Limited Access To Health Care Research Articles

Emergency Department Visits Before Cancer Diagnosis Among Women at Mayo Clinic

ObjectiveTo determine associations of incident cancer diagnoses in women with recent emergency department (ED) care. Patients and MethodsA retrospective cohort study analyzing biological females aged 18 years and older, who were diagnosed with an incident primary cancer (12 cancer types studied) from January 1, 2015, to December 31, 2021, from electronic health records. The primary outcome was a cancer diagnosis within 6 months of a preceding ED visit. Secondary outcomes included patient factors associated with a preceding ED visit. ResultsOf 25,736 patients (median age of 62 years, range 18-101) diagnosed with an incident primary cancer, 1938 (7.5%) had an ED visit ≤6 months before a diagnosis. The ED-associated cancer cases were highest in lung cancer (n=514, 14.7%) followed by acute lymphoblastic leukemia (n=22, 13.3%). Patient factors increasing the likelihood of ED evaluation before diagnosis included 18-50 years of age (OR=1.32; 95% CI, 1.09-1.61), Elixhauser score (measure of comorbidities) >4 (OR=17.90; 95% CI, 14.21-22.76), use of Medicaid or other government insurance (OR=2.10; 95% CI, 1.63-2.69), residence within the institutional catchment areas (OR=3.18; 95% CI, 2.78-3.66), non-Hispanic Black race/ethnicity (OR=1.41; 95% CI, 1.04-1.88), and established primary care provider at Mayo Clinic (OR=1.45; 95% CI, 1.28-1.65). The ED visits were more likely in those who died within 6 months of diagnosis (n=327, 37.8%) than those who did not die (n=1611, 6.5%). ConclusionPatient characteristics identified in this study offer opportunities to provide cancer risk assessment and health navigation, particularly among individuals with comorbidities and limited health care access.

Cholera: A Latent Threat to Human Health

: Cholera outbreaks caused by the bacterium Vibrio cholerae present a significant global health challenge, with a notable increase in cases recently reported. The disease is characterized by severe watery diarrhea, leading to dehydration and potential fatalities if not promptly addressed. Transmission occurs through contaminated food and water sources, underscoring the importance of water sanitation and hygiene measures to prevent outbreaks. Limited healthcare access and inadequate reporting systems make estimating cholera cases and deaths challenging. Antibiotic resistance is also a concerning issue, necessitating the development of new treatment options. Prompt laboratory diagnosis is essential, with rapid diagnostic tests and PCR showing promise for pathogen detection. Treatment involves fluid replacement and appropriate antibiotic use to reduce disease severity and transmission. Oral cholera vaccines offer preventive measures for high-risk individuals during outbreaks. To combat the escalating cholera epidemic and save lives, a comprehensive approach, including improved water sanitation, early detection, and timely treatment, is crucial.

Evaluation of an initiative to address polypharmacy in hospitalized older adults

AbstractBackgroundPolypharmacy contributes to medication‐related harm in older adults. Deprescribing interventions are often employed in the outpatient setting, potentially missing patients with limited healthcare access. Hospitalization represents a unique touch point to address polypharmacy in older adults with a multidisciplinary team.MethodsThis retrospective cohort study examined the feasibility and effectiveness of a polypharmacy intervention in hospitalized older adults. The intervention was developed by a multidisciplinary team with a quality improvement framework and implemented by clinical pharmacists on an academic teaching service. Adults aged 65 years and older were included. Pharmacists completed a comprehensive medication review with the identification of medication therapy problems (MTPs), with additional evaluation for polypharmacy (five or more chronic medications) and potentially inappropriate medications (PIMs) using validated tools (Beers and STOPP/START criteria), with recommendations implemented during hospitalization. Descriptive statistics were used to describe the intervention and its outcomes. Reporting followed the SQUIRE statement.ResultsThe polypharmacy intervention was provided to 155 patients. Polypharmacy occurred in 98.7% of older adults, whereas 82.6% received at least one PIM (261 total). This demonstrates a significant need for an intervention to address polypharmacy and PIMs during hospitalization. A median of two MTPs was identified per patient (total 287), the most common being adverse drug reaction (present in 52.3% of patients), medication without indication (47.7%), and indication without medication (31%). Opioids were the most common PIM (present in 36.1% of patients), followed by benzodiazepines (10.3%) and skeletal muscle relaxants (8.4%). A total of 40.6% of PIMs were successfully deprescribed at discharge.ConclusionPolypharmacy is ubiquitous in hospitalized older adults. A multidisciplinary approach to deprescribing can reduce PIMs during hospitalization.

Impact of Air Quality on Respiratory Health in Children in Mexico

Purpose: The aim of the study was to analyze the impact of air quality on respiratory health in children in Mexico. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: High air pollution levels in Mexico, largely from traffic and industry, worsen respiratory health in children. This includes higher rates of asthma, respiratory infections, and decreased lung function. Urban areas with limited healthcare access are hit hardest. Urgent action is needed, including stricter regulations and public health initiatives, to protect Mexican children's well-being. Unique Contribution to Theory, Practice and Policy: Environmental determinism theory, bronfenbrenner’s ecological systems theory & health belief model (HBM) may be used to anchor future studies on analyze the impact of air quality on respiratory health in children in Mexico. Encourage pediatricians and healthcare providers to routinely discuss air quality issues during visits and provide guidance on minimizing exposure, especially in areas with known poor air quality. Policy initiatives should aim to reduce the emission of key pollutants identified in the research as harmful to children's respiratory health.

Caring for Individuals with Alzheimer’s Disease: A Spotlight on Hispanic Caregivers

A caregiver is a constantly evolving role that an individual most likely undertakes at some point in their lifetime. With discoveries and research in increasing life expectancy, the prevalence of neurological-related diseases, such as Alzheimer’s disease (AD) and dementia, is certainly likely to require more caregivers. The demand for AD caregivers is escalating as the prevalence of the disease continues to rise. The projected rise in AD within the Hispanic population in the United States over the next few decades is expected to be the most significant among all ethnic groups. The Hispanic population faces unique dementia risks due to cultural factors like language barriers, lower education, and limited healthcare access. Higher rates of conditions such as diabetes and cardiovascular disease further elevate dementia risk. Family dynamics and caregiving responsibilities also differ, affecting dementia management within Hispanic households. Addressing these distinct challenges requires culturally sensitive approaches to diagnosis, treatment, and support for Hispanic individuals and their family’s facing dementia. With AD and other dementia becoming more prevalent, this article will attempt to expand upon the status of caregivers concerning their economic, health, and cultural statuses. We will attempt to focus on the Hispanic caregivers that live in Texas and more specifically, West Texas due to the lack of current literature that applies to this area of Texas. Lastly, we discuss the ramifications of a multitude of factors that affect caregivers in Texas and attempt to provide tools that can be readily available for Hispanics and others alike.

Neurodevelopmental outcomes following possible serious bacterial infection in early infancy in Karachi, Pakistan: a prospective cohort study

BackgroundPakistan reports a significant burden of neonatal mortality, with infections as one of the major causes. We aim to assess the long-term impact of early infancy infections on neurodevelopmental outcomes during later childhood.MethodsWe conducted a prospective follow-up study of the cohort enrolled at the Karachi site of the Aetiology of Neonatal Infection in South Asia (ANISA) during 2019–2020. Children with a possible serious bacterial infection (based on the WHO IMCI algorithm) at early infancy were assessed for neurodevelopment at 6–9 years of age and compared with healthy controls. The Ten Questions (TQS) questionnaire, Strengths and Difficulties Questionnaire (SDQ), and Parent’s Evaluation of Developmental Stage Assessment Level (PEDS: DM-AL) neurodevelopmental assessment tools, were administered and scored by the research staff who were blinded to the child’s exposure status. Generalized Structural Equation Modelling (GSEM) was employed to verify relationships and associations among developmental milestones, anthropometry, and sociodemographic variables.ResultsA total of 398 children (241 cases and 157 controls) completed neurodevelopmental and growth assessments. Cases had a significantly higher rate of abnormal TQS scores (54.5% vs. 35.0%, p-value 0.001), greater delays in motor milestones (21.2% vs. 12.1%, p-value 0.02), lower fine motor skills (78.4 ± 1.4 vs. 83.2 ± 1.5, p-value 0.02). The receptive language skills were well-developed in both groups. According to the logistic regression model, exposure to infection during the first 59 days of life was associated with delayed TQS milestones (β = -0.6, 95% CI -1.2,-0.04), TQS hearing domain (β = -0.3, 95% CI: -1.2 to 0.7), PEDS: DM-AL fine motor domain (β = -1.3, 95% CI: -4.4 to 1.7), PEDS: DM-AL receptive language development (β = -1.1, 95% CI: -3.7 to 1.4) and child anthropometric measurements such as weight and height (β = -0.2, 95% CI: -0.4 to 0.01 and β = -0.2, 95% CI: -0.4 to -0.01, respectively). Early pSBI exposure was positively associated with PEDS: DM-AL self-help domain (β = 0.6, 95% CI: -1.2 to 2.4) and SDQ-P overall score (β = 0.02, 95% CI: -0.3 to 0.3).ConclusionChildren exposed to PSBI during early infancy have higher rates of abnormal development, motor delays, and lower fine motor skills during later childhood in Pakistan. Socioeconomic challenges and limited healthcare access contribute to these challenges, highlighting the need for long-term follow-ups with integrated neurodevelopment assessments.

Exploring suicidal ideation prevalence in multiple sclerosis patients during the COVID-19 pandemic: A study on the relationship between drug use and suicidal ideation

BackgroundThe COVID-19 pandemic has exacerbated psychological challenges, leading to increased rates of clinically significant depression and suicidal ideation among MS patients. Despite advancements in MS treatments, there remains a need to investigate the impact of different drugs on the prevalence of suicidal ideation, particularly in the context of the pandemic. MethodThis cross-sectional study, conducted in 2021, received ethics approval from the Ethics Committee of Kerman University of Medical Science. The study involved 234 MS patients selected from the MS Association in Kerman Province. Questionnaires were prepared and distributed via Google Drive and WhatsApp, with participants providing informed consent. The collected data were analyzed using SPSS software. Inclusion criteria encompassed adults diagnosed with MS according to specific criteria and willing to complete the questionnaires, while exclusion criteria included unclear diagnostic criteria and lack of cooperation. The instruments included a demographic questionnaire, medication checklist, and the Beck Suicidal Thought Scale questionnaire, which has been validated in Iran. Results202 MS patients completed the questionnaires, most of whom were women and married. The prevalence of Suicidal Ideation was 46.5 %, with 8.9 % at high risk. Factors such as gender, marital status, education, occupation, and city did not show statistically significant differences in SI. Patients with SI had a longer duration of illness and were more likely to have seen a psychiatrist. The COVID-19 pandemic affected the necessary care for 44.6 % of patients and worsened symptoms in 28.7 %. Additionally, 30.2 % of patients had seen a psychiatrist, and the prevalence of SI was significantly higher in this group. The study also explored the prevalence of SI with comorbidities and types of drugs used, finding no statistically significant differences. ConclusionThe study revealed a high prevalence of suicide ideation among MS patients, emphasizing the need for tailored comprehensive support. Factors contributing to SI included limited healthcare access, fear of COVID-19 complications, social isolation, and heightened anxiety. Recommendations for healthcare providers stress early diagnosis, personalized treatment plans, and collaborative efforts to enhance the well-being of individuals with MS in Iran post-COVID-19.

Quad Shot Palliation, A Considerable Option for Non-Osseous Recurrent or Metastatic Malignancies in Elderly or Frail Patients.

Background: Palliative radiation therapy (RT) is increasingly recognized as a crucial component of care for patients with advanced, incurable malignancies. In Pakistan, where patients often present at advanced stages due to socio-economic barriers and limited healthcare access, efficient and effective treatment protocols are essential. Objective: This study aimed to evaluate the efficacy of the Quad Shot hypo-fractionated RT protocol for pain palliation in elderly and frail patients with recurrent or metastatic non-osseous malignancies. Methods: A quasi-experimental study was conducted at the Oncology Department of Ganga Ram Hospital, Lahore. Forty-two elderly patients with histologically confirmed inoperable malignancies and a WHO Performance Status of 2 to 3 were enrolled. Patients with prior RT or a second cancer were excluded. RT was delivered using a Cobalt-60 beam, with a total dose of 14 Gy divided into four fractions over two consecutive days. Pain severity was assessed using a 10-point scale before and four weeks after treatment. Statistical analysis was performed using the Wilcoxon Sign Rank Test on SPSS version 25.0. Results: The study population comprised 52% males and 48% females, with the majority of primary tumors located in the head and neck (64%). Post-treatment, the mean pain score significantly decreased from 8.04 ± 1.22 to 4.32 ± 0.89 (p < 0.05). Conclusion: The Quad Shot hypo-fractionated RT protocol effectively reduces pain in elderly and frail patients with advanced malignancies, suggesting its suitability as a quick and effective palliative care option in resource-limited settings.

Empowering Expecting Women to Obtain High-Quality Healthcare in Pakistan: An Evaluation of Khyber Pakhtunkhwa's Conditional Cash Transfer Program.

Maternal mortality, largely stemming from complications during pregnancy and childbirth, impacts poor expecting women with limited healthcare access in rural Pakistan. Conditional Cash Transfers (CCTs), commonly implemented in developing nations, are designed to improve the well-being of vulnerable populations by focusing on health and education. A CCT initiative named Chief Minister's Special Initiative for Mother and Child Health (CM-SIMCH) was launched in Khyber Pakhtunkhwa (KP), one of the less-developed provinces of Pakistan, to empower expecting women to access quality healthcare. This study investigates the factors influencing CM-SIMCH program participation and assesses its impact on the health of expecting women by analyzing health-seeking hospital visits in KP, Pakistan. The study utilizes the Propensity Score Matching (PSM) technique to analyze cross-sectional data obtained from 303 expecting women residing in the Nowshera district of KP. The PSM allows for a balanced comparison of participants who received the CM-SIMCH transfers with those who did not, assessing its impact on maternal healthcare access and outcomes. Empirical results show that factors such as education and family system positively influence the participation of expecting women in the CM-SIMCH program, whereas travel costs exert a negative effect. The intervention leads to a notable increase in hospital visits among these women, contributing to improved health outcomes in KP. This underscores the program's potential effectiveness in addressing maternal healthcare challenges and enhancing healthcare access for vulnerable women in less-developed areas. Therefore, empirical evidence supports the CM-SIMCH program's potential to promote maternal health and improve healthcare access in KP. The study recommends government intervention in health sector as a strategic imperative to empower women and enhance infant health.

Malaria Parasitemia and Severe Health Complications in Children Under Five Years of Age in Nigeria: A Study Using the Demographic and Health Survey (DHS) Malaria Indicator Survey (MIS) 2021.

In Nigeria, 97% of the population is at risk of contracting malaria. It is transmitted by female Anopheles mosquitoes carrying the Plasmodium parasite and can be lethal. An estimated 55 million illnesses and 80,000 deaths per year result from it. Children under five are more likely to contract malaria. Efforts to control malaria in Nigeria include indoor residual spraying, insecticide-treated bed nets, and quick detection and treatment of confirmed cases with effective antimalarial medications. These attempts have been impeded by limited healthcare access, poor financing, and drug-resistant parasites. Thus, the study of therelationship between malaria complications and housing for children under five is essential. The Demographic and Health Survey (DHS) Malaria Indicator Survey (MIS) 2021, a nationally representative data set from developing countries on population and health, was used for this study. A sample size of 13,727 was employed (n=13,727). Logistic regression analyses were conducted to test the association between the type of place of residence and malaria complications (outcome). Overall, 4.2% (n=570, weight HV005) of participants in the sample reported malaria complications. The results of the logistic regression revealed that children residing in urban settlements (aOR 0.37, 95% CI 0.37-0.37, p-value <0.001), children from the poorest class families (aOR 11.63, 95% CI 1.62-1.63, p-value 0.004), children from poorer class families (aOR 7.56, 95% CI 7.55-7.57, p-value <0.001), children from middle-class families (aOR 4.05, 95% CI 4.03-9.06, p-value <0.001), children from richer class families (aOR 1.22, 95% CI 2.21-2.23, p-value <0.001), children of mothers with primary education (aOR 0.42, 95% CI 2.32-4.112, p-value 0.001), children of mothers with secondary education (aOR 0.24, 95% CI 3.21-3.22, p-value <0.001), children of mothers with higher education (aOR 0.08, 95% CI 0.72-0.80, p-value <0.001), and children of the female gender (aOR 0.65, 95% CI 0.65-0.66, p-value <0.001) are all associated with severe malaria complications. In conclusion, the study examined malaria complications in Nigerian children under five by residency. The findings imply that rural children are more likely to have serious malaria complications than urban children. This emphasizes the necessity for targeted malaria therapies in rural areas with limited healthcare access.

Factors influencing delivery-related complications and their consequences in hard-to-reach areas of Bangladesh

Background and objectivesBangladesh's high maternal mortality ratio is exacerbated by delivery-related complications, particularly in hard-to-reach (HtR) areas with limited healthcare access. Despite this, few studies have explored delivery-related complications and factors contributing to these complications among the disadvantaged population. This study aimed to investigate the factors contributing to delivery-related complications and their consequences among the mothers residing in the HtR areas of Bangladesh. MethodsData were collected using a cross-sectional study design from 13 HtR sub-districts of Bangladesh between September 2019 and October 2019. Data from 1,290 recently delivered mothers were analysed. ResultsAround 32% (95% CI: 29.7–34.8) of the mothers reported at least one delivery-related complication. Prolonged labour pain (21%) was the highest reported complication during the delivery, followed by obstructive labour (20%), fever (14%), severe headache (14%). Mothers with higher education, a higher number of antenatal care (ANC) visits, complications during ANC, employed, and first-time mothers had higher odds of reporting delivery-related complications. More than one-half (51%) of these mothers had normal vaginal delivery. Nearly one-fifth (20%) of mothers who reported delivery-related complications were delivered by unskilled health workers at homes. On the other hand, about one-fifth (19%) of the mothers without any complications during delivery had a caesarean delivery. Nine out of ten of these caesarean deliveries were done at the private facilities. ConclusionDelivery-related complications are significantly related to a woman's reproductive history and other background characteristics. Unnecessary caesarean delivery is prominent at private facilities.

Self-Care Practices and Health-Seeking Behaviors Among Older Adults in Urban Indian Slums: A Mixed Methods Study.

Background Effective self-care is crucial for maintaining health among older adults in resource-constrained communities. This study examined self-care practices, health-seeking behaviors, and associated factors among older adults in urban slums in India. Materials and methods A mixed methods study was conducted among 432 adults aged ≥65 years. Participants were selected through multistage random sampling from five slum areas. Self-care practices, health-seeking behaviors, demographic information, chronic conditions, self-efficacy, and health literacy were assessed through interviews. The qualitative data was explored through in-depth interviews with 30 participants. Results Inadequate health literacy (194, 45%) and low self-efficacy (162, 37.5%) were common. While 324 (75%) had an adequate diet and 378 (87.5%) took medications properly, only 86 (20%) monitored diabetes complications. Only 194 (45%) of the patients underwent recommended cancer screening, and 324 (75%) of the patients saw doctors ≥twice a year. Age, sex, education, income, comorbidities, self-efficacy, and health literacy had significant associations. Alongside facilitators such as social support, barriers such as limited healthcare access and suboptimal prevention orientation emerged. Conclusion Suboptimal prevention orientation and overreliance on secondary care instead of self-care among elderly people are problematic given the limited use of geriatric services. Grassroots health workers can improve health literacy and self-efficacy through home visits to enable self-care. Healthcare access inequities for vulnerable groups merit policy attention.

0527 Is Inpatient Polysomnography Associated with Limited Healthcare Access, and Economic and Social Deprivation?

0527 Is Inpatient Polysomnography Associated with Limited Healthcare Access, and Economic and Social Deprivation?

Comprehensive Outreach: Reach Every Child Initiative Expanded Program on Immunization Khyber Pakhtunkhwa, Pakistan

Background: Vaccination is one of the most effective public health interventions for preventing infectious diseases. In regions like Khyber Pakhtunkhwa, Pakistan, where access to healthcare is limited, immunization coverage often remains below optimal levels. Targeted outreach activities can play a pivotal role in improving vaccine uptake, particularly in underserved populations. Objective: This study aimed to assess the effectiveness of immunization outreach activities in increasing vaccine coverage in Khyber Pakhtunkhwa over a defined period. Methods: A comprehensive methodological approach was utilized involving predefined Excel sheets for daily data collection by trained personnel. Data validation procedures were implemented to ensure accuracy, with regular feedback sessions to improve data collection processes. Monthly reports were compiled and analyzed using SPSS version 25 to summarize immunization activities and coverage rates. The outreach strategy included community announcements and door-to-door campaigns by Local Health Workers (LHWs), designed to identify and vaccinate zero-dose and defaulting children. Results: The outreach campaign significantly improved immunization coverage, with zero-dose vaccinations achieving 100% coverage. Penta I, II, and III vaccines saw coverage rates of 78.99%, 72.48%, and 78.02%, respectively. Measles vaccines MCV-I and MCV-II achieved coverage rates of 83.01% and 86.11%. The overall strategy effectively reduced gaps in vaccine coverage across various districts. Conclusion: The study confirms that structured and well-coordinated outreach activities can effectively increase immunization coverage in areas with limited healthcare access. Continuous effort and strategic planning are essential to sustain and build upon these gains to ensure comprehensive vaccine coverage.

From erosion to epidemics: Understanding the overlapping vulnerability of hydrogeomorphic hotspots, malaria affliction, and poverty in Nigeria

Hydrogeomorphic changes, encompassing erosion, waterlogging, and siltation, disproportionately threaten impoverished rural communities. Yet, they are often marginalized in discussions of disasters. This oversight is especially concerning as vulnerable households with limited healthcare access are most susceptible to related diseases and displacement. However, our current understanding of how these risks intersect remains limited. We explore the complex relationships between hydrogeomorphic hazards, malaria incidence, and poverty in Nigeria. Through spatial analyses we expand traditional boundaries, incorporating factors such as healthcare access, migration patterns, dam locations, demographics, and wealth disparities into a unified framework. Our findings reveal a stark reality: most residents in hydrogeomorphic hotspots live in poverty (earnings per person ≤$1.25/day), face elevated malaria risks (80 % in malaria hotspots), reside near dams (59 %), and struggle with limited healthcare access. Moreover, exposure to hydrogeomorphic hotspots could double by 2080, affecting an estimated 5.8 million Nigerians. This forecast underscores the urgent need for increased support and targeted interventions to protect those living in poverty within these hazardous regions. In shedding light on these dynamics, we expose and emphasise the pressing urgency of the risks borne by the most vulnerable populations residing in these regions—communities often characterised by limited wealth and resilience.

Intra-Familial Cases of Hepatitis B Virus and Their Associated Risk Factors of Transmission in District Mardan, Khyber Pakhtunkhwa, Pakistan

Introduction: Hepatitis - B Virus is a prevalent viral hepatitis, with high morbidity, and mortality worldwide. It affects 2 billion people, especially those with limited healthcare access and low socioeconomic status. It causes liver problems which may be acute or chronic. HBV is transmitted from mother to fetus during pregnancy (vertical transmission) and also transmitted from infected individuals to others (horizontal transmission). In our society, the family living system is a joint system, many people live in a single house which results in the sharing of different personal items. So, there are high chances of intra-familial cases of HBV. This study aimed to find out the intra-familial cases of HBV infections and their associated risk factors of transmission within a family in District Mardan. Methodology: This was a descriptive cross-sectional study conducted in the Department of Pathology, Mardan Medical Complex, District Mardan, Khyber Pakhtunkhwa Pakistan. After ethical approval and informed consent from participants a total of 36 positive families of HBV were taken by using a non-probability convenience sampling method. Data was collected from positive individuals with the help of a pre-designed questionnaire. That data was analyzed through SPSS version 22. Results: Out of 36 families, 50% had no HBV-positive members, while 50% had positive individuals. There were 18 households (50%) with only one member positive for HBV, 12 families (33.3%) with two members, 4 families (11.1%) with three individuals, and 2 families (5.6%) with four members. There were three major risk factors present, which resulted in intra-family HBV transmission. There were 7 (19.4%) families where Vertical transmission was the main risk factor. 7 were (19.4%) due to the use of personal hygiene goods, whereas 4 families (11.1%) were due to unsafe sexual intercourse among couples (husband/wife). Conclusion: There was an equal chance of the hepatitis B virus to affect only one member of a family or have transmission to other members within a family. Multiple risk factors are involved in the transmission of HBV in a family but most of the cases were due to vertical transmission, use of personal hygienic items, and unsafe sexual intercourse between (couples)wife and husband in district Mardan, Pakistan. Key words: Hepatitis-B virus, Intra-familial, vertical transmission, Mardan, Risk factor

Unravelling The Complexities of Cervical Cancer: A Comprehensive Exploration

Cervical cancer (CC) ranks as the second most common cause of cancer-related deaths among women aged 20-39, resulting in ten premature deaths weekly. CC affects women worldwide as the most common form of genital cancer, with approximately 500,000 new cases diagnosed annually. Besides the risk of death, CC can lead to increased morbidity, causing symptoms like pain, haemorrhage, and kidney failure. These complications pose significant challenges to treatment, particularly in areas with limited healthcare access. Immune dysregulation and chronic inflammation further contribute to CC pathogenesis, creating a pro-carcinogenic microenvironment through immune cell recruitment, cytokine release, and inflammatory responses triggered by persistent HPV infection. Moreover, understanding the socio-economic determinants influencing the prevalence of CC and promoting awareness can contribute to effective public health interventions. Research endeavours in these domains are vital to reduce the burden of CC, enhance early detection, and ultimately save lives. This review covers recent research on CC global epidemiology, intricate pathogenesis insights, protein-based HPV vaccines, and diverse treatment modalities, including recurrent cases. Molecular markers indicating prognosis and the role of artificial intelligence. The review will briefly highlight preventive strategies, offering a comprehensive overview of crucial research areas in CC.

A One Health approach toward the control and elimination of soil-transmitted helminthic infections in endemic areas

Soil-transmitted helminths (STHs) pose significant health challenges, particularly in developing countries. Over 2 billion people are estimated to have been infected with at least one STH species. These parasites rely on the soil for part of their life cycle and are transmitted to humans through ova ingestion or skin penetration. Key risk factors include poor water, sanitation, hygiene practices, limited healthcare access, and poverty. Globally, STHs are primarily controlled through chemo-preventive deworming of high-risk groups in moderate (where prevalence of STHs is between 20 % and 50 %) to highly endemic areas (prevalence >50 %). Despite the use of deworming to control the STHs in endemic areas, infections still occur. The aim of this article is to explore the potential for enhancing STH control and elimination as Neglected Tropical Diseases (NTDs) in endemic areas through an integrated approach—the One Health approach. The current control program has a single strategy of chemoprophylaxis; in the integrated approach to control of STHs, the parasite control strategies besides being based on the epidemiology of the parasite (endemicity), also include strategies based on the biology (transmission cycle) of the parasites and human behavior patterns in endemic areas. Through the involvement of local communities, healthcare authorities, and stakeholders, participatory approaches foster collaborative efforts to devise and implement control measures. By integrating this integrated approach into existing healthcare and educational initiatives, more effective results can be achieved. The promotion of health education, clean water access, improved sanitation, and hygiene awareness can further enhance control strategies and reduce STH prevalence sustainably. Here, we highlight the benefits of adopting an integrated (One Health) approach to tackle STHs in endemic areas. Through community empowerment and multi-sectorial collaboration, we can strengthen our collective efforts to combat STHs and alleviate the burden of these NTDs.

Empowering rural Maharashtra: A holistic approach to rabies control and one health perspectiv

Rabies, a grave threat in rural areas with limited healthcare access, poses significant global concern due to its near 100% fatality rate in humans and animals. The shift to intradermal vaccines highlights cost-effectiveness. Maharashtra, India’s one of largest states, faces unique challenges in rabies prevention and management, despite efforts, owing to poor awareness and limited healthcare access. In India, Maharashtra stands out due to challenges in rabies prevention and management despite ongoing efforts. This study proposes transformative strategies grounded in community engagement, education and vaccination campaigns to reduce rabies incidence. Emphasizing community empowerment, it advocates for integrating traditional knowledge with modern interventions. Globally, 330,000 people face rabies risk annually, with India accounting for 36% of cases. Limited vaccine access perpetuates transmission risks, necessitating collaborative efforts to enhance awareness and intervention, particularly in rural Maharashtra. The study emphasizes removing stray dogs and implementing widespread vaccination as key prevention strategies. The success of Goa’s One Health program exemplifies human rabies elimination feasibility and cost-effectiveness, aiming to eradicate canine-mediated human rabies deaths by 2030. Targeted interventions can effectively reduce rabies incidence, safeguarding both human and animal populations. By targeting these key areas, communities can effectively reduce the incidence of rabies and protect both human and animal population.

Abstract P451: Clinical, Demographic, and Geographic Trends in Cardiovascular Causes of Deaths Associated With Homelessness

Background: Cardiovascular disease (CVD) remains the leading cause of death in the United States, accounting for a staggering 928,741 fatalities in 2020. Persons experiencing homelessness (PEH) have a 3- to 5-fold excess risk of mortality from CVD, which ranks as a predominant cause of mortality in this setting, second only to overdose deaths. The elevated incidence of CVD mortality for PEH may be attributable to complex interactions between social determinants and risk factors that include delayed diagnosis, limited healthcare access, heightened smoking rates, and the increased incidence of diabetes and hypertension among other factors. Methods: This study utilized records from the county medical examiner in the third most populous county in the US from 2021-2022, focusing exclusively on CVD mortality in medicolegal cases to analyze the impact of specific risk factors for PEH. All medicolegal deaths involving CVD were analyzed to determine relative frequencies of associated or secondary causes between housed and PEH deaths along with insights into the influence of age, race, and gender. Results: The examination of the CVD mortality in PEH cases in 2021 (n=52) and 2022 (n=71) revealed important trends, yielding an estimated, unadjusted mortality rate of 23 deaths per 1,000 person-years-exposed-to-homelessness (compared to around 2 per 1,000 person-years in population). The mean age for CVD deaths in PEH was 58.6 and 60.6 years in 2021 and 2022 respectively (males increased 57.8 to 61.3 years; females increased 58.8 to 60.6 years), while the proportion of CVD deaths increased among males (30-32%) but decreased for females (29-22%). This widening gap in the percent of CVD deaths occurring among male PEH and female PEH is evident where the gap stood at 1% in 2021 but expanded to 10% in 2022 (p=n.s.). Racial disparities show a rapid increase in CVD deaths for Black/African American PEH (26.1-33.7%). Top conditions associated with CVD deaths were hypertension and atherosclerosis, regardless of housing status at death. Diabetes mellitus (25%), obesity (22%), and chronic ethanolism (16%) round out the top 5 conditions for housed decedents, while among the unhoused COPD (19.7%), CHF (12.7%), and diabetes mellitus (11.3%) were the most common. Conclusion: Exposure to homelessness and housing instability is a major driver of cardiovascular mortality. These findings suggest that PEH face ongoing challenges in the management and prevention of CVD. Additionally, CVD deaths associated with homelessness often point foremost to hypertensive and atherosclerotic vascular changes, contributing to natural deaths. These conditions point to persistent risk factors such as limited healthcare access, high smoking rates (contributing to COPD), and higher incidences of diabetes and hypertension. Additional research is needed on underlying causes of the identified gender disparities.