Inadequate Coverage Research Articles

Paraspinous Muscle Flaps in Complex Pediatric Spine Surgeries: A 12-Year Single Institution Experience.

The benefits of paraspinous flaps in adult complex spine surgery patients are established in the literature; however, their use in pediatric patients has not been well described. This study compares clinical outcomes with and without paraspinous muscle flap closure in pediatric patients who have undergone spine surgery. We conducted a retrospective review of all pediatric spine surgeries at the University of California, San Francisco from 2011 to 2022. Patients were divided into 2 cohorts based on whether the plastic surgery service closed or did not close the wound with paraspinous muscle flaps. We matched patients by age, American Society of Anesthesiology classification, prior spinal surgical history, and diagnosis. Surgical outcomes were compared between the 2 cohorts. We identified 226 pediatric patients who underwent at least one spinal surgery, 14 of whom received paraspinous flap closure by plastic surgery. They were matched in a 1:4 ratio with controls (n = 56) that did not have plastic surgery closure. The most common indication for plastic surgery involvement was perceived complexity of disease by the spine surgeon with concern for inadequate healthy tissue coverage (78.6%), followed by infection (21.4%). Postoperative complications were similar between the two groups. The plastic surgery cohort had a higher rate of patients who were underweight (57.1% vs 14.3%, P < 0.01) and had positive preoperative wound cultures (28.6% vs 8.9%, P = 0.05), as well as a higher rate of postoperative antibiotic usage (78.6 vs 17.9%, P < 0.01). There was no difference in recorded postoperative outcomes. Spine surgeons requested paraspinous flap closure for patients with more complex disease, preoperative infections, history of chemotherapy, or if they were underweight. Patients with paraspinous flap coverage did not have increased postoperative complications despite their elevated risk profile. Our findings suggest that paraspinous muscle flaps should be considered in high-risk pediatric patients who undergo spine surgery.

Abstract 4791: Characterizing interventions to reduce disparities in lung-cancer screening uptake by state Medicaid expansion status: A scoping review

Abstract Background: Lung cancer is the leading cause of cancer-related deaths in the United States, and yet, lung cancer screening rates remain persistently low. Many interventions are being developed to address the low rates of lung cancer screening (LCS), including interventions that address the additional barriers faced by historically marginalized racial and ethnic populations as well as low-income and rural populations. However, the impact of Medicaid expansion on the types of interventions developed in non-expansion states and the efficacy of those interventions is not well understood. Methods: A research librarian conducted searches in MEDLINE via PubMed, Web of Science, and Embase. Results were screened and evaluated for eligibility by three reviewers in Covidence. Data was extracted from included studies after full-text review and analyzed using both a thematic analysis and a descriptive numerical summary of studies. The chosen framework was based on scoping review guidelines by Levac et al. and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Results: Of 4696 studies found through the initial search, 53 met inclusion criteria. This includes 34 studies in Medicaid expansion states (M) and 17 studies in non-Medicaid expansion states (NM). Two additional studies compared interventions implemented in a Medicaid expansion state to a similar intervention implemented in a non-expansion state. Studies in both groups were primarily focused on addressing disparities by race and ethnicity (M=74%; NM=65%), with fewer studies focusing on rurality (M=9%; NM=12%), income (M=9%; NM=0%), or multiple disparities (M=9%; NM=24%). In non-expansion states, the most common interventions were patient navigation (29%) and community outreach (24%). While in Medicaid expansion states, the most common interventions were EHR algorithms (24%) and decision aids (21%). The intervention setting for both Medicaid expansion and non-expansion states were most commonly in a hospital/health system (M=53%; NM=47%) or community setting (M=24%; NM=47%). Interventions in both groups typically showed some improvement in uptake of LCS, though the degree of impact was variable between studies. Conclusion: Due to continued barriers to access posed by inadequate insurance coverage, there is a critical need for interventions to reduce disparities in lung cancer mortality in states that have not expanded Medicaid. Interventions focused on patient navigation and community outreach have been effective in multiple settings in these states and could fill that gap. Citation Format: Miranda J. Reid, Caretia Washington, Meghann Wheeler, Lauren Adkins, Dejana Braithwaite, Ramzi Salloum. Characterizing interventions to reduce disparities in lung-cancer screening uptake by state Medicaid expansion status: A scoping review [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4791.

Low Vision Practice and Service Provision Among Optometrists in Ghana: A Nationwide Survey

ABSTRACT Purpose To characterize practice patterns of low vision services among Optometrists in Ghana. Methods The nationwide cross-sectional survey identified entities through the Ghana Optometrists Association (GOA) registry and utilized a semi-structured questionnaire to consolidate survey information that comprises practitioners’ demographics, available services, diagnostic equipment, barriers to service provision and utilization, and interventions. Results 300 Optometrists were identified, with 213 surveyed (71% response rate). About fifty percent (52.6%) were in private practice, and more than two-thirds (77%) did not provide low vision services. Most (≥70%) reported lack of assistive devices, and basic eye care examination kits as the main barriers to low vision service provision. Similarly, practitioners reported unawareness of the presence of low vision centres (76.1%), and high cost of low vision aids (75.1%) as the prime perceived barriers for patients to utilize low vision services. Continuous professional development and public education (89–90%) were suggested as interventions to improve the uptake of low vision services. After statistical adjustment, private facility type (Adjusted odds ratio [AOR] = 0.35, p = 0.010) and lack of basic eye examination kits (AOR = 0.32, p = 0.002) were significantly associated with reduced odds of low vision service provision. Conversely, ≥15 years of work experience (AOR = 6.37, p = 0.011) was significantly associated with increased odds of low vision service provision. Conclusions Overall, the results indicate inadequate low vision coverage and service delivery. Government policies must be directed towards equipping practitioners with equipment and subsidize patient cost of treatment to optimize low vision care.

Intangible Cultural Heritage Awareness Survey among Residents in Zhangzhou City: A Perspective on Cultural Heritage Security

This study, taking the perspective of cultural heritage security, conducted a survey among residents of Zhangzhou on their awareness of intangible cultural heritage (ICH) using questionnaires. The findings reveal that residents of Zhangzhou exhibit relatively high awareness of ICH in folk customs, fine arts, and drama, while awareness is comparatively lower in music and folk performing arts. The primary channels of awareness include new media (66.6%), traditional media (53.3%), and family and friends (51.5%). Traditional drama (60.6%) and traditional craftsmanship (57.3%) emerge as the most prominent areas of interest among ICH projects. The majority supports heritage protection through live demonstrations and multimedia materials, emphasizing challenges such as insufficient government support, inadequate media coverage, and a shortage of heritage inheritors. The government is perceived as the primary responsible entity (32.9%), while heritage inheritors are considered the main custodians (36.2%). Regarding consumption related to ICH, most respondents adopt a cautious stance, with 59.8% indicating an annual spending of less than 500 yuan. In conclusion, the survey calls for collective efforts within society to address key issues in heritage protection, ensuring its sustainable inheritance and development.

Balto and Togo during the cold winter of Alaska (1925): the two canine heroes in the fight against diphtheria.

In recent years, diphtheria has re-emerged in areas with inadequate vaccination coverage, and Europe has not been spared with several cases among migrants. Diphtheria is a potentially fatal infection caused mainly by toxigenic strains of Corynebacterium diphtheriae. Due to the high mortality rate, especially among young children, the fight against diphtheria is considered one of the first conquests of immunization. In the history of medicine, there is a unique case of an unconventional response to a diphtheria outbreak in which sled dogs were used to overcome the supply difficulties of diphtheria antitoxin. The mass media followed the medical response to the outbreak and raised audience awareness of public health issues. The facts of Nome, Alaska, in 1925 can serve as a catalyst to rethink conventional responses to diphtheria outbreaks in low-income countries today and promote mass media awareness of public health importance.

Endovascular Thrombectomy for Acute Ischemic Stroke in Indonesia: Challenging and Strategic Planning.

High rates of morbidity and mortality indicate that stroke is a major health concern. Unfortunately, the management of ischemic stroke is hindered by several obstacles, particularly in developing countries such as Indonesia, where the burden of morbidity and mortality remains high. In this literature review, we intend to conduct a thorough investigation and analysis of the obstacles to stroke thrombectomy in developing countries, with a focus on Indonesia. Even though numerous studies and recent advances in thrombectomy techniques have been developed, many centers around the world continue to struggle to implement them. The majority of these institutions are located in developing nations like Indonesia. It faces numerous obstacles, including a lack of public awareness, infrastructure, human resources, and financial difficulties. The absence of early education and large-scale campaigns contributes to the dearth of public awareness. Inadequate imaging facilities, prehospital and referral systems, as well as disparities in healthcare expenditure and accessibility, contribute to the absence of infrastructure. Inadequate numbers of neurointerventionists, neurologists, and neurosurgeons, as well as a disparate distribution of these professionals, contribute to human resource issues. Inadequate national insurance coverage, high import tariffs on medical devices, and the high cost of healthcare have a negative impact on the financial situation. We provide related strategies regarding the current situation in Indonesia based on the recent evidence and comparison with developed countries. Academic institutions, medical associations, and government agencies must collaborate to overcome these challenges.

Overcoming barriers to prostate cancer care in the Philippines

Prostate cancer (PCa) is a health concern affecting millions of men globally, with a concerning rise in incidence in the Philippines, a country that faces a complex set of barriers to equitable access to quality PCa care. In this article, we describe the unique geographic, economic, socio-cultural, and political factors that influence access to screening, diagnosis, treatment, and supportive services in the country, and explore avenues for development. The country lacks a nationwide PCa registry to inform resource allocation and guide PCa cancer care programs and policy. Misconceptions, cultural barriers and negative attitudes about PCa among Filipino men adversely influence health-seeking behavior. Inadequate insurance coverage, and high out-of-pocket costs obstruct access to essential care. Geographic and political factors contribute to the uneven distribution of healthcare resources needed for comprehensive PCa care, including access to medical specialists, essential medicines, and surgical and radiotherapeutic equipment. Overcoming these challenges requires a collaborative effort encompassing robust data collection, awareness campaigns to reshape societal norms, policy and economic reforms, infrastructure improvements, and enhanced collaboration among healthcare professionals to provide evidence-based care. Addressing these issues holistically can pave the way to better outcomes and improved quality of life for Filipino men with this life-altering disease.

The circular policy canvas: Mapping the European Union's policies for a sustainable fashion textiles industry

Policy plays a major role in enabling and accelerating the shift to a Circular Economy (CE). Transitioning to a CE in the Fashion Textiles Industry (FTI) requires a holistic policy approach through comprehensive and coherent policy interventions across the resource life cycle. This paper introduces the novel Circular Policy Canvas tool to systematically and visually map CE policies across six dimensions (policy environment, resource life cycle, CE loop, CE strategy, system element and circular business model). This is applied to thirty FTI policies in the EU policy landscape. The canvas enables policymakers and researchers to assess policies to identify gaps and priorities for CE policy development. The findings determine the recency of the EU policy agenda for a circular FTI meaning that there are gaps in terms of coverage and coherence. In particular, the study identifies a lack of attention to displacing the linear economy, a concentration of policies in the head and tail of the resource life cycle with gaps in the core, a dominance of policies in the outer over the inner loop and inadequate coverage of policies focused on actors, infrastructure and resources.

A single-point mutation in the rubella virus E1 glycoprotein promotes rescue of recombinant vesicular stomatitis virus.

Rubella virus (RuV) is an enveloped plus-sense RNA virus and a member of the Rubivirus genus. RuV infection in pregnant women can lead to miscarriage or an array of severe birth defects known as congenital rubella syndrome. Novel rubiviruses were recently discovered in various mammals, highlighting the spillover potential of other rubiviruses to humans. Many features of the rubivirus infection cycle remain unexplored. To promote the study of rubivirus biology, here, we generated replication-competent recombinant VSV-RuV (rVSV-RuV) encoding the RuV transmembrane glycoproteins E2 and E1. Sequencing of rVSV-RuV showed that the RuV glycoproteins acquired a single-point mutation W448R in the E1 transmembrane domain. The E1 W448R mutation did not detectably alter the intracellular expression, processing, glycosylation, colocalization, or dimerization of the E2 and E1 glycoproteins. Nonetheless, the mutation enhanced the incorporation of RuV E2/E1 into VSV particles, which bud from the plasma membrane rather than the RuV budding site in the Golgi. Neutralization by E1 antibodies, calcium dependence, and cell tropism were comparable between WT-RuV and either rVSV-RuV or RuV containing the E1 W448R mutation. However, the E1 W448R mutation strongly shifted the threshold for the acid pH-triggered virus fusion reaction, from pH 6.2 for the WT RuV to pH 5.5 for the mutant. These results suggest that the increased resistance of the mutant RuV E1 to acidic pH promotes the ability of viral envelope proteins to generate infectious rVSV and provide insights into the regulation of RuV fusion during virus entry and exit.IMPORTANCERubella virus (RuV) infection in pregnant women can cause miscarriage or severe fetal birth defects. While a highly effective vaccine has been developed, RuV cases are still a significant problem in areas with inadequate vaccine coverage. In addition, related viruses have recently been discovered in mammals, such as bats and mice, leading to concerns about potential virus spillover to humans. To facilitate studies of RuV biology, here, we generated and characterized a replication-competent vesicular stomatitis virus encoding the RuV glycoproteins (rVSV-RuV). Sequence analysis of rVSV-RuV identified a single-point mutation in the transmembrane region of the E1 glycoprotein. While the overall properties of rVSV-RuV are similar to those of WT-RuV, the mutation caused a marked shift in the pH dependence of virus membrane fusion. Together, our studies of rVSV-RuV and the identified W448R mutation expand our understanding of rubivirus biology and provide new tools for its study.

Sociodemographic characteristics and their association with survival in women with cervical cancer

BackgroundIn 2020, the highest incidence and mortality from cervical cancer (CC) were detected in low and middle-income countries. CC remains a health problem for women living in them. In Mexico, CC ranks second in cancer incidence and mortality in women. The main characteristics of this population are low income, low educational level, and inadequate medical coverage. The present study characterized the Mexican population by CC, and the sociodemographic variables that impacted overall survival (OS) were identified.MethodsA retrospective study that included a cohort of patients with a confirmed diagnosis of CC at the Instituto Nacional de Cancerologia between 2003 and 2016. Information was collected on sociodemographic variables related to the disease and OS.ResultsFour thousand six hundred thirty-one patients were included. The median age was 51 years, 78.5% were unemployed, 44.4% lived in a rural/suburban area, 50.8% had a partner when collecting this information, and 74.3% were classified as having low socioeconomic status. Age, living in a rural/suburban area, more advanced stages of the disease, and not receiving cancer treatment were associated with lower OS.ConclusionCC continues to affect mainly women with minimal resources, low educational levels, and living in marginalized areas. These characteristics influence the OS. Prevention and timely detection programs, education, and training focused on this population and with broader coverage are required to identify patients with CC at earlier stages.

Stellar Population Properties in the Stellar Streams around SPRC047

We have investigated the properties (e.g., age, metallicity) of the stellar populations of a ringlike tidal stellar stream (or streams) around the edge-on galaxy SPRC047 (z = 0.031) using spectral energy distribution (SED) fits to integrated broadband aperture flux densities. We used visual images in six different bands and Spitzer/IRAC 3.6 μm data. We have attempted to derive best-fit stellar population parameters (metallicity, age) in three noncontiguous segments of the stream. Due to the very low surface brightness of the stream, we have performed a deconvolution with a Richardson–Lucy–type algorithm of the low spatial resolution 3.6 μm IRAC image, thereby reducing the effect of the point-spread function aliased emission from the bright edge-on central galaxy at the locations of our three stream segments. Our SED fits that used several different star formation (SF) history priors, from an exponentially decaying SF burst to continuous SF, indicate that the age–metallicity–dust degeneracy is not resolved, most likely because of inadequate wavelength coverage and low signal-to-noise ratios of the low surface brightness features. We also discuss how future deep visual–near-infrared observations, combined with absolute flux calibration uncertainties at or below the 1% level, complemented by equally well absolute flux-calibrated observations in ultraviolet and mid-infrared bands, would improve the accuracy of broadband SED fitting results for low surface brightness targets, such as stellar streams around nearby galaxies that are not resolved into stars.

Troubleshooting the bypass: intraoperative management of initially failed anastomosis in direct cerebral revascularization surgery.

Direct cerebral revascularization is considered as one of the most technically challenging operations in neurosurgery. Technical errors are often not identified during the case, but only after the recirculation stage, making management crucial at that time of the procedure. In this study, the authors sought to describe troubleshooting of the technical errors encountered in initially failed bypass cases. A retrospective analysis describing a single-surgeon, single-institution experience between 2014 and 2021 was performed, based on operative reports and videos, including a 30-day follow-up period. Initially failed bypass was defined if the bypass was not patent or had a significant leak after recirculation, irrespective of the final result. One hundred thirty-eight bypass cases were reviewed for complex aneurysms (n = 49), moyamoya disease (n = 59), and atherosclerosis (n = 30). Fifty-one initially failed anastomoses were identified; 43 of these were the result of a technical error. Etiologies of these failed anastomoses included a clot (n = 14), vessel kinking (n = 4), spasm (n = 5), suture-related cause (n = 5), inappropriate donor or recipient (n = 3), or lack of demand (n = 8). A major leak was attributed to an uncoagulated side branch (n = 4), vessel injury due to suture/clip placement (n = 1), or inadequate suture line coverage (n = 7). Thirty-seven (86%) of 43 cases were troubleshot successfully, as salvage maneuvers included papaverine vessel massage, donor repositioning, re-anastomosis for occlusion in select cases, local hemostatic agents, and suturing or coagulating side branches in a leak. Thirty-day follow-up revealed similar rates of patency between successfully troubleshot patients (35/37) and the rest of the cases (80/87, p = 0.6). Three major patterns of a noncompatible bypass were found: a major leak, an acute occlusion, or a delayed occlusion. Based on the authors' experience, salvage strategies proved successful, showing an eventual high patency rate. The authors suggest a gradual, structured algorithm to address this stage in surgery that may contribute specifically to cerebrovascular neurosurgeons at the beginning of their careers.

Axillary Lymph Node Coverage in Breast Cancer Patients Treated with Adjuvant Radiation Using High Tangent Fields Technique: A Single Institution’s Experience

Background: The high tangent field (HTF) technique is used to provide radiation coverage of the inferior axillary nodal levels for breast cancer patients when the lower axilla is at risk for micrometastatic disease. Despite its use in clinical practice, there is concern about whether HTF provide sufficient coverage of level I and II axillary nodal regions. The purpose of this study is to quantify and evaluate the coverage of HTF at our institution. Methods: Patients diagnosed with early invasive breast carcinoma (pT1-2 pN0-1a) who received HTF radiation between January 1st, 2012 and December 31st, 2016 were retrospectively reviewed. Level I and II axillary nodal regions were contoured on each patient’s simulation CT. Dosimetric parameters were re-calculated to evaluate coverage. Statistical analysis was conducted using Mann-Whitney-U method. Results: Thirty-seven patients with low-risk breast adenocarcinoma were included. For level I and II, the mean V90% was 94.63% ± 7.60% and 73.33% ± 21.83% respectively. Twenty-nine patients received adequate V90% coverage of level I and had a mean level II V90% of 76% ± 18.71% while eight patients who did not receive adequate V90% level I coverage had a mean level II V90% of 63.64% ± 30.22%. The median level II V90% of patients receiving adequate and inadequate level I V90% was 77.74% and 71.11% respectively; the difference was not statistically significant (P = 0.33). Conclusion: HTF provides adequate coverage for level I nodes, but inadequate coverage for level II. Contouring nodal volumes may assist field placement and improve nodal volume coverage.

Inadequate needle and syringe coverage among people who inject psychoactive drugs across England and Wales

Aim Needle and syringe (NS) provision is a proven intervention for reducing harms associated with injecting drug use, such as infections, but impact is coverage-dependent. We characterised people who injected drugs (PWID) in England and Wales who had insufficient NS in the past month to meet their injecting requirements. Methods This study utilised 2017–2019 data from the annual Unlinked Anonymous Monitoring (UAM) Survey of PWID recruited through specialist services. Logistic regression was used to identify factors associated with inadequate NS coverage. Findings Of 2,442 PWID surveyed who had injected in the past month, 34% reported inadequate NS coverage (or as high as 51% if including unsuccessful injections). Younger PWID (adjusted odds ratio: 2.18, 95% confidence interval: 1.35–3.52), those who began injecting in the past three years (1.46, 1.09–2.00), and those who reported sharing injecting equipment (1.46, 1.22–1.75) had greater odds of having inadequate NS coverage. PWID currently prescribed Opioid Substitution Treatment (OST) had lower odds of inadequate NS coverage (0.60, 0.49–0.73). Conclusion Given the poor reported coverage of NS provision in England and Wales, there is urgent need to address inequity in accessing sufficient NS and increase coverage among this vulnerable group to reduce injecting-related harms.

Trends in Health Care Coverage and Out-Of-Pocket Cost Barriers: A Gender Comparison.

Objective: The presence of disparities in access to health care and insurance coverage can have a tremendous impact on health care outcomes. Programs like the Affordable Care Act were implemented to improve health care access and to address the existing inequities. The objective of this study was to identify any disparities that exist between males and females regarding health care coverage and out-of-pocket cost to health care. Methods: This analysis was a cross-sectional study using the Behavioral Risk Factor Surveillance System survey data collected between 2013 and 2018. The primary predictor was sex assigned at birth (with the binary option of male vs. female). The primary outcome was adequate health coverage. Survey participants who indicated that they had health insurance with no out-of-pocket cost barriers to receiving medical care were considered to have adequate health coverage, while participants who did not meet these criteria were considered to have inadequate health coverage. Covariates measured were age, race/ethnicity, educational level, employment status, and annual household income. SAS survey procedures and weighting methods were used to measure the association between the sex and adequate health coverage, after controlling for covariates. Results: The data spanning 6 years included 2,249,749 adults, of whom 1,898,097 (84.4%) had adequate health coverage. Females made up 55.8% (N = 1,256,243) of the total sample. About 32.6% (N = 733,216) survey participants were aged ≥65 years. Most respondents, 77.6%, were White (Non-Hispanic). Across the 6-year period, females were more likely to have health insurance but with out-of-pocket costs that served as a barrier to their medical care (adjusted odds ratios with 95% CI from 2013 to 2018 were 1.36 [1.29-1.43], 1.38 [1.32-1.46], 1.31 [1.24-1.38], 1.33 [1.26-1.40], and 1.32 [1.25-1.40], respectively). Conclusions: Females were more likely than males to indicate an out-of-pocket cost barrier to medical care despite having health insurance.

Blockchain-Based Implementation of National Census as a Supplementary Instrument for Enhanced Transparency, Accountability, Privacy, and Security

A national population census is instrumental in offering a holistic view of a country’s progress, directly influencing policy formulation and strategic planning. Potential flaws in the census system can have detrimental impacts on national development. Our prior research has pinpointed various deficiencies in current census methodologies, including inadequate population coverage, racial and ethnic discrimination, and challenges related to data privacy, security, and distribution. This study aims to address the “missing persons” challenge in the national census population and housing system. The integration of blockchain technology emerges as a promising solution for addressing these identified issues, enhancing the integrity and efficacy of census processes. Building upon our earlier research which examined the national census system of Pakistan, we propose an architecture design incorporating Hyperledger Fabric, performing system sizing for the entire nation count. The Blockchain-Based Implementation of National Census as a Supplementary Instrument for Enhanced Transparency, Accountability, Privacy, and Security (BINC-TAPS) seeks to provide a robust, transparent, scalable, immutable, and tamper-proof solution for conducting national population and housing censuses, while also fostering socio-economic advancements. This paper presents a comprehensive overview of our research, with a primary focus on the implementation of the blockchain-based proposed solution, including prototype testing and the resulting outcomes.

"100 Things I Wish Someone Would Have Told Me": Everyday Challenges Parents Face While Caring for Their Children With a Tracheostomy.

Equitable access to appropriate care, emergency department services, and in-home support aids are needed to minimize the occurrences of adverse events that have a significant impact on families. However, many families of children with medical complexity (CMC) lack consistent care due to issues of health inequity. We conducted 11 qualitative interviews with primary caregivers who were asked about their experiences of providing care to children who have a tracheostomy and are supported by multiple life-saving machines at home. Guided by ecological systems theory, we identified three themes that contextualize the lived experiences of the participants who expressed needs that arose from poor interactions within the mesosystem. Findings convey participant frustrations that result from insufficient support, ineffective training, and inadequate healthcare coverage. Although each theme is organized systematically to emphasize specific concerns within the mesosystem, together these themes emphasize the inextricable relationship between daily needs with systemic barriers to care. We provide a discussion of these needs with a broader context that also impacts the perceived quality of care among families managing the needs of their children who are supported by life-saving technology. By addressing existing challenges and identifying opportunities for improvement within the healthcare system, we seek to contribute to the collective effort of advocating for ethical systemic change on behalf of CMC and their families.

Out-of-pocket expenses and healthcare service utilisation among maintenance haemodialysis patients: A study at a tertiary care hospital in Udupi, Karnataka.

Financial burdens faced by patients in India suffering from chronic kidney disease (CKD) are linked to healthcare access and inadequate insurance coverage. This study analyses out-of-pocket expenses and explores their healthcare utilisation patterns. This time-bound hospital-based cross-sectional study was conducted in a tertiary care hospital in Udupi district, Karnataka, among patients who have undergone haemodialysis (HD) treatment for at least a year. Following ethics approval and CTRI registration, informed consent was obtained from all the patients prior to data collection. The study involved 109 HD patients. The direct medical and non-medical costs incurred by HD patients were Rs 9,400 (IQR = 13,700) and Rs 3,200 (IQR = 2,000), respectively. The monthly health-related OOPE was Rs 16672.0 (IQR = 14,630.0). Overall, 103 (94.5%) individuals had been hospitalised since they began HD, and 50.5% of patients were hospitalised within the past year. On linear regression analysis, it was observed that the joint monthly income (β 0.134, 95% CI 0.007 - 0.182, P value = 0.048), number of dialyses per week (β 1.14, 95% CI 7541.5 - 16551.07, P value < 0.001), and social security (β -1.02, 95% CI -13463.0 - 7982.56, P value < 0.001) exhibited significant correlations and served as predictors for household out-of-pocket expenditure (HROOPE) experienced by the patients. The study concludes that people receiving HD incur a considerable financial cost. Additionally, the CKD population uses healthcare services at a notable rate, including frequent hospital stays, visits to outpatient departments (OPDs), and emergency treatment, underscoring the pressing need for an increase in insurance coverage.

Successful management of severe tetanus in a 10-year-old unvaccinated girl: A case report

Tetanus is a potentially fatal disease caused by Clostridium tetani, which produces muscle spasms, autonomic dysfunction, and respiratory failure by the action of a powerful neurotoxin. Tetanus can be prevented by vaccination, proper wound care, and tetanus prophylaxis, but it remains a significant public health concern in regions with inadequate vaccination coverage. We report a case of severe tetanus in an unvaccinated 10-year-old girl following a tetanus prone injury on her right big toe and was treated with antibiotics, tetanus immunoglobulin, tetanus toxoid, sedatives, neuromuscular blockers, and tracheostomy with mechanical ventilation. She recovered after 28 days of supportive multi-disciplinary intensive care and was discharged with no neurological sequelae.

The Effect of Boko Haram Insurgency on Health and Nutrition among the Residents of Bolori 2 of Maiduguri Metropolitan Council of Borno State, Nigeria.

The Effect of Boko Haram Insurgency on Health and Nutrition among the Residents of Bolori 2 of Maiduguri Metropolitan Council of Borno State, Nigeria.