Country's Public Health Research Articles

A fractional derivative model of the dynamic of dengue transmission based on seasonal factors in Thailand

Climate variability affects the changes in controlling diseases transferred by insects. An increase in the population, the growth of communities, and a lack of public health infrastructure bring about the return of diseases of which insects are carriers, one of the illness issues. Therefore, the disease control is significant to help reduce the burden on the government and strengthen the country's public health structure. This research proposes a novel approach to modeling dengue fever dynamics, we employ a fractional derivative model with the Atangana–Baleanu–Caputo derivative, which offers a more accurate representation of real-world disease dynamics compared to traditional integer-order models. Basic qualifications are proposed. Equilibrium points and basic reproduction numbers are analyzed. The next-generation matrix method is used to identify the transmission. Besides, parameter sensitivity analysis is performed to learn about factors affecting input parameter values' effects on the basic reproduction number. It was found that the most common parameter affecting the transmission was the biting rate of mosquitoes was 1. In addition, the existence and uniqueness of the solution are examined using the Banach fixed point theorem. The Toufik–Atangana method is used for the numerical examination of a fractional version of the proposed model. We compared different values of fractional-order α=0.965, 0.975, 0.985, 0.995 and 1 it was found that when the order of derivatives decreases, the transmission shall decrease accordingly. This research provides valuable insights for developing effective control strategies to reduce the burden of dengue fever and strengthen public health systems.

Clip versus coil shift for aneurysm treatment in Brazil: an exploratory analysis of trends in a 10-year time-series.

Regarding intracranial aneurysm treatment, the clip versus coil debate remains inconclusive and lacking studies in Brazil. To examine trends in the management of intracranial aneurysms in Brazil over time, both ruptured and unruptured. A descriptive and exploratory study was conducted based on data of neurovascular procedures for aneurysm treatment using the Brazilian Public Health System database (DATASUS). The variables analyzed were the number of procedures, mortality rates, length of hospital stays, and global costs of hospitalization, from 2010 to 2019. Temporal trend analysis and statistical comparisons were conducted to assess changes over time and differences between the treatment options. The mean annual number of aneurysm treatments with endovascular embolization was 2206.30 (± 309.5), with a non-significant increasing trend (B = 55.66; p = 0.104). Conversely, microsurgical clipping exhibited a significant decreasing trend (B = -69.97; p < 0.001) with a mean of 1133.1 (± 223.12) procedures. The mortality rate associated with clipping procedure was higher in the period, with a mean difference of 5.23 (± 0.39); ([CI95%: 4.36; 6.10]; p < 0.001) and showed an increase trend, while embolization showed a stable trend. The length of in-hospital stay remained stable for clipping but increased for embolization. Costs associated with clipping increased over time, whereas costs for embolization decreased. This study highlights a significant shift in the treatment of aneurysm towards Endovascular Embolization. Despite higher costs, endovascular procedures were associated with lower mortality rates and shorter hospital stays. These findings provide valuable insights into aneurysm treatment patterns and indicators in a middle-income country's Public Health System.

To give or not to give? Pandemic vaccine donation policy

ObjectivesThe purpose of this work is to characterize scenarios under which it may be in a donor country's own public health interests to donate vaccine doses to another country before its own population has been fully vaccinated. In these scenarios, vaccinating other countries can delay the evolution of new variants of the virus, decrease total deaths, and, in some cases, decrease deaths in the donor countries. Study designWe simulate the effects of different vaccine donation policies using an epidemiological model employing COVID-19 transmission parameters. MethodsWe use the epidemiological model of Holleran et al. that incorporates virus mutation to simulate epidemic progression and estimate numbers of deaths arising from several vaccine allocation policies (donor-first, non-donor-first, and vaccine sharing) across a number of scenarios. We analyze the results in light of herd immunity limits derived in Holleran et al. ResultsWe identify realistic scenarios under which a donor country prefers to donate vaccines before distributing them locally in order to minimize local deaths during a pandemic. We demonstrate that a non-donor-first vaccination policy can delay, sometimes dramatically, the emergence of more-contagious variants. Even more surprising, donating all vaccines is sometimes better for the donor country than a sharing policy in which half of the vaccines are donated, and half are retained because of the impact donation can have on delaying the emergence of a more contagious virus. Non-donor-first vaccine allocation is optimal in scenarios in which the local health impact of the vaccine is limited or when delaying the emergence of a variant is especially valuable. ConclusionIn all cases, we find that vaccine distribution is not a zero-sum game between donor and non-donor countries, illustrating the general moral reasons to donate vaccines. In some cases, donor nations can also realize local health benefits from donating vaccines. The insights yielded by this framework can be used to guide equitable vaccine distribution in future pandemics.

Addressing emerging public health threats: the Noncommunicable Disease Capacity Assessment and Planning (N-CAP) Process.

The global epidemic of noncommunicable diseases (NCDs) is increasing. Current assessments that monitor capacity to address NCDs are often externally led and do not facilitate country planning. The Noncommunicable Disease Capacity Assessment and Planning (N-CAP) Process assists ministries of health and other governmental and non-governmental stakeholders to assess, prioritize, and plan how to address NCDs and other public health threats. This paper describes the development of this tool. Driven by ministries of health, the N-CAP Process engages new and existing stakeholders in three activities: Stakeholder Mapping; Strengths, Weaknesses, Opportunities, and Threats Workshop; and N-CAP Workshop that uses Discussion Guides to lead in-depth assessment and planning. Standard Operating Procedures, a library of Discussion Guides based on common NCD themes, and an open-access e-learning course are available. The N-CAP Process outcome is a prioritized plan of how to improve the country's public health functions. Adaptations to the tool were made after piloting in Jordan and Iraq. The N-CAP Process helps countries engage various stakeholders to identify gaps and create collaborative, country-specific strategies to effectively respond to NCDs, a leading public health threat. The pilots sparked interest from other countries and underscored its potential for broader implementation to combat the rising global burden of NCDs.

Evaluating Oral and Dental Health and the RelatedFactors regarding the Elderly in Aliabad City of Golestan Province in 2022

&#x0D; &#x0D; &#x0D; Introduction: Considering the increasing growth of the elderly population, the importance of their life quality e, and the impact of oral and dental health on their quality of life, this study was conducted with the aim of evaluating oral and dental health and the factors affecting it in the elderly of Aliabad city, Golestan province, in 1400.&#x0D; Methods: This was a descriptive and analytical cross-sectional study. The research population consisted of 216 elderly of over 60 living in Aliabad city of Golestan province in 2022; they were selected through cluster random sampling method. 128 people (59/3 percent) were women and 88 people (40/ 7 percent) were men. This study was conducted from May to September 2022. To collect data, demographic information questionnaire and Geriatric Oral Health Assessment Index (GOHAI) were used, whose Persian version was valid and reliable. In addition, the last dental visit, the number of times the mouth was washed, the need for dental treatment, and personal assessment of the individual's oral and dental health status were among the items that were collected and recorded in the form of dental information regarding the elderly. After completing the questionnaires, data were entered into SPSS version 20 software and the analysis was done through descriptive statistics (frequency distribution calculation and central and dispersion indices), one way ANOVA, and t-test.&#x0D; Results: In the present study, the score of oral and dental health questionnaire regarding the elderly was 49/51±8/67, which was considered satisfactory. This variable had a statistically significant relationship with the number of mouth washes (p=0/02) , personal evaluation of mouth condition (p=0/01), and the number of teeth (p&lt;0/001). While there was no significant relationship regarding education level (p=0/26), place of residence (p=0/072), gender (p=0/56), employment status (p=0/63), income level (p=0/062), smoking (p=0/23) and the last dental visit (p=0/28),and the presence or absence of dentures (p=0/62) did not show a significant difference.&#x0D; Conclusion: Although the quality of life score related to the oral health of the elderly in Aliabad city was satisfactory, there is still roome to improve this score. Prevention strategies for chronic diseases and high blood pressure, re-emphasizing oral and dental hygiene, and improving related health behaviors should be considered as the most important future programs in this city. Integrating oral and dental health program in the country's public health program and creating a team to promote oral and dental health at primary care level are considered effective and low-cost solutions.&#x0D; &#x0D; &#x0D;

Using Quantitative Polymerase Chain Reaction (qPCR) to Identify a Myriad of Carbapenemase Genes in Fresh Cow Dung in Bangladesh.

Introduction The emergence of antimicrobial resistance (AMR) is driven by the selection pressure of frequent uses of antimicrobial agents in healthcare, the food chain, agriculture, fishery, and the food animal industry, which poses a serious health risk for transmission-linked humans and the surrounding environment. Livestock, particularly cattle, play an essential role in the food sector in Bangladesh. The food-animal chains can be the potential routes of exposure to AMR-microorganisms for every domain of one health. Antimicrobial resistance genes (ARGs) can impart a reservoir of AMR within the food supply chain, even without pathogenic microorganisms. This study investigated the history of infection for the last six-month period of antimicrobials utilized in cattle farms and the distribution of selected carbapenemase resistance genes, namely, bla-KPC, bla-IMP, bla-VIM, bla-NDM-1, bla-SIM, bla-GIM, bla-SPM, andbla-SME, in cattle feces in Bangladesh. Methods A cross-sectional study was designed to analyze ARGs in fresh cow dung samples collected from commercial farms and individual houses in four Bangladesh districts, namely, Dhaka, Gazipur, Manikganj, and Tangail. Types of cattle breeds, their existing diseases, recent antimicrobial uses, and vaccine uses were recorded. DNA was extracted from each cow dung sample using commercial kits (Qiagen GmbH, Germany). Real-time quantitative polymerase chain reaction (RT-qPCR) was employed to assess the eight carbapenem resistance genes in the extracted DNA.The eight carbapenem resistance genes in the extracted DNA were assessed byRT-qPCR using the qTOWER3 thermal cycler (Analytik Jena GmbH, Konrad-Zuse-Straße 1, 07745 Jena, Germany). Results Group A carbapenemase, bla-KPC, was detected in 66.7% of the samples. However, no bla-SME was identified in all of the test samples. Group B metallo carbapenemase, bla-IMP, bla-NDM-1, bla-VIM, bla-SIM, bla-GIM, andbla-SPM, were in 66.7% (80/120), 49.2% (59/120), 48.3% (58/120), 68.3% (82/120), 58.3% (70/120), and 12.5% (15/120), respectively. Only 8.3% of the tested samples contained no MBL gene; 10% carried a single-type carbapenemase gene; and the remaining 81.7% carried two or more carbapenemase genes concurrently. Co-carriage of four or more genes was found in over 59% of samples. As many as seven genes were found together in 6.7% of samples. ARG detection in commercial cattle samples and household feces is not statistically significant. Conclusions Substantial carbapenem-resistance ARGs were detected in commercially farmed cow dung and household cattle samples. Frequent use of antibiotics for cattle for treatment and prophylactic purposes may influence the high acquisition of ARGs. Bangladeshi cattle farms are reservoirs and routes of AMR, posing a significant threat to the country's public health.

LaSap vaccine: Immunotherapy and immunochemotherapy associated with allopurinol in dogs naturally infected with Leishmania infantum.

Canine visceral leishmaniasis is a parasitic zoonosis that has a profound impact on public health in countries where it is endemic. Chemotherapeutic treatments cannot keep dogs stable for long periods, and the risk of generating parasitic resistance must be considered. Forty-four symptomatic and naturally infected dogs with Leishmania infantum were tested with two treatment protocols (i) immunotherapy with LaSap vaccine and (ii) immunochemotherapy with LaSap vaccine plus allopurinol. At 90 days after the end of the treatment, it was verified that, although both protocols had generated significant clinical improvements with a greater production of IFN-γ/IL-10, in relation to the parasite load, mainly in the skin, the dogs treated only with immunotherapy maintained the same profile. These results indicate that LaSap is a good strategy to control dog parasitism.

Investigation of Efforts and Problems in Implementing the Basel Convention on the Control of Transboundary Movements of Wastes and Their Disposal in Nigeria

Pollution from toxic chemicals and hazardous waste from domestic and international sources are among the environmental challenges that Nigeria is facing. It is against this background that the country ratified the Basel Convention on the control of transboundary movements of hazardous wastes. This project was designed to discuss Nigeria's efforts in implementing and complying with the Convention. It relied on secondary sources of information such as published articles and books. The study finds that there is a potential threat to human health and the environment posed by the importation of used consumer electronics such as televisions, laptop computers, music systems, and mobile phones. The study results also show that there is a significant amount of waste that is dumped illegally over international borders and improperly managed, which is detrimental to the country's ecology, economic expansion, and public health. Heavy metals are introduced into the environment as a consequence of the unregulated disposal of hazardous waste and electronic trash that occurs across international borders. While the prevention of waste or its reduction should be of the utmost importance, waste treatment and disposal should be prioritized so that they are carried out as close as possible to its point of origin. It was also discovered that there is continuous sensitization of the people who have been dumping electronic garbage about the repercussions of their acts, and new regulations and legislation have been enacted to prevent this from happening again in the future. There is a need to strengthen institutions and effectively implement the laws to adequately protect human health and the environment against the adverse effects of waste.

LSD use in the United States: Examining user demographics and their evolution from 2015–2019

AbstractBackgroundLysergic acid diethylamide (LSD) use has risen in the United States in recent years amid increased interest in therapeutic applications of psychedelics. Despite this, contemporary epidemiological investigations of LSD users are few. To expand the literature on this topic, we sought to characterize past-year LSD users in the United States and investigate recent demographic evolution within this population.MethodsUsing National Survey on Drug Use and Health (NSDUH) data from 2015–2019, we investigated correlates of past-year LSD use and associated changes over the study period.ResultsPast-year LSD use increased by 47% from 2015 to 2019 (0.59%–0.87%). However, among people reporting past-year hallucinogen use disorder there was no significant proportional increase in LSD users. Notable correlates of LSD use on multivariable analysis were: increased LSD access, lower perceived risk of trying LSD, low income, fewer children in the home, being approached by someone selling drugs in the past month, and past-year suicide attempt among people age 18 and older. We found no associations with unemployment, arrest history, or past-year psychological distress. From 2015 to 2019, the proportion of respondents reporting past-year LSD use who were age 26–34 and married increased. Past-year LSD use among lifetime users of methamphetamine also rose.ConclusionsThough still uncommonly used in the United States, LSD's societal acceptance may be increasing. Overall, LSD does not appear to contribute significantly to the country's public health problems.

Resource potential of municipal solid waste in Odesa Region

Despite the widespread use of the term "municipal solid waste" (MSW), the main regulatory and legislative documents of Ukraine use the term "household waste". International practice also does not have a clear definition of the "municipal solid waste" concept, however, there are a number of related terms. Municipal solid waste is defined as a waste that is generated in the course of human activity, accumulated in residential buildings and social institutions and considered as unsuitable for further use at places of its generation. As for the related terms used in foreign and national practice, the term “household waste”, i.e. waste generated directly by households, is more appropriate. Municipal solid waste is a heterogeneous mixture that has a complex waste composition and its quantitative and qualitative characteristics are not constant and depend on characteristics of a certain country, region, city or town where it was generated, season and other factors. Growing volumes of municipal solid waste is one of the components of growing anthropogenic load that poses a threat to environmental safety of the country's regions and public health and negatively affects the state of our environment. The main methods of such solid waste management in Ukraine include landfilling, incineration, recycling and recovery. Out of the total annual waste volume generated on the post-Soviet territories, 93% are taken to landfills or dumpsites, 4% – incinerated, and only about 3% – recycled.&#x0D; Therefore, creation and implementation of an effective system of solid waste management is an important task for ensuring environmental safety and sustainable development of the country's regions. Moreover, solid waste is a significant reserve for obtaining secondary material resources. According to the circular economy concept, almost all components of solid waste should be reused for production of new items. This will minimize negative impact on the environment and allow rational use of natural resources. The article analyses the current state of municipal solid waste management system in Odesa Region and assesses resource value of such waste. Secondary raw materials worth of almost UAH 1.4 million can be produced annually from the total flow of municipal solid waste in Odesa Region. And this figure does not take into account liquidity of food and other waste. After establishing an effective food and other organic waste management system, such amount may be significantly increased. Separation of resource-value components from the total solid waste flow and their subsequent use will help to reduce technogenic load on the environmental natural components and improve the overall environmental situation in Odesa Region.

Access to health care for Afghan immigrants and refugees: an ethico-legal analysis based on the Iranian health law system.

The right to health is an internationally recognized and established human right with a long history of appreciation, indicating that governments should guarantee the highest possible level of access to health and provide health-care serivces with no discrimination based on nationality, race, gender, language or religion. The present study explored this topic using an analytic-descriptive approach. We reviewed related laws, policies and other available documents with the aim to investigate the ethico-legal aspects of Afghan refugees' and immigrants' access to health care and the challenges in in this regard within the Iranian health law system. According to the results of this study, the Iranian health law could be interpreted to include all Afghan immigrants in the country's public health system as a legal commitment. In addition, while basic and primary health coverage is available for all Afghan immigrants in Iran, provision of other medical and rehabilitative health services to documented and undocumented immigrants follow different methods. In order to alleviate the current situation, we recommend strategies such as supporting policy changes intended to register undocumented immigrants, which naturally results in an increase in their access to health care.

Patterns of Pregnancy Care Based on Indonesian Culture

Background: The health of pregnant women is one of the nation’s health indicators. Maternal mortality rate (MMR) and infant mortality rate (IMR) are important indicators to assess a country's welfare and public health conditions. The majority of infant mortality occurs during the neonatal period, which is related to the mother’s health during pregnancy, the awareness of the mother and family about the importance of antenatal care, the participation of health workers, and the availability of medical facilities. In addition, communities in some regions still believe in myths and have a culture that is contrary to the health sciences, which has an impact on the health of pregnant women. This study aims to describe the pattern of pregnancy care in Indonesia.Method: This study is a literature review study. In the data identification process, a total of 263 articles were identified and filtered based on inclusion criteria, language, and research location. Then, the relevant research articles were extracted, sequenced, and examined to identify the subtopics and topics. After the screening and eligibility process, 14 relevant final articles were selected.Results: This study is a literature review study. In the data identification process, a total of 263 articles were identified and filtered based on inclusion criteria, language, and research location. Then, the relevant research articles were extracted, sequenced, and examined to identify the subtopics and topics. After the screening and eligibility process, 14 relevant final articles were selected.

The effect of armed conflict on public health and strengthening of healthcare system during and post -armed conflict in Sudan

Background: Armed conflict has catastrophic effect on public health and overall wellbeing including causalities during war, long lasting physical and psychological effects, the reduction in human and financial resources which available to meet social needs and creation of setting in which violence is primary domain this issues clearly appeared in Sudan since conflict between Sudan army force and Rapid response force in 15th of April 2023. Methodology: This review aimed to reflect the effect of armed conflict on public health especially vulnerable groups and create plan for reform of collapsed health system during and after war in Sudan. Comprehensive review for previous related article using Pub –med, Google scholar Lancet and records from Federal and Local Ministry of Health in Sudan was done. Also SWOT analysis for current complexes was done to detect problems and achieve solutions. Results: The study reflects the effect of armed conflict on public health in countries suffered from war. The vulnerable populations those sufferings during war are elderly, children, neonates and women. SWOT analysis for current situation in Sudan reflects devastating effect of war in healthcare system. The study also offering a plan for strengthening of healthcare system which build on decentralization policy, Innovation related to community healthcare workers (CHWs) adoption and health-financing system strengthens. Conclusion: Strengthening of healthcare systems after disasters is an urgent concern, especially in countries that have experienced armed conflict due to great impact on public health. However, since few studies have been conducted concerning this topic in Sudan, further research is recommended.

6.F. Workshop: Digital public health in Europe - What is the new normal?

Abstract Digital public health has influenced how countries use health data for research and practice, how we deliver healthcare, and how health professionals monitor infectious diseases. The COVID-19 pandemic accelerated the international adoption of digital health interventions for public health aims. While some European countries were already advanced in digital health and digital public health before the pandemic, other nations took the opportunity to catch up. Internationally, governments introduced contact-tracing apps, telemedical services, digitally supported health promotion programs, nationally regulated medical apps, and education programs for citizens and experts to improve digital (health) literacy. The planned European Health Data Space will lift the level of digital public health in Europe once more. However, the maturity of digital public health among European countries varies drastically. While some are global leaders in digitalizing their health systems, others barely implemented the necessary infrastructure. But there is also a third perspective: Some countries that led Europe through the pandemic from a digital public health perspective started withdrawing from digitalizing their healthcare and health promotion and returning to “normal”. It is time to examine what this new “normal” post-pandemic means and how countries evolved. We will learn from the experience of 4 different European countries (Romania, Ireland, Slovenia, and Germany) how COVID-19 changed their health system and if digital public health is still applied now that the pandemic is officially over. The workshop's ultimate goal is to highlight and discuss which digital transformations in European health systems were permanent and whether or not Europe will continue to take a leading role in digital public health in the future. Each representative will have 10 minutes to contextualize their country's digital public health strategy before the pandemic (the old normal), their strategy to address the crisis, and how the country includes digital public health in its health system after the pandemic (the new normal). We will use the remaining 20 minutes of the workshop for a discussion between the speakers and the audience. Key messages • The COVID-19 crisis pushed Europe's digital public health transformation so that countries were enabled to use digital health data for improved healthcare and health promotion on a national level. • In order for the transformation to be sustainable, countries need to fundamentally rethink their health systems and make way for better digital innovation.

Media exposure, trustworthiness of sources and the health information literacy knowledge gap: a study in China.

Health information literacy (HIL), as an essential part of the wellbeing of citizens, is a crucial indicator used to measure a country's primary public health level. The present study collected 1051 samples in southern China to examine the factors predicting HIL. The results showed that males, those less educated, and older adults had lower HIL. Television exposure, unofficial Internet exposure, trust in government and trust in doctors and medical institutions were positively associated with HIL. In contrast, newspapers, radio exposure and trust in web celebrities were negatively associated with HIL. Official Internet media exposure helps to bridge the HIL knowledge gap generated by differences in education level, while trust in celebrities-especially web celebrities-could widen the HIL knowledge gap. This study extends the knowledge gap theory in health communication in the Chinese context and provides pathways for future health interventions.

Perceptions and use of Universal Health Coverage (Plan Sésame) among the elderly in Dakar (Senegal), impacts on health expenditure related to diabetes and hypertension

In 2006, the Senegalese government set up a health coverage programme for people aged 60 and over - the Plan Sésame - to provide free medical care in all the country's public health facilities. This scheme has been integrated into the Universal Health Coverage (CMU) promoted from 2013. The objective of the study was to describe and analyse the knowledge and representations of professionals and users about health coverage and the Plan Sésame, the use of the scheme by the elderly, to evaluate the amount of medical expenses incurred during a routine medical consultation for the monitoring of their illness (hypertension and diabetes), and to calculate the out-of-pocket expenses related to the consultation. Study conducted between July 2020 and October 2021 in two public health facilities in Dakar. Mixed approach: 1/ qualitative study by semi-directive interviews, informal interviews, observations and field diary with 35 people selected according to a reasoned choice procedure with the aim of diversifying gender, age, social status, therapeutic itineraries for 23 people (including 12 women, ages between 60 and 85 years), and professional activities for 12 health actors; 2/ quantitative cross-sectional study by questionnaire of 225 people (including 141 women) aged 60 and over; we calculated the total cost of the consultation and associated prescriptions (complementary examinations and medicines) as well as the remaining medical expenses (out-of-pocket) and the cost of transporting patients. This is a descriptive exploratory study of a non-representative sample of the elderly population in Senegal. The health professionals interviewed supported the principle of health coverage, but most of them had limited and sometimes imprecise knowledge of the existing schemes and the methods of access or the services covered. Their point of view about the consequences of the Plan Sésame on their practice reveals some contradictions: some complain about the increase in workload, the criticism is extended to all the free schemes which would have a negative impact on daily practice because of the increase in the number of consultations which would be linked to abuse by patients.The interviews highlight the heterogeneity of the knowledge of elderly people about the health coverage intended for them, even though the Plan Sésame has been in place for over ten years. The interviews clearly show that the use of the health coverage system by the elderly depends closely on the information they have and their ability to use it, both for women and men. There is a close link between the level of social integration of people and their use of health coverage: the most socially integrated people are those who know how to use CMU services best. The use of health coverage by the elderly appears to vary according to the individual.Although Plan Sésame is defined as part of a national strategy, its implementation varies according to the health structures and the periods; in the two study sites, the range of services covered by Plan Sésame is very limited, so the coverage provided by Plan Sésame is only partial: between 30 and 50% of the medical costs; the remaining cost of a consultation for elderly patients with hypertension and/or diabetes varies between 24,000 and 28,000 CFA francs.These amounts must be put into perspective with the resources available to people. Statistical studies published in 2021 report that in Senegal the average daily expenditure is 1,390 CFA francs/person/day; and that almost 38% of the population lives on 913 CFA francs/person/ day, which is the poverty line calculated in 2019. Thus, the average out-of-pocket expenses for a follow-up consultation for hypertension, diabetes or a combination of the two diseases represent 15 to 30 days of daily expenditure. While the vast majority of elderly people in Senegal do not have a retirement pension, health expenses are therefore borne by their relatives. Within households, medical expenditure for the elderly competes with basic needs, particularly food, which usually take up more than half of household resources. This indispensable family support places the elderly in a situation of total dependence. In 2021, Plan Sésame does not yet allow for completely free care for the elderly. However, its application, even partial, has resulted in a real reduction in health care costs for the elderly. Its use remains limited due to inconsistent application by most health structures. Its impact is insufficient in view of the amounts that users have to pay in a context of social and economic vulnerability. These observations reinforce the need to work on reducing the price of medical services and strengthening the UHC, in order to improve the equity and performance of the system, and to make it fully functional in all health structures.

Knowledge and Perceptions of Artificial Intelligence Use in Screening for Diabetic Retinopathy in Botswana: Survey for Eye Care Clinicians

Diabetic retinopathy (DR), is one of the most prevalent visual impairments in the country and is on the rise. The study seeks to investigate eye care physicians' knowledge and perceptions on the use of artificial intelligence (AI) in screening for DR in the country. Materials and Methods A convenience sample of voluntary willing participants completed an online survey. All information was entered in Microsoft excel and analyzed utilizing SPSS v22.0. Results 83% of clinicians indicated no awareness of AI fundus examinations. 66.7% had no understanding what the word AI meant. 100% of clinicians said they have never used AI software for DR screening. The study's knowledge of the use of AI was tested using "AI fundus exams", and as a result, it was poor. There was a 66.7% positive attitude towards employing AI-integrated workflow vs a 33.3% negative attitude. 50% strongly agreed that artificial intelligence would help the field of DR screening. Conclusion Overall, clinicians have limited knowledge on the use of AI technology. Regardless, they are optimistic about its possibilities, thus AI adoption and training for eye care practitioners on how to use it should be considered in the country's public health system.

Hospital bed capacity across in Tunisia hospital during the first 4 waves of the COVID-19 pandemic: A descriptive analysis

BackgroundIn March 2020, the WHO declared COVID-19 as a pandemic, and Tunisia implemented a containment and targeted screening strategy. The country's public health policy has since focused on managing hospital beds. MethodsThe study analyzed the bed occupancy rates in public hospitals in Tunisia during the pandemic. The evolution of daily cases and nonpharmaceutical interventions (NPI) actions undertaken by the Tunisian Government were also analyzed. The study used 3 indices to assess bed flexibility: Ramp duration until the peak, ramp growth until the peak, and ramp rate until the peak. The study also calculated the time shift at the start and peak of each wave to evaluate the government's response efficacy. ResultsThe study found that the evolution of the epidemic in Tunisia had 2 phases. The first phase saw the pandemic being controlled due to strong NPI actions, while the second phase saw a relaxation of measures and an increase in wave intensity. ICU bed availability followed the demand for beds, but ICU bed occupancy remained high, with a maximum of 97%. The government's response in terms of bed distribution and reallocation was slow. The study found that the most deadly wave by ICU occupied bed was the third wave due to a historical variant, while the fifth wave due to the delta variant was the most deadly in terms of cumulative death. ConclusionsThe study concluded that decision-makers could use its findings to assess their response capabilities in the current pandemic and future ones. The study highlighted the importance of flexible and responsive healthcare systems in managing pandemics.

Do not let the ideal be the enemy of good enough regulation.

Research on the effectiveness and efficiency of different methods of regulating cannabis potency should be a high priority for public health research that will inform the design of cannabis regulations that minimize public health harms. Our article [1] was intended to alert the addictions field to the critical issue of increased cannabis potency as a public health concern, counter the cannabis industry argument that such regulation is unnecessary and canvas some regulatory options. We thank our commentators for their thoughtful responses, which reveal that regulating tetrahydrocannabinol (THC) potency is more complex than it seems at first sight. Freeman & Lorenzetti highlight consumers’ need for simpler advice on labels, much as standard drinks of alcohol [2]. They have led consensus projects to define standard doses of THC that could be used in this way. They also make the useful point that regulators need to consider setting minimum unit prices for cannabis, much as those that have been implemented to reduce heavy alcohol consumption in some countries. Pardal & Wadsworth highlight the fact that the US model of cannabis legalization—a commercialized for-profit market, with minimal regulation of potency and promotion—is not the only model on offer [3]. Uruguay has limited sales to herbal cannabis and capped the THC content of cannabis sold in pharmacies. The Canadian province of Quebec has banned sales of cannabis extracts, limited the sale of edibles and imposed a cap on the THC content of herbal cannabis. The effectiveness of these policies is well worth investigation. The major empirical question is whether the policies will succeed in the longer term, when neighbouring jurisdictions allow the sale of banned products that can be easily transported across borders. Caulkins points out the economic drivers of increasing cannabis potency in the United States; namely, cannabis producers’ need to make maximum use of whole cannabis plants to compete in a market in which cannabis prices are declining [4]. He argues that bans on the sale of high-potency cannabis products would be simpler and easier to implement than attempting to regulate the potency of the many different cannabis products in US legal cannabis markets. He cites evidence that bans need not generate large-scale illicit markets. We agree that banning high-potency products could be the most effective measure to protect public health in countries contemplating cannabis legalization. We doubt its feasibility, however, in mature US markets that already sell high-potency products and in which cannabis retailers will strenuously oppose the policy. Governments regulating these markets may also prefer the revenue from taxing cannabis products on the basis of their THC content. The regulation of cannabis potency is nowhere near as straightforward as regulating alcohol, but we should not allow the cannabis industry to use this as a reason for failing to regulate cannabis potency. In cannabis regulation, as in any area of public health, we should not allow the ideal to be the enemy of the good enough. Research on the effectiveness and efficiency of different methods of regulating cannabis potency should be a high priority for public health research that will inform the design of cannabis regulations which minimize public health harms. Open access publishing facilitated by The University of Queensland, as part of the Wiley - The University of Queensland agreement via the Council of Australian University Librarians. None.

State and situation of avian influenza in the Eastern Mediterranean Region.

Avian influenza viruses have had a significant burden of disease on animal and public health in countries of the Eastern Mediterranean Region. In this review, we aimed at describing the state of avian influenza in the region from 2011 to 2021. We gathered information available through the peer-reviewed scientific literature, public gene sequence depositories, OIE World Animal Health Information System platform, World Health Organization FluNet, Joint External Evaluation reports, and governmental, Food and Agriculture Organization of the United Nations, and World Organization for Animal Health websites. We used an interdisciplinary perspective consistent with the One Health approach to perform a qualitative synthesis and making recommendations. Analysis showed that although avian influenza research in the Eastern Mediterranean Region has gained more attention during the last decade, it was limited to only few countries and to basic science research. Data highlighted the weakness in surveillance systems and reporting platforms causing underestimation of the actual burden of disease among humans and animals. Inter-sectoral communication and collaboration for avian influenza prevention, detection, and response remain weak. Influenza surveillance at the human-animal interface and the application of the One Health paradigm are lacking. Countries' animal health and public health sectors rarely publish their surveillance data and findings. This review suggested that surveillance at the human-animal interface, research, and reporting capacities should be enhanced to improve understanding and control of avian influenza in the region. Implementing a rapid and comprehensive One Health approach for zoonotic influenza in the Eastern Mediterranean Region is recommended.