Regional Health Center Research Articles

Social movements to ban asbestos in Japan: influence of trade unions and the late development of grassroots mobilization

ABSTRACT This article explores the social movements in Japan that aimed to ban asbestos and help those afflicted with asbestos-related diseases (ARDs) and their families. Trade unions representing dock and construction workers, whose members were occupationally exposed to asbestos, played significant roles in the early stages of the anti-asbestos movement, from the mid-1970s to the mid-1980s. These unions were crucial members of the first national anti-asbestos organization, the Ban Asbestos Network Japan (BANJAN), founded in 1987. Initially, BANJAN focused on policy and legislative efforts to ban asbestos. Later, in collaboration with regional occupational safety and health (OSH) centers, BANJAN strove to identify ARD victims across different areas using telephone hotlines and consultation services. They also facilitated meetings for the ARD victims and their families, which led to the formation of the ARD victims’ organization. Thus, grassroots activities organized by ARD victims and their families emerged later, with the first national ARD victims’ organization being established in 2004. This article shows that the grassroots social movement led by ARD victims and their families in Japan depended largely on the resources mobilized by trade unions and related organizations.

Pediatric endocardial temporary pacemaker implantation: Clinical characteristics and outcomes from a Chinese National Regional Health Center

AbstractEndocardial temporary pacemakers (TP) are widely used in the treatment of cardiovascular diseases in adults, but their application and clinical experience in the treatment of pediatric cardiovascular cases are relatively limited. This study aims to share the experience of using endocardial TP at a pediatric medical center in China. The study included patients who received their first endocardial TP implantation in the Department of Cardiology at Children's Hospital of Chongqing Medical University, China, from 2016 to 2022. A retrospective analysis of their clinical data was conducted. Our study involved 45 children who underwent endocardial TP implantation. Among these, 25 children (55.56%) converted to sinus rhythm after pacemaker parameter adjustment and the pacemaker was successfully removed; 13 children (28.89%) did not recover sinus rhythm and ultimately required a permanent pacemaker; in 4 cases, the family refused permanent pacemaker implantation; in 1 case, the treatment was abandoned by the family; and 2 children died during hospitalization. Notably, among the 20 children with fulminant myocarditis (FM), 16 children (80.00%) converted to sinus rhythm after pacemaker parameter adjustment and the pacemaker was successfully removed; 3 children (15.00%) ultimately received a permanent pacemaker; and 1 child died during hospitalization. Endocardial TP have shown remarkable efficacy in the treatment of critical heart disease, especially FM.

The influence of pregnant women's anxiety levels on fetal well-being and pregnancy complications: A cross-sectional study in Lombok, Indonesia

Pregnant women are a vulnerable group who are at risk of experiencing physiological changes that result in a partial decrease in immunity. Pregnancy with anxiety for pregnant women, which can affect maternal health, hinder development, cause emotional disturbances at birth, and even result in pregnancy complications. This type of research is observational-analytic with a cross-sectional design from January to June 2021. The population in this study is all third-trimester pregnant women at the Mataram City Regional Health Center and West Lombok Regency. There were 228 respondents in the study, taken using the accidental sampling technique. Data collection was carried out by accessing medical record data and filling out questionnaires for pregnant women who underwent examinations. The results of the chi square test showed that there was a relationship between anxiety and pregnancy complications with a p value of 0.0000 (p < 0.05) and a relationship between anxiety and fetal heart rate with a p value of 0.007 (p < 0.05). The ANOVA test results also showed that there was a simultaneous influence of fetal heart rate and pregnancy complications on anxiety in pregnant women, with a significance value of 0.0000 (p < 0.05) and an effect size of 74.6%. This research shows that early detection and management of anxiety during pregnancy is very necessary to prevent and minimize the occurrence of pregnancy complications and disruption of fetal well-being, which is characterized by an abnormal fetal heart rate.

Pengaruh Capacity Building dan Motivasi Kerja terhadap Produktivitas Kerja Pegawai Puskesmas Limo

UPTD Puskesmas Limo is a regional public health center for Limo sub-district which is underpinned by the health department and health facilities managed by the local government. The health Dcenter has the responsibility of providing primary health services to the people of Limo city. With these demands and types of work, training or employee self-development is needed to hone employees' abilities and work motivation. To find out how much influence capacity building and work motivation have on the productivity of UPTD Puskesmas Limo employees, this title was raised. This study uses quantitative methods using non-probability sampling techniques, namely saturated sampling techniques. The sample of this study amounted to 50 people. Then tested quantitative statistical analysis, multiple linear regression analysis and coefficient of determination analysis using a data processing program, namely SPSS 25 software. This study found the results using the t test stated that Capacity Building partially has a significant effect on work productivity with a significant level of 0.02 <0.05 and the t test results of 3.021> 2.008. and work motivation partially has a positive and significant effect on work productivity with a significant value of 0.01 <0.05 and a t test value of 3.146> 2.008 Capacity Building d is a positive and significant effect on work productivity.

Pelatihan, Pengalaman Kerja, Kompetensi dan Motivasi Sebagai Faktor Penentu Terhadap Kinerja Tenaga Kesehatan

The aim of this research is to determine the effect of training, work experience, competence and motivation on performance. The study was conducted on mental health management employees at the Tasikmalaya Regency Regional Health Center. Sampling was carried out using census techniques, with a sample size of 97 samples, consisting of mental health management employees at the Tasikmalaya Regency Regional Health Center, which consists of 40 Community Health Centers. The research instrument used was a questionnaire with a Likert scale. The analysis technique used is path analysis using the SPSS application. The results of this research show that: 1) Training, work experience, competence, motivation and performance are in good condition. 2) Training, work experience and competence have a positive and significant effect on performance, motivation has a positive but not significant effect on performance. 3) Training, work experience, competency and motivation have a significant effect on the performance of mental health management health workers at the Tasikmalaya Regency Regional Health Center

Clinical experience of pulmonary vein isolation via single transseptal puncture in atrial fibrillation patients: Comprehensive characterization and follow-up

BackgroundAtrial fibrillation is the most commonly observed cardiac rhythm disorder. Pulmonary vein isolation (PVI) is an effective treatment option to maintain sinus rhythm. This study evaluates the safety, efficacy, clinical outcomes and radiation exposures using a standardized single transseptal puncture (STP)-strategy. MethodsWe analyzed data from patients who underwent our STP-ablation technique with transesophageal echocardiography (TEE) guidance at a university hospital and a regional tertiary health center in Switzerland between January 1, 2017, and May 30, 2022. Collected data included demographics, symptoms, echocardiography results, procedural details, complications and outcomes. Mean follow-up time was 21.4 ± 16 months. ResultsThe study population included 304 patients with a median age of 67 years, who had at least one ablation using our STP-approach. Among these, 248 (82 %) patients underwent de novo PVI with this technique. Ablation was successful in all patients with isolation of all pulmonary veins, with an average procedure duration of 120 min and an average fluoroscopy time of 3 min, resulting in a mean X-ray dose of 252 cGy × cm2. TEE guidance was performed in 235 (95 %) patients. During the first intervention, 17 complications occurred in 13 patients (5 %). After the first PVI, 135 (54 %) patients experienced no recurrence during the follow-up period. The one-year recurrence rate for atrial fibrillation requiring therapy was 30 %. ConclusionOur STP- approach demonstrated comparable success rates to traditional methods, with similar procedural durations, low radiation exposure and a low complication rate. Therefore, this method may offer procedural, economic and safety benefits without compromising efficacy or safety.

Feasibility and Success of Muscular Ventricular Septal Defect Occluders and Mushroom-Shaped Occluders in Transcatheter Patent Ductus Arteriosus Closure in Low-Weight Children: A Propensity Score-Matched Retrospective Analysis from a Chinese National Regional Health Center.

Muscular ventricular septal defect occluders (MVSDOs) have been attempted as an option in low-weight patients with patent ductus arteriosus (PDA). However, few studies have assessed the safety of transcatheter patent ductus arteriosus closure (TCPC) using MVSDO. Therefore, we compared the outcomes in low-weight patients who used MVSDO and mushroom-shaped occluder (MSO). Medical records of children under 10 kg (n = 417) who underwent TCPC from 2015 to 2021 at a Chinese health center were reviewed. They were divided into MSO (n = 372) and MVSDO (n = 45) groups. A 1:1 propensity score matching (PSM) was done considering gender, height, weight, body surface area (BSA), PDA diameter, and BSA-corrected PDA diameter. All 45 children in the MVSDO group (mean weight: 5.92 ± 1.32 kg) achieved successful immediate occlusion. One case in the MVSDO group experienced device migration within 24 h requiring unplanned surgery. MVSDO significantly ameliorated pulmonary artery hypertension. After PSM, each group comprised 41 children. The MVSDO group had a smaller effect on platelet counts (MVSDO vs. MSO = 259.85 ± 114.82 vs. 356.12 ± 134.37, p < 0.001), a reduced incidence of thrombocytopenia (MVSDO vs. MSO = 2/41 vs. 7/41, p = 0.001), and a higher rate of residual shunting (MVSDO vs. MSO = 16/41 vs. 5/41, p = 0.005), compared with the MSO group. Thrombocytopenia resolved during hospitalization and micro-shunts disappeared by 6 months. No pulmonary artery or descending aortic secondary stenosis was observed in 1-year follow-up. MVSDO used in low-weight children is feasible, with high success and satisfactory postoperative and short-term follow-up outcomes, including lower thrombocytopenia incidence, compared to MSO. Further long-term studies with larger samples are recommended.

Assessing the effectiveness of “BETTER Women”, a community-based, primary care-linked peer health coaching programme for chronic disease prevention: protocol for a pragmatic, wait-list controlled, type 1 hybrid effectiveness-implementation trial

IntroductionThe Building on Existing Tools to Improve Cancer and Chronic Disease Prevention and Screening in Primary Care (BETTER) programme trains allied health professionals working in primary care settings to develop...

Therapeutic effect of honey on acute respiratory infections in adults

Context: In Morocco, acute respiratory infections (ARI) are a frequent cause of consultations in the first level health facilities. Scientific reports indicate that honey has an important biochemical therapeutic activity. Aims: To explore the therapeutic effect of honey on ARI in the Guelmim region of southern Morocco. Methods: This was a prospective clinical study aiming to compare the therapeutic effect of honey in the population that consumes it versus a control population, at the level of the regional hospital and health centers, the period of the study was between September 2022 and March 2023, All the participants were questioned through a questionnaire and the study of their files and monitoring forms. Results: The study population was divided into two equal groups of 417 people each. Honey significantly reduced the overall symptom score at Day 5 (p<0.001) in the honey group compared with the reference group, according to the ANOVA test, the significant variables are age, presence of associated diseases, duration of illness, number of consultations for respiratory episodes and current smoking status, the present study also shows that non consumption of honey OR = 15.09 [10.26-22.17], high symptom score at D1 OR = 3.85 [2.37-5.39], frequency of nocturnal cough OR = 4.26 [1.65-10.9], frequency of diurnal cough OR = 3.34 [1.5-7.4], duration of illness OR = 7.12 [3.4-14.6] and type of cough OR = 1.5 [1.04-2.2] were the determinants of high symptom score at Day 5. Conclusions: Honey was effective in relieving symptoms associated with ARI and may be suggested as an adjuvant treatment in adults.

Characteristics of Pulmonary TB Patients in The Region Health Center

Pulmonary tuberculosis (TB), caused by Mycobacterium tuberculosis, is an infectious disease that spreads globally and is the second largest cause of death after HIV/AIDS. According to the World Health Organization (WHO), approximately one third of the world's population is believed to be infected with M. tuberculosis, with 10% of them at risk of developing the disease. Tuberculosis germs generally infect the lungs, but can also attack other body organs. Transmission occurs through close contact with pulmonary tuberculosis sufferers who have BTA (+), where each sufferer can transmit this disease to 10-15 people each year. Factors that influence a person's risk of developing pulmonary tuberculosis include weakness in the body's immune system, which can be caused by a lack of nutritional intake and other factors. The aim of this research is to find out the characteristics of pulmonary TB sufferers. The research method used was descriptive analytical, with 37 pulmonary TB sufferers as samples selected using accidental sampling techniques at Community Health Center X. The measuring instrument used was a questionnaire, and the measurement results were analyzed using a frequency distribution table. The results of the study showed that the majority of tuberculosis (TB) sufferers were over 45 years old, reaching 54.1%, the majority of TB sufferers were men, with a percentage of 70.3%, the majority of TB sufferers had elementary school education, with the number reaching 48 .6%, The majority of TB sufferers work as farmers and employees, which reaches 32.4%, The majority of TB cases are old cases, accounting for 56.8%, The majority of TB sufferers receive treatment regularly, reaching 54.1%, and The majority of TB sufferers TB was declared cured after treatment, with the number reaching 75.7% of the total sample. The conclusion is that these results reflect the general profile of TB sufferers in the population studied. This provides an overview of the demographic characteristics, disease history, and response to treatment of TB sufferers in the context of the research conducted. It is recommended that this data can be used as a basis for planning more effective interventions and treatment strategies as well as more targeted prevention efforts in controlling TB disease in the future.

IMPLEMENTASI DIORAMA 3D INTERAKTIF BERBASIS PILAR (Dio- 3D IBP) DALAM MENINGKATKAN SELF MANAGEMENT DAN BLOOD PRESSURE CONTROL PADA PENDERITA HIPERTENSI

Introduction & Aim: Hypertension is a chronic disease and is considered a global health problem that can cause complications, such as cardiovascular disease, chronic kidney disease, dementia, and death from cardiovascular disease. Patients need a support system in managing their disease. One way to control blood pressure and prevent hypertension complications is to improve self-management. Community involvement is integrated in the program to have a social support system in carrying out self-management. The aim of this community service is to improve self-management and blood pressure control in hypertension sufferers. Method of Activity: Implementation of the Pillar-Based Interactive 3D Diorama (Dio-3D IBP) was carried out on 20 hypertensive respondents who had previously undergone examinations at the Surabaya regional health center. The community service lasted for four weeks in RW 07, Kapasan Village, Simokerto District, Surabaya. The activity stages are initial survey, implementation, education, mentoring and evaluation. Self management was measured using the Hypertension Self Management Behavior Questionnaire and blood pressure control was measured using a sphygmomanometer. Community service results are assessed by analyzing data using the Wilcoxon Signed Rank Test statistical test. Results: This community service can change people's behavior regarding self-management and blood pressure control. The results of the Wilcoxcon test are self-management p=0.001 and improvement in blood pressure with systole and diastole values p=0.00. Discussion: Implementation of a Pillar-Based Interactive 3D Diorama (Dio-3D IBP) can improve self-management and blood pressure control in hypertension sufferers. Health care workers should participate in health education programs to meet community needs and improve compliance with their treatment regimens.

Epidemiology of antibiotic consumption and resistance in Mauritius.

This study aims at determining the pattern of antibiotic consumption and resistance in Mauritius, a tropical island in the Indian Ocean. Antibiotic consumption was measured in kilograms of purchased antibiotics and also in defined daily dose (DDD) in different health institutions from 2015 to 2017. Data on antibiotic resistance was collected at the Central Health Laboratory (CHL) at Victoria Hospital and at Jeetoo Hospital Laboratory, where antibiotic sensitivity testing is done for all public health institutions. For this study, Escherichia coli, Klebsiella species, Acinetobacter species, and Pseudomonas aeruginosa isolates from blood samples of patients from 2015 to 2023 were included. The resistance rate and prevalence of multi-drug-resistant (MDR) organisms were calculated. The amount of antibiotics (in kilograms) distributed to the human sector was between 11,000 to 13,000 kg, compared to only 700 to 1,500 kg in the animal sector. The DDD per 1,000 inhabitants per day was 20.9, 22.1, and 21.7 in 2015, 2016, and 2017, respectively, with a greater consumption of WATCH and RESERVE group antibiotics in the private sector. In public health institutions, health centers in the northern region had the highest DDD per 1,000 outpatients per day for beta-lactams penicillins and quinolones. Concerning antibiotic resistance, the proportion of MDR Acinetobacter baumannii and Pseudomonas aeruginosa has increased from 58% to 74% and from 33% to 45%, respectively, from 2015 to 2023. During the same period, the proportion of E. coli and K. pneumoniae isolates sensitive to ceftriaxone decreased from 55% to 39% and from 37% to 22%, respectively, while the proportion of E. coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa isolates sensitive to meropenem decreased from 98% to 94%, 83% to 53%, 45% to 28%, and 63% to 47%, respectively. This study provides valuable insights on antibiotic consumption and resistance in the country and emphasizes the significance of adopting a One Health approach to combat antimicrobial resistance (AMR) effectively. These findings will aid policymakers in formulating targeted strategies to address the challenge of AMR and should be integrated into the National Action Plan on AMR in Mauritius.

Web-Based Development of Standard Operating Procedures and Midwifery Trainings at Ugandan Birth Clinic in the Framework of Implementing a Quality Improvement System for the MEWU-Midwife Exchange with Uganda.

High maternal and newborn mortality rates in Sub-Saharan Africa indicate the need for global action interventions. Thus, the clinic cooperation midwife exchange with Uganda (MEWU) between Hannover Medical School and Mutolere Hospital, Uganda, was founded. This study, as the first intervention within the MEWU framework, explored whether a web-based approach is suitable for developing, training, and establishing standard operating procedures (SOPs) at Mutolere Hospital. We focused on assessing midwives' confidence in midwifery core competencies. The study was conducted in a prospective, non-controlled intervention design. As a quality improvement tool, the Plan, Do, Check, Act cycle was implemented. SOPs for standard obstetric care were developed and trained in online meetings. Qualitative and quantitative data were collected through a questionnaire completed pre- and post-intervention by participating midwives, evaluations, minutes and video recordings of each case training, and annual analytical reports from Mutolere Hospital containing morbidity and mortality data. The online intervention was successfully implemented. Nine SOPs on basic obstetric care were developed, trained in online case training, and integrated into clinical practice at Mutolere Hospital. An increase in midwives' confidence regarding all surveyed core competencies was observed. There were no significant changes in the hospital's morbidity and mortality rates. The quality management system was implemented to optimize the follow-up projects further. This pilot study shows the potential of web-based interventions as a quality improvement tool in developing countries. The developed SOPs and video database are being used in subsequent studies and extended to further health centers in the Kisoro region.

Feasibility of regional center telehealth visits utilizing a rural research network in people with Parkinson's disease.

Impaired motor and cognitive function can make travel cumbersome for People with Parkinson's disease (PwPD). Over 50% of PwPD cared for at the University of Arkansas for Medical Sciences (UAMS) Movement Disorders Clinic reside over 30 miles from Little Rock. Improving access to clinical care for PwPD is needed. To explore the feasibility of remote clinic-to-clinic telehealth research visits for evaluation of multi-modal function in PwPD. PwPD residing within 30 miles of a UAMS Regional health center were enrolled and clinic-to-clinic telehealth visits were performed. Motor and non-motor disease assessments were administered and quantified. Results were compared to participants who performed at-home telehealth visits using the same protocols during the height of the COVID pandemic. Compared to the at-home telehealth visit group (n = 50), the participants from regional centers (n = 13) had similar age and disease duration, but greater disease severity with higher total Unified Parkinson's disease rating scale scores (Z = -2.218, p = 0.027) and lower Montreal Cognitive Assessment scores (Z = -3.350, p < 0.001). Regional center participants had lower incomes (Pearson's chi = 21.3, p < 0.001), higher costs to attend visits (Pearson's chi = 16.1, p = 0.003), and lived in more socioeconomically disadvantaged neighborhoods (Z = -3.120, p = 0.002). Prior research participation was lower in the regional center group (Pearson's chi = 4.5, p = 0.034) but both groups indicated interest in future research participation. Regional center research visits in PwPD in medically underserved areas are feasible and could help improve access to care and research participation in these traditionally underrepresented populations.

Binary Logistic Regression Analysis in Determining Risk Factors of Acute Respiratory Infection (IRA) on Under-Five Children

Acute Respiratory Infection (ARI) is a prevalent ailment and stands as one of the primary causes of mortality among children under the age of five. As reported by the Ministry of Health of the Republic of Indonesia, ARI predominantly affects children aged one to four years, with an incidence rate of 13.7%. Binary logistic regression is utilized to predict the likelihood of ARI occurrences in children under five, employing a linear combination of log-odds pertaining to suspected contributory factors. This study aims to evaluate the risk factors associated with ARI and develop an optimal logistic regression model by analyzing data from 166 participants who visited the Tarus regional health center between July 21 and September 1, 2023. Factors considered in this research as predictors for ARI (dependent variable ) include Immunization Status (X1), exposure to cigarette smoke at residence (X2), exposure to wood smoke at residence (X3), exclusive breastfeeding (X4), and nutritional status (X5). The final analysis revealed that incomplete immunization, exposure to cigarette smoke, and exposure to wood smoke at residence significantly heighten the risk of ARI. The most fitting logistic model obtained was expressed as logit (π_ijk)=-1.1051+1.2297X1+0.8709X2+1.31085X3.

Knowledge Level of Dry Skin Care in The Elderly at The Koto Tangah Regional Health Center

Introduction. The occurrence of dry skin in the elderly requires good and extra skin care. The incidence and severity of dry skin increases with age. Dry skin conditions in the elderly can cause discomfort and can even cause disease, such as atopic dermatitis which is a disease caused by inflammation of the skin. This research aims to determine the level of knowledge of dry skin care in the elderly at the Koto Tangah Health Center in the city of Padang. Methods. This research was a descriptive observational study with a cross-sectional design. The sample in this study was selected by technique consecutive sampling and this research requires a minimum of 100 samples. Results. The knowledge level of dry skin care of the respondents is mostly in the medium category (62%), the age of the majority of respondents was in the age category of 60-70 years (65%), the sex of the majority of respondents was male (53%), most respondents had primary school education (56%), worked as laborer (26%), and live with their families (83%). Conclusion. The level of knowledge of nursing for most of the elderly dry skin is in the medium category.

Psychological Approach Physical Distancing Model on Immune Resistance Imun New Normal Post Pandemic COVID 19

BACKGROUND: The first COVID-19 reported in Indonesia on March 2, 2020, was two cases. Data on March 31, 2020, showed that there were 1528 confirmed cases and 136 deaths. The COVID-19 mortality rate in Indonesia is 8.9%, this figure is the highest in Southeast Asia. As of March 30, 2020, there were 693,224 cases and 33,106 deaths worldwide. Inadequate immune response leads to viral replication and tissue damage. On the other hand, an exaggerated immune response can cause tissue damage. Several other risk factors established by the Centers for Disease Control and Prevention are close contact, including living in the same house as a COVID-19 patient and a history of travel to an infected area. Based on a preliminary study at the Yogyakarta Special Region Health Center and the Borobudur Magelang Health Center, Central Java, there were 95 cases of corona virus and 75% with comorbidities. Of the corona cases in the Special Region of Yogyakarta and in Borobudur, Magelang, Central Java, the body’s resistance decreased. Researchers are interested in taking the title “The Effect of Psychological Approach Physical Distancing on New Normal Immune Resistance after the COVID 19 Pandemic” AIM: It is known the influence of Psychological Approach Physical Distancing on New Normal Immune Resistance after the COVID 19 Pandemic. METHODS: This type of research is Research and Development using a quasi-experimental, “Pre-test Post-test with Control Group Design” design. In this design, there was a comparison group (control), the observations were carried out twice. The first observation was to determine the New Normal maximum resilience after the COVID 19 pandemic before being given Psychological Approach Physical Distancing and the second observation after being given Psychological Approach Physical Distancing with the criteria for comorbid respondents at the Puskesmas. Data were analyzed using pair t-test and Wilcoxon with a significant level of p &lt; 0.05. RESULTS: Differences in initial immune resistance at month 1, month 1 and month 2, and month 2 and month 3 there was a difference with p = 0.000 (&lt; 0.05). CONCLUSION: There is an influence of Psychological Approach Physical Distancing on New Normal Immune Resistance after the COVID 19 Pandemic.

PREVALÊNCIA DO ANTICORPO CONTRA HEPATITE B EM UMA REGIONAL DE SAÚDE DO PARANÁ

ABSTRACT Objective: To estimate the positivity rate of the Hepatitis B Surface Antigen with demographic characteristics and exposure categories among confirmed cases in the municipalities of the 17th Health Region of Paraná, Brazil. Method: This is a descriptive, quantitative cross-sectional study based on notified/confirmed cases in people aged ≥ 1 year and living in the area of the regional health center between 2017 and 2022. The serological marker was used as the outcome variable, and the exposure variables were categorized using absolute and relative frequencies, the Chi-square test, and Fisher’s exact test. Results: The variables gender, age group, pregnancy, schooling, and exposure to injecting drugs showed a statistical difference between the groups with a positive rate for the reactive marker. Conclusion: It is important to train health professionals in the use of rapid tests and in filling out the form in full so that they know the epidemiological profile of each region and can draw up specific strategies for prevention, control, and treatment.

Follow-Up of Patients With Axial Spondyloarthritis in Specialist Health Care With Remote Monitoring and Self-Monitoring Compared With Regular Face-to-Face Follow-Up Visits (the ReMonit Study): Protocol for a Randomized, Controlled Open-Label Noninferiority Trial.

Patients with chronic inflammatory joint diseases such as axial spondyloarthritis have traditionally received regular follow-up in specialist health care to maintain low disease activity. The follow-up has been organized as prescheduled face-to-face visits, which are time-consuming for both patients and health care professionals. Technology has enabled the remote monitoring of disease activity, allowing patients to self-monitor their disease and contact health care professionals when needed. Remote monitoring or self-monitoring may provide a more personalized follow-up, but there is limited research on how these follow-up strategies perform in maintaining low disease activity, patient satisfaction, safety, and cost-effectiveness. The Remote Monitoring in Axial Spondyloarthritis (ReMonit) study aimed to assess the effectiveness of digital remote monitoring and self-monitoring in maintaining low disease activity in patients with axial spondyloarthritis. The ReMonit study is a 3-armed, single-site, randomized, controlled, open-label noninferiority trial including patients with axial spondyloarthritis with low disease activity (Ankylosing Spondylitis Disease Activity Score <2.1) and on stable treatment with a tumor necrosis factor inhibitor. Participants were randomized 1:1:1 to arm A (usual care, face-to-face visits every sixth month), arm B (remote monitoring, monthly digital registration of patient-reported outcomes), or arm C (patient-initiated care, self-monitoring, no planned visits during the study period). The primary end point was disease activity measured with the Ankylosing Spondylitis Disease Activity Score, evaluated at 6, 12, and 18 months. We aimed to include 240 patients, 80 in each arm. Secondary end points included other measures of disease activity, patient satisfaction, safety, and cost-effectiveness. The project is funded by the South-Eastern Norway Regional Health Authority and Centre for the treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Norway. Enrollment started in September 2021 and was completed with 242 patients by June 2022. The data collection will be completed in December 2023. To our knowledge, this trial will be among the first to evaluate the effectiveness, safety, and cost-effectiveness of remote digital monitoring and self-monitoring of patients with axial spondyloarthritis compared with usual care. Hence, the ReMonit study will contribute important knowledge to personalized follow-up strategies for patients with axial spondyloarthritis. These results may also be relevant for other patient groups with inflammatory joint diseases. ClinicalTrials.gov NCT05031767; hpps://www.clinicaltrials.gov/study/NCT05031767. DERR1-10.2196/52872.

Conceptual model of regional system of organ donation and transplantation

Annotation. The aim – to substantiate the conceptual organizational and functional model of the regional system of organ donation and transplantation. In order to solve the problem of development of transplant medical care for the population of the region, an attempt was made to develop an organizational and functional model of the regional system of organ donation and transplantation. The study uses general scientific methods of analysis, synthesis, generalization, modeling, interpretation of scientific data, as well as systemic and structural-functional approaches. The developed model of the regional system of organ donation and transplantation is represented by a comprehensive regional system of engaged in the field of donation and transplantology, which integrates the activities of health care institutions that have the status of territorial donor bases and that are regional centers for organ transplantation. From the point of view of a systemic approach, this model provides transplant coordination of the activities of the health centers that are part of it, a clear algorithmization of actions at the stages of the donor process, organizational and methodological support of the donor bases and an interdisciplinary approach aimed at involving a number of regional organizations to assist the regional system of organ donation and transplantation in matters that depend from their competences. The conceptual model of the regional system of organ donation and transplantation is patient-oriented and aims to ensure the availability of highly specialized transplant medical care for the population of the region. The regional system of organ donation and transplantation model is presented as a system, a complex of interconnected regional health centers in the field of organ donation and transplantation, united in an effective regional system, the combined interaction of which provides a synergistic effect.