Preventive Care Research Articles

Recognising and Responding to Suicide-Risk Factors in Primary Care: A Scoping Review.

The cost of one suicide is estimated to be £1.67 million (2 million euros) to the UK economy. Most people who die by suicide have seen a primary care practitioner (PCP) in the year prior to death. PCPs could aim to intervene before suicidal behaviours arise by addressing suicide-risk factors noted in primary care consultations, thereby preventing suicide and promoting health and wellbeing. This study aimed to conduct a rapid, systematic scoping review to explore how PCPs can effectively recognise and respond to suicide-risk factors. MedLine, CINAHL, PsycINFO, Web of Science and Cochrane Library databases were searched for three key concepts: suicide prevention, mental health and primary care. Two reviewers screened titles, abstracts and full papers independently against the eligibility criteria. Data synthesis was achieved by extracting and analysing study characteristics and findings. Forty-two studies met the eligibility criteria and were cited in this scoping review. Studies were published between 1990 and 2020 and were of good methodological quality. Six themes regarding suicide risk assessment in primary care were identified: Primary care consultations prior to suicide; Reasons for non-disclosure of suicidal behaviour; Screening for suicide risk; Training for primary care staff; Use of language by primary care staff; and, Difference in referral pathways from general practitioners or primary care practitioners. This review focused on better recognition and response to specific suicide-risk factors more widely such as poor mental health, substance misuse and long-term physical health conditions. Primary care is well placed to address the range of suicide-risk factors including biological, physical-health, psychological and socio-economic factors and therefore these findings could inform the development of person-centred approaches to be used in primary care.

Development of a cancer risk model and mobile health application to inform the public about cancer risks and risk factors

ObjectiveTo develop and evaluate a mobile health application, the Cancer Risk Calculator (CRC), aimed at improving public health literacy by providing personalized information on cancer risks and preventive measures. Materials and MethodsThe CRC was developed through a comprehensive process involving the identification of necessary content, integration of average cancer risks using data from reliable sources, creation of a novel risk model emphasizing modifiable factors, and the application’s development for easy access. The application covers 38 cancer types, 18 subtypes, and approximately 790 risk factors, utilizing data from the Surveillance, Epidemiology, and End Results Program and scientific literature. ResultsCRC offers users personalized risk assessments across a broad range of cancers, emphasizing modifiable risk factors to encourage preventive behaviors. It distinguishes itself by covering more cancer types and risk factors than existing tools, with preliminary user feedback indicating its utility in promoting health literacy and lifestyle changes. DiscussionThe CRC application stands out as an innovative tool in health informatics, significantly enhancing public understanding of cancer risks. Its development underscores the potential of digital health technologies to bolster preventive healthcare strategies through improved health literacy. ConclusionThe Cancer Risk Calculator is a pivotal development in mobile health technology, offering comprehensive and personalized insights into cancer risks and prevention. It serves as a valuable resource for public health education, facilitating informed decisions and lifestyle modifications for cancer prevention.

Diabetes Prediction using Machine Learning

This study explores the application of machine learning for diabetes prediction. Leveraging a dataset of relevant features such as glucose levels, BMI, and family history, various algorithms are employed to develop predictive models. The goal is to enhance early detection and management of diabetes, contributing to more effective healthcare interventions. Results indicate promising accuracy and potential for real-world implementation in preventive healthcare systems. This presents an approach for predicting diabetes using machine learning techniques. With the increasing prevalence of diabetes worldwide, early detection and effective management are crucial for mitigating its impact on public health. Leveraging machine learning algorithms, such as decision trees, support vector machines, and neural networks, this research aims to develop predictive models based on various patient attributes and medical history data. The dataset used for model training and evaluation comprises demographic information, clinical measurements, and lifestyle factors collected from diabetic patients. Through extensive experimentation and evaluation, the performance of different machine learning algorithms is compared in terms of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC-ROC). The results demonstrate the efficacy of the proposed approach in accurately predicting diabetes risk, thereby offering valuable insights for preventive healthcare strategies and personalized treatment plans

Metabolic memory and diabetic retinopathy: Legacy of glycemia and possible steps into future.

The response of retinal pathology to interventions in diabetic retinopathy (DR) is often independent of the glycated hemoglobin (HbA1c) values at the point of care. This is despite glucose control being one of the strongest risk factors for the development and progression of DR. Previous preclinical and clinical research has indicated metabolic memory, whereby past cumulative glucose exposure may continue to impact DR for a prolonged period. Preclinical studies have evaluated punitive metabolic memory through poor initial control of DM, whereas clinical studies have evaluated protective metabolic memory through good initial control of DM. In this narrative review, we evaluate the preclinical and clinical evidence regarding metabolic memory and discuss how this may form the basis of preventive care for DR by inducing "metabolic amnesia" in people with a history of uncontrolled diabetes in the past. While our review suggested mitochondrial biology may be one such target, research is still far from a possible clinical trial. We discuss the challenges in such research.

Role of Sport Vision in Performance: Systematic Review.

Sport Vision is a speciality of multidisciplinary interest aimed at improving the performance of the visual system to achieve benefits in practiced sports, as well as in daily life and in preventive care. The type of training practiced by the athlete, his or her physical condition, cognitive level, and level of fatigue condition affects the speed of the reaction time and, consequently, the speed of motor response. Specific orthoptic exercises, the use of technological devices, the recovery of static and dynamic postural stability by using unstable platforms and the dual-task paradigm can help to achieve the expected results. The aim of this systematic review of Sport Vision was to assess the overall existing literature on Sport Vision, paying particular attention to the effects of visual training and its application in different sports and in rehabilitation and preventive settings. We analysed published English language studies about the role of sport vision in athletic performance from 1950 to 2023. We searched through the Medline database. The PRISMA 2020 checklist was used to assess the transparency and reproducibility of this review. The enrolled papers were evaluated with the Jadad Scale, Amstar 2 Scale and Newcastle-Ottawa Scale. 25 (16 studies, 5 reviews, 2 comments, 1 editorial, 1 descriptive paper) out of 476 studies met the inclusion criteria. Due to the variability in the age of the samples, the different techniques, the treatments among the participants in the studies and the finding of non-evaluable articles, a meta-analysis was not conducted. The limitations of this review are the single database research, the studies analyzed contain a non-statistically representative sample size and the lack of a control group. There is no standardized test to measure performance. It was shown that the development of visual skills can benefit athletes in injury prevention, and can lead to improved sports performance and motor function at any age, acquiring adaptive motor behaviour even when the visual system is impaired, due to task repetition and familiarity of the gesture. We intended to identify a multidisciplinary approach and a manual treatment scheme to optimize the circuitry involved in sport vision in order to increase the results that are achieved, but further studies will be needed to this end.

Artificial Intelligence in Cardiovascular Disease Prevention: Is it Ready for Prime Time?

This review evaluates how Artificial Intelligence (AI) enhances atherosclerotic cardiovascular disease (ASCVD) risk assessment, allows for opportunistic screening, and improves adherence to guidelines through the analysis of unstructured clinical data and patient-generated data. Additionally, it discusses strategies for integrating AI into clinical practice in preventive cardiology. AI models have shown superior performance in personalized ASCVD risk evaluations compared to traditional risk scores. These models now support automated detection of ASCVD risk markers, including coronary artery calcium (CAC), across various imaging modalities such as dedicated ECG-gated CT scans, chest X-rays, mammograms, coronary angiography, and non-gated chest CT scans. Moreover, large language model (LLM) pipelines are effective in identifying and addressing gaps and disparities in ASCVD preventive care, and can also enhance patient education. AI applications are proving invaluable in preventing and managing ASCVD and are primed for clinical use, provided they are implemented within well-regulated, iterative clinical pathways.

#2434 Literature review on the burden of herpes zoster in patients with kidney disease—a need for earlier prevention

Abstract Background and Aims Kidney disease (KD), including end stage renal disease (ESRD), is a global health problem. Both are associated with impaired immune systems, which can lead to infections. Complications such as cardiovascular disease and various infections are leading causes of morbidity and mortality in KD patients. Notably, patients with KD have an increased risk of herpes zoster (HZ). While the link between ESRD and renal transplant with increased HZ risk is understood, knowledge gaps regarding the burden of HZ across the KD spectrum still exist. This review aims to describe the risk and impact of HZ across the KD spectrum in order to guide preventive care strategies for patients with renal diseases. Method A structured literature review was conducted in PubMed using a combination of keywords and Medical Subject Heading (MeSH) terms to identify studies related to HZ risk in adult KD patients aged ≥18 years published in the English language between 01/11/2003–31/10/2023. Data extracted from published studies included the burden of HZ infection in patients with KD (risk of HZ and related complications), impact of HZ on underlying KD, and the efficacy/effectiveness of HZ vaccines among patients with KD. Results A total of 47 studies were identified (Randomized controlled trials [RCT] = 2; observational studies = 45) in this review (Fig. 1). Included studies presented evidence from regions in Europe (n = 18), Asia (n = 17), North America (n = 7), South America (n = 1), multinational (n = 2) and Australia (n = 1); country not reported in one study. Evidence from observational studies (n = 37) reported a high risk of HZ infection and related complications, such as disseminated HZ, and recurrent HZ across the KD spectrum, including chronic KD, polycystic KD, hemodialysis, peritoneal dialysis and kidney transplant patients. Infection with HZ was reported to accelerate KD progression and increased the risk of ESRD and cardiovascular events. In general, for ESRD patients with an inpatient HZ diagnosis, mortality increased with age, followed by malnutrition and bacteremia/septicemia. Studies reporting vaccine efficacy (n = 2) and effectiveness results (n = 8) suggest that HZ vaccination was associated with a reduced risk of HZ when compared to unvaccinated individuals. Furthermore, the recombinant zoster vaccine (RZV) was found to be immunogenic in kidney transplant recipients, with immunogenicity persisting through 12 months post-vaccination. An RCT post-hoc analysis showed high vaccine efficacy in patients aged ≥50 years with medical conditions at enrollment, including KD, which was consistent with the overall population. A favorable benefit-risk profile was reported in randomized and observational studies. Studies evaluating the effectiveness of the zoster live-attenuated vaccine (ZVL) found a lower risk of HZ in patients with ESRD immunized against HZ compared to unvaccinated individuals. In many countries, vaccination guidelines specifically recommended immunization of people with KD to protect against HZ. However, ZVL is contraindicated for immunocompromised (e.g. kidney transplant) patients. Conclusion Findings indicate that HZ has a significant HZ burden across the KD spectrum, which may negatively impact renal disease progression. With effective vaccines offering durable protection against HZ and its complications, the immunization of renal patients at earlier stages could enhance healthcare management and patient outcomes.

Barriers to pregnancy prevention for adolescents in rural Haiti: perceptions of healthcare providers.

Little is known about healthcare providers' (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs' perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. We conducted a cross-sectional survey and qualitative interviews with HCPs in two rural communities in Haiti from 08/2021-03/2022. We assessed demographics, clinical practice behaviors and explored contraception perspectives according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control (e.g., people's perceptions of their ability to perform a given behavior, barriers and facilitators of a behavior).15-17 We used descriptive statistics to report proportions and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through thematic inductive coding and team debriefing. Among 58 respondents, 90% (n = 52) were female and 53% (n = 31) were nurses. Most reported always (n = 16, 28%) or very often (n = 21, 36%) obtaining a sexual history for adolescents. A majority agreed/strongly agreed that clinicians should discuss pregnancy prevention (n = 45, 78%), high-risk sexual behaviors (n = 40, 69%), and should prescribe contraception (n = 41, 71%) to adolescents. The most frequently cited provider-level barriers (i.e., significant or somewhat of a barrier) included insufficient contraception knowledge (n = 44, 77%) and time (n = 37, 64%). HCPs were concerned about barriers at the patient-level (e.g. adolescents' fear of parental notification [n = 37, 64%], adolescents will give inaccurate information about sexual behaviors [n = 25, 43%]) and system-level (e.g. resistance to providing care from administration [n = 33, 57%]). In interviews (n = 17), HCPs generally supported contraception care for adolescents. Many HCPs echoed our quantitative findings on concerns about privacy and confidentiality. HCPs reported concerns about lack of contraception education leading to misconceptions, and community and parental judgement. HCPs expressed interest in further contraception training and resources and noted the importance of providing youth-friendly contraceptive care. While HCPs support contraceptive care, we identified actionable barriers to improve care for adolescents in rural Haiti. Future efforts should include increasing HCP knowledge and training, community and parent coalition building to increase contraception support and offering youth-friendly contraceptive care to offset risk for related adverse health outcomes in adolescents in rural Haiti.

Do no harm: the impact of implementing cancer prevention strategies on other preventive health measures

BackgroundTranslational efforts to increase uptake of evidence-based practices typically look at those outcomes in isolation of their impact on other aspects of care delivery. If we are in fact to “do no harm”, we must consider the possible negative impact of improving use of one practice on other quality measures. Alternatively, a focus on one practice could lead to spread of effective strategies to other practices, which would be highly beneficial. We studied the impact of a colorectal cancer (CRC) screening initiative on delivery of other preventive care measures.MethodsWe used an interrupted time series design with implementation year as the interruption point. The initiative was conducted between 2015 and 2020, with three staggered cohorts. Main outcomes were quality measures for colorectal cancer screening, cervical cancer screening, hypertension management, diabetes management, weight screening and follow-up, tobacco use screening and cessation treatment, and depression screening and follow-up.ResultsThe initiative was associated with an increase in CRC screening (OR = 1.67, p ≤ 0.01; average marginal effect = 12.2% points), and did not reduce performance on other quality measures in the year of CRC program implementation or a change in their respective secular trends.ConclusionsThe initiative led to a clinically meaningful increase in CRC screening and was not associated with reductions in delivery of six other preventive services. Quality improvement (QI) initiatives typically approach implementation with an eye towards reducing unintended impact and leveraging existing staff and resources. Implementation research studies may benefit from considering how QI initiatives factor in the local context in implementation efforts.

Use of HIS in achieving preventive care performance: a resource orchestration study

PurposeThis study investigated two key aspects: (1) how a hospital bundles limited resources for preventive care performance and (2) how to develop IS capabilities to enhance preventive care performance.Design/methodology/approachA case study method was adopted to examine how a hospital integrates its limited resources which leads to the need for resource bundles and an understanding of IS capabilities development to understand how they contribute to the delivery of preventive care in a Malaysian hospital.FindingsThis research proposes a comprehensive framework outlining resource-bundling and IS capabilities development to improve preventive care.Research limitations/implicationsWe acknowledge that the problem of transferring and generalizing results has been a common criticism of a single case study. However, our objective was to enhance the reader’s understanding by including compelling, detailed narratives demonstrating how our research results offer practical examples that can be generalized theoretically. The findings also apply to similar-sized public hospitals in Malaysia and other developing countries, facing challenges like resource constraints, HIS adoption levels, healthcare workforce shortages, cultural and linguistic diversity, bureaucratic hurdles, and specific patient demographics and health issues. Further, lessons from this context can be usefully applied to non-healthcare service sector domains.Practical implicationsThis study provides a succinct strategy for enhancing preventive care in Malaysian public hospitals, focusing on system integration and alignment with hospital strategy, workforce diversity through recruitment and mentorship, and continuous training for health equity and inclusivity. This approach aims to improve resource efficiency, communication, cultural competence, and healthcare outcomes.Social implicationsEfficiently using limited resources through HIS investment is essential to improve preventive care and reduce chronic diseases, which cause approximately nine million deaths annually in Southeast Asia, according to WHO. This issue has significantly impacted the socioeconomic development of developing countries.Originality/valueThis research refines resource orchestration theory with new mechanisms for resource mobilization, extends IS literature by identifying how strategic bundling forms specialized healthcare IS capabilities, enriches preventive care literature through actionable resource-bundling activities, and adds to HIS literature by advocating for an integrated, preventive care focus from the alignment of HIS design, people and institutional policies to address concerns raised by other research regarding the utilization of HIS in improving the quality of preventive care.

Comparative review of vasectomy guidelines and novel vasal occlusion techniques.

Vasectomy is the most commonly performed urologic procedure in the United States and is a highly effective form of male contraception. The introduction of guidelines by urological societies has standardized vasectomy care. Providers should be awadre of the rationale behind these guidelines, as well as key differences among them. While few major changes to vasectomy technique have been adopted over the past 40 years, new, reversible vasal occlusive technologies may affect delivery of male contraceptive care in the future. Here, we perform a comparative review of vasectomy guidelines from six urological societies worldwide. In addition, we report on the status of several experimental vasal occlusion methods that may be available in the next decade.

Leveraging data analytics and IoT technologies for enhancing oral health programs in schools

This paper explores the potential of leveraging data analytics and IoT technologies to enhance oral health programs in schools. By analyzing data generated from IoT devices such as smart toothbrushes and oral health trackers, schools can implement targeted interventions, promote better oral hygiene practices, and prevent dental issues among students. This comprehensive approach not only improves oral health outcomes but also contributes to overall student health and academic success. In recent years, the integration of data analytics and Internet of Things (IoT) technologies has brought about significant transformations across multiple industries, with healthcare being a prominent example. Oral health, a fundamental aspect of overall well-being, stands to benefit greatly from these advancements. This paper delves into the potential of harnessing data analytics and IoT technologies to elevate oral health programs within educational institutions, particularly schools. By tapping into the wealth of data generated by IoT devices such as smart toothbrushes and oral health trackers, schools can devise targeted interventions, foster improved oral hygiene practices, and preemptively address dental issues among their students. This comprehensive approach not only yields tangible improvements in oral health outcomes but also holds the promise of enhancing overall student health and bolstering academic success. In recent years, the integration of data analytics and Internet of Things (IoT) technologies has not only revolutionized various sectors but has also become a driving force in reshaping healthcare practices. Amidst these advancements, oral health, often overlooked yet crucial to overall well-being, emerges as a domain ripe for transformation. This paper embarks on an exploration of how the amalgamation of data analytics and IoT can invigorate oral health programs within educational settings, particularly schools. By delving into the vast pool of data generated by IoT devices such as smart toothbrushes and oral health trackers, schools can strategically design interventions tailored to individual needs, foster the adoption of superior oral hygiene practices, and proactively mitigate dental issues among their student body. Keywords: Data Analytics, Internet of Things (IoT), Oral Health, Schools, Dental Hygiene, Student Health, Preventive Care.

Biomechanical modeling and imaging for knee osteoarthritis – is there a role for AI?

ObjectiveThis mini review aims to assess the latest advancements in the field of osteoarthritis (OA) research, particularly focusing on the early detection and prediction of disease progression through the use of advanced imaging technologies utilizing biomechanical modeling and artificial intelligence (AI). DesignThe review consolidates and discusses findings from studies that utilize biomechanical modeling and/or machine learning algorithms to identify pathological changes in joint tissues indicative of OA or prediction of disease progression. It also briefly reviews future research and how these methods could be used as a part of OA management. ResultsAI algorithms have proven highly effective in recognizing the subtle changes in joint tissues associated with OA and in identifying patients at high risk for the disease. While these automated tools facilitate early diagnosis, they typically do not provide personalized intervention strategies to prevent disease progression. AI-enhanced biomechanical modeling has the potential to simulate the effects of various conservative interventions (e.g., weight management, optimal footwear, and gait retraining) on slowing OA progression, which could be pivotal for patient engagement and preventive care. ConclusionsThe integration of AI with biomechanical modeling holds significant promise for enhancing the management of OA by not only predicting disease onset and progression but also by enabling personalized intervention plans. Future research should focus on the development of these models to include personalized, preventive strategies that could effectively engage patients and potentially delay or prevent the onset of OA. This approach could revolutionize patient care by making early, targeted intervention feasible.

Guidelines for safe use of Polygoni Multiflori Radix

Polygoni Multiflori Radix is a Chinese medicine widely used in clinical treatment and preventive healthcare. However, recently there have been frequent reports of liver injury caused by Polygoni Multiflori Radix and its related preparations, and some patients have serious adverse outcomes, attracting wide attention worldwide. The risk of liver damage caused by preparations containing Polygoni Multiflori Radix or Polygoni Multiflori Caulis has been repeatedly reported by the Chinese Food and Drug Administration. Fortunately, substantial progress has recently been made in revealing the basic properties, main causes, material basis, and molecular mechanism of Polygoni Multiflori Radix-related liver injury. The basic characteristics and biomarkers of susceptible people have been identified, indicating that Polygoni Multiflori Radix has the risk of inducing liver injury only in a few specific populations and is safe for most populations. This study provides a scientific basis for a correct and objective understanding of liver injury caused by Polygoni Multiflori Radix, and a reasonable formulation of safe medication measures for Polygoni Multiflori Radix and related preparations. The China Association of Chinese Medicine organized experts in relevant fields across the country to draft and formulate the “Guidelines for Safe Use of Polygoni Multiflori Radix,” with the aim of helping the public and relevant institutions at home and abroad to scientifically understand, evaluate, and avoid the risk of liver injury; guide the rational use; protect the health rights and interests of consumers; and promote the healthy and sustainable development of Polygoni Multiflori Radix and related preparations. These guidelines were issued by the China Association of Chinese Medicine (No.T/CACM 1328-2019).

Impact of Broadband Internet on Preventive Healthcare Behaviors in Senegal

Impact of Broadband Internet on Preventive Healthcare Behaviors in Senegal

Comparison of Financial Hardship and Healthcare Utilizations Associated with Cancer in the United States Medicare Programs during the COVID-19 Pandemic.

In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled in Medicare Advantage (MA) compared to those in traditional fee-for-service Medicare (TM) during the COVID-19 pandemic. Our study aims to investigate the subjective financial hardships experienced by individuals enrolled in TM and MA and to determine whether these two Medicare programs exhibit differences in healthcare utilization during the pandemic. We utilized data from the 2020-2022 National Health Interview Survey (NHIS), focusing on nationally representative samples of cancer survivors aged 65 or older. Financial hardship was categorized into three distinct groups: material (e.g., problems with medical bills), psychological (e.g., worry about paying), and behavioral (e.g., delayed care due to cost). Healthcare utilization included wellness visits (preventive care), emergency care services, hospitalizations, and telehealth. We used survey design-adjusted analysis to compare the study outcomes between MA and TM. Among a weighted sample of 4.4 million Medicare beneficiaries with cancer (mean age: 74.9), 76% were enrolled in MA plans. Cancer survivors with a college degree (59.3% vs. 49.8%) and high family income (38.2% vs. 31.1%) were more likely to enroll in MA plans. There were no significant differences in any material, psychological, or behavioral financial hardship domains between beneficiaries with MA and TM plans except forgone counseling due to cost. For healthcare utilization measures, cancer survivors in MA were more likely than those in TM to have flu vaccination (77.2% vs. 70.1%) and experience lower hospitalizations (16.0% vs. 20.0%). However, there were no differences in other health service utilizations between MA and TM. While no significant differences were observed in any materialized, psychological, or behavioral financial hardships, older cancer survivors enrolled in MA plans were more likely to receive vaccinations and lower hospitalization rates during COVID-19. Although other preventive or primary care visits (i.e., wellness visits) were higher, their difference did not reach statistical significance. As MA grows in popularity, it is essential to consistently monitor and evaluate the performance and outcomes of Medicare plans for cancer survivors as we navigate the post-pandemic landscape.

The effects of mobile primary health teams: Evidence from the Médico del Barrio strategy in Ecuador

Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N = 55,666), 2012–13 (N = 92,500) and 2018–19 (N = 168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program’s implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.

ANALYSIS OF REGULATORY AND LEGAL SUPPORT FOR THE PREVENTION OF DIABETES MELLITUS IN CHILDREN

Diabetes mellitus has become one of the most prevalent chronic diseases in childhood today. International forecasts suggest that the incidence of diabetes will continue to rise in the coming decades, leading to a lifelong burden for millions of children worldwide. Therefore, prediction, prevention, and optimal treatment of diabetes, as well as early prevention of serious long-term complications, remain essential. Providing highly qualified medical care to diabetic patients is a crucial step in preventing the development of complications. The purpose of this article is to review existing research on diabetes prevention strategies for children, considering the different levels of medical care support available. Materials and Methods. This study investigates the organization of preventive care for children with diabetes in Ukraine. Researchers employed three key methods: bibliosemantic analysis, content analysis focused on analyzing Ukraine relevant regulations and legal frameworks, and the method of systemic approach and analysis to gain a comprehensive understanding of how preventive care is currently organized for children with diabetes in Ukraine. Results. In Ukraine, preventive measures and the provision of medical care to pediatric patients with diabetes in the past years and today are regulated by a number of documents and orders of the Ministry of Health. As part of the Comprehensive Program “Diabetes Mellitus” (1999) and in accordance with the Order of the Ministry of Health of Ukraine “On Improving the Organization of Providing Endocrinological Care to the Population of Ukraine” (2006), the State Register of Patients with Diabetes Mellitus (SYNADIAB) was created. The next step was the approval of the State Target Program “Diabetes Mellitus”. Subsequently, the Project of the national program “Health 2020: Ukrainian Dimension” became an effective tool, which outlined the main principles of the program implementation in the “Endocrinology” section for 2013-2020. It defined measures at all stages of diabetes prevention, such as primary prevention, which consists of maintaining and strengthening the general state of health and preventing or delaying the development of diabetes; secondary prevention should improve early detection of diabetes mellitus; tertiary prevention, which ensures the effectiveness and safety of treatment of children with diabetes to prevent the development of long-term complications. Today, the guidelines for the management of children with diabetes mellitus have been continued in such documents as “Diabetes Mellitus in Children”, Evidence-Based Clinical Guidelines (2023) and Standards of Care (2023). Conclusion. Diabetes mellitus is a chronic disease that ranks third in prevalence after cardiovascular and cancerous diseases and second in the structure of endocrine diseases after thyroid gland pathology. Today, the prevalence of diabetes mellitus among children is constantly increasing and, therefore, solving the issues associated with this disease is one of the priority tasks for the national health care system. This is because diabetes mellitus is associated with a high risk of complications leading to loss of work capacity, disability, and mortality across various population groups. Organizing high-quality medical care and establishing an effective prevention system based on the latest medical technologies is crucial. Diabetes demands attention. Understanding the risks and prevention of the disease can significantly increase the chances of protection and a long, healthy life through timely treatment.

ANALYSIS OF DENTAL CARE INDICATORS FOR CHILDREN BASED ON DATA FROM THE PEDIATRIC DENTAL CLINIC OF POLTAVA CITY

In the period from 2020 to 2023, the dental care system in Ukraine underwent significant changes considering the effects of healthcare reforms, the COVID-19 pandemic, and the ongoing conflict. The objective of this article is to assess the changes in the provision of general dental care at the Pediatric Dental Polyclinic in Poltava City over the past five years based on a retrospective analysis of statistical reports from 2019 to 2023. In 2019, emergency dental care accounted 9.69% of all visits. Complicated caries of permanent teeth was found in 2.28% of filled teeth, with light-cured resin fillings representing 29.52% of them. Periodontal diseases were detected in 0.62% of visits. Preventive examinations comprises a significant portion of visits, 86.43% of visits; 94.66% of children who needed dental sanitation received full treatment. Preventive measures including fissure sealing, remineralizing therapy, and supervised tooth brushing played a significant role in these outcomes. In 2020, the number of visits dramatically decreased, but the share of emergency dental care increased to 11.65%, compared to 2019 (p < 0.0001). The number of filled teeth decreased, while the percentage of complicated caries of permanent teeth increased to 4.09% (p < 0.0001). The proportion of fillings made of light-cured resins rose to 40.19%, representing a 1.36-fold increase (p < 0.0001). Preventive examinations accounted for 26.47% of visits, and 88.47% of examined children in need of dental sanitation were fully treated. However, the share of preventive measures and the number of visits for children with periodontal disease dropped. In 2021, the number of preventive examinations increased to 49.49% of visits. The percentage of complicated caries of permanent teeth in the filling structure rose to 4.93% compared to 2020 (p < 0.0001). The share of fillings made of light-cured resins reached 51.19%, and the rate of children receiving treatment under anesthesia increased (p < 0.0001). Indicators of preventive measures, which received less attention during quarantine, continued to decline. In 2022, complicated caries of permanent teeth constituted 4.96% of fillings that was higher than in 2021 (p < 0.0001). The proportion of preventive examinations significantly decreased to 33.45% (p < 0.0001), and the percentage of treated children among those who needed treatment dropped to 77.5%. Pedodontists started paying more attention to periodontal disease, preventive care, and treatment under anesthesia, which increased significantly. In 2023, the share of complicated caries of permanent teeth increased to 5.53% (p < 0.0001). The number of children treated under local or general anesthesia increased by 2.5 times. The number of visits for children with periodontal disease and indicators of preventive measures also increased (p < 0.001). In 2023, the share of preventive examinations was 36.28%, and the percentage of treated children among those who needed help decreased compared to 2022 (p < 0.0001), reaching 79.29%. The closure of school dental offices due to Covid-19 significantly reduced the number of patients in the pediatric dental polyclinic in 2020, leading to a significant decline in planned sanitation for children and preventive measures. In 2021, despite further decreases in visits, planned sanitation for children improved. In 2022, due to the treatment of internally displaced persons, the quantitative performance indicators of the polyclinic improved. From 2019 to 2023, there was an increase in the number of light-cured fillings, reflecting a trend in modern dentistry. Indicators for the treatment of periodontal disease, preventive measures, and treatment with anesthesia increased since 2022. During 2020-2023, there was a growth in the number of filled permanent teeth due to complicated caries, possibly due to budget funding for such dental aid in the polyclinic or because young patients may delay seeking medical attention. In 2023, the trend of decreasing the number of patients who were completely treated during planned sanitation was overcome. Further analysis of dental aid indicators for children is necessary for planning and funding to reduce the impact of socio-economic factors on children's health.

A nomogram-based prediction model for dysphagia in patients with chronic obstructive pulmonary disease: A cross-sectional study.

To investigate the prevalence of dysphagia in patients with COPD, identify the risk factors for dysphagia, develop a visual clinical prediction model and quantitatively predict the probability of developing dysphagia. Patients with COPD are at high risk of dysphagia, which is strongly linked to the acute exacerbation of their condition. The use of effective tools to predict its risk may contribute to the early identification and treatment of dysphagia in patients with COPD. A cross-sectional design. From July 2021 to April 2023, we enrolled 405 patients with COPD for this study. The clinical prediction model was constructed according to the results of a univariate analysis and a logistic regression analysis, evaluated by discrimination, calibration and decision curve analysis and visualized by a nomogram. This study was reported using the TRIPOD checklist. In total, 405 patients with COPD experienced dysphagia with a prevalence of 59.01%. A visual prediction model was constructed based on age, whether combined with cerebrovascular disease, chronic pulmonary heart disease, acute exacerbation of COPD, home noninvasive positive pressure ventilation, dyspnoea level and xerostomia level. The model exhibited excellent discrimination at an AUC of .879. Calibration curve analysis indicated a good agreement between experimental and predicted values, and the decision curve analysis showed a high clinical utility. The model we devised may be used in clinical settings to predict the occurrence of dysphagia in patients with COPD at an early stage. The model can help nursing staff to calculate the risk probability of dysphagia in patients with COPD, formulate personalized preventive care measures for high-risk groups as soon as possible to achieve early prevention or delay of dysphagia and its related complications and improve the prognosis. No patient or public contribution.