Ministry Of Health Research Articles

Assessing outcomes and complications of secondary hepatolithiasis after choledochoenterostomy: A nationwide survey in Japan.

This study aimed to evaluate the outcomes and complications of secondary hepatolithiasis following choledochoenterostomy to guide suitable management. The study analyzed 127 patients from a 2017 national survey conducted by the Ministry of Health, Labor, and Welfare. The 2023 cohort study assessed residual stones, recurrences, cholangitis, cholangiocarcinoma, and prognosis. The median follow-up duration was 48 months. Balloon endoscopy-assisted endoscopic retrograde cholangiography (BE-ERC) was the most common treatment, achieving complete stone clearance in 84.4% of patients. Anatomical hepatectomy was the most common surgery. Predictors of residual stones were stone number ≥10 (odds ratio [OR], 7.480; p = .028) and stone diameter ≥10 mm (OR, 5.280; p = .020). Predictors of stone recurrence during follow-up were biliary strictures (hazard ratio [HR], 3.580; p = .005) and cholangitis (HR, 2.700; p = .037). Predictors of cholangitis during follow-up were biliary stricture (HR, 5.016; p = .006) and dilatation (HR, 3.560; p = .029). Any treatment for hepatolithiasis reduced cholangitis occurrence (HR, 0.168; p = .042). Balloon dilation combined with stenting for ≥3 months improved biliary strictures in 57.1% of patients. This study recommends BE-ERC as the first-choice treatment for secondary hepatolithiasis. Stone removal and relief of biliary strictures and dilatation are crucial to prevent stone recurrence and cholangitis after treatment.

Death Risk Response of High-Altitude Resident Populations to COVID-19 Vaccine: A Retrospective Cohort Study.

Vásquez-Velásquez, Cinthya, Diego Fano-Sizgorich, and Gustavo F Gonzales. Death risk response of high-altitude resident populations to COVID-19 vaccine: Retrospective cohort study. High Alt Med Biol. 00:00-00, 2024. Background: Peru had one of the highest mortality rates caused by the coronavirus disease 2019 (COVID-19) pandemic worldwide. Vaccination significantly reduces mortality. However, the effectiveness of vaccination might differ at different altitudinal levels. The study aimed to evaluate the effect modification of altitude on the association between vaccination and COVID-19 mortality in Peru. Methodology: A retrospective cohort, using open access databases of deaths, COVID-19 cases, hospitalizations, and vaccination was obtained from the Peruvian Ministry of Health. Deaths due to COVID-19 were evaluated in vaccinated and nonvaccinated patients. Crude (RR) and adjusted relative risks (aRR) were calculated using generalized linear models of Poisson family with robust variances. Models were adjusted for age, sex, pandemic wave, and Human Development Index. To evaluate the interaction by altitude, a stratified analysis by this variable was performed. The variable altitude was categorized as, 0-499 m (828,298 cases), 500-1,499 m (64,735 cases), 1,500-2,499 m (106,572 cases), and ≥2,500 m (179,004 cases). The final sample studied included 1,362,350 cases. Results: The vaccine showed a considerable reduction of death risk with the second (aRR: 0.41, 95% confidence interval [CI]: 0.38-0.44) and third doses (aRR: 0.21, 95% CI: 0.20-0.23). In the adjusted and interaction model, it can be observed that medium and high altitude present a higher risk of death compared to sea level (aRR: 2.58 and 2.03, respectively). Likewise, the two doses' group presents an aRR:1.22 for medium altitude (1,500-2,499 m) and 1.6 for high altitude (≥2,500 m), compared with low-altitude population, suggesting that the action of vaccination at high altitude is altered by the effect of the altitude itself. Conclusions: Altitude might modify the protective effect of SARS-CoV-2 vaccine against COVID-19 death.

Assessment of community health workers activities in six districts of Zambézia Province, Mozambique

Mozambique’s Community Health Worker (CHW) or Agentes Polivalentes Elementares in Portuguese (APE) in Mozambique was reinitiated in 2010 after an unsuccessful first attempt decades prior. Two decades after this reinitialization, the Ministry of Health of Mozambique (MoH) and other interested parties sought to understand how the implementation of APEs interventions is progressing. Given its low coverage of many health interventions. A cross-sectional study was carried out in six districts of the Province of Zambézia, namely: Ile, Inhassunge, Milange, Mocubela, Mulevala, and Pebane. A questionnaire was developed based on government plans, APE training material, and best practices for implementing ACS programs found in the literature for individual face-to-face interviews with APEs. A descriptive analysis was carried out to summarize the different components of the APEs program according to the interviewees' responses. A total of 148 APEs were interviewed. Only 48% of APEs replenished their kits every month, and stock-outs of medications ranged from 19 to 92%, with expired medication being found for 5–13% of the medications. Although the quality of supervision appears high with APEs reporting service delivery observation (88%), discussion of work performance (81%) and work-related problems (91%), checking of supplies (90%), review of records (93%), and praise (92%) during their last supervision, only 59% of the sample study reported having had their last meeting with their supervisor less than 1 month ago. APEs are very important in providing care to patients in remote communities. Nonetheless, challenges persist in ensuring the proper performance of the APEs program. More urgently, there is a need to focus more on securing a constant supply of APE kits to provide patient care and on regular and timely delivery of subsidies as an incentive.

Implementing the patient partnership approach to quality improvement of care and services: A multiple case study protocol.

Patient and family partners are being increasingly engaged worldwide in processes aimed at the quality improvement (QI) of healthcare services. There is also growing interest in documenting these engagement processes within organizations to share and improve them. To support the provincial implementation of this approach, the Quebec's ministry of health and social services published, in 2018, the "Framework for the partnership approach between patients, their families and health and social service stakeholders". However, while this framework provides guidelines by describing each partner's role and the ways in which patient and family partners should be engaged in QI processes, it remains unclear how these recommendations were actually used and implemented by different healthcare organizations. The aim of this paper is to present the protocol of a multiple case study that is being conducted to document how this approach was implemented in different large healthcare organizations in Quebec. This study is being conducted in partnership with a patient partner/co-researcher. This qualitative multiple case study will be conducted in four large healthcare organizations in Quebec. Twelve to 15 key respondents will be recruited for each case. Data will be collected from multiple sources: 1) semi-structured individual interviews with the key respondents, 2) non-participant observations of the meetings of the QI committee engaging PFPs and 3) analysis of documents describing the implementation context, vision, structures and/or processes. The framework method will be used to conduct intracase and intercase qualitative data analysis. The multiple cases included will allow for comparisons between different ways of engaging PFPs in QI processes within an organization, the factors influencing these practices, their advantages and disadvantages, and their implementation outcomes. The conclusions drawn from this study will allow us to make recommendations regarding PFP engagement in the QI of care and services and to propose implementation examples for other organizations wishing to design and implement PFP engagement initiatives in their context in Quebec or elsewhere.

Genomic surveillance and vaccine response to the dominant SARS-CoV-2 XBB lineage in Rio Grande do Sul

The COVID-19 pandemic has been marked by novel viral variants, posing challenges to global public health. Recombination, a viral evolution mechanism, is implicated in SARS-CoV-2's ongoing evolution. The XBB recombinant lineage, known for evading antibody-mediated immunity, exhibits higher transmissibility without increased disease severity. We investigated the prevalence and genomic features of XBB in SARS-CoV-2-positive cases in Rio Grande do Sul (RS), Brazil. We sequenced 357 samples from epidemiological weeks (EW) 47/2022 to 17/2023, and included 389 publicly available sequences. Clinical and epidemiological data were obtained from DATASUS, e-SUS, and SIVEP GRIPE (data recording systems of the Brazilian Ministry of Health). Of these, 143 were classified as XBB and 586 were other Omicron lineages. In March 2023 (EW 10), XBB became dominant, accounting for 83.3% of cases. 97.7% of XBB-infected patients successfully recovered from the infection, with a low mortality rate (2.3%). Even after receiving three vaccine doses and having been previously infected, 59.5% of the patients experienced reinfection with XBB. However, for 54% of the individuals, the interval between their XBB infection and the last vaccine dose exceeded one year, potentially leading to a decline in antibody levels. In addition, we identified 90 mutations in RS circulating XBB, spread throughout the genome, notably in the Spike protein region associated with immune resistance. This study provides insights into the dynamics and impact of a recombinant variant becoming predominant for the first time in the state. Continued surveillance of SARS-CoV-2 genomic evolution is crucial for effective public health management.

How will the emergence of lecanemab change dementia treatment?

The introduction of lecanemab has dramatically changed the field of dementia medicine. Lecanemab, defined as an anti-amyloid-β (Aβ) drug, comprises an antibody against Aβ, a protein structure believed to cause Alzheimer's disease. This drug represents a new direction in dementia treatment. In a phase III study, lecanemab was found to significantly slow cognitive decline, while showing manageable levels of amyloid-related imaging abnormalities, which are side-effects of lecanemab. Furthermore, lecanemab has been shown to effectively reduce Aβ accumulation in patients with early Alzheimer's disease, which might contribute not only to delaying the progression of cognitive decline, but also to improving the quality of life of patients and their families. However, there are conditions for the use of lecanemab, for which the Ministry of Health, Labor and Welfare has issued the Guidelines for Promotion of Optimal Use. These guidelines specify requirements for appropriate patient selection, prescribing physicians and administering medical institutions to ensure safe and effective use. Particular emphasis is placed on the confirmation of amyloid-β accumulation, amyloid-related imaging abnormalities risk management and appropriate handling of side-effects. The clinical use of lecanemab represents an important advancement in the treatment of dementia; however, the understanding and cooperation of healthcare professionals, patients and families are essential to maximize its efficacy and safety. Future issues to be addressed include the sustainability and long-term efficacy of treatment, improvement of clinical symptoms after removal of Aβ and motivation to administer the drug. Although lecanemab offers hope for the treatment of dementia, its use requires careful management. Geriatr Gerontol Int 2024; ••: ••-••.

Experience in treating multifocal alopecia areata in a child with Jak kinase inhibitors

Alopecia Areata is an autoimmune disease characterized by hair loss mediated by CD8 + T cells. There are no proven effective treatments for alopecia. Recent research on the immunology of hair follicles and recent developments in the field of immunopatogenesis, as well as common ways of developing the disease with other autoimmune disorders have led to research on new treatments, targeted at specific immunological pathways. The so-called JAK-STAT pathway is responsible for transmitting signal from different cytokines to the nucleus of the cell, suggesting that blocking this pathway may be effective in the treatment of alopecia.Study purpose. Presentation of Clinical Case of Multi-focal Alopecia Treatment in Child Oral Tofacitinib.Materials and methods. The study was conducted on the basis of the dermatology department with the laser surgery group of the Center for Pediatric Dermatology and Laboratory of Skin Pathology in children FGAU «National Medical Research Center for Children’s Health» of the Ministry of Health of Russia from April 2021 to November 2022. Severity Alopecia Tool (SALT) was used to determine the severity of the disease in participants. The SALT scale takes into account the percentage of affected hair and divides it into 6 subclasses (S 0 %, S1 <25 %, S2 25–49 %, S3 50–74 %, S4 75–99 % and C5100 %).Results. When oral tofacitinib was administered for 6 months in a 9-year-old patient, full recovery of hair growth on the scalp was observed. No significant abnormalities based on clinical and biochemical blood results were found for the period of treatment and for a year after withdrawal. There was no recurrence of hair loss after the withdrawal of the drug for 12 months.Conclusion. JAK inhibitors can be effective new treatments for alopecia in children. Additional data from randomized controlled trials are required for safe use of JAK inhibitors.

Adherence to iron supplementation during the first year of life infants in Izmir, Turkey.

To determine the prevalence of adherence to iron supplementation and the risk factors for incomplete adherence during the first year of life of infants in Izmir, Turkey. In this cross-sectional study, a total of 511 infants aged 2 to 12 months who presented to the Pediatrics outpatient clinics of Ege University Children's Hospital were included. Mothers (n = 511) who agreed to participate in the study were interviewed face-to-face and a comprehensive questionnaire including questions about the sociodemographic characteristics of the children and the family, and their adherence to iron supplementation was administered. The data obtained from 471 (92.2%) mothers who used iron supplements for their babies were subjected to further statistical analysis. Analyses were performed with SPSS 25.0. Chi-square test was used for univariate analysis and logistic regression analysis was used to determine the independent factors associated with incomplete adherence to iron supplementation. A total of 511 mothers were surveyed. Among the infants of mothers who participated in the study, 471 (92.2%) were taking iron supplementation. Of the infants who received iron supplementation, 58.3% were given iron supplementation with complete adherence. The percentage of complete adherence with iron supplementation was 35.1% between 2 and 4 months, 66.3% between 5 and 8 months, and 52.4% between 9 to 12 months. In univariate analysis, statistically significant differences were found between complete and incomplete adherence to iron supplementation in terms of infant age, time of birth, family income, maternal education, and maternal employment status (P < .001). When the data were analyzed using multivariate analysis, only maternal education level and infant age group were found to be statistically significant independent variables for complete and incomplete adherence to iron supplementation (P < .001). In populations with a high prevalence of ID, incomplete adherence to iron supplementation is a serious risk factor for ID/IDA. Although iron supplements are routinely given to infants by the Ministry of Health in Turkey, the prevalence of complete adherence to iron supplementation is low. Therefore, in order to increase the rate of complete adherence to iron supplementation, the iron supplementation status of infants should be reviewed in detail at each health child visit and families should be informed about the importance of supplementation to prevent iron deficiency.

Structural barriers to maternity care in Cameroon: a qualitative study

BackgroundThe maternal mortality and perinatal mortality rate in Cameroon are among the highest worldwide. To improve these outcomes, we conducted a formative qualitative assessment to inform the adaptation of a mobile provider-to-provider intervention in Cameroon. We explored the complex interplay of structural barriers on maternity care in this low-resourced nation. The study aimed to identify structural barriers to maternal care during the early adaptation of the mobile Medical Information Service via Telephone (mMIST) program in Cameroon.MethodsWe conducted in-depth interviews and focus groups with 56 key stakeholders including previously and currently pregnant women, primary healthcare providers, administrators, and representatives of the Ministry of Health, recruited by purposive sampling. Thematic coding and analysis via modified grounded theory approach were conducted using NVivo12 software.ResultsThree main structural barriers emerged: (1) civil unrest (conflict between Ambazonian militant groups and the Cameroonian government in the Northwest), (2) limitations of the healthcare system, (3) inadequate physical infrastructure. Civil unrest impacted personal security, transportation safety, and disrupted medical transport system. Limitations of healthcare system involved critical shortages of skilled personnel and medical equipment, low commitment to evidence-based care, poor reputation, ineffective health system communication, incentives affecting care, and inadequate data collection. Inadequate physical infrastructure included frequent power outages and geographic distribution of healthcare facilities leading to logistical challenges.ConclusionDynamic inter-relations among structural level factors create barriers to maternity care in Cameroon. Implementation of policies and intervention programs addressing structural barriers are necessary to facilitate timely access and utilization of high-quality maternity care.

Frequency of use and annual costs of biological therapy for psoriasis in Colombia in 2019.

Evidence describing the types and annual costs of biological treatments for psoriasis in Latin America is scarce. This study aimed to estimate the frequency of use and costs of biologic therapy for psoriasis in Colombia in 2019. This secondary data analysis uses the International Classification of Diseases terms associated with psoriasis, excluding those related to psoriatic arthritis, based on data from the registry of the Colombian Ministry of Health. We estimated the prevalence of psoriasis per 100,000 inhabitants; then, we retrieved the frequency of use of biologic therapy in patients with psoriasis and estimated the cost per year of each and overall therapies in 2019 in US dollars (USD). There were 100,823 patients with psoriasis in Colombia in 2019, which amounts to a prevalence of 0.2% in the general population. Of those patients, 4.9% received biologic therapy, most frequently males (60%). The most commonly used biological therapies for psoriasis in Colombia in 2019 were ustekinumab (35.2%), with an annual cost per patient of $12,880 USD; adalimumab (26%), with a yearly cost per patient of $7130 USD; and secukinumab (19.8%), with an annual cost per patient of $6825 USD. This is the first study to describe the use and cost of biological therapy for psoriasis in Colombia. It provides valuable cost-awareness information for the Colombian health system.

Pattern of morbidity and mortality amongst Iraqi Hajj pilgrims: Experience of Iraqi Hajj medical mission 2023

IntroductionHajj is one of the largest global religious mass gatherings that takes place in Saudi Arabia and involves around three million Muslims from all over the world. It carries potential health risks both for Saudi Arabia and pilgrims’ home countries. Like all countries, the Iraq Ministry of Health is part of the Hajj coordinating committee and has developed a plan to prepare and respond to Iraqi pilgrims’ health needs during the Hajj season. This study aimed to demonstrate Iraqi pilgrims' leading health complaints before, during, and after the Hajj time in 2023. MethodWe conducted a retrospective cross-sectional study analyzing the data from electronic records of the main clinical presentations from the 38 clinics established in Al-Madeena Almunawara, Makka, Mina, Arafat, and Muzdalifah, KSA, during the three phases: the pre-Hajj (6th-26th June), the Hajj (27th-30 June), and the post-Hajj (1st-9th July). Result89,973 patients attended the clinics; 46,457 (51.6 %) were females. The highest daily attendance was 3429 during the pre-Hajj phase. The most frequent cause of attendance was rheumatologic/orthopedic diseases (18.8 %), HT (18 %), DM (11.4 %), influenza (9.7 %), other respiratory infections (8.3 %), ENT conditions (6.3 %); with similar distributions between the pre-Hajj, the Hajj, and the Post-Hajj phases, except for rheumatologic/orthopedic diseases, which contributed the highest during the Hajj phase (25.4 %), and influenza, which accounted for 21.1 % in the post-Hajj phase. Eight hundred-eleven referrals to secondary and tertiary care were reported, and 29 deaths were recorded among the pilgrims. ConclusionNon-communicable conditions exerted the highest burden on health services, as many pilgrims are elderly with preexisting chronic medical conditions. Respiratory infections were common, considering the overcrowding during Hajj. Raising pilgrims’ knowledge of potential health risks encountered during Hajj and following the preventive measures can help mitigate pilgrims’ health risks during the Hajj. Data availability statementData used for this study will be available upon request

Characterising HIV acquisition risk, treatment gaps and populations reached through venue-based outreach and clinical services in Blantyre, Malawi: findings from a district-wide CLOVE Study.

In 2017, Blantyre district had the highest adult HIV prevalence in Malawi (17.7%) and lowest viral suppression (60%). In response, the Ministry of Health expanded prevention and treatment services. We assessed whether outreach to social venues could identify individuals with increased HIV acquisition risk or with unsuppressed HIV not currently reached by clinic-based services. We conducted a cross-sectional bio-behavioral survey in Blantyre, Malawi, from January to March 2022. We visited social venues where people meet new sexual partners and government clinics providing HIV testing or STI screening. Participants aged > 15 years were interviewed, and tested for HIV infection if not on ART. HIV recency tests were performed on those testing positive, and dried blood spots (DBS) was collected to quantify viral load and also to identify acute infection in those with HIV- results. HIV prevalence (18.5% vs 8.3%) and unsuppressed HIV infection (3.9% vs 1.7%) were higher among venue-recruited (n=1802) compared with clinic-recruited participants(n=2313). Among PLHIV at both clinics (n=199) and venues (n=289), 79% were virally suppressed. Few had acute(n=1) or recent infection(n=8). Among women, HIV prevalence was four times higher (38.9% venue vs 8.9% clinic). At clinics, PLHIV reporting visiting venues were less likely to be suppressed (54.6 vs 82.6%). More men at venues than at clinics reported paying for sex (49% vs 30%) or having multiple sex partners in the past 4 weeks (32% vs 16%). Enhanced venue-based prevention and testing for men and women could reduce treatment lapses, HIV treatment outcomes and reduce onward transmission.

Characteristics and considerations of French medical education

Abstract French medical education, with a long history and guided by laws and decrees set by the French Ministry of Education and Ministry of Health, aims at elite training, focusing on the cultivation of students’ clinical practice and scientific research capabilities, and implementing a unified medical talent training model. The French medical education system continuously seeks innovation and change. In September 2020, a new round of reforms was initiated in aspects such as admission pathways, examination system, and assessment methods. These changes aim to enhance medical students’ disciplinary backgrounds, strengthen process-based assessment, and foster the development of versatile medical professionals. This article analyzes the characteristics of French medical education and the main measures of this round of reforms, providing insights and considerations for the training of cultivated medical talents in China.

THE SCHOOL FEEDING PROGRAMME STRATEGIES AND LEARNER PARTICIPATION IN PUBLIC PRIMARY SCHOOLS IN MAKUENI COUNTY, KENYA

Objective: This paper sought to determine how school feeding programme strategies influence learner participation in public primary schools in Makueni County, Kenya. Theoretical Framework: The study was anchored on; Social Learning Theory, Abraham Maslow’s Theory of Human Motivation and theory of Change. Method: Descriptive and correlation research design were employed. The target population was 875 respondents. Data was analyzed using descriptive, and inferential statistics. Results and Discussion: The findings were; there is no significant relationship between giving nutritious meals and learner participation was rejected from learners’ view but was not rejected as per the Headteachers, Teachers and Chairpersons board of governors’ view, there is no significant relationship among dietary teaching and learner participation was rejected from learners’ view but was not rejected as per the Headteachers, Teachers and Chairpersons board of governors’, there is no significant relationship between regular food supply during school days and learner participation was rejected from learners’ view but was not rejected as per the Headteachers, Teachers and Chairpersons board of governors’ view, there is no significant relationship between small-scale farmers’ engagement and learner participation was not rejected from learners’ view but was rejected as per the Headteachers, Teachers and Chairpersons board of governors’ views. Research Implications: The study found that learner participation within the study's territory was significantly correlated with the approaches used. The study recommends that Government Ministries of Education, Health and relevant Authorities, Head Teachers, Teachers, Chairpersons -BOM need to provide nutrition meals and dedicate adequate resources to sustain learner participation in Public Primary Schools in Makueni County, Kenya.

Perceptions of followership among nurses: A qualitative study

BackgroundFollowership is defined as the role individuals play in supporting, contributing to, and realizing the vision and directives set by their leaders. Such a role is indispensable in healthcare, facilitating effective team dynamics and healthcare delivery. Within the nursing field, it encompasses nurses' active engagement and participation in healthcare delivery, ensuring safety, fostering teamwork, and enhancing patient outcomes. Despite its significance, the exploration of followership within the nursing context of Saudi Arabia remains limited. ObjectiveThis study aims to explore how followership is perceived and practiced by nurses in this unique cultural and professional setting, and its implications for healthcare delivery. MethodsWe conducted a qualitative inquiry involving seven registered nurses working in hospitals affiliated with the Saudi Arabian Ministry of Health. Semi-structured interviews were conducted, and a thematic analysis was utilized to extract key findings. ResultsOur thematic analysis identified four main themes and several sub-themes that encapsulate the participants' perspectives on followership. The themes include: (1) Understanding of followership, where a predominant lack of clarity about the concept was observed, often conflating it with teamwork; (2) Followers' involvement in decision-making, highlighting the limited participation of nurses in decision-making processes due to hierarchical and autocratic leadership structures; (3) Barriers to followership, which encompassed issues such as poor leadership, the undervaluation of the follower role, lack of training and development opportunities, challenges in collaboration, and language barriers; and (4) Facilitators of followership, identified as effective leadership, followership training, communication skills, positive relationships, respect, collaboration, understanding of roles, commitment, and flexibility. These findings elucidate the complex landscape of followership within the nursing profession in Saudi Arabia, revealing both the challenges and pathways to fostering effective followership in healthcare settings. Conclusion and ImplicationsThis study reveals a widespread lack of awareness about followership among nurses in Saudi Arabia, highlighting significant challenges related to hierarchy and the undervaluation of the follower role in nursing practice and education. It underscores the need for educational and training interventions that redefine and elevate the role of followership in clinical settings to enhance collaboration, assertiveness, and decision-making skills. Moreover, the study advocates for the re-evaluation of leadership practices to better acknowledge and value followership, promoting a more flattened hierarchy that encourages active participation in patient care and organizational development. Implementing these changes could improve patient outcomes and increase nurse satisfaction by effectively addressing the identified barriers related to hierarchy and leadership.

Declining trend in the estimated annual rupture rate of unruptured cerebral aneurysms in Japan: a nationwide study.

The incidence of subarachnoid hemorrhages (SAHs) in Japan has recently decreased. However, trends in the annual rates of unruptured cerebral aneurysms (UCAs) are unclear because calculations based on follow-up periods are limited to patients with ruptured cerebral aneurysms. We aimed to clarify current trends in the estimated annual rupture rates of UCAs in Japan and to identify the most relevant contributing factors. We analyzed data from the Japanese Ministry of Health, Labour and Welfare and records of the Japan Neurosurgical Society. The estimated annual rupture rates of UCAs between 2003 and 2018 were calculated according to age-adjusted mortality rates of SAH and number of treated ruptured cerebral aneurysms (RCAs). We estimated trends in annual rupture rates using sensitivity analysis and assessed associations between estimated annual rupture rates and the prevalences of hypertension and current smoking. The estimated annual rupture rate of UCAs significantly decreased from 1.44 to 0.87% and from 0.92 to 0.76%, respectively, in terms of age-adjusted mortality rates of SAH and number of treated RCAs (p < 0.001). The range of changes in estimated annual rupture rates of UCAs was - 1.13%‒0.83%, representing a declining UCA trend of 88%. The estimated annual rupture rates of UCAs declined by 0.02-0.10% and 0.01-0.05% with every percent decrease in hypertension and current smoking prevalence, respectively. The estimated annual rupture rate of UCAs has recently decreased in Japan, possibly due to a decrease in the prevalence of hypertension rather than smoking.

Caries prevalence among children at public and private primary schools in Riyadh: a retrospective study

Dental caries is a global oral health issue, especially critical in children, affecting their growth, nutrition, and education due to school absences or distractions from dental pain. The aim of the study was to investigate the correlation between school types (indicative of socioeconomic conditions) and dental caries prevalence among primary school children in Riyadh, alongside assessing the overall caries prevalence among schoolchildren in Riyadh. Retrospective study on 28,343 first and fourth-grade students from 960 public and private schools in Riyadh, using data from the Saudi Ministry of Health (Feb-April 2019). Utilized the DMFT/dmft index for assessment and collected demographic data. Most of the schools were public (76.1%), private national (17.1%), and private international (6.8%). Overall, the mean DMFT index for permanent teeth and the dmft index for primary teeth were 1.78 and 1.94, respectively. 58% of school children had no dental caries, 25% had mild caries, and 17% had moderate to severe caries. Public school children showed a higher caries prevalence than private schools. Oral disease rates were higher in girls than in boys, and grade four students had a higher prevalence than grade one students. Saudi Arabia, a developing nation, faces challenges in addressing oral health, especially in public schools. Targeted initiatives are crucial for awareness, preventive measures, and meeting oral health needs.

Costs and cost drivers of comprehensive sexual reproductive health services to female sex workers in Kenya

BackgroundComprehensive sexual reproductive health (SRH) programs for female sex workers (FSW) offering clinical, behavioural, and structural interventions have contributed to declining rates of HIV in this population. However, data on costs and cost drivers is needed to support programs and their donors to better allocate resources, make an investment case for continued funding, and to identify areas of improvement in program design and implementation. We aimed to estimate the annual per-FSW costs of comprehensive services for a standalone FSW program in Kenya.MethodsWe implemented a top–bottom and activity-based costing study of comprehensive FSW services at two drop-in centres (DICs), Mtwapa and Kilifi town, in Kilifi County, Kenya. Service costs were obtained from routinely collected patient data during FSW scheduled and unscheduled visits using Kenyan Ministry of Health records. Costing data were from the program and organization’s expenditure reports, cross checked against bank documents and supported by information from in-depth interviews. Data were collected retrospectively for the fiscal year 2019. We obtained approval from the AMREF Research Ethics Committee (AMREF-ESRC P862/2020).ResultsIn 2019, the unit cost of comprehensive services was 105.93 USD per FSW per year, roughly equivalent to 10,593 Kenya shillings. Costs were higher at Mtwapa DICs compared to Kilifi town DIC; 121.90 USD and 89.90 USD respectively. HIV counselling and testing cost 63.90 USD per person, PrEP was 34.20 USD and family planning was 9.93 USD. Of the total costs, staff salaries accounted for about 60%. Adjusted for inflation, costs in 2024 would be approximately 146.60.ConclusionPrograms should strive to maximize the number of FSW served to benefit from economies of scale. Given that personnel costs contribute most to the unit costs, programs should consider alternative designs which reduce personnel and other costs.

Challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana

IntroductionCervical cancer is one of the causes of female deaths worldwide. Cervical cancer incidence is rising with almost three thousand (2797) women in Ghana being diagnosed with the condition each year, with almost two thousand (1,699) of them dying from its complications Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation, the burden of care, patients’ suffering and the alarming number of deaths associated with it. Improving positive patient outcomes require identifying the challenges and support systems available to nursing staff so as to harness these support systems for improving care outcomes.AimThis study explored the challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana.MethodIn this study, we adopted an exploratory qualitative design. The study was conducted among eleven (11) nurses and nine (9) midwives engaged at the national referral hospital in Ghana who were providing care for patients with advanced cervical cancer for over a year who were purposively sampled. The data was collected using in-depth interviews with a pre-tested semi-structure interview guide from the twenty participants. We recorded the interviews using an audio-tape. The audio files were transcribed verbatim and thematic analysis was undertaken with the aid of Nvivo 10.0.ResultsThe challenges when rendering nursing care faced by participants of this study were exposure to frequent deaths, inadequate resources, and workload. Most participants lamented that they received absolutely no support from their workplace, hence their only form of support was from their family and friends. They also added that most of them were general nurses and midwives with no special training in oncology nursing or palliative nursing.ConclusionNurses and midwives experience resource, knowledge and skill challenges when caring for patients with advanced cervical cancer. However, the nurses and midwives had emotional attachment to their jobs and their patients and were not distracted by their bad experiences. We recommend improving resource allocation for cervical cancer care through the National Health Insurance Authority (NHIA), Ghana and increased training of nurses in oncology and palliative nursing by the Ministry of Health, Ghana to improve knowledge and skills of the nurses and midwives caring for women with advanced cervical cancer to improve their quality of care. Further, hospitals must make it a priority to have more nurses and midwives trained in oncology and end of life care to improve the knowledge and skills of nurses and midwives caring for advanced cervical cancer patients. Also, these findings should trigger policy-level discussions at the Ministry of Health, Ghana on the training of specialized nurses and midwives in cancer and end of life care to help Ghana meet the sustainable development goal targets related to health.

A Proof of Concept Using BLE to Optimize Patients Turnaround Time (PTAT) in Health Care

In 2022, Malaysia's Ministry of Health (MOH) acknowledged that government hospitals continue to face challenges in delivering high-quality patient care. A significant issue is the absence of a Real-Time Patient Location Monitoring and Tracking Solution, which prevents doctors from efficiently tracking patients within medical facilities. This lack of real-time tracking contributes to a decline in service quality, creating an urgent need for optimization in patient monitoring and tracking solutions. Implementing an effective tracking system can significantly enhance patient care quality, improve resource utilization management, and boost staff productivity, ultimately saving costs, time, and resources for hospitals. One critical area for improvement is the Patient Turnaround Time (PTAT), which refers to the duration a patient spends being processed at a hospital before being discharged. PTAT is currently prolonged in many hospitals due to the complex processes involved and patients becoming untraceable while waiting for their turn. To address these challenges, we have developed an Internet of Things (IoT) solution utilizing Bluetooth Low Energy (BLE) technology to optimize PTAT. This solution enables hospital staff to track patient movements and localize them in real-time. By using wearable devices, the system measures the distance from patients to various Access Points (AP) spread throughout the hospital based on the dBm value. This paper presents comprehensive experimentation for the Proof of Concept (POC) and pilot testing of this BLE-based solution. The results demonstrate the accuracy of using the Received Signal Strength Indicator (RSSI) to optimize patient turnaround times in hospitals. By implementing this BLE solution, hospitals can reduce the time patients spend waiting for treatment, thereby improving overall patient satisfaction and hospital efficiency. The ability to monitor patient locations in real-time will ensure that patients receive timely care, reducing the likelihood of them wandering off and becoming untraceable. This technology represents a significant step forward in modernizing patient care and streamlining hospital operations in Malaysia.