Ministry Of Health Research Articles

Does suicide in New Zealand follow a semi-lunar rhythm?

The hypothesis that lunar cycles influence human behaviour, particularly incidents recorded by police or coroners, has been a topic of public and media interest around the world for decades. While connections between lunar cycles and numerous cultural practices are well-documented, claims that lunar cycles influence crime or suicide statistics have not been consistently supported. There have been recent media claims that suicide rates in New Zealand follow a lunar cycle, correlating with the Māori Maramataka lunar calendar. Building on prior research, this study scrutinises the postulated association between lunar phases and suicide rates, for general and Māori populations. Utilising 2 decades (2000-2022) of data from the National Coronial Information System (NCIS) and the New Zealand Ministry of Health - Manatū Hauora, the study employs Poisson regression models and cosine curve analyses. Results reveal no significant correlation between lunar phases and suicide rates for the overall population or the Māori sub-group. The absence of a lunar effect persists across univariate and multivariate analyses, incorporating annual, seasonal and day-of-the-week variations. Contrary to claims linking lunar phases to Māori suicide rates, this study provides a robust analysis of comprehensive suicide data. While acknowledging potential limitations, such as the diversity among Maramataka systems and unaccounted external factors, this study emphasises the need for evidence-based practices in mental health interventions. Further research is warranted to explore potential lunar influences on less severe mental health indicators and to substantiate claims supporting traditional Māori Maramataka-based treatments.

The impact of the Lesotho health reform in the re-structuring of the village health workers program

BackgroundCommunity Health Workers locally known as Village Health Workers (VHW) in Lesotho are key members of the primary health workforce, and has been playing a significant role in building primary health systems in many countries and they can fill significant gaps in human resources as low and middle income countries work towards universal health coverage in the era of Sustainable Development Goals (SDGs). The 2014 Lesotho health reform restructured the VHW program to compensate, professionalize, and integrate VHWs into primary care services. We sought to document the ways in which the VHW program changed as a result of the health reform and the perceived impact of those changes.MethodsIn 2018, we conducted a qualitative research study with an inductive content analysis approach in the four pilot health reform districts of Lesotho. We conducted 26 in-depth interviews with health workers practicing in the community and in primary health facilities, as well as district health authorities, and Ministry of Health officials.ResultsWe found that the Lesotho health reform program was observed that it helped to professionalize the VHW program by introducing clear roles and responsibilities, regular monitoring, and supervision. The initiation of performance-based payment of VHWs and regular monitoring and reporting was thought contribute to overall improvement; in performance, strengthened links between communities and facilities, and promoted uptake of services.ConclusionThe Lesotho Health Reform program was felt to be highly effective in re-structuring the VHW program in Lesotho, suggesting that when VHWs are well-incentivized, monitored, and supervised they can better fulfil their essential role as the backbone of the primary health workforce.

Dissociative and Deep Sedations Administered by Trained Unsupervised Pediatric Residents in Israeli Emergency Departments.

To cover pediatric emergency physicians' off-hours, third-year pediatric residents in Israel are trained for unsupervised administration of emergency department (ED) dissociative and deep sedation. We assessed the frequency of critical sedation events associated with resident-performed sedations. We conducted a retrospective chart review on all patients receiving intravenous sedation across 10 pediatric EDs between January 2018 and September 2022. We defined a critical sedation event as one or more of the following: chest compressions, tracheal intubation, neuromuscular blockers, vasopressors, atropine for bradycardia, aspiration syndrome, death, or unplanned hospital admission due to sedation. We liaised with the Ministry of Health's reporting department and ED directors to verify complete identification of all sentinel events. Pediatric residents and pediatric emergency physicians performed 12,733 and 10,845 sedations, respectively, most frequently for fracture reduction (44.4%) and laceration repair (25.6%). Patients' mean (SD) age was 6.9 (4.4) years. Residents and emergency physicians administered ketamine or propofol alone in 6,473 and 3,465 cases, respectively, with drug combinations for the remainder. We identified 6 critical sedation events, of which 3 were resident-performed sedations. The frequency of critical sedation events among pediatric residents and emergency physicians was 0.024% (95% CI, 0.005% to 0.069%) and 0.028% (95% CI, 0.006% to 0.080%), respectively. We observed a low frequency of critical sedation events in this large sample of dissociative and deep sedations performed by pediatric residents and pediatric emergency physicians. Our findings suggest that ED sedation by unsupervised, trained pediatric residents is a safe practice in Israel.

Over a decade of HIV infection prevalence and incidence among Mozambican pregnant women: a secondary analysis of prospectively collected data

BackgroundMonitoring HIV infection estimates is critical to guide health interventions and assess their impact, especially in highly vulnerable groups to the infection such as African pregnant women. This study describes the trends of HIV infection over eleven years in women attending selected antenatal care (ANC) clinics from southern Mozambique.MethodsWe performed a secondary analysis of data registered at the ANC clinic of the Manhiça District Hospital and from the Ministry of Health's HIV National Program Registry between 2010 and 2021. HIV incidence was calculated using prevalence estimates. HIV incidence trends over time were obtained by fitting splines regression model.ResultsData from 21,810 pregnant women were included in the analysis. Overall HIV prevalence was 29.3% (95% CI: 28.7–29.9), with a reduction from 28.2% (95% CI: 25.6–30.8) in 2010 to 21.7% (95% CI: 19.8–23.6) in 2021, except for a peak in prevalence (35.3%, 95% CI: 30.1–40.8) in 2016. Over the study period, by maternal age group, the largest reduction in HIV prevalence was in the 15–20 year-old group [62% reduction, from 14.3% (95% CI 10.8–18.4) to 5.3% (95% CI: 3.6–7.5)], followed by the 20–25 year old group [43% reduction, from 29.0% (95% CI: 24.2–34.5) to 16.6% (95% CI: 13.6–19.8)] and the 25–30 year old group [13% reduction, from 36.9% (95% CI: 31.0–43.1) to 32.0% (95% CI: 27.3–37.0)] (p < 0.001). Incidence of HIV infection increased from 12.75 per 100 person-years in 2010 to 18.65 per 100 person-years in 2018, and then decreased to 11.48 per 100 person-years in 2021.ConclusionsThe prevalence of HIV decreased while the overall incidence stayed similar in Mozambican pregnant women, during 2010 to 2021. However, both estimates remain unacceptably high, which indicates the need to revise current preventive policies and implement effective ones to improve HIV control among pregnant women.

Assessing longitudinal prenatal knowledge and skills retention among community birth attendants enrolled in a novel school.

Guatemala has one of the highest rates of maternal mortality in Central America. A total of 60% of births in Guatemala are attended by traditional Mayan birth attendants, or comadronas. Their prevalence in these communities makes them a valuable resource to bridge home births with safe prenatal care. The objective of this study was to evaluate a low-cost prenatal care training program for Guatemalan comadronas with the goal of improving maternal health outcomes in the region. In this retrospective longitudinal cohort study, we examined the knowledge retention of comadronas enrolled in a 12-month prenatal care training program known as the School of PowHER (SOP). Recruited from the Lake Atitlán region of Guatemala by Saving Mothers, 501(c)(3) and the Guatemalan Ministry of Health, comadronas participated in a four-month didactic curriculum followed by a nine-month clinical curriculum. Pre- and post-tests were administered to assess learning outcomes over the study's duration (2014-2022), and test results were evaluated to assess the effectiveness of the SOP. A total of 123 women were recruited and enrolled in all eight graduating classes of the SOP from 2014, 2016-2019, and 2021-2022. An average, statistically significant improvement in didactic and clinical pre- and post-test scores was found across all years analyzed. The SOP is a low-cost, culturally appropriate, community-based model that empowers comadronas through knowledge and skill acquisition to improve local maternal health outcomes. This program proves effective at not only teaching comadronas prenatal health information and clinical skills, but also at promoting long-term retention of these skills.

Examining the Impact of Strategic Intelligence on Crisis Management Effectiveness at Jordanian Ministry of Health

Examining the Impact of Strategic Intelligence on Crisis Management Effectiveness at Jordanian Ministry of Health

Characterisation of pregnancy-induced alterations in apolipoproteins and their associations with maternal metabolic risk factors and offspring birth outcomes: apreconception and longitudinal cohort study.

Apolipoproteins as an integral part of lipoproteins are crucial for the transport and metabolism of lipids. However, there is a lack of longitudinal studies to quantify the concentrations of maternal apolipoproteins from preconception to postpartum and their associations with maternal metabolic health and offspring birth outcomes. Quantification of apolipoproteins was performed on maternal plasma samples (N=243 trios) collected at preconception, 26-28 weeks' pregnancy, and three months postpartum in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) cohort study. Linear regression models and network analysis were implemented to investigate the association of apolipoproteins with maternal genetic variants, biochemical measures, metabolic risk factors, and offspring birth outcomes. The concentrations of ApoC-III, ApoB and ApoL1 substantially increased in pregnancy compared to preconception and postpartum. Genome-wide association studies (GWAS) identified multiple single-nucleotide polymorphisms (SNPs) associated with plasma apolipoproteins (P<5.00E-08), including APOE-rs7412 for ApoE, LPA-rs56393506 for Apo(a), APOM-rs707921 for ApoM, ABCC4-rs117797426 for ApoJ, THSD7B-rs575613 for ApoA-II, and LOC102724443-rs140433245 for ApoA-IV. Plasma apolipoproteins were strongly associated with biochemical measures including lipidomic profiles, lipoprotein features and fat-soluble vitamins, as well as metabolic risk factors including glycaemic traits, liver enzymes, inflammatory markers, albumin, and blood pressure. Integrative network analysis of apolipoproteins and their correlates/determinants revealed both shared and specific associations, with the strongest relationships observed among apolipoproteins, cholesterol, triglycerides, alpha tocopherol, and GlycA (Padj<0.05). Higher maternal ApoC-I and ApoC-III concentrations at preconception were significantly associated with shorter gestational age of the offspring. We describe the longitudinal landscape of maternal circulating apolipoproteins from preconception to postpartum and their associations with maternal metabolic risk factors and offspring birth outcomes. This multi-omics characterisation of biochemical correlates and genetic determinants of maternal apolipoproteins will deepen our understanding of the molecular basis of metabolic flexibility in expectant mothers, leading to better assessment of pregnancy-related outcomes. This research was supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore- NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. The Singapore Lipidomics Incubator (SLING) is supported by grants from the National University of Singapore via the Life Sciences Institute, the National Research Foundation (NRF, NRFI2015-05 and NRFSBP-P4) and A∗STAR IAF-ICP I1901E0040. Additional funding is provided by Institute for Human Development and Potential (IHDP)-Agency for Science, Technology and Research (A∗STAR), Singapore.

Impact of immigration-specific stress on safety attitudes: a national cross-sectional study on overseas qualified nurses in Japan

BackgroundMany countries have addressed the global issue of nursing shortage by recruiting overseas nurses who are also qualified in the host country. Nevertheless, such nurses may encounter various obstacles in...

Assessing the development of health technology assessment in Iran: a policy analysis using Kingdon’s Multiple streams framework: a qualitative study

BackgroundHealth Technology Assessment (HTA) is crucial for optimizing healthcare investments and improving system efficiency. In Iran, the rising costs of healthcare technologies and systemic inefficiencies have highlighted the need for a structured HTA framework. However, despite academic discussions, HTA has not yet been fully integrated into formal health policy. This study explores the development of HTA in Iran using Kingdon’s Multiple Streams Framework to identify challenges and opportunities for its advancement.MethodsThe study employed qualitative methods, including 16 semi-structured interviews with key stakeholders in Iran’s healthcare system. Participants, consisting of 12 males and 4 females with an average age of 41.56 years and an average work experience of 14.37 years, provided insights into the current state of HTA. The participants included individuals in key leadership roles within public and private institutions, such as the Ministry of Health and Medical Education, hospital managers, policymakers, and senior academics. Data were analyzed using Kingdon’s framework to examine the problem, policy, and politics streams, as well as the role of policy entrepreneurs and potential policy windows.ResultsFindings revealed that the rising costs of healthcare technologies, particularly imported ones, and inefficiencies in technology use were major concerns. Participants indicated that HTA could address these issues by ensuring cost-effectiveness and better health outcomes. Despite the technical feasibility of implementing HTA in Iran, there is a significant gap between theoretical discussions and policy action. Resistance from the private sector and the need for political backing were identified as major barriers. However, the political climate in Iran is becoming increasingly favorable, with growing interest in healthcare efficiency and transparency. The Covid-19 pandemic and healthcare shortages have exposed vulnerabilities, presenting potential opportunities for HTA’s adoption. Leadership roles in key institutions, including the Ministry of Health and Medical Education, were identified as vital to advancing HTA initiatives. Policy entrepreneurs play a crucial role in advocating for HTA and capitalizing on these opportunities.ConclusionHTA is recognized as a valuable tool for improving healthcare efficiency and equity in Iran. However, significant challenges remain in transitioning from academic discussions to formal policy. The political environment and recent healthcare crises offer opportunities to advance HTA. To successfully integrate HTA into Iran’s healthcare system, it is essential to address existing barriers, leverage political interest, and support policy entrepreneurs. The experiences of other countries, especially those with strong institutional leadership in HTA, provide useful models for Iran to follow in its HTA development journey.

Analysis of equity in the distribution of human resources and hospital beds and its association with the COVID-19 mortality rate: a case of Iran

Background and objectiveEquitable distribution of health resources is important to achieving equity, guaranteeing access to healthcare services, and improving societies’ health status. This study aimed to examine equity in the distribution of health resources and its association with the mortality caused by COVID-19 in South Khorasan province, east Iran.MethodThis was a secondary analysis of data from a cross-sectional study conducted in South Khorasan province in 2022. Data were drawn from an existing online database (Farabar) provided by the Public Health Department of the Ministry of Health in Iran. Data related to the number of hospital beds, medical specialists and practitioners, nurses, paramedical workers, health watch, community health workers (Behvarz), healthcare financial resources, and COVID-19 mortality rate were extracted from the Farabar system for each city separately. The equity in the distribution of resources was analyzed by calculating the Gini Coefficient index and using EXCEL software. The Gini Coefficient was used to measure the distribution of health resources and services (i.e. financial resources, human resources, hospital beds, ICU beds) against population size and geographic size. Data were analyzed using SPSS software, version 25.ResultsThe Gini Coefficient ranged between 0.006 and 0.320. The Gini Coefficient of health care system financial (0.006) resources distribution was more equitable, while that of hospital beds (0.229) and intensive care beds (0.320) was more inequitable. The Gini Coefficient of the distribution of human resources was estimated at less than 0.3, which is relatively equitable. The COVID-19 mortality rate per 100,000 population was estimated at 113.6, lower than the national average. After controlling the confounding variable (rural population (as % of the total population)), there was no significant correlation between COVID-19 mortality and the distribution of human resources, hospital beds, and healthcare financial resources.ConclusionAccording to the results, the distribution of resources relative to the province’s population was relatively equitable, and there was no significant correlation between the COVID-19 mortality rate and the distribution of human resources, hospital beds, and healthcare financial resources. This can be due to the equitable distribution of health resources. Having a better and deeper understanding of the regions and populations disproportionately impacted by COVID-19 can help with intervention and resource allocation.

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.

Evaluation of the safety and efficacy of isotretinoin in treatment of COVID-19 : A randomized controlled clinical trial.

The pandemic of SARS-CoV2 is not only limited to the health issues and fatalities encountered in a worldwide overwhelming burden but also the social, economic, and well-being devastation. Many trials were done to find a safe and reliable therapy for COVID-19. Isotretinoin was reported as a possible therapy for COVID-19 through the mining of post-transcriptomic and genomic datasets, which revealed isotretinoin as a potent down-regulator of the ACE2 protein the crucial gateway of SARS-CoV2 to hijack host cells. A total of 106 patients with mild to moderate COVID-19 were recruited. Patients were randomized into two groups and treated with the Standard Care (STD) protocol of the Ministry of Health, Egypt, or the STD in combination with isotretinoin (0.5mg/kg/day) for 5days. The study involved 66 (63%) females and 39 (37%) males, median age 42years (interquartile 32-55.5 y). The main findings revealed a significant reduction in the time to improvement in the isotretinoin-treated (6.6±2 d) compared to the STD-treated patients (10.4±3.3). Survival analysis (HR: 4.1, 95% CI: 2.5-6.6) in comparison to the STD-treated patients. The main adverse event reported during the therapeutic duration was the dryness of the skin, which was of acceptable tolerability through skin care instructions to the patients. The data presented herein highlights the efficacy of isotretinoin in the management of mild to moderate COVID-19 patients with a significant reduction of the time to recovery. The adverse events reported were tolerable and did not outweigh the therapeutic benefits.

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.

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. 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. 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. 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.