Ministry Of Health Research Articles

Anaphylactic shock (2nd revision). Clinical guidelines of Russian Association of Allergists and Clinical Immunologists and the All-Russian Public Organization “Federation of Anesthesiologists and Reanimatologists”

Anaphylaxis is a severe life-threatening emergency that requires prompt recognition, prompt respond and of lifesaving therapy. Therefore, anaphylaxis can develop both in a medical institution and outside it (outpatient), and physicians of any specialties should be ready to treat this condition. In this regard, clinical guidelines for anaphylaxis have been developed in Russia. Previous version of recommendations were approved by the Russian Association of Allergologists and Clinical Immunologists and the Federation of Anesthesiologists and Resuscitators, approved at a meeting of the Scientific and Practical Council of the Ministry of Health of the Russian Federation (protocol No. 2020 No. 743/12). The second edition important clarifications have been made in etiology, epidemiology, classification, clinical picture, diagnosis, treatment and prevention of anaphylaxis and clear some definitions for prompt response, and also management of patients with concomitant diseases. Clinical guidelines of anaphylaxis are intended for practitioners of all specialties, students and teachers of medical universities, residents, graduate students.

Results of a clinical study of the influenza tetravalent inactivated subunit adjuvant vaccine Grippol Quadrivalent in children aged 6 months to 5 years (inclusive)

The article presents the results of a clinical investigation on the administration of the Grippol Quadrivalent vaccine (influenza tetravalent inactivated subunit adjuvant vaccine) in children from 6 months to 5 years old. The vaccine has demonstrated no less effectiveness in comparison with the Grippol plus vaccine (influenza trivalent inactivated polymer-subunit vaccine). Comparable results were obtained for all evaluated indicators of immunological efficacy against matching strains of the influenza virus, while for additional strain B (Yamagata line) there was a statistically significant difference in the increase in the immune response in the Grippol Quadrivalent group. The results of the assessment of the reactogenicity and frequency of systemic adverse events indicated a favorable and comparable safety profile of the vaccines Grippol Quadrivalent and Grippol plus in children from 6 months to 5 years old. The data obtained allowed us to conclude that the immunological efficacy of the Grippol Quadrivalent vaccine is no less when compared to the Grippol plus vaccine, as well as a comparable safety and reactogenicity profile. According to the results of the clinical investigation, on 08/04/2023, the Ministry of Health of the Russian Federation amended the “Instructions for the medical use of the drug”: Grippol Quadrivalent is indicated for children from the age of 6 months.

Investigation of occupational stress among radiologic technologists in Saudi Arabia using HSE stress indicator tool

BackgroundThe increasing concern about occupational stress and its effects on radiologic technologists (RTs) has been noted, as it can lead to decreased productivity and compromised healthcare quality. This study aimed to evaluate occupational stress and pinpoint the primary indicators of organizational psychosocial hazard exposures among RTs working in hospitals under the Saudi Ministry of Health. The Health and Safety Executive Indicator Tools (HSE-IT) for occupational stress were utilized for this assessment. MethodsThe study employed a cross-sectional online survey that utilized both quantitative and qualitative methods. The quantitative method was based on the HSE-IT, which focuses on six HSE Management Standards that represent potential stress hazards, namely: demands, control, support, relationships, roles, and change. The qualitative method, on the other hand, was based on narrative comments that shed light on the most common sources of occupational pressure and suggestions on how to alleviate this pressure in the radiology department. ResultsA total of 864 responses were collected from RTs in Saudi Arabia. This study revealed that urgent action was needed for demand, managers’ support, workplace relationship, and organizational roles, while assessment of control and organizational change standards were indicated as a “clear need for improvement” and “good, but in need of improvement”, respectively. This study identified particular areas of concern such as workload, shortage of staff, lack of control, feedback, social support, personal harassment, job description, and consultation of staff with changes in their work environment. The relationship between the sociodemographic data and the overall stress results revealed statistically significant differences related to gender (P = 0.020), living place, and working night shifts (P = 0.003). ConclusionThe study found that the risks of occupational stress for RTs are substantial and are not being appropriately addressed. The need for awareness to manage occupational stress is warranted, and therefore, this study presented recommendations for reducing the risks associated with occupational stress.

Improving healthcare delivery at a district hospital through teaching interns - A short report.

Every district in Malawi has at least two doctors managing the social and healthcare needs of the local population. The medical doctors at the district are involved in administrative work and have minimal time for clinical practice. As such in most district hospitals, clinical officers (COs) form the backbone of patient care provision. These are cadres that have a 3-year training in clinical medicine; they work side by side with medical assistants (MAs) and nurses. Apart from the Ministry of Health (MoH) workforce, the Department of Family Medicine (FM) of Kamuzu University of Health Sciences (KUHeS) has its main district site at Mangochi. Family physicians and residents from FM department assist in provision of mentorship and teaching to other cadres. Work-based learning requires various strategies and approaches. The experience reported here involves deliberate mentorship and support to enhance the learning of other cadres. Family medicine residents learn through the active participation in these sessions to become future consultants and leaders in primary health care.

The relationship between knowledge and willingness COVID-19 vaccination among adolescence, in Samarinda, Indonesia

Background: In 2020, infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are still a pandemic, including in Indonesia. Numerous efforts have been made to reduce morbidity and mortality rates caused by the virus, including vaccination. The existence of a vaccine for COVID-19 in the Indonesian community faces pros and cons. The achievement rate of vaccination, in general, is still not as expected. To accelerate vaccination, the government through the Ministry of Health has issued a circular on the acceleration of COVID-19 vaccination for children from 12-17 years old. The study aims to assess the relationship between the level of knowledge and willingness to vaccinate against COVID-19 in adolescents from 12-17 years old in Sambutan Village, Samarinda city, Indonesia. Methods: This study is observational analytic with a cross-sectional design. We took samples through online questionnaires distributed to adolescents aged 12-17 years old, in Sambutan village, Samarinda city from September to December 2021. Results: The sample was 179 people, consisting of 86 people (48.04%) male and 93 people (51.96%) female. Based on the knowledge level, 144 (80.4%) have good knowledge and 35 (19.6%) have less knowledge about vaccination. As for the willingness to vaccinate, 150 (83.8%) people are willing, and 29 (16.2%) are unwilling to be vaccinated. The analysis test, obtained p<0.001, indicating that there is a relationship between the level of knowledge and willingness to vaccinate. Conclusions: The better adolescents comprehend vaccination, then their willingness to be vaccinated is higher.

Lessons From the Design and Rollout of an Electronic Medical Record System for Cervical Cancer Screening in Rwanda.

In its commitment to delivering comprehensive women's cancer early detection services, the Rwanda Ministry of Health rolled out a new cervical cancer screening program. The paper-based medical record system that tracked clients at different points in the continuum of cervical cancer care had challenges with storing data, accessing client information for follow-up visits, and fragmenting information on individual clients. To support the rollout of the new cervical cancer screening program, a new electronic medical record system was designed and implemented to ensure clients were followed along the complete continuum of care. We document the development and implementation of the electronic medical record system and highlight challenges and lessons learned during implementation. Implementation took a participatory approach to ensure that the electronic medical record system was efficient in tracking clients along the continuum of care. At every stage, a wide range of stakeholders were engaged, including clinicians, program managers, and software developers. Health facility visits and conversations were conducted with health care providers and data managers to review the existing system and ensure that the design and development of the electronic record system were suitable for the context in which it would be used. Cervical cancer screening sites are currently using the electronic medical record system to document client information and track women along the continuum of care to reduce loss to follow-up. The system has been rolled out to all newly activated screening sites as part of national scale-up. Planning, collaboration, and adaptability were the key factors in this system's successful rollout and should be the foundation of future data systems development.

Comparative analysis of availability and affordability of hypoglycaemic medicines for Ukrainian patients during the war 2022-2023

Purpose: Diabetes care, particularly type 2 diabetes (T2D), is recognised as a growing challenge in emergency situations. During the humanitarian crisis of war in Ukraine, it is important to focus on ensuring that patients have access to essential medicines for T2D. Since 1 April 2017, the Ministry of Health of Ukraine has been implementing the government programme "Affordable medicines". The List of reimbursed medicines necessary for the treatment of hypertension, diabetes and bronchial asthma includes 3 glucose lowering medicines (GLMs) - gliclazide, metformin, glibenclamide. From 01 April 2019, electronic prescribing has been implemented as part of the "Affordable Medicines" programme. It is important to investigate changes in the availability and affordability of GLMs for the treatment of T2D during the war and future directions in 2022-2023 in Ukraine. Methods: Information from the State Register of Medicinal Products of the Ministry of Health of Ukraine from March 2023 and February 2022 (before the start of the war) was the subject of the study. Marketing, analytical, graphical, generalisation analyses were applied. Analysis of the cost of 1 DDD GLM according to the WHO ATC/DDD index and solvency ratio analysis were applied. Results: This study is based on actual data from before the war in Ukraine and now shows that the affordability and availability of GLMs during the war in 2022-2023 has not changed dramatically. The 'Affordable Medicines' program was stably implemented, with €111.9 million allocated in 2023 and within 6 months of 2023. The National Health Service of Ukraine reimbursed €42.8 million to pharmacies for the Reimbursement List. Most Ukrainian manufacturers and foreign GLMs are very affordable due to the reimbursement system. From October 2023, 23 names of test stripes were included in the Reimbursement list of the "Affordable medicines" programme. However, foreign GLMs of innovative groups are moderately affordable for the working population based on the calculated solvency ratio. Conclusions: Our study revealed that despite the challenges of war, the healthcare system in Ukraine remains robust, particularly in ensuring stable access to pharmaceuticals for diabetes treatment. The "Affordable Medicines" programme and the Reimbursement List are updated twice a year, and the introduction of the new drugs for T2D and diabetes insipidus was completed in 2022. Thus, the innovative GLMs, despite being registered on the market in 2022, such as Semaglutide, Semaglutide and Dapagliflozin, are not affordable in 2023. A prospective trend is the inclusion of innovative GLMs for diabetes better care on the reimbursement list.

Cannabidiol (CBD) Listed as a Drug of Abuse by the Italian Health Ministry: Expert Opinion

Abstract: In August 2023, the Italian Health Ministry listed cannabidiol (CBD) as a drug of abuse. This rekindled the debate on the medical and non-medical use of cannabis. The most discussed topics are risks related to the use of cannabis, the decriminalization/legalization of recreational cannabis, and use of cannabis-based drugs for medical purposes. The decision to include CBD in the “Unique Text for drugs of abuse” (DPR.309/1990), along with the already included main psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), is not particularly relevant to such ongoing discussions. Even when it comes to cannabis-based drugs for medical purposes, such a decision will have a minimum impact on CBD-based medical prescriptions. Instead, a high economic impact is expected on CBD-based products sold online or in specific shops, including the so-called “cannabis-light”, formally sold as a “technological product” for collection purposes but used as over-the-counter drugs for the treatment of several medical conditions. Cannabis-light products have reduced regular drug consumption by about 10%. Also, they are not entirely safe, as the actual content of THC may significantly differ from the one stated, carrying unexpected health risks. Further, CBD is likely not a drug with addictive potential; however, its uncontrolled use for medical purposes needs to be regulated as the court battles are ongoing.

The coronavirus disease 2019 infodemic: a concept analysis.

This study aimed to analyze the coronavirus disease 2019 (COVID-19) infodemic phenomenon in the medical field, providing essential data to help healthcare professionals understand it. This study utilized a hybrid model for concept analysis. In the theoretical phase (first phase), a literature review was conducted using ScienceDirect, PubMed, CINAHL, ProQuest, Scopus, Web of Science, DBpia, RISS, and KISS. Semi-structured interviews, involving eight physicians and six nurses, were used in the fieldwork phase (second phase). In the final analysis phase (third phase), the results of the preceding phases were combined. Based on the findings of these phases, the COVID-19 infodemic can be defined as "the phenomenon of information flood, reproduction, dissemination, and asymmetry, which occurred during the pandemic through social networks among the public lacking essential knowledge of infectious disease, and is associated with negative and positive effects." Our findings can help the Ministry of Health and Welfare and healthcare professionals to understand the phenomenon of the infodemic and prepare necessary strategies and education programs for the public. Therefore, the provision of basic data is important for developing influential roles for healthcare professionals during infectious disease outbreaks.

Care-seeking patterns and timely access to care among survivors of sexual violence in North Kivu, the Democratic Republic of the Congo: a retrospective file-based study

ABSTRACT Background Sexual violence is widespread in war-torn North Kivu province in the Democratic Republic of the Congo (DRC). Timely access to care is crucial for the healing and wellbeing of survivors of sexual violence, but is problematic due to a variety of barriers. Through a better understanding of care-seeking behaviours and factors influencing timely access to care, programmes can be adapted to overcome some of the barriers faced by survivors of sexual violence. Objective The aim of this study was to describe demographics, care-seeking patterns and factors influencing timely care-seeking by survivors of sexual violence. Methods Retrospective file-based data analysis of sexual violence survivors accessing care within two Médecins Sans Frontières (MSF) programmes supporting the Ministry of Health, in North Kivu, DRC, 2014–2018. Results Most survivors (66%) sought care at specialised sexual violence clinics and a majority of the survivors were self-referred (51%). Most survivors seeking care (70%) did so within 3 days. Male survivors accessing care were significantly more likely to seek care within 3 days compared to females. All age groups under 50 years old were more likely to seek care within 3 days compared to those aged 50 years and older. Being referred by the community, a family member, mobile clinic or authorities was significantly associated with less probability of seeking care within 3 days compared to being self-referred. Conclusion Access to timely health care for survivors of sexual violence in North Kivu, DRC, is challenging and varies between different groups of survivors. Providers responding to survivors of sexual violence need to adapt models of care and awareness raising strategies to ensure that programmes are developed to enable timely access to care for all survivors. More research is needed to further understand the barriers and enablers to access timely care for different groups of survivors.

Hospital care direct costs due to ambulatory care sensitive conditions related to diabetes mellitus in the Mexican public healthcare system

BackgroundHospitalizations for ambulatory care sensitive conditions (ACSC) incur substantial costs on the health system that could be partially avoided with adequate outpatient care. Complications of chronic diseases, such as diabetes mellitus (DM), are considered ACSC. Previous studies have shown that hospitalizations due to diabetes have a significant financial burden. In Mexico, DM is a major health concern and a leading cause of death, but there is limited evidence available. This study aimed to estimate the direct costs of hospitalizations by DM-related ACSC in the Mexican public health system.MethodsWe selected three hospitals from each of Mexico’s main public institutions: the Mexican Social Security Institute (IMSS), the Ministry of Health (MoH), and the Institute of Social Security and Services for State Workers (ISSSTE). We employed a bottom-up microcosting approach from the healthcare provider perspective to estimate the total direct costs of hospitalizations for DM-related ACSC. Input data regarding length of stay (LoS), consultations, medications, colloid/crystalloid solutions, procedures, and laboratory/medical imaging studies were obtained from clinical records of a random sample of 532 hospitalizations out of a total of 1,803 DM-related ACSC (ICD-10 codes) discharges during 2016.ResultsThe average cost per DM-related ACSC hospitalization varies among institutions, ranging from $1,427 in the MoH to $1,677 in the IMSS and $1,754 in the ISSSTE. The three institutions’ largest expenses are LoS and procedures. Peripheral circulatory and renal complications were the major drivers of hospitalization costs for patients with DM-related ACSC. Direct costs due to hospitalizations for DM-related ACSC in these three institutions represent 1% of the gross domestic product (GDP) dedicated to health and social services and 2% of total hospital care expenses.ConclusionsThe direct costs of hospitalizations for DM-related ACSC vary considerably across institutions. Disparities in such costs for the same ACSC among different institutions suggest potential disparities in care quality across primary and hospital settings (processes and resource utilization), which should be further investigated to ensure optimal supply utilization. Prioritizing preventive measures for peripheral circulatory and renal complications in DM patients could be highly beneficial.

Community-level group sports participation and all-cause, cardiovascular disease, and cancer mortality: a 7-year longitudinal study

BackgroundCommunity-level group sports participation is a structural aspect of social capital that can potentially impact individual health in a contextual manner. This study aimed to investigate contextual relationship between the community-level prevalence of group sports participation and the risk of all-cause, cardiovascular disease (CVD), and cancer mortality in older adults.MethodsIn this 7-year longitudinal cohort study, data from the Japan Gerontological Evaluation Study, a nationwide survey encompassing 43,088 functionally independent older adults residing in 311 communities, were used. Cause of death data were derived from the Japanese governmental agency, The Ministry of Health, Labour and Welfare, for secondary use. “Participation” was defined as engaging in group sports for one or more days per month. To analyze the data, a two-level survival analysis was employed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated.ResultsAmong the participants, 5,711 (13.3%) deaths were identified, with 1,311 related to CVD and 2,349 to cancer. The average group sports participation rate was 28.3% (range, 10.0–52.7%). After adjusting for individual-level group sports participation and potential confounders, a higher community-level group sports participation rate was found to be significantly associated with a lower risk of both all-cause mortality (HR: 0.89, 95% CI: 0.83–0.95) and cancer mortality (HR: 0.89, 95% CI: 0.81–0.98) for every 10% point increase in the participation rate. For CVD mortality, the association became less significant in the model adjusted for all covariates (HR: 0.94, 95% CI: 0.82–1.09).ConclusionsOur findings support the existence of a preventive relationship between community-level group sports participation and the occurrence of all-cause and cancer mortality among older individuals. Promoting group sports within communities holds promise as an effective population-based strategy for extending life expectancy, regardless of individual participation in these groups.

Thermal stress and hospital admissions for cardiorespiratory disease in Brazil

The growing body of scientific literature underscores the intricate relationship between meteorological conditions and human health, particularly in the context of extreme temperatures. However, conventional temperature-centric approaches often fall short in capturing the complexity of thermal stress experienced by individuals. Temperature alone, as a metric, fails to encompass the entirety of the thermal stress individuals face, necessitating a more nuanced understanding. In response to this limitation, climatologists have devised thermal indices—composite measures meticulously crafted to reflect the intricate interplay of meteorological factors influencing human perception of temperature. Recognizing the inadequacy of simplistic temperature-focused methodologies, our study aims to address the multifaceted nature of thermal stress. In this study, we explored the association between thermal indices and hospital admissions for circulatory and respiratory diseases in Brazil. We used an extensive dataset spanning 11 years (2008–2018) from the Brazilian Ministry of Health, encompassing a total of 23,791,093 hospitalizations for circulatory and respiratory diseases. We considered four distinct thermal indices—Discomfort Index (DI), Net Effective Temperature (NET), Humidex (H), and Heat Index (HI). We used an extension of the two-stage design with a case time series to assess this relationship. In the first stage, we applied a distributed lag non-linear modeling framework to create a cross-basis function. We next applied quasi-Poisson regression models adjusted by time-varying confounders. In the second stage, we applied meta-analysis with random effects to estimate the national relative risk (RR). Our findings suggest robust variations among the thermal indices under examination. These variations underscore the intricate nature of associations between temperature and health, with each index capturing distinct aspects of thermal conditions. Our results indicate that extreme thermal conditions, both at the low and high ends, are associated with increased risks of hospital admissions. The diverse impact observed among different indices emphasizes the complex interplay between various meteorological factors and their specific physiological consequences. This underscores the necessity for a comprehensive comprehension of temperature metrics to guide precise public health interventions, recognizing the multifaceted nature of temperature-health relationships.

Insights into COVID-19 data collection and management in Malawi: exploring processes, perceptions, and data discrepancies

Background The completion of case-based surveillance forms was vital for case identification during COVID-19 surveillance in Malawi. Despite significant efforts, the resulting national data suffered from gaps and inconsistencies which affected its optimal usability. The objectives of this study were to investigate the processes of collecting and reporting COVID-19 data, to explore health workers’ perceptions and understanding of the collection tools and processes, and to identify factors contributing to data quality. Methods A total of 75 healthcare professionals directly involved in COVID-19 data collection from the Malawi Ministry of Health in Lilongwe and Blantyre participated in Focus Group Discussions and In-Depth Interviews. We collected participants’ views on the effectiveness of surveillance forms in collecting the intended data, as well as on the data collection processes and training needs. We used MAXQDA for thematic and document analysis. Results Form design significantly influenced data quality and, together with challenges in applying case definitions, formed 44% of all issues raised. Concerns regarding processes used in data collection and training gaps comprised 49% of all the issues raised. Language issues (2%) and privacy, ethical, and cultural considerations (4%), although mentioned less frequently, offered compelling evidence for further review. Conclusions Our study highlights the integral connection between data quality and the design and utilization of data collection forms. While the forms were deemed to contain the most relevant fields, deficiencies in format, order of fields, and the absence of an addendum with guidelines, resulted in large gaps and errors. Form design needs to be reviewed so that it appropriately fits into the overall processes and systems that capture surveillance data. This study is the first of its kind in Malawi, offering an in-depth view of the perceptions and experiences of health professionals involved in disease surveillance on the tools and processes they use.

Concern over Orthodox and First Aids Treatments of Snakebite Victims in Kaltungo L.G.A, Gombe State, Nigeria

Snakebite by venomous snake causes multi-dimensional fast adverse clinical and non-clinical effects; including mortality and morbidity.  Hence, the need for urgent first aid and treatments always in such conditions. Unfortunately, most of the bites occur in very remote rural  areas with no health facilities at all or poor health facilities where available for proper treatment. So, the alternative as a matter of necessity is self-help by means of traditional methods of “first aid or treatment”. Unfortunately, the disadvantage of such methods far  out-weigh the advantages in many ways for many reasons such as toxicity, none efficacy, lack of hygiene, unknown dosage and delay in  going for proper health care early, due to hopeful confidence. The Tropical and Sub-Saharan regions of the globe are more affected;  Nigeria is inclusive with the high burden in 12 States. This study was aimed at evaluating the level of dependence on some of these  traditional methods of first and treatment of snakebite victims in Kaltungo, Gombe State. After getting ethical clearance from the State  Ministry of Health and consent of the victims; a simple questionnaire was used to collect relevant information regarding first aids and treatments from 200 snakebite victims. The study showed that 167 (83.5%) of the victims took at least one form of first aid and/or  treatment or the other before visiting the health centre for proper care. The first aids/treatments methods include at least one traditional  methods – 27 (13.5%), orthodox only – 4 victims (2%), spiritual method only – 3 (1.5%), tourniquet method only – 7 (3.5%)  combinations of two or more methods – 126 (63.0%), while 33 (16.5%) only did not take any first aid/treatment at all before getting to the  treatment centre.

Outcomes and Comparative Analysis of the Initial Results of Standard Balloon Angioplasty Versus Drug-Coated Balloons Alone Versus in Association With Laser-Excimer Atherectomy in the Treatment of Femoropopliteal Artery In-Stent Restenosis (INTACT).

Despite improved patency with newer-generation nitinol stents, one-half of patients will require secondary interventions for in-stent restenosis (ISR). The best treatment strategy remains unclear. This study aimed to compare drug-coated balloons (DCBs) used alone or in association with excimer laser atherectomy (ELA) to simple percutaneous transluminal angioplasty (PTA) in the treatment of femoropopliteal-ISR. The INTACT trial is a multicenter, prospective, triple-arm randomized trial conducted across 14 centers from December 2015 to November 2019. Patients Rutherford Class 2-5 with ISR≥70% were followed-up for 18 months. The primary efficacy endpoint was recurrent ISR>70% by duplex ultrasound analysis. The primary safety endpoint was major adverse events (MAEs) defined as death, major amputation, or target lesion revascularization (TLR). Around 134 subjects were randomized to PTA alone (n=41), PTA+DCB (n=43) or PTA+ELA+DCB (n=50). Procedural success was similar (p=.74), as was clinical success (p=.17). The number of recurrent ISR>70% decreased after PTA+ELA+DCB (30.0%; p=.04) and PTA+DCB (30.2%; p=.05) compared to PTA alone (51.2%). Primary patency was higher after PTA+ELA+DCB (log-rank p=.04) and PTA+DCB (log-rank p=.02) compared to PTA alone at 12 months (78.7% and 70.4% vs 61.5%) and 18 months (61.6% and 67.7% vs 37.3%). Freedom from MAEs was lower after PTA+DCB (27.9%) compared to PTA alone (53.7%; p=.02) but did not differ with PTA+ELA+DCB (40.0%). It was primarily driven by TLR; 2 major amputations occurred after PTA+ELA+DCB (4.0%; p=.18). This independent study demonstrated a decrease in recurrent ISR>70% and increase in primary patency up to 18 months after PTA+ELA+DCB and PTA+DCB compared to PTA alone in the treatment of FP-ISR. It did not show an increase in MAEs but could have lacked power. This multicenter, prospective, triple-arm randomized, controlled trial focuses on the results of adjunctive therapies, such as excimer laser atherectomy (ELA) and/or drug-coated balloons (DCBs) in the treatment of in-stent restenosis (ISR) in femoropopliteal lesions in 134 patients. It has the originality of being an independent study funded by a grant from the French Ministry of Health. This study confirms a significant decrease in recurrent ISR >70% and increase in primary patency up to 18 months after the use of ELA+DCB and DCBs compared to simple percutaneous transluminal angioplasty in the treatment of femoropopliteal ISR without an increase in major adverse events.

Pragmatic Carbohydrate Quality Metrics in Relation to Glycemic Index, Glycemic Load, and Front-of-Pack Warning Labels in Grain Foods.

The challenges in the characterization of the nutritional quality of grain foods comprise obstacles to public health actions toward promotion of healthier grain-based foods. The present study investigated how carbohydrate metrics related to glycemic index (GI), glycemic load (GL), and warning labels of grain foods consumed by individuals living in São Paulo, Brazil. Information on intake of grain foods at individual level was obtained using 24 h recalls within a cross-sectional population-based survey conducted in 2015. There were 244 unique grain products reported by individuals in the survey, assessed through four metrics of carbohydrate quality, considering contents per 10 g of total carbohydrate: (1) ≥1 g fiber, (2) ≥1 g fiber and <1 g free sugars, (3) ≥1 g fiber and <2 g free sugars, and (4) ≥1 g fiber, and <2 g free sugars per 1 g of fiber. Outcomes included GI, GL, and inclusion of warning labels proposed by the Brazilian National Health Surveillance Agency (ANVISA), the Chilean Ministry of Health (1st and 3rd stages), and the Pan American Health Organization (PAHO). Metrics identified products with lower mean GI (-12.8 to -9.0 [p-values < 0.001]), and GL (-12.5 to -10.3 [p-values < 0.001]). Warning systems showed a certain degree of discrimination between products according to the metrics (p-value < 0.01 each); however, >50% of products with good nutritional quality according to the carbohydrate metrics still would receive warnings. Findings suggest that carbohydrate metrics identified products with lower GI and GL, and current warning labels may not adequately capture overall nutritional quality of grain foods.

Patient satisfaction with pharmaceutical services at primary healthcare centers under the Palestinian Ministry of Health

BackgroundThe measurement of patient satisfaction is a vital metric that enhances stakeholders to take proactive steps in improving the quality of healthcare services within medical care systems. This study assessed patient satisfaction receiving pharmaceutical services from primary health care centers in the Palestinian Ministry of Health (PMoH) governorate directorates in the West Bank.MethodsA total of 938 patients, all aged 18 years or older, completed a self-administered questionnaire. The assessment of general satisfaction was based on selected questions. Analyses were conducted to explore demographic characteristics. Mean and standard deviation (S.D.) were reported. Likert method was used to average scale satisfaction. To examine statistically significant differences, Chi-square analysis and binary logistic analysis were employed.Results56.8% of the survey respondents were women, 57.2% were 40 years or older, and 63.2% had graduated from high school. The general satisfaction score averaged 4.10 ± 0.77 indicating good satisfaction. Patients were satisfied with interpersonal relationships, with a mean score of 4.19 ± 0.70. However, satisfaction with therapy management was lower, with a mean score of 3.99 ± 0.77 indicating moderate satisfaction. A significant factor can affect patient’s satisfaction such as the location of the pharmacy (OR = 1.720, P = 0.012), the waiting area (OR = 1.671, P = 0.002) and the cleanness of pharmacy (OR = 2.307, P = 0.001).ConclusionThis study underlines the main components of patient satisfaction who receive pharmaceutical services in PMoH. It is highly recommended that PMoH must address patient dissatisfaction points in a total quality management plan.

An Analysis of COVID-19 Statistics in Rivers State, Nigeria: A Study of Demographic Patterns, Geographic Distribution, and Prevalent Symptoms from April 2020 to March 2021

Introduction: Coronavirus disease (COVID-19) is an acute infectious disease caused by the SARS-CoV-2 virus which is characterized mainly by fever and cough and is capable of progressing to severe symptoms and in some cases death. Aims: To analyze COVID-19 statistics in Rivers State, Nigeria, during the specified period to contribute to the broader understanding of the epidemiology of COVID-19 in the region. Methodology: Study Design: A cross-sectional study was conducted involving the retrieval of secondary data. Place and Duration of Study: The study was carried out at the Epidemiology Division of the Rivers State Department of Public Health, Ministry of Health, in December 2022. Participants: A total of 6,299 patients recorded between April 2020 to March 2021 in the Epidemiology Unit were included in the study. Patients with incomplete data were excluded from the analysis. Data Collection and Analysis: Secondary data recorded in Excel format was retrieved from the Epidemiology Unit of the Rivers State Ministry of Health. The data was then exported to IBM Statistical Product and Service Solutions (SPSS) version 25 for analysis. Frequencies were generated and reported in tabular format. Ethical Considerations: Ethical approval for the study was obtained from the Ethics Committee of the State Ministry of Health Board, Port Harcourt, ensuring compliance with ethical standards in research and the University of Port Harcourt Ethics Committee to the State Hospital Board. Results: The mortality rate stood at 1.4%. Port Harcourt Local Government Area (LGA) accounted for approximately two-thirds of all infections, while nearly one-third originated from Obio/Akpor LGA. Among those infected, 17.4% reported a history of travel, while 1% had attended a burial before contracting the virus. Symptomatic presentation was prevalent, with four out of every five confirmed cases (76.9%) experiencing various symptoms, with sore throat emerging as a common presentation alongside fever and other symptoms. Significant disparities were observed concerning the sex and age distribution of infections (p &lt; 0.0001). Males were more affected than females, and individuals within the age groups of 31-40 and 41-50 constituted three-fifths of the total infections. Conclusion: As the COVID-19 pandemic unfolded, a notable shift in infection rates emerged, highlighting a trend where younger demographics, notably women, became increasingly susceptible. Despite initial perceptions of heightened severity and mortality among older males, nuanced analysis revealed diverse vulnerabilities across gender and age spectrums. Occupational exposures, biological variations, and behavioural disparities all contributed to the observed gender discrepancies in infection rates and outcomes. Furthermore, the urban landscape, with its higher population density and increased mobility, served as a catalyst for the rapid spread of the virus, albeit impacting genders in differing proportions. Moreover, the varied presentation of symptoms, with sore throat emerging as a prevalent feature alongside fever and other manifestations, underscores the necessity for tailored public health interventions.

The effect of craniocervical flexion and neck endurance exercises plus pulmonary rehabilitation on pulmonary function in spinal cord injury: a pilot single-blinded randomised controlled trial.

Randomised controlled trial with computerised allocation, assessor blinding and intention-to-treat analysis. This study wanted to prove that cervicocranial flexion exercise (CCFE) and superficial neck flexor endurance training combined with common pulmonary rehabilitation is feasible for improving spinal cord injury people's pulmonary function. Taoyuan General Hospital, Ministry of Health and Welfare: Department of Physiotherapy, Taiwan. Thirteen individuals who had sustained spinal cord injury for less than a year were recruited and randomised assigned into two groups. The experimental group was assigned CCFEs and neck flexor endurance training plus normal cardiopulmonary rehabilitation. The control group was assigned general neck stretching exercises plus cardiopulmonary rehabilitation. Lung function parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), inspiratory capacity (IC), dyspnoea, pain, and neck stiffness were recorded once a week as short-term outcome measure. The experimental group showed significant time effects for FVC (pre-therapy: 80.4 ± 21.4, post-therapy: 86.9 ± 16.9, p = 0.021, 95% CI: 0.00-0.26) and PEFR (pre-therapy: 67.0 ± 33.4; post-therapy: 78.4 ± 26.9, p = 0.042, 95% CI: 0.00-0.22) after the therapy course. Furthermore, the experimental group showed significant time effects for BDI (experimental group: 6.3 ± 3.0; control group: 10.8 ± 1.6, p = 0.012, 95% CI: 0.00-0.21). The exercise regime for the experimental group could efficiently increase lung function due to the following three reasons: first, respiratory accessory muscle endurance increases through training. Second, posture becomes less kyphosis resulting increasing lung volume. Third, the ratio between superficial and deep neck flexor is more synchronised. TYGH108045. NCT04500223.