Ministry Of Health Research Articles

Socio-economic factors related to premature death from colorectal cancer in Santiago de Chile, 2014–2018: a cross-sectional study

ObjectivesIn Chile, colorectal cancer (CRC) is the fourth cause of death by cancer. Few studies have evaluated the role of contextual and individual socio-economic variables associated with premature death by CRC (<70 years). We analyzed the association between socio-economic factors (at individual and contextual levels) and premature death from CRC in Santiago de Chile. Study designThis was a cross-sectional study. MethodsWe analyzed deaths from CRC between 2014 and 2018 using data published by the Ministry of Health. Individual predictors were sex, marital status, and educational level. Contextual variable included the Social Priority Index (SPI) of the commune where the deceased lived. The association was assessed through multilevel logistic regression models. ResultsDuring the period, 4762 deaths occurred (51.7% women); 39.3% were premature. At the individual level, male sex (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.20–1.53) and single marital status (OR 1.45; 95% CI 1.24–1.68) were associated with premature death from CRC. Primary or lower education was a protective factor (OR 0.53; 95% CI 0.47–0.60). At the contextual level, communes with a higher SPI were three times more at risk than those with a lower SPI (OR 3.13; 95% CI 2.15–4.57). ConclusionsThis study showed that individual and contextual socio-economic variables are related to premature death from CRC. Residing in communes with greater socio-economic vulnerability was associated with greater risk. To reduce this gap, it is urgent to design and implement structural policies to reduce social inequities and improve access to health care.

A hybrid deep learning optimization for predicting the spread of a new emerging infectious disease

&lt;span lang="EN-US"&gt;In this study, a novel approach geared toward predicting the estimated number of coronavirus disease (COVID-19) cases was developed. Combining long short-term memory (LSTM) neural networks with particle swarm optimization (PSO) along with grey wolf optimization (GWO) employ hybrid optimization algorithm techniques. This investigation utilizes COVID-19 original data from the Ministry of Health of Indonesia, period 2020-2021. The developed LSTM-PSO-GWO hybrid optimization algorithm can improve the performance and accuracy of predicting the spread of the COVID-19 virus in Indonesia. In initiating LSTM initial weights with weaknesses, using the hybrid optimization algorithm helps overcome these problems and improve model performance. The results of this study suggest that the LSTM-PSO-GWO model can be utilized as an effective and reliable predictive tool to gauge the COVID-19 virus’s spread in Indonesia. &lt;/span&gt;

Monkeypox Virus (MPXV) Infection: A Review.

Monkeypox is a viral disease; its outbreak was recently declared a global emergency by the World Health Organization. For the first time, a monkeypox virus (MPXV)-infected patient was found in India. Various researchers back-to-back tried to find the solution to this health emergency just after COVID-19. In this review, we discuss the current outbreak status of India, its transmission, virulence factors, symptoms, treatment, and the preventive guidelines generated by the Indian Health Ministry. We found that monkeypox virus (MPXV) disease is different from smallpox, and the age group between 30-40 years old is more prone to MPXV disease. We also found that, besides homosexuals, gays, bisexuals, and non-vegetarians, it also affects normal straight men and women who have no history of travel. Close contact should be avoided from rats, monkeys and sick people who are affected by monkeypox. To date, there are no monkeypox drugs, but Tecovirimat is more effective than other drugs that are used for other viral diseases like smallpox. Therefore, we need to develop an effective antiviral agent against the virulence factor of MXPV.

Geospatial analysis of cholera outbreak mapping of prone areas in communities in Ondo State, Southwestern, Nigeria

Cholera stands as an abrupt intestinal infection brought about by the consumption of food or water contaminated with comma-shaped bacteria, specifically Vibrio cholerae. The prime objective of this study is to employ Geospatial methodologies in the mapping of cholera occurrences within Ondo State. Geographical Information System (GIS) is utilized to chart the instances of cholera outbreaks. The pivotal aims of this endeavor encompass: · delineating the prevalence of cholera incidents across all Local Government Areas (LGA) within Ondo State; · assessing the trajectory of cholera occurrences within the research locale; · identifying the principal causes of cholera within Ondo State; · Outlining and suggesting potential strategies to counteract the incidence of cholera in the state; and · Forecasting the occurrence of cholera cases over the subsequent 5 to 10 years. Recorded instances of cholera were sourced from the ministry of health, supplemented by the use of questionnaires to amass primary data. The research leveraged both ArcGIS and SPSS as analytical tools. ArcGIS facilitated the mapping of cholera causes and plausible remedies. It is evident that Local Government Areas (LGAs) boasting larger populations recorded more cholera cases compared to their smaller counterparts. Furthermore, it is observed that the highest count of reported cholera cases across all LGAs was reached in 2014. The study establishes the potential for early diagnosis and preventive measures to obliterate the disease and integrate the resulting database into the primary health sector. It was discovered that there’s know significant differences in reported cases of cholera in all the Local Government Areas (LGA) despite the fact that the values looks similar or varies. The study recommends advancing the field of cholera mapping to unveil risk factors and preclude potential cholera outbreaks within the state. Anticipated production of risk maps will identify regions prone to future cholera attacks within the state.

Past, present and future of Psoralea glandulosa Linn, Chilean medicinal plant, an inexhaustible resource: A literature review

Culén is the popular term used in Chile for the only endemic species of the Fabaceae family, Psoralea glandulosa Linn. It is one of the most widely used medicinal plants in Chile and in some regions of South America, not only as a home remedy, but also recommended by medicine and widely used in the gastronomic industry. Many properties are known, supported by biological tests both in vitro and in vivo. Because it is so highly appreciated, it is included in the book "Medicamentos Herbarios Tradicionales" (Traditional Herbal Medicines) of the Chilean Ministry of Health. Given the great interest in this plant since time immemorial, this review contains information on its history, popular uses and scientific studies, for a better knowledge, management and sustainable care of this Chilean natural resource.

Whose culture is it anyway? Perceptions of accessibility in museums by professionals working with people with intellectual disabilities in Greece

ABSTRACT This research examines perceptions of accessibility in museums by professionals who work with people with intellectual disabilities and live in housing/rehabilitation settings in Greece and highlights factors and conditions that hinder people with intellectual disabilities from experiencing culture when visiting museums. Out of the 46 officially registered social organisations by the Hellenic Ministry of Health and the Hellenic Ministry of Employment and Social Affairs, 35 participated in the study, a percentage that allows monitoring the situation on a national level. The results showcase deficiencies in the provision of accessibility to cultural heritage with regards to information content, exhibitions and visitor experience, and participation and co-creation opportunities for this particular audience. This paper also makes policy proposals targeted at museums, aiming at enhancing accessibility to culture for people with intellectual disabilities and comes to fill a gap in the respective literature.

Specifics of regional recurrences in lateral tissue of the neck after surgical treatment of highly differentiated thyroid cancer

Introduction. Despite the fact that highly differentiated thyroid cancer is included in the group of malignant neoplasms with a favorable prognosis, data on the high frequency and recurrence of relapses are reported. The presence of metastatic lymph nodes in HDTC increases the risk of regional relapse by up to 27%. According to the literature, the factors that increase the risk of recurrence are: histological type, stage, depth of extrathyroid invasion, the presence of metastatic lymph nodes, age, and the volume of primary surgical intervention. Lateral neck dissection should be performed in patients with morphologically verified metastatic thyroid cancer, but there is still no clear consensus on the volume of dissection.Aim. Assessment of factors affecting the risk of regional recurrence in the lateral neck tissue and the localization of recurrence.Materials and methods. The study included 56 patients with HDTC, in whom metastatic lateral neck nodes were identified and verified. All patients previously underwent unilateral or bilateral neck lymph node dissection in various institutions. During the period of dynamic follow-up, these patients revealed regional recurrences in the lateral tissue of the neck. The patients were observed and treated for recurrence at the N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia.Results. Age over 55 years is a prognostically significant factor affecting the frequency of regional relapse in the lateral neck tissue (p=0.002). The presence of metastatic nodes in the lateral tissue of the neck at the initial treatment is a prognostically significant factor that increases the risk of regional recurrence in the lateral tissue of the neck (p=0.017). According to the results of a single-factor analysis, a statistically significant effect of the stage on the risk of regional relapses in the lateral neck tissue was noted (p=0.014). In 35.7% of cases, recurrent nodes were localized in the level V.Conclusion. Main risk factors for relapse are clinico-morphological, such as age, aggressive type of HDTC, stage of the disease, N1b status after primary surgery, as well as technical defects during primary surgical treatment.

The impact of emergency guidance to the COVID-19 pandemic on treatment entry, retention and mortality among patients on methadone in Ukraine.

Ukraine's Ministry of Health released urgent COVID-19 guidelines, allowing for early implementation of take-home dosing (THD) for opioid agonist therapies (OAT) such as methadone. Enrollment in OAT and retention in the program are the most effective HIV prevention strategies for people who inject drugs (PWID). This study aimed to evaluate the impact of Ukraine's COVID-19 emergency guidance on OAT treatment enrollment, retention on treatment and mortality. Using Ukraine's national OAT registry for 252 governmental clinics across 25 regions, we conducted a 12-month comparative prospective cohort survival analysis. This study compared newly enrolled methadone patients within the initial 6 months following the COVID-19 guidance (COVID) with patients from the preceding year (pre-COVID) in a country with high adult HIV prevalence (1.2%) that is concentrated in PWID. In the nation-wide sample of newly enrolled PWID in Ukraine, comprising 2798 individuals, 1423 were in the COVID cohort and 1375 were in the pre-COVID cohort. The majority were male (86.7%), with an average age of 39.3years. Primary outcomes were average monthly enrollment per cohort, treatment retention and mortality, with internal time-dependent predictors, including THD and optimal (> 85 mg) methadone dosing. Relative to the pre-COVID period, the monthly average patient enrollment was statistically significantly higher during the COVID period (283.7 versus 236.0; P < 0.0001), where patients were more likely to transition to THD and achieve optimal dosing earlier. Significant differences were observed in the proportions of person-months on THD (41 versus 13%, P < 0.0001) and optimal dosing (38 versus 31%, P < 0.0001) between the COVID and pre-COVID cohorts. Predictors of treatment retention, expressed as adjusted hazard ratios (aHR), included early THD [aHR = 1.90, 95% confidence interval (CI) = 1.47-2.45], early optimal dosing (aHR = 1.71, 95% CI = 1.37-2.13) and prior methadone treatment (aHR = 1.39, 95% CI = 1.15-1.68). These factors persisted, respectively, in the pre-COVID (aHR = 2.28, 95% CI = 1.41-3.70; aHR = 1.84, 95% CI = 1.32-2.56; and aHR = 1.36, 95% CI = 1.06-1.74) and COVID (aHR = 1.91, 95% CI = 1.40-2.59; aHR = 1.61, 95% CI = 1.20-2.16; and aHR = 1.49, 95% CI = 1.08-1.94) cohorts. Survival did not differ significantly between the two prospective cohorts. Ukraine's prompt adoption of early take-home dosing for opioid agonist therapies, such as methadone, following the emergency COVID-19 guidance appears to have increased enrollment into methadone and improved treatment retention for people who inject drugs without adverse effects on patient survival.

Analysis of Readiness to Switch Manual Medical Records to Electronic Medical Records to Support the Effectiveness of Outpatient Registration at Muhammadiyah Hospital

The transition from manual to electronic medical records (EMR) is becoming a global trend in healthcare, driven by the Indonesian Ministry of Health's policy to improve service quality and efficiency in patient data management. This study aims to assess the readiness of Muhammadiyah Bandung Hospital to transition from paper-based medical records to EMR in outpatient registration. This descriptive qualitative study involved 5 informants, with data collected through interviews and direct observations. The results indicate that Muhammadiyah Bandung Hospital is ready to transition from paper-based to EMR in outpatient registration, although further engagement with key personnel in the polyclinic (PPA) and improvements in other factors such as infrastructure and staff training are needed. In conclusion, while the hospital shows good readiness, comprehensive strategies are required to ensure a smooth and effective transition.

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research.

Mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in birth facilities. This study identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). An exploratory qualitative study, involving 30 in-depth interviews, was conducted between July 2022 and February 2023. Participants included a purposive sample of key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience, and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companions: e.g., patient needs and resources, structural characteristics, culture); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief during childbirth guidelines: e.g., networks and communications, patient needs and resources, executing, reflecting and evaluating). This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise their current programs and policies regarding the quality of maternity care by focusing on the identified challenges.

Website posts and the voice offrontline healthcare workers: athematic analysis.

With the soaring rise in popularity of social media platforms in recent decades, the use of website posts for the expression of work-related views has also increased. Despite websites being extensively used, there has been no examination of the views and concerns expressed by frontline workers through website posts. The present research aims to contribute to the "voice literature" first by evaluating how frontline workers utilize anonymous media platforms to express their views and work-related concerns and, second, by demonstrating how anonymous voice systems can encourage frontline health workers in providing feedback and dissatisfaction. The study utilizes the thematic analysis method to analyze the content of posts by psychologists on a collaborative consultation website administrated by Israel's Ministry of Health, discussing their perceptions of work-related concerns. The analysis identified three work-related themes through the employees' voices. These include insufficient support from management, conflicts and excessive occupational demands. The workers expressed their apprehension with regard to organizational pressures, deficient budgetallocations, excessive workloads, lack of recognition and work-life imbalances. The application of thematic analysis method to anonymous open-public data should be viewed as an effective, affordable, genuine and unique research method for data analysis. Anonymous platforms can generate unique insights that may not be possible through traditional means. This can provide practitioners with a comprehensive understanding of various issues and challenges and be a useful tool for identifying shortcomings within health settings.

Stages of motor development in children with cyanotic congenital heart defects after surgical treatment

Background. The article deals with the actual problem of pediatric neurology, pediatric cardiology, and pediatric cardiac surgery, in particular, the peculiarities of neurodevelopment in children with congenital heart defects (CHD). The purpose is to conduct a study of stages of stato-motor development (SMD) in patients with cyanotic congenital heart defects after surgical treatment and to determine the influence of pathogenic factors on neurodevelopmental delay. Materials and methods. Thirty-five patients with cyanotic CHD underwent examination and surgical treatment at the Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine: 20 children — with transposition of the great vessels (TGV) and 15 children — with tetralogy of Fallot (TOF). The control group consisted of 35 healthy patients whose motor development corresponded to their age. Gestational age, body weight at birth, Apgar score, saturation, and duration of artificial blood circulation during surgical treatment for CHD were considered. Assessment of motor development was carried out with the help of the following scales: Munich Functional Developmental Diagnosis (G.J. Köhler, H.D. Egelkraut) and section 2 of the Hammersmith Infant Neurological Examination. Data were processed using the software Microsoft Excel version 16.0.12527.21236. Results. The gestational age of the studied group of patients with cyanotic CHD was 38 weeks, body weight — 3,500 g, which corresponded to the control group. Patients of the first subgroup with TGV were diagnosed with lower saturation indicators (р = 0.0001), a lower 1-minute Apgar score (p = 0.028) and a longer duration of artificial blood circulation — 146.00 ± 29.03 (р = 0.043) compared to the second subgroup with TOF. SMD delay was diagnosed in 29 % of cases, namely 12 % with TGV and 17 % with TOF. The average period of sitting with delayed SMD was 8.4 ± 2.2 months (p = 0.002), walking — 18.4 ± 6.3 months (p = 0.0001). Subsequently, children with TGV continue to develop without a significant delay compared to the TOF subgroup. Conclusions. 1. Patients with cyanotic CHD are born at 38 weeks of gestation, with sufficient body weight without a significant difference depending on the type of CHD and compared to the control group of healthy children. The predominance of the male gender is typical in cyanotic CHD. However, children with transposition of the great vessels are characterized by a lower 1-minute Apgar score and lower indicators of saturation at birth compared to those with tetralogy of Fallot. 2. Based on the conducted study, a delay of SMD was found in 29 % of patients with cyanotic CHD, namely 17 % with TOF and 12 % with TGV. The average duration of sitting with delay was 8.4 ± 2.2 months and walking was 18.4 ± 6.3 months. 3. Surgical treatment was carried out according to the detected indications, for transposition of the great vessels on the first day and for tetralogy of Fallot at 8 months of life. No pathogenic influence of the duration of artificial blood circulation and aortic clamping during cardiosurgical treatment on SMD in children was found. An increase in the duration of artificial blood circulation was noted during arterial switch operation in children with TGV, but no significant difference was found in children with SMD delay. 4. Timely early surgical treatment of critical CHD — TGV on the first day after birth, a developed route for pregnant women, techniques of performing operations — ensure a better SMD of this subgroup in the future. In patients with TOF, taking into account the long period of hypoxia before the start of surgical correction, neuropsychiatric disorders of varying degrees are more often noted. The development of an individual rehabilitation program is provided for this category of children.

Insecticide susceptibility status of Anopheles albimanus populations in historical malaria foci in Quintana Roo, Mexico

BackgroundMexico has experienced a significant reduction in malaria cases over the past two decades. Certification of localities as malaria-free areas (MFAs) has been proposed as a steppingstone before elimination is achieved throughout the country. The Mexican state of Quintana Roo is a candidate for MFA certification. Monitoring the status of insecticide susceptibility of major vectors is crucial for MFA certification. This study describes the susceptibility status of Anopheles albimanus, main malaria vector, from historically important malaria foci in Quintana Roo, using both phenotypic and genotypic approaches.MethodsAdult mosquito collections were carried out at three localities: Palmar (Municipality of Othon P. Blanco), Buenavista (Bacalar) and Puerto Morelos (Puerto Morelos). Outdoor human-landing catches were performed by pairs of trained staff from 18:00 to 22:00 during 3-night periods at each locality during the rainy season of 2022. Wild-caught female mosquitoes were exposed to diagnostic doses of deltamethrin, permethrin, malathion, pirimiphos-methyl or bendiocarb using CDC bottle bioassays. Mortality was registered at the diagnostic time and recovery was assessed 24 h after exposure. Molecular analyses targeting the Voltage-Gated Sodium Channel (vgsc) gene and acetylcholinesterase (ace-1) gene were used to screen for target site polymorphisms. An SNP analysis was carried out to identify mutations at position 995 in the vgsc gene and at position 280 in the ace-1 gene.ResultsA total of 2828 anophelines were collected. The main species identified were Anopheles albimanus (82%) and Anopheles vestitipennis (16%). Mortalities in the CDC bottle bioassay ranged from 99% to 100% for all the insecticides and mosquito species. Sequence analysis was performed on 35 An. albimanus across the three localities; of those, 25 were analysed for vgsc and 10 for ace-1 mutations. All individuals showed wild type alleles.ConclusionThe results demonstrated that An. albimanus populations from historical malaria foci in Quintana Roo are susceptible to the main insecticides used by the Ministry of Health.

Eight years into the horizon of aspirational maternal and newborn health pledges: a nationwide cross-sectional exploration of the Burundian EmONC network capacity and budget deficits

ObjectiveThe Burundian emergency obstetric and neonatal care (EmONC) programme, which was initiated in 2017 and supported by a specific policy, does not appear to reverse maternal and newborn mortality trends....

#1357 Regional and national hospitalization burden of lupus nephritis and systemic lupus erythematous in Spain

Abstract Background and Aims The regional epidemiology of Systemic lupus erythematosus (SLE) and lupus nephritis (LN) within the same country is poorly understood. Being a rare disease, its severity may be influenced by local expertise and treatment protocols, especially when healthcare systems are fragmented, like in Spain (17 different healthcare systems in 17 Autonomous Community (AACC), population range 319.796 to 8.472.407), resulting in potentially different levels of expertise in regional referral centers. Additional heterogeneity may derive from different specialists (rheumatology, internal medicine, nephrology) caring for SLE and LN. We aim to investigate the disease burden of SLE and LN in Spain and its AACC between 2019 and 2021, and to characterize factors that may influence this burden. Method The primary diagnostic data and average cost of SLE and NL hospitalization were extracted from the Minimum Basic Data Set (MBDS, Ministry of Health) that contains data from private and public hospitals. Sociodemographic data were obtained from the National Statistics Institute. Results From 2019 to 2021, there were 872 LN and 3612 SLE nationwide hospitalizations. Over 60% occurred in Andalucia, Catalonia, and Madrid, which account for 48% of Spanish population. Nationwide, the incidence of LN and SLE hospitalization was 1.44 and 4.59 per 100 000, respectively. However, regional variability was large, with a 3.7-fold difference for LN and a 7.3-fold difference for SLE between Madrid and Valencia, 2 of the more populated AACC. The median LN/SLE hospitalization ratio was 0.33. Relative risk for hospitalization, compared to the national mean, ranged in AACC from 0.37 (Baleares) to 2.55 (La Rioja) for LN and from 0.22 (Baleares) to 3.67 (Ceuta and Melilla) for SLE (Fig. 1A). Heterogeneity was larger at the provincial level where 10/50 provinces had significantly higher or lower relative risk than the national mean (Fig. 1B). The length of SLE/LN hospitalizations was very variable across specialties and AACC. There was a trend for shorter duration in Nephrology and longer in Internal Medicine for both LN and SLE. Nephrology was mainly responsible (76%) for LN hospitalization, with regional differences. For SLE hospitalization, Nephrology was also most commonly in charge. Heterogeneity was larger at the province level within the same AACC. The average All-Patient-Related (APR) cost per LN and SLE hospitalization episodes was €5254 and €4376, respectively, with significant geographical variability. Total annual hospitalization costs varied significantly among AACC, ranging from €8683 (Ceuta and Melilla) to €682512 (Catalonia) for LN and from €68361 (Ceuta and Melilla) to €2229456 (Madrid) for SLE. Adjusted per million population, total LN hospitalization cost ranged from €27920 (Baleares) to €179248 (La Rioja), and SLE cost from €91563 (Baleares) to €399693 (Ceuta and Melilla). When adjusted by €1000 of average household net income, the budget burden of LN hospitalization was highest in La Rioja (€5812 per €1000 of average household net income) and lowest in Baleares (€809 per €1000), while for SLE was highest in Murcia (€11186 per €1000) and lowest in Baleares (€2652 per €1000) (Fig. 2A,B). Conclusion In conclusion, the burden of LN and SLE hospitalization is heterogeneous across and within Spanish AACC, with large regional differences in the distribution of cases, costs and specialists who care for these patients. The analysis of these differences may contribute to benchmarking of best practices, decreasing clinical practice heterogeneity, optimizing care for SLE and LN and improving outcomes.

Preclinical Online Sсreening for Stress-Associated Disorders in Combatants

Background: the need to improve standards, organizational methods and practical scientific approaches to the prevention and treatment of mental pathology and the restoration of mental health of military personnel involved in combat operations determines the importance of developing and implementing effective strategies for correcting the mental state of combatants. The aim: to analyze the results of preclinical online screening of stress-associated disorders in combatants to assess its effectiveness in conducting routine psychoprophylactic examinations of military personnel after returning from the combat zone. Subjects and methods: 176 male employees of the Russian Guard who returned after a business trip of up to 90 days in the combat zone were examined. All combatants underwent preclinical online screening for the detection of stress-associated mental disorders, including methods regulated by the Ministry of Health of the Russian Federation. After testing, the obtained data were processed using cluster analysis by the K-means method. Clinical and psychopathological examination and laboratory studies were conducted, including: the content of carbohydrate-deficient transferrin (CDT), testosterone and cortisol levels, processing of the data obtained using statistical methods. Results: the combination of high levels of evening cortisol and CDT in combatants may indicate a complex interaction of physical stress, psychological trauma and possible alcohol abuse, which may be the result of both specific conditions of military service and a way to cope with post-war stress and trauma. Conclusions: it was found that the data of preclinical screening testing are consistent with clinical and laboratory results. Online screening testing for the detection of stress-associated disorders in combatants, combined with the determination of testosterone, evening cortisol and CDT levels, can serve as markers of the presence of stress-associated disorders.

#1173 The duration of SARS-CoV-2 persistence in dialysis patients was inversely correlated with serum albumin levels

Abstract Background and Aims Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who are undergoing dialysis are known to experience delayed viral clearance. However, the clinical characteristics that contribute to viral persistence in these patients have not been well documented. This study reviewed a case series of dialysis patients infected with SARS-CoV-2 at Yokohama General Hospital to investigate factors affecting the duration of viral persistence. The association between clinical features and the duration of SARS-CoV-2 persistence, as assessed by serial viral antigen (Ag) titers, was examined. Method This was a retrospective observational study of 22 dialysis patients infected with SARS-CoV-2 between February 2022 and September 2023 at Yokohama General Hospital. Patients who tested positive for SARS-CoV-2 RNA in nasopharyngeal swabs or saliva were diagnosed with coronavirus disease 2019 (COVID-19). Those with confirmed COVID-19 were serially tested for SARS-CoV-2 Ag on nasopharyngeal swabs. The duration of viral persistence was defined as the interval between the day of diagnosis and the first day that Ag titers fell below 10 pg/mL. Clinical parameters were collected and their association with the duration of Ag positivity was examined. Parameters analyzed included age, body mass index (BMI), dialysis vintage, serum albumin and C-reactive protein (CRP), COVID-19 severity at diagnosis, fever duration, and comorbidities including cardiovascular disease, diabetes, hypertension, and dyslipidemia. COVID-19 severity was classified as mild, moderate I, moderate II, or severe, following the Japanese Ministry of Health, Labour and Welfare guideline. The groups were compared using the Kruskal-Wallis test. Spearman's rank correlation coefficient was used to analyze the correlation. Statistical analyses were performed using JMP version 17. Results Out of the 22 dialysis patients who were infected with SARS-CoV-2, two were excluded from the study due to a lack of serial results for SARS-CoV-2 Ag. Five of the patients were outpatients, while the remaining were infected in hospital clusters. The patients had a mean age of 76.6 years (SD=7.1), and 17 of them were male. Ten of the patients had diabetes mellitus, 11 had hypertension, and 10 had dyslipidemia. Cardiovascular disease was excluded from the analysis because all patients, except for two, had it. The median BMI was 19.45. The median dialysis vintage was 57.5 months. Serum albumin levels ranged from 1.4 g/dl to 4.0 g/dl, with a median of 3.1 g/dl, and CRP levels ranged from 0.38 mg/dl to 8.70 mg/dl, with a median of 2.57 mg/dl. At the time of diagnosis, 15 and 5 patients were classified as having mild and moderate I disease, respectively. Seventeen patients had fever, which lasted from 1 to 11 days, with a median of 3 days. The duration of antigen positivity ranged from 10 to 26 days with a median of 18 days. The duration of Ag positivity showed an inverse correlation with serum albumin levels, which was the only parameter associated with viral clearance (Table 1 and Fig. 1). Conclusion Serum albumin levels were associated with prolonged viral clearance in a small series of dialysis patients infected with SARS-CoV-2 in our study. Serum albumin levels may have prognostic value for the viral clearance in dialysis patients.

#1817 Decrease in hospital-acquired blood stream infection by using automated sensor technology to improve and keep a high level of hand hygiene compliance

Abstract Background and Aims Hospital-acquired infection (HAIs) is a problem for 6-8% of hospitalized patients. HAIs has personal costs, prolongs the hospital stay, increasing the risk of morbidity, mortality, time and staff consuming. Hand hygiene (HH) is essential for preventing infections. World Health Organization (WHO) recommends hand hygiene compliance (HHC) as a key performance indicator. Manual observations of HHC are time consuming and may affect compliance by the physical presence of the observers (Hawthorne effect). There is a need to identify the most effective long-term intervention to improve HHC and reduce HAI. The Danish Ministry of Health have chosen blood stream infections (HA-BSI) as a national indicator for the overall risk of HAIs expecting an incidence of no more than 8 cases per 10,000 patient days. The aim of the present study was to examine the use of an automated sensor technology to improve HHC and prevent HAIs in an inpatient department for nephrology and intern medicine. Nephrology patients have a high number of invasive catheters, which may increases the risk of HAI. Method The study comprised a 2 year cohort with no specific HHC interventions (July 2018-June 2020), a baseline period (February 2020-June 2020) to investigate HHC level by an electronic hand hygiene measuring system (EHHMS) without ongoing HHC interventions followed by a 3 year cohort period (July 2020-June 2023) with various EHHMS-based feedback interventions to staff. Intervention consisted primarily of group feedback and later individual feedback. All caregivers and doctors carried an anonymous Sani ID tag (Sani Nudge, DK) fixed to their nametag throughout the study period. EHHMS-based Sani Sensors were located in designated locations in the clinical department with the purpose of continuously capturing the caregiver patient contact including staff use of liquid alcohol based hand rub (ABHR). In Denmark, the national hygiene guidelines also require that ABHR follow hand wash. Local hygiene mentors regularly presented anonymous group data on boards and in letters to the staff. Soon after there was a demand on individual data, which was then added by individual results forwarded in a personal email every week. HA-BSI was defined as the presence of a pathogen in the blood and the prescription of an appropriate concomitant antimicrobial treatment and classified as hospital-acquired if the patient has been hospitalized for &amp;gt;48 hours. Data were obtained from various electronic health care systems in the hospital. Results We collected HHC data by monitoring 203 caregivers and 50 doctors for a period of 40 months. Caregivers HHC improved after implementation of an electronic hand hygiene measuring system from baseline to group feedback and finally individual feedback (39% vs 50% vs 71%). For doctors, the improvement from baseline to group feedback and finally individual feedback was 30% vs. 32% vs 52%. The overall improvement curve reached a stable plateau after 20 months. An incidence rate of 14 HA-BSI cases per 10,000 patient days during a previous two years control period (95% CI 8.8-21.2) was during the intervention period markedly reduced to 5 HA-BSI cases per 10,000 patient days (95% CI 2.3-9.0). This difference was statistically significant, P = 0.004. Conclusion The use and feedback of the electronic hand hygiene monitoring system improved successfully hand hygiene compliance in the groups of both caregivers, doctors, and furthermore reduced the rate of HA-BSI significantly. We observed a significant stepwise increase in compliance after group feedback data and later after reporting individual data. There continue to be a need to find effective long-term interventions to improve and keep a high level of hand hygiene compliance and a sustained reduction in hospital-acquired bloodstream infection.

Vaccine communication strategies among healthcare workers as a reflection of the Israeli Ministry of Health’s communication strategies before and after the COVID-19 pandemic

BackgroundHealthcare workers play a central role in communicating information to the public regarding vaccines. Most of the literature has focused on healthcare workers’ hesitancy and doubts about getting the flu vaccine themselves. However, few studies have dealt with how they perceive their role in communicating information regarding vaccines, especially following the COVID-19 pandemic.Objectives(1) To identify the communication strategies used by the Israeli Ministry of Health regarding vaccines during epidemic crises (before and after the COVID-19 pandemic); (2) To identify the communication strategies used by healthcare workers regarding vaccines before and after the COVID-19 pandemic.MethodsA qualitative study based on in-depth interviews was conducted among healthcare workers and used a semi-structured protocol as a research tool. A total of 18 healthcare workers were sampled using purposeful and snowball sampling.ResultsDespite healthcare workers’ perception that there has been a decrease in trust in the Israeli Ministry of Health among the public following the COVID-19 outbreak, they still rely on the Israeli Ministry of Health as their primary source of information and use the same communication strategies (such as fear appeals and correcting information) as of the Israeli Ministry of Health to communicate with the public, healthcare providers, and other relevant stakeholders.ConclusionHealthcare workers have been shaped by the professional socialization processes within the health system, leading to a predominant reliance on established communication strategies and informational channels. This reliance underscores the importance of evolving these methods to better engage with the public. To address this, there is a compelling need to innovate and adopt new communication techniques that emphasize effective dialogue and transparent interactions. By doing so, healthcare professionals can ensure that their outreach is not only informative but also responsive to the diverse needs and preferences of the community.

Soil and Urine Mercury Levels in Secocha: A Case Study of Artisanal and Small-Scale Gold Mining in Peru

In recent decades, artisanal and small-scale gold mining (ASGM) has spurred population and economic growth in the small rural communities in which it is located, along with causing contamination of the soil, air, and water with grave effects on human health due to the uncontrolled use of mercury for gold processing activities. This study analyzes the levels of mercury in Secocha, an ASGM community in Arequipa, Peru. A total of 44 soil samples were taken from two ASGM commercial-extractive zones (n = 18) and non-processing urban zones (n = 26). Soil mercury analysis with atomic absorption spectrometry revealed average mercury levels of 86.11 mg/kg in commercial-extractive zone I, where ore processing has occurred for about 17 years, and mercury levels of 43.81 mg/kg in commercial-extractive zone II, where processing has occurred for about 7 years. In the urban zone, the average mercury level was 9.53 mg/kg. The average mercury concentrations for each zone exceed the relevant environmental quality standards established by the Peruvian Ministry of the Environment. In addition, urine samples were obtained from 15 miners and 15 people from the general urban population (non-miners). The average mercury level in the urine of miners was 7.04 µg/L, and in the urine of non-miners it was 0.49 µg/L. In both cases, the mercury urine level did not exceed the limits established by WHO and the Peruvian Ministry of Health, though miners’ elevated levels do raise concerns.