Preventive Measures Research Articles

Characterization and assessment of exposure risks of healthcare personnel during the COVID-19 pandemic

ABSTRACT Introduction: Healthcare personnel have the right to decent, healthy, and safe working conditions during COVID-19. Despite our best efforts to safeguard them against SARS-CoV-2 infection, a substantially large number of healthcare personnel fell ill and succumbed to COVID-19. This study aimed to characterize the SARS-CoV-2 exposures among healthcare personnel and determine the risk level of those events, thereby identifying and focusing on the key areas that influence workplace safety. Materials and Methods: A pre-tested questionnaire was used to collect data from healthcare personnel on the type of exposure, place, and use of preventive measures, along with demographic and occupational data. Exposure events were categorized into low, moderate, and high-risk by using a risk categorization protocol. Results: Doctors were primarily found to be involved in the aerosol-generating procedure, which had 94 times higher odds (95% CI: 43.9926–201.17) for high-risk exposures than other activities. In contrast, nurses were more likely to experience close-contact exposures (OR: 2.77, 95% CI: 1.44–5.33). Both critical care units and operation theaters were identified to have higher odds (OR: 2.34, 95% CI: 1.33–4.23 and OR: 2.31; 95% CI: 0.99–5.42, respectively) than the wards for high-risk exposures. Use of personal protective equipment was poor, with breaches reported in 10.2% of all exposure events. The lacunae in practice were addressed by repeated training and counseling and by ensuring the adequacy of resources in required areas. Conclusions: The assessment was beneficial for safeguarding healthcare personnel and assuring a safer workplace during the early phase of the COVID-19 pandemic.

Arterial stiffness as a screening tool for cardiovascular risk in health and disease

ABSTRACT Background: Cardiovascular diseases (CVD) account for approximately one-third of all deaths worldwide. The incidence of cardiovascular events such as myocardial infraction has been reported to be progressively increasing with age, especially with existing comorbidities such as hypertension, diabetes and obesity. Assessing arterial stiffness indices may serve as a screening tool in identification of population at risk of cardiovascular diseases and assist in implementation of preventive measures and early treatment in this population. Objectives: To measure and compare the arterial stiffness indices in healthy adults with diabetes, hypertension and obesity. Methods: A total of 184 adults in the age group of 30-50 years were included in the study who were divided into 4 groups: Group I (n = 64) (diabetic), group II (n = 40) (hypertensives), group III (n = 40) (obese) and group IV (n = 40) (control). The arterial stiffness indices were measured by using a certified oscillometric device in all the participants. Results: The arterial stiffness indices were assessed by using a certified oscillometric device in all the participants. The mean values of right baPWV and left baPWV are found to be significantly higher in hypertensive subjects compared with obese, diabetic and healthy controls. Conclusion: The pulse wave velocity, ASI and pulse pressure serve as independent predictors of cardiovascular mortality and outcomes in hypertension, diabetes and obesity as well as healthy individuals.

A practice already in use: a snapshot survey on the use of doxycycline as a preventive strategy (Doxy-PEP and Doxy-PrEP) in the GBMSM population in Spain.

. While doxycycline shows promise as a preventative measure against certain STIs (post-exposure prophylaxis or PEP, and pre-exposure prophylaxis or PrEP), very few medical and scientific associations favor its community use. Nevertheless, sexual health organizations for gay, bisexual and other men who have sex with men (GBMSM) community have noticed an increase in requests of its use. . The sexual health organization "Stop Sida" in Spain launched an anonymous snapshot survey to evaluate the current use of doxycycline as prevention strategy (both PEP and PrEP) in Spain through its social networks and its support groups in telegram. . 150 valid answers were obtained from different parts of Spain. 82 respondents (54,6% of total) had ever taken doxycycline, out of which 29 (35,4%) indicated the use as doxy-PEP and 7 (8,5%) as doxy-PrEP. The self-reported rate of STI diagnoses (mainly of syphilis and chlamydia) in the past 12 months was lower among those participants who reported having used doxy-PEP compared with those who did not report using doxy-PEP. The most common ways to obtain the doxycycline were telling a specialist that they have had a risky contact or by using leftover pills from a previous treatment. The current study is the first study to describe the use of doxycycline as a preventive strategy among the GBMSM community in Spain, and the first designed, launched and analyzed entirely by an NGO dealing with sexual health for the GBMSM community. The results obtained are aligned with other studies in other parts of Europe, such as Germany.

Forecast models for start and peak dates of Poaceae pollen season in Tétouan (NW Morocco) using multiple regression analysis.

Poaceae pollen is one of the most widespread sources of aeroallergens in the world. The aim of this study is to build predictive models for the pollen season start day (PSsd) and peak dates of the Poaceae pollen season and thus give an overview of the climatic parameters that have the greatest influence. In Tétouan, sampling was carried out using a volumetric spore trap of the Burkard Hirst type. The relationships between the PSsd, peak dates and meteorological parameters were determined using correlation analysis. The models were constructed using multiple regression analysis with data from 2008 to 2019 and tested on data from 2022. The PSsd was especially significantly influenced by minimum temperature during winter and precipitation in the autumn of the previous year. The peak dates were significantly correlated with precipitation in January, March and April, but not with temperature. Three models were obtained for each of the season's parameters; the most accurate model for the PSsd explained a variability of 61% and includes as main predictors rainfall from the autumn of the previous year and the mean daily average temperature from 23 February to 8 March. The two most efficient peak dates models included precipitation in January and April as the main predictor variables, and explained greater variability (87 and 88%). Precipitation in autumn and the mean daily and the sum of minimum temperature in winter, showed significant decreasing tendencies. However, the PSsd trend delay was not statistically significant. This study draws the importance of the weather during preseason for grass pollen production and emphasises the usefulness of the models for allergic patients to take preventive measures and for healthcare professionals in allergy therapy.

Improving Safety and Comfort of Healthcare Workers Caring for Patients With High-Consequence Infectious Diseases in a High-Level Isolation Unit Using Innovative Approaches.

Patients with high-consequence infectious diseases (HCIDs) require high-quality care by specially trained staff in a high-level isolation unit (HLIU) that follows strict infection prevention and control (IPC) measures. Caring for patients with (suspected) HCID is challenging, mainly because of the strict personal protective equipment (PPE) and IPC protocols healthcare workers (HCW) must adhere to for protection. The Radboud University Medical Center, located in Nijmegen, the Netherlands, has been a dedicated HLIU facility since 2008. A newly built HLIU opened in May 2022, and encouraged us to review the existing PPE selection, IPC protocols, and HCID training program to improve safety and comfort for HCWs working in the HLIU. Based on a systematic search through (inter)national HCID PPE guidelines and semistructured interviews with end users, we selected an improved, more comfortable set of PPE. Additionally, we developed a more concise and easier-to-use patient care process flow and implemented a new teaching strategy. The new way of working was tested in October 2022 when the first 2 patients with suspected HCID were admitted to our unit. We used surveys to evaluate the experiences of HCWs involved in this care to further improve the workflow of the unit. When optimizing safety and comfort for HCWs, it is important to consider (inter)national guidelines as well as user preferences. By systematically evaluating recent experiences of patient admission to the HLIU and then adjusting protocols and training, we can ensure that the quality of provided healthcare and the safety of HCWs working in the HLIU remains high.

Typhoid and paratyphoid fever epidemiological indicators and spatiotemporal analysis in China from 2004 to 2019

Typhoid and paratyphoid fever are systemic infections caused by Salmonella Typhi and Salmonella Paratyphi. These diseases are endemic in many parts of China, occurring periodically throughout the year. Epidemiological features, temporal trends, and spatial distribution of these fevers were analyzed using GraphPad Prism 9 with data collected by China's Public Health Science Data Center from 2004 to 2019. Charts were generated to depict their incidence across provinces, years, age groups, and occupations. Spatial clustering was assessed using ArcGIS 10.5 and Moran's I index. SaTScan 9.5 was employed to analyze their spatiotemporal distribution. From 2004 to 2019, China reported 197,623 cases of typhoid fever, resulting in 72 deaths, and 84,583 cases of paratyphoid fever, with 17 fatalities, showing a yearly reduction. Epidemic zones for these diseases are primarily in Yunnan, Guangxi, Guizhou, and other southwestern regions, affecting predominantly peasants and students. Children and adolescents are particularly vulnerable. Due to the epidemic nature of these diseases, they can occur year-round, with peaks in the summer months. This study provides a comprehensive understanding of their epidemiological characteristics and geographic distribution in China, emphasizing the need for authorities to improve living conditions, implement preventive measures, and develop effective treatments and vaccines in these high-risk areas.

Association between the triglyceride-glucose (TyG) index and stroke risk in Chinese normal-weight adults: a population-based study

BackgroundIdentifying high-risk populations and promoting stroke prevention measures can be achieved through studies on stroke and its risk factors. As a new alternative indicator of insulin resistance (IR), the triglyceride glucose (TyG) index may potentially increase stroke risk. However, the evidence confirming this association is inadequate and inconsistent, possibly due to variations in stroke assessment criteria or characteristics of the study populations. This study aims to evaluate the association between the TyG index and stroke risk level among individuals with normal-weight.MethodsA total of 30,895 participants aged ≥ 40 years with normal-weight were enrolled in this study. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Normal-weight was described as a body mass index (BMI) of 18.5-<24.0 kg/m2. Stroke risk was assessed by the Stroke Risk Assessment Scale, developed by the China National Stroke Screening and Prevention Project. To evaluate the associations between the TyG index and stroke risk level, multivariate logistic regression models were employed.ResultsResults showed that when the TyG index was considered as a continuous variable, each one unit increase in the TyG index was associated with a significantly higher risk of stroke [Moderate-risk (OR, 2.15; 95% CI, 2.03–2.28; P<0.001); High-risk (OR, 3.83; 95% CI, 3.57–4.10; P<0.001)]. Compared with Q1 of the TyG index, Q4 was significantly associated with moderate stroke risk (OR, 2.73; 95% CI, 2.50–2.99; P<0.001) and high stroke risk (OR, 5.39; 95% CI, 4.83–6.01; P<0.001). The continuous TyG index was an important risk factor for high stroke risk in the metabolically obese, normal-weight (MONW) individuals (OR, 3.44;95% CI, 2.92–4.06; P < 0.001). In the MONW individuals, when Q1 was used as a reference, participants in Q4 (OR, 5.33; 95% CI, 4.19–6.78; P < 0.001) was significantly associated with high stroke risk. Subgroup analysis showed significant interaction in the age and sex subgroups in the overall population (Pinteraction <0.001).ConclusionThe risk of stroke is increased with the TyG index among Chinese adults of normal weight; hence, the index may be an important indicator for identifying high-risk stroke populations among individuals with normal body weight.

Acceptability of the Dapivirine Vaginal Ring and Daily Oral Pre-exposure Prophylaxis (PrEP) during Pregnancy in Malawi, South Africa, Uganda, and Zimbabwe.

Pregnant and lactating persons in sub-Saharan Africa face a heightened risk of HIV acquisition, due to biological and behavioral factors, combined with limited access to prevention and treatment services. Oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring are promising tools for HIV prevention, and the ring's recent approval in multiple African countries represents a significant advancement in expanding access to HIV prevention. In a nested qualitative study within the MTN-042 trial, we explored the acceptability of study products among pregnant persons in the second and early third trimesters. Interviews were conducted privately, using a semi-structured guide with 77 participants, in participants' preferred language. Topics explored included product acceptability (using the theoretical framework of acceptability), user experience, satisfaction, disclosure, community attitudes, and sexual activity during pregnancy. Interview transcripts were analyzed using Dedoose software. We observed positive attitudes among participants towards the study products, which they found generally user-friendly, despite the added complexities of using them during pregnancy. Participants recognized that consistent and correct use would provide protection for both them and their unborn children. Although initial concerns existed, most of these worries dissipated over time, with study staff support and increased product use experience. These findings emphasize the importance of continued surveillance, support, and education to ensure the successful rollout of new HIV prevention measures during pregnancy.

Integrating discrete-event simulation and artificial intelligence for shortening bed waiting times in hospitalization departments during respiratory disease seasons

Seasonal Respiratory Diseases (SRDs) usually produce a heightened number of Emergency Department (ED) attendances due to their rapid dissemination within the community and the ineffective prevention measures. Such a context requires effective management of the emergency care processes to provide in-time diagnosis and treatment to infected patients. Nonetheless, EDs have evidenced severe operational deficiencies during these periods, thereby provoking extended bed waiting times in Hospitalization Departments (HDs). Therefore, this paper presents a hybrid approach merging Artificial Intelligence (AI) and Discrete-Event Simulation (DES) to shorten the bed waiting times in HDs considering patient records collated in the first emergency care stages. First, we implemented Random Forest (RF) to estimate the probability of respiratory worsening based on sociodemographic and clinical patient data. Second, we inserted these probabilities into a DES model mimicking the emergency care from the admission to the HD. We then pretested different HD configurations and strategies seeking to reduce the HD bed waiting time. A case study of a European hospital group was used to validate the suggested framework. The AI-DES model enabled decision-makers to identify an improvement proposal with hospitalization bed waiting time lessening, oscillating between 7.93 and 7.98 h.

Postoperative Delirium and Neurocognitive Disorders: Updates for Providers Caring for Cancer Patients.

To provide up to date information on postoperative delirium and neurocognitive disorders in surgical cancer patients. Established risk factors such as age, psychosocial factors, comorbidities, frailty and preexisting cognitive decline continue to exhibit associations with perioperative neurocognitive disorders (PND); novel risk factors identified recently include microbiome composition and vitamin D deficiency. Prevention measures include cognitive prehabilitation, perioperative geriatric assessment and multidisciplinary care, dexmedetomidine and multimodal analgesic techniques. Studies investigating ciprofol, remimazolam, esketamine, ramelteon and suvorexant have shown encouraging results. Controversy remains regarding the use of inhalational versus intravenous general anesthesia. Innovative approaches to address PND are a rapidly developing area of research, but more studies are needed to identify effective prevention and management interventions. Despite challenges and controversy in the field, implementation of best practice can reduce the detrimental impact of PND on patients, caregivers, and society at large.

Epidemic Keratoconjunctivitis: A Growing Concern in Pakistan

Dear Editor, A significant public health concern in Pakistan has arisen—a concerning surge in cases of Epidemic Keratoconjunctivitis (EKC). Though a relatively mild ocular disease, this form of viral conjunctivitis primarily attributed to adenoviruses is being widely reported in Pakistan, highlighting its rapid transmission potential. EKC, characterized by marked conjunctival inflammation, photophobia, pain, lymphadenopathy and occasional vision impairment, stands out for its remarkable ability to spread swiftly.1 This inherent transmission risk makes EKC a critical matter to address in our densely populated communities. While EKC is typically a self-limiting condition with a relatively low risk of severe complications, corneal involvement poses a concern. Within the first week of adenoviral conjunctivitis, individuals may experience the onset of punctate or geographic epithelial keratitis. This early development can serve as an indicator for the later occurrence of stromal keratitis. It presents as the formation of subepithelial infiltrates, which frequently endure or reappear for extended periods, even after the acute infection has cleared.2 The economic implications of EKC are of concern, especially for individuals facing financial adversity. Medical expenses, the cost of pharmacological interventions, and the absence from work can strain an individual's financial condition.3 Our healthcare infrastructure, already facing multiple challenges, experiences added pressure as EKC cases rise. Though EKC does not often require intensive medical care, the speedy transmission and sheer number of cases can strain our clinics and limited healthcare resources, underscoring the urgency of a proactive response. Prevention and education remain our best defences against EKC. We must vigorously promote hand hygiene, advocate for minimizing close ocular contact, and emphasize timely medical attention.1 Adequate disinfection, especially of medical instruments, proves to be essential in combatting the spread of infection, even more so than washing of hands.4,5 Maintaining proper hygiene is a crucial strategy as it has been demonstrated to substantially decrease the duration of the epidemic outbreak.6 In conclusion, it is paramount that we recognize and address the transmission risks associated with Epidemic Keratoconjunctivitis, particularly within the context of Pakistan's densely populated areas. I urge healthcare authorities, professionals, and the media to unite in disseminating critical information and advocating for preventive measures. By doing so, we can effectively mitigate the spread of EKC while ensuring our healthcare system remains resilient.

Recent Progress toward the Discovery of Small Molecules as Novel Anti-Respiratory Syncytial Virus Agents.

Respiratory syncytial virus (RSV) stands as the foremost cause of infant hospitalization globally, ranking second only to malaria in terms of infant mortality. Although three vaccines have recently been approved for the prophylaxis of adults aged 60 and above, and pregnant women, there is currently no effective antiviral drug for treating RSV infections. The only preventive measure for infants at high risk of severe RSV disease is passive immunization through monoclonal antibodies. This Perspective offers an overview of the latest advancements in RSV drug discovery of small molecule antivirals, with particular focus on the promising findings from agents targeting the fusion and polymerase proteins. A comprehensive reflection on the current state of RSV research is also given, drawing inspiration from the lessons gleaned from HCV and HIV, while also considering the impact of the recent approval of the three vaccines.

The influence of patriarchal cultural factors on pregnancy complications (antepartum hemorrhage) at Mitra Medika General Hospital, Bandar Klippa, Indonesia

HIGHLIGHTS 1. Antepartum hemorrhage stands as one of the major contributors to maternal mortality globally. 2. Patriarchal culture is among the societal factors impacting maternal mortality rates.3. Patriarchal cultural factors associated with antepartum hemorrhage are examined to establish effective preventive measures. ABSTRACT Objectives: The objective of this study was to determine the influence of patriarchal culture on the occurrence of antepartum hemorrhage at Mitra Medika General Hospital. Materials and Methods: This study employed an analytical observational design with a case-control approach. The sample for this study included pregnant women in their third trimester and mothers who had given birth within a maximum of 4 months from the time of the study at Mitra Medika General Hospital, Bandar Klippa, Indonesia. There were 90 respondents, comprising 30 case groups and 60 control groups. The sampling method for the case group used quota sampling, while the control group utilized accidental sampling. The research instrument utilized questionnaires and secondary data (antepartum hemorrhage diagnoses). Data analysis employed the chi-square test for bivariate analysis and multiple logistic regression for multivariate analysis, with a significance level of 0.05. Results: There was a significant relationship between decision-making (p=0.030), family support (p=0.003), psychological domestic violence (p=0.024), and sexual domestic violence (p=0.039), no relationship with physical domestic violence (p=0.257) with the occurrence of antepartum hemorrhage. Multivariate analysis revealed that the family support variable was the most dominant risk factor with an Exp (B) value of 8.230 in causing antepartum hemorrhage. Conclusion: The patriarchal cultural factors that significantly affect antepartum hemorrhage at Mitra Medika General Hospital, Bandar Klippa, Indonesia, are decision-making, family support, psychological domestic violence, and sexual domestic violence.

Seasonal patterns of hip fracture incidence and mortality rates across age groups of older adults in Israel.

This study investigates the seasonal patterns of hip fracture occurrence and mortality rates in the elderly population of Israel. In this retrospective study, we examined a random sample of 400 patients who underwent a hip fracture repair surgery at a 495-bed hospital in northern-central Israel during the years 2021-2022. Our findings reveal a heightened incidence of hip fractures during the spring (30.8%) in contrast to relatively consistent rates during other seasons (22-24.2%). Patients experiencing hip fractures in the spring were notably younger and had shorter hospital stays compared to those in other seasons. Furthermore, we identified seasonal variations in hip fracture incidence concerning gender, culture, and nationality. Over the 2-year follow-up period, 20% of patients had succumbed to mortality. The highest survival rate was associated with hip fractures sustained in the spring, while the lowest rates were observed in the autumn and winter. While our study highlights significant seasonal variations in hip fracture occurrence and mortality rates among the elderly population in Israel, caution is warranted in interpreting the implications for post-fracture care and resource allocation. The observed heightened incidence of hip fractures during the spring, particularly among younger patients with shorter hospital stays, suggests the need for further investigation into potential risk factors and preventive measures specific to this season. Additionally, our identification of seasonal variations in hip fracture incidence across demographic factors underscores the importance of tailored interventions to address the diverse needs of different populations.

Assessing factors associated with compliance to preventive measures of COVID-19 in Rwanda: a cross-sectional community survey

ObjectiveTo assess the level of compliance with COVID-19 preventive measures and compliance-associated factors in the Rwanda community.DesignCross-sectional study.SettingsCountry-wide community survey in Rwanda.Participants4763 participants were randomly sampled following the sampling frame...

The evolution of adhesive dentistry: a review of materials and techniques

Adhesive dentistry has undergone remarkable advancements since its inception, fundamentally transforming restorative dental care. Initially marked by the development of early resins and etching techniques, adhesive dentistry has evolved to incorporate sophisticated materials and innovative techniques that significantly enhance clinical outcomes. The introduction of Bis-GMA resins in the 1960s improved mechanical properties and reduced polymerization shrinkage, paving the way for modern composite resins. These composites, enhanced by nanotechnology and advanced filler technology, provide superior strength, wear resistance, and esthetic qualities. Techniques such as selective enamel etching and multi-layering of adhesive systems have further improved bond strength and reduced technique sensitivity. The clinical applications of adhesive dentistry are extensive, ranging from direct and indirect restorations to cosmetic procedures and preventive measures. Direct composite restorations offer minimally invasive solutions with excellent esthetics, while indirect restorations such as inlays, onlays, and veneers benefit from strong, reliable bonds and improved durability. Cosmetic procedures, including veneers, achieve dramatic esthetic improvements with long-lasting results. Preventive applications, such as sealants, effectively protect against caries, especially in pediatric and high-caries-risk patients. The continuous refinement of materials and techniques has led to better clinical outcomes, increased patient satisfaction, and reduced need for invasive procedures. Advances in adhesive materials and methods have ensured that restorations not only mimic natural tooth structures but also maintain their integrity under functional forces. As research and development in adhesive dentistry continue to progress, the field is poised to offer even more innovative and effective solutions, further enhancing the quality of dental care. Overall, the evolution of adhesive dentistry underscores its pivotal role in modern dental practice, providing durable, esthetic, and reliable restorative options that meet the diverse needs of patients.

Identifying risk clusters for African swine fever in Korea by developing statistical models.

African swine fever (ASF) is a disease with a high mortality rate and high transmissibility. Identifying high-risk clusters and understanding the transmission characteristics of ASF in advance are essential for preventing its spread in a short period of time. This study investigated the spatial and temporal heterogeneity of ASF in the Republic of Korea by analyzing surveillance data on wild boar carcasses. We observed a distinct annual propagation pattern, with the occurrence of ASF-infected carcasses trending southward over time. We developed a rank-based statistical model to evaluate risk by estimating the average weekly number of carcasses per district over time, allowing us to analyze and identify risk clusters of ASF. We conducted an analysis to identify risk clusters for two distinct periods, Late 2022 and Early 2023, utilizing data from ASF-infected carcasses. To address the underestimation of risk and observation error due to incomplete surveillance data, we estimated the number of ASF-infected individuals and accounted for observation error via different surveillance intensities. As a result, in Late 2022, the risk clusters identified by observed and estimated number of ASF-infected carcasses were almost identical, particularly in the northwestern Gyeongbuk region, north Chungbuk region, and southwestern Gangwon region. In Early 2023, we observed a similar pattern with numerous risk clusters identified in the same regions as in Late 2022. This approach enhances our understanding of ASF spatial dynamics. Additionally, it contributes to the epidemiology and study of animal infectious diseases by highlighting areas requiring urgent and focused intervention. By providing crucial data for the targeted allocation of resources for disease management and preventive measures, our findings lay vital groundwork for improving ASF management strategies, ultimately aiding in the containment and control of this devastating disease.

Reported Increase in Substance Use Following Mass Terrorism and the Role of Psychosocial Factors

Research has shown evidence of increased substance use (ISU) in populations affected by mass terrorism; however, less is known regarding how psychosocial factors interact to estimate ISU following such events. To examine which factors are associated with reporting ISU, test whether psychological distress (PD) mediated the association between exposure to trauma and reporting ISU, and whether the mediation effect differed among those with prior mental health (MH) difficulties and those without. A partially representative cross-sectional survey of the adult Jewish population in Israel (aged 18-70 years) was conducted 4 weeks after October 7, 2023 (October 31 to November 5, 2023). A national Web panel using quotas based on national distributions was used. Randomly chosen adult Jewish members were invited to participate until a predetermined sample size was reached. The study measures included reporting ISU (outcome), PD (mediator), exposure to terror events and sociodemographic characteristics (variables), and prior MH difficulties (moderator). Hypotheses regarding outcome and variables were formulated before data collection. A total of 7000 invitations were distributed, 2679 individuals consented, 1432 were excluded owing to quota limits, 74 failed attention tests, and 205 opted out, resulting in 968 participants (490 women [50.6%]; mean [SD] age, 41.5 [14.6] years). Hierarchical regression analysis revealed that participants were significantly more likely to report ISU if they had experienced direct exposure (odds ratio [OR], 5.75; 95% CI, 2.53 to 13.05), indirect exposure (OR, 1.84; 95% CI, 1.27 to 2.67), media exposure (OR, 1.22; 95% CI, 1.09 to 1.36), PD (OR, 1.80; 95% CI, 1.44 to 2.25), or previous MH difficulties (OR, 2.76; 95% CI, 1.86 to 4.09). PD partially mediated the association between indirect exposure (b = 0.20; 95% CI, 0.11 to 0.31) and media exposure (b = 0.14; 95% CI, 0.10 to 0.19) and reporting ISU. No evidence was found to support previous MH difficulties as a moderator of these indirect effects (indirect exposure, b = -0.003; 95% CI, -0.28 to 0.28; media exposure, b = 0.01; 95% CI, -0.06 to 0.08). This study contributes to the research on the association of mass terrorism with ISU while shedding important light on the role it may play in the self-medication of PD following exposure, even in those who might have no previous MH difficulties. These insights are crucial for planning essential health services and preventive measures.

Prevalence of inflammatory periodontal diseases

BackgroundDetermining the prevalence of inflammatory periodontal diseases makes it possible to determine the age group most prone to them, which will help to implement correct treatment and prevention measures for persons of this group, aimed at increasing the level of individual and public health of the Republic of Kazakhstan. The purpose of the study was to determine the prevalence of inflammatory periodontal diseases among the population of the city of Astana according to several criteria and to compare data on the statistics of periodontitis incidence from the world and Kazakhstan.ObjectiveThe research was conducted using the methods of clinical examinations and statistical data processing.Material and methodsThe study involved 642 people aged 18 to 80 years who, within twelve months, applied to dental institutions in the city of Astana and were checked according to the inclusion and exclusion criteria. Clinical studies included determining the level of oral hygiene using the OHI-S simplified oral hygiene index and determining the condition of periodontal tissue using the CPITN periodontal disease treatment need index.ResultsIt was found that the highest prevalence of various forms of gingivitis and periodontitis was observed in the 66-80 age group – 99% and 69%, respectively. The general distribution in all groups indicated a directly proportional relationship between the frequency of detection of inflammatory periodontal diseases and the age of the group participants. A comparison of data on the incidence of periodontal disease in the world and in Kazakhstan showed a 3.52% lower incidence rate in Kazakhstan compared to the world average.ConclusionsThe use of regular and timely preventive and treatment measures for the population group most prone to inflammatory periodontal diseases will make it possible to improve the state of individual health of the population and, accordingly, raise the level of public health.

Patterns, outcomes, and preventability of clinically manifest drug-drug interactions in older outpatients: a subgroup analysis from a 6-year-long observational study in North India.

Older adults are vulnerable to adverse drug reactions (ADRs) and drug-drug interactions (DDIs). Evidence on clinically manifest DDIs in older outpatients is scanty. The present study aims to report clinically manifest DDIs, their risk factors, and preventive measures. A subgroup analysis of a 6-year (2015-2021) long prospective study was conducted in a tertiary hospital in North India. Older outpatients with ADRs constituted the study participants. Among 933 ADRs reported in 10,400 patient registrations, clinically manifest DDIs were involved in 199 (21.3%). DDIs accounted for 29.9%, 26.5%, and 21.3% of drug-related metabolic, vascular, and nervous system disorders, respectively. Movement disorders (n = 18), hypotension (n = 16), and hypoglycemia (n = 15) were the most common manifestations. Eighty-six percent of DDIs were of the pharmacodynamic type, and 13.1% were immune-mediated. Around 35% of DDIs resulted in hospitalization, with hyponatremia, movement disorder, and renal impairment as the common reasons. Older adults with Parkinsonism, infection, coronary artery disease, neuropsychiatric disease, and diabetes mellitus, respectively, had 3.28, 2.85, 1.97, 1.76, and 1.80 times higher odds of DDIs. Those receiving ≥ 10 drugs had 5.31 times higher odds of DDIs compared to individuals receiving 1-4 drugs. "Avoiding the causative drug," "optimal monitoring of the patient," and "start-low and go-slow" policy together could prevent 85% of DDIs. In conclusion,every fifth case of ADRs and nearly one third of ADR-related hospitalizations in older adults are related to DDIs. Movement disorder, hypotension, and hypoglycemia are the common manifestations. A holistic approach with drug omission, optimal patient monitoring, and slow titration of therapy can prevent significant DDIs in older adults.