2050 (Elimination-2050) scenario provides estimates for countries considering policies to steadily reduce smoking prevalence to 5%. Together, these scenarios underscore the magnitude of health benefits that could be reached by 2050 if countries take decisive action to eliminate smoking. The 95% uncertainty interval (UI) of estimates is based on the 2·5th and 97·5th percentile of draws that were carried through the multistage computational framework. Global age-standardised smoking prevalence was estimated to be 28·5% (95% UI 27·9-29·1) among males and 5·96% (5·76-6·21) among females in 2022. In the reference scenario, smoking prevalence declined by 25·9% (25·2-26·6) among males, and 30·0% (26·1-32·1) among females from 2022 to 2050. Under this scenario, we forecast a cumulative 29·3 billion (95% UI 26·8-32·4) overall YLLs among males and 22·2 billion (20·1-24·6) YLLs among females over this period. Life expectancy at birth under this scenario would increase from 73·6 years (95% UI 72·8-74·4) in 2022 to 78·3 years (75·9-80·3) in 2050. Under our Elimination-2023 scenario, we forecast 2·04 billion (95% UI 1·90-2·21) fewer cumulative YLLs by 2050 compared with the reference scenario, and life expectancy at birth would increase to 77·6 years (95% UI 75·1-79·6) among males and 81·0 years (78·5-83·1) among females. Under our Elimination-2050 scenario, we forecast 735 million (675-808) and 141 million (131-154) cumulative YLLs would be avoided among males and females, respectively. Life expectancy in 2050 would increase to 77·1 years (95% UI 74·6-79·0) among males and 80·8 years (78·3-82·9) among females. Existing tobacco policies must be maintained if smoking prevalence is to continue to decline as forecast by the reference scenario. In addition, substantial smoking-attributable burden can be avoided by accelerating the pace of smoking elimination. Implementation of new tobacco control policies are crucial in avoiding additional smoking-attributable burden in the coming decades and to ensure that the gains won over the past three decades are not lost. Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

Environmental degradation, climate change and health from the perspective of Brazilian Indigenous stakeholders: a qualitative study

BackgroundThe WHO identifies climate change as the most significant threat to global health systems. Indigenous peoples, whose lives are deeply intertwined with nature, are particularly vulnerable to the impacts of...

The Impact of Sleep and Mental Health on the Quality of Work Among Paramedics in the Kingdom of Saudi Arabia

The emergency services sector is one of the most arduous and crucial fields wherein an individual’s life lies in the hands of emergency responders such as paramedics and police. Paramedics are crucial figures in the emergency medical services system. They deliver immediate medical care to patients who suffer from critical and life-threatening conditions, serving as a gap-filler between the accident scene and health facilities. In the Kingdom of Saudi Arabia, the health authority has been constantly striving to build a credible, professional, and trustworthy EMS system while discovering challenges faced by the service in the rapidly changing health scenario of KSA. This study employed a mixed-methods approach, combining quantitative surveys and qualitative interviews to assess the relationship between sleep patterns, mental health, and work quality among paramedics in the Kingdom of Saudi Arabia. The results of this study reveal a significant correlation between sleep quality, mental health, and the overall performance of paramedics in the Kingdom of Saudi Arabia. In conclusion, the findings of this comprehensive study emphasize and highlight the critical and significant relationship that exists between sleep quality, mental health, and overall job performance among paramedics working in the Kingdom of Saudi Arabia. This highlights an urgent need for targeted and effective interventions designed specifically to enhance their well-being and support their mental health in the demanding field of emergency services.

Enhancing Health Data Assessment Performance: A Multi-Sensor Focused Study for Public Health

The term health data assessment performance described the process of assessing efficacy of acquiring and reporting health data. Multi sensor approach for predicting diabetes in public health scenarios, multi sensor for public health assimilates assorted data source and addresses community health challenges widely and efficiently. In this study, we proposed a Horse Herd Fused Discriminant Generative Adversarial Network (HHF-DGAN) algorithm for diabetes prediction. Sensor-based diabetes data is gathered from kaggle, and then data preprocessing using z-score normalization is inaccurate records from a dataset. To extract feature from the pre-processed data, Short-Time Fourier Transform (STFT) is used for dimensionality reduction. HHF-DGAN is a public health technique that addresses diabetes prevention and management while also including multi sensor assessment data. The proposed methods are to evaluate F1-score (86%), precision (92%), recall (93%), and accuracy (93%). The effectiveness of the suggested strategy in improving prediction reliability for diabetes detection in public health circumstances has been established by comparing it with existing methods. The study concludes field of healthcare assessments with a robust framework for leveraging multi sensor data and deep learning methods in disease prediction.

Integration of digital twins to simulate community health scenarios and evaluate the effectiveness of public health interventions led by pharmacists

Public health emergencies such as the 2019 coronavirus disease (COVID-19) have increased the focus on digital technology. A digital twin (DT) is a cybernetic representation of a physical object (e.g., a person or a community) that helps us comprehend the complexity of the real thing and makes it easier to foresee, avoid, track, and improve its actual performance. To prepare for a new age of reliable and precise public health and medical care, DT technology can propel a much-needed radical transformation of conventional electronic health and medical records, which centre on individuals and their aggregates covering populations. Hence, this paper presents the Digital Twin-based Public Health Intervention Model (DT-PHIM) to simulate community health led by pharmacists. The use of digital twins in healthcare has the potential to revolutionize workflow analysis and resource allocation, ultimately resulting in better patient care and more efficient operations. In addition, healthcare providers may hone their abilities and rehearse intricate treatments in a secure and realistic environment with the help of digital twins. There is great promise for digital twin technology to revolutionize healthcare by boosting innovation, patient safety, and overall patient outcomes. On top of that, DTs may help doctors and other medical staff, such as hospital pharmacists, make decisions by simulating how therapy would affect these patients. The experimental outcomes demonstrate that the suggested DT-PHIM model increases the patient data access ratio by 97.4%, the monitoring efficiency ratio by 96.2% and the decision-making ratio by 98.2% compared to other existing models.

An exploratory single-arm open-label clinical study to evaluate the combined effect of Vamana and Sarasvata Churna in reducing excessive daytime sleepiness

BackgroundExcessive Daytime Sleepiness (EDS) is inferred as persistent sleepiness and often a general lack of energy during the day even after apparently adequate or even prolonged nighttime sleep. The subjects may not be identifying excessive daytime sleepiness but may present as feeling tired, lack of energy etc. They may seem apparently healthy and without any other systemic illness. The prevalence was found to be as high as 18 % in 2012 in United Kingdom. Also, it is a risk factor for diseases like Alzheimer's disease, Parkinson's disease and other neurodegenerative diseases. Conventional management (Modafinil, Sodium Oxybate and Stimulants) addresses only the subjective condition in EDS and is associated with adverse effects compromising the quality of life. In the current health scenario there is a need for alternative interventions to manage this disease. On analyzing this condition through Ayurveda, we could understand it as Nidradhikya (Excessive daytime sleepiness) which is caused due to vitiated Kapha Dosha along with Vriddha Tamoguna (increased Tamoguna) that can be managed by Shodhana (biopurification) followed Shamana (pacification) therapies. ObjectiveThis study was aimed to assess the combined effect of Vamana (therapeutic vomiting) and Sarasvata Churna in reducing Excessive Daytime Sleepiness. Materials and methodsThis was a single-arm exploratory open-label clinical trial. 10 subjects having EDS diagnosed using Modified Epworth Sleepiness Scale (MESS) with a score of 10–24 with proper exclusion were recruited from OPD and IPD, Department of Kāyacikitsa, Amrita School of Ayurveda. All the participants were clinically examined, sought for medical history and further checked biochemically to exclude any other systemic illness that may lead to this condition. Only healthy subjects with quality night sleep (assessed by PSQI) and without any other systemic illness were selected. The treatment protocol adopted was Vamana Karma followed by 30 days of Sarasvata Churna as Shamana Aushadha (medicine for pacification). Assessment was done using MESS on 0th day and after 30 days of Shamana Aushadha Sevana. After completion of treatment, the results were statistically analysed using Wilcoxon Signed Rank Test and final conclusion was drawn. ResultsOn analysis of the symptoms using Modified Epworth Sleepiness Scale, the mean total score reduced from 14.8 to 2.8 with 81.08 % relief in these 10 subjects and a significant p value < 0.05 after Vamana followed by 30 days of Shamana Aushadha Sevana. DiscussionVamana helps in Kapha Nirharana (expelling) which removes the Avarana (occlusion) of Manas seen in Nidradhikya. This results in Hrit Shuddhi (purity of heart) that helps in bringing the equilibrium of Mano Gunas (qualities of mind) (Satvoudaryam Tamojayaha) which forms the line of management. Sarasvata Churna which was administered as Shamana Aushadha possesses Medhya (Nootropic), Buddhi Smriti Dhriti Vardhaka (intellect, memory and patience promoting) attributes and is being indicated in Vicetas. Most of the drugs in Sarasvata Churna are Rasayana (rejuvenation) that imparts Indriya Bala (strengthening of senses) and Priti (contempt) to Manas by Prinana (nourishing) of Rasa Dhatu. ConclusionFrom this study, we could conclude that the combination of Vamana Karma followed by Sarasvata Churna administration is effective in reducing EDS.

MetaFun: unveiling sex-based differences in multiple transcriptomic studies through comprehensive functional meta-analysis

BackgroundWhile sex-based differences in various health scenarios have been thoroughly acknowledged in the literature, we lack sufficient tools and methods that allow for an in-depth analysis of sex as a variable in biomedical research. To fill this knowledge gap, we created MetaFun as an easy-to-use web-based tool to meta-analyze multiple transcriptomic datasets with a sex-based perspective to gain major statistical power and biological soundness.DescriptionMetaFun is a complete suite that allows the analysis of transcriptomics data and the exploration of the results at all levels, performing single-dataset exploratory analysis, differential gene expression, gene set functional enrichment, and finally, combining results in a functional meta-analysis. Which biological processes, molecular functions or cellular components are altered in a common pattern in different transcriptomic studies when comparing male and female patients? This and other biological questions of interest can be answered with the use of MetaFun. This tool is available at https://bioinfo.cipf.es/metafun while additional help can be found at https://gitlab.com/ubb-cipf/metafunweb/-/wikis/Summary.ConclusionsOverall, Metafun is the first open-access web-based tool to identify consensus biological functions across multiple transcriptomic datasets, helping to elucidate sex differences in numerous diseases. Its use will facilitate the generation of novel biological knowledge that can be used in the research and application of Personalized Medicine considering the sex of patients.

Development of nucleic acid lateral flow immunoassay for duplex detection of Leishmania martiniquensis and Leishmania orientalis in asymptomatic patients with HIV.

Leishmaniasis, a neglected tropical disease caused by parasitic protozoa of the Leishmania genus, remains a global health concern with significant morbidity and mortality. In Thailand, the rising incidence of autochthonous leishmaniasis cases involving Leishmania (Mundinia) martiniquensis and novel Leishmania (Mundinia) orientalis underscores the critical need for accurate diagnosis and effective control strategies. This study presents a sensitive and specific nucleic acid lateral flow immunoassay (NALFIA) that integrates a duplex PCR assay with a lateral flow device (LFD) strip format. Targeting the internal transcribed spacer 1 (ITS1) region, known for its unique combination of conserved and variable sequences, this assay employs primers labeled with biotin, digoxigenin, and fluorescein isothiocyanate (FITC) markers, enabling precise species identification and differentiation of these two Leishmania species. Remarkably, the assay achieves a sensitivity that surpasses agarose gel electrophoresis, detecting as few as 10-2 parasite/μL for L. martiniquensis and 10-4 parasite/μL for L. orientalis. Notably, the assay exhibited reliable specificity, revealing no cross-amplification with other major viscerotropic Leishmania species or reference organisms. Evaluation using 62 clinical samples further confirms the effectiveness of the PCR-LFD assay, with a sensitivity of 100% for L. martiniquensis and 83.3% for L. orientalis, and an excellent agreement (κ value = 0.948) with nested PCR. This integrated assay represents a promising advancement in diagnostic tools, offering rapid and accurate results that can significantly contribute to effective disease management and control. Given the increasing relevance of these Leishmania species in current public health scenarios, this assay serves as a valuable tool for both diagnostic and research applications.

The curfew bell and the COVID-19 pandemic: A historical–medical perspective based on the Italian case

The present communication examines the phenomenon of curfew in relation to the COVID-19 pandemic with special attention being laid on the management of the epidemic by Italian health authorities. A literature review and a historical–medical analysis were performed. A historical–medical excursus on the word curfew is offered and a comparison between military and health scenarios is given. Finally, this article stresses how words connected with wartime events should be contextualized when adopted in unmilitary scenarios such as pandemic emergencies and related public health responses.

Lifestyle and risk factors for atherosclerotic cardiovascular disease in Brazilian health scenario

Lifestyle and risk factors for atherosclerotic cardiovascular disease in Brazilian health scenario

Selection of Best Hospital in Mumbai for Tuberculosis Treatment using AHP Technique

The healthcare sector in India is one of the largest sectors in the Indian economy where private sector dominates. Tuberculosis, commonly known as TB, is seen as one of the major health problems in the Indian health scenario. Treatment for the same has been progressing continuously. Tuberculosis being a bacterial infection requires antibiotics for treatment and prevention. Increasing sophistication of technology has also been playing a huge role in the treatment of tuberculosis. A survey was conducted for three known hospitals in the city of Mumbai, Maharashtra- Fortis Hospital, Apollo Hospital and Nanavati Hospital. A survey was done considering four factors- cost, infrastructure, quality and technology. Reasons for choosing these factors are elaborated upon ahead in the research paper. The data was collected through a primarysource where physical papers were circulated and responses collected were then analysed for the further process. Respondents were surveyed and their opinions on various factors as well as priorities of hospitals based on these factors were collected, analysed and processed for further understanding. By the way of conducting Analytic Hierarchy Process Method, it finds out which of these hospitals in Mumbai is preferred the most for its tuberculosis treatment. Keywords: Healthcare, Tuberculosis, treatment, survey, cost, infrastructure, quality, technology

Food supplementation policy for pregnant women: analysis of coverage in Brazilian regions in the light of COVID-19

Objective: in the context of Brazil, a peripheral country, pregnant women are a vulnerable class. Proper nutrition and fetal health depend directly on maternal nutrition, which is often precarious. Thus, the food supplement, which has already changed the health scenario of malnutrition in children, is big important in the best Prenatal Care. The objective is to analyze the quality and supply of food supplementation for pregnant women in Brazil, before and during the COVID-19 pandemic. Methods: analysis of public domain data, from pregnant women registered in the E-manager primary care system, between 2019 and 2021. Results: the micronutrients offered in Brazil in the public policy of supplementation for pregnant women are iron and folic acid, since 2005 until the present date. Data analysis showed that the offer of those both in the pre-pandemic year and in the pandemic was inadequate, reaching less than 20% of pregnant women in the five regions of the country, with only one state in the northeast region, of the 27 national states, having an adequate supply to 100% of pregnant women. Conclusion: supplementation rich in several micronutrients, used preventively during pregnancy, reduces maternal and fetal diseases. However, in Brazil, the supplementation policy during pregnancy is poor in quality, offering only folic acid and iron for years, as well as inadequate distribution of these. This fact proved to be unrelated to the health crisis of the pandemic, as it occurred since the pre-pandemic and worse in numbers before than during it. Therefore, a set of “poor quality and low supply” was identified in the supplementation of pregnant women in Brazil, which contributes to maintaining greater maternal-fetal and child morbidity and mortality.

Situational awareness across different temporalities: scenario exercises for health, security and energy futures

ABSTRACT This article looks at the concept of situational awareness in the context of scenario planning. It draws on three cases in which scenarios are used – scenario-based Turning Point exercises in Israel, which focus on security and emergency situations; health scenarios and simulations conducted by the World Health Organization’s Regional Office for Europe; and energy scenarios in the World Energy Council – and examines the different ways in which situational awareness is manifested in these scenarios. In WHO scenarios, situational awareness is initially intricately connected to specific details of the situation described in the scenario, triggering a predefined model for reporting and responding to health crises. In Turning Point scenarios, however, the use of situational awareness not only activates a predetermined response but also encourages critical thinking about the broader context of the event and the important questions and challenges that arise from it. In the WEC scenarios, situational awareness is directed towards potential future changes and developments by creating rich narratives of plausible futures that enable engagement with the future. The analysis shows that the particular temporality of the context in which the scenario technology is used affects the way in which situational awareness is manifested in each case.

Using behavioral skills training to teach goal setting for health behaviors

AbstractGoal setting is a component of many behavior‐change interventions, with the Specific, Measurable, Attainable, Relevant, Time‐Bound (SMART) goal‐setting method being a commonly used strategy. The current study used a multiple‐baseline across participants design to evaluate the efficacy of behavioral skills training (BST) to teach individuals to set health‐related SMART goals in response to multiple hypothetical health scenarios. Participant attempts at goal setting were scored according to a task analysis encompassing each major element of SMART goals. Goal‐setting performance noticeably improved following an average of 1.25 h of BST, and participants rated the intervention and outcomes favorably.