National Coverage Research Articles

COVID-19 Vaccination Coverage Among Pregnant Women by Race and Ethnicity: National Immunization Survey Adult COVID Module, United States, December 2020 to July 2022 [ID: 1375059

INTRODUCTION: Pregnant and postpartum women are at increased risk for severe illness from COVID-19. METHODS: Data from the National Immunization Survey Adult COVID Module collected April 22, 2021 to August 27, 2022, were analyzed to assess COVID-19 vaccinations (receipt of ≥1 dose) received from December 2020 to July 2022 among women aged 18–49 years who were pregnant at the time of the survey using Kaplan-Meier survival analysis. The NIS-ACM is a random-digit–dialed cellular telephone survey of adults aged 18 years or older. Data are weighted to represent the noninstitutionalized U.S. adult population and calibrated to state-level vaccine administration data. RESULTS: By the end of April 2021, national COVID-19 vaccination coverage was highest among Asian and non-Hispanic White (White) pregnant women (56.4% and 42.5%, respectively) and lower among multiple or other race (38.2%), Hispanic (34.5%), American Indian or Alaska Native (AI/AN) (34.3%), Native Hawaiian or other Pacific Islander (NH/OPI) (32.4%), and non-Hispanic Black (Black) (25.2%) pregnant women. By the end of July 2022, coverage had increased in all racial and ethnic groups and was highest among Asian (98.6%) and Hispanic (79.0%) pregnant women. Coverage was similar for multiple or other race (67.8%), White (66.2%), NH/OPI (64.6%), and Black (64.2%) pregnant women; however, coverage remained lower for AI/AN (49.1%) pregnant women. CONCLUSION: Although COVID-19 vaccination coverage among pregnant women has increased and racial and ethnic disparities have narrowed over time, approximately 1 in 3 remain unvaccinated. A strong recommendation for COVID-19 vaccination is critical for all women of reproductive age to increase coverage and help achieve vaccine equity.

Connected and Automated Mobility Services in 5G Cross-Border Environments: Challenges and Prospects

The next generation of mobile networks, namely 5G, promises significant qualitative and quantitative advances for multiple vertical domains. However, most studies and investigations assess these advances under the implicit assumption of a single network service provider, with typical national coverage. In this article, we take a close look at the automotive sector and highlight a series of challenges emerging in the context of its inherent (inter)national mobility and the corresponding importance of cross-border and/or multioperator environments. Our target is to pinpoint the key influential factors affecting the transition toward seamless (cooperative) connected and automated mobility services within and across national borders. To this end, we identify and analyze a series of challenges in the areas of, networking, application, security, and regulation. We further present and discuss a series of corresponding solutions investigated in the pragmatic context of our experimental activities.

Association between universal health coverage and the disease burden of acute illness and injury at the global level

BackgroundThis study examines the relationship between universal health coverage (UHC) and the burden of emergency diseases at a global level.MethodsData on Disability-Adjusted Life Years (DALYs) from emergency conditions were extracted from the Institute for Health Metrics and Evaluation (IHME) database for the years 2015 and 2019. Data on UHC, measured using two variables 1) coverage of essential health services and 2) proportion of the population spending more than 10% of household income on out-of-pocket health care expenditure, were extracted from the World Bank Database for years preceding our outcome of interest. A linear regression was used to analyze the association between UHC variables and DALYs for emergency diseases, controlling for other variables.ResultsA total of 132 countries were included. The median national coverage of essential health services index was 67.5/100, while the median national prevalence of catastrophic spending in the sample was 6.74% of households. There was a strong significant relationship between health service coverage and the burden of emergency diseases, with an 11.5-point reduction in DALYs of emergency medical diseases (95% CI -9.5, -14.8) for every point increase in the coverage of essential health services index. There was no statistically significant relationship between catastrophic expenditures and the burden of emergency diseases, which may be indicative of inelastic demand in seeking services for health emergencies.ConclusionIncreasing the coverage of essential health services, as measured by the essential health services index, is strongly correlated with a reduction in the burden of emergency conditions. In addition, data affirms that financial protection remains inadequate in many parts of the globe, with large numbers of households experiencing significant economic duress related to seeking healthcare. This evidence supports a strategy of strengthening UHC as a means of combating death and disability from health emergencies, as well as extending protection against impoverishment related to healthcare expenses.

Recontact: a survey of current practices and BRCA1/2 testing in Japan.

Genetic testing advances have enabled the provision of previously unavailable information on the pathogenicity of genetic variants, frequently necessitating the recontact of former patients by clinicians. In Japan, national health insurance coverage was extended to BRCA1/2 testing for the diagnosis of hereditary breast and ovarian cancer for patients who meet certain criteria in 2020, and conditions necessitating recontact were expected to increase. Studies and discussions regarding recontact have been conducted in the U.S. and Europe; however, in Japan, the national discussion around recontact remains undeveloped. We conducted a cross-sectional study by interviewing 73 facilities accredited by the Japanese Organization of Hereditary Breast and Ovarian Cancer regarding the practice of recontacting patients at these facilities. Sixty-six facilities responded that they recontact patients, but only 17 facilities had a protocol for this. The most common reason for recontact was that it could benefit the patient. Facilities that did not recontact stated that they lacked the necessary personnel or services. Most facilities indicated that a recontact system should be implemented in their practice. The increased burden on too few medical personnel, unestablished systems, patient confusion, and the right not to know were cited as barriers to implementing recontact. Although developing recommendations on recontact would be useful for providing equitable healthcare in Japan, there is an urgent need to deepen the discussion on recontacting, as negative opinions about recontacting patients were observed.

Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England.

People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the National Health Service via the Improving Access to Psychological Therapy (IAPT) primary care programme. It is currently unknown whether positive therapy outcomes may be associated with cardiovascular risk reduction. This study aimed to examine the association between psychotherapy outcomes for depression and incident CVD. A cohort of 636 955 individuals who have completed a course of psychotherapy was built from linked electronic healthcare record databases of national coverage in England: the national IAPT database, the Hospital Episode Statistics (HES) database, and the HES-ONS (Office of National Statistics) mortality database. Multivariable Cox models adjusting for clinical and demographic covariates were run to estimate the association between reliable improvement from depression and the risk of subsequent incidence of cardiovascular events. After a median follow-up of 3.1 years, reliable improvement from depression symptoms was associated with a lower risk of new onset of any CVD [hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.86, 0.89], coronary heart disease (HR: 0.89, 95% CI: 0.86, 0.92), stroke (HR: 0.88, 95% CI: 0.83, 0.94), and all-cause mortality (HR: 0.81, 95% CI: 0.78, 0.84). This association was stronger in the under 60 compared with the over 60 for all outcomes. Results were confirmed in sensitivity analyses. Management of depression through psychological interventions may be associated with reduced risk of CVD. More research is needed to understand the causality of these associations.

Establishment and Utility of SwedAD: A Nationwide Swedish Registry for Patients with Atopic Dermatitis Receiving Systemic Pharmacotherapy

SwedAD, a Swedish nationwide registry for patients with atopic dermatitis receiving systemic pharmacotherapy, was launched on 1 September 2019. We describe here the establishment of a user-friendly registry to the benefit of patients with atopic dermatitis. By 5 November 2022, 38 clinics had recorded 931 treatment episodes in 850 patients with an approximate national coverage rate of 40%. Characteristics at enrolment included median Eczema Area and Severity Index (EASI) 10.2 (interquartile range 4.0, 19.4), Patient-Oriented Eczema Measure (POEM) 18.0 (10.0, 24.0), Dermatology Life Quality Index (DLQI) 11.0 (5.0, 19.0) and Peak Itch Numerical Rating Scale-11 (NRS-11) 6.0 (3.0, 8.0). At 3 months, median EASI was 3.2 (1.0, 7.3) and POEM, DLQI, and NRS-11 were improved. Regional coverage varied, reflecting the distribution of dermatologists, the ratio of public to private healthcare, and difficulties in recruiting certain clinics. This study highlights the importance of a nationwide registry when managing systemic pharmacotherapy of atopic dermatitis.

An analysis of the uptake of anti-retroviral treatment among pregnant women in Nigeria from 2015 to 2020.

The percentage of Human Immunodeficiency Virus (HIV) positive pregnant women that receive anti-retroviral treatment in Nigeria is low and has been declining. Consequently, 14% of all new infections among children in 2020 occurred in Nigeria. A detailed analysis of available data was undertaken to generate evidence to inform remedial actions. Data from routine service delivery, national surveys and models were analyzed for the six-year period from 2015 to 2020. Numbers and percentages were calculated for antenatal registrations, HIV testing, HIV positive pregnant women and HIV positive pregnant women on antiretroviral treatment. The Mann-Kendall Trend Test was used to determine the presence of time trends when the p-value was less than 0.05. In 2020, only 35% of an estimated 7.8 million pregnant women received antenatal care at a health facility that provided and reported PMTCT services. Within these facilities, the percentage of HIV-positive pregnant women on anti-retroviral treatment from 71% in 2015 to 88% in 2020. However, declining HIV positivity rates at these antenatal clinics and an absence of expansion of PMTCT services to other pregnant women due to cost-efficiency considerations contributed to a progressive decline in national PMTCT coverage rates. To achieve elimination of mother-to-child transmission of HIV, all pregnant women should be offered a HIV test, all who are HIV positive should be given anti-retroviral treatment, and all PMTCT services should be reported.

Syphilis screening coverage and positivity by HIV treatment status among South African pregnant women enrolled in the 2019 antenatal HIV sentinel survey

We describe coverage of maternal syphilis screening, syphilis positivity, coverage of treatment and their association with maternal HIV infection and antiretroviral treatment (ART) status among pregnant women attending South African antenatal clinics. The 2019 antenatal care sentinel survey was a cross-sectional survey conducted from 1 October to 15 November 2019 at 1589 sentinel sites in all nine provinces of the country and aimed to enrol 36,000 pregnant women ages 15–49 years regardless of HIV, ART or syphilis status. Data collection procedures included obtaining written informed consent, a brief interview, medical record review and blood specimen collection. Completed data collection forms and specimens were sent to designated regional laboratories for data capture and HIV serology testing. Data analysis determined four outcomes i) syphilis screening coverage ii) syphilis positivity iii) coverage of any treatment and iv) with Benzathine penicillin G (BPG). Multivariable logistic regression models with or without interaction between HIV infection and ART status with province were used to determine factors associated with syphilis positivity. Of the 41 598 women enrolled, 35 900 were included in the analysis for syphilis screening coverage. The weighted syphilis screening coverage was 96.4% [95% Confidence Interval (CI) 95.9–96.7%] nationally and was lowest among HIV positive women not on ART at 93.5% (95% CI 92.2–94.5%). Syphilis positivity was 2.6% (95% CI 2.4–2.9%) nationally. Among those who were syphilis positive, 91.9% (95% CI 89.8–93.7%) had documentation of syphilis treatment status, of whom 92.0% (95% CI 89.8–93.9%) were treated, with the majority treated with one or more doses of BPG [92.2% (95% CI 89.8–94.3%)]. HIV-positive women, not on ART [adjusted odd ratio (aOR) 2.24 (95% 1.71–2.93)] and those on ART [aOR 2.25 (95% CI 1.91–2.64)] were more likely to be syphilis positive compared to those who were HIV negative. The national syphilis screening coverage met the global screening target of 95%. Syphilis positivity was higher among HIV positive women compared to negative women. Introduction of rapid syphilis testing and ensuring a universal supply of appropriate treatment for syphilis will reduce the likelihood of mother-to-child transmission of syphilis.

Public health insurance and the risk of cancer-specific mortality in patients with cervical cancer: A Chinese prospective cohort study.

Cervical cancer has one of the highest incidence and mortality rates of any malignant tumor of the female reproductive tract, and its longer treatment period will place significant financial strain on patients and their families. Little is known about how health insurance policies influence cervical cancer prognosis, particularly in developing countries. The relationship between cervical cancer specific death and cervical cancer all-cause mortality with public health insurance, self-payment rate, and the combined effect of public health insurance and self-payment rate was investigated in this study. From 2015 to 2019, a prospective longitudinal cohort study on cervical cancer was carried out in Chongqing, China. We chose 4,465 Chongqing University Cancer Hospital patients who had been diagnosed with cervical cancer between 2015 and 2019. The self-payment rate and public health insurance are taken into account in our subgroup analysis. After applying the inclusion and exclusion criteria, we describe the demographic and clinical traits of patients with various insurance plans and self-payment rates using the chi-square test model. The relationship between cervical cancer patients with various types of insurance, the self-payment rate, and treatment modalities is examined using the multivariate logistic regression model. After applying the inclusion and exclusion criteria, we summarize the demographic and clinical traits of patients with various insurance plans and self-payment rates using the chi-square test model. The association between cervical cancer patients with various types of insurance, the self-payment rate, and treatment modalities is examined using the multivariate logistic regression model. The cumulative hazard ratio of all-cause death and cervical cancer-specific mortality for various insurance types and self-payment rates was then calculated using the Cox proportional hazard model and the competitive risk model. This study included a total of 3,982 cervical cancer patients. During the follow-up period (median 37.3 months, 95% CI: 36.40-38.20), 774 deaths were recorded, with cervical cancer accounting for 327 of them. Patients who obtained urban employee-based basic medical insurance (UEBMI) had a 37.1% lower risk of all-cause death compared to patients who received urban resident-based basic medical insurance (URBMI) (HRs = 0.629, 95% CI: 0.508-0.779, p = 0.001). Patients with a self-payment rate of more than 60% had a 26.9% lower risk of cervical cancer-specific mortality (HRs = 0.731, 95% CI: 0.561-0.952, p <0.02). The National Medical Security Administration should attempt to include the more effective self-paid anti-tumor medications into national medical insurance coverage within the restrictions of restricted medical insurance budget. This has the potential to reduce not only the mortality rate of cervical cancer patients, but also their financial burden. High-risk groups, on the other hand, should promote cervical cancer screening awareness, participate actively in the state-led national cancer screening project and enhance public awareness of HPV vaccine. This has the potential to reduce both cervical cancer patient mortality and the financial burden and impact.

Front-page prominence and newspaper ownership: Examining US women’s national team coverage after 2015 and 2019 World Cup victories

The FIFA Women’s World Cup was a steeple of professional sport in the summers of 2015 and 2019. Did newspapers deem the story newsworthy enough to reach the front page? This content analysis of over 900 U.S. newspapers’ front pages published on July 6, 2015 (the day after the 2015 WWC final) or July 8, 2019 (the day after the 2019 WWC final) indicates that, for 1 day, newspapers avoided the trap of gendered, trivialized sport representation. Also, content changes highlight the potential impact from newspaper ownership consolidation on layout design that can have long-term implications for agenda-setting research.

Clinical and Scientific Challenges to Effectiveness Studies Under Coverage with Evidence Development in Alzheimer's Disease.

The Centers for Medicare and Medicaid Services (CMS) has recently issued a national coverage determination for US Food and Drug Administration (FDA)-approved anti-amyloid monoclonal antibodies (mAbs) for the treatment of Alzheimer's disease (AD) under coverage with evidence development (CED). CED schemes are complex, costly, and challenging, and often fail to achieve intended objectives because of administrative and implementation issues. AD is a heterogeneous, progressive neurodegenerative disorder with complex care pathway that additionally presents scientific challenges related to the choice of study design and methods used in evaluating CED schemes. These challenges are herein discussed. Clinical findings from the US Veterans Affairs healthcare system help inform our discussion of specific challenges to CED-required effectiveness studies in AD.

Local versus National News about COVID-19 in Spain: Coverage and Public Engagement

ABSTRACT In this study, we evaluated the differences between national and local newspapers coverage of the COVID-19 pandemic in Spain using a dataset of 421,438 Facebook posts. We assessed the trends in the interest in COVID-19 of local and national newspapers, measured as the proportion of COVID-19 news; and also, the trends in the interest of their readers, measured as the proportion of interactions related to COVID-19. While the overall interest in COVID-19 in local and national newspapers was similar and high, some differences were observed between several of the pandemic phases. National news media interest was higher during the long central phases of the pandemic, but certain news fatigue was observed by the end of 2021. Local news media interest seemed more constant throughout the pandemic. Surprisingly, the overall interest of national and local newspapers was consistently lower than the interest of their readers. Our study also shows homogenous responses among local newspapers during the key phases of the pandemic and heterogeneous responses in the remaining phases. Finally, we found that in the case of local media, their news and interactions were more correlated with the national epidemiological indicators (i.e., cases and deaths) than with the local indicators.

Predicting health services utilization using a score of perceived barriers to medical care: evidence from rural Senegal

BackgroundEnsuring access to healthcare services is a key element to achieving the Sustainable Development Goal 3 of “promoting healthy lives and well-being for all” through Universal Health Coverage (UHC). However, in the context of low- and middle-income countries, most studies focused on financial protection measured through catastrophic health expenditures (CHE), or on health services utilization among specific populations exhibiting health needs (such as pregnancy or recent sickness).MethodsThis study aims at building an individual score of perceived barriers to medical care (PBMC) in order to predict primary care utilization (or non-utilization). We estimate the score on six items: (1) knowing where to go, (2) getting permission, (3) having money, (4) distance to the facility, (5) finding transport, and (6) not wanting to go alone, using individual data from 1787 adult participants living in rural Senegal. We build the score via a stepwise descendent explanatory factor analysis (EFA), and assess its internal consistency. Finally, we assess the construct validity of the factor-based score by testing its association (univariate regressions) with a wide range of variables on determinants of healthcare-seeking, and evaluate its predictive validity for primary care utilization.ResultsEFA yields a one-dimensional score combining four items with a 0.7 Cronbach’s alpha indicating good internal consistency. The score is strongly associated—p-values significant at the 5% level—with determinants of healthcare-seeking (including, but not limited to, sex, education, marital status, poverty, and distance to the health facility). Additionally, the score can predict non-utilization of primary care at the household level, utilization and non-utilization of primary care following an individual’s episode of illness, and utilization of primary care during pregnancy and birth. These results are robust to the use of a different dataset.ConclusionAs a valid, sensitive, and easily documented individual-level indicator, the PBMC score can be a complement to regional or national level health services coverage to measure health services access and predict utilization. At the individual or household level, the PBMC score can also be combined with conventional metrics of financial risk protection such as CHE to comprehensively document deficits in, and progress towards UHC.

The Hidden Impact of the COVID-19 Pandemic on Routine Childhood Immunization Coverage in Cameroon.

Background: The third round of the global pulse survey demonstrated that the abrupt and rapid progression of the COVID-19 pandemic significantly disrupted childhood immunization in many countries. Although Cameroon has reported over 120,000 COVID-19 cases, the reported national childhood vaccination coverage during the pandemic seems to have increased compared to that during the pre-COVID-19 period. Indeed, the first dose of the diphtheria, tetanus, and pertussis-containing vaccine (DTP-1) coverage increased from 85.4% in 2019 to 87.7% in 2020, and DTP-3 coverage increased from 79.5% in 2019 to 81.2% in 2020. The paucity of literature on the impact of COVID-19 on childhood vaccination in COVID-19 hotspot regions poses a challenge in developing a context-specific immunization recovery plan, hence the need to conduct this study. Methodology: We conducted a cross-sectional study using 2019 (pre-pandemic period) and 2020 (pandemic period) district childhood immunization data from the DHIS-2 database, weighted using completeness for each data entry against regional data completeness in 2020. Based on COVID-19 incidence, two hotspot regions were selected, with all districts (56/56) included in the final analysis. The Chi-square test was used to compare DTP-1 and DTP-3 coverage during the pre-pandemic and pandemic periods. Results: In the two hotspot regions, 8247 children missed DTP-1, and 12,896 children did not receive DTP-3 vaccines in the pandemic period compared to the results from the pre-pandemic period. Indeed, there was a significant drop in DTP-1 and DTP-3 coverage of 0.8% (p = 0.0002) and 3.1% (p = 0.0003), respectively, in the Littoral Region. Moreover, the Centre Region reported a 5.7% (p < 0.0001) and 7.6% (p < 0.0001) drop in DTP-1 and DTP-3 coverage, respectively. Most districts in the hotspot regions reported a decline in childhood immunization access (62.5%) and utilization (71.4%). Indeed, in the Littoral Region, 46% (11/24) and 58% (14/24) of districts experienced decreased vaccination access and utilization, respectively. Meanwhile, 75% (24/32) and 81% (26/32) of districts in the Centre Region experienced a drop in vaccination access and utilization, respectively. Conclusion: This study reported a situation where the national immunization indicators mask the impact of COVID-19 on childhood immunization in heavily hit regions. Therefore, this study presents valuable information for ensuring continuous vaccination service delivery during public health emergencies. The findings could also contribute to developing an immunization recovery plan and informing policy on future pandemic preparedness and response.

The variability of diagnosed migraine epidemiology amongst different municipalities in southern Israel

BackgroundAppropriate and timely diagnosis is one of the most important milestones in effective migraine care and is affected by public awareness, access to medical care, health care systems, and physicians’ knowledge. We assessed the variability in migraine diagnosis rates in different communities under universal national health coverage in Israel.MethodsIn this population-based retrospective, observational, cohort study, adult (≥18 years) migraine patients were identified in the computerized database of the southern district of the Clalit Health Services Health Maintenance Organization (HMO) based on recorded diagnosis and/or purchase of specific anti-migraine acute medication (triptans). Migraine prevalence in 2018 was calculated in the entire study population and in different municipalities. We utilized a standardized (age and gender) mortality ratio (SMR) approach for comparison among the municipalities.ResultsIn 2018, a total of 29,938 migraine patients were identified out of 391,528 adult HMO members, with an overall prevalence (per 10,000) of migraine of 764.64 (7.65%), 1143.34 (11.43%) for women, and 374.97 (3.75%) for men. Among the municipalities, adjusted prevalence (per 10,000) ranged from 386.15 (3.86%) to 1320.60 (13.21%). The female-to-male ratio ranged from 1.8:1 to 5.1:1. Prevalence rates were positively associated with the socioeconomic status of the municipalities (Spearman rho = 0.472, P = 0.031).ConclusionsHigh variability in the prevalence of diagnosed migraine suggests underdiagnosis. Resources for awareness and educational programs should be directed to low diagnosed prevalence communities.Graphical

Studying Vaccination Coverage and Design of Short Message Service Based Reminder to Improve Children Vaccination Coverage in Hawassa; Sidama Region; Ethiopia

A vaccine is a kind of remedy that trains the body’s protection system so that it can combat an infection. The national routine immunization coverage in Ethiopia is low. Among the main reason for defaulting children vaccinations are disremembering the appointment date, communication gap between service providers and the community, knowhow about vaccination and etc. This work is to investigate vaccination coverage in Hawassa city and main reasons of vaccination drop out, and then provide a solution for that main reason. Data was collected from 360 children whose age is between 1 to 2 years who live in Hawassa city. The data analysis result showed that only 51% of the children are fully vaccinated; and the main reason for vaccination dropout which weighs 57% was found to be disremembering the appointment date. Providing a solution to not only one of the main reasons but also for the one which weighs the most in the city of this study will improve the vaccination coverage. As the main reason is found to be disremembering the vaccination appointment date, this work provides a Short Message Service (SMS) based automatic reminding system. The design part uses database, OzekiNG network gateway and global system for mobile communication modem with active subscriber identity module. In this system the health extension workers will register the clients’ detailed information including appointment dates during the birth of baby that will be accessed periodically by the OzekiNG to send the reminder SMS to the mothers one day a head to the day of vaccination. After automatic reminding mechanism was developed and implemented, coverage of fully vaccinated children increases from 51% to 71% and the problem of forgetting appointment date decreases from 57% to 14%. The efficiency of the developed system is found to be 85%. From the above-mentioned results and the current available communication mechanisms, it can be concluded that the reminding system can be simply implemented to improve the child vaccination coverage by bridging the gap due to disremembering the vaccination appointment date.

Studying Vaccination Coverage and Design of Short Message Service Based Reminder to Improve Children Vaccination Coverage in Hawassa; Sidama Region; Ethiopia

A vaccine is a kind of remedy that trains the body’s protection system so that it can combat an infection. The national routine immunization coverage in Ethiopia is low. Among the main reason for defaulting children vaccinations are disremembering the appointment date, communication gap between service providers and the community, knowhow about vaccination and etc. This work is to investigate vaccination coverage in Hawassa city and main reasons of vaccination drop out, and then provide a solution for that main reason. Data was collected from 360 children whose age is between 1 to 2 years who live in Hawassa city. The data analysis result showed that only 51% of the children are fully vaccinated; and the main reason for vaccination dropout which weighs 57% was found to be disremembering the appointment date. Providing a solution to not only one of the main reasons but also for the one which weighs the most in the city of this study will improve the vaccination coverage. As the main reason is found to be disremembering the vaccination appointment date, this work provides a Short Message Service (SMS) based automatic reminding system. The design part uses database, OzekiNG network gateway and global system for mobile communication modem with active subscriber identity module. In this system the health extension workers will register the clients’ detailed information including appointment dates during the birth of baby that will be accessed periodically by the OzekiNG to send the reminder SMS to the mothers one day a head to the day of vaccination. After automatic reminding mechanism was developed and implemented, coverage of fully vaccinated children increases from 51% to 71% and the problem of forgetting appointment date decreases from 57% to 14%. The efficiency of the developed system is found to be 85%. From the above-mentioned results and the current available communication mechanisms, it can be concluded that the reminding system can be simply implemented to improve the child vaccination coverage by bridging the gap due to disremembering the vaccination appointment date.

Os efeitos espaciais são fatores determinantes dos preços das terras agrícolas no Brasil

Abstract This study aims to determine whether spatial effects are determinants of agricultural land prices in Brazil. For this purpose, data on the value of the bare land in municipalities in Brazil for 2020, provided by the Federal Revenue Service, were used. Although this database has national coverage, the contiguous data necessary for the application of spatial econometric models allowed us to cover the central-south region of the country. An exploratory spatial data analysis was performed, and the spatial Durbin econometric model was applied. Based on our results, there is a strong spatial dependence on land price, manifested both in the dependent variable, spatially lagged, and through the spillover effects of the independent variables. In addition, it was found that the degree of urbanization of a municipality, the municipal gross domestic product per capita, the average size of properties, the agricultural productivity, and the area dedicated to soybean planting in a rural property are also important determining factors in the pricing of agricultural land. Accordingly, it is possible to conclude that spatial effects influence the determination of agricultural land prices in Brazil.

Putting Politics Aside: The Congressional Baseball Game

Putting Politics AsideThe Congressional Baseball Game Dylan Garvin (bio) and Rick Burton (bio) overview For many Americans, watching representatives from the two major US political parties locked in fierce political battles is nothing new. And while legislative disagreements and challenges have traditionally taken place inside the US Capitol in Washington, DC, the two parties that have dominated American politics for more than 150 years have annually taken their combative spirit to nearby settings (most recently Washington Nationals Park) to settle their perceived and very real differences via competitive baseball. This contest, the Congressional Baseball Game (CBG) played between Democrats and Republicans in the nation’s capital, stands as an American cultural tradition unlike almost any other. Despite receiving limited national media coverage, this annual baseball event serves as a symbolic strand in America’s foundational and social DNA. From a historical standpoint, the Congressional Baseball Game started as a friendly competition between the two opposing parties. It has since grown into a significant public fundraising event raising millions of dollars for various charitable causes. It has also enjoyed visitations from sitting American presidents, including Woodrow Wilson, the first to attend the game in 1917. Years later Dwight D. Eisenhower threw out the first pitch for the 1953 contest.1 The most recent presidential attendee was Joe Biden, who made a brief appearance during the 2021 game.2 The CBG has also showcased three future presidents. Both the thirty- eighth president, Gerald Ford, and forty- first, George H. W. Bush, played for the Republican team during their time in the House of Representatives. Ford is credited with hitting the first recorded grand slam in the game’s history in 1957.3 Bush, who captained Yale’s baseball team during his time in New Haven, Connecticut, was a mainstay in the Republicans’ infield during his two terms [End Page 89] in Congress (1967–71).4 The third future president to play in the game, Joe Biden, is the only Democratic president to do so. Biden made three appearances during his time in the Senate and during the 1974 matchup wore a Philadelphia Phillies uniform, which he described as having been “stolen” from the team. The uniform happened to be the number forty- six, the same number as his future presidency.5 Interestingly, since its inception more than 112 years ago, the game has built a distinct political legacy filled with numerous narrative twists and turns, perhaps befitting of a game that has often been described as America’s national pastime. The game has also featured former professional baseball players, including a National Baseball Hall of Fame member, widely celebrated as one of the greatest major league pitchers ever. But of all the politicians to ever play the game, the best player ever to compete in the congressional game (by a wide margin) never played past the inter-collegiate (NCAA) level. the father of the game The first game between congressional Democrats and Republicans took place in 1909. This initial contest was organized by John Tener, a first-year congressman from Pennsylvania and former Major League Baseball (MLB) player. The event was designed as a change of pace for the lawmakers, who were used to contesting legislation within the walls of the Capitol, but as the proposed game date drew closer, members became more excited.6 At the price of seventy-five cents per ticket, more than one thousand attendees filed into Washington’s American League Park to watch something far removed from an elite baseball game. In staging the game, however, the modestly talented politicians could suggest their patriotism (by playing America’s symbolic game) but also show a “down- home” linkage to their constituencies (by rolling up their figurative sleeves and taking turns in the batter’s box). This first game ended after a full seven innings with the Democrats’ 26– 16 victory. The Associated Press summed the game up by claiming, “More varieties of baseball were played in that game than [were] ever crowded into seven innings before.”7 The game included fourteen errors in total, nine by the Republicans. The Washington Times (which was published between 1894 and 1939 and should not be confused with the contemporary conservative...

Abstract P5-04-09: Analysis of an update to a novel breast cancer screening web-app

Abstract Introduction A minority of women with breast cancer in Mexico are diagnosed through a screening program with a low rate of national coverage of about 20%, which translates into late diagnosis and worse outcomes. The detection of high-risk groups through easy-access interventions is essential to increase the screening rate. OBJECTIVE To identify and analyze patients at high risk of breast cancer, through a web app specially designed for this purpose. MATERIAL AND METHODS The web app stratified respondents according to breast cancer risk into 4 categories: very high risk (symptomatic), high lifetime risk, average risk (usual screening recommendations), or low risk. The app was programmed to guide patients to a risk-based information page or urge them to seek medical advice if indicated (https://cuccuanl.com/tamiz_mama/). The web app also provided the contact information of our center, or an appointment could also be scheduled within the app. Distribution was made via social media. An upgrade of the app was launched, which expanded the functionality with the inclusion of the Gail model to identify women with a high lifetime risk for developing breast cancer and the option for a simple interpretation of mammographic results. In version 2.0, the patients were divided into 2 populations, the first one which already had a breast imaging test but wished to know what the BIRADS score obtained meant and the other group were those who answered a simple survey similar to the one available on version 1.0, with added questions to calculate the Gail model risk. RESULTS The web app was originally released in October 2021 with a total number of 1,012 women answering the survey. The update was released in June 2022 with 406 new subjects. 281 patients wished for a risk calculation with no prior breast imaging tests and 124 patients already had a breast image diagnosis test that wanted a simple interpretation. Table1 depicts the answers given between both versions. Among the group of patients that had a mammography but had doubts about the result 12.9% (n=16) reported a BIRADS 0, 12.1% (n=15) BIRADS 1, 46% (n=57) BIRADS 2, 14.5% (n=18) BIRADS 3, and 14.4% (n=18) BIRADS 4 or 5. To date 41 patients have booked an appointment at the cancer prevention clinic directly within the webapp for further evaluation. DISCUSSION AND CONCLUSION The changes in the criteria of high risk did not translate into changes in the proportion of patients considered at high lifetime risk of breast cancer, but these changes made might be more specific for subsequent screening and chemoprevention strategies. The app persisted with a high proportion of symptomatic patients. The results of integration of the simple mammography interpretation were surprising, with a high proportion of subjects with indication for a biopsy founded. In the Mexican population there is a significant gap between the screening mammography and the first consultation with a specialist, averaging 113 days from an abnormal screening test to a diagnosis of breast cancer (1), which delays treatment initiation resulting on a worst outcome. These kinds of apps may empower patients to seek earlier consultation if warranted or educate patients on their personal risk for developing cancer so they may have a closer adherence to early detection programs. These results and subsequent updates might help evolve the app into something more akin to a digital navigator for patients. Bibliography 1)Unger-Saldaña K, Cedano Guadiamos M. Delays to diagnosis and barriers to care for breast cancer in Mexico and Peru: a cross sectional study. The Lancet Global Health. 2020 Apr 1;8:S16. Table 1 Results stratified by risk groups between version 1.0 and 2.0 Citation Format: Jose F. Muñoz Lozano, Omar Zayas Villanueva, Estefania Abundis Marquez, Fernando Alcorta Nuñez, Maria Fernanda Noriega, Carlos Salazar Mejia, Celia B. Gonzalez Alcorta, Diana Cristina Pérez Ibave, Victor Oyervides Juarez, Larisa M. Renteria Garcia, Adelina Alcorta Garza, Juan Francisco Gonzalez Guerrero, David Hernandez, Rafael Piñeiro Retif, Oscar Vidal Gutiérrez. Analysis of an update to a novel breast cancer screening web-app [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-09.