Ministry Of Health Research Articles

ASSESSING THE EFFECTIVENESS OF INTEGRATED TREATMENT IN ADOLESCENTS WITH CHRONIC CATARRHAL GINGIVITIS LIVING IN ENVIRONMENTALLY COMPROMISED AREAS

The challenging ecological situation in Western Ukraine, coupled with natural geochemical factors such as deficiencies in fluorine and iodine, contributes to the deterioration of children's somatic and dental health. This underscores the urgent need to develop comprehensive treatment and preventive strategies to mitigate pathological processes in periodontal tissues and enhance treatment outcomes. Purpose: The study aimed to evaluate the effectiveness of treating chronic catarrhal gingivitis in children residing in environmentally polluted areas with iodine and fluorine deficiencies (the cities of Yavoriv and Zhydachiv). The study observed children aged 12–15, comprising 59 participants in the main group and 42 in the control group (from the city of Lviv, considered an ecologically clean region). Children in the main group were treated according to a specialized protocol developed for the study, while those in the control group received treatment per the Ministry of Health of Ukraine's protocols for “Therapeutic Dentistry”. Methods. The treatment regimen for chronic catarrhal gingivitis in the main group included: local measures such as Professional oral hygiene, traditional anti-inflammatory agents (tinctures of chamomile, St. John’s wort, calendula), applications of “Holisal” gel on the gingival surface, use of “Lacalut Aktiv Herbal” toothpaste and “Lacalut Aktiv” mouthwash; systemic treatment including “Kinder Biovital Lecithin” gel to enhance immune system function, “Ascorutin” to reduce capillary fragility and permeability. This multifaceted approach aimed to address both local and systemic factors influencing periodontal health in children from ecologically compromised regions. Results and discussion. The evaluation of the immediate results of the treatment was carried out visually, taking into account the change in clinical symptoms (on 5-6 days) and with the help of periodontal and hygienic indices, immunological indicators. Periodontal status was assessed by papillary-marginal alveolar indices, communal periodontal index and gingival bleeding index. Oral hygiene was assessed by the Fedorov-Volodkina index. In order to assess the adaptive capabilities of the body and determine the risk factors for periodontal tissue lesions, the content of leukocytes in the oral fluid of children was evaluated. In the initial period of the treatment course, we found a decrease in the values ​​of periodontal indices in both the main and control groups. On the 5-6th day after the start of treatment of chronic catarrhal gingivitis, the value of the papillary-marginal alveolar index in the main group was 20.16±1.95% that was significantly lower compared to the control group, 33.21±1.82%. Following the treatment, a decrease in the bleeding index was found in the children of the main group accounting 0.94±0.11 points versus 1.42±0.15 points in the control group. Analyzing the changes in the communal periodontal index, a more significant decrease was found in the children of the main group (1.09±0.15 points) compared to the control group (1.39±0.16 points). Along with the normalization of the clinical condition of the periodontal tissues in children with chronic catarrhal gingivitis who were under our observation, an improvement in oral hygiene was noted, which, in our opinion, can be due to the implementation of professional hygiene, quality control of tooth brushing, as well as conversations on hygiene education with children and their parents. This is confirmed by indicators of the hygienic index of Fedorov-Volodkina. Since local immunity is a sensitive indicator of the effect of external and internal environmental factors, we determined the concentration of leukocytes in the oral fluid 5-6 days after the treatment of chronic catarrhal gingivitis. It is worth noting that after treatment for 5-6 days, the number of leukocytes in the oral fluid of children with chronic catarrhal gingivitis in the study groups significantly decreased. Thus, in the children of the main group, the number of leukocytes was 205.14±4.28 × 106 /l and 220.40±4.21 × 106 /l in the control group, which was significantly lower than the corresponding values ​​before treatment (р<0 ,01). Thus, the study results have demonstrated the described treatment course can significantly normalize and improve the condition of periodontal tissues and oral hygiene in the children of the main group with chronic catarrhal gingivitis that is confirmed by oral hygiene indices and laboratory findings.

Profile of Cervical Cancer Screening in a Family Health Unit in Salvador, Bahia State, Brazil: an Evaluative Study of the 2020-2023 Period

Objective: The objective of this study is to outline the profile of cervical cancer screening at the Family Health Unit (FHU) San Martin 3, in the municipality of Salvador, Bahia, Brazil, from 2020 to 2023, in order to analyze the coverage of the preventive exam or Pap smear. Theoretical Framework: Brazil performs opportunistic screening of women with pre-neoplastic lesions or precursor lesions of Cervical Cancer (CC), through the performance of the Preventive Exam (PE) or Pap smear. Where the woman occasionally seeks the health service. The recommendation of the Brazilian Ministry of Health (BMH) is to screen primarily women in the age group at risk, from 25 to 64 years, delimited by the highest incidence and mortality rate of CC. Method: This is a descriptive ecological study, where the trend of the historical series of cytopathological tests performed for cervical cervical cancer screening in women at FHU San Martin 3, in the municipality of Salvador, Bahia, Brazil, between 2020 and 2023, from the date of inauguration of the unit until December 2023, was analyzed. The data were taken from the electronic medical record, Sistema Vida, and from the unit's PE record book, in February 2024. Results and Discussion: The results obtained revealed [synthesize the main results of the research]. In the discussion section, these results are contextualized in light of the theoretical framework, highlighting the implications and relationships identified. Possible discrepancies and limitations of the study are also considered in this section. Research Implications: The cytopathological examination of the cervix performed by the unit is the procedure chosen by the World Health Organization (WHO) and adopted by the BMH for cervical cancer screening, in the study in question most of the reports with precursor alterations for this type of cancer are in the standardized age range for PE, from 25 to 64 years old. The altered results in women under 25 years of age were low-grade intraepithelial lesions, a common alteration in women under 25 years of age, usually associated with the HPV virus, which in most cases regress without treatment. Originality/Value: The research on the profile of cervical cancer screening in a family health unit in Salvador presents significant originality and value for public health.

Early Detection Model of Drug Abuse Relapse in the City of Padang

The past year prevalence rate was 1.80% or 180 out of 10,000 Indonesians aged 15-64 years or equivalent to approximately 3.4 million people. The survey also found that drug abuse has penetrated into the countryside with very prominent drug use at a very productive age (25-49 years) and the prevalence rate in the past year of use above 2.5%. The various impacts of drug use can be overcome by conducting a rehabilitation program. The process of drug rehabilitation is a process given to drug addicts so that their mental, physical and social conditions improve, the existence of rehabilitation is expected to be able to reduce the adverse effects on physical and mental conditions and can reduce dependence and relapse due to drug use, so as to reduce the number of drug abusers. In this post-rehabilitation stage, drug abusers are prone to relapse. The case of relapse in drug users is very high, found in more than 50% of addicts in the last decade. Based on research, relapse rates are known to reach approximately 80 percent within the first six months, and occur as much as approximately 50 percent within two years. However, the various definitions of relapse have led to different relapse rates in Indonesia. The Ministry of Health in 2018 claimed that the relapse rate in Indonesia reached 24.3% while the relapse rate according to BNN stated that before the implementation of rehabilitation, Indonesia's relapse rate reached 90%. Indonesia's relapse rate after the implementation of rehabilitation at the Lido Bogor rehabilitation and therapy center is around 7%. Methods: This study uses a qualitative design with a phenomenological approach and aims to determine the determinants of early detection of relapse in drug abusers in Padang city. The informants in this study are drug abuser clients who are undergoing rehabilitation, in the post-rehabilitation program, and who have completed the rehabilitation program at HB Saanin Mental Hospital Padang, West Sumatera BNNP Clinic, and Yayasan Karunia Insani in Padang City, with a total of 6 people. In addition, the respondent sample consisted of 30 drug abusers who were undergoing rehabilitation. The analysis included instrument validity and reliability tests, expert analysis, and diagnostic test analysis. Results: Respondents' ages varied from 18 to 46 years old Factors that encourage relapse are the influence of friends and invitations from friends who use drugs. In addition, the absence of work and family problems also encourage relapse, Family, friends and community support for resilience, Informants revealed that rehabilitation programs can help informants from the risk of relapse, Informants confirmed that relapse can occur in anyone even in people undergoing intensive treatment, comprehensive and sustainable lecture programs can prevent relapse, Stress, depression, and social pressure factors affect the risk of relapse, the first signs of relapse felt by informants are unstable emotions. The developed relapse early detection model has significant predictive ability with an AUC of 78% and can predict the incidence of relapse with an accuracy between 60.2% and 95.8%. The model shows a strong correlation with the SSRS and has a 10,200 times greater chance of detecting relapse cases than the SSRS. Conclusion: Informants define relapse as a situation where someone who has used drugs uses drugs again, Factors that encourage relapse are the influence of friends and invitations from friends who use drugs. In addition, the absence of work and family problems also encourage relapse, Family, friends and community support for resilience, Informants revealed that rehabilitation programs can help informants from the risk of relapse, Informants confirmed that relapse can occur in anyone even in people undergoing intensive treatment, comprehensive and sustainable lecture programs can prevent relapse events, Stress, depression, and social pressure factors affect the risk of relapse, the first signs of relapse felt by informants are unstable emotions.

Analysis of Pre-Exposure Prophylaxis (PrEP) Program in Preventing HIV/AIDS Based on the Health Policy Triangle

Background: Pre-exposure prophylaxis (PrEP) is an action to prevent HIV transmission using antiretroviral (ARV) drugs. During 2022, the PrEP program was implemented in 21 districts/cities as a trial limited to MSM and sex worker populations. This study aims to analyze the PrEP program in preventing HIV/AIDS using a health policy triangle approach that assesses the aspects of actor, context, content, and process. Methods: The study was performed using qualitative methods from electronic document searches. Results: The results of the analysis show that the actors in the PrEP program as HIV/AIDS prevention are the President, Legislative, Ministry of Health, Ministry of Education, Ministry of Internal Affairs, health office, community health centers, hospitals, non-governmental organization (NGOs)/HIV and AIDS care groups, HIV/AIDS key populations, correctional institutions, the Indonesian Ulema Council (MUI), and the Food and Drug Monitoring Agency (BPOM). The context of PrEP implementation in the form of situational factors is high HIV transmission within at-risk populations, structural factors are legal bases, cultural factors are patriarchal culture and MSM and sex workers which are still taboo, as well as international factors in the form of WHO policy. The policy process consists of problem identification, policy analysis, policy formulation, implementation, and program monitoring and evaluation. Conclusion: PrEP content regarding the aim of PrEP, targets, types of drugs used, how to get PrEP services, how to use the drugs, and how to monitor has been explained in the Technical Guidelines for PrEP Services made by WHO and adapted by the Indonesian Ministry of Health.

Stress, distress and anxiety in surgical specialists

The purpose of the study is the assessment of the level of anxiety among surgeons providing medical care in specialized COVID-19 hospitals, multidisciplinary hospitals, and polyclinics during the pandemic of the novel coronavirus infection COVID-19, as well as early diagnosis, prediction, and prevention of the development of anxiety associated with the level of occupational burnout in this category of medical specialists. Material and research methods. The study was carried out on the basis of the Department of Occupational Diseases and Clinical Pharmacology named after honored scientist of the Russian Federation professor V. V. Kosarev, FSBEI HE Samara State Medical University of the Ministry of Health of the Russian Federation, and the Department of Occupational Pathology, Regional Center for Occupational Pathology of the Samara City Hospital No. 5. The study was carried out within the framework of a complex theme «Systematic approach to early diagnosis, prevention, and prediction of the impact of low-intensity production factors on workers’ health» (state registration number AAAA-A18‑118122190069‑6, registration date — December 21, 2018) of the Department of Occupational Diseases and Clinical Pharmacology named after honored scientist of the Russian Federation professor V. V. Kosarev, FSBEI HE Samara State Medical University. The study was approved by the local ethics committee of the FSBEI HE Samara State Medical University of the Ministry of Health of the Russian Federation on November 23, 2021. Patient consent. Each participant of the study gave informed voluntary written consent to participate in the study and publish personal medical information in an anonymized form. The study included the following groups of subjects: group 1 consisted of surgeons working in a COVID hospital (in the «red zone») (n=61); group 2 included doctors of surgical specialties working in a multidisciplinary hospital (n=58); group 3 consisted of surgical specialists working in a polyclinic (n=55); group 9 consisted of nurses working in the polyclinic (n=29); group 4 was the control group (n=190) comprising workers of engineering, technical, and economic specialties not related to medical organizations (healthy). The method for assessing the anxiety in medical workers during the pandemic of the novel coronavirus infection COVID-19 was the original test method «Application of the Integrative Anxiety Test», created in 2005 at the St. Petersburg Psychoneurological Research Institute named after V. M. Bekhterev by PhD Candidate in Psychology A. P. Bizyuk, PhD in Medicine, professor L. I. Vasserman, and PhD Candidate in Medicine B. V. Iovlev. The technique is reliable and adapted for the Russian-speaking population, which was the basis for its use in the study of anxiety in healthcare workers during the pandemic of the novel coronavirus infection COVID-19. The obtained data were processed using the Statistica package from StatSof t (USA). Results. The professional activities of surgical specialists providing medical care in the «red zone», multidisciplinary hospitals, and clinics are associated with the exposure of physicians to a number of risk factors in the working environment and the labor process, interrelated with the provision of regular or occasional care to COVID-19 patients, which, under conditions of exposure to increased levels of occupational stress, leads to an increase in the level of anxiety in these categories of medical workers. The increase in the level of anxiety among medical workers of medical institutions of various profiles during the pandemic of the novel coronavirus infection COVID-19 is due to the fact that medical workers faced many additional difficulties during this period: sleep deprivation, stress, strain, and fatigue. Fatigue can affect behavior, communication, learning, and decision-making, which generally leads to an increase in the level of anxiety of doctors and nursing staff. Limitations of the study. The study has regional (Samara Region) and professional (in terms of detailing working conditions in the studied comparison groups) limitations. Conclusion. Thus, the obtained data indicate that when identifying risk factors for an increase in the level of anxiety in medical workers providing care in situations of high epidemic risk, there is the need to use specialized rehabilitation measures with relaxation techniques, art therapy, as well as professional adaptation programs, physiotherapeutic techniques, such as electrosleep and reflexology, and, if possible, resort treatment in health care centers, local sanatoriums, etc. with visits to psychotherapy offices, as well as psychopharmacological medications.

PROTECTIVE ACTIVITY OF HYBRID DERIVATIVES OF TRITERPENOID COUMA-RINS AGAINST INFLUENZA AND HERPES VIRUSES

The aim of this study was to evaluate the protective properties of new hybrid deriva-tives of triterpenoid-coumarins using models of lethal influenza pneumonia and herpetic con-junctivitis. Materials and Methods. Animals. The study used two types of animals: female Balb/c mice (16-18 g) and male guinea pigs (400 g). The study employed the influenza virus strain A/California/07/09 (H1N1)pdm09, adapted to mice, from the collection of the Research Insti-tute of Influenza, A.A. Smorodintsev, Ministry of Health of Russia. Passage history: E4/E3M8E1. Conclusions. The protective activity of some hybrid derivatives of triterpenoid-coumarin was studied in the model of lethal influenza pneumonia caused by the influenza vi-rus and in the model of herpetic conjunctivitis during therapeutic and preventive use. It was shown that in the model of lethal influenza pneumonia using high doses of the influen-za virus, the use of all compounds improved the dynamics of animal weight, even if the animal mortality coincided with that of the control group. All the tested compounds, except for AV-49, positively affected the dynamics of death in infected animals. The most active compounds were AV-41, AV-42, and AV-53, with protection indices of 45%, 56%, and 34%, respective-ly. When studying the activity of compounds AV-41, AV-49, and AV-54 with lower doses of the virus, the protective properties of AV-41 and AV-53 were preserved at levels comparable to the reference drug oseltamivir. When investigating the protective activity of AV-42 and AV-53 in the model of her-petic conjunctivitis, it was shown that both drugs reduced the severity of disease symptoms (both keratitis and blepharitis), though less effectively than the reference drug acyclovir. Based on the overall protective activity in both viral models, the group of new hybrid triterpe-noid-coumarin derivatives appears promising for further antiviral research.

Analysis of the Influence of Marketing Mix and Store Layout on Purchase Decisions at Kimia Farma Pharmacy Central Jakarta Branch

In 2020, the Ministry of Health reported that there were 30,199 registered pharmacies (Ministry of Health of the Republic of Indonesia, 2022). This number fluctuated from 2018 to 2020, indicating competition in the pharmacy business. To face this competition, pharmacies need to implement strategies that can influence customers' purchasing decisions. This study aims to determine the influence of marketing mix and store layout on purchase decisions. The method used is quantitative with data collection through a Likert scale questionnaire. The number of samples was 100 respondents, calculated using the Yamane and Isaac-Michael formulas, and tested for validity and reliability using SPSS. The results of the multiple regression test show that the marketing mix and store layout together influence the purchase decision. This proved that both significantly influenced the purchase decision, so Ho was rejected and H1 was accepted. In addition, the test results also show that partially, these two factors have a significant influence on purchase decisions. The marketing mix strategy and store layout implemented by Kimia Farma's Central Jakarta branch is considered effective because it is able to influence purchasing decisions, as evidenced by the value of the R2 determination coefficient of 85.2%.

Pola Hubungan Ruang Rumah Sakit Umum Daerah Tebing Tinggi terhadap Peraturan Menteri Kesehatan

In the relationship of space, the architect makes a precondition of how each space should relate and the type of relationship. The pattern of hospital room relationships has been regulated in the regulation of the Minister of Health. This study aims to analyze the level of suitability of the hospital room relationship with the regulations of the Minister of Health. The object of the research used is the Kumpulan Pane Regional General Hospital or abbreviated as RSKP, located in the city of Tebing Tinggi, Serdang Bedagai Regency, North Sumatra Province. This research is a quantitative research, with data obtained through direct observation and juxtaposed with the Regulation of the Minister of Health. The results of observations at the location of the research object found that the spatial relationship pattern between hospital buildings did not meet the standard of spatial relationship pattern contained in the Regulation of the Minister of Health. This study has a conclusion that some of the buildings in the hospital do not meet the existing regulatory standards so that they need to be adjusted. The targeted output is an accredited journal.

Association Between Adolescent Violence Exposure and the Risk of Suicide: A 15-Year Study in Taiwan

Background/Objectives: According to the 2023 Ministry of Health and Welfare statistics, the suicide rate among adolescents aged 15 to 24 has steadily increased since 2018, from 3.7 to 5.5 per 100,000 populations, reaching a recent high. Although previous studies have pointed out that the future risk of suicide of those who had suffered from abuse was higher than that of the general population, researchers seldom focused on adolescent groups. Therefore, the aim of this study was to explore the risk of suicide after youth violence and the impact of subsequent comorbid mental illness and suicide risk. Methods: This retrospective matched cohort study analyzed data from the NHIRD, covering the period from 2000 to 2015. A total of 976 cases aged 10–18 who had experienced violence were included in this study. Controlled grouping was conducted by 1:10 matching based on gender, age, and the time of medical treatment, and a control group who had not experienced violence was selected for comparison. We used the Cox proportional hazards model to analyze the risk of suicide among adolescents after exposure to violence. Results: The suicide rate among adolescents who have experienced violence was significantly higher than that of the control group after 15 years of follow-up (1.0% vs. 0.5%). The prevalence of mental illness or disorders in adolescents exposed to violence was significantly higher than in the control group (45.2% vs. 40.1%). Among adolescents who had experienced violence, the methods of suicide included poisoning (solid and liquid) (53.6% vs. 43.2%), hanging (1.2% vs. 0.6%), firearms (2.4% vs. 0%), and cutting instruments (27.4% vs. 22.8%), all of which were significantly higher than in the control group. After adjusting for gender, age, residential area, and mental health comorbidities, the risk of suicide in those who had experienced violence was 1.475 times that of the control group (95% CI = 1.125–1.933; p = 0.005). Conclusions: In this study, female, younger age, and comorbid mental disorders were identified as risk factors for suicide among the adolescent victims of violence. Exposure to youth violence was associated with an increased prevalence of emotional disorders, including depression and social isolation, which subsequently elevated the suicide risk. These findings underscore the urgent need for governmental attention to the mental health of adolescent victims of violence. Implementing targeted psychological support and intervention programs could play a crucial role in mitigating the risk of suicide among this vulnerable population.

Innovation Trends: Untilization of Social Media and Interective Video in Leprosy-Related Health Promotion

Leprosy is an infectious disease caused by Mycobacterium Leprae. This disease has become a health problem in several countries, one of which is Indonesia. The impact of leprosy is physical, economic and psychological disability. Health promotion is an effort by individuals and communities to increase their abilities in several factors that influence health so that they can improve their health. Health promotion activities regarding leprosy are carried out by making videos regarding education the prevention of leprosy using promotional media in the form of Instagram. The method used is qualitative content analysis from educational videos related to leprosy which are posted on the Instagram page @komkes.ikmb.22. There are 2 processes in this activity: 1) formulation of material and content ideas related to leprosy prevention; and 2) creating leprosy health promotion media. Leprosy education using social media can be done by disseminating accurate and educative information about leprosy through social media platforms and not causing discrimination against leprosy sufferers. Instagram can be used as a means of health promotion and health communication tool to fight leprosy. Instagram is effective medium, because it is widely used and has a large number of active users. The Indonesian Ministry of Health stated that there are still a number of challenges in eliminating leprosy cases in Indonesia. Therefore, an effective solution is needed to overcome this. Through social media, especially Instagram, it is hoped that efforts to deal with leprosy in society will become more systematic, comprehensive and effective

Developing and integrating a destination decision support algorithm into an innovative electronic communication platform to improve injury care service coordination in Rwanda: The Rwanda912 study protocol.

Delays in getting injured patients to hospital in a timely manner can increase avoidable death and disability. Like many low- or middle-income countries (LMICs), Rwanda experiences delays related to lack of efficient prehospital communication and formal guidelines to triage patients for hospital care. This paper describes the protocol to develop, roll out, and evaluate the effectiveness of a Destination Decision Support Algorithm (DDSA) integrated in an electronic communication platform, '912Rwanda'. The DDSA will facilitate the linkage of patients to health facilities able to treat their condition(s). Work will be conducted in three phases: i. development, ii. training and roll-out, and iii. evaluation. Work will be conducted in the pre-hospital emergency service "SAMU - Service d'Aide Medicale Urgente" and health facilities in Kigali City and Musanze District, which serve predominately urban and rural populations, respectively. We will develop interfaces to capture facility and patient-relevant data, which feed into a guideline-based electronic DDSA to match patients to hospitals. We will assess existing trauma care processes using qualitative and quantitative methodologies. This will be followed by a series of consensus workshops to develop at-scene triage guidelines and agree variables to capture in the interfaces. The DDSA will be developed based on outputs from these workshops and tested against historical ambulance data and expert opinion until acceptable thresholds of performance are passed. User interfaces will be developed and tested using human computer interface design principles. The combined collaborative approach of bringing together experts and software developers, and with deep engagement of Rwandan stakeholders, including leadership of Rwanda Ministry of health through its technical arm, the Rwanda Biomedical Center, should lead to an ambulance communication system which is utilized, sustained, and effective.

Current status of relocation among terminally ill older residents of nursing facilities: Observational study using anonymous long-term care receipt information

Objectives In Japan, efforts to provide "end-of-life care" in nursing homes are increasing and its introduction through long-term care insurance in 2006 is a major step forward. However, previous studies have shown that relocating older adults to their end-of-life care affects their burden. This study examined individuals' end-of-life care use under long-term care insurance in older care facilities and investigated the relocation frequency among terminally ill older residents of nursing facilities using receipt data.Methods The research targeted individuals aged ≥ 65 years under long-term care insurance who used formal end-of-life care services and were passed into residential facilities between April 1, 2018 and March 31, 2021. Data were obtained from anonymous long-term care certification information provided by the Ministry of Health, Labor, and Welfare. Six facilities providing end-of-life care were considered; older care facilities, geriatric health service facilities, designated establishments, and dementia group homes. A total of 233,735 individuals with service use records in the month of service cessation were aggregated according to facility, individual factors, and prefecture. Additionally, we defined end-of-life relocation as occurring if three categories of end-of-life care fees (day of death, 1-2 days before death, and 4-30 days before death) did not continue until the day of death.Results The participants were individuals aged ≥ 85 years (83.35%), 25.29% were men, and 93.53% required a care level of ≥ 3. Older nursing care facilities recorded the highest number (114,356) of end-of-life care users. The proportion of individuals with moderate-to-severe dementia (level ≥ IIIa; approximately 80%) was higher in nursing homes for older adults, community-based nursing homes for older adults, and dementia group homes than in other facilities. Relocation during the terminal phase was less prevalent in facilities with higher doctor and nurse staffing levels. At the individual level, relocation is more frequent among men, younger individuals, those with lower care levels, and those with intact decision-making and communication abilities. Conclusion Terminally ill residents aged ≥ 80 years with severe levels of care were the most likely to use end-of-life care. Moreover, 0.2-2% relocated across all facilities within 30 days before death. The relocation frequency increased based on individual factors and was mitigated by a thorough system of medical staff deployment.

Effect of the combination of "weight gain of more than 10 kg since age 20" and obesity on the new onset of diabetes mellitus

Objective Few reports have examined the association between "weight gain since the past combined with the presence of obesity" and diabetes mellitus (DM). Therefore, we longitudinally examined the influence of the combination of "weight gain of ≥10 kg since the age of 20 years" and the presence of obesity on the new onset of DM.Methods We identified 8,704 National Health Insurance enrollees in Habikino City, Osaka Prefecture, who underwent specific health checkups in 2013. After excluding those who had DM previously and those who were untraceable and had missing data, 5,708 participants were included in the analysis. The risk of the new onset of DM was classified into "no weight gain/non-obese," "no weight gain/obese," "weight gain/non-obese," and "weight gain/obese" groups. Weight gain and obesity were defined as gaining ≥10 kg since the age of 20 based on responses to a standard questionnaire from the Ministry of Health, Labour and Welfare and a BMI ≥25 kg/m2. A Cox proportional hazards model was used to examine the risk of the new onset of DM.Results Participants' mean age was 64.3 ± 7.9 years. During the mean follow-up period of 3.14 ± 1.13 years, 126 (6.0%) men and 133 (3.7%) women developed DM. The hazard ratios (95% confidence interval [CI]) for the new onset of DM were significantly higher in the weight gain/non-obese (1.77 [95% CI: 1.26-2.49]) and weight gain/obese groups (2.76 [95% CI: 2.05-3.72]), with the no weight gain/non-obese group as the reference group. By sex, the hazard ratio for men in the weight gain/obese group was 2.06 (95% CI: 1.34-3.18), whereas the hazard ratio was higher for women in the weight gain/obese (3.68 [95% CI: 2.44-5.53]) and weight gain/non-obese groups (2.19 [95% CI: 1.35-3.55]).Conclusion Weight gain was a risk factor for the development of DM in individuals without obesity. This factor was more pronounced in women, who had a higher risk of the new onset of DM if they had gained > 10 kg since the age of 20, even if their BMI was less than 25 kg/m2. The results suggest that those who fall into this category should receive lifestyle improvement guidance, even if they are not eligible for specific health guidance.

Safety Evaluation of Marketed Anti-Diabetic Herbal Medicines in Ghana

Purpose: Despite readily available over-the-counter drugs, most herbal products are not scientifically validated for their safety profile. The study aimed to evaluate the safety profile of marketed anti-diabetic herbal medicines in Ghana. Design/Methodology/Approach: Four antidiabetic herbal medicines were purchased from herbal shops at Okaishie market in Accra. The mixtures were dried at 70oC in a water bath to obtain powdered extracts. A single dose of 5000mg/kg body weight of each extract was administered to 10 female Sprague Dawley rats once for the acute toxicity studies, and signs of toxicity were observed. Histopathological examination of essential organs was conducted after sacrificing the rats. P < 0.05 was considered statistically significant after multiple comparison tests. Findings: No mortality or adverse side effects were recorded. The rats ' normal growth, food, and water consumption were observed during the study period. No significant biochemical or haematological differences were observed, and no significant histological alterations were observed in the tissues studied. Research Limitation: This study used a specific batch of screened antidiabetic herbal medicines, and the results cannot be generalised to all batches of these herbal medicines. Practical Implication: It will help the Food and Drugs Authority, Ghana Standard Authority, Ministry of Health, and Ghana Health Service to intensify their surveillance of these antidiabetic herbal medicines. Social Implication: Safety evaluation of herbal medicines is vital in protecting society from serious adverse health effects from harmful herbal products. Originality/Value: The study employs laboratory animals to assess these herbal medicines for safety evaluations. Rats have almost the same physiology and anatomy as humans.

Investigating the Level of Knowledge of Nurses Working in Educational Hospitals of Ilam about COVID-19 in Iran

Introduction: Since nurses are responsible for caring of patients, increasing their knowledge will lead to better care. Here, we measured nurses’ COVID-19 knowledge in the teaching hospitals of Ilam. Materials and Methods: In this study, descriptive-analytical approach was used for data collection using a self-assessment questionnaire including demographic information and 12 questions about nurses' knowledge of COVID-19 disease. The data were collected in May 2020 and analyzed by SPSS 19 software. The significance level was considered at P <0.05. Results: Overall, 134 (72.4%) and 51 (27.6%) of the participants were males and females, respectively. The mean score of knowledge about COVID-19 disease was 6.04± 0.45. Nearly half of the nurses (45.4%) had good knowledge on the source of the disease, signs and symptoms, transmission routes, and progression and mortality rate of COVID-19. Conclusion: Most of the nurses had intermediate knowledge about COVID-19. However, it is essential for the Ministry of Health to provide accurate and coherent information according to the WHO guidelines.

Vaccination strategies to identify and reach zero-dose and under-immunized children in crisis-affected states in Sudan: a qualitative study

Abstract Background Globally, 21 million children were un- or under-vaccinated with Diphtheria-Tetanus-Pertussis (DTP)-containing vaccines in 2023. Around 20% of zero-dose children, those who had not received any DTP doses, live in conflict-affected settings in low and middle-income countries. There is insufficient evidence on vaccination interventions to identify and reach zero-dose children in these settings. This study aimed to map and assess current vaccination strategies to identify and reach zero-dose and under-vaccinated children in the crisis-affected states of South Kordofan, South Darfur and Blue Nile in Sudan. Methods We conducted a cross-sectional qualitative study guided by the (Identify-Reach-Monitor-Measure-Advocate (IRMMA) framework, developed by Gavi, the Vaccine Alliance. We conducted 20 individual semi-structured interviews during November and December 2022. We interviewed governmental and non-governmental vaccination stakeholders at federal, state and locality levels. We used the IRMMA framework to analyze the interview transcripts. Results Zero-dose and under-immunized children in the study sites were concentrated in opposition-controlled areas, nomadic communities, and remote rural areas. Zero-dose and under-immunized children in accessible areas were identified through routine vaccination strategies and surveillance reports. Various strategies were used in inaccessible areas. This includes tasking local institutions and individuals trusted by communities to identify and reach children, and infrequent integration and co-delivery of routine vaccines with other health interventions such as COVID-19 vaccination and insecticidal net distribution. There are inaccurate population estimates and a lack of guidance from ministries of health for measuring and monitoring zero-dose and under-immunized children. Respondents conflated advocacy with mobilization, and advocacy was broadly characterized as an ad hoc activity mostly connected to immunization campaigns. Conclusions Our study underscored the complexity of vaccinating zero-dose and under-immunized children in crisis-affected states of Sudan. Further research is needed to evaluate these practices and the role of non-governmental organizations (NGOs) and community engagement in improving vaccination coverage. Furthermore, exploring alternative funding methods and using geographic information systems (GIS) could enhance vaccination data and address funding limitations.

Asymptomatic Malaria Cases and Plasmodium Species in Mainland Tanzania and Zanzibar Archipelago (Pemba).

Malaria remains a major public health threat in Sub-Saharan Africa. According to the World Health Organization (WHO) estimates, Plasmodium falciparum species account for nearly 100% of the malaria cases occurring on the African continent. According to the Centers for Disease Control and Prevention (CDC), falciparum malaria predominates, but non-falciparum species are also present in Africa. The aim of the study was to assess the occurrence of asymptomatic malaria cases, as well as to identify Plasmodium species at two different settings with the lowest index of infections in Tanzania (according to the Tanzanian Ministry of Health < 1%), i.e., on the mainland (Arusha Region) and on the Pemba Island (Zanzibar Archipelago). The study was conducted in June 2023 and involved 722 individuals, including 449 residents of mainland Tanzania and 273 residents of the Zanzibar Archipelago. The screening consisted of two phases. In the first one, which was carried out at two different settings, i.e., in the Karatu Lutheran Hospital (Arusha Region, mainland Tanzania) and the Amal Hospital (Pemba, Zanzibar Archipelago), mRDTs (malaria rapid diagnostic tests) were performed, haemoglobin concentrations were measured, and blood samples for further molecular tests were collected onto Whatman micro cards from each of the individuals involved. In the second phase (conducted in Poland, Europe), RT-PCR tests for malaria were performed. The screening found asymptomatic Plasmodium infections in 4.2% of the study subjects from mainland Tanzania and in 4.8% from the Archipelago. The research confirmed cases of P. falciparum malaria but also found single cases of mixed infections with P. falciparum + P. malariae or P. ovale. The results demonstrated that the occurrence of malaria in northern mainland and Zanzibar Archipelago is higher than the official MoH reports present. The study findings are consistent with the reports by CDC, which suggest that non-falciparum species are also present in Sub-Saharan Africa.

Correlation of Geographic Variables with the Incidence Rate of Dengue Fever in Mexico: A 38-Year Study.

Dengue is a viral disease transmitted by the mosquitoes Aedes, which is characterized by fever, myalgia and arthralgia. In some cases, it can be fatal. For many years, dengue fever has been endemic to Mexico; however, few studies have investigated the historical and current extents of dengue fever at the national level or considered the effects of variables such as temperature, precipitation and elevation on its occurrence. An ecological study was carried out to compare the incidence rates of different types of dengue fever per hundred thousand inhabitants with temperature, precipitation and elevation between 1985 and 2023 in Mexico. The sources of information were the public records of the Ministry of Health and the National Meteorological Service. Multiple linear regression analysis was performed with Pearson and Spearman correlation coefficients at an alpha of <0.05. The global linear regression presented an R2 of 0.68 between the mean temperature and the cases of haemorrhagic dengue/severe/with warning signs. The degree of rainfall was not strongly correlated with the incidence rate, except in the eastern part of the country, where average temperature was also strongly correlated with the incidence rate. Nonsevere/classic dengue was most common from 1501 to 2000 m elevation, whereas severe forms of the disease were more prevalent at elevations greater than 2000 m.

Evaluation of the Effectiveness of Vector Management Methods in Hospital X Batam City

According to the Ministry of Health, disease vector and pest management includes all actions or activities aimed at reducing the population of disease vectors and animals as low as possible so that their presence in an area no longer poses a risk of disease transmission. The purpose of this study is to determine the Input, Process, and Output aspects of evaluating the effectiveness of vector handling methods in Hospital X in Batam City. This study used qualitative methods through in-depth interviews and observations with a total of six informants, namely the Head of Subdivision of Public Facilities, Head of Public Facilities Affairs, Health &amp; Safety Coordinator, Human Resources, Head of Finance, 3rd agent (CV. Bumi Resik). The results of this study indicate that vector handling in Hospital X has been quite effective, lack of awareness of Human Resources of the prohibition of leaving food scraps in the work room. It is necessary to collaborate with entomologists to get advice and vector handling strategies that are more effective and specific according to the conditions of Hospital X, apply strict sanctions for those who violate the prohibition of leaving food scraps in the work room, provide informative posters in the hospital area about simple procedures that can be done to support vector handling

Reform of Working Hours Regulations for Medical Specialist Education Programs Towards Balance in Education and Service

Regulations on working hours for Medical Specialist Education Program (PPDS) participants in Indonesia play an important role in maintaining a balance between education and health services. However, legal loopholes and lack of supervision have led to many PPDS participants being forced to work beyond the prescribed limits, which negatively affects their physical and mental health. This study aims to analyze existing regulations related to PPDS working hours, identify legal loopholes that affect the welfare of participants, and provide recommendations for regulatory improvements. The method used in this research is a normative legal research method with a legislative and conceptual approach. The data used are secondary sources, including relevant laws, legal journals, and official government documents. The results show that although there are regulations governing working hours, their implementation is often inconsistent in the field. Many PPDS participants reported working hours exceeding 80 hours per week, especially in emergency situations. This finding indicates the need for legal reform to create a better system. In conclusion, regulatory reforms regarding working hours for PPDS participants are urgently needed to ensure the welfare of participants and the quality of health services. Recommendations for improvement include stricter enforcement of working hour limits, improved supervision systems, and active collaboration with the Ministry of Health.