Preventable Illness Research Articles

Comparison of NFHS 4 and 5 data in Tamil Nadu for diarrhoeal disease and risk factors among children under 5 years

Background: Globally, 4 billion cases of diarrhea occur every year and 88% of these can be attributed to unsafe water, inadequate sanitation and poor hygiene. One out of ten babies born in developing countries do not reach their fifth birthday as they die from diarrhoeal diseases. Diarrhoeal diseases remain the number one cause of child mortality in India even though it is a preventable illness. The study aims to compare the prevalence of diarrhoeal diseases and enumerate its risk factors among children aged below 5 years in different districts of Tamil Nadu from NFHS 4 and 5. Methods: This study is a secondary data analysis based on the NFHS 4 & 5 data of Tamil Nadu, which has data available in round 4 for 26,033 households and for 27,929 households in round 5. The analysis pertains to children aged below 5 years who were 7,658 in round 4 and 6,283 in round 5. Results: Overall there was a 53.8% decrease in prevalence in Tamil Nadu. Prevalence in Salem had reduced by 92.1%. Erode, Kanniyakumari and Krishnagiri achieved 84.5%, 86.6%, 89.2% reductions respectively. Nagapattinam and Virudhunagar experienced a higher number of prevalence with 7.5% and 12% increase of cases respectively. Overall Tamil Nadu 71.6% improvement in sanitation from NFHS-4. Tiruvannamalai achieved the highest improvement (96.5%), while Erode did not achieve much improvement (7.8%). Overall Tamil Nadu had 0.92% improvement in drinking water facility from NFHS-4. Nagapattinam and Perambalur have the highest improvement (6.8 and 6.5% respectively) and have achieved 100%. Ariyalur has had a 6.1% decline in quality of drinking water facility. Conclusion: Between NFHS 4 and 5, the prevalence of diarrhoeal cases among children under 5 has dropped by 53.8% and child mortality has reduced by 16.8% in Tamil Nadu. We can also see that there is an overall improvement in of 27.4% in sanitation and 0.92% in drinking water quality.

Paediatric iGAS Morbidity and Mortality in Ireland 2022-2023 episodic upsurge

Abstract There was an unseasonal upsurge in invasive Group A Streptococcal (iGAS) activity in Ireland during the 2022/2023 winter period. In particular, there was an increase in the proportion of paediatric infections and a rise in the age specific death rate for those under the age of 18, from 0.10 to 1.43 per 100,000. This review aimed to describe the demographic and clinical factors associated with paediatric iGAS infection during this upsurge. All iGAS cases under the age of 16 years, notified to Public Health between 1st October and 30th June 2023, were included. A review of hospital records for each case was conducted using a standardised electronic data collection proforma. Descriptive, univariate and multivariate analysis was conducted using SPSS statistical package. There was a total of 183 cases of iGAS notified during this upsurge in Ireland. A hospital chart review was conducted for 169 of these cases, giving a response rate of 92.3%. The median age was 4 years (range 0-15,) with 44.4% (75) having a previous healthcare attendance during their illness. Varicella coinfection occurred in 27.8% (47) of cases. There was respiratory viral coinfection in 40.8% (69) of cases, and this was significantly associated with an increased risk of death RR 6.49 (95% CI 4.45 - 29.08) p < 0.05. A respiratory site of infection was also significantly associated with an increased risk of death RR 10.13 (95% CI 2.23 - 45.95) p < 0.001. However, both factors did not remain significant once adjusted for age, sex, ethnicity and deprivation index. This national review demonstrated the significant burden of paediatric iGAS morbidity and mortality during this upsurge. A significant proportion of cases, 37.9% (64) were associated with vaccine preventable illness, with respiratory viral infections and a respiratory site of infection both being significantly associated with an increased risk of death. Key messages • A significant proportion of iGAS cases were associated with a vaccine preventable illness. • A respiratory site of iGAS infection was significantly associated with an increased risk of death in paediatric cases.

Neonatal tetanus in South Sudan: a case series

Introduction: Neonatal tetanus is a life-threatening disease of public health importance; it is yet to be eliminated and is still occurring in South Sudan. It is caused by a neurotoxin from a bacterium Clostridium tetani whose spores exist in the environment. Compared to high-income countries, most low-income countries lack intensive care units, and magnesium sulfate shown to improve neonatal tetanus outcomes. Objectives: We aimed to determine the outcome of neonatal tetanus in Al Sabah Children’s Hospital, Juba, South Sudan. Methods: We conducted a case series study in Al Sabah Children’s Hospital in Juba, South Sudan. It described three neonates who presented within the first seven days of life with a history of excessive crying, inability to breastfeed, and tetanic muscle spasms when stimulated. They had signs of respiratory distress, fever, and labile heart rates. We made a diagnosis of neonatal tetanus with autonomic dysfunction, and started them on phenobarbitone because diazepam was not available, oxygen, and antibiotics. However, tetanus immune globulin and anti-tetanus serum were not available. Results: Unfortunately, all three neonates died within 24 hours of admission. Conclusion: Our primary focus as a nation is to improve access to quality health services and the prevention of neonatal tetanus through encouraging appropriate antenatal care, facility delivery, clean delivery and healthy umblical cord care practices, and tetanus vaccinations in teenage girls and young adults. When prevention fails, there is a need for neonatal intensive care with recommended medicines to significantly decrease mortality in this preventable tragic illness. Keywords: Neonatal tetanus; low-income countries; neonates; Al sabah children hospital; South Sudan.

Barriers Towards Healthcare Access and Services among People with Disabilities: A Scoping Review of Qualitative Studies

Healthcare access and services is one of the challenges faced by people with physical disability (PWPD). PWPD also has at risk of early death and preventable chronic illness. Lack of access to healthcare services includes delay or failure to receive needed care, lack of continuity of care and financial burden will result in deterioration of health, wellbeing and functional status. The aim of this paper was to review barriers towards healthcare access and services among PWPD based on the existing qualitative studies. We conducted a scoping review of relevant qualitative articles from PubMed, Scopus and ProQuest. The article search was based on the available keyword in the title with the publication restricted within 10 years (between 2012 to 2021). The search strategy was conducted using MeSH terms of ‘barriers, healthcare access, healthcare services and physical disability’. In this review, people with different kinds of physical disabilities were included. There were 2004 articles obtained from the initial search. 27 articles met the inclusion criteria for the final review. In each study, PWPD noted various barriers to access healthcare services. Findings from this review revealed five themes: personal; financial; attitudinal and communication; health system; structural and physical barriers. The findings showed that PWPD faces various barriers when accessing healthcare services. Addressing these barriers could help create a healthcare system that is inclusive and accessible for all.

Vaccination Across the Lifespan: A Public Health Imperative

Vaccination is an essential public health intervention, preventing infectious diseases, saving millions of lives globally, and reducing the burden on the healthcare system. Currently, vaccines prevent between 3.5 and 5 million deaths annually from diseases like diphtheria, tetanus, pertussis, influenza, and measles.1 It not only protects individuals but also contributes to herd immunity, safeguarding entire communities. Maintaining high vaccination coverage across all age groups reduces the burden of preventable illnesses and safeguards public health. Childhood immunization is a cornerstone of preventive healthcare, providing protection against various life-threatening diseases during the most vulnerable years of life. Key vaccines include the DTP, MMR, IPV, Hib, and pneumococcal. 2 Global immunization coverage has stagnated since 2022, with 14.5 million children missing all DTP doses and 6.5 million not completing follow-up doses. There is an urgent need for innovative solutions to meet the Immunization Agenda 2030 targets of 90% vaccination coverage. 3 Vaccination has a pivotal role in women's healthcare, especially during pregnancy. The CDC recommends the inactivated flu and Tdap vaccines for protection of both mother and baby, with the flu vaccine best administered by the end of October and Tdap between 27 and 36 weeks of gestation. The HPV vaccine is recommended for girls aged 9–14 (two doses) and women over 14 (three doses) to protect against cervical cancer and genital warts, but it should not be given during pregnancy due to insufficient safety data.4 Regular vaccinations are crucial for adults aged 50–64, including COVID-19, influenza, shingles, and Tdap/Td. Hepatitis B is recommended for those up to 59 years old, and MMR for those born in 1957 or later. For those 65 and older, COVID-19, influenza, pneumococcal, and shingles vaccines are essential, with an RSV recommended. Healthcare providers should be consulted to determine additional vaccines for older adults, as regular vaccinations are important to prevent serious health issues due to immune decline and chronic conditions. 5 A comprehensive vaccination strategy is important for community health, encompassing children, women, adults, and older adults. A strong public health infrastructure that guarantees vaccine access and affordability should serve as the foundation for this strategy. In order to improve vaccination coverage, public awareness campaigns must be customized to address the concerns of all age groups. Children's immunization programs must be implemented in schools and coincide with routine physical examinations while women, particularly those who are of reproductive age, require special attention. Adult immunization programs must to prioritize occupational health, and older people need to remain updated. Considering immunization as a top public health priority, policy makers and healthcare professionals must work together to ensure continuous monitoring and evaluation of vaccination campaign’s coverage and effectiveness in order to spot gaps and launch prompt interventions.

The Role of Tranexamic Acid in Postpartum Hemorrhage: A Narrative Review.

Postpartum hemorrhage is the leading cause of preventable maternal illness and death globally, and carries a disproportionately high burden of mortality in low-to-middle income countries. Tranexamic acid, an antifibrinolytic drug, has been widely adopted to control bleeding in trauma and other surgical conditions. Within the last decade, the World Health Organization updated their guidelines for the treatment of postpartum hemorrhage to include the use of tranexamic acid in all cases of postpartum hemorrhage. However, despite these guidelines, and the proven utility of tranexamic acid to treat postpartum hemorrhage, widespread adoption of tranexamic acid into global standards of care across professional organizations has not been achieved. It is important for healthcare providers to understand the etiologies of postpartum hemorrhage, the mechanism of action and adverse effect profile of tranexamic acid, and the available literature regarding the use of tranexamic acid to prevent and treat postpartum hemorrhage to provide the best care for the pregnant patient.

A Randomized, Placebo-Controlled Trial to Evaluate the Safety and Efficacy of VIR-2482 in Healthy Adults for Prevention of Influenza A Illness (PENINSULA).

Influenza A results in significant morbidity and mortality. VIR-2482, an engineered human monoclonal antibody with extended half-life, targets a highly conserved epitope on the stem region of influenza A hemagglutinin, and may protect against seasonal and pandemic influenza. This double-blind, randomized, placebo-controlled, phase 2 study examined the safety and efficacy of VIR-2482 for seasonal influenza A illness prevention in unvaccinated healthy adults. Participants (N = 2977) were randomized 1:1:1 to receive VIR-2482 450 mg, VIR-2482 1200 mg, or placebo via intramuscular (IM) injection. Primary and secondary efficacy endpoints were the proportions of participants with reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed influenza A infection and either protocol-defined influenza-like illness (ILI) and Centers for Disease Control and Prevention (CDC)-defined ILI or World Health Organization (WHO)-defined ILI, respectively. VIR-2482 450 mg and 1200 mg prophylaxis did not reduce the risk of protocol-defined ILI with RT-PCR-confirmed influenza A versus placebo (relative risk reduction [RRR], 3.8% [95% CI: -67.3, 44.6] and 15.9% [95% CI: -49.3, 52.3], respectively). At the 1200 mg dose, the RRRs in influenza A illness were 57.2% [95% CI: -2.5, 82.2] using CDC-ILI and 44.1% [95% CI: -50.5, 79.3] using WHO-ILI definitions, respectively. Serum VIR-2482 levels were similar regardless of influenza status; variants with reduced VIR-2482 susceptibility were not detected. Local injection-site reactions were mild and similar across groups. VIR-2482 1200 mg IM was well tolerated but did not significantly prevent protocol-defined ILI. Secondary endpoint analyses suggest this dose may have reduced influenza A illness.

Combining app-based behavioral therapy with electronic cigarettes for smoking cessation: a study protocol for a single-arm mixed-methods pilot trial

BackgroundCigarette smoking remains a leading cause of preventable illness and death, underscoring the need for effective evidence-based smoking cessation interventions. Nuumi, a novel smoking cessation program integrating a digital behavioral therapy and an electronic cigarette, may provide a solution.ObjectiveTo investigate the initial efficacy, acceptability and psychological outcomes of an evidence-based smoking cessation intervention comprised of a mobile phone app and an electronic cigarette among adults who smoke and who are motivated to quit.MethodsA prospective 6-month single-arm mixed-methods pilot study will be conducted. Seventy adults who smoke and who are motivated to quit will be recruited via web-based advertisements and flyers. Participants receive access to an app and an electronic cigarette with pods containing nicotine for temporary use of at least 3 months. The electronic cigarette is coupled with the app via Bluetooth, allowing for tracking of patterns of use. The behavioral therapy leverages evidence-based content informed by cognitive behavioral therapy and mindfulness-informed principles. Web-based self-report surveys will be conducted at baseline, at 4 weeks, at 8 weeks, at 12 weeks, and at 24 weeks post-baseline. Semi-structured interviews will be conducted at baseline and at 12 weeks post-baseline. Primary outcomes will be self-reported 7-day point prevalence abstinence from smoking at 12 weeks and 24 weeks. Secondary outcomes will include other smoking cessation-related outcomes, psychological outcomes, and acceptability of the nuumi intervention. Descriptive analyses and within-group comparisons will be performed on the quantitative data, and content analyses will be performed on the qualitative data. Recruitment for this study started in October 2023.DiscussionAs tobacco smoking is a leading cause of preventable morbidity and mortality, this research addresses one of the largest health burdens of our time. The results will provide insights into the initial efficacy, acceptability, and psychological outcomes of a novel mobile health intervention for smoking cessation. If successful, this pilot may generate an effective intervention supporting adults who smoke to quit smoking. The results will inform feasibility of a future randomized controlled trial.Trial Registration German Clinical Trials Register DRKS00032652, registered 09/15/2023, https://drks.de/search/de/trial/DRKS00032652.

Health Workers Perceived Hindrances to Implementation of National Programme on Immunization among People in Kwara State, Nigeria

Abstract Background: Childhood preventable illnesses that cause high rates of morbidity and mortality in Nigeria include poliomyelitis, tuberculosis, diphtheria, tetanus, measles, and hepatitis. Some factors prevent the effective implementation of the national immunization program among Kwara State residents, despite numerous interventions aimed at preventing them through routine immunization. This study investigated inadequate funding, lack of community involvement, and low public awareness as factors that prevented the implementation of the Kwara State’s national immunization program. Methods: A descriptive survey research design with 460 respondents was used in this study. Results: The results showed inadequate funding, low community involvement, and low public awareness impede the successful execution of the national immunization program in Kwara State, Nigeria. Conclusion: In Kwara State, Nigeria, inadequate funding, lack of community involvement, and lack of public awareness impede successful execution of the national immunization program.

School as a space for nursing: a review of health literacy

Objective: To understand the role of school nursing in the context of child and adolescent health literacy. Methods: An integrative review using the Web of Science, MEDLINE/Pubmed, Scopus, Cinahl, Virtual Health Library databases, and search terms related to child and adolescent health, health literacy, and school nursing. No time or language limits were considered. Results: 419 articles were identified and, after excluding duplicates and applying the eligibility criteria, seven articles made up the final sample, none of them developed in Brazil. Despite being a field of research that is still little studied, the results revealed the positive impact of nursing in the school context in promoting physical and mental health literacy, preventing preventable illnesses, and managing chronic non-communicable diseases. This evidence leads to reflections on the recognition of school nursing in Brazil. Conclusion: Nurses are references in the implementation of health literacy programs and in the construction of health literate organizations. In the Brazilian context, there is an urgent need to expand the training of nurses trained to work in schools.

How Primary Care Clinicians Process Patient Death: Logistics, Emotions, and Opportunities for Structural Support

BackgroundNavigating the logistics and emotional processing of a patient’s death is an inevitable part of many physicians’ roles. While research has primarily examined how inpatient clinicians cope with patient loss, little work has explored how primary care clinicians (PCCs) handle patient death in the outpatient setting, and what support resources could help PCCs process loss.ObjectiveTo explore PCCs’ experiences with the logistics and emotional processing of patient deaths and suggestions for supportive resources.DesignQualitative study using semi-structured interviews conducted between March and May 2023.ParticipantsRecruitment emails were sent to 136 PCCs (physicians and nurse practitioners) at three San Francisco academic primary care clinics. Twelve clinicians participated in the study.ApproachThis study used a template analysis approach. Interview transcripts were analyzed in an iterative fashion to identify themes for how PCCs navigate patient death.ResultsParticipants (n=12) described outpatient death notification as inconsistent, delayed, and rife with uncertainty regarding subsequent actions. They felt various emotions, notably sadness and guilt, especially with deaths of young, vulnerable patients or those from preventable illnesses. Participants identified strategies for emotional processing and recommended improvements including clear procedural guidance, peer debriefings, and formal acknowledgements of deceased patients.ConclusionsInterviewing PCCs about their experiences following a patient death revealed key themes in logistical and emotional processing, and clinic resource recommendations to better support PCCs. Given the distinct characteristics of primary care—such as enduring patient relationships, greater isolation in ambulatory settings compared to inpatient environments, and rising burnout rates—enhancing guidance and support for PCCs is crucial to mitigate administrative burdens and grief after patient loss.

Mortality from non-communicable diseases and associated risk factors in Zambia; analysis of the sample vital registration with verbal autopsy 2015/2016

BackgroundNon-communicable diseases (NCDs) are the world’s growing cause of preventable illness, disability, morbidity, and mortality which account for 71% of deaths. The aim of this study was to determine the factors associated with mortality from NCDs among persons aged 15 years and above in Zambia.MethodologyThe study used data from Sample Vital Registration with Verbal Autopsy (SAVVY) 2015/16 (Zambia). A total of 3529 Verbal Autopsy were completed in the study, with only 2599 of death where among people aged 15 years and above. Three-level data analysis was applied; univariate analysis, bivariate analysis, and multivariate analysis (binary logistic regression).FindingsThe overall number of deaths from NCDs was 28.81%. Stratified analysis by gender showed that deaths from NCDs were higher among women (32.60%) as compared to men (26.25%). Among all persons, dying from NCDs was associated with tobacco use, age, and education. Tobacco use was negatively associated with mortality from NCDs (adjusted odds ratio [aOR] = 0.68; 95% confidence interval [CI]: 0.48–0.98). Age was positively associated with the odds of dying from NCDs among persons aged 45–59 years (aOR = 3.87, 95% CI: 2.13–7.01), 60–74 years (aOR = 12.05, 95% CI: 6.44–22.55), and 75 + years (aOR = 15.16, 95% CI: 7.93–28.97). The likelihood of dying from NCDs was higher among persons with secondary education as compared to those with no education (aOR = 1.93, 95% CI: 1.11–3.33).ConclusionThe findings from this study suggest that public health interventions targeting NCDs need to consider behavioural factors, especially tobacco use which exposes people to second-hand smoke. We also recommend large-scale national-level studies to further examine the contribution of each factor leading to mortality from NCDs.

Ongoing Measles in the Developed and Developing World.

Measles is a vaccine-preventable illness. Nevertheless, in recent years, measles is still endemic and epidemic in both the developed world and the developing world. The public perception of measles in the past was that it was not a big deal. However, measles is associated with a number of complications which can be places in three categories which are: acute(diarrhea, otitis media, pneumonia, encephalitis, seizures, and death) and delayed-subacute sclerosing panencephalitis (SSPE) and post-measles immune amnesia. Contrary to the beliefs of the anti-vaccine lobby, measles is bad. In acute measles, the death rate is 1-3 per 1000 and the risk of encephalitis is 1 per 1000. Relatively recent investigations indicate that SSPE is considerably more common than previously believed. The worldwide contribution of post-measles immune amnesia to morbidity and mortality is likely to be huge. In exposure situations, two doses of measles vaccine will prevent 99% of cases. Presently in the United States, the first dose is given at 12 through 15 months of age. The second dose is most often administered at 4 through 6 years of age. In my opinion, the second dose of measles vaccine should be given 4-6 weeks after the first dose rather than at 4-6 years of age. Children who don't have antibody to measles should not travel to risk areas.

How and why do financial incentives contribute to helping people stop smoking? A realist review

BackgroundTobacco smoking remains a key cause of preventable illness and death globally. In response, many countries provide extensive services to help people to stop smoking by offering a variety of effective behavioural and pharmacological therapies. However, many people who wish to stop smoking do not have access to or use stop smoking supports, and new modes of support, including the use of financial incentives, are needed to address this issue. A realist review of published international literature was undertaken to understand how, why, for whom, and in which circumstances financial incentives contribute to success in stopping smoking for general population groups and among pregnant women.MethodsSystematic searches were undertaken from inception to February 2022 of five academic databases: MEDLINE (ovid), Embase.com, CIHAHL, Scopus and PsycINFO. Study selection was inclusive of all study designs. Twenty-two studies were included. Using Pawson and Tilley’s iterative realist review approach, data collected were screened, selected, coded, analysed, and synthesised into a set of explanatory theoretical findings.ResultsData were synthesised into six Context-Mechanism-Outcome Configurations and one overarching programme theory after iterative rounds of analysis, team discussion, and expert panel feedback. Our programme theory shows that financial incentives are particularly useful to help people stop smoking if they have a financial need, are pregnant or recently post-partum, have a high threshold for behaviour change, and/or respond well to external rewards. The incentives work through a number of mechanisms including the role their direct monetary value can play in a person’s life and through a process of reinforcement where they can help build confidence and self-esteem.ConclusionThis is the first realist review to synthesise how, why, and for whom financial incentives work among those attempting to stop smoking, adding to the existing evidence demonstrating their efficacy. The findings will support the implementation of current knowledge into effective programmes which can enhance the impact of stop smoking care.PROSPERO registration numberCRD42022298941.

A120 A HUMAN-CENTERED DESIGN APPROACH TO THE DEVELOPMENT OF A VACCINE IMPLEMENTATION STRATEGY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract Background Vaccination uptake amongst patients with inflammatory bowel disease (IBD) remains suboptimal. Our previous study assessed perceived barriers and solutions related to implementation of evidence-based guidelines for vaccine preventable illness (VPI). Barriers included limited time, lack of access to a family physician, and incomplete understandings of coverage/access to vaccines. Aims The aim of this study was to use human-centered design (HCD) to design a vaccine implementation program in patients with IBD. Methods The HCD approach consisted of multiple phases. Phase 1 (discovery and define) consisted of semi-structured interviews of healthcare providers. Phase 1 also included the development of a context-specific patient journey map of the processes involved in accessing vaccines. This map was developed in collaboration with a multidisciplinary IBD team. Phase 2 involved identifying common barriers and facilitators through thematic analysis and journey mapping. In Phase 3, these analyses were used to design an implementation strategy for evidence-based management of VPI in the local health system context. Results Twelve interviews (including 11 gastroenterologists and one IBD nurse practicing in Nova Scotia and New Brunswick) were conducted. Mean participant age was 45.1 years, with 63.6% identifying practice in an urban/academic setting compared to a rural/community setting (36.4%). Lack of access to a family physician, limited time, vaccine hesitancy, and incomplete understanding of coverage/access to vaccines were among the barriers identified. Using facilitator themes as well as the journey mapping process, a proposal for an early implementation strategy prototype was designed. Prototype development involved collaborative partnership with a third-party patient support program to overcome various barriers identified in our surveys. Conclusions Barriers to implementation of evidence-based guidelines for management of VPI are well documented. The use of HCD to design an effective implementation strategy that is sensitive to the local healthcare context holds potential to increase access to and uptake of high quality, evidence-based VPI management. In future studies, the implementation-effectiveness of the implementation strategy (model prototype) will be evaluated and compared to standard of care. Funding Agencies None

Current State of Food Prescriptions Used to Treat Cardiometabolic Risk Factors in the US Adult Population.

Cardiometabolic syndrome is unfortunately widely prevalent in medically underserved areas with one possible non-pharmacological solution being food prescriptions from food pharmacies. Food prescriptions are defined as when a physician prescribes certain foods as a treatment for health conditions. There seems to be a promising future for food prescriptions; however, there is a huge literature gap. Given this lack of knowledge regarding this burgeoning practice, we decided to review the current state of food prescriptions used to treat cardiometabolic conditions in the US adult clinical setting. A thorough search of PubMed and Google Scholar databases for articles written about food prescriptions' impact on cardiometabolic risk factors was done. The keywords used included "food prescriptions, vegetables prescription, produce prescription, fruit prescriptions, food pharmacy, food as medicine, cardiometabolic, blood pressure, glucose, insulin, cholesterol, obesity, BMI, body mass index, triglycerides, and microalbuminuria." Of the 637 articles found with the associated keywords, 115 were kept after being screened by title and abstract. Finally, after a full-text record screening, 30 articles were deemed eligible based on our inclusion criteria. We analyzed the health markers, patient populations, methods of food procurement, and financial incentives in food prescription programs. On average, the implementation of food prescription programs decreased participants' BMI, waist circumference, blood pressure,and HbA1c. Participants in the programs were primarily comprised of African American, Hispanic, underinsured, low-income, older, and women groups. Programs with subsidies and vouchers had a higher compliance rate, and food sourced from farmers' markets, grocers, and mobile vendors had the best program compliance rates. According to the literature, adherence to food prescription programs on average decreases the BMI, blood pressure, waist circumference, and Hb1Ac of participants. However, those are the only biomarkers being studied currently, and future studies should incorporate other markers of chronic conditions. For example, a reliable indicator of cardiometabolic health is total cholesterol/HDL cholesterol, which should be measured in future experiments. Additionally, insulin, glucose, triglycerides, and LDL cholesterol are all great markers of cardiometabolic health that can be measured in the future. The current implementation of many food prescription programs is in medically underserved areas. The patient populations are typically low-income, under- or uninsured, food insecure, and originating from diverse ethnic backgrounds. In the future, food prescription studies should be done on other ethnic populations including but not limited to Native Americanswho also carry a large burden of preventable and chronic illnesses.

Mpox: Awareness, knowledge and information channels used by individuals accessing a sexually transmitted infections Helpline.

Up until recently, monkeypox (mpox) was considered to be a rare zoonotic infection restricted to Central and West Africa. However, in July 2022, the World Health Organization declared mpox to be a public health emergency of international concern, after there were several outbreaks in non-endemic countries. This study assessed the information channels used by individuals accessing the "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse" of Istituto Superiore di Sanità (National Institute of Health in Italy) with regard to mpox. We also evaluated their awareness, and knowledge about mpox focusing on transmission and prevention. This is a cross-sectional study conducted on "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse" users, between January and April 2023. The target population was helpline users who were older than 18 years of age, and were phoning the service for the first time (i.e. who have not phoned in the last 12 months). Participants were interviewed using a questionnaire containing 19 questions filled by the interviewer. Collected data were analysed through descriptive statistics, and significance testing. From January to April 2023, "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse" received 2,389 phone calls, 216 of which participated in this study. Most of these were male (85.2%; n=186), single (79.2%; n=171) and in employment (72.2%; n=156). Awareness about mpox was high (71.3%; n=154), with the central and south/islands regional areas having the highest percentage of participants who heard about the virus (84.3%; n=43 vs 72.4%; n=42; p=0.078). Television was the most frequently mentioned source of information about mpox by participants (63%; n=97; p<0.001). This medium was also the most preferred source of information about mpox (39%; n=60; p=0.109). The majority of participants stated that they did not know what mpox is (67.6%; n=146), and less than half knew that it is preventable (42.4%; n=89). Of those who stated that mpox is a preventable illness, less than half knew about the existence of a vaccine (44.9%; n=40; p<0.001). This study provides insights into the awareness, knowledge, prevention tools and information channels of individuals who contacted the "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse". Useful indications for defining future information campaigns were obtained.

The 2021 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and the outpatient management: Examining physician adherence and its effects on patient outcome.

Chronic obstructive pulmonary disease (COPD) is a common preventable illness that carries a large global economic and social burden. The global initiative for chronic obstructive lung disease (GOLD) guidelines has been utilized as a global strategy for the continued COPD diagnosis, assessment, and treatment. We aimed to determine if the adherence to the 2021 GOLD guideline directed management influenced outcomes. Retrospective medical records review of adult patients with COPD, who received care in our office during the entire year of 2021. Patients managed as per the 2021 GOLD guidelines were compared with those who received usual care. Among 242 patients, 171 (70.7%) were GOLD management adherent (GA) and 71 (29.3%) were GOLD non-adherent (GNA). Certain comorbidities were associated with higher frequencies in the GA group, such as allergic rhinitis (63.2 vs. 18.3%; P < 0.001), coronary artery disease (55.9 vs. 38.0%; P = 0.011), GERD (63.2 vs. 32.4%; P < 0.001), anemia (38.6 vs. 19.7%; P = 0.004), malignancy (34.5 vs. 19.7%; P = 0.023), and immunodeficiency (12.3 vs. 1.4%; P = 0.007). There was no significant difference in the mortality between the GA and GNA groups (5.3 vs. 9.9%; P = 0.254). Although the frequency of number of exacerbations was greater in the GA group, the difference in the mean number of exacerbations was not statistically significant (0.39 ± 1.08 vs. 0.39 ± 1.14; P = 0.984). We found no significant difference in the patient outcomes, such as number of exacerbations of COPD and mortality, when comparing the 2021 GOLD guideline adherent versus GOLD guideline non-adherent management of COPD.

Prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Adama Hospital Medical College, Adama, Central Ethiopia

Depression is the most frequently detected and preventable mental illness among people with human immunodeficiency syndrome, with rates two to four times higher than in the general population. Currently, depression is estimated to affect 350 million people worldwide. To assess the prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Adama Hospital Medical College, Adama, Central Ethiopia. An institutional-based cross-sectional study was conducted from April 01 to September 30, 2021, at Adama Hospital Medical College, Adama, Ethiopia. A total of 420 individuals were selected using a systematic random sampling technique. After informed consent was obtained from each study participant, data were collected through face-to-face interviews, observations, and document reviews. Subsequently, the data were entered into EPI-Info Version 7 and analyzed by Statistical Package for the Social Sciences version 21. Variables with p-values less than 0.25 in the univariable logistic regression analysis were subsequently included in the multivariable logistic regression analysis to account for potential confounding factors. The association was measured using adjusted odds ratio (AOR) with a 95% confidence interval (CI), and variables with p-values less than 0.05 were considered statistically significant. The prevalence of depression was 52.4% (95% CI 47.6–57.1). Factors significantly associated with depression among HIV-positive patients on antiretroviral therapy included employment status [AOR = 0.22(95% CI 0.13–0.36)], the patient’s most CD4 count [AOR = 6.99 (95% CI 2.81–17.38)], duration of months on antiretroviral therapy [AOR = 5.05 (95% CI 2.38–10.74)] and presence of chronic non-communicable diseases [AOR = 7.90 (95% CI 4.21–14.85)]. The highest proportion of HIV-positive patients taking antiretroviral drugs exhibited depression. Employment was identified as a preventive factor, whereas having a low CD4 count, recently initiating antiretroviral therapy, and having chronic non-communicable diseases were associated with increased odds of depression among HIV-positive patients on antiretroviral therapy. There need to strengthen mental health screening and treat depression among HIV-positive patients, particularly by targeting identified factors.

Clinic Readiness for Trauma-Informed Health Care Is Associated With Uptake of Screening for Adverse Childhood Experiences.

Adverse childhood experiences (ACEs) are strongly correlated with many of the most common causes of preventable illness, preventable death, and health disparities. In January 2020, California launched the first statewide initiative to integrate ACE screening throughout its Medicaid system. A key element of the initiative was the California ACEs Learning and Quality Improvement Collaborative, a 48-clinic, 16-month learning collaborative. This evaluation aimed to determine whether developing a trauma-informed environment of care was associated with uptake of ACE screening. Participants included 40 of 48 clinics that participated in the statewide learning collaborative. Clinics completed an assessment of progress in 5 essential components of trauma-informed health care at baseline and 1-year follow-up. Clinics tracked data on ACE screens completed on an ongoing basis and submitted data quarterly. A hierarchical linear model was used to examine the association between change in readiness for trauma-informed health care and change in quarterly screens. Readiness for trauma-informed health care increased for all participating clinics over the course of the learning collaborative. The average number of quarterly screens also increased, with considerable variability among clinics. Clinics with larger increases in readiness for trauma-informed health care had larger increases in quarterly screens. The findings align with long-standing recommendations for trauma screening to occur in the context of trauma-informed environments of care. A trauma-informed clinic is the foundation for successful adoption of ACE screening. ACE screening initiatives should include education and sufficient support for clinics to embrace a trauma-informed systems change process.