Preventable Cause Research Articles

Decreasing Productivity in the Primary Healthcare: A Study of the Brazilian Case

ABSTRACT: In 2015, the United Nations (UN) proposed the 2030 Agenda, a resolution that outlines the global goals for sustainable development. This report focuses on promoting health and well-being, emphasizing the importance of primary healthcare (PHC). However, Brazil faces challenges in managing its healthcare system, exacerbated by fiscal policy changes that have reduced public sector expenditures after 2015. This study was motivated by these recent changes in Brazil’s fiscal policy. We evaluated potential fluctuations in total factor productivity (TFP) in 5,524 Brazilian municipalities’ primary healthcare from 2015 to 2019. TFP, a measure of efficiency and production technology in PHC, was computed using the bootstrapping Malmquist productivity index (MPI) derived from the Data Envelopment Analysis (DEA) algorithm. This study focused on the economic recession and austerity measures initiated in 2015. Moreover, it’s essential to highlight that the SARS-CoV-2 pandemic in Brazil in 2020 brought significant changes to the country’s economic, social, and health dynamics. Therefore, this research intentionally concentrated on the pre-pandemic period. Our results revealed that TFP in the PHC sector in Brazil decreased between 2015 and 2019. It was possible to note that three out of every four Brazilian municipalities experienced either stagnation or a decline in the TFP of primary healthcare, with more pronounced challenges in the Midwest and Northeast regions. Looking at the TFP elements, we could see a continuous drop in technical efficiency everywhere in the country, markedly in the Midwest and Northeast. Conversely, there was a considerable uptick in Brazil’s technological component. These results implied that there might have been advancements in PHC’s technological infrastructure, preventing even less favorable outcomes in the TFP indicator. We concluded that the productivity of primary healthcare in Brazil declined when the 2015 fiscal ceiling was implemented. This decrease in performance was evident in the sluggish growth rate of primary healthcare inputs, a diminution in vaccination coverage indicators, and an increase in hospitalizations for preventable causes. Given that health is a crucial component of social well-being, it is vital to highlight the need for comprehensive efforts to guarantee the effective operation and advancement of primary healthcare services, even during economic downturns.

Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever at Jiblah University Hospital, Yemen

Background: Acute Rheumatic Fever (ARF) is an important and preventable cause of morbidity and mortality in developing countries including Yemen. Jones criteria provided a standardized approach for the identification of Acute Rheumatic Fever and facilitated an improvement in early case detection. Aims: To determine the extent to which physicians rely on Jones criteria to diagnose acute rheumatic fever in patients attending Jiblah University Hospital, Yemen. Materials and Methods: A hospital-based cross-sectional study was carried out at Jiblah University Hospital in Jiblah town, Yemen. Data of 71 convenience samples were collected through an open-ended questionnaire and analyzed using SPSS version 26. Results: Of 71 clinically diagnosed cases of ARF who tested high ASO titer, only 10 (14.1%) met the revised Jones criteria. Conclusions: The financial inability of patients to undergo Doppler echocardiography coupled with physician’s negligence about the importance of Jones criteria for diagnosing rheumatic fever and their reliance on high ASO titers for diagnosing rheumatic fever could lead to misdiagnosis of rheumatic fever in the study area.

Interactions of Nutrition and Infection: The Role of Micronutrient Deficiencies in the Immune Response to Pathogens and Implications for Child Health.

Approximately five million children die each year from preventable causes, including respiratory infections, diarrhea, and malaria. Roughly half of those deaths are attributable to undernutrition, including micronutrient deficiencies (MNDs). The influence of infection on micronutrient status is well established: The inflammatory response to pathogens triggers anorexia, while pathogens and the immune response can both alter nutrient absorption and cause nutrient losses. We review the roles of vitamin A, vitamin D, iron, zinc, and selenium in the immune system, which act in the regulation of molecular- or cellular-level host defenses, directly affecting pathogens or protecting against oxidative stress or inflammation. We further summarize high-quality evidence regarding the synergistic or antagonistic interactions between MNDs, pathogens, and morbidity or mortality relevant to child health in low- and middle-income countries. We conclude with a discussion of gaps in the literature and future directions for multidisciplinary research on the interactions of MNDs, infection, and inflammation.

Patterns of Cigarette and Waterpipe Smoking in Erbil City, Iraq. A Household Survey

Background and objective: Globally, tobacco use is one of the most serious public health concerns and preventable causes of morbidity and mortality, expected to reach annually more than 8 million deaths by the year 2030. In light of this estimation and limited surveillance of smoking, this study aimed to identify the tobacco use trends and patterns in various forms in Erbil city. Methods: A community‐based cross‐sectional household survey was carried out from September 2021 through June 2022, on a sample of 2601 respondents selected through a multi‐stage cluster sampling method in Erbil city. A specially designed questionnaire through direct interviews was used to collect socio-demographic and smoking-related data. Results: The prevalence of current daily smoking was 44.3%, occasional smoking was 14.5%, Ex-smoking was 8.0%, and those who never smoked before 33.2%.The prevalence of cigarette, and waterpipe smoking was 37.2%, and 46.5%respectively. More than half (51.0%) had tried to quit smoking at least once in their life, while 11.9% succeeded to quit. The main reason behind quitting was anticipated health risks (97.3%). The prevalence of smoking was significantly higher among those aged 20-29 years, single, males, college education, those having skilled manual /non-manual occupations, those who have smoker friends, and from a middle socioeconomic level Conclusion: The prevalence of smoking (current daily and occasional) was more than half and about one-third never smoked before. More than half had tried to quit smoking at least once in their life but (11.9%) succeeded to quit due to anticipate health risks and family pressure.

Association of Anemia and Diabetic Retinopathy Among Patients With Type 2 Diabetes Mellitus: Retrospective Cross-Sectional Study.

Introduction Type 2 diabetes mellitus (T2DM) is a common metabolic disorder characterized by the combination of defective insulin secretion and the inability of insulin-sensitive tissues to respond appropriately to insulin. Diabetic retinopathy (DR) is a common microvascular complication that can result in a preventable cause of blindness. Research to determine the prevalence of anemia among diabetic patients is necessary to assess whether treatment practices should be changed. Anemia is a common complication in patients with T2DM and has been associated with the progression of DR. In this study, our aim is to determine the prevalence of DR and its association with hemoglobin levels in patients diagnosed with T2DM in Dubai, UAE. Methods In this retrospective cross-sectional study, we extracted the data using electronic medical records. The study was performed over a span of three years in Dubai from 2019 to 2022. A total of 368 T2DM patients were included based on retinal exam findings classified into mild, moderate, severe non-proliferative retinopathy, and proliferative retinopathy. Descriptive statistics were used for categorical (frequency, percentage) and continuous variables (mean, SD), with chi-square/Fisher exact tests for categorical associations, ANOVA for continuous variables, and multiple logistic regression to identify DR risk factors, using OR, 95% CI, and p < 0.05 for significance. Results The prevalence of anemia (defined as hemoglobin levels ≤13 mg/dL for men and ≤12 mg/dL for women) was observed in 39.4% of individuals with DR aged between 40 and 88 years; 60.6% of the patients had normal hemoglobin, while 91 individuals (24.7%) exhibited mild anemia, 53 individuals (14.4%) showed moderate anemia, and only one individual (0.3%) had severe anemia. DR grading was as follows: mild non-proliferative DR (16.8%), moderate non-proliferative DR (30.2%), severe non-proliferative DR (13.3%), and proliferative DR (39.7%). Macular edema was present in 59.2% of patients, showing a statistically significant association with more severe DR stages (p < 0.0001). No significant association was found between hemoglobin levels and DR severity (p = 0.568). However, among males, a significant difference in mean hemoglobin levels across DR grades was observed (p = 0.009), with higher hemoglobin levels associated with lower odds of severe DR (OR = 0.775, p = 0.036). Macular edema strongly predicted DR severity, with significant odds ratios across all stages (p < 0.0001). Conclusions There is a significant prevalence of anemia among the examined population. DR severity was notably associated with lower hemoglobin levels in males, and macular edema was significantly linked to more severe stages of DR. Vigilant monitoring and integrated care for both anemia and DR are crucial to optimize patient outcomes and mitigate complications. Regular retinopathy screening is essential for early detection and timely intervention, particularly considering the challenges posed by anemia, such as delayed wound healing and increased infection risk post-screening.

Deep Vein Thrombosis

Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide. Venous thromboembolism (VTE), which includes DVT and pulmonary embolism (PE), affects an estimated 1 per 1,000 people and contributes to 60,000–100,000 deaths annually. Normal blood physiology hinges on a delicate balance between pro- and anti-coagulant factors. Virchow’s Triad distills the multitude of risk factors for DVT into three basic elements favoring thrombus formation: venous stasis, vascular injury, and hypercoagulability. Clinical, biochemical, and radiological tests are used to increase the sensitivity and specificity for diagnosing DVT.

Study on incidence and clinical profile of anemia in children aged 1 years to 15 years attending tertiary care hospital

Background: Children are considered as an important asset for any country and their health as one of the important indicators of a healthy country. There are various factors influencing children's health, with anemia being one of them. Anemia is a major global health problem, especially in developing countries like India, despite the fact that this problem is largely preventable and easily treatable. Methods: It is a descriptive study conducted in 140 children aged 1 year to 15 years who presented with anemia in the department of pediatrics at Navodaya Medical College Hospital and Research Center, Raichur. Aim was to study the incidence and profile of anemia in children aged 1 years to 15 years. Results: A total 0f 140 cases aged between 1- 15 years were included in the study. The highest number of cases occurred in the 11-15 years age group (38.5%), followed by the 6-10 years group (35.0%). There is more female preponderance in this study (55.7%) compared to males (44.2%). Moderate degree of anemia was the commonest grade of anemia (42.8%) The most common cause of anemia in this study was iron deficiency, accounting for 58 cases (41.4%) followed by 17 cases (12.1%) had megaloblastic anemia. Conclusions: Iron deficiency anemia is a preventable cause of cognitive impairment, and early interventions can prevent the morbidity and mortality associated with anemia. Despite the implementation of national programs to combat iron deficiency, the problem persists. Early detection of anemia among these children enables the planning of suitable interventions, such as nutritional education for mothers, growth monitoring, nutritional supplementation, deworming, and more, to effectively address and mitigate the issue.

Access to community-based eye services in Meru, Kenya: a cross-sectional equity analysis

BackgroundOver 80% of blindness in Kenya is due to curable or preventable causes and 7.5 m Kenyans currently need eye services. Embedding sociodemographic data collection into screening programmes could help identify the groups facing systematic barriers to care. We aimed to determine the sociodemographic characteristics that were associated with access among patients diagnosed with an eye problem and referred for treatment in the Vision Impact Programme, currently operating in Meru County.MethodWe used an embedded, pragmatic, cross-sectional design. A list of sociodemographic questions was developed with input from key stakeholders. The final question set included the following domains: age, gender, religion, marital status, disability, education, occupation, income, housing, assets, and health insurance. These were integrated into an app that is used to screen, refer, and check-in (register) participants within a major eye screening programme. We gathered data from 4,240 people who screened positive and were referred to their local outreach treatment clinic. We used logistic regression to identify which groups were facing the greatest barriers to accessing care.ResultsA quarter of those screened between April – July 2023 were found to have an eye problem and were referred, however only 46% of these people were able to access care. In our fully adjusted model, at the 0.05 level there were no statistically significant differences in the odds of attendance within the domains of disability, health insurance, housing, income, or religion. Strong evidence (p < 0.001) was found of an association between access and age, gender, and occupation; with males, younger adults, and those working in sales, services and manual jobs the least likely to receive care.ConclusionsAccess to essential eye services is low and unequal in Meru, with less than a third of those aged 18–44 receiving the care they need. Future work should explore the specific barriers faced by this group.

Answering a Call to Action: Reducing Fetal Alcohol Spectrum Disorders Using a Healthcare Champion Model.

Prenatal alcohol exposure and fetal alcohol spectrum disorders (FASDs) remain critical public health issues. Alcohol use in pregnancy is a leading preventable cause of birth defects, developmental disabilities, and learning disabilities. Alcohol screening and brief intervention (SBI) is effective at reducing excessive alcohol use. However, this clinical preventive service remains critically underutilized in primary care. In 2014, the Centers for Disease Control and Prevention called for the creation of FASD Champion programs to promote clinician education about FASDs. Six professional health organizations and groups providing reproductive and child health services set out to create FASD Champion programs. The American College of Obstetricians and Gynecologists FASDs Prevention Program was created to focus on reducing alcohol-exposed pregnancies. The American Academy of Pediatrics' Champion program maintains the goal of improving health outcomes for children with FASDs by improving pediatricians' diagnostic capacity. The American Academy of Family Physicians has prioritized training family physician champions to improve the delivery of alcohol SBI among adult patients. The University of Alaska Anchorage has partnered with the National Association of Nurse Practitioners in Women's Health, the American College of Nurse-Midwives, and the Association of Women's Health, Obstetric, and Neonatal Nurses to assure advanced practice registered nurses and midwives have the knowledge and skills to prevent alcohol-exposed pregnancies and FASDs. The American Association of Medical Assistants has prioritized expanding the knowledge and skills of medical assistants related to promoting alcohol-free pregnancies. Finally, the Champions program at the University of Texas at Austin was established to train health social workers in alcohol SBI. Through the advocacy, education, and mission of these 6 health sectors in collaboration with national organizations and educational institutions, the evidence-based approach of alcohol SBI is being disseminated throughout the United States to reduce the harmful effects of prenatal alcohol exposure.

Prevention of NICU Admission Hypothermia in Moderate- and Late-Preterm Infants.

Neonatal hypothermia is a common and preventable cause of neonatal morbidity and mortality. Although hypothermia prevention has been extensively studied in infants <32 weeks' gestation, the authors of few studies have targeted moderate- and late-preterm infants (MLPIs) in the delivery room. This quality improvement initiative was conducted from June 2019 to June 2023 at the Massachusetts General Hospital NICU and Labor and Delivery Unit. All inborn MLPIs 32 + 0/7 to 36 + 6/7 weeks' gestation admitted to the NICU were included. We expanded thermoregulatory measures typically used in protocols for infants <32 weeks' gestation, including increasing delivery room ambient temperature to 74°F and thermal mattress use. The primary outcome was hypothermia (<36.5°C) after NICU admission. The balancing measure was hyperthermia (≥38 °C). During the study period, there were 566 inborn MLPIs with a mean gestational age of 34 + 3/7 weeks and a mean birth weight of 2269 g. Special cause variation in neonatal hypothermia incidence was observed with a decrease from a mean baseline of 27% to 7.8% postintervention. Special cause variation was observed in hyperthermia incidence, with an increase from 1.4% to 6.2% postintervention largely initially associated with noncompliance with the protocol for thermal mattress removal. The expansion of several thermoregulation techniques commonly used in infants <32 weeks' gestation, particularly thermal mattress use, was associated with a decreased incidence of NICU admission hypothermia in MLPIs, with an increase in mild hyperthermia predominantly associated with concomitant polyethylene wrap use.

The Analysis Study of Gender and Risk of Congenital Hypothyroidism : A Comprehensive Systematic Review

Background: Congenital hypothyroidism is defined as a deficiency of thyroid hormone at birth and is one of the most common endocrine disorders in newborns. Congenital hypothyroidism, with a prevalence of 1 in 3000-4000 live births, is the most common preventable cause of mental retardation in children. The aim: The aim of this study to show about gender and risk of congenital hypothyroidism. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. Result: Eight publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: many risk factors are involved in the development of congenital hypothyroidism in children. It should be noted that the irreversible consequences of this disease for children including mental retardation is one of the cases which to control and remove it. Accordingly, awareness of the birth season could help policymakers who plan preventive programs to reduce the false negative results among neonates, especially girls.

Some aspects of tactical medicine in service and combat activities of police officers under the conditions of the legal regime of martial state: problem issues in critical situations and combat conditions

The article highlights the problematic issues of tactical training of law enforcement officers in today’s conditions, considers the actual problems and challenges that law enforcement officers may face during the performance of official duties and the provision of first aid in combat conditions and emergency situations. The issue of the interaction of the National Police of Ukraine with other rescue services at the scene for the effective provision of first aid was considered. It is noted that the interaction of the police and other rescue services at the scene of the event in the conditions of martial law requires a special approach and careful planning. It is necessary to ensure a clear coordination of actions, an appropriate level of protection for the personnel of the rescue services, and to take into account the peculiarities of work in the conditions of hostilities. Effective interaction between different services will minimize the consequences of emergency situations and ensure the safety of the population in the conditions of martial law. The article highlights the algorithm of actions for providing assistance to injured persons by police officers under fire, considers the key issues of training law enforcement officers to provide effective first aid in conditions of martial law or extreme situations in general. The authors of the article emphasize the importance of unified training programs for police officers in tactical medicine, which should include both theoretical knowledge and practical skills. Special attention is paid to ensuring a high level of readiness of police officers for quick and effective response to emergency situations and saving lives in the conditions of an aggravated conflict. Service situations in which police officers may find themselves are often accompanied by conflicts and their escalation, up to “fire contact” with the offender. Therefore, for the training of police officers, the section of tactical medicine is the most relevant, which teaches the basic skills of providing self- and mutual aid in combat conditions, which are primarily aimed at eliminating the preventive causes of death, taking into account the threat from combat operations or an active shooter. Unfortunately, there are infamous cases of the death of police officers while performing law enforcement tasks, which indicates the need for mandatory integration of first aid standards into their training and operations in various tactical situations. In addition, it is important to note that training police officers in tactical medicine will not only help them provide effective care to victims, but will also increase their level of safety while performing their duties. Therefore, unified training programs for police officers in tactical medicine should be an integral part of the training of law enforcement officers.

Analysis of the causes of neonatal death and genetic variations in congenital anomalies: a multi-center study.

Neonatal deaths often result from preventable conditions that can be addressed with appropriate interventions. This study aims to analyze the distribution of the causes of neonatal death and explore genetic variations that lead to congenital anomalies in Northwest China. This multi-center observational study was conducted across six medical centers in Shaanxi province, Northwest China. Clinical data were retrospectively collected from neonates admitted between 2016 and 2020. Kaplan-Meier analysis was utilized to estimate survival rates, while high-throughput sequencing platforms were employed to detect mutations causing congenital anomalies. Among 73,967 neonates requiring hospital care, 424 neonatal deaths were recorded, leading to a neonatal mortality rate of 0.57%. The primary causes of death included neonatal respiratory distress syndrome (23.8%), birth asphyxia (19.8%), neonatal septicemia (19.3%), and congenital anomalies (13.6%). The leading causes of neonatal deaths due to congenital anomalies were congenital heart defects (38.6%), bronchopulmonary dysplasia (14.0%), and inherited metabolic disorders (10.5%). Genetic analysis identified 83 pathogenic or likely pathogenic variants in 23 genes among the neonates with congenital anomalies, including four novel mutations (c.4198+1G>T, c.1075delG, c.610-1G>A, c.7769C>T) in the ABCC8, CDKL5, PLA2G6, and NIPBL genes. Congenital anomalies represent a significant and preventable cause of neonatal deaths in Northwest China. Early detection of congenital anomalies through genetic testing and comprehensive prenatal care are crucial for reducing neonatal mortality rates and improving pregnancy outcomes.

Medication Adherence of Children with Congenital Hypothyroidism in Iran: A National Cross-Sectional Study

Background: Congenital hypothyroidism is the most common preventable and treatable cause of intellectual disability in children. A key component of the surveillance system for congenital hypothyroidism is ensuring a regular treatment program for affected children. Despite nearly 20 years since the successful implementation of the newborn screening program for hypothyroidism in Iran, a comprehensive evaluation of patients' adherence to treatment has not been conducted. Objectives: The aim of this study was to investigate the adherence to treatment among patients with congenital hypothyroidism in Iran. Methods: In this national cross-sectional study conducted in 2024, the adherence to treatment of 400 children with congenital hypothyroidism born between 2019 and 2023 in Iran was examined using the Morisky Medication Adherence Scale. The patients were randomly selected from national registry data. Data were analyzed using chi-squared tests, Fisher's exact test, and logistic regression in Stata software version 16. Results: The mean and standard deviation of medication adherence was 6.35 ± 1.41. Overall, adherence was good (≥ 6) in 284 (71.0%) of the study participants. In the univariate analysis, the most significant factors influencing adherence were place of residence, higher maternal education, lower paternal education, and type of congenital hypothyroidism (CH). In the multivariate analysis, children with permanent CH had good adherence, and parental education was not statistically significant (P &gt; 0.05). Conclusions: The results of this study showed that medication compliance in more than two-thirds of hypothyroid children diagnosed by national newborn screening is good. Given the importance of treatment in these patients, it is recommended that intervention plans be implemented, including educational programs and active follow-up of patients to increase compliance.

The history of smoking cessation support in Hungary: A narrative review.

Tobacco use remains the largest preventable cause of death worldwide, including Hungary with a smoking-related death rate in 2019 of 360/100000 (age-standardized death rate), among the highest in the World Health Organization (WHO) European Region. Despite the well-formulated tobacco control interventions defined by the WHO Framework Convention on Tobacco Control (WHO FCTC) in place, smoking prevalence in 2019 was high (27%) and has not decreased since 2014. Therefore, greater emphasis should be placed on addressing and treating smokers. This narrative review summarizes the progress in smoking cessation support in Hungary to identify strengths and areas for improvement. A literature search was conducted in the Hungarian Arcanum Digital Science Library. After 2012, data were derived from the National Methodology Center for Cessation Support reports. The National Korányi Institute for Pulmonology established the first organized network of cessation counselling services in 1987 in outpatient pulmonary clinics (OPCs) sponsored by a State Insurance tender. By 1999, individual behavioral counselling with medication was accessible to 130 healthcare providers, due to the support of pharmaceutical companies. Since 2005, the National Health Insurance Fund has financed smoking cessation support in OPCs, albeit at a low value. Having recognized that OPCs are overburdened by the organizational tasks of cessation support and that funding is intermittent, from 2020, the counselling service has transferred to the existing network of health promotion offices, although without specific funding for cessation programs and communication. Adequate and regular funding for established counselling services and nicotine withdrawal treatment is essential to achieve progress in tobacco control. The role of healthcare professionals is outstanding; therefore, individual responsibilities should be recognized.

Manual Sutureless (MSICS) Cataract Surgery and Corneal Astigmatism

The most frequent preventable cause of blindness worldwide is cataracts. Manual Small Incision Cataract Surgery (MSICS) is still very much in use, even though cataract surgery is always changing. The resurgence of MSICS can be attributed to its low cost and safety, as it primarily uses easily sterilizable equipments and does not require sophisticated technology. This study aims to assess corneal astigmatism and manual sutureless (MSICS) cataract surgery after a month of follow-up. Forty individuals with cataract diagnoses were enrolled in this prospective study. During the procedure, a posterior chamber intraocular lens (IOL) implantation was done in addition to a superior manual minor incision under local anesthesia. The findings indicated that 15% or so of the patients experienced astigmatism following surgery. Also the findings revealed that sphere and cylinder refraction was significantly influenced by surgery. The means of sphere refraction before and after surgery were 3.93±6.37 and 0.93±0.98 D, while the corresponding means for cylinder refraction were 1.37±1.08 and 1.94±1.18 D. The results showed that means preoperative and postoperative Keratometry of cornea (K1) were 43.09±1.21 and 43.37±1.42 mm, while the corresponding means of Keratometry (K2) were 43.97±1.35 and 44.49±1.59 mm. The study concluded that the length of the superior incision (6.0 mm) may have contributed to the higher mean SIA than reported in other studies. However, more research is required to determine the impact of incision size on surgically produced astigmatism.

Kappa-opioid receptor antagonism in the nucleus accumbens shell distinguishes escalated alcohol consumption and negative affective-like behavior from physiological withdrawal in alcohol-dependence

Alcohol use disorder (AUD) is a chronic relapsing disease that is deleterious at individual, familial, and societal levels. Although AUD is one of the highest preventable causes of death in the USA, therapies for the treatment of AUD are not sufficient given the heterogeneity of the disorder and the limited number of approved medications. To provide better pharmacological strategies, it is important to understand the neurological underpinnings of AUD. Evidence implicates the endogenous dynorphin (DYN)/κ-opioid receptor (KOR) system recruitment in dysphoric and negative emotional states in AUD to promote maladaptive behavioral regulation. The nucleus accumbens shell (AcbSh), mediating motivational and emotional processes that is a component of the mesolimbic dopamine system and the extended amygdala, is an important site related to alcohol's reinforcing actions (both positive and negative) and neuroadaptations in the AcbSh DYN/KOR system have been documented to induce maladaptive symptoms in AUD. We have previously shown that in other nodes of the extended amygdala, site-specific KOR antagonism can distinguish different symptoms of alcohol dependence and withdrawal. In the current study, we examined the role of the KOR signaling in the AcbSh of male Wistar rats in operant alcohol self-administration, measures of negative affective-like behavior, and physiological symptoms during acute alcohol withdrawal in alcohol-dependence. To induce alcohol dependence, rats were exposed to chronic intermittent ethanol vapor for 14 h/day for three months, during which stable escalation of alcohol self-administration was achieved and pharmacological AcbSh KOR antagonism ensued. The results showed that AcbSh KOR antagonism significantly reduced escalated alcohol intake and negative affective-like states but did not alter somatic symptoms of withdrawal. Understanding the relative contribution of these different drivers is important to understand and inform therapeutic efficacy approaches in alcohol dependence and further emphasis the importance of the KOR/DYN system as a target for AUD therapeutics.

Unrolling the Invisible: Socio-Cultural Grounds of Child Mortality in the Slums of Dhaka

According to World Health Organization, there is an 85% decline in the recorded child deaths from 1971 in Bangladesh from 371.3 to 22.6 per 1000 live births. However, the rate of child mortality is still quite significant considering the growing development of Bangladesh. In maximum literatures, the prevalent reasons behind child mortality are portrayed as complete biological phenomena and medical conditions (e.g., asphyxia, prematurity, and low birth weight) for the children under the age of 5 in Bangladesh. This research focused on the reasons behind child mortality beyond the biological and medical conditions while stressing on finding the preventable causes of child mortality, through a systematic method of death study named Social Autopsy. Social autopsy refers to a structured qualitative research tool that aims at identifying social, behavioral, and health systems contributors to child deaths. Using this tool, the research has identified that multiple socio-cultural, structural, and behavioral conditions along with medical conditions for child mortality. The research was done in two of the biggest slum areas of Dhaka city: Hazaribagh and Kamrangir Char. 15 families who lost children under 5 years and 5 health care providers were interviewed with a semi-structured method to draw an inclusive picture of socio-cultural dynamics of child mortality. The data was analyzed manually through thematic analysis and narrative analysis which showed the interconnection of all the broader underlying reasons and a detailed impacts of specific causes of child mortality.

Practice Facilitation to Address Unhealthy Alcohol Use in Primary Care

Unhealthy alcohol use (UAU) is the fourth most preventable cause of death in the US. The US Preventive Services Task Force recommends that primary care clinicians routinely screen all adults 18 years and older for UAU; however, this preventive service is poorly implemented. To determine if practice facilitation improved delivery of the recommended care for UAU compared to usual care. This practice-level cluster randomized clinical trial was conducted across diverse and representative primary care practices throughout Virginia. A total of 76 primary care practices enrolled between October 2019 and January 2023. Practices received immediate (intervention) or 6-month delayed (control) practice facilitation, which included tailored educational sessions, workflow management, and tools for addressing UAU. Outcomes included the increase in recommended screening for UAU, brief interventions, referral for counseling, and medication treatment. Data were collected via medical record review (structured and free text data) and transcripts of practice facilitator sessions and exits interviews. Of the 76 primary care practices enrolled, 32 were randomized to intervention and 35 to control; 11 789 patients (mean [SD] age, 50.1 [16.3] years; 61.1% women) were randomly selected for analysis, with patient demographics similar to Virginia at large. From baseline to 6 months after intervention, screening with a validated instrument increased from 2.1% (95% CI, 0.5%-8.4%) to 35.5% (95% CI, 11.5%-69.9%) in the intervention group compared to 0.4% (95% CI, 0.1%-1.8%) to 1.4% (95% CI, 0.3%-5.8%) in the control group (P < .001). Brief office-based interventions for the intervention group increased from 26.2% (95% CI, 14.2%-45.8%) to 62.6% (95% CI, 43.6%-78.3%) vs 45.5% (95% CI, 28.0%-64.1%) to 55.1% (95% CI, 36.5%-72.3%) in the control group (P = .008). Identification of UAU, referral for counseling, and medication treatment had similar changes for both groups. Qualitative analyses of transcripts revealed that few clinicians understood the preventive service prior to practice facilitation, but at the end most felt much more competent and confident with screening and brief intervention for UAU. This cluster randomized clinical trial demonstrated that practice facilitation can help primary care practices to better implement screening and counseling for UAU into their routine workflow. Effective primary care practice implementation interventions such as this can have a profound effect on the health of communities. Given the number of people that the participating practices care for, this intervention resulted in an additional 114 604 patients being screened annually for UAU who would not have been otherwise. ClinicalTrials.gov Identifier: NCT04248023.

Deciphering the Role of Peroxisome Proliferator-activated Receptor α and Phosphodiesterase Type 5 Targets in Alzheimer's Disease.

The most prevalent cause of dementia is Alzheimer's disease (AD). Although the global AD rate is on a constant rise, medical research is yet to find a cure for this neurological condition. Current available therapeutic drugs for AD treatment only provide symptomatic alleviation. Therefore, it is essential to establish effective AD treatment strategies in addressing clinical needs. The development of disease-modifying treatments for use in the disease's early stages and the advancement of symptomatic drugs principally used in the disease's later stages are priorities in AD research. Given that the etiology of AD is difficult to comprehend, using a multimodal therapy intervention that targets molecular targets of AD-related degenerative processes is a practical strategy to change the course of AD progression. The current review article discussed PPAR-α (Peroxisome proliferator-activated receptor-α) and PDE5 (Phosphodiesterase type 5) targets with evidence for their preclinical and clinical importance. Furthermore, we support the targets with AD-related processes, functions, and remedial measures. A unique synergistic method for treating AD may involve the beneficial combinatorial targeting of these two receptors. Furthermore, we reviewed different PDE chemical families in this research and identified PDE5 inhibitors as one of the promising AD-related experimental and clinical disease-modifying medications. Lastly, we suggest jointly targeting these two pathways would be more beneficial than monotherapy in AD treatments.