Ministry Of Health Research Articles

Evaluation of the adherence of municipalities and states to the Ministry of Health’s microplanning for high-quality vaccination activities and the increase in vaccination coverage in Brazil

BackgroundImmunization is a significant public health achievement for the whole world, although the population’s adherence to vaccination efforts remains a concern. To address this, Brazil’s Ministry of Health introduced the concept of operational microplanning (OM) for high-quality vaccination activities (HQVA) in 2023 to ensure excellence in routine service and campaigns. OM is defined by structured interventions using assertive techniques to enhance the likelihood of covering a broader population previously unprotected from vaccine-preventable diseases.ObjectiveTo assess the adherence of states and municipalities to OM for HQVA and examine the relationship between adherence levels and increased vaccination coverage in Brazil.MethodsAdopting an epidemiological approach with an ecological design, this study analyzed data on the adherence of the 27 Brazilian federative units to HQVA, as reported through the REDCap electronic form in 2023, as per an agreement with the Ministry of Health. The criteria for assessing the states’ adherence to the OM included: (1) Formation of a coordination committee for the OM for HQVA; (2) Inclusion of representatives from Primary Care in the committee; (3) Inclusion of representatives from COSEMS in the committee; (4) Regular coordination meetings between health surveillance and primary care for vaccination actions; and (5) Utilization of a management tool for decision-making and strategic planning (e.g., SWOT). Adherence levels were categorized as: 0 = High adherence (responding positively to 4 or 5 criteria); 1 = Medium adherence (3 positive responses); 2 = Low adherence (2 or fewer positive responses). For municipalities, the adherence criteria were similar, excluding the COSEMS representation and focusing on the involvement of primary care representatives.ResultsThe findings indicated that 45.75% of municipalities achieved full adherence, implementing all the evaluated actions. Despite declaring adherence to the OM, ~ 30.68% of municipalities executed two actions, 19.27% only one, and 4.30% none. Among the states, 37.04% showed full adherence by employing all evaluated actions, with 33.33% executing four actions. States with higher adherence levels to the OM also had greater vaccination coverage (VC), particularly in 2023. Municipalities with complete adherence to the OM met the VC objectives for polio (D3), 10-valent pneumococcal (D2), and triple viral (D1) vaccines in 2023. In states with full adherence to the OM, most municipalities achieved the VC targets for all evaluated vaccines in 2023, showing statistical significance for pentavalent (D3), polio (D3), and 10-valent pneumococcal (D2) vaccines.ConclusionThe findings underscore the impact of OM on improving VC in Brazil, demonstrating that its effective implementation is correlated with meeting VC targets, especially in states and municipalities that enacted all recommended actions. Municipalities engaging in all OM actions met VC objectives for crucial vaccines, highlighting the OM’s positive influence on VC. Full adherence to the OM by states correlated with a notable rise in VC averages across all analyzed vaccines. This analysis suggests that higher adherence to OM improves VC outcomes, emphasizing the role of OM in these metrics and shows that comprehensive implementation of OM improves vaccination efforts and significantly boosts VC, particularly in states fully adhering to guidelines.

From one size fits all to a tailored approach: integrating precision medicine into medical education

BackgroundAs precision medicine gains momentum, the traditional - One Size Fits All - approach to disease prevention and treatment is becoming less reliable. Medical education must prioritize equipping physicians with the knowledge to apply precision medicine effectively. The present study aimed to investigate the knowledge, attitudes, and perceived barriers to precision medicine among medical students, interns, and physicians in Jordan.Materials and methodsAn analytical cross-sectional study, using an online validated and reliable questionnaire to collect data, was conducted. The knowledge, attitudes, and perceptions related to precision medicine were assessed and explored for statistical associations. The strength of each association was further presented by calculating the Cramér’s phi (φc).ResultsParticipants in the present study were 607 individuals, 55.5% were males. 29.6% of participants had low knowledge scores (marks between − 12 and 0). The strongest association was reported between knowledge score and primary care setting followed by age (φc = 0.27 and 0.29, respectively). Physicians at the Ministry of Health had the highest odds of a high knowledge score (OR = 5.3, 95% CI 2.7–10.2, P < 0.001). Most respondents (79.1%) would consider using genome-guided prescribing tools developed by researchers, with only (15.8%) deeming these tools clinically useless. Nevertheless, almost 78% of participants expressed concern regarding patient anxiety with test results. Students showed better perception than physicians (p = < 0.001), but Physicians were more confident to implement precision medicine (P = < 0.0001). Most participants (87.1%) considered expanding their knowledge in precision medicine. Physicians cited limited accessibility as the main barrier to adopt precision medicine (92.9%), while high cost was the primary obstacle reported by students (80.2%).ConclusionMedical students and Physicians share a positive attitude toward implementing Precision Medicine, but barriers must be overcome for successful implementation. Integrating precision medicine and genome-based technologies into medical education is necessary for its successful application in clinical practice.

SURVEILLANCE OF PARASITIC DISEASES IN BULGARIA

The incidence and number of cases of several parasitic diseases subject to mandatory reporting and registration under the Ministry of Health (MoH) 2005 Regulation 21 increased after the end of the global pandemic of COVID-19 in 2023. In addition, parasitic infections imported from endemic tropical regions are recorded annually in the country. A significant number of people are screened for parasitic diseases each year. The primary indication for screening is prophylactic, followed by epidemiological and clinical indications. This report aims to analyse the dynamics of parasitic diseases in 2023. Data from the periodic and annual reports of the RHI, medical institutions and NCIPD were used as inputs. In 2023, 647 781 people were tested for parasites, of whom 2.0% were diagnosed with various parasitic infections. Cystic echinococcosis increased from 89 cases in 2022 to 117 cases in 2023. The annual incidence of the disease increased from 1.3% in 2022 to 1.81% in 2023. Regarding soil-transmitted parasitic diseases, 447 people were diagnosed with ascariasis and 50 with trichuriasis. Among the 458 764 people tested, the prevalence of enterobiasis was 1.74%. Out of 1 305 suspected cases, 10 individuals were diagnosed with imported malaria. Unfortunately, the disease was fatal for one patient of Bulgarian nationality. Analysis of the data showed no discernible trend in the incidence of parasitic diseases in 2023. However, cases of cystic echinococcosis show an upward trend. For the first time, no epidemic outbreaks of trichinellosis were recorded in 2023.

Changing patterns of treatment and prescribers of stimulants for children, adolescents and young adults with attention deficit hyperactivity disorder in New South Wales, Australia: evidence for a treatment bottleneck? - A database study.

Investigate the treatment patterns and prescribers of stimulants for attention deficit hyperactivity disorder (ADHD) in young people in New South Wales (NSW). Longitudinal cohort study of persons born after 1983 and prescribed stimulants for ADHD as per the NSW Ministry of Health Controlled Drugs Data Collection. Results were analyzed descriptively: a) treatment prevalence by year; age; sex; b) speciality of prescribers over time; c) rate of transition from paediatrics to adult psychiatry. The main analysis covered 2003-2015, with data on general practitioner prescribing to 2023. Treatment prevalence rates were highest at age 10 (22.8 per 1000 person years), declining among teenagers and stabilizing in adulthood at 2.5 per 1000. The childhood male treatment predominance (4:1) resolved to 1.6:1 in adulthood. Paediatricians were the main prescribers until age 20. The average annual percent increase in prescribers was: adult psychiatry - 13%, general practice - 20%, paediatrics - 2.6%. Only 6.3% of treated children had transitioned to adult psychiatrists by age 25; 50% starting treatment with adult psychiatrists had no previous treatment records. The proportion on treatment and the male predominance declined substantially with age. Future studies may determine whether increased prescribing by general practitioners and psychiatrists reduces treatment attrition during adolescence.

Trends in single-fraction palliative radiotherapy across the COVID-19 pandemic in Japan: a nationwide claims study.

This study aimed to evaluate the recent trends in single-fraction conventional radiotherapy (CRT) as palliative treatment in Japan, using data from the National Database published by the Ministry of Health, Labor, and Welfare. Data from fiscal year (FY) 2014 to FY2022, specifically related to the utilization of single-fraction CRT, were analyzed. Multi-fraction CRT, stereotactic body radiotherapy (SBRT), intensity-modulated radiotherapy (IMRT), and brachytherapy were excluded. The primary outcome was the cumulative and annual number of single-fraction CRT courses. Additionally, quarterly course data from FY2019 to FY2022, the period for which monthly data were available, were assessed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on single-fraction CRT utilization. Of the total 2 315 607 radiotherapy courses, we identified 33 221 single-fraction CRT courses after excluding multi-fraction CRT (n = 1 835 650), SBRT (n = 33 935), IMRT (n = 332 827), and brachytherapy (n = 113 195). The annual number of single-fraction CRT courses increased from 1730 in FY2014 to 5642 in FY2022, with an average annual growth rate of 0.28 (range: -0.07 to 0.65). Outpatient courses significantly increased, particularly from FY2019 onward, surpassing inpatient courses in FY2022 (2914 vs 2728). The highest annual increase was observed in FY2020, particularly from April to December, although this upward trend did not persist in 2021. In conclusion, single-fraction CRT has exhibited a consistent upward trend, highlighting its expanding role in palliative radiotherapy. Although the COVID-19 pandemic temporarily accelerated this trend, its impact has already subsided, with growth rates returning to pre-pandemic levels.

Diffusion of COVID-19 Misinformation in Kenyan X Conversations

Purpose: The study set out to explore the role of X conversations in the spread of misinformation about the COVID-19 pandemic in Kenya. Methodology: The study was guided by the Rumor Theory. The study adopted a descriptive survey design which allowed the researchers to collect data without interacting with participants. Data was collected from existing online records of conversations on X and other relevant websites such as the Ministry of Health. The data was sourced from hashtags and tweets related to the COVID-19 pandemic in Kenya, posted in the period from March 2020 to April 2021. The hashtags and tweets were mined using the free API tool for geolocated tweets. 16 hashtags and 200 tweets were selected for the study. Quantitative data was analyzed using descriptive statistics while qualitative data was analyzed using content analysis under classified themes. Findings: The findings of the study indicate that none of the hashtags created by Kenyans was framed to spread misinformation but the tweets under the different hashtags analyzed contained misinformation. Findings also indicate that verified X handles were involved in either creating or spreading COVID-19 misinformation. Additionally, false claims were found to diffuse faster than partially false claims as observed in the tweets with misinformation. Compared to a background corpus of COVID-19 tweets, tweets with misinformation were more often concerned with discrediting other information on social media. Unique Contribution to Theory, Practice and Policy: We recommend that the government and stakeholders in health ought to counter COVID-19 misinformation online, and equip users with basic digital literacy skills regarding consumption of online information while continuously monitoring online discourses. A policy on online health communication needs to be developed and implemented.

Serum metabolome indicators of early childhood development in the Brazilian National Survey on Child Nutrition (ENANI-2019).

Background: The role of circulating metabolites on child development is understudied. We investigated associations between children's serum metabolome and early childhood development (ECD).Methods: Untargeted metabolomics was performed on serum samples of 5,004 children aged 6-59 months, a subset of participants from the Brazilian National Survey on Child Nutrition (ENANI-2019). ECD was assessed using the Survey of Well-being of Young Children's milestones questionnaire. The graded response model was used to estimate developmental age. Developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Partial least square regression selected metabolites with a variable importance projection ≥ 1. The interaction between significant metabolites and the child's age was tested.Results: Twenty-eight top-ranked metabolites were included in linear regression models adjusted for the child's nutritional status, diet quality, and infant age. Cresol sulfate (β = -0.07; adjusted-p &lt; 0.001), hippuric acid (β = -0.06; adjusted-p &lt; 0.001), phenylacetylglutamine (β = -0.06; adjusted-p &lt; 0.001), and trimethylamine-N-oxide (β = -0.05; adjusted-p = 0.002) showed inverse associations with DQ. We observed opposite directions in the association of DQ for creatinine (for children aged -1 SD: β = -0.05; p =0.01; +1 SD: β = 0.05; p =0.02) and methylhistidine (-1 SD: β = - 0.04; p =0.04; +1 SD: β = 0.04; p =0.03).Conclusion: Serum biomarkers, including dietary and microbial-derived metabolites involved in the gut-brain axis, may potentially be used to track children at risk for developmental delays.Funding: Supported by the Brazilian Ministry of Health and the Brazilian National Research Council.

Factors associated with multidrug-resistant organism (MDRO) mortality: an analysis from the national surveillance of multidrug-resistant organism, 2018-2022

IntroductionAntimicrobial resistance is a global issue, with the World Health Organization identifying it as one of the greatest threats to public health, with an estimated 4.95 million deaths linked to bacterial AMR in 2019. Our study aimed to determine the prevalence of mortality among multidrug-resistant organism (MDRO)-infected patients in state hospitals and major specialist hospitals and to identify risk factors that could be associated with mortality outcomes.MethodsThis is a cross-sectional study performed at 28 hospitals under the Ministry of Health, Malaysia, involved in the National Surveillance of Multidrug-Resistant Organism, which surveys 6 MDROs (Acinetobacter baumanii, extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae, carbapenem-resistant Entrobacterales (CRE), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE)).ResultsIn terms of mortality, 9.6% (n = 951) of the patients died overall, whereas 90.4% (n = 8931) of the patients survived. Healthcare-acquired infection (HCAI) poses a high risk of mortality, with an adjusted odds ratio (aOR) of 2.91 (95% CI: 2.15–3.94). The presence of sterile specimens was significantly associated with increased mortality risk (aOR: 2.33, 95% CI: 2.02–2.68). Gram-negative bacteria had a greater mortality risk (aOR 1.63 95% CI: 1.37–1.93), whereas Acinetobacter baumanii had the highest prevalence of 30.7% (3033) among the 6 MDRO organisms isolated. Patients in medical-based departments had a greater mortality risk (aOR: 1.47, 95% CI: 1.22–1.75).ConclusionHCAIs, Gram-negative bacteria, sterile specimens, medical-based departments and state hospitals have been shown to be associated with increased mortality risk in patients with MDRO infections. Improved surveillance and reporting mechanisms are necessary to better understand the burden of MDRO infections and guide research funding allocation.

Prevalence of Being Obese, Overweight, and Underweight Among Jordanian Children and Adolescents Based on International Growth Standards

Objectives: The rise of obesity and other nutrition-related conditions among children and adolescents is a global challenge, particularly in the Middle East. This study aimed to determine the prevalence of being underweight, overweight, and obese among Jordanian children and adolescents using the body mass index (BMI) percentiles of the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) standards. Methods: This retrospective cross-sectional/longitudinal study analyzed 58,474 (42.6% males; 57.4% females) height, weight, and BMI-for-age records from 31508 healthy Jordanian children and adolescents aged 2–19 years. The data were retrieved from the Ministry of Health’s nationwide electronic database (2017–2023) and assessed using the CDC and WHO growth standards. Logistic regression was performed to assess the variables associated with overweight/obese status. Results: The prevalence of being underweight, overweight, and obese varied by the reference used, as more cases of being obese and underweight were reported when applying the CDC standards. The regression models showed the males had significantly lower odds of being overweight and obese than the females. Increased age was associated with higher odds of being overweight and obese, with annual increases observed across all age groups. Conclusions: Using the WHO and CDC standards, the prevalence of being underweight was higher in the males aged 6 years and older, while being overweight and obese was more prevalent in the females. The observed annual increase in the prevalence of being overweight and obese underscores the need for targeted strategies. Growth references tailored to regional profiles may improve national nutrition policies for Jordanian children and adolescents.

Benefits, challenges, and best practices of collaborative partnerships among health supply chain stakeholders in Rwanda: a cross-sectional study

BackgroundStrong partnerships, community engagement, and multisectoral collaboration in the health supply chain are synergistic pillars towards achieving universal health coverage. In Rwanda, the health supply chain involves the collaboration of various stakeholders, including distributors, manufacturers, wholesalers, and customers. However, since the eruption and ending of COVID-19, there has not been any study to assess stakeholders' perspectives on the status of the benefits, challenges, and best practices of collaborative partnerships among health supply chain stakeholders in Rwanda. Therefore, this research was conducted to fill that gap in order to devise ways for improved visibility, coordination, and efficiency of the health supply chain management system in Rwanda.MethodsThis quantitative cross-sectional study, collected data from 11th April to 18th May 2024. It involved 103 respondents from 54 institutions engaged in the management of the health commodities supply chain in Rwanda. These were the Ministry of Health, Rwanda Biomedical Center, Rwanda Food and Drugs Authority, Rwanda Medical Supply Ltd, other Central Medical Stores namely Bureau des Formations Médicales Agréées du Rwanda (BUFMAR) and Medical and Allied Service Solutions (MEDIASOL); private wholesale pharmacies, non-government organizations, and Health Facilities (hospitals). A sample size of 103 respondents was determined by the Yamane formula, and purposive sampling was used to select the respondents to complete a self-administered questionnaire specifically developed for this study. The outcome measures were perceived benefits, challenges, and strategies to overcome challenges of collaborative partnerships among health supply chain stakeholders in Rwanda.ResultsAvailability of health commodities ranked at 98.0%, infrastructure/accessibility of health services (86.4%), and cost-effectiveness (84.5%) were the most mentioned benefits. Most stated challenges included insufficient financial resources from stakeholders (84.5%), shortage of skilled staff (77.7%), and limited dialogue or lack of information sharing (69.9%). Most respondents agreed that collaborative partnerships can be improved by political will (96.1%), supply performance measurement (92.2%), improved financing policies (84.5%), fostering trust and transparency building (78.6%), and a well-structured health supply chain (72.5%).ConclusionEstablishing and strengthening stakeholder collaborations are essential for improved performance. Staff capacity strengthening and mutual information sharing will reduce risks, and improve forecasting, leading to cost-effectiveness and customer satisfaction.

Implementation of RedCap data systems in Kenyan psychiatric rehabilitation: a community case study

Data collection systems are vital in implementation of interventions within patient care as they allow us to better understand and improve the care given. This is equally true in the field of psychiatric rehabilitation, which has been steadily growing in the medical world for the past 20 years. It has recently been a focus of psychiatric medicine in Kenya with the Kenya Mental Health Action Plan 2021-2025 calling for improvement of care in the field. With psychiatric rehabilitation growing in low- and middle-income countries in recent years studies have come out showing the effects of newly employed programs and stressing the need for data collection practices that can be used to encourage best practices in local communities. This paper describes the implementation of data systems for the Moi Teaching and Referral Hospital Nawiri Skills and Recovery Centre (Nawiri) in Eldoret, Kenya. The goals of the data systems were 1) To collect and organize information for continuous quality improvement of services at Nawiri, 2) To collect information for reporting to MTRH leadership, Ministry of Health as well as private funders, 3) To provide data to assess outcomes of people who receive services at Nawiri to create evidence for effective interventions to help create policy to make psychiatric rehabilitation more available to people living with Severe mental illness in Kenya. Lessons learned from data systems implementation included insights into ease of data collection, adaptability of data instruments to fit facility needs, and ability to reproduce RedCap data collection in other settings.

A participatory process in all aspects? Negotiating agreements within Swedish healthcare (*)

ABSTRACT This article deals with agreements within healthcare in Sweden, a unitary state where responsibility for healthcare is decentralized to 21 regions with self-rule. The agreements are concluded by the central government and the Swedish Association of Local Authorities and Regions (SALAR). The literature categorizes agreements as a ‘soft’ policy instrument with participation as a crucial aspect. We investigate the process behind the agreements and focus on the participation of SALAR. Our material consists of interviews with respondents of SALAR and the Ministry of Health and Social Affairs. The findings suggest that the process is participatory, but not in all aspects. Differences are noticed during various phases. A conclusion is that the power relationship between the central government and SALAR is unequal. The results contribute to a more nuanced understanding of central–local relations in the era of multi-level governance, highlighting a power hierarchy.

Semantic Analysis of Legal Documents in the Memorandum of Understanding (Mou) of The Indonesian Ministry of Health

The use of language in a MoU requires precision so that the message conveyed can be understood clearly, which ultimately supports the achievement of effective cooperation. By understanding the denotative and connotative meaning, parties entering into cooperation agreements in the business sector can better understand the contents of the MoU document. The research method used in this research is a descriptive method with qualitative data analysis. This research will analyze the denotative meaning and connotative meaning based on three stages of interpretation, namely literal meaning, explicature and implicature. The data source used is the Memorandum of Understanding (MoU) of the Indonesian Ministry of Health, from three different MoUs, namely the Danish MoU, Japan MoU and Tanzania MoU. The results of this research found denotative and connotative meanings in each MoU document. In the Danish MoU research there was 60% Denotative Meaning, 40% Connotative Meaning, while in the Japanese MoU research there was 50% Denotative Meaning, 50% Connotative Meaning, and the results found in the Tanzanian MoU research were 62.5% Denotative Meaning and 37.5% % Connotative Meaning. Of the three Memorandums of Understanding (MoU), the denotative meaning is more dominant than the connotative meaning.

Deficient Mismatch Repair and BRAF Mutations in Metastatic Colorectal Cancer in the South Island of New Zealand.

Manatū Hauora, the Ministry of Health of New Zealand (NZ), published minimum standards for molecular testing of colorectal cancers (CRCs) in June 2018. These included mismatch repair (MMR) testing at diagnosis and BRAFV600E mutation analysis on newly diagnosed stage IV CRCs. This study aimed to determine the proportion of patients with CRC in the South Island of NZ with metastatic deficient mismatch repair (dMMR) CRC, the proportion of metastatic CRCs and dMMR CRCs that have a BRAFV600E mutation, and audit testing for BRAF mutations and appropriate referral to genetics services. People from the South Island with histologically diagnosed colorectal adenocarcinoma between July 1, 2018, and June 30, 2019, were identified by the National Cancer Registry. Data points extracted from the electronic medical record included staging, MMR status, BRAF mutation testing, and genetics referral. A total of 845 patients met the inclusion criteria; 166 of 845 (19.6%) had dMMR CRC, and of these 130 (78%) had BRAF mutation, 256 patients developed metastatic disease by data cut-off, 20 (7.8%) had dMMR, and 41 (22.2%) had BRAF mutation. When indicated, 275 of 330 (83.3%) were tested for BRAF mutation and 32 of 45 (71.1%) referred to genetics. Compared with other populations, South Island CRC patients had higher rates of dMMR and BRAF mutation. Less than 10% of patients (n = 20) had metastatic dMMR CRC. These patients could be considered candidates for immune checkpoint inhibitor therapy, a small number that would not significantly burden the NZ health system if funded. The vast majority of dMMR CRC was sporadic. Rates of testing could be improved.

Genetic profile of antibiotic resistance of enterobacteria strains isolated from obstetrics, gynecology and pediatric patients

Background. Antibiotic resistance of microorganisms is a significant problem for public health in countries around the world. Studying the structure and prevalence of genetic determinants of antibiotic resistance is a current research area that makes it possible to determine the mechanisms of resistance to antibacterial drugs.Purpose of the study. To study the genetic profile of antibiotic resistance of Enterobacteriaceae strains isolated from obstetrics, gynecology and pediatric patients.Materials and methods. The genetic profile of antibiotic resistance was determined in ESBL-producing strains of Enterobacteriaceae isolated from samples of biological material obtained from 43 women and 24 children hospitalized in the departments of the Federal State Budgetary Institution “Research Institute of OMM” of the Russian Ministry of Health in 2024. The DNA of bacterial cells of ESBL-producing isolates was isolated from a daily culture of microorganisms using the PROBA-NK kit. Detection of genes blatem, blactx-M-1, blashv; blaoxa-40-like, blaoxa-48-like, blaоxa-23-like, blaoxa-51-like, blaimp, blaKPS, blaNDM, were carried out using the BakResist GLA kit on a DT-48 detection amplifier (DNA technology, Russia ).Results. In representatives of the Enterobacteriaceae family isolated from children, the blactx-M-1+blashv genovariant was identified in 29.2% of cases and was found only in Klebsiella pneumoniae. Blatem+blactx-M-1 was detected in 20.8%, and blactx-M-1+blashv+blatem — in 12%. Among representatives of the Enterobacteriaceae family isolated from women, the blactx-M-1 genovariant was found in 37.2% of cases and was detected only in Escherichia coli. And the options blactx-M-1+blatem and blactx-M-1+blashv — in 16.3%. In 2024, for the first time in 7 years of our research to identify the genetic determinants of antibiotic resistance, a multidrug-resistant Escherichia coli strain with the blaNDM gene was identified. Also noteworthy is the identification of K. pneumoniae with the genetic profile of antibiotic resistance blatem, blactx-M-1, blashv, blaoxa-48-like, blaNDM.Conclusion. The genetic profile of antibiotic resistance of Enterobacteriaceae strains isolated from patients in obstetrics, gynecology and pediatric departments is represented by 8 genovariants, in which the dominant gene providing resistance to beta-lactam antibiotics among Enterobacteriaceae in 2024, as in 2021, 2022, blaCTX-M-1 remains, which is found both as a monovariant and in association with blatem and blashv.

RETENÇÃO DE TALENTOS EM EMPRESAS PÚBLICAS ANGOLANAS: DESAFIOS E ESTRATÉGIAS NUM CENÁRIO DINÂMICO

This study addresses the main challenges faced by Angolan public enterprises in talent retention, considering the constantly changing legal, regulatory, and economic context of the country. The aim of the research was to identify the factors that hinder the retention of qualified professionals in Angolan public institutions and to propose strategies to overcome these obstacles. The research was conducted in three ministerial departments, namely: the Ministry of Health, the Ministry of Justice and Human Rights, and the Ministry of Youth and Sports, using a qualitative approach, with semi-structured interviews conducted with managers and some employees. The results showed that economic instability, the shortage of qualified professionals, the lack of effective career development programmes, and frequent changes to the Labour Code are the main challenges to talent retention. Furthermore, the research revealed that the organisational culture of these institutions does not adequately value employee growth and development, contributing to high staff turnover. The study also highlights specific characteristics of the public sector, such as bureaucracy and the lack of resources. The research suggests that, to improve talent retention, it is essential for public enterprises to invest in continuous training programmes, adopt more attractive incentive policies, and adapt their human resources management practices to the new demands of the labour market. In addition, implementing well-structured career development plans, mentorship programmes, and strengthening leadership and development actions are crucial to increasing employee motivation and commitment. Although the research focused on three ministries, its findings offer valuable contributions to public administration in Angola and can serve as a basis for the formulation of more effective public policies.

Trends in Israel's Medical Administration subspecialty, 1987–2022

BackgroundIsrael is unique in offering a formal subspecialty in Medical Administration and mandating it for physicians applying for senior roles. Data on the prevalence and characteristics of these specialists are limited.MethodsThe national registry of licensed physicians was used to identify all living physicians who completed the Medical Administration subspecialty by December 31, 2022. Data on year of medical licensing, city of residence, and list of additional recognized specialties along with their respective date of completion were extracted. Websites of key public health organizations were sampled to identify qualifications of persons in senior leadership positions.ResultsSince 1987, 277 physicians have completed the Medical Administration subspecialty, with a significant increase in annual certifications from 4.5 in 2015 (interquartile range [IQR] 4–6) to 13 (IQR 10.5–15) in 2022 (p < 0.001). Specialists completed the subspecialty a median of 18 years (IQR 13–21) post-licensing, with 269 physicians (97.1%) holding additional specialties, primarily in Internal Medicine, Pediatrics, Family Medicine, or Public Health. Compared to the general physician population, some base specialties like Public Health are over-represented while others, like Anesthesiology, are under-represented. Only 40 (14.4%) specialists reside outside major metropolitan areas. Nineteen (61.3%) general hospital CEOs, 2 (20%) psychiatric hospital CEOs, 13 (35.1%) Ministry of Health and 4 (7.8%) Sick Fund executives are specialists in Medical Administration (p < 0.005).ConclusionsThe steady growth in the number of specialists in Medical Administration demonstrates the sustainability and scalability of this model, which may serve as a template for other healthcare systems. However, the limited representation of these specialists in senior roles of some organizations, and their concentration within certain specialties and regions, indicates areas for policy attention to enhance leadership diversity and reduce healthcare disparities.

A holistic view on the COVID-19 epidemic process: smoking cessation behaviour, epidemic process and precautions

ABSTRACT The aim of this study is to investigate the smoking cessation tendencies of people with different levels of smoking addiction during the COVID-19 epidemic process and to investigate the variables that most affect the risk perception of being Covid-19. Data were collected between November 8 and December 20 2021. A total of 898 participants living in the Turkey aged 18 years or older were recruited from Google online form panel. In general, it can be said that the higher the education level and the higher the income, the better the people adapt to the epidemic conditions. During the epidemic, it is seen that people generally (88.2%) get the news about the process from official sources. It is seen that the participants trust the ministry of health and the scientific committee at a rate of 67.1% in the epidemic management. It is possible that those who have chronic diseases and are addicted to cigarettes will experience the COVID-19 process more heavily. However, in this study, it could not be said that those who have a chronic disease and are addicted to smoking are more inclined to quit smoking.

Вплив харчового заліза на розвиток хвороб аліментарного генезу

The main task of modern medicine is the development and implementation of effective large-scale programs aimed at optimizing the qualitative and quantitative composition of food rations. Modern environmental conditions (pollution of soils with pesticides, heavy metals, radionuclides, etc.) require constant control and correction of the plastic, energetic and catalytic components of food. Iron, as a food ingredient, is an important component of energy metabolism, synthesis of nucleic acids and cell proliferation. To prevent iron-deficiency anemia (IDA) of alimentary origin, it is necessary to quickly and effectively replenish the losses and reserves of iron in the body, which is possible with a timely increase in the supply of this trace element with food. The most rational ways to prevent IDA of alimentary genesis can be substantiated dietary recommendations that take into account a sufficient variety of nutrition, the use of animal products, and substances that increase the assimilation of iron. Aim. To evaluate the supply of iron to residents of radioactively contaminated territories of Ukraine and to establish the impact of the latter on the development of diseases of alimentary origin. Materials and Methods. In order to assess the supply of iron to the population of the territories affected by the consequences of the accident at the Chernobyl Nuclear Power Plant (ChNPP) and to determine its impact on morbidity and mortality, a cohort of people of working age (men and women aged 18–29, 30–39, 40–60 years old at the time of the accident at the ChNPP), who live in ecologically dangerous areas of Zhytomyr region, was analyzed. The source of initial information for epidemiological research and analysis was own observations and data from the Ukrainian Center for Information Technologies and the National Register of the Ministry of Health of Ukraine. The total cohort consisted of 163,047 people of both sexes, including: men – 72,654 or 44.6%, women – 90,393 or 55.4%. To achieve the goal, the following methods were used: bibliosemantic; theoretical analysis of the generalization of data on the problem of health and nutrition of the population living in disadvantaged regions of Ukraine; mathematical statistics. Results. Between 60 and 65% of the population living in areas radioactively contaminated by the accident at the Chernobyl nuclear power plant are diagnosed with iron-deficiency anemia. The primary cause of the lack of essential substances, including iron, in food is a decrease (by 2.0–2.5 times) in energy expenditure and a decrease in the volume of food consumed. In addition, the impetus for the deformation of the relationship between essential substances in the diet is the increase in the use of technologically processed and anthropogenically contaminated products. Our research established that the nutrition of both men and women did not meet the recommended values. Thus, the diets of men of different groups of labor intensity were the most deficient in the content of meat and meat products – up to 55%, fish and fish products – up to 72%, milk and milk products – up to 57%, fruits – up to 58%. At the same time, they consumed a surplus of bread, legumes, cereals, lard, potatoes, sour cream, and eggs. The most unbalanced was the nutrition of women. Thus, the shortage of bread and bakery products was 41.4%, meat and meat products – 63.9%, milk and milk products – up to 40.0%, vegetables – up to 25.5%, hard cheese – up to 80.0 % of the recommended values. At the same time, women consumed an excess of cereals, eggs, potatoes and confectionery. The content of iron in the diets of men, regardless of physical exertion, exceeded the recommended values from 12.0 to 28.0%. At the same time, the lack of iron in women's diets amounted to 13.2–34.0%. Conclusions. The use of international models for the prevention of iron-deficiency conditions among the population living in the territories of Ukraine affected by the accident at the Chernobyl nuclear power plant requires information on reliable estimates and a list of demographic data, life expectancy, incidence of malignant neoplasms, and mortality from all causes. Keywords: dietary iron, heme iron, iron-deficiency anemia, prevention, population of ecologically dangerous regions, accident at Chornobyl NPP.

Workplace violence and associated factors against nurses working in public hospitals in Ethiopia: a systematic review and meta-analysis

BackgroundThe issue of workplace violence (WPV) directed at nurses is a chronic and global public health concern. Numerous studies on workplace violence in Ethiopia have been conducted; however, the results have been inconsistent. The review aims to identify the pooled prevalence and associated factors of workplace violence against nurses.MethodsA systematic and methodical literature search was conducted using electronic databases such as Google Scholar, EMBASE I, Scopus, PubMed, HINAR, the Web of Science, and the African Journal Online (AJOL). Each original study’s efficacy and quality were assessed using a modified Newcastle-Ottawa scale (NOS) technique designed for cross-sectional research. The Cochrane Q and I2 test statistics were used to verify the heterogeneity of the studies. Using a random effect model, the pooled estimate of workplace violence among nurses was calculated.ResultThe pooled estimate of workplace violence among nurses in Ethiopia was 39.43% (95% CI: 27.63, 51.23). Female nurse (POR = 2.25; 95% CI: 1.29, 3.92), short work experience (POR = 3.25; 95% CI: 2.37, 4.45), and living without a spouse (POR = 2.03; 95% CI: 1.03, 3.99) were identified factors associated with workplace violence.ConclusionThis study found that about two-fifths of nurses encounter workplace violence. According to this study, there was a significant association between work place violence among Nurses and being female, having less job experience, and being single. To address this issue, the Federal Ministry of Health (FMOH), policymakers, and other stakeholders should prioritize interventions aimed at reducing workplace violence.