Treatment Policy Research Articles

Analyzing disease control through testing game approach embedded with treatment and vaccination strategies.

This research introduces an expanded SEIR (Susceptible-Exposed-Infected-Recovered) model that incorporates the components of testing, treatment, and vaccination. The study utilizes an evolutionary game theory (EGT) framework to investigate the impact of human behavior on the acceptance and implementation of these interventions. The choice to undergo testing and vaccination is considered a strategic decision influenced by perceived risks and benefits. Regarding disease dynamics, adherence to vaccination and testing protocols is seen as a behavioral factor. The present study employs a finite difference method to numerically examine the impact of proactive vaccination and retroactive treatment policies on human behavior. The investigation focuses on these policies' individual and combined effects, considering various factors, including vaccination and testing costs, vaccine efficacy, awareness level, and infection rates. The findings indicate that the integration of heightened awareness and enhanced vaccination efficacy can successfully alleviate the transmission of diseases, even in situations where the expenses associated with testing and vaccination are substantial. Reducing infections in situations characterized by low or moderate awareness or vaccination effectiveness is contingent upon low testing costs. The final epidemic size (FES) negatively correlates with testing and vaccine costs, indicating that lower costs are linked to a lower FES. Optimal vaccine coverage (VC) occurs when vaccine costs are minimal and vaccine efficiency is efficient, whereas treatment coverage (TC) reaches its peak when testing costs are minimal. This research underscores the significance of considering human behavior and the intricate relationship between vaccination, testing, and treatment approaches in managing the transmission of contagious illnesses. It offers valuable perspectives for policymakers to mitigate the consequences of epidemics.

A simulation study showed that linear regression and Mann-Whitney test can be used to analyse the Days Alive and at Home by day 30 (DAH30) outcome in a randomized controlled trial.

The aims of the work were to consider the properties of the DAH30 from a statistical perspective, and to conduct a simulation study exploring the use of simple (unadjusted) linear regression and Mann-Whitney test as the method of analysis reflect realised analysis options. The days alive and at home by day 30 (DAH30) has been proposed a patient-centric outcome, and clinically relevant outcome suitable for clinical trials. It has unusual statistical properties, and suitability of standard statistical analysis methods is unclear. The properties of DAH30 were reviewed. Simulations based upon 1:1 allocation in a RCT based upon empirical data were conducted reflecting different additive and realised (reflecting the DAH30) treatment effects, sample sizes and distributions with varying and central locations and zero value level. A variety of metrics were used to assess performance (including bias, coverage, rejection rate). Linear regression provided a valid estimate of the unadjusted average treatment effect with an additive treatment. This was confirmed in terms of bias, estimation of variance, rejection rate in the absence of an effect, and coverage of the 95% confidence interval for the true realised effect. Mann-Whitney provided greater (power) than linear regression in some situations. Simple linear regression is a reasonable analytic option for the DAH30 for estimating the average treatment effect in the RCT cohort (i.e. an intention to treat, or "treatment policy" estimand) where zero-inflation is relatively low. Mann-Whitney test in some circumstances (small effects and smaller samples sizes) provides better ability (like for like) to detect a difference between the groups.

Global, regional, and national burden inequality of chronic kidney disease, 1990-2021: a systematic analysis for the global burden of disease study 2021.

Chronic kidney disease (CKD) is a significant global health issue, often linked to diabetes, hypertension, and glomerulonephritis. However, aggregated statistics can obscure heterogeneity across subtypes, age, gender, and regions. This study aimed to analyze global CKD trends from 1990 to 2021, focusing on age, gender, socio-demographic index (SDI), and regional variations. Data were extracted from the Global Burden of Disease (GBD) 2021 database, covering prevalence, incidence, mortality, and disability-adjusted life years (DALYs). These were presented as counts per 100,000 population and age-standardized rates, with uncertainty intervals (UIs) to highlight variability. Joinpoint regression was used to assess trends over the 30-year period. In 2021, global CKD prevalence was 359 million, with 11.13 million new cases, 1.53 million deaths, and 44.45 million DALYs-up 92, 156, 176, and 114% since 1990. While prevalence slightly declined, incidence, mortality, and DALYs increased significantly. CKD burden varied by region and age, with notable gender disparities. The study highlights a dramatic rise in CKD burden linked to population growth and aging, emphasizing the need for targeted treatment and effective global healthcare policies.

Smart Imitator: Learning from Imperfect Clinical Decisions.

This study introduces Smart Imitator (SI), a 2-phase reinforcement learning (RL) solution enhancing personalized treatment policies in healthcare, addressing challenges from imperfect clinician data and complex environments. Smart Imitator's first phase uses adversarial cooperative imitation learning with a novel sample selection schema to categorize clinician policies from optimal to nonoptimal. The second phase creates a parameterized reward function to guide the learning of superior treatment policies through RL. Smart Imitator's effectiveness was validated on 2 datasets: a sepsis dataset with 19711 patient trajectories and a diabetes dataset with 7234 trajectories. Extensive quantitative and qualitative experiments showed that SI significantly outperformed state-of-the-art baselines in both datasets. For sepsis, SI reduced estimated mortality rates by 19.6% compared to the best baseline. For diabetes, SI reduced HbA1c-High rates by 12.2%. The learned policies aligned closely with successful clinical decisions and deviated strategically when necessary. These deviations aligned with recent clinical findings, suggesting improved outcomes. Smart Imitator advances RL applications by addressing challenges such as imperfect data and environmental complexities, demonstrating effectiveness within the tested conditions of sepsis and diabetes. Further validation across diverse conditions and exploration of additional RL algorithms are needed to enhance precision and generalizability. This study shows potential in advancing personalized healthcare learning from clinician behaviors to improve treatment outcomes. Its methodology offers a robust approach for adaptive, personalized strategies in various complex and uncertain environments.

Tailored text-messaging versus standard Quitline telephone counselling for smoking cessation among people who smoke from a low-socio-economic status background in Australia: A study protocol for a non-inferiority randomized controlled trial (The Quit By Phone Study).

Signficant inequalities in tobacco smoking exist, with higher smoking rates among people from low-socio-economic status (low-SES) populations. Tailored technology-based programs for low-SES smoking populations have the potential for high reach, but require effectiveness data from large-scale trials. This trial among Australians who smoke from a low-SES background will determine the effectiveness and cost-effectiveness of tailored text-message (TTM) support compared with standard Quitline (SQL) telephone support service. This is a two-arm, parallel group, randomized, non-inferiority trial with allocation concealment and blinded outcome assessment in an Australian population within the greater Sydney region in New South Wales. Participants are adults who smoke daily (n = 1246), are interested in quitting and currently receiving a government pension or allowance, and will be recruited via advertisements. Participants will be randomized (1:1 ratio) to receive either 12 months of TTM quit support or enrolment in SQL telephone support. Assessments will be completed at baseline (telephone interview), within 1 month (check-in call), at 3months (on-line questionnaire) and 12 months (telephone interview) post-randomization. The primary outcome will be 6-month continuous abstinence verified by carbon monoxide breath test at 12-month follow-up. The study will test whether TTM is non-inferior to SQL by a non-inferiority margin of 2%, i.e. the quit rate in the TTM group will be no worse than 2% less than the quit rate in the SQL group. Secondary outcomes will include self-reported continuous and point prevalence abstinence and acceptability and cost-effectiveness of TTM versus SQL. Should the tailored text-message support prove non-inferior and more cost-effective than Quitline for this population, this will provide an opportunity for the upscaling of an effective, inexpensive and tailored quit support service. The trial findings will inform cessation treatment policy for priority populations in Australia and globally.

Outcomes of free flap reconstructive surgery in cancer patients-institutional experience

Background: The success rate of free flap reconstruction following cancer surgery has steadily improved over past decades and has achieved a success rate of 91–99%, but occasional failures still occur. The aim of this study was to identify the outcomes of free flap reconstructions in our institution. The primary objective was to assess the success rates of free tissue transfer. The second objective was to assess independent preoperative, intra-operative, and postoperative risk factors for flap loss after microvascular reconstruction. Methods: All consecutive cancer patients who received a free flap for head and neck, appendicular bone, perineal, and extremity reconstruction between October 2020 and September 2023 in our institute were included. Patient characteristics, surgical data, postoperative complications, and reoperations were collected. Results: A total of 37 patients who underwent reconstruction by free flaps were analysed. The overall flap success rate was 73%. Among 37 patients, 12 (32.4%) had flap complications and 10 (27%) had flap loss. Smoking, comorbidity, and operating time did not show significant association with flap failure whereas the choice of flap, reconstruction post radiation, and reconstruction for recurrent cancers showed significant association with flap loss. Conclusion: The overall success rate of 73% in free flap reconstructive surgery in our study mandates us to modify our treatment policy by careful patient selection, better choice of free flap, improved treatment algorithm in terms of flap monitoring and timing of re-exploration, which will help in reduction of free flap failure rates.

Surveillance of public health pathogens in Lagos wastewater canals: a cross-sectional study

BackgroundWastewater-based epidemiology (WBE) is already being adopted for the surveillance of health conditions of communities and shows great potential for the monitoring of infectious pathogens of public health importance. There is however paucity of robust data to support extensive WBE in Nigeria. This study evaluated the prevalence of clinically relevant infectious pathogens and provided antimicrobial resistance profiles of bacteria pathogens in wastewater canals in Lagos State at a single point in time.MethodsThis is a cross-sectional survey of wastewater canals in 20 Local Government Areas (LGAs) in Lagos State for detection of bacteria pathogens of public health importance including non-tuberculous mycobacteria and SARS-Cov-2 virus using cultural analysis and conventional Polymerase Chain Reaction (PCR) techniques. Descriptive epidemiological survey of communities around the canals was done using questionnaires to assess exposure pathways. Statistical analysis was done using SPSS version 27 while P value of < 0.05 was considered as significant.ResultsThree thousand and fifty-four (3054) questionnaires were administered to 1215 (39.8%) females and 1658 (54.3%) males in communities situated around 40 canals in 20 LGAs. Although majority (81.8%) reported using water closet toilet system and pit latrine (12.5%), a few of them admitted to open defaecation [101 (3.3%)] while 299 (9.8%) engaged in open field waste disposal. SARS-CoV-2 was not detected from wastewater in this study. Two mycobacterial species that included Mycobacterium fortitium group (13, 32.5%) and Mycobacterium kansasii (11, 27.5%) were identified in 15 out of 20 LGAs sampled. A total of 123 bacteria pathogens were isolated across the 40 canals. Prominent enteropathogens isolated included Escheriachia coli (28.5%), Salmonella spp (16.3%), Vibro cholerae (10.6%) and Shigella spp (5.7%). Extended spectrum beta-lactamase genes were prominent (87.5%) in the wastewater samples with almost a half (42.5%) of the canals containing both SHV and CTX-M.ConclusionThis study highlights the presence of pathogens with potential to cause epidemic in wastewater canals in Lagos State and provides evidence to inform policy and strategies for wastewater monitoring and treatment. Further studies involving longitudinal monitoring of time-based variations is needed to identify trends in pathogen loads and AMR patterns over time.

Neurofilament Light Chain Levels in Serum and Cerebrospinal Fluid Do Not Correlate with Survival Times in Patients with Prion Disease.

Prion diseases, including Creutzfeldt-Jakob disease (CJD), are deadly neurodegenerative disorders characterized by the buildup of abnormal prion proteins in the brain. This accumulation disrupts neuronal functions, leading to the rapid onset of psychiatric symptoms, ataxia, and cognitive decline. The urgency of timely diagnosis for effective treatment necessitates the identification of strongly correlated biomarkers in bodily fluids, which makes our research crucial. In this study, we employed a fully automated multiplex ELISA (Ella®) to measure the concentrations of 14-3-3 protein, total tau protein, and neurofilament light chain (NF-L) in cerebrospinal fluid (CSF) and serum samples from patients with prion disease and analyzed their link to disease prognosis. However, in North American and European cases, we did not confirm a correlation between NF-L levels and survival time. This discrepancy is believed to stem from differences in treatment policies and measurement methods between Japan and the United States. Nonetheless, our findings suggest that NF-L concentrations could be an early diagnostic marker for CJD patients with further enhancements. The potential impact of our findings on the early diagnosis of CJD patients is significant. Future research should focus on increasing the number of sCJD cases studied in Japan and gathering additional evidence using next-generation measurement techniques.

A Scoping Review of the Current Knowledge of the Social Determinants of Health and Infectious Diseases (Specifically COVID-19, Tuberculosis, and H1N1 Influenza) in Canadian Arctic Indigenous Communities.

Social determinants of health (SDHs) and the impact of colonization can make Canadian Arctic Indigenous communities susceptible to infectious diseases, including the coronavirus disease 2019 (COVID-19). This scoping review followed the PRISMA guidelines for scoping reviews and studied what is known about selected pandemics (COVID-19, tuberculosis, and H1N1 influenza) and SDHs (healthcare accessibility, food insecurity, mental health, cultural continuity, housing, community infrastructure, and socioeconomic status (SES)) for Canadian Arctic Indigenous communities. Original studies published in English and French up to October 2024 were located in databases (PubMed, Medline, and CINAHL), AlterNative: An International Journal of Indigenous Peoples, and through reference tracking. We included 118 studies: 6 relating to COVID-19, 5 to influenza, 5 to TB, 27 to food insecurity, 26 to healthcare access, 22 to mental health, 9 to SES, 8 to housing, 7 to cultural continuity, and 3 to community infrastructure. SDHs affecting Indigenous individuals include food insecurity, limited healthcare access, mental health challenges, low SES, suboptimal housing, and limited cultural continuity. These findings are relevant to other Arctic regions. It is crucial to understand how SDHs impact the health of Arctic communities and to utilize this information to inform policy and practice decisions for pandemic prevention, management, and treatment. Many SDHs pose challenges for preventing and managing infectious diseases.

Perception of patient-centered care in three fertility clinics: influence of domestic or cross-border treatment and reimbursement policy

Introduction: This study aimed to evaluate the experience of patients undergoing patient-centered care (PCC) at three fertility clinics in Southeastern Europe in terms of the treatment cost coverage and quality of care provided. Methods: Couples who underwent assisted reproductive technology (ART) were divided into three groups: (i) Slovenian patients covered under the national insurance programme; (ii) self-pay patients receiving treatment in their country of origin/a clinic abroad; and (iii) cross-border self-pay patients receiving treatment in Maribor, Slovenia. A standardized questionnaire, the “Patient Centeredness Questionnaire on Infertility Treatment (PCQ-Infertility)”, was translated into each patient’s native language and administered to 400 couples, of whom 78% completed it. For each of the three patient groups, the mean scores of the PCC domains and indicators were calculated. These data were then used for the score gap analysis. Results: Overall, the domain assessing the competence level of medical staff produced the biggest score domain gap (SDG) in the group of cross-border, self-pay patients, while the smallest score was observed for the health organization domain in the group of domestic patients with reimbursed cycles. In our research, the indicator corresponding to information about any possible side-effects of the prescribed medication produced the smallest score indicator gap (SIG), while the biggest SIG was observed for staff members assigned to be contacted for questions at any time. Conclusion: The results did not show that the financing method of ART treatment affected patient experiences of PCC. Although the competence of the medical staff is rated highly, domestic patients with reimbursed ART cycles continue to experience a lack of PCC in the health organization domain.

Dengue infection during pregnancy and the occurrence of pathological neonatal outcome: a systematic review and meta-analysis

Background Dengue infection during pregnancy increases the risk of maternal and neonatal complications; therefore, the objective of this research is to determine these outcomes and describe the clinical manifestations of the infection. Methods A systematic review of studies published in PubMed, MEDLINE, LILACS, Web of Science, Scopus and thesis repositories published between 2013 and October 2023 was performed. DeCS and MeSH dengue and maternal-neonatal outcome were used. Thirteen studies were selected and the New Castle-Ottawa scale was used to assess their quality. Mantel-Haenszel hazard ratios were calculated to report the overall effect size using random-effects models. All analyses were performed in Rev Man 5.4.1 Results The 13 studies involved a population of 18,724 pregnant women, with cohorts ranging from 25 to 17,673 pregnant women. The most frequent outcomes in the pregnant women were cesarean section and postpartum hemorrhage, and in the newborns, preterm delivery and low birth weight. According to the New Castle-Ottawa scale, six studies were considered low risk and seven studies moderate risk. Dengue is a risk factor for postpartum hemorrhage (OR: 2.24), premature rupture of membranes (OR: 1.04) and cesarean section (OR: 1.13). It could not be concluded that dengue is a risk factor for the neonatal outcomes studied. The clinical picture of pregnant women with dengue was predominantly fever, abdominal pain, vomiting and nausea, anemia, dyspnea and myalgia. Conclusions Pregnancy-related changes in the immune, cardiovascular and coagulation systems, among others, increase the probability of adverse maternal and neonatal outcomes in case of DENV infection, such as postpartum hemorrhage, premature rupture of membranes, cesarean section, low birth weight and preterm delivery. Pregnant women should be considered a population at risk and should be included in dengue control, diagnosis and treatment policies.

Knowing and Caring About the Impact of Crime on Victims: Results From an Intervention for Justice-Involved Youth

Impact of crime (IOC) interventions are delivered to justice-involved populations to increase sensitivity to and awareness of the harm experienced by crime victims. Such programs are common, but empirical evaluations have been rare. This study addressed that gap by evaluating an IOC intervention used with residential youth in Florida. The study focused on two questions. First, did IOC participants experience improvement on key outcomes? Second, was improvement affected by key individual qualities of youth? Pre- and post-intervention survey data were collected for 419 IOC participants on five outcomes: Sensitivity to victim impact, willingness to take responsibility, antisocial thinking, readiness to make life changes, and factual awareness of victim impact. The analysis revealed that all five outcomes were marked by significant pre-to-post improvements. There was individual variation, with some youth showing substantial improvement and others showing modest improvement or iatrogenic effects. This pattern included modest evidence of greater improvement among those with extensive prior offending and lower improvement among Black youth. We conclude by describing the implications of these findings for the policy and practice of juvenile correctional treatment.

Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections.

This study aimed to evaluate real-world data on the differences in outcomes between antiplatelet (AP) and anticoagulation (AC) therapies for intracranial arterial dissection (IAD). This study included patients with symptomatic unruptured IAD between 2010 and 2021 that were treated with anti-thrombotics. Patients were dichotomized to AC and AP based on a treatment policy analysis. Primary endpoints were a composite of ischemic early neurological deterioration, recurrent ischemic or hemorrhagic stroke, or 3-month mortality. Arterial changes were evaluated both in the early (during admission) and late (after discharge) periods. A treatment effectiveness analysis was also performed with AC, AP and a third group of antithrombotic cross-overs. Propensity score matching (PSM) was used to adjust significant baseline differences. In unruptured IAD patients (N = 311), the AC group (N = 211) presented with a higher rate of ischemic stroke or TIA (74.4% vs. 51.0%, p < 0.001) and steno-occlusive morphology (vs. dilatation, 63.0% vs. 39.0%, p < 0.001) compared to AP group (N = 100). After PSM, there was no difference in rates of primary endpoint (9.4% vs. 6.5%, p = 0.470). The results of the treatment effectiveness analysis resembled that of the treatment policy analysis. However, there was a high rate of cross-overs from AC to AP (57/211 [27.0%]). In this group, there was a higher rate of early arterial changes (26.8% vs. 13.1%, p = 0.019) compared to the AC group. In patients with unruptured IAD, this study did not show differences in primary endpoints according to antithrombotic regimen, while there was a high rate of cross-overs from AC to AP.

Addressing the Human Experience of Chronic Kidney Disease: ACall to Transform Kidney Care.

Chronic kidney disease (CKD), a long-term condition in which kidney function declines over time, is a growing global healthcare concern. CKD can have a major impact on the quality of life of patients and their caregivers. Recent research by the International Society of Nephrology highlights that current treatment strategies and policies do not fully address patients' needs. This commentary provides patient insights into the real-life concerns of those who are living with CKD, with main concerns focusing on relationships and support, work and finances, and awareness, prevention, and intervention. Strong support networks are essential for patients and caregivers, but the burden of CKD can make it difficult to maintain personal connections. Limiting disease progression and providing mental health support can help patients and caregivers to maintain their relationships. Work or education can be challenging to manage with CKD; however, employers and educational institutions can create supportive environments that meet the diverse needs of people with CKD. Although delaying disease progression can preserve patient quality of life, people are often unaware of their disease prior to diagnosis, the severity of their CKD, and the risk factors for progression. This presents an opportunity to involve patients in their care by improving education about the benefits of maintaining kidney health. Early identification and holistic intervention could slow disease progression and protect the well-being of patients with CKD and their caregivers. This commentary brings together the diverse perspectives of patients and patient advocacy groups, as well as primary care and specialist healthcare professionals, to advocate for a transformation of CKD management that encourages patient self-care and that prioritizes timely intervention.A patient perspective video and a graphical abstract are available with this article. Addressing the Human Experience of Chronic Kidney Disease: A Call to Transform Kidney Care. Watch Lweendo Hamusankwa discuss his experience of living with chronic kidney disease, from how it impacted his family life to the importance of support networks and patient-facing information. Lweendo advocates for patients to be educated on CKD progression, treatment options, and lifestyle interventions to encourage people to manage their own health and well-being.

Genetic surveillance shows spread of ACT resistance during period of malaria decline in Vietnam (2018-2020).

Vietnam's goal to eliminate malaria by 2030 is challenged by the further spread of drug-resistant Plasmodium falciparum malaria to key antimalarials, particularly dihydroartemisinin-piperaquine (DHA-PPQ). The custom targeted NGS amplicon sequencing assay, AmpliSeq Pf Vietnam v2, targeting drug resistance, population genetic- and other markers, was applied to detect genetic diversity and resistance profiles in samples from 8 provinces in Vietnam (n = 354), in a period of steep decline of incidence (2018-2020). Variants in 14 putative resistance genes, including P. falciparum Kelch 13 (PfK13) and P. falciparum chloroquine resistance transporter (Pfcrt), were analyzed and within-country parasite diversity was evaluated. Other targets included KEL1-lineage markers and diagnostic markers of Pfhrp2/3. A concerning level of DHA-PPQ resistance was detected. The C580Y mutation in PfK13 was found in nearly 80% of recent samples, a significant rise from previous data. Vietnam has experienced a significant challenge with the spread of DHA-PPQ resistant malaria parasites, particularly in the provinces of Binh Phuoc and Gia Lai. Resistance spread to high levels in Binh Thuan prior to the country-wide treatment policy change from DHA-PPQ to pyronadine-artesunate (PA). A complex picture of PPQ-resistance dynamics was observed, with an increase of PPQ-resistance associated Pfcrt mutations, indicating an evolutionary response to antimalarial pressure. Additionally, the compensatory mutation C258W in Pfcrt, which increases chloroquine (CQ) resistance while reversing PPQ resistance, is emerging in Gia Lai following the adoption of PA as the first-line treatment. This study found high levels of multidrug resistance, with over 70% of parasites in 6 out of 8 provinces showing significant sulfadoxine-pyrimethamine (SP) resistance and widespread chloroquine-resistant Pfcrt haplotypes. We also report an absence of P. falciparum histidine rich protein 2 and 3 (Pfhrp2/3) gene deletions, ensuring the continued reliability of HRP2/3-based rapid diagnostic tests. P. falciparum populations in Vietnam are becoming more isolated, with clonal populations showing high geographical clustering by province. The central highlands, particularly Gia Lai province, have the highest residual malaria burden but exhibit low diversity and clonal populations, likely due to the pressures from the antimalarial drugs and targeted national malaria control program (NMCP) efforts. In conclusion, examining a broad panel of full-length resistance genes and SNPs provided high-resolution insights into genetic diversity and resistance evolution in Vietnam, offering valuable information to inform local treatment and intervention strategies.

사랑의 형법학과 통합적 형사사법 - 마약류 범죄에 관한 형법정책을 예로 하여

As This article proposes specific criminal justice policies for drug-related offenses by placing the criminal law of love as the theoretical basis for solving the crisis of our society in which the 'war on drugs' has been declared, and envisioning its practical consequences as an integrated criminal justice model. First, the core of the criminal law of love, which has been advocated as an alternative to adversarial criminal law theory, takes a step further from the ‘God-man metaphor’ and focuses on its purpose and meaning. The meaning of human dignity is understood as the dignity of a person as a person, not because they are made in the same image as God, but as a person who is made in the same image as God and loved enough to make autonomous decisions based on reason. Imagining a dignified human being as a being in its own right can emphasize the guiding function of criminal law beyond its regulatory function. Based on this reinterpreted criminal jurisprudence of love, this article emphasizes the need to build an integrated criminal justice system with ‘retributive, restorative, and therapeutic’ justice as its pillars, and proposes a strategy for criminal justice policy on drug offenses. First, it argues that drug offenses should be regulated by the Criminal Act, which fulfills the principle of protecting the interests of the law and maintaining the basic order as a fundamental norm of our living world. It explains that the relationship between the Criminal Act and the Narcotics Control Act is not that of a general law and a special law, so that both laws are applied in cases where the application of both laws overlap. Second, it suggests that the current inoperative “Crimes Concerning Opium” statute should be amended to “Crimes Concerning Narcotics” to reflect reality so that it can be applied. Third, it proposes that a protectionist provision be added to the Criminal Act to allow foreigners to be subject to Korean criminal law for drug supply offenses. On the other hand, the existence of special laws is necessary because the Criminal Act, whose main function is to suppress crime, cannot contain all treatment and prevention policies. Individual laws, including the Narcotics Control Act, are suitable for carrying out criminal law policies on drug crime prevention and treatment. To do this, this article envisions a desirable operation plan for the government's recently expanded “justice, treatment, and rehabilitation” model. Using the therapeutic justice strategy as a benchmark, the article emphasizes the role of criminal justice in helping drug-consuming offenders to overcome their addiction by requiring them to actively participate in treatment as early as possible, from the time investigative agencies become aware of a drug crime and before prosecution. The article also develops policy recommendations to emphasize community solidarity and to use professional community groups to operate a mandatory treatment system.

The COVID-19 experience among international migrant workers in the Republic of Korea: knowledge and awareness of treatment and immigration policies

IntroductionThe COVID-19 pandemic has exposed various health risks and inequities experienced by international migrant workers. The number of migrant workers in the Republic of Korea (ROK) is rapidly growing and is expected to continue growing. Health related research on migrant workers in ROK is limited, especially among undocumented migrant workers who were more vulnerable to the pandemic. This study aims to examine the experiences of migrant workers and their knowledge and awareness of treatment and immigration policies during the pandemic.MethodsWe used data from the International Migrant Workers’ COVID-19 Health Literacy and Access to Medical Care project, a cross-sectional survey conducted with international migrant workers residing in ROK in 2021 (n = 537). Descriptive statistics and multivariable regression models were employed to understand different demographic, occupational, and immigration factors affecting migrant workers’ knowledge and awareness of treatment and immigration policies.ResultsUndocumented migrant workers had a longer length of residence in ROK and earned less compared to workers with work visa status. None of the undocumented migrant workers had access to health insurance since they were ineligible to enroll in the national health insurance scheme. In the early days of the pandemic, most undocumented migrant workers experienced a decrease in their average income. After adjusting for demographic differences and language proficiency, undocumented migrant workers (AOR: 0.41, 95% CI: 0.21, 0.78) were less likely to be aware of the policy allowing foreigners, including undocumented individuals, to access COVID-19 testing and treatment without the risk of deportation. Workers with a longer length of residence (AOR: 1.29, 95% CI: 1.09, 1.53) were more likely to be aware of this policy.ConclusionUndocumented migrant workers were often less informed about COVID-19 policies. While most of the survey respondents were knowledgeable about governmental policies regarding COVID-19 treatment and immigration, our results reveal multiple occupational and health insurance vulnerabilities of undocumented migrant workers living in ROK. More attention is needed to understand healthcare service barriers and how to provide adequate resources for this vulnerable population.

Multivariate Techniques for Monitoring Susceptible, Exposed, Infected, Recovered, Death, and Vaccination Model Parameters for the COVID-19 Pandemic for Qatar.

The COVID-19 pandemic has highlighted the crucial role of health sector decision-makers in establishing and evaluating effective treatment and prevention policies. To inform sound decisions, it is essential to simultaneously monitor multiple pandemic characteristics, including transmission rates, infection rates, recovery rates (which indicate treatment efficacy), and fatality rates. This study introduces an innovative application of existing methodologies: the Multivariate Exponentially Weighted Moving Average (MEWMA) and Multivariate Cumulative Sum (MCUSUM) control charts (CCs), used for monitoring the parameters of the Susceptible, Exposed, Infected, Recovered, Death, and Vaccination (SEIRDV) model. The methodology is applied to COVID-19 data from the State of Qatar, offering new insights into the pandemic's dynamics. By monitoring changes in the model parameters, this study aims to assess the effectiveness of interventions and track the impact of emerging variants. The results underscore the practical utility of these methodologies for decision-making during similar pandemics. Additionally, this study employs an augmented particle Markov chain Monte Carlo scheme that enables real-time monitoring of SEIRDV model parameters, offering improved estimation accuracy and robustness compared to traditional approaches. The results demonstrate that MEWMA and MCUSUM charts are effective tools for monitoring SEIRDV model parameters and can support decision-making in any similar pandemic.

Exploring Music-Based Interventions for Executive Functioning and Emotional Well-Being in Stroke Rehabilitation: A Scoping Review.

Stroke is one of the leading causes of disability with life-long implications requiring assessment and treatment of several functional domains. This review identifies the results from research into music-based interventions (MBIs), including music therapy (MT), for executive functions (EFs) and emotional well-being (EWB) in adults with stroke and highlights opportunities for clinical practice and future research. APA PsycInfo (EBSCOhost), and CINAHL (EBSCOhost) were searched, in addition to grey literature. A total of 49 studies were included and encompassed experimental, analytic, and descriptive observational studies, and case reports, involving a total of 1663 participants. In total, 32 studies included MT interventions, and 17 were MBIs. EFs were an outcome in 20.41%, and EWB in 61.22% of studies, for which active interventions were the most utilized. Overall, 73.47% of the studies reported positive results. This scoping review indicates that music interventions can be beneficial for the improvement of different aspects of EFs and EWB at different stages of stroke recovery. Further research may benefit clinical practice by including standardized protocols, outcome and self-reported measures, and brain imaging data to determine the effects of interventions and support evidence-based decisions for treatment policies for stroke survivors.

The role of the estimand framework in the analysis of patient-reported outcomes in single-arm trials: a case study in oncology

BackgroundPatient-reported outcomes (PROs) play an increasing role in the evaluation of oncology treatments. At the same time, single-arm trials are commonly included in regulatory approval submissions. Because of the high risk of biases, results from single-arm trials require careful interpretation. This benefits from a clearly defined estimand, or target of estimation. In this case study, we demonstrated how the ICH E9 (R1) estimand framework can be implemented in SATs with PRO endpoints.MethodsFor the global quality of life outcome in a real single-arm lung cancer trial, a range of possible estimands was defined. We focused on the choice of the variable of interest and strategies to deal with intercurrent events (death, treatment discontinuation and disease progression). Statistical methods were described for each estimand and the corresponding results on the trial data were shown.ResultsEach intercurrent event handling strategy resulted in its own estimated mean global quality of life over time, with a specific interpretation, suitable for a corresponding clinical research aim. In the setting of this case study, a ‘while alive’ strategy for death and a ‘treatment policy’ strategy for non-terminal intercurrent events were deemed aligned with a descriptive research aim to inform clinicians and patients about expected quality of life after the start of treatment.ConclusionsThe results show that decisions made in the estimand framework are not trivial. Trial results and their interpretation strongly depend on the chosen estimand. The estimand framework provides a structure to match a research question with a clear target of estimation, supporting specific clinical decisions. Adherence to this framework can help improve the quality of data collection, analysis and reporting of PROs in SATs, impacting decision making in clinical practice.