Ministry Of Health Research Articles

Cost savings of a nationwide project preventing healthcare-associated infections in adult, paediatric and neonatal critical care settings in Brazil: a micro-costing study

ObjectiveTo provide evidence of the cost savings of a quality improvement (QI) initiative preventing healthcare-associated infections (HAIs) in critical care settings.DesignA micro-costing study focused on financial data related to a...

Competency-Based Neurosurgical Residency Training Program in Korea.

A proposed program for competency-based neurosurgery training was presented for adaptation to a specialized project. The core of this training program is to reflect the contents of medicine that develop in the ordinary competency course necessary during the training period of residency and to systematize the training curriculum focused on competency. For that, the Development project of the competency-based training program for neurosurgical residency was conducted under the leadership of the Training Education Committee (TEC) under the Korean Neurosurgical Society (KNS), with the support of the Ministry of Health and Welfare. In this article, we introduce an educational program for a competency-oriented training system. The educational program sets the goal of the final competency that a neurosurgeon must possess and presents a list of core competencies and activities to perform for this purpose, called entrustable professional activity (EPA). The program structure includes the following domains: seven final competencies, four core competencies, ten EPAs, and 12 neurosurgical procedures. These educational programs will be uploaded to the KNS website in the future, and we would like to encourage each training hospital to reflect on them.

Scaling Up and Enhancing the Functionality of the Electronic Integrated Diseases Surveillance and Response System in Uganda, 2020-2022: Description of the Journey, Challenges, and Lessons Learned.

In 2017, Uganda implemented an electronic Integrated Disease Surveillance and Response System (eIDSR) to improve data completeness and reporting timelines. However, the eIDSR system had limited functionality and was implemented on a small scale. The Ministry of Health, with support from the Infectious Disease Institute, Makerere University, and Health Information Systems Program Uganda, upgraded the system functionality and scaled up its implementation. This study describes the process and impact of upgrading eIDSR functionality and expanding its implementation across additional districts. The Ministry of Health, through its Integrated Epidemiology, Surveillance & Public Health Emergency Department, coordinated the implementation of the eIDSR. User requirements were identified through consultations with national surveillance stakeholders. The feedback informed the design and development of the upgraded eIDSR functionalities. The eIDSR rollout followed a consultative workshop to create awareness of the system among stakeholders. A curriculum was developed, and a national training of trainers was conducted. These trainers cascaded the training to the district health teams, who later cascaded the training to health workers. The training adopted an on-site training approach, where a group of national or district trainers would train new users at their desks. The eIDSR system was upgraded to the District Health Information Software 2 (DHIS2) 2.35 platform featuring faster reading and writing tracker data, handling over 100 concurrent users and enhanced case-based surveillance features on Android and web platforms. From October 2020 to September 2022, the eIDSR was rolled out in 68% (100/146) of districts. Additionally, the system permitted prompt reporting of signals of epidemic-prone diseases. Improving the functionality and the expanded geographical scope of the eIDSR system enhanced disease surveillance. Stakeholder commitment and leveraging existing structures will be needed to scale up eIDSR.

Evaluation of pulse therapy with intravenous methylprednisolone on leprosy neuritis in a Brazilian referral center

BackgroundLeprosy neuritis (LN) is an immune hyperactivity majorly responsible for the deformities and sequelae present in leprosy disease. This observational study aimed to evaluate the use of intravenous methylprednisolone in refractory LN cases in a national reference center of leprosy in Brazil.MethodsEpidemiological and clinical data were collected, and the following instruments were used on evaluation: visual analog pain scale (VAS), Douler Neuropathic 4 questionnaire (DN4), Screening of Activity Limitation and Safety Awareness (SALSA), and the simplified neurological assessment protocol by the Brazilian Ministry of Health. The initial and final results of pulse therapy were compared.ResultsWe included 18 patients. After pulse therapy, there was no difference regarding sensory and motor scores. At the beginning of the treatment, 66.7% (12/18) of patients were using oral prednisone at 35.0 mg (± 12.43). After treatment, 38.9% (7/18) of them maintained oral prednisone at a lower dose (16.4mg ±6.3; p=0.002). Salsa score improved after treatment (p=0.020) and DN4 scores dropped from 6.7 (± 1.7) to 5.2 (± 2.1) (p<0.0001).ConclusionPulse therapy with endovenous methylprednisolone in LN was effective in decreasing pain intensity, preventing worsening of sensory-motor function, and reducing the dose of corticosteroids, reflecting the patient’s improvement of functionality.

Maternal deaths due to hypertensive disorders of pregnancy in Brazil from 2012 until 2023: a cross-sectional populational-based study

ABSTRACT Objective This study evaluated the maternal deaths due to hypertensive disorders in Brazil from 2012 until 2023. Methods We performed a cross-sectional study including public data from Brazilian Ministry of Health, including age group, self-reported skin color, and geographical region. The Maternal Mortality Ratio (MMR) was calculated for each year and for the entire period; we estimated the prevalence ratio (PR), confidence interval (CI) and trend (R2) of MMR according to the variables included. Results We analyzed 3,721 deaths attributed to complications of hypertension (MMR = 11.01/100,000 live births; R2 = 0.03). Those deaths were most prevalent among women aged 30 and older (PR 1.73, CI 1.61–1.85), especially those over 40 (PR 3.77, CI 3.34–4.25). Black (PR 2.75, CI 2.46–3.06), mixed-race (Pardo) (PR 1.27, CI 1.18–1.37), and Indigenous (PR 2.28, CI 1.76–2.97) women had significantly higher MMRs compared to White women. Central-West (PR 1.30, CI 1.13–1.46), North (PR 1.92, CI 1.74–2.13), and Northeast (PR 1.82, CI 1.68–1.97) regions had the highest maternal mortality rates due to hypertension. MMR due to hypertensive disorders of pregnancy in Brazil remained stable. Conclusion Women at higher risk of dying were older, Black, Indigenous, Pardo, and lived in the Central-West, North, and Northeast regions of the country.

Clinico-Epidemiology and Molecular Detection of Zika Virus in Kassala, Eastern Sudan

Zika is a disease transmitted to humans by mosquitoes in Africa, Asia, and America, it’s caused by Zika virus (ZIKV) which is a RNA virus, ZIKV is classified within the family Flaviviridae, genus Flavivirus. The monitoring and diagnosis of the viruses early with specific molecular techniques will reduce the severity of viruses. This study aimed to detect the prevalence and molecular detection of ZIKV, and relation of age, sex, locality and other biomarkers to ZIKAV in Kassala State, Eastern Sudan. This was a cross-sectional study conducted in Kassala Teaching Hospital, Kassala State in Eastern Sudan, 286 samples for ZIKV analyzed using Real Time Polymerase chain reaction (RT-PCR), patients data were collected from questionnaire, from the Health Research Ethics Committee of the Ministry of Health and Social Development Kassala State ethical approval was achieved, and informed consent was obtained from participants or their guardians, statistical significance was determined using chi-square with significant set at P < 0.05. Out of 286 participants, 9 patients were positive for ZIKV, ZIKV positive was determined using RT-PCR, 2(22.2%) were males and 7(77.8%) were females, there was no a statistically significant association between gender and infection (χ² = 3.1, P = 0.1). The symptoms of positive patients were fever 9(100%) headache 9(100%), joint pain 9 (100%), back pain 9(100%), loss of appetite 9(100%), sweating 9(100%), chill 9(100%), vomiting 6(2.1%), skin rash 3(33.3%) and bleeding 0 (0%) and Poly arthralgia 8(88.9%). There were no a statistically significant differences between these symptoms and ZIKV positive patients. The haematological parameters in this study showed normal and abnormal, the most abnormal was low (thrombocytopenia, leucopenia, low RBCs), there was no a statistically significant differences with ZIKV infection ((χ² = 0.66, P = 0.717), (χ² = 0.43, P = 0.803), (χ² = 0.191, P = 0.909)) respectively. The study concluded no statistically significant differences were found among the symptoms of ZIKV-positive patients. Patients not used mosquito net, from family with same signs and past infection were a statistically significant differences with ZIKV infection ((X2 = 4.1, P = .008), (X2 = 8.1, P = .011), (X2 = 9.4, P = .014)) respectively There were no a statistically significant differences between thrombocytopenia, leucopenia and low RBCs concerning ZIKV infection ((χ² = 0.66, P = 0.717), (χ² = 0.43, P = 0.803), (χ² = 0.191, P = 0.909)) respectively.

СONFERENCE OF THE ASSOCIATION OF UROLOGISTS OF UKRAINE «MINIMALLY INVASIVE TECHNOLOGIES IN UROLOGY»

On February 12–14, 2025, according to the plan of organizational events of the Ministry of Health of Ukraine, in the beautiful location of the Ukrainian Precarpathian region, the city of Yaremche, Ivano-Frankivsk region, the Scientific and Practical Conference of the Association of Urologists of Ukraine “Minimally Invasive Technologies in Urology” was held, in which 744 delegates participated. Over the course of two days, more than 30 reports on various aspects of sexology, andrology, urology, uro-oncology, and reproductology were heard at the meetings.

Delayed correct diagnoses in emerging disease outbreaks: Historical patterns and lessons for contemporary responses.

The gap between early diagnostic assumptions and final diagnoses in disease outbreaks represents a persistent challenge in global health despite advancements in diagnostic and response capabilities. To analyze the unfolding 2025 outbreak in the Democratic Republic of Congo (DRC) through the lens of historical cases where initial misattributions contributed to delayed recognition of novel or unexpected threats with varying public health consequences; identifying patterns from past outbreaks that can inform current diagnostic approaches and response strategies. We selected illustrative examples from peer-reviewed publications, focusing on cases with initial diagnostic uncertainties that highlight specific diagnostic patterns relevant to the current DRC outbreak. For the ongoing DRC outbreak, we analyzed official World Health Organization Africa bulletins and communications from the DRC Ministry of Health through February and early March 2025. As of beginning of April 2025, health authorities continue investigating clusters of unexplained acute febrile illness in Équateur Province with clinical features that were initially being suggestive of a viral haemorrhagic fever. Primary VHF pathogens have now been excluded. From selected historical and recent outbreaks, it can be deduced that diagnostic challenges extend beyond individual cognition to include structural biases in global health systems, methodological limitations and sociocultural factors. We identified five evidence-informed interventions to mitigate diagnostic delays: systematic consideration of multiple working hypotheses, development of sustainable local diagnostic capacity, enhancement of clinician-to-public-health communication networks, implementation of cognitive debiasing strategies, and strengthening of One Health surveillance platforms. Historical 'misdiagnoses' offer crucial lessons for transforming outbreak response from reactive to anticipatory, potentially averting future epidemics through earlier, more accurate recognition of emerging pathogens within their complex ecological and social contexts.

Accuracy of the qPCR method in intradermal scraping samples from individuals with suspected leprosy in a Brazilian macroregion

Leprosy is an infectious and chronic dermatoneurological disease, considered the most frequent cause of physical disabilities worldwide. It remains a major challenge for public health in Brazil, which is classified as a country with a high burden of the disease and ranks second in number of cases among all nations. Laboratory tests are important tools to complement the clinical-epidemiological evaluation, and molecular techniques emerged in the hope of reducing the limitations existing in the laboratory diagnosis of leprosy. We aimed to evaluate the accuracy of real-time polymerase chain reaction (qPCR) in the detection of Mycobacterium leprae in direct intradermal scrapings (swabs) and smears from bacilloscopy slides. This is an observational and cross-sectional study to evaluate diagnostic tests, which used bacilloscopy as the gold standard. Participants with epidemiological and/or clinical suspicion of leprosy from the northeastern region of Minas Gerais, referred to the Macroregional Laboratory of Teófilo Otoni for collection of intradermal scrapings from the earlobes, right elbow, left elbow or suspicious lesion were included. Bacilloscopy was performed according to the Technical Procedures Guide of the Ministry of Health and the DNA samples, after extraction and quantification, were subjected to qPCR with primers specific for the RLEP region of Mycobacterium leprae. The study obtained the number of 45 samples collected from suspected cases of leprosy in the period between May/2022 and February/2023. Descriptive, comparative and accuracy statistical analyses were performed using Minitab 17 and GraphPad Prism version 6.00 software. The sensitivity of qPCR on direct intradermal scraping samples (swabs) and smear slides, compared with bacilloscopy, was 100%. The specificity was higher for qPCR on swab samples (64.3%) than on smear slides (53.8%). The performance of qPCR on intradermal scraping swab samples and smear slides indicated accuracies of 82.10 and 76.9%, respectively. The results of the comparison of the proportions of qPCR positivity of the two samples showed a statistically significant association (P-value = 0.005), with a degree of agreement of 55% (Kappa = 0.55). Taken together, the results of the performance and comparative analyses of qPCR on intradermal scraping swabs and smear slides showed good accuracy in relation to bacilloscopy and moderate agreement between these different qPCR strategies.

Malawi newborn and child health national clinical practice guidelines: a landscape analysis.

Clinical practice guidelines (CPGs) are essential for standardizing healthcare, but their adoption, updating and adaptation remain inconsistent in Malawi. This review evaluated publicly available newborn and child health CPGs from 2017 to 2022, identifying relevant guidelines and assessing their quality using the Appraisal of Guidelines, Research and Evaluation (AGREE) II tool. Key gaps were found in stakeholder involvement and accessibility, highlighting the need to strengthen CPG development and dissemination to improve health outcomes. A total of 322 records were identified through Google Scholar, Google, the Ministry of Health (MOH) website and MOH offices using predetermined search terms. Hand searches were also conducted. The quality of reporting was appraised using the AGREE II tool. Six CPGs met the eligibility criteria, five covering child health from the perinatal period onwards. CPGs targeted healthcare providers (n=6), program managers (n=2) and researchers (n=2). Topics included prevention, management and treatment. Reporting quality was generally poor, particularly regarding methodological rigour and editorial independence. A collaborative effort including the MOH, non-governmental organizations, professional associations and researchers in developing and adapting newborn and child health CPGs could yield large benefits in improving the quality of care of children in Malawi.

National Creutzfeldt–Jakob disease research biobank, a novel approach to the establishment of the scientific platform: collaboration between patient advocacy group, scientists, regulators and physicians

Creutzfeldt–Jakob disease (CJD) is a severe neurodegenerative disorder characterized by the abnormal accumulation of prion proteins. In Israel, a unique epidemiological pattern of CJD has been identified, specifically a genetic form (gCJD) associated with the E200K mutation in the PRNP gene. Investigating rare diseases such as CJD syndrome poses challenges due to their low prevalence, hindering the formation of an adequate patient cohort for comprehensive research and treatment trials. To overcome this limitation, biobanks have emerged as transformative tools for collecting and distributing biological specimens along with corresponding health data. Biobanks offer a solution to the inherent heterogeneity in rare diseases, allowing researchers to access diverse and extensive sample sets, thereby enhancing the understanding of disease nuances toward potential therapy. We introduce a novel collaborative model involving the Negev BioBank (NBB), the Creutzfeldt–Jakob Israel Foundation, the Israeli National BioBank for Research (MIDGAM), and the Israeli Ministry of Health. Each entity contributes unique expertise and resources to establish a comprehensive platform for studying the disease. The goal was to establish a participant pool of 500 individuals, including clinically diagnosed cases, confirmed carriers of the E200K mutation, and their first- and second-degree relatives. During the pilot phase of the last year, 250 participants were enrolled, with each family contributing between 1 and 25 participants. This collaborative approach involving communities, scientists, physicians, and regulatory bodies establishes a model applicable across various fields. These synergistic efforts aim to advance research on CJD and potentially serve as a blueprint for studying other rare diseases.

Unleashing the power of intelligence: revolutionizing malaria outbreak preparedness with an advanced warning system in Benin, West Africa

BackgroundMalaria is a significant vector-borne disease that exhibits high sensitivity to climatic variations within the West African region. In Benin, the effective prevention and mitigation of malaria pose considerable challenges, primarily due to the prevailing conditions of poverty and environmental adversities. This study endeavours to devise an advanced system for early detection and warning of malaria outbreaks in the northern part of Benin, employing monthly time series data pertaining to climatic variables.MethodsMonthly climate data were sourced from Meteorological Agency of Benin (METEO-Benin), alongside malaria incidence data procured from the database of the Benin Ministry of Health, that covered the timeframe of 2009–2021. To ascertain the influence of climatic variables on malaria incidence, principal component analysis was applied. Subsequently, an intelligent model for forecasting malaria outbreaks was developed using support vector machine (SVM) algorithm. The developed model for malaria outbreaks was then employed to establish an intelligent system for warning and forecasting malaria incidence on a monthly basis, utilising the Meteostat platform, an online weather data service provider, in conjunction with the Streamlit framework. This application exhibits responsiveness and compatibility across all web browsers.ResultsRelative humidity and maximal temperature significantly influence malaria incidence in the northern region of Benin. SVM regression algorithm forecasts 80% prediction rate for malaria incidence. Consequently, the intelligent malaria outbreak warning system was successfully devised, enabling the automatic and manual prediction of monthly malaria incidence rates within the districts of northern Benin.ConclusionsThis system serves as a valuable tool for stakeholders and policymakers, facilitating proactive measures to curtail malaria transmission in Benin.

The overlapping global distribution of dengue, chikungunya, Zika and yellow fever

Arboviruses transmitted mainly by Aedes (Stegomyia) aegypti and Ae. albopictus, including dengue, chikungunya, and Zika viruses, and yellow fever virus in urban settings, pose an escalating global threat. Existing risk maps, often hampered by surveillance biases, may underestimate or misrepresent the true distribution of these diseases and do not incorporate epidemiological similarities despite shared vector species. We address this by generating new global environmental suitability maps for Aedes-borne arboviruses using a multi-disease ecological niche model with a nested surveillance model fit to a dataset of over 21,000 occurrence points. This reveals a convergence in suitability around a common global distribution with recent spread of chikungunya and Zika closely aligning with areas suitable for dengue. We estimate that 5.66 (95% confidence interval 5.64-5.68) billion people live in areas suitable for dengue, chikungunya and Zika and 1.54 (1.53-1.54) billion people for yellow fever. We find large national and subnational differences in surveillance capabilities with higher income more accessible areas more likely to detect, diagnose and report viral diseases, which may have led to overestimation of risk in the United States and Europe. When combined with estimates of uncertainty, these suitability maps can be used by ministries of health to target limited surveillance and intervention resources in new strategies against these emerging threats.

Exploring influenza vaccination determinants through digital participatory surveillance

BackgroundVaccination is key for mitigating the impact of recurring seasonal influenza epidemics. Despite the efficacy and safety of influenza vaccines, achieving optimal vaccination uptake remains a challenge. This study aimed to explore the determinants of influenza vaccination uptake using data from Influweb, the Italian node of the Influenzanet participatory surveillance network.MethodsThis study utilizes a longitudinal dataset of self-reported vaccination statuses from Italian participants across the 2011–2021 flu seasons. Logistic regression models were used to identify factors associated with vaccination uptake. Post-stratification weights were applied to account for demographic differences between the Influweb sample and the general population.ResultsThe analysis reveals that individuals using public transport and those living with minors are less likely to receive the influenza vaccination. On the other hand, university-educated individuals, and those on medication for chronic diseases are more likely to be vaccinated. Age also plays a role: individuals aged 44 and under are less likely to vaccinate compared to those aged 45–65, while those over 65 are more likely to do so. Furthermore, higher cumulative influenza-like illness incidence rates within a macro-region are associated with increased vaccination uptake. Finally, the impact of COVID-19 pandemic was associated with an increase in influenza vaccination uptake. Comparison of the Influweb data to vaccination rates reported by the Italian Health Ministry revealed higher coverage for self-reported vaccination. This could be linked to the voluntary nature of the survey, possibly attracting a more health-conscious cohort.ConclusionsOur study found that individuals living with minors and those relying on public transportation have lower odds of being vaccinated, despite having a higher documented risk of respiratory virus exposure. These findings highlight the importance of continued public health efforts targeting vulnerable groups and raising awareness about the risks of forgoing vaccination. The complex interplay of socioeconomic, demographic, and public health context significantly shapes vaccination decisions, emphasizing the need for tailored public health campaigns.

Convalescent plasma for the treatment of patients with COVID-19: the Singapore experience and lessons learnt.

We report Singapore's convalescent plasma (CP) programme during the first year of the COVID-19 pandemic. Based on historical data and its potential therapeutic promise, CP was offered as an experimental treatment option for severe or high-risk COVID-19 patients when established therapeutics were lacking. The CP programme was implemented under monitored expanded access approved by Singapore's Ministry of Health. CP donors were primarily selected based on specific antibody titres, while suitable recipients were chosen based on risk factors and disease severity. Operational protocols and logistical considerations are discussed in-depth. Between April 2020 and September 2020, the CP donor programme successfully collected 33 plasma units from 27 qualified donors. Seven patients received CP treatment under this programme. Six of the seven recipients of CP survived for more than 28 days post-transfusion and were discharged alive. Given the availability of other validated therapeutic options, the CP programme was officially suspended in September 2021. This study provides a comprehensive overview of the intricacies of Singapore's CP programme, from its operational challenges to the observed clinical outcomes, while highlighting the potential benefits and complexities of CP as a therapeutic option. Successful implementation of the CP programme requires robust collaboration across multidisciplinary teams. Access to serological tests was crucial for donor selection. Both the selection of CP with high neutralising antibodies and careful selection of appropriate recipients are key aspects to optimise the therapeutic success of CP. A meticulous approach is warranted if CP were to be used in future pandemics.

Environmental costs in healthcare system: the case studies of Greece health care

Climate change is considered one of the greatest threats to environmental sustainability, human health and social well-being worldwide. The healthcare sector is one of the main actors with a strong negative environmental footprint, being responsible for about 4% of global emissions, and is also considered one of the costliest sectors, with healthcare spending absorbing about 10% of global economic output. This article examines the environmental costs of the healthcare system in Greece, with a focus on public hospitals. The data analysis methodology was based on linear ordinary regression (OLS) models to calculate environmental costs related to energy consumption, waste management and water consumption. Data was collected through the Ministry of Health’s platform (BI Health) and analyzed using Stata software. The main findings suggest that environmental costs are a significant part of total operating costs, particularly in university and specialist hospitals. Factors such as the number of beds, the existence of special units (e.g. ICU) and the use of natural gas have a significant impact on environmental costs. The study offers a mathematical model for predicting environmental costs, which can help hospital administrators to make decisions about sustainable practices. This model could provide an important opportunity for practical application to make targeted decisions such as investing in sustainable technologies, improving energy efficiency and enhancing waste management, leading to cost-effective and environmentally sustainable practices.

The cost of delivering COVID-19 vaccines in Mozambique: a bottom-up costing study

BackgroundVaccines were a key tool in controlling the COVID-19 pandemic. However, the cost of delivering these vaccines in low- and middle-income countries was highly uncertain, due to the unprecedented delivery volume and the need to reach new target populations. To fill this evidence gap, this study estimates the cost of delivering COVID-19 vaccines in Mozambique.MethodsThis retrospective, bottom-up costing study estimated the financial and economic costs of delivering COVID-19 vaccines in 2022 USD, during the first year of introduction. Recurrent costs were collected for the initial rollout period (March 8th to April 8th 2021) and for a later, higher-volume period (December 1st 2021 to February 28th 2022). The study was conducted from a payer perspective. Data was collected at health facilities from a purposively selected sample of 27 vaccination sites, as well as from 6 district and provincial health offices in 2 provinces, the Ministry of Health, and development partners. The overall cost per dose was obtained by estimating and aggregating the volume-weighted average cost per dose for each administrative level. Qualitative interviews were also conducted to contextualize cost findings.ResultsThe cost per dose for the first year of implementation was $1.14 for economic costs and $0.50 for financial costs. For the initial rollout period, when the volume delivered was low (64 doses/vaccination day on average), the economic cost per dose was $3.56 and decreased considerably to $0.85 when the program delivered at scale and volume delivered increased to 225 doses/vaccination day. Opportunity costs made up a considerable share of the economic cost per dose, 73% and 49% respectively during the initial rollout and when the program delivered at scale. The qualitative interviews found that political prioritization and workers’ commitment made the program possible despite little financial investment.ConclusionsThe cost of delivering COVID-19 vaccines in Mozambique was found to be low compared to other countries, due to heavy reliance on existing resources and little additional investment into the program. Findings from this study can support the government in planning and budgeting for the future of the COVID-19 vaccination program as well as other vaccination efforts.

The Importance of Minimally Invasive Therapy and Family Education Regarding Molluscum Contagiosum in Children

The Molluscum contagiosum virus (MCV), a member of the poxvirus family, is the cause of the widespread viral skin disease known as Molluscum contagiosum (MC). It primarily affects children aged 1–10 years, with an estimated global prevalence of 5–20%. A 2020 report from the Indonesian Ministry of Health documented MC as the third most common viral skin infection in children, with prevalence rates of 8–12% in densely populated regions like Jakarta and Surabaya. Usually confined to the face, torso, or extremities, the infection manifests as skin colored, dome-shaped papules with central umbilication. Transmission occurs via direct skin contact, autoinoculation, or contaminated things. While MC is self-limiting, treatment is often sought to prevent spread, alleviate cosmetic concerns, or address persistent lesions. This case highlights a typical presentation of MC in a toddler and underscores the importance of family education and minimally invasive therapies. The treatment we gave to this patient was in the form of cantharidine 0.7% (left for 4 hours then rinsed) and mupirocin cream 2% (used if the bumps/papules have broken). The patient's family was also educated about preventing disease transmission, such as not touching, scratching, or squeezing papules, diligently cleaning hands by washing hands in running water or using wet wipes that are safe for babies, and avoiding sharing personal items.

Clinical features and mortality outcomes of people transferred from prison to forensic mental health units: a nationwide 14-year retrospective cohort study.

To describe a cohort of people transferred from prison to psychiatric hospital care and their mortality outcomes. Retrospective nationwide cohort of people (n = 1320) transferred from prison to a psychiatric hospital in New Zealand from 2009 to 2022. Follow up commenced at the first transfer and ended on 30 June 2023 or death if earlier. Ministry of Health records were used to describe the cohort and their service utilization profile. Records were linked to official mortality data, and mortality ratios were calculated using publicly available life tables. The cohort was 85% male and 55% Māori, with a median age of 31.2 years. Most had a psychotic disorder (74%) or bipolar disorder (11%) and there were high levels of coexisting substance use disorder. Follow-up duration ranged from 2months to 14.5 years (median 7.5 years) after the first transfer, of which 17% was in a psychiatric hospital. The age and sex-standardised mortality ratio for the cohort compared to the New Zealand population was 4.7 (95% CI 3.6-5.9). Among deaths with a known cause, 60% were from natural causes and 40% were from injuries including suicide. Despite extended periods of psychiatric hospitalization there was high mortality among people in the cohort. Investment in targeted prevention and coordinated, continuous healthcare is needed for people with a serious mental illness who experience incarceration.

The Efficacy of the “CREB Innovation” Derives From the Application of Bandura and Orem's Theory towards Self-Care Knowledge, Self-Efficacy, Self-Care Behavior, and Satisfaction among Older Thai Hypertensive Patients in Thailand

Objectives: The "CREB innovation" (C=counseling and empowerment, R=role models, E=effective communication, B=backward design) was developed based on Bandura's self-efficacy and Orem's self-care theories to help elderly individuals control their blood pressure. The study aimed to evaluate its effectiveness in four phases: Phase 1 involved theoretical studies; Second entailed developing the "CREB innovation"; Third tested its effects on self-care knowledge, behaviors, and BP; and the fourth assessed satisfaction. The sample included elderly residents of Chaiyapoom province. Instruments measuring self-care knowledge, behaviors, and satisfaction had Cronbach’s alpha coefficients of 0.87, 0.87, and 0.85, respectively. Data was analyzed using content analysis and paired t-tests. Results showed significant improvements in self-care knowledge, behaviors, and both systolic and diastolic BP after implementing the CREB innovation (P<.05). Satisfaction with the program was 93.33%. The findings suggest that integrating mastery experiences, live modeling, verbal persuasion, and emotional support through the CREB innovation effectively enhances BP control in the elderly. The Ministry of Health should promote this approach to manage hypertension in older adults.