Population Coverage Research Articles

P837 Improving Vaccination Rates in Patients with Inflammatory Bowel Disease: A Single Centre Audit and Quality Improvement Project

Abstract Background Patients with inflammatory bowel disease (IBD) are at an increased risk of infections. Vaccine preventable diseases in patients with IBD are associated with high rates of hospitalizations, costs, mortality and longer hospitalizations. Despite societal recommendations, the uptake of vaccinations is still suboptimal. We aimed to conduct an audit of vaccination status in patients with IBD followed by a quality improvement project (QIP) to improve the vaccination rates in the outpatient clinic setting. Methods This is a retrospective cohort study in a tertiary hospital in Singapore. Patients with a confirmed diagnosis of IBD aged >18 years’ old who attended outpatient clinics between June to September 2022 were identified, and their influenza (IFV) and pneumococcal (PCV) vaccination status was assessed. A QIP was instituted to increase the rate of IFV and PCV coverage in this ambulatory population. Interventions were directed at both the provider and the patient. All providers were educated on vaccination schedules and a standardized electronic template was implemented for clarity of documentation. Laminated posters of vaccination guidelines were placed in each consultation room. All patients were issued with a personalized vaccination card documenting their vaccination status and serving as a prompt for subsequent consultations. We analysed the rate of IFV and PCV coverage post implementation from November 2022 to June 2023. Results 70 patients were identified in the pre-intervention cohort. 30 patients were either >65 years old or on immunosuppression, of which 6/30 (20%) received IFV and 11/30 (36.7%) already received PCV. In the post-intervention cohort, we assessed 187 consecutive patient clinic visits which comprised 115 unique patients. Baseline characteristics are detailed in Table 1. 73 patients were either aged > 65 years old or on immunosuppression, 65 patients had no IFV within 1 year, of which 20/65 (30.7%) obtained vaccination coverage for IFV in the post-intervention period (p=0.01). 63 patients were eligible for PCV and 12/63 (19%) received either pneumococcal conjugate vaccine 13 or pneumococcal polysaccharide vaccine 23 during this period (Fig. 1). Conclusion A structured QIP with an established protocol engaging patients and guiding providers significantly increased the rate of IFV but not PCV in our cohort. A major hurdle to timely PCV uptake was the erroneous perception of a wider window period by patients and providers given its 5-yearly interval, as compared to IFV. Overall adherence to societal guidelines and uptake of vaccinations is still suboptimal and more work needs to be done to educate providers and patients, increase vaccination uptake and reduce vaccine preventable diseases in patients with IBD.

Facts and Hopes in Immunotherapy Strategies Targeting Antigens Derived from KRAS Mutations.

In this commentary, we advance the notion that mutant KRAS (mKRAS) is an ideal tumor neoantigen that is amenable for targeting by the adaptive immune system. Recent progress highlights key advances on various fronts that validate mKRAS as a molecular target and support further pursuit as an immunological target. Because mKRAS is an intracellular membrane localized protein and not normally expressed on the cell surface, we surmise that proteasome degradation will generate short peptides that bind to HLA class I (HLA-I) molecules in the endoplasmic reticulum for transport through the Golgi for display on the cell surface. T-cell receptors (TCR)αβ and antibodies have been isolated that specifically recognize mKRAS encoded epitope(s) or haptenated-mKRAS peptides in the context of HLA-I on tumor cells. Case reports using adoptive T-cell therapy provide proof of principle that KRAS G12D can be successfully targeted by the immune system in patients with cancer. Among the challenges facing investigators is the requirement of precision medicine to identify and match patients to available mKRAS peptide/HLA therapeutics and to increase the population coverage by targeting additional mKRAS epitopes. Ultimately, we envision mKRAS-directed immunotherapy as an effective treatment option for selected patients that will complement and perhaps synergize with small-molecule mKRAS inhibitors and targeted mKRAS degraders.

Comparative Analysis of Outpatient Antibiotic Prescribing in Early Life: A Population-Based Study Across Birth Cohorts in Denmark and Germany.

Comparing antibiotic prescribing between countries can provide important insights into potential needs of improving antibiotic stewardship programs. We aimed to compare outpatient antibiotic prescribing in early life between children born in Denmark and Germany. Using the Danish nationwide healthcare registries and a German claims database (GePaRD, ~ 20% population coverage), we included children born between 2004 and 2016, and followed them regarding outpatient antibiotic prescriptions until end of enrollment or the end of 2018. We then determined the median time to first antibiotic prescription. Based on all prescriptions in the first 2years of life, we calculated the rate of antibiotic treatment episodes and for the children's first prescriptions in this period, we determined established quality indicators. All analyses were stratified by birth year and country. In the 2016 birth cohorts, the median time to first antibiotic prescription was ~ 21months in Denmark and ~ 28 in Germany; the rate of antibiotic treatment episodes per 1000 person-years was 537 in Denmark and 433 in Germany; the percentage of prescribed antibiotics with higher concerns regarding side effects and/or resistance potential was 6.2% in Denmark and 44.2% in Germany. In the 2016 birth cohorts, the age at first antibiotic prescription was 50-59% higher compared to the 2004 birth cohorts; the rate of antibiotic treatment episodes was 43-44% lower. Infants in Denmark received antibiotics markedly earlier and more frequently than in Germany, while quality indicators of antibiotic prescribing were more favorable in Denmark. Although both countries experienced positive changes towards more rational antibiotic prescribing in early life, our findings suggest potential for further improvement. This particularly applies to prescribing antibiotics with a lower potential for side effects and/or resistance in Germany.

Pooling sputum samples for the Xpert MTB/RIF assay: a practical screening strategy for highly infectious tuberculosis cases

The Xpert MTB/RIF test (Xpert) can help in the accurate screening of tuberculosis, however, its widespread use is limited by its high cost and lack of accessibility. Pooling of sputum samples for testing is a strategy to cut expenses and enhance population coverage but may result in a decrease in detection sensitivity due to the dilution of Mycobacterium tuberculosis (Mtb) by sample mixing. We investigated how the mixing ratio affected the detection performance of Xpert. We used frozen sputum samples that had been kept after individual Xpert assays of the sputa from Mtb-confirmed TB patients and non-TB patients. Our results showed that the overall sensitivity of the Xpert pooling assay remained higher than 80% when the mixing ratio was between 1/2 and 1/8. When the mixing ratio was raised to 1/16, the positive detection rate fell to 69.0%. For patients with either a high sputum Mtb smear score ≥ 2+, a time-to-positive culture ≤ 10 days, or an Xpert test indicating a high or medium abundance of bacteria, the pooling assay positivity rates were 93.3%, 96.8%, and 100% respectively, even at a 1/16 mixing ratio. For participants with cavities and cough, the pooling assay positivity rates were 86.2% and 90.0% at a 1/8 ratio, higher than for those without these signs. Our results show that the Xpert pooled assay has a high overall sensitivity, especially for highly infectious patients. This pooling strategy with lower reagent and labor costs could support TB screening in communities with limited resources, thereby facilitating reductions in the community transmission and incidence of TB worldwide.

Routine Vaccination Coverage in an Adolescent Transgender Population in a Large Tertiary Care Center in the United States

To address healthcare disparities among transgender and gender diverse (TGD) adolescents, we examined vaccination coverage in those receiving gender-affirming care. Our study analyzed de-identified data (2013-2022) from a tertiary care clinic. Comparing vaccination rates of 203 TGD adolescent patients to age-matched peers in New York State using CDC National Immunization Survey-Teen data. We found TGD patients had similar vaccination coverage to the general adolescent population. Notably, TGD patients had significantly higher up-to-date human papillomavirus vaccination coverage (76.4%, CI=69.9, 82.0) than the NYS adolescent population (60.5%, CI=53.0, 67.5). This suggests TGD adolescents at gender-affirming clinics maintain or exceed vaccination rates of their cisgender counterparts. Future research should explore vaccination rates for TGD individuals without access to gender-affirming care.

Epidemiological behaviour and interventions of malaria in Niger, 2010–2019: a time-series analysis of national surveillance data

BackgroundMalaria remains a significant public health concern in Niger, with the number of cases increasing from 592,334 in 2000 to 3,138,696 in 2010. In response, a concerted campaign against the disease has been initiated. However, the implementation of these malaria interventions and their association with epidemiological behaviour remains unclear.MethodsA time-series study was conducted in Niger from 2010 to 2019. Multiple data sources concerning malaria were integrated, encompassing national surveillance data, Statistic Yearbook, targeted malaria control interventions, and meteorological data. Incidence rate, mortality rate, and case fatality ratio (CFR) by different regions and age groups were analysed. Joinpoint regression models were used to estimate annual changes in malaria. The changes in coverage of malaria interventions were evaluated.ResultsBetween 2010 to 2019, the incidence rate of malaria decreased from 249.43 to 187.00 cases per 1,000 population in Niger. Niamey had a high annual mean incidence rate and the lowest CFR, while Agadez was on the contrary. Joinpoint regression analysis revealed a declining trend in malaria incidence for all age groups except the 10–24 years group, and the mortality rate and the CFR initially decreased followed by an increase in all age groups. Niger has implemented a series of malaria interventions, with the major ones being scaled up to larger populations during the study period.ConclusionsThe scale-up of multi-interventions in Niger has significantly reduced malaria incidence, but the rise in mortality rate and CFR addresses the challenges in malaria control and elimination. Malaria endemic countries should enhance surveillance of malaria cases and drug resistance in Plasmodium, improve diagnosis and treatment, expand the population coverage of insecticide-treated bed nets and seasonal malaria chemoprevention, and strengthen the management of severe malaria cases.

Immunocontraceptive Efficacy of Native Porcine Zona Pellucida (pZP) Treatment of Nevada's Virginia Range Free-Roaming Horse Population.

In North America, range constraints due to burgeoning development increasingly encroach on wild horse habitat and necessitate effective but humane reproductive management. The largest free-roaming wild horse fertility control program by population (>3500) and territory size (≈300,000 acres) is located within Nevada's Virginia Range. Data from a field study investigated porcine zona pellucida (pZP) immunocontraception via remote dart delivery to mares in this population. Analyses aimed to measure efficacy by treatment effects on annual birth rates and population demographics and to evaluate treatment frequency and season against these variables. Analyses included mares' monthly data (January 2019-December 2022; 48 months), characterized by cumulative vaccination numbers subset into four classifications considering the vaccine as having no loss of efficacy or a loss within a 6-, 12-, and 18-month period post vaccination; from foaling data, the likelihood of being in foal and of conceiving in that month; and from age, as mature or immature (<1 years-old). A downward foaling rate and trend in the numbers of mature mares, descriptively presented at monthly intervals, showed markedly declining annual seasonal breeding peaks, with no observed change in foaling season or duration. Within four years, population coverage surpassed 70% and was associated with a 58% reduction in foaling, with only a 10% conception rate. Vaccinated mares increased proportionally: assuming a 12-month decay rate, the system reached stability at an average ≈1.0 vaccination/mare/year, providing a robust recommendation for treatment frequency contributing to best management practices.

Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales

Undervaccination (receiving fewer than the recommended number of SARS-CoV-2 vaccine doses) could be associated with increased risk of severe COVID-19 outcomes-ie, COVID-19 hospitalisation or death-compared with full vaccination (receiving the recommended number of SARS-CoV-2 vaccine doses). We sought to determine the factors associated with undervaccination, and to investigate the risk of severe COVID-19 outcomes in people who were undervaccinated in each UK nation and across the UK. We used anonymised, harmonised electronic health record data with whole population coverage to carry out cohort studies in England, Northern Ireland, Scotland, and Wales. Participants were required to be at least 5 years of age to be included in the cohorts. We estimated adjusted odds ratios for undervaccination as of June 1, 2022. We also estimated adjusted hazard ratios (aHRs) for severe COVID-19 outcomes during the period June 1 to Sept 30, 2022, with undervaccination as a time-dependent exposure. We combined results from nation-specific analyses in a UK-wide fixed-effect meta-analysis. We estimated the reduction in severe COVID-19 outcomes associated with a counterfactual scenario in which everyone in the UK was fully vaccinated on June 1, 2022. The numbers of people undervaccinated on June 1, 2022 were 26 985 570 (45·8%) of 58 967 360 in England, 938 420 (49·8%) of 1 885 670 in Northern Ireland, 1 709 786 (34·2%) of 4 992 498 in Scotland, and 773 850 (32·8%) of 2 358 740 in Wales. People who were younger, from more deprived backgrounds, of non-White ethnicity, or had a lower number of comorbidities were less likely to be fully vaccinated. There was a total of 40 393 severe COVID-19 outcomes in the cohorts, with 14 156 of these in undervaccinated participants. We estimated the reduction in severe COVID-19 outcomes in the UK over 4 months of follow-up associated with a counterfactual scenario in which everyone was fully vaccinated on June 1, 2022 as 210 (95% CI 94-326) in the 5-15 years age group, 1544 (1399-1689) in those aged 16-74 years, and 5426 (5340-5512) in those aged 75 years or older. aHRs for severe COVID-19 outcomes in the meta-analysis for the age group of 75 years or older were 2·70 (2·61-2·78) for one dose fewer than recommended, 3·13 (2·93-3·34) for two fewer, 3·61 (3·13-4·17) for three fewer, and 3·08 (2·89-3·29) for four fewer. Rates of undervaccination against COVID-19 ranged from 32·8% to 49·8% across the four UK nations in summer, 2022. Undervaccination was associated with an elevated risk of severe COVID-19 outcomes. UK Research and Innovation National Core Studies: Data and Connectivity.

Enhancing accessibility through rail transit in congested urban areas: A cross-regional analysis

The efficacy of urban rail transit in reducing the impact of road congestion is the subject of debate in policy and academic communities. Despite huge challenges arising from multifaceted factors such as data limitation, the recently released annual average congestion data enables us to empirically analyze the effect of urban rail transits in terms of their contribution to the average accessibility under road congestion. This paper presents a framework to evaluate the accessibility improvement benefit of urban rail transit under road congestion from a mean-field perspective. A cross-regional analysis in 43 Chinese cities demonstrates that the rail transit networks enhance the potential accessibility and contour accessibility by up to 5.07% and 12.09%, respectively. Besides, the accessibility improvement benefit largely depends on the road congestion level, rail network size, and layout of rail network. Furthermore, simulations on randomly generated rail transit networks indicate that the population coverage and proximity to roads are two structural determinants on the performance of rail transit. The proposed framework, together with the empirical findings, provides insights for city authorities to plan urban rail networks.

Blockchain-Based Implementation of National Census as a Supplementary Instrument for Enhanced Transparency, Accountability, Privacy, and Security

A national population census is instrumental in offering a holistic view of a country’s progress, directly influencing policy formulation and strategic planning. Potential flaws in the census system can have detrimental impacts on national development. Our prior research has pinpointed various deficiencies in current census methodologies, including inadequate population coverage, racial and ethnic discrimination, and challenges related to data privacy, security, and distribution. This study aims to address the “missing persons” challenge in the national census population and housing system. The integration of blockchain technology emerges as a promising solution for addressing these identified issues, enhancing the integrity and efficacy of census processes. Building upon our earlier research which examined the national census system of Pakistan, we propose an architecture design incorporating Hyperledger Fabric, performing system sizing for the entire nation count. The Blockchain-Based Implementation of National Census as a Supplementary Instrument for Enhanced Transparency, Accountability, Privacy, and Security (BINC-TAPS) seeks to provide a robust, transparent, scalable, immutable, and tamper-proof solution for conducting national population and housing censuses, while also fostering socio-economic advancements. This paper presents a comprehensive overview of our research, with a primary focus on the implementation of the blockchain-based proposed solution, including prototype testing and the resulting outcomes.

Hospitalisations and Deaths Averted by COVID-19 Vaccination in Navarre, Spain, 2021-2022.

In 2021-2022, most of the Spanish population received COVID-19 vaccines and a high proportion of them had SARS-CoV-2 infection. We estimated the rate of hospitalisations and deaths that were averted by risk reduction among vaccinated COVID-19 cases. Hospitalisations and deaths were analysed among COVID-19 cases confirmed in 2021 and 2022 in Navarre, Spain. To calculate the number of prevented outcomes by sex, age, comorbidities, and semester, the difference in the risk of each outcome between unvaccinated and vaccinated cases was multiplied by the number of vaccinated cases. COVID-19 vaccination coverage with any dose reached 88%, 86% with full vaccination, and 56% with a booster dose. The cumulative rates per 1000 inhabitants were 382 COVID-19 confirmed cases, 6.70 hospitalisations, and 1.15 deaths from COVID-19. The estimated rates of prevented events by vaccination were 16.33 hospitalisations and 3.39 deaths per 1000 inhabitants, which was 70.9% and 74.7% of expected events without vaccination, respectively. People aged 80 years and older or with major chronic conditions accounted for the majority of hospitalizations and deaths prevented by COVID-19 vaccination. One hospitalisation and death due to COVID-19 were averted for every 53 and 258 people vaccinated, respectively. The high COVID-19 vaccine effect in reducing the risk of severe outcomes and the high vaccination coverage in risk populations prevented three out of four hospitalisations and deaths due to COVID-19 during a period of intense circulation of SARS-CoV-2.

SARS-CoV-2 vaccination and risk of infectious diseases in hospitalized older patients.

Vaccinations, for example flu vaccine, may be a cause of cross-reactive immunostimulation that prevents a larger spectrum of infections. However, whether SARS-CoV-2 vaccinations may also determine this effect is unclear. This study aims, first, to assess the incidence of infections at hospital admission and during the hospitalization in older inpatients vaccinated and unvaccinated against SARS-CoV-2; second, to compare length of hospital stay and in-hospital mortality between vaccinated and unvaccinated individuals. This retrospective study included 754 older inpatients admitted to the Geriatrics and Orthogeriatrics Units of the University Hospital of Ferrara (Italy) between March 2021 and November 2021. Sociodemographic and health-related data, and the diagnosis of infections at hospital admission and during hospitalization were collected from medical records. The sample's mean age was 87.2years, 59.2% were females, and 75.5% were vaccinated against SARS-CoV-2. Vaccinated individuals had 36% lower odds of intra-hospital infections (OR = 0.64, 95%CI 0.44-0.94) and 39% lower in-hospital death (HR = 0.61, 95%CI 0.39-0.95), also after adjusting for potential confounders, while no significant results emerged about infections at hospital admission. Considering the hospitalization's endpoints, SARS-CoV-2 vaccination was associated with a lower probability of being transferred to long-term care or other hospital departments than returning home (OR = 0.63, 95%CI 0.40-0.99). In older inpatients, SARS-CoV-2 vaccination seems to be associated with a lower likelihood of intra-hospital infectious diseases not caused by SARS-CoV-2 and all-cause in-hospital mortality. The vaccination coverage in the older population could limit not only the onset and severity of COVID-19 but also the occurrence of other infectious diseases.

Urban-rural differences in seasonal malaria chemoprevention coverage and characteristics of target populations in nine states of Nigeria: a comparative cross-sectional study.

Differences between urban and rural contexts in terms of sociodemographic characteristics, geographical features and risk perceptions may lead to disparities in coverage and related outcomes of community-based preventive interventions, such as seasonal malaria chemoprevention (SMC). This study investigated urban-rural differences in SMC coverage and other programme outcomes, as well as child and caregiver characteristics of target populations in nine implementing states in Nigeria during the 2022 SMC round. This is a comparative cross-sectional study based on comprehensive end-of-round household surveys conducted in nine states where SMC was delivered in Nigeria in 2022. Data of 11,880 caregiver-child pairs were included in the analysis. Rural-urban differences in SMC outcomes and child and caregiver characteristics were assessed, first by using Pearsons' chi-square test for independence for categorical variables. Univariate multilevel mixed-effect logistic regression models, with random intercepts for cluster units, were used to quantify the strength of association between location and each SMC coverage and related outcomes. Significant urban-rural differences were observed in caregivers' sociodemographic characteristics, such as age, gender, level of education, occupation status and health-seeking behaviour for febrile childhood illnesses. Disparities were also seen in terms of SMC coverage and related outcomes, with lower odds of the receipt of Day 1 dose direct observation of the administration of Day 1 dose by community distributors, receipt of the full three-day course of SMC medicines and receipt of SMC in all cycles of the annual round among children residing in urban areas, compared with those residing in rural areas. Similarly, urban-dwelling caregivers had lower odds of being knowledgeable of SMC and believing in the protective effect of SMC than rural-dwelling caregivers. Findings highlight observable urban-rural disparities in SMC programme delivery and related outcomes, as well as target population characteristics, underscoring the need for context-specific strategies to ensure optimal delivery of SMC and improve programme implementation outcomes in urban settings.

Advanced vaccinomic, immunoinformatic, and molecular modeling strategies for designing Multi- epitope vaccines against the Enterobacter cloacae complex.

The increasing and ongoing issue of antibiotic resistance in bacteria is of huge concern globally, mainly to healthcare facilities. It is now crucial to develop a vaccine for therapeutic and preventive purposes against the bacterial species causing hospital-based infections. Among the many antibiotic- resistant bacterial pathogens, the Enterobacter cloacae complex (ECC) including six species, E. Colcae, E. absuriae, E. kobie, E. hormaechei, E. ludwigii, and E. nimipressuralis, are dangerous to public health and may worsen the situation. Vaccination plays a vital role in the prevention of infections and infectious diseases. This research highlighted the construction and design of a multi-epitope vaccine for the E. cloacae complex by retrieving their complete sequenced proteome. The retrieved proteome was assessed to opt for potential vaccine candidates using immunoinformatic tools. Both B and T-cell epitopes were predicted in order to create both humoral and cellular immunity and further scrutinized for antigenicity, allergenicity, water solubility, and toxicity analysis. The final potential epitopes were subjected to population coverage analysis. Major histocompatibility complex (MHC) class combined, and MHC Class I and II world population coverage was obtained as 99.74%, and 98.55% respectively while a combined 81.81% was covered. A multi-epitope peptide-based vaccine construct consisting of the adjuvant, epitopes, and linkers was subjected to the ProtParam tool to calculate its physiochemical properties. The total amino acids were 236, the molecular weight was 27.64kd, and the vaccine construct was stable with an instability index of 27.01. The Grand Average of Hydropathy (GRAVY) (hydrophilicity) value obtained was -0.659, being more negative and depicting the hydrophilic character. It was non-allergen antigenic with an antigenicity of 0.8913. The vaccine construct was further validated for binding efficacy with immune cell receptors MHC-I, MHC-II, and Toll-like receptor (TLR)-4. The molecular docking results depict that the designed vaccine has good binding potency with immune receptors crucial for antigen presentation and processing. Among the Vaccine-MHC-I, Vaccine-MHC-II, and Vaccine-TLR-4 complexes, the best-docked poses were identified based on their lowest binding energy scores of -886.8, -995.6, and -883.6, respectively. Overall, we observed that the designed vaccine construct can evoke a proper immune response and the construct could help experimental researchers in the formulation of a vaccine against the targeted pathogens.

Performance-based reimbursement for digital therapeutics in Germany: A misconceptualized opportunity.

Germany has one of the oldest social security systems in the world. Population coverage has subsequently increased, reaching coverage of approximately 90% of the population in the statutory health insurance (SHI) system today. Before this background, Germany has been pioneering the integration of digital therapeutics (DTx) into its SHI system by the introduction of the Digital Healthcare Law (Digitale-Versorgung-Gesetz, DVG) in 2019. Thereby, patients became eligible for digital health applications (Digitale Gesundheitsanwendungen, DiGA), which are available upon prescription by qualified healthcare professionals. As conventional healthcare delivery often lacks direct outcome measures as and is mostly still reimbursed on a fee-for-service basis, DiGA offer the opportunity to continuously provide individual outcome and performance data. They are, therefore, well-suited for a performance-based payment framework. While the DVG introduced the option for performance-based reimbursement components in 2019 already, the ongoing debate about the value of DiGA and to what extent they can contribute to the healthcare system has now been reflected in a 2023 health policy bill by the German Federal Ministry of Health, which aims to introduce a mandatory performance-based reimbursement component for DiGA. In this light, we propose a framework for performance-based reimbursement of DiGA, involving an intervention-specific, performance-linked reimbursement framework with shared accountability between manufacturers and payers. The approach aims to align the often contradicting interests of the involved stakeholders to incentivize the delivery of high-value digital health care. Yet, the proposal also acknowledges the need for further research to establish a robust foundation for implementing such a framework.

Geographical Disparities in the Distribution of Community Pharmacies Providing Aseptic Preparation Services in Japan.

Providing medical, nursing, and welfare services in each community is becoming increasingly important as population ages in Japan, and the demand for aseptic preparation in community pharmacies is expected to increase. In this study, the disparity in the distribution of community pharmacies providing aseptic preparation services were examined to explore how the unequal distribution of the pharmacies can be improved in the future. The regional inequality of community pharmacies providing aseptic preparation services was evaluated using Gini coefficients. The regional distribution was evaluated using a geographic information system application. Only 8.0% of all insurance community pharmacies in Japan provided aseptic preparation services. The Gini coefficient of pharmacies providing aseptic preparation services for the total population of each municipality was 0.410. The population coverage, within 16 km of pharmacies providing aseptic preparation services, was 96.5% of the total population. The residential grid coverage, within 16 km of the pharmacies, was 75.2% of the total network, approximately one quarter not covered. It is estimated that the coverage ratios will improve by some percentage by 2050, although the projected population in 2050 is expected to decrease by approximately 20%. The current number and distribution of pharmacies providing aseptic preparation services are inadequate, and measures need to be taken to avoid future problems.

The impact of the 2022 spring COVID-19 booster vaccination programme on hospital occupancy in England: An interrupted time series analysis.

Regular booster vaccination programmes help protect the most vulnerable from COVID-19 and limit pressure on health systems. Existing studies find booster doses to be effective in preventing hospital admissions and deaths but focus on individual effects, failing to consider the population impact of incomplete vaccination coverage and seasonal patterns in disease transmission. We estimated the effectiveness of the 2022 spring booster vaccination programme, available for those aged 75 years and older, residents in care homes, and adults with weakened immune systems, on COVID-19 hospital bed occupancy in England. Booster vaccine coverage in the eligible population increased rapidly in the months after rollout (from 21st March 2022), flattening out just below 80% by July 2022. We used interrupted time series analysis to estimate a 23.7% overall reduction in the rate of hospital occupancy for COVID-19 following the programme, with a statistically significant benefit in the 6-12 weeks following rollout. In the absence of the programme, we calculate that a total of 380,104 additional hospital bed-days would have been occupied by patients with COVID-19 from 4th April to 31st August 2022 (95% CI: -122,842 to 1,034,590). The programme delayed and shortened the duration of the peak while not reducing its magnitude. In sensitivity analyses adjusting the start of the post-intervention period or removing the rate of COVID-19 infection in the over 60s from the model, the effect of the spring booster programme on hospital bed occupancy remained similar. Our findings suggest that timing is a critical consideration in the implementation of COVID-19 booster programmes and that policymakers cannot rely on intermittent booster vaccination of high-risk groups alone to mitigate anticipated peaks in hospital pressure due to COVID-19 epidemics.

High rates of deferring antiretroviral treatment for patients with HIV and substance use disorders: Results from a national sample of HIV physicians in Ukraine.

HIV incidence and mortality are increasing in Ukraine despite their reductions globally, in part due to suboptimal antiretroviral therapy (ART) coverage in key populations of people with HIV (PWH) where the epidemic is concentrated. As physicians are gatekeepers to ART prescription, stigma and discrimination barriers are understudied as a key to meeting HIV treatment targets in key populations. A national sample (N = 204) of ART-prescribing physicians in Ukraine were surveyed between August and November 2019. Participants underwent a series of randomized, hypothetical HIV clinical scenarios and decided whether to initiate or defer (or withhold) ART. Scenarios varied based on 5 distinct CD4 counts (CD4: 17, 176, 305, 470, or 520 cells/mL) and 10 different PWH key populations. Z scores and McNemar's test for paired samples were used to assess differences between key populations and CD4 count. Feeling thermometers were used to assess stigma-related measures toward key populations among physicians. Physicians were highly experienced (mean = 19 years) HIV treaters, female (80.4%), and trained in infectious diseases (76.5%). Patients who drink alcohol (range: 21.6%-23.5%) or use (PWUD range: 16.7%-20.1%) or inject (PWID range: 15.5%-20.1%) drugs were most likely to have ART deferred, even at AIDS-defining CD4 counts. PWID maintained on methadone, however, were significantly (p<0.001) less likely to have ART deferred compared with those who were not (range: 7.8%-12.7%) on methadone. Men who have sex with men (range: 5.4%-10.8%), transgender women (range: 4.9%-11.3%), sex workers (range: 3.9%-10.3%),and having an HIV-uninfected sex partner (range: 3.9%-9.3%) had the lowest likelihood of ART deferral. Increasing levels of stigma (i.e., feeling thermometers) towards a key population was correlated with ART deferral (i.e., discrimination). Despite international and Ukrainian guidelines recommending ART prescription for all PWH, irrespective of risk or CD4 count, ART deferral by experienced HIV experts remains high in certain key populations, especially in PWH and substance use disorders. Strategies that initiate ART immediately after diagnosis (i.e., rapid start antiretroviral therapy), independent of risk group, should be prioritized to truly mitigate the current epidemic.

ЭПИДЕМИОЛОГИЧЕСКАЯ СИТУАЦИЯ С РАСПРОСТРАНЕНИЕМ ВИЧ-ИНФЕКЦИИ В ДАЛЬНЕВОСТОЧНОМ ФЕДЕРАЛЬНОМ ОКРУГЕ (КРАТКИЙ АНАЛИЗ ЗА 2023 г.)

HIV-infection remains a pressing issue in both Russia and Far Eastern Federal district. Current re-search was conducted to evaluate HIV epidemic tendencies in the Far Eastern Federal district. Cu-mulative number of HIV-infected has reached 56 799 people in early January 2024. HIV screening coverage of district population has reached 33.04%. HIV-infection incidence rate equaled 34.0 per 100 000 population, prevalence rate – 451.2 per 100 000 population in 2023. Rate of men among newly infected people with HIV remained high. Heterosexual route of transmission was prevailing. A total number of 83.5% of people living with HIV were registered for regular medical check-ups and 72.1% of them received antiretroviral therapy.

Corporate social responsibility management for labeled companies in the emerging market: A study of corporate strategy

In contemporary managerial aspects, corporate social responsibility (CSR) plays an important role in the societal commitment of businesses. According to Cheffi et al. (2021), the dimension of CSR encompasses a variety of approaches and models, contributing to the enlightenment of management practices within companies. This article highlights the importance of these CSR managerial practices and their ability to illustrate the performance and efficiency of the daily companies’ activities. In this vein, we are interested in companies’ accreditation with CSR in the Moroccan context, following a quantitative approach based on 104 questionnaires involving all aspects of these practices, including various elements such as international pressures, governmental commitment, increasing local awareness, sustainable development imperatives, and sector-specific initiatives. Thus, ensuring comprehensive coverage of the target population. The adoption of this methodological approach enabled us to gather valuable and diverse data, consequently providing a solid foundation for formulating robust and informed conclusions on how Moroccan companies integrate and implement CSR into their daily management. The results obtained by our study confirm that all the practices designed by the ISO 26000 standard from the International Organization for Standardization (ISO) in the field of CSR executed in the Moroccan environment excepted loyal practices and norms related to human rights.