Health Care Programs Research Articles

Comparative study of allopathy and ayurveda for treatment of diabetes mellitus

These days, one of the most prevalent non-communicable diseases is diabetes mellitus. It has an impact on people worldwide of all ages and their families, and it heavily strains national budgets and healthcare systems. In the short term, implementing a comprehensive healthcare management program for individuals with diabetes can result in significant improvements in clinical outcomes and costs. Millions of people throughout the world suffer from diabetes mellitus, a chronic metabolic illness. To avoid complications and enhance the quality of life for those with diabetes, management is crucial. The two main methods used to treat diabetes are Ayurveda, an ancient system of traditional medicine, and Allopathy, a conventional medical system. The purpose of this study is to compare and contrast these two methods for treating diabetes. The study includes a thorough analysis of the research on diabetes treatment in allopathy and ayurveda, as well as clinical studies and expert opinions.

Oral health-related quality of life among people living with HIV and HIV-negative adults in Kigali, Rwanda: a comparative cross-sectional study

BackgroundAssessing health-related quality of life has become integral to people living with HIV (PLHIV) follow-up. However, there is a lack of data regarding the impact of oral health on quality of life, known as Oral health-related quality of life (OHRQoL) among PLHIV compared to HIV-negative individuals in Rwanda.AimThe study aimed to assess OHRQoL among PLHIV compared to HIV-negative counterparts in Kigali, Rwanda.MethodsThe Oral Health Impact Profile short version (OHIP-14) questionnaire was interviewer-administered to 200 PLHIV and 200 HIV-negative adults (≥ 18 years old) at an HIV clinic of Kigali Teaching Hospital (CHUK). Socio-demographic characteristics, including age, sex, occupation, and socioeconomic status (SES) of participants, were collected using a survey questionnaire. A 4-point Likert scale was used to assess the frequency of oral impacts for all 14 items within 7 domains of the OHIP tool. The descriptive statistics were used to see frequencies and percentages of OHRQoL among PLHIV and HIV-negative persons, respectively. The Chi-square test was used to determine the association of OHRQoL with caries (DMFT) and periodontal disease (CPITN) among PLHIV compared to HIV-negative individuals.ResultsThe results revealed a higher prevalence of PLHIV with poor OHRQoL than HIV-negative individuals in 5 domains and almost all items of OHIP-14 except for the OHIP 3 (found it uncomfortable to eat any foods because of problems with teeth or mouth) and OHIP-14 (being totally unable to function because of problems with teeth or mouth). The findings showed statistically significant results (p ≤ 0.05) for the OHIP1 item “trouble pronouncing any word,” with a prevalence of 2.5% (n = 11) and 2.25% (n = 9) in PLHIV and HIV-negative, respectively. Also, PLHIV had a significantly higher prevalence, 2.75% (n = 11) for the OHIP 13 item “life not satisfying due to teeth and mouth problems compared to HIV-negative individuals 2% (8) p ≤ 0.05. Moreover, dental caries was significantly associated with poor OHRQoL among PLHIV and HIV-negative adults and for all 14 items of the OHIP tool. Periodontal disease was not significantly associated with OHRQoL among PLHIV and HIV-negative adults.ConclusionThis study revealed poor OHRQoL among PLHIV compared to HIV-negative adults. There is a need for further longitudinal studies to investigate the OHRQoL in Rwanda, especially among PLHIV. It is essential to include oral health care as one of the components of the medical health care programs for PLHIV in Rwanda.

Intellectual and developmental disabilities in Ontario's criminal justice and forensic mental health systems: Using data to tell the story.

International studies show that adults with intellectual and developmental disabilities (IDD) are disproportionately represented in the criminal justice and forensic mental health systems; however, it is difficult to capture their involvement across systems in any one jurisdiction. The current study aimed to estimate the prevalence of IDD across different parts of the criminal justice and forensic mental health systems in Ontario and to describe the demographic and clinical profiles of these individuals relative to their counterparts without IDD. This project utilised administrative data to identify and describe the demographic and clinical characteristics of adults with IDD and criminal justice or forensic involvement across four sectors: federal correctional facilities, provincial correctional facilities, forensic inpatient mental health care and community mental health programmes. Questions were driven by and results were contextualised by a project advisory group and people with lived experience from the different sectors studied, resulting in a series of recommendations. Adults with IDD were over-represented in each of the four settings, ranging from 2.1% in federal corrections to 16.7% in forensic inpatient care. Between 20% (forensic inpatient) and 38.4% (provincial corrections) were under the age of 25 and between 34.5% (forensic inpatient) and 41.8% (provincial corrections) resided in the lowest income neighbourhoods. Medical complexity and rates of co-occurring mental health conditions were higher for people with IDD than those without IDD in federal and provincial corrections. Establishing a population-based understanding of people with IDD within these sectors is an essential first step towards understanding and addressing service and care needs. Building on the perspectives of people who work in and use these systems, this paper concludes with intervention recommendations before, during and after justice involvement.

Experiences of a student with a visual impairment transitioning to higher education: A narrative inquiry

Transition to higher education is a considerable period of change for students, and can be a particularly challenging time for students with a visual impairment. The aim of this study was to understand the transition experiences of an undergraduate student in Sport Rehabilitation with a visual impairment. A narrative inquiry was conducted with one participant purposively sampled due to being certified severely sight impaired. Data were collected using a semi-structured interview, and analysed by creating narrative threads within Clandinin and Connelly’s three-dimensional framework. The social influence of role models, peers, and staff were noted in relation to their impact on confidence and feeling of fitting in. Navigating the campus, teaching spaces, and demonstrations were all highlighted as spatial factors that affected independence and participation during transition. Time-related aspects such a personal development, proactivity, and pre-, during, and post-teaching session experiences were identified as key considerations. The narratives uncovered should serve as a tool to trigger reflection on previous teaching practice, and inform future direction. The findings and recommendations within this study will benefit transition and inclusivity for students with a visual impairment, particularly on Sport Rehabilitation or other healthcare programmes, allowing them to study and practice effectively.

Strategies to decrease inequalities in cancer therapeutics, care and prevention: Proceedings on a conference organized by the Pontifical Academy of Sciences and the European Academy of Cancer Sciences, Vatican City, February 23-24, 2023.

Analyses of inequalities related to prevention and cancer therapeutics/care show disparities between countries with different economic standing, and within countries with high Gross Domestic Product. The development of basic technological and biological research provides clinical and prevention opportunities that make their implementation into healthcare systems more complex, mainly due to the growth of Personalized/Precision Cancer Medicine (PCM). Initiatives like the USA-Cancer Moonshot and the EU-Mission on Cancer and Europe's Beating Cancer Plan are initiated to boost cancer prevention and therapeutics/care innovation and to mitigate present inequalities. The conference organized by the Pontifical Academy of Sciences in collaboration with the European Academy of Cancer Sciences discussed the inequality problem, dependent on the economic status of a country, the increasing demands for infrastructure supportive of innovative research and its implementation in healthcare and prevention programs. Establishing translational research defined as a coherent cancer research continuum is still a challenge. Research has to cover the entire continuum from basic to outcomes research for clinical and prevention modalities. Comprehensive Cancer Centres (CCCs) are of critical importance for integrating research innovations to preclinical and clinical research, as for ensuring state-of-the-art patient care within healthcare systems. International collaborative networks between CCCs are necessary to reach the critical mass of infrastructures and patients for PCM research, and for introducing prevention modalities and new treatments effectively. Outcomes and health economics research are required to assess the cost-effectiveness of new interventions, currently a missing element in the research portfolio. Data sharing and critical mass are essential for innovative research to develop PCM. Despite advances in cancer research, cancer incidence and prevalence is growing. Making cancer research infrastructures accessible for all patients, considering the increasing inequalities, requires science policy actions incentivizing research aimed at prevention and cancer therapeutics/care with an increased focus on patients' needs and cost-effective healthcare.

Experiences and Challenges with Congenital Hypothyroidism Newborn Screening in Indonesia: A National Cross-Sectional Survey.

The expansion of newborn screening (NBS) for congenital hypothyroidism (CH) is essential to reducing the number of preventable intellectual disabilities in children. Because of logistical issues, including geographic extremes, distinct cultures, and 4.8 million births annually, Indonesia has struggled to achieve universal NBS coverage. A national cross-sectional electronic survey was conducted to explore challenges in CH NBS. Responses from 423 healthcare professionals and program administrators across 30 provinces in Indonesia were collected. The major challenges reported were refusal from families (39.2%), newborns being discharged <24 h (38.3%), and limited availability of filter paper (35.9%). The respondents considered refusal from families to be due to fear, while others did not understand the necessity of CH NBS. The vast majority of respondents believed that parents do not have sufficient understanding regarding CH NBS (96.5%). Our study found that only 38.5% of respondents had received formal CH NBS training, with pediatric endocrinologists being the only profession in which all respondents had been trained. Concerted efforts are needed to improve the access to and availability of resources, increase the capacity for sample collection and analysis, empower healthcare professionals, and develop educational resources to promote understanding and acceptance of NBS amongst families.

Analyzing COVID-19 and Air Pollution Effects on Pediatric Asthma Emergency Room Visits in Taiwan.

(1) Background: An asthma exacerbation that is not relieved with medication typically requires an emergency room visit (ERV). The coronavirus disease 2019 (COVID-19) pandemic began in Taiwan in January of 2020. The influence of the COVID-19 pandemic on pediatric ERVs in Taiwan was limited. Our aim was to survey pediatric asthma ERVs in the COVID-19 era; (2) Methods: Data were collected from the health quality database of the Taiwanese National Health Insurance Administration from 2019 to 2021. Air pollution and climatic factors in Taipei were used to evaluate these relationships. Changes in the rates of pediatric asthma ERVs were assessed using logistic regression analysis. Poisson regression was used to evaluate the impact of air pollution and climate change; (3) Results: The rate of pediatric asthma ERVs declined in different areas and at different hospital levels including medical centers, regional and local hospitals. Some air pollutants (particulate matter ≤ 2.5 µm, particulate matter ≤ 10 µm, nitrogen dioxide, and carbon monoxide) reduced during the COVID-19 lockdown. Ozone increased the relative risk (RR) of pediatric asthma ERVs during the COVID-19 period by 1.094 (95% CI: 1.095-1.12) per 1 ppb increase; (4) Conclusions: The rate of pediatric asthma ERVs declined during the COVID-19 pandemic and ozone has harmful effects. Based on these results, the government could reduce the number of pediatric asthma ERVs through healthcare programs, thereby promoting children's health.

The Prerequisites of Executing the Accreditation Program for Primary Healthcare: A Systematic Review and Meta-Synthesis.

In Iran, the primary healthcare system is the front-line for society's encounter with healthcare. Health planners aim to enhance quality and administer an accreditation program. This study examined program administration prerequisites through systematic review and meta-synthesis. We conducted a systematic review and meta-synthesis of qualitative literature using Thomas and Hudson's framework. Peer-reviewed papers were searched in Scopus, PubMed, Web of Science, Google, and Google Scholar up to 2023. The search found 1308 articles, with 37 relevant ones selected for review. Data extraction included setting, participants, study design, data collection, analysis, and themes. Thirteen qualitative subthemes were identified and were categorized under three elements of the Donabedian model. Before implementing a plan, it is crucial to consider its executive prerequisites. Revision and trial-and-error approaches can be costly and time-consuming, potentially hindering the plan's effectiveness and diverting organizations from their primary goal, leading to failure.

Resilience and Social Support Improve Mental Health and Quality of Life in Patients with Post-COVID-19 Syndrome.

Physical and mental health problems among post-COVID-19 patients are common, even a year after infection. As there is no prior study available, we investigated the impacts of resilience and social support on anxiety, depression, and quality of life among patients with post-COVID-19 syndrome. We conducted a cross-sectional study with a convenience sample. The measures included the demographic and clinical characteristics of patients, the Brief Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Patient Health Questionnaire-4 (PHQ-4), and the EuroQol-5D-3L. The mean age of patients was 44.8 years. The total PHQ-4 score suggested that 32.8% of patients with post-COVID-19 syndrome experienced severe psychological distress, 32.8% experienced moderate distress, 23% experienced mild distress, and 11.5% had no distress. Moreover, 60.7% of patients had anxiety scores of ≥3 and 69.7% had depression scores of ≥3, indicating possible major anxiety or depression disorder. The mean EQ-5D-3L index value was 0.36, and the mean EQ-5D-3L VAS was 54.1. Multivariable analysis identified that resilience and social support reduced anxiety and depression among patients. Also, we found a significant positive relationship between resilience and social support, and quality of life. Our findings suggest that resilience and social support can be protective by reducing anxiety and depression and improving quality of life among patients with post-COVID-19 syndrome. Policymakers should develop and implement healthcare management programs to provide psychological support to these patients.

Oral Health and Dental Treatment Needs in Thalassemia Major Patients

Abnormalities in haemoglobin is a defining characteristic of hemoglobinopathies, encompassing conditions such as sickle cell anaemia and thalassemia. Thalassemia major, a condition marked by profound anaemia resulting from insufficient haemoglobin production, impacts a significant global population. The objective of this study was to enhance comprehension of the oral health needs specific to individuals with thalassemia major, to improve the provision of healthcare services for this population. A descriptive multicentric cross-sectional study was undertaken including a cohort of 42 individuals diagnosed with severe thalassemia. The assessment of the participants' oral health was conducted with the DMFT/DMFT Index and the OHI-Simplified (OHI-S). The research revealed a significant occurrence of dentofacial abnormalities and dental treatment requirements, thereby emphasizing the importance of complete oral health care for those diagnosed with thalassemia. Individuals diagnosed with thalassemia major may present a distinctive facial attribute referred to as "Chipmunk facie" or "Rodent facie," which arises from the enlargement of the maxilla and zygomatic bone. Malocclusion, along with dental caries and oral ulcers, is a prevalent dental and facial abnormality observed within the study population. The findings of this study underscore the imperative of early detection and intervention of oral health concerns among individuals with thalassemia. Regular dental examinations and prompt intervention for dental and facial abnormalities confer advantages to individuals afflicted with thalassemia. The research highlights the importance of enhancing oral health awareness and providing education to the community as a means to enhance the provision of oral health care for those with thalassemia. The integration of dental care into thalassemia management necessitates the collaborative efforts of medical and dental professionals. Notwithstanding the perceptive conclusions drawn from the study, further research employing larger and more diverse sample sizes is necessary to substantiate and advance the obtained findings. The findings of this study will have significant implications for the development of enhanced management procedures and targeted oral health care programs for those diagnosed with thalassemia major, hence offering substantial benefits to this population. By emphasizing the significance of oral health in the context of thalassemia care, we can augment the overall well-being and quality of life of patients.

Development of a Community Informed Approach for Implementing Support Network Trainings for Children with Autism Spectrum Disorder in Western Kenya

Background:Autism spectrum disorder (ASD) impacts a large global community, with a prevalence of nearly 1 in 100 children. However, little is known about the educational experience of children with ASD and other neurodevelopmental disorders (NDD) in low- and middle-income countries (LMICs). Guidance from local communities is essential when developing a cultural inquiry into this educational landscape. Our project objective was to evaluate community perspectives on ASD and areas of development for future support network trainings.&#x0D; Methods:This qualitative study was performed within the Academic Model Providing Access to Healthcare (AMPATH) program in Eldoret, Kenya. Using group discussions, this approach engaged stakeholders from three areas: medical personnel, educators, and caregivers/families. Kenyan professionals in child psychiatry, occupational therapy, and special education guided discussion and led the recruitment of key informants for interviews. Within this qualitative analysis, brief thematic analysis of dialogue elucidated key themes.&#x0D; Results:Four focus groups were held, with 87 total participants (group size = 12-29). Four main themes were identified in the data: beliefs about causes, treatment options, barriers to education, and a need for community advocacy. Advocacy was a major focus of discussions, due to a sentiment of fragmentation and poor acceptance from the community. Stigmatization carried over into localbeliefs about causes of ASD, which included poor nutrition, witchcraft, and genetics. Finding resources to access education and therapy was a challenge, especially for families in rural settings. These viewpoints informed study protocol adaptation by expanding recruitment to include community-based service providers and staff from additional schools, and integrating themes into interview questions.&#x0D; Conclusion:This project prioritized dialogue with stakeholders to gain insights to inform the development of a cultural inquiry into the special education landscape in western Kenya. Themes elucidated from this project provided critical feedback to inform future study protocol and an expanded recruitment plan.

Evaluation of a Pediatric High-Flow Nasal Cannula Training Program for Providers at Moi Teaching and Referral Hospital in Eldoret, Kenya

Background: High-flow nasal cannula (HFNC) is a relatively safe, effective, and well-tolerated form of non-invasive ventilation for children with respiratory distress and is regularly used in resource-rich settings. Pediatric HFNC has been successfully implemented in resource-limited settings; however, little is known about the training process required to integrate HFNC into care. The present study evaluates a pediatric HFNC training program conducted at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya prior to HFNC implementation at Shoe4Africa Children’s Hospital.&#x0D; Methods: This study took place within the Academic Model Providing Access to Healthcare (AMPATH) program, a partnership among MTRH, Moi University, and a consortium of North American universities led by Indiana University. The training program curriculum included information about HFNC; clinical signs of respiratory distress; a demonstration and hands-on practice with HFNC machines; a locally adapted protocol for pediatric HFNC implementation; and a sample patient case. Fifty-nine acute care providers (nurses, clinical officers, medical officers, and registrars) participated in training. Participants completed pre-tests and post-tests (immediate and 3-month follow-up) containing open-ended questions to assess HFNC knowledge and five-point Likert scale questions to assess HFNC comfort and attitudes. Data were analyzed using descriptive statistics and two-proportion Z-tests (α=0.05).&#x0D; Results: Average knowledge assessment scores significantly increased from pre-test (2.19/6) to post-test (5.59/6; p&lt;0.001). While scores decreased slightly at the 3-month follow-up, they remained increased from pre-test levels (4.53/6; p&lt;0.001). The percentage of respondents who answered each knowledge assessment question correctly on the post-test and 3-month followup were significantly increased from the pre-test. Participant comfort using HFNC was increased on both the post-test (p&lt;0.001) and 3-month follow-up (p=0.038).&#x0D; Conclusions: This program successfully trained providers in pediatric HFNC use at MTRH and could inform future HFNC training in resource-limited settings. Future studies should evaluate pediatric outcomes at Shoe4Africa after HFNC implementation.

Student Opposition to University Pouring Rights Contracts

IntroductionThe majority of large public universities have exclusive pouring rights contracts (PRCs) with beverage companies that produce and market sugar-sweetened beverages (SSBs). PRCs contain provisions that conflict with recommendations from major public health organizations that institutions reduce SSB availability, marketing, and consumption. This study assessed the following among students at 3 public universities: student perception of PRCs–the extent to which they favored or opposed PRCs, the association between student socioeconomic characteristics and perception of PRCs, student estimates of PRC revenue, and the association between student PRC revenue estimates and perception of PRCs. To contextualize results, actual PRC revenue as a percent of total revenues was estimated. MethodsA cross-sectional exploratory study was conducted among a convenience sample of 1,311 undergraduate SSB-consuming students recruited from 3 large and diverse public universities in Northern California. On an online questionnaire, undergraduate students indicated the extent to which they favored or opposed PRCs on a 10-point scale (oppose=1-5, favor=6-10) and provided a numeric estimate of the percentage of total university revenue they thought their university's PRC generated. Regression models were used to analyze differences in perception of PRCs by student socioeconomic status and estimates of university revenues generated by PRCs. Additionally, PRCs and financial reports were obtained from the 3 universities to estimate actual PRC revenue as a percent of total revenues. Survey data were collected between August and November 2018 and analyzed August 2022. ResultsA large majority of students (81%) opposed PRCs, and opposition did not significantly differ by student socioeconomic status, including by levels of food security, need-based financial aid, participation in federal food assistance or healthcare programs, parental education, or parental income (all p-values > 0.14). The median student estimates for PRC revenue as a percentage of total university revenue was 10%. In contrast, the estimated actual annual revenue generated from the PRCs ranged from 0.01-0.04% at these schools. Revenue estimates were not significantly associated with participants’ opposition or favoring of PRCs (p = 0.65). ConclusionsA large majority of students opposed PRCs, and this opposition was similar regardless of student socioeconomic status or student estimates of PRC revenues. Students markedly overestimated (by >100-1000-fold) the percentage of university revenue that came from PRCs. University administration should consider student views on PRCs when deciding whether to exit or continue with PRCs.

Oral health and healthy ageing: a scoping review

BackgroundGood oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.MethodsA systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O’Malley’s scoping review framework.ResultsThe findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride.ConclusionThere is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

Street medicine: An interprofessional elective to address the unhoused population crisis

Background and purposeThe homelessness crisis continues to escalate nationwide, yet many healthcare providers are not adequately prepared to provide care for unhoused patients. An interprofessional Street Medicine elective was developed to address identified knowledge gaps in the unhoused population healthcare needs. Educational activity and settingThe course comprised didactic and clinical elements focused on empathetic communication, resource utilization, and medical management for unhoused patients. Course learning outcomes were evaluated via thematic analysis of students' post-course reflective essays. Additionally, students completed a voluntary survey to evaluate course effectiveness in preparing students for healthcare in the unhoused population and to identify areas for course improvement. FindingsThirty students completed the course (17 osteopathic medical, five pharmacy, eight joint physician assistant/public health). All enrolled students submitted mandatory post-course reflections and 57% completed the voluntary survey. Thematic analysis of reflections indicated that the course content challenged biases toward unhoused populations, equipped students with new perspectives on the unique healthcare needs for unhoused patients, and provided interprofessional approaches to address these needs. Voluntary survey results demonstrated students' preparedness to provide effective care for local unhoused patients without bias or stigma. Most students reported they were likely to incorporate the knowledge/skills acquired from the course in their future clinical practice and were satisfied with the course content and organization. SummaryThe Street Medicine elective provided a structured interprofessional curricular opportunity on specialized care for unhoused individuals. This course can be adapted by other healthcare professional programs to empower students to address the growing homelessness crisis.

ANALYSIS OF BRAZILIAN STATES' ADHERENCE TO THE AT SCHOOL HEALTH PROGRAM

The School Health Program (PSE) is a Primary Health Care (PHC) program formulated in an intersectoral way, articulating PHC professionals and schools to develop actions aimed at Brazilian schoolchildren. To adhere to the PSE, it is necessary to link PHC health teams with Oral Health teams and the Term of Commitment validated by health and education managers. This study aimed to verify the adherence of Brazilian states to the PSE as a strategic tool for integrating health and education for the development of citizenship and the qualification of Brazilian public policies. Research was carried out through a descriptive analysis of data contained in public databases of the Primary Care Health Information System (SISAPS) and the Brazilian Institute of Geography and Statistics (IBGE). It was observed that for the 2021-2022 Cycle, Piauí showed the highest percentage of adherence considering the number of municipalities, Minas Gerais showed more students benefiting considering absolute numbers and São Paulo is the state with the highest number of students enrolled in elementary education and the number of students benefiting. The PSE showed adherence above 80% in all Brazilian states, presenting itself as a strategic tool for integrating health and education for the development of citizenship and the qualification of Brazilian public policies.

Effectiveness of a culturally tailored text messaging program for promoting cervical cancer screening in accra, Ghana: a quasi-experimental trial

IntroductionDespite breakthroughs in cervical cancer detection, resource-constrained countries continue to have a disproportionately high incidence and death rate. Mhealth has been identified as an important tool for increasing cervical cancer screening rates in Sub-Saharan Africa. We determined whether sending Ghanaian women culturally tailored one-way mobile phone SMS text messages about cervical cancer would encourage the uptake of the human papillomavirus (HPV) test.MethodsFrom August to November 2016, 88 women aged 18 to 39 living or working in an urban community (Accra, Ghana) participated in a quasi-experimental study. For 8 weeks, 32 SMS messages regarding cervical cancer were developed and sent to the personal phones of intervention arm participants (n = 42). Women in the control group (n = 46) received SMS texts with general health and lifestyle advice. Fischer’s exact tests were performed to assess cervical cancer screening uptake and associated reasons for non-uptake between the intervention and control groups (p < 0.05).ResultsAt the baseline, women differed in terms of ethnicity and wealth. After the intervention, participants’ self-reported risk factors for cervical cancer, such as early menarche, usual source of medical treatment, family history of cancer, smoking, and alcohol history, changed. None of the women in the intervention group sought cervical cancer screening after the intervention, but only one (2.2%) of the control arm participants did. Almost all the women (> 95%) agreed that an HPV test was essential and that regular healthcare check-ups could help prevent cervical cancer. Some women believed that avoiding particular foods could help prevent cervical cancer (23.8% intervention vs. 58.7% control, p < 0.001). Time constraints and out-of-pocket expenses were significant barriers to cervical cancer screening. Conclusion: A one-way SMS delivered to urban women did not increase cervical cancer screening attendance. The time spent in screening facilities and the lack of coverage by the National Health Insurance Scheme limited screening uptake. We urge for the establishment of screening centers in all healthcare facilities, as well as the inclusion of cervical cancer screening in healthcare programs through cost-sharing.

Government Policies in Implementing Social Welfare for National Development

This study evaluates the welfare state model applied in the development of Indonesia and the relevance of the welfare state concept in developing Indonesian policies. The method used is qualitative research, and the research object is government policies utilized in the application of the welfare state concept (welefar staat) in the forms of documents, books, and journals, as well as research results. Secondary data in the form of documents, laws and regulations, references/books, journals, and other supporting documents were obtained by researchers from existing sources in the literature. . Data were recorded and materials were systematically analyzed. Data analysis was done in the form of a clear and concrete description of the objects discussed qualitatively. Results show that the Indonesian government separates model categories in running a welfare state, namely the old-age security program and the healthcare program. This means that state administrators (government) must continuously strive to achieve the welfare of their citizens. This is a constitutional mandate that cannot be simply ignored, so it is impossible for state administrators to escape it.&#x0D; Keywords: government policy, social welfare, national development

Addressing Anxiety, Perfectionism, and Coping in Healthcare Students: A Call for Integrated Mental Health Interventions

This commentary calls for integrated mental health interventions to address anxiety, perfectionism, and coping mechanisms among Doctor of Physical Therapy (DPT) students and other healthcare programs. Healthcare programs, with their rigorous academic and clinical demands, often leave students facing significant psychological stress, which can impact their learning and future professional performance. The primary study discussed illustrates that anxiety, particularly influenced by perfectionism and coping styles, is prevalent in these students, indicating a need for comprehensive mental health support within the curriculum. The commentary expands upon traditional approaches by suggesting the incorporation of proven mental health initiatives such as cognitive-behavioral therapy (CBT) and mindfulness programs within healthcare education. These initiatives are vital for managing stress and preventing burnout, which is particularly prevalent in high-pressure environments like healthcare education. By integrating such mental health strategies, educational institutions can foster a more supportive learning environment that not only addresses immediate student needs but also enhances overall educational outcomes. Moreover, it advocates for a holistic educational practice that goes beyond typical academic goals to include mental well-being. It proposes practical steps for embedding mental healthcare into health professions' curricula, thus preparing students not only academically but also psychologically for the demands of healthcare professions. This proactive approach in educational settings can significantly mitigate the psychological burdens faced by healthcare students, enhancing their academic performance, clinical competencies, and overall well-being.

The impact of accessibility to non-calcium-based phosphate binders and calcimimetics on mineral outcomes in patients receiving maintenance hemodialysis: A 10-year retrospective analysis of real-world data.

Hyperphosphatemia and hyperparathyroidism are common in end-stage kidney disease and are associated with poor outcomes. In addition to adequate dialysis, medications are usually required for optimum control of serum phosphate and parathyroid hormone (PTH) levels. The use of calcium-based phosphate binders (CBPBs) and active vitamin D is associated with an increase in serum calcium and worsening vascular calcification. To overcome these limitations, non-calcium-based phosphate binders (NCBPBs) and calcimimetics have been developed. However, the coverage for these new medications remains limited in several parts of the world due to the lack of patient-level outcome data and cost. The present study examined the differences in mineral outcomes between two main categories of healthcare programs that provided different coverage for medications used to control mineral and bone disorders (MBD). The Social Security/Universal Coverage (SS/UC) program covered only CBPBs and active vitamin D, whereas the Civil Servant/State Enterprise (CS/SE) program provided coverage of CBPBs, active vitamin D, NCBPBs, and calcimimetics. This 10-year retrospective cohort study examined the differences in mineral outcomes between two healthcare programs in maintenance hemodialysis patients. The differences in serum calcium, phosphate, and PTH levels, as well as the aortic arch calcification score, were analyzed according to dialysis vintage by linear mixed-effects regression analyses. The difference in the composite outcome of severe hyperparathyroidism and parathyroidectomy was analyzed by the Cox-proportional hazard regression model. 714 patients were included in the analyses (full cohort). Of these patients, 563 required at least one type of medication to control MBD (MBD medication subgroup). Serum calcium, phosphate, and the proportions of patients with hypercalcemia and hyperphosphatemia were substantially higher in the SS/UC group compared with the CS/SE group after appropriate adjustments for confounders in both the full cohort and the MBD medication subgroup. These findings were confirmed in propensity-score matched analyses. Higher parathyroid hormone levels and a higher rate of the composite endpoint of severe hyperparathyroidism and parathyroidectomy were also observed in the SS/UC group. A more rapid progression of aortic arch calcification was suggested in the SS/UC group, but between-group changes were not significant. Patients under the healthcare program that did not cover the use of NCBPBs and calcimimetics showed higher serum calcium and phosphate levels and a more rapid progression of hyperparathyroidism. The difference in the progression of vascular calcification could not be confirmed in the present study.