Health Improvement Research Articles

Teamworking in Dentistry: The Importance for Dentists, Dental Hygienists and Dental Therapists to Work Effectively Together-A Narrative Review.

To consider teamworking in dentistry, focusing especially on the role of dental hygienists (DHs) and dental therapists (DTs) as part of the dental team. A narrative review of studies that have investigated teamworking in periodontology and dentistry in general together with consideration of examples of relevant regulatory and governmental policy documents. The inclusion of DHs and DTs as key members of the dental team yields significant patient benefits in terms of access to care (particularly among under-served populations), efficient and effective treatment and improved healthcare outcomes for patients. However, barriers can exist to full implementation of effective working in dental teams, including both systemic and regulatory barriers, as well as attitudinal barriers. Furthermore, DHs and DTs are not always working to their full scope of practice, thereby limiting the care that these team members can provide. Mutual respect between dental team members, high-quality communication and a common ethos and shared clinical standards are all essential for effective teamworking. DHs and DTs have a clear role to play in achieving sustainable improvements in oral and dental health for patient populations globally. Full and effective integration of DHs and DTs into healthcare teams will benefit not only the dental team, but also healthcare systems and patient populations, via more effective teamworking, improved access to care and enhanced treatment outcomes.

Faktor-Faktor yang Mempengaruhi Indeks Pembangunan Manusia Melalui Belanja Daerah Sebagai Variabel Pemediasi

This research uses quantitative techniques to examine and evaluate the impact of the Revenue Sharing Fund and Special Allocation Fund on the Human Development Index using regional expenditure as a mediating variable. The East Nusa Tenggara region's 110 data points from 22 districts and cities between 2019 and 2023 served as the study's sample. Path analysis and multiple linear regression are the study approaches that are employed. The results of this study prove that increasing the amount of Special Allocation Fund (DAK) and Revenue Sharing Fund (DBH) can increase Regional Expenditure, besides that DBH is able to increase the Human Development Index (HDI), DAK and Regional Expenditure have not contributed to changes in HDI, and DAK and DBH have no impact on HDI through Regional Expenditure. This illustrates that the East Nusa Tenggara local government has optimized the allocation of Revenue Sharing Funds through extracting funds by utilizing the potential of natural resources and taxes as a strategy to improve the quality of the Human Development Index through improvements in education, health, and income levels.

Cross national patterns in educational inequalities in functional limitations among middle aged and older adults at two time points

IntroductionIn recent decades, the global population has aged rapidly while socioeconomic inequalities in health have widened, with older adults who are most disadvantaged experiencing the poorest health. Functional limitations are key predictors of disability and quality of life and are therefore considered an important measure of how well individuals and populations are aging. We determine if educational inequalities in functioning have widened over time and across countries. MethodsWe used data from five nationally representative surveys of aging, covering 14 high- and middle-income countries, with harmonized measures of functional limitations. We examined change over time in the number of functional limitations among adults aged 50-64 and 65 and older in each country as well as changes in educational inequality in functional limitations over time for both age groups. ResultsIn most high-income countries, the number of functional limitations decreased over time, but they increased in China and Mexico, with the largest increases occurring among adults 65 and older. Educational inequality in functional limitations among those aged 65 and older widened for several countries in our study, but for different reasons. In some countries, it widened due to increased limitations among the least-educated, while in others it widened due to declines in limitations among the most-educated. ConclusionGrowing educational inequality in functional limitations for older adults in several high- and middle-income countries suggests that, despite improvements in health and mortality, socioeconomic differences in functional health among older adults are widening.

Nourishing sustainability: clinical nutrition’s impact on climate change

IntroductionPreserving our planet's delicate balance is not merely a choice but a responsibility we owe to future generations, ensuring equitable, and sustainable world. The 2030 Agenda for Sustainable Development, adopted by all United Nations (UN) member states in 2015, offers a collective vision for global peace and prosperity. Central to this agenda are the 17 Sustainable Development Goals (SDGs), which call for unified action from all nations, irrespective of their developmental status, under a global partnership. MethodThis paper examines the SDGs' framework and its applicability to clinical nutrition (CN). We provide a comprehensive narrative review relating to the integration of SDGs in CN practices. Whilst recognising the importance of the SDG framework we elected to focus specifically upon the environmental aspects of CN care. ResultsThe analysis revealed that the SDGs provide a robust framework for promoting sustainability in clinical nutrition. Key findings highlight the interconnection between health improvement and other SDGs, such as poverty reduction and climate action. Effective CN practices contribute to broader sustainable development by ensuring better health outcomes, which in turn support economic growth and reduce inequalities. Additionally, strategies in CN that focus on reducing waste and improving resource efficiency align with environmental sustainability goals. Conclusion: The 17 SDGs offer a comprehensive guide for advancing sustainability across various fields, including clinical nutrition. By adopting these goals, healthcare providers can implement holistic strategies that not only improve health outcomes but also support broader efforts to achieve global sustainability.

SWOT analysis of Janani Suraksha Yojana among women of Western Uttar Pradesh, India

ABSTRACT Introduction: In April 2005, under the umbrella of National Rural Health Mission (NRM) in response to the slow and varied progress in improvement of maternal and neonatal health, the Government of India launched a scheme known as Janani Suraksha Yojana (ISY) Objectives: With the help of this study, we intend to understand the knowledge, source of information, awareness, and barriers to acceptance of JSY among women in Western Uttar Pradesh and conduct a SWOT analysis for the same. Material and Methods: The sample size was 300 and calculated using the prevalence of institutional delivery taken from National Family Health 2015-16 Survey (NFHS-4) in Uttar Pradesh, India, which was 67.8%. Data were analysed using appropriate statistical tests by Statistical Package for Social Sciences (SPSS) software and Microsoft excel. Results: Grassroot-level workers, namely, ASHA, ANM, AWW, and Dai, were an important source of information regarding JSY in the rural area with 68% beneficiaries saying that they got their information about JSY from them compared to only 22% in the urban area. Out of the 105 beneficiaries who delivered at home, the two most common reasons for noninstitutional delivery were the cost of the institutional delivery (51.4%) and home is convenient (47.696). Conclusion: Cash incentives help in the use of health services such as antenatal care, postnatal care, and counselling services. Less focus and ASHA coverage in urban areas as compared to rural areas.

Initiatives to improve lung and sleep health in children: Delphi consensus from the pediatrics, pulmonary, and sleep conference.

The lung and sleep health of adults is heavily influenced by early factors, both genetic and environmental; therefore, optimizing respiratory health begins in childhood. Multiple barriers impede improvements in lung and sleep health for children. First, the traditional siloing between general pediatric care in the community, pediatric pulmonary and sleep subspecialty care, and the research community limits the translation of knowledge into practice. Additionally, identifying and addressing health disparities remains a challenge. The 2021 NHLBI-sponsored workshop "Defining and Promoting Pediatric Pulmonary Health (DAP3H)" was a first step in defining critical gaps in our current healthcare system in identifying and optimizing lung and sleep health in children. The workshop identified key opportunities including measuring pulmonary function in young children, sleep-focused outcomes, developing biomarkers, and longitudinal research cohorts. To expand on the work of DAP3H and continue initiatives to improve childhood lung and sleep health, the Pediatrics & Pulmonary Network: Improving Health Together conference was held in 2023. A modified Delphi process was applied to form consensus surrounding gaps, barriers, and action items, with the goal of identifying the most urgent opportnities for improving childhood lung and sleep health. Cross-cutting foundational principles were identified as: (1) Authentic Stakeholder Collaboration & Engagement, (2) Reach & Implementation in Real World Settings, (3) Understanding Current Landscape & Resources and (4) Purposeful Diversity, Equity, & Inclusion Initiatives. To improve lung and sleep health in children, these principles should be the foundation for research design, development, and implementation.

Using salience and availability to promote sustainable and healthy food choices in hospital cafeterias

Sustainable diets can achieve considerable reductions in greenhouse gas emissions and improvements in human health, but changing dietary behavior remains a challenge. We assessed the impacts of two behavioral insights strategies on bridging the intention-action gap related to sustainable and healthy food choices amongst hospital cafeteria patrons. In a pilot survey of hospital staff (N = 1,165), 56% identified limited awareness and availability of sustainable food as barriers to purchasing, although 46% were extremely willing to try sustainable dishes. We examined increasing salience (Study 1), varying availability (Study 2a), and decreasing availability (Study 2b) on sustainable and healthy dish purchases in three hospital cafeterias. Each study ran for seven weeks from March to April, 2023. In total, 10,616 dishes were purchased. In Study 1, increasing salience was associated with significant uptake of sustainable and healthy dishes, but the effect disappeared once the salience intervention was removed. In Study 2a, increasing availability of sustainable dishes corresponded to a significant increase in purchases of sustainable dishes, while decreasing availability in Study 2b followed a downward trend in purchases, suggesting that availability drove dietary choices. We recommend hospitals consider these choice architecture interventions to support the adoption of sustainable and healthy diets.

Success of Immunopathogenetic Therapy for Management of Congenital Ichthyosis, Combined Form, in a Child: Rare Clinical Case

Background. Congenital ichthyosis (CI) is relating to the group of clinical and genetically heterogeneous severe genodermatoses. SAM syndrome is included in classification of CI syndromic forms. Defects in the desmoplakin (DSP) and desmoglein 1 (DSG1) genes are the prime cause of disease. Impaired function of encoded proteins leads to desmosomal anomalies and disease symptoms. Comorbid atopic syndrome becomes the major cause of diagnostic mistakes. Patients are observed continuously with diagnosis “Atopic dermatitis (AD) torpid to standard treatment methods”. Clinical case description. This article describes a rare case of a boy with severe AD. Despite the chronic dermatosis several systemic disorders were revealed during examination: short stature, protein-energy malnutrition, adrenal insufficiency, juvenile polyarthritis, vitamin D deficiency, onychodystrophy, dysmorphic disorders. Molecular genetic study conducted via high-throughput sequencing followed by validation with Sanger sequencing has revealed two genetic variants: novel variant chr18:28934543G>T in the DSG1 gene in the heterozygous state and pathogenic variant chr5:157468728C>A in the NIPAL4 gene in the homozygous state. As a result, the final diagnosis was established: “SAM syndrome. Congenital ichthyosiform erythroderma”. Flow cytometry immunology study has shown dominant immunological profile of Th17-, and Thact-lymphocyte proliferation. The immunobiological therapy with IL-17A inhibitor, secukinumab, was initiated. Clinical efficacy was evaluated via ISS (Ichthyosis Severity Index), CDLQI (Children’s Dermatology Life Quality Index), pruritus numerical rating scale. ISS was 5.8 points, pruritus scale — 9, CDLQI — 24 at therapy initiation. Improvement in the skin condition was observed after a month of therapy. ISS was 1.2 points, pruritus scale — 2, CDLQI — 4 6 months after the therapy initiation. Conclusion. The diagnosis of a child with combined form of CI made it possible to change the management strategy, to prescribe pathogenetically justified targeted immunobiological therapy, and to achieve significant improvement in the child's health and quality of life, which does not differ from healthy peers.

Intercambio guiado por farmacocinética de factores VIII de vida media estándar a factores VIII de vida media extendida pegilados en la terapia de la hemofilia A en práctica clínica

ObjectiveTo analyze the differences in pharmacokinetic and clinical parameters (bleeding rates and joint health) before and after switching from standard half-life factor VIII (FVIII) to extended half-life pegylated FVIII in patients with severe/moderate hemophilia A on prophylaxis, one year before and after the switch in real-life. MethodThis is a single-center, comparative, observational, sequential, retrospective, and multidisciplinary study. Population pharmacokinetic models from the WAPPS-Hemo® application were used to calculate pharmacokinetic parameters and individualize prophylaxis. The annual rate of total and joint bleeds, joint health (Hemophilia Joint Health Score), plasma half-life and area under the curve ratios, FVIII consumption, administration frequency, and cost were analyzed. ResultsThirty-eight adult patients with hemophilia A who switched from standard half-life FVIII to extended half-life pegylated FVIII were analyzed. Significant improvements (p < 0.05) were observed in all pharmacokinetic parameters, with plasma half-life and area under the curve improvement ratios of 1.5 and 1.9, respectively, as well as reductions in annual total and joint bleeding rates were registered. A higher number of patients with zero total (16.0 vs. 29.0) and joint bleeds (23.0 vs. 33.0) was also observed. The median reductions in administration frequency and dose/kg/week were 30.0% and 19.7%, respectively, avoiding 44.3 infusions/patient/year, resulting in savings of 20,843 €/patient/year. Furthermore, joint health improved (23.0 vs. 21.0; p = 0.017), and target joints resolved after the switch. ConclusionsThe pharmacokinetically guided switch from standard half-life FVIII to pegylated FVIII demonstrated significant clinical benefits with reduced bleeding rates and improvements in joint health. Additionally, improvements in pharmacokinetic parameters were observed, allowing for reduced treatment burden by decreasing administration frequency, as well as lower consumption and costs.

Career Advancement Insights from Certified Pharmacy Technicians: Enhanced Opportunities for the Pharmacy Technician Workforce

Sustainable career advancement opportunities for pharmacy technicians will be a critical part of patient-centered community pharmacy environments as the role of the pharmacist provider expands. (1) To determine the impact of a Pharmacy Technician Certification Board pharmacy (PTCB) certification on career advancement and professional growth metrics; (2) To assess technicians' role in advanced pharmacy services before and after certification; and (3) To identify changes in pharmacist services when a certified pharmacy technician (CPhT) was added to the provider team. A 73-question web-based survey was distributed to all PTCB certified pharmacy technicians (CPhT) in the United States, Washing D.C., Puerto Rico, Guam, and the US Virgin Islands. The survey was distributed by PTCB in April 2021 with a 28-day collection period. The survey included multiple choice, rating scale, and free text questions centered on five domains: Practice experience, Career aspirations, Compensation, Pharmacy practice motivations, and Impact of COVID-19 pandemic. 23,007 CPhTs completed the survey. Respondents were primarily female (85.5%), age 30-39 (32.8%), and ≥ 10 years CPhT experience (42.8%). The majority of respondents cited improvement of patient health (77.4%), career advancement opportunities (53.5%), the ability to expand their role during emergencies (e.g., COVID-19) (52.6%), and future career advancement opportunities (51.7%) as benefits of CPhT certification. Increases in job responsibility after certification included changes occurring in roles related to clinical pharmacy services, patient education, preventive health services, provider communication, and staff training. Respondents agreed that PTCB-certification allowed for the expansion of pharmacists' services where they practiced, including clinical services (18.5%), patient education (18.3%), and preventive health services (18.1%). CPhT's value certification for its benefits on career advancement, personal growth, and salary enhancement. Affirmation of skill and training through certification is also recognized to positively influence patient care and the pharmacy's ability to provide advanced patient care and services.

The impact of a lifestyle behaviour change program on healthcare costs: Quasi-experimental real-world evidence from an open-access mobile health app in the Netherlands

ObjectiveRecognizing the substantial role of modifiable risk factors such as physical inactivity, unhealthy diets, and substance use in driving global healthcare expenses, this study aims to assess the impact of a lifestyle behaviour change mobile health (mHealth) app on healthcare costs within a real-world setting. MethodsEmploying a difference-in-difference approach, this research compared healthcare costs between users of an mHealth app (treatment group) and a propensity score-matched control group of non-users. The study included data from 15,506 participants in the Netherlands, covering healthcare cost records collected from 2015 to 2019. ResultsThe implementation of the mHealth app was linked to a steady reduction in healthcare costs, achieving a 4.9 % decrease (β=−0.05,95%CI:−0.10to0.00) during the first year following the program's implementation, and a further 5.3 % decrease (β=−0.05,95%CI:−0.10to−0.00) in the second year. This healthcare costs reduction is associated with lower expenses for general practitioner services as well as diminished specialist visits. Additionally, increased app use led to further cost reductions, with frequency of use proving more important than intensity. ConclusionsThis study demonstrates that a behaviour change mHealth app is linked to significant reductions in healthcare costs, with more frequent and intense use leading to greater savings. Given their relatively low cost and ability to reach diverse population groups, such apps not only enhance individual health outcomes but can also serve as effective policy tools for large-scale health promotion, supporting broader societal health improvements.

Contemporary epidemiology of hospitalised heart failure with reduced versus preserved ejection fraction in England: a retrospective, cohort study of whole-population electronic health records.

Heart failure is common, complex, and often associated with coexisting chronic medical conditions and a high mortality. We aimed to assess the epidemiology of people admitted to hospital with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), including the period covering the COVID-19 pandemic, which was previously not well characterised. In this retrospective, cohort study, we used whole-population electronic health records with 57 million individuals in England to identify patients hospitalised with heart failure as the primary diagnosis in any consultant episode of an in-patient admission to a National Health Service (NHS) hospital. We excluded individuals with less than 1 year of medical history records in primary or secondary care; admissions to NHS hospitals for which less than 10% of heart failure cases were linkable to the National Heart Failure Audit (NHFA); individuals younger than 18 years at the time of the heart failure hospitalisation; and patients who died in hospital during the index heart failure admission. For patients with new onset heart failure, we assessed incidence rates of 30-day and 1-year all-cause and cause-specific (cardiovascular, non-cardiovascular, and heart failure-related) emergency rehospitalisation and mortality after discharge, and dispensed guideline-recommended medical therapy (GRMT). Follow-up occurred from the index admission to the earliest occurrence of the event of interest, death, or end of data coverage. We estimated adjusted hazard ratios (HRs) to compare HFrEF with HFpEF. We computed population-attributable fractions to quantify the percentage of outcomes attributable to coexisting chronic medical conditions. Among 233 320 patients identified who survived the index heart failure admission across 335 NHS hospitals between Jan 1, 2019, and Dec 31, 2022, 101 320 (43·4%) had HFrEF, 71 910 (30·8%) had HFpEF, and 60 090 (25·8%) had an unknown classification. In patients with new onset heart failure, there were reductions in all-cause 30-day (-5·2% [95% CI -7·7 to -2·6] in 2019-22) and 1-year rehospitalisation rates (-3·9% [-6·6 to -1·2]). Declining 30-day rehospitalisation rates affected patients with HFpEF (-4·8% [-9·2 to -0·2]) and HFrEF (-6·2% [-10·5 to -1·6]), although 1-year rates were not statistically significant for patients with HFpEF (-2·2% [-6·6 to 2·3] vs -5·7% [-10·6 to -0·5] for HFrEF). There were no temporal trends in incidence rates of 30-day or 1-year mortality after discharge. The rates of all-cause (HR 1·20 [1·18-1·22]) and cause-specific rehospitalisation were uniformly higher in those with HFpEF than those with HFrEF. Patients with HFpEF also had higher rates of 1-year all-cause mortality after discharge (HR 1·07 [1·05-1·09]), driven by excess risk of non-cardiovascular death (HR 1·25 [1·21-1·29]). Rates of rehospitalisation and mortality were highest in patients with coexisting chronic kidney disease, chronic obstructive pulmonary disease, dementia, and liver disease. Chronic kidney disease contributed to 6·5% (5·6-7·4) of rehospitalisations within 1 year for HFrEF and 5·0% (4·1-5·9) of rehospitalisations for HFpEF, double that of any other coexisting condition. There was swift implementation of newer GRMT, but markedly lower dispensing of these medications in patients with coexisting chronic kidney disease. Rates of rehospitalisation in patients with heart failure in England have decreased during 2019-22. Further population health improvements could be reached through enhanced implementation of GRMT, particularly in patients with coexisting chronic kidney disease, who, despite being at high risk, remain undertreated. Wellcome Trust, Health Data Research UK, British Heart Foundation Data Science Centre.

Health promoting lifestyle in educational setting: an intervention study in the universities

The "health promoting universities" strategy has gained popularity and a presence in the higher education system, particularly in universities. It is imperative for higher education establishments to prioritize the promotion of health within their student body and academic community. By safeguarding and boosting students' wellbeing, a strategy centered on encouraging healthy lifestyles has the potential to boost the university's contribution to health improvement and offer significant value to the community. Universities have the power to improve health promotion through community service and to make policies in this area through research and teaching. In order to investigate student behavior in relation to the standard aspects of the healthpromoting lifestyle profile, this project will undertake an intervention study involving 150 students with the goal of promoting a healthy lifestyle. A pretest and post-test control group design was employed in this investigation. The health-promoting lifestyle standard profile II questionnaire was the research instrument, and descriptive statistics and inference were employed for analysis at the .05 significant level. The outcomes demonstrated a noteworthy impact on the implemented measures. This study's findings indicated that interventions in learning environments successfully raised student behavior linked to a healthy lifestyle and its components.

Comparative Assessment of Indoor Air Quality and Comfort Parameters in Government and Non-Government Hospitals in Southwestern Bangladesh

Indoor air quality (IAQ) is considered crucial in the hospital environment for the health improvement of the patients and the well-being of all the staff and visitors. Despite that, in a lot of hospitals in developing and underdeveloped countries, IAQ is severely impaired by different factors. The lower-income people are mostly dependent on the government-subsidized public hospital, and that necessarily creates a huge number of patients and gatherings and results in impaired IAQ. In this study, nine hospital wards were selected from one public and one private hospital in the southwestern part of Bangladesh to compare the IAQ with respect to the outdoor values. Five IAQ parameters (PM2.5, PM10, VOC, CO2, and HCHO) and three indoor comfort parameters (temperature, relative humidity, and noise) were assessed at three different times of the day (morning, midday, and after noon). The results suggested that PM2.5, PM10, and CO2 were significantly higher in the private hospital units (48.59±12.34µg/m3, 65.27±14.18µg/m3, and 721.13±159.20ppm, respectively) than the public hospital units. In contrast, temperature and relative humidity were found to be slightly lower in the private hospital units (RH: 81.80±1.29%, T: 31.27±1.24°C) than in the public hospital units. The detected noise level was significantly higher in each hospital's indoor units than the outdoor units. The I/O ratio suggests most contamination sources are indoors for the private hospital units, while the toxicity potential found considerable health implications for those indoor locations.

Promoting Health and Wellbeing Through Non-Clinical Arts Programming: Multi-Stakeholder Perspectives From the Veterans Health Administration.

While the value of art therapy is well-established and arts are increasingly leveraged to promote health and wellbeing more broadly, little is known about the impacts of non-clinical arts programs. In this preliminary investigation, we sought to fill this gap by exploring diverse stakeholders' perspectives on the impacts of non-clinical arts programming on Veterans receiving care at the Veterans Health Administration (VA). Semi-structured qualitative interviews with Veterans, VA staff, and community partners. Interviewees were recruited from 7 VA medical centers that have recently implemented non-clinical arts programming to promote Veterans' health and wellbeing, some of them in partnership with community organizations. 33 individuals were interviewed, including 9 Veterans, 14 VA staff, and 10 community partners involved in non-clinical arts program implementation. Interview transcripts were analyzed using iterative rounds of qualitative content analysis. The following impacts on Veterans were described: (1) mental health improvements, (2) renewed sense of purpose; (3) increased social connectedness, (4) improved self-esteem, and (5) self-driven engagement in art activities. Non-clinical arts programming was perceived by diverse stakeholders to offer important benefits for Veterans' health and well-being. Offering non-clinical arts programming inside and outside healthcare facilities' walls is a promising direction for the field of public health undergoing a shift towards holistic approaches to improving individual and population health outcomes.

Micronutrient inadequacy differs by intake of fat amount and class among adults that consume a restricted carbohydrate diet: National Health and Nutrition Examination Survey, 2007-2018

BackgroundRestricted carbohydrate diets remain among the most popular for weight loss and general health improvement. Recent evidence demonstrates that carbohydrate restricted diets are low in overall diet quality, yet their association with micronutrient inadequacy has not been well characterized at a population-level in adults in the United States. Objective1) To evaluate the prevalence of not meeting daily micronutrient recommendations in US adults that met the Acceptable Macronutrient Distribution Ranges (AMDRs) and those who restricted carbohydrate to <45% energy, and 2) examine the effect of total fat and fat class on these results for the restricted carbohydrate group. DesignThis study utilized 24-hour recall data on food and nutrient intake from respondents in the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Participants/settingThis study included 15,029 respondents who were ≥20 y, had complete and reliable nutrient intake data, and were not pregnant or breastfeeding. Main outcome measuresThe main outcome was the prevalence of not meeting daily micronutrient recommendations based on Dietary Reference Intakes (DRIs). Statistical analyses performedThe National Cancer Institute’s usual intake methodology was used to estimate usual dietary intake and the prevalence of the US adult population not meeting the DRIs. ResultsCompared to participants that met the AMDRs, those that consumed restricted carbohydrate diets had greater prevalence of inadequacy (% <Estimated Average Requirement) for vitamin A (46.7% vs 33.6%), folate (12.9% vs 4.3%), vitamin C (42.5% vs 23.3%), vitamin D (64.6% vs 61.3%), magnesium (45.2% vs 41.3%), and iron (3.0% vs 1.3%), and lower prevalence of inadequacy for zinc (8.1% vs 12.2%) and vitamins B-12 (1.7% vs 2.8%; P<0.05 for all comparisons). Restricted carbohydrate diet consumers had a lower likelihood of exceeding the Adequate Intake (AI) for vitamin K (57.8% vs 67.6%) and potassium (32.1% vs 39.2%; P<0.001 for both), higher likelihood of exceeding the AI for choline (16.9% vs 5.6%, P<0.001), and a greater proportion exceeded the Chronic Disease Risk Reduction Intake (CDRR) for sodium (92.1 vs 88.5%, P<0.001). Fat amount and class in those consuming restricted carbohydrate diets modified many of these associations, but the effects were heterogenous across micronutrients. ConclusionThis study shows that there are different types of restricted carbohydrate diets that can be characterized by fat amount and class, each with their own association with micronutrient intake. This information can be used by clinicians to provide more targeted dietary counseling to their patients who restrict carbohydrates, depending on the amount and type of fat they consume.

Modeling the Population Equity of Alzheimer Disease Treatments in the US

The arrival of new medications for Alzheimer disease (AD) has prompted efforts to measure their value using conventional cost-effectiveness analyses; however, these analyses focus on how much health improvement new medications generate per dollar spent. As AD disproportionately affects older adults, women, racial and ethnic minority individuals, and individuals with lower socioeconomic and educational levels, it is critical to also examine the health equity outcomes of treatment. To estimate the health equity impact of a hypothetical disease-modifying treatment for early AD in the US and to examine targeted policies to mitigate health care disparities. This economic evaluation, which used a distributional cost-effectiveness analysis, was conducted from June 16, 2022, to January 11, 2024. The study included subgroups defined by race and ethnicity and by social vulnerability quintiles in the US. A hypothetical disease-modifying treatment compared with best supportive care. The main outcomes were population-level quality-adjusted life-years (QALYs), lifetime costs, and net health benefits. The social welfare impact and change in health inequality were estimated using the Atkinson index. The distributional cost-effectiveness analysis simulated 316 037 100 individuals from the US population, including 25 subgroups defined by 5 categories of race and ethnicity and population quintiles of social vulnerability, with the fifth quintile representing the most socially vulnerable group. At an opportunity cost benchmark of $150 000 per QALY, treatment was associated with improved population health, adding 28 197 QALYs per year to the US population. Accounting for health inequality preferences (using an aversion level of 11, based on an Atkinson inequality aversion parameter that can range from 0 to infinity, with higher values assigning greater weight to health gains that accrue to the population with the lowest lifetime quality-adjusted life expectancy), treatment was associated with a 0.009% reduction in existing population health inequalities annually. Scenario analyses examining earlier and expanded treatment access suggested a population health improvement of up to 221 358 QALYs. The findings of this economic evaluation suggest that treatment for AD could improve population health and health equity. Policies to enable earlier diagnosis and treatment initiation, as well as expanded access to treatment, may further improve treatment and health equity impacts.

Male partners’ involvement in antenatal care and its associated factors in West-central Ethiopia

BackgroundMale partner involvement in antenatal care is a key factor that cannot be ignored in the quest for improvement in maternal health and is recommended as an essential intervention to improve maternal and neonatal health outcomes. However, little attention has been given to male partners’ involvement in maternity care, particularly in developing countries.ObjectiveThis study aimed to assess male partners’ involvement in antenatal care and its associated factors among male partners whose wives gave birth within the last one-year in Bichena town, Westcentral, Ethiopia, 2019.MethodsA community-based cross-sectional study design was conducted from October 1/2018 to June 15/2019, in Bichena town, among 406 male partners. The data was collected by a simple random sampling technique and analyzed using the Statistical Package of the Social Science 23.0 version. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of < 0.05 considered statistically significant.ResultsIn this study, 53.4% [95% CI: 48.3- 58.1%] of male partners had high involvement in antenatal care. The age group of 20–29 years [AOR = 2.14, 95% CI = 1.04–4.38], having primary, secondary, and diploma and above educational level [AOR = 2.04, 95% CI = 1.02–4.07], [AOR = 3.02, 95% CI = 1.49–6.11] and [AOR = 4.03, 95% CI = 2.06–7.89] respectively, ≤ 10 years marriage length [AOR = 2.92, 95% CI = 1.46–5.87], good knowledge of the services provided in antenatal care [AOR = 2.68, 95%, CI = 1.62–4.42], good awareness of the danger signs of pregnancy [AOR = 1.77, 95 CI = 1.10–2.85], favorable attitude towards antenatal care [AOR = 2.62, 95% CI = 1.64–4.19], travel less than 15 min to reach a nearby health facility [AOR = 3.43, 95% CI = 1.54–7.65] and making decision together to seek care in health facility [AOR = 2.44, 95% CI = 1.19–5.03] were associated with male partners involvement in antenatal care.ConclusionsMale partners' involvement in antenatal care was encouraging in the study area compared to previous studies done in Ethiopia. We suggest strengthening awareness among male partners about their shared responsibility during pregnancy. Male partners should be invited to attend the antenatal care. Policymakers and healthcare planners should design programs and plans that will encourage male partners’ involvement in maternal healthcare services utilization.

Exploring Tri Hita Karana-Based CSR: A Sustainable Approach to Village Community Empowerment

This study explored the implementation of Corporate Social Responsibility (CSR) based on Tri Hita Karana in supporting community empowerment in Klungkung village, Bali. The method employed was a descriptive qualitative approach, utilizing data collection techniques such as interviews and documentation. The research informants included 10 purposively selected respondents, encompassing company representatives, village heads, and beneficiary communities to ensure relevant information. This study identified community participation and involvement in CSR programs focusing on education, health, and local economic improvement. Despite the positive impact, significant challenges remain, such as low community awareness and inadequate information about the CSR program of the company. By involving the community at every stage of planning and evaluation, the company can ensure the relevance and success of the program. The study emphasized the need for enhanced socialization, transparency, and two-way communication between the company and the community to overcome these obstacles. Involving local community leaders and youth in the socialization process is expected to improve community understanding and participation, fostering a more harmonious relationship. The results provided new insights into the dynamics between the company, village government, and community, highlighting the importance of collaboration in achieving sustainable community empowerment.

Self-Care Practices and Perspectives in Managing Coronary Heart Disease Patients: A Qualitative Study

Background/Objectives: Self-care experiences and understanding of coronary heart disease (CHD) play a pivotal role in the management of CHD and can contribute to positive health outcomes. This qualitative study aimed to explore the views and experiences of CHD patients, their families, and Indigenous leaders about self-care practices of CHD. Methods: A qualitative design employing semi-structured interviews and a focus group discussion was used. Employing purposive sampling, 49 respondents, comprising 30 patients, 10 family members, and 9 Indigenous leaders, were recruited and interviewed from April to September 2022. The data were analyzed using content analysis. Results: Five major categories were constructed: (1) inadequate knowledge and early symptom identification; (2) self-care activities for physical, psychosocial, and spiritual needs; (3) family and kinship support for self-care efforts; (4) barriers to self-care including physical, psychological, and access issues; and (5) health improvement expectations based on culturally sensitive health education. Conclusions: The study reveals significant gaps in knowledge about CHD and the identification of early symptoms among patients, families, and Indigenous leaders. Despite efforts to meet physical, psychosocial, and spiritual needs, self-care is hindered by various barriers, including limited access to healthcare and entrenched habits. The support from family and kinship systems is crucial for self-care. Participants expressed a strong desire for culturally tailored health education and better health control to improve heart health outcomes.