Health Strategy Research Articles

The effect of molnupiravir and nirmatrelvir on SARS-CoV-2 genome diversity in severe models of COVID-19.

Immunocompromised individuals are susceptible to severe COVID-19 and potentially contribute to the emergence of variants with altered pathogenicity due to persistent infection. This study investigated the impact of immunosuppression on SARS-CoV-2 infection in k18-hACE2 mice and the effectiveness of antiviral treatments in this context during the first 7 days of infection. Methods Mice were immunosuppressed using cyclophosphamide and infected with a B lineage of SARS-CoV-2. Molnupiravir and nirmatrelvir, alone and in combination, were administered and viral load and viral sequence diversity was assessed. Treatment of infected but immune compromised mice with both compounds either singly or in combination resulted in decreased viral loads and pathological changes compared to untreated animals.Treatment also abrogated infection of neuronal tissue. However, no consistent changes in the viral consensus sequence were observed, except for the emergence of the S:H655Y mutation. Molnupiravir, but not nirmatrelvir or immunosuppression alone, increased the transition/transversion (Ts/Tv) ratio, representative of A>G and C>U mutations and this increase was not altered by the co-administration of nirmatrelvir with molnupiravir. Notably, immunosuppression itself did not appear to promote the emergence of mutational characteristic of variants of concern (VOCs). Further investigations are warranted to fully understand the role of immunocompromised individuals in VOC development,especially by taking persistence into consideration, and to inform optimised public health strategies. It is more likely that immunodeficiency promotes viral persistence but does not necessarily lead to substantial consensus-level changes in the absence of antiviral selection pressure. Consistent with mechanisms of action, molnupiravir showed a stronger mutagenic effect than nirmatrelvir in this model.

Prevalence and associated risk factors of sarcopenia in community-dwelling older adults in Pakistan: a cross-sectional study

BackgroundAdvancements in medical facilities have led to an increase in global life expectancy, emphasizing the need to address age-related health issues. Sarcopenia, characterized by muscle mass loss, poses significant challenges for older adults. Despite a higher prevalence in Asian populations, there is a remarkable absence of studies addressing sarcopenia among the older adults in Pakistan. This research aims to determine sarcopenia prevalence, identify risk factors, and explore gender- and age-specific patterns among older adults in Pakistan.MethodsA cross-sectional study involving 142 participants (65 males, 77 females) aged 60 and above was conducted using DEXA scans. Over a six-month period from January to June 2023, data were collected from the Islamabad Diagnostic Centre. This comprehensive dataset covered anthropometric measurements, body composition details, and health parameters. Statistical analyses, including logistic regression, were employed to examine the associations between sarcopenia and various factors.ResultsSarcopenia manifested in 47.18% of the older adult population (n = 142), with a distribution of 39 males (60%) and 28 females (36.36%). The investigation unveiled a compelling correlation between underweight status and sarcopenia across genders. Indeed, males exhibited a significant negative correlation between skeletal muscle mass index and age, whereas females did not show a statistically significant association. Males presented higher odds of sarcopenia in comparison to females (Odds Ratio [OR] = 2.63, 95% Confidence Interval [CI]: 1.33–5.18, p = 0.005). Age (OR = 1.12, 95% CI: 1.02–1.22, p = 0.014), lower BMI (OR = 0.35, 95% CI: 0.20–0.60, p < 0.001), and reduced body fat percentage (OR = 1.75, 95% CI: 1.31–2.33, p < 0.001) emerged as significant contributors to sarcopenia. These detailed gender-specific findings emphasize the importance of customizing intervention strategies to address gender disparities in sarcopenia risk factors.ConclusionThis study highlights the significant prevalence of sarcopenia among older adults in Pakistan, with distinct gender and age-related patterns observed. The overall prevalence of sarcopenia was found to be 47.18%, with higher rates among males compared to females. Age emerged as a significant risk factor, with each additional year increasing the odds of sarcopenia. Furthermore, weight, BMI, lean mass, and total body fat demonstrated important associations with sarcopenia prevalence, highlighting the multifaceted nature of this condition. The practical implications of this study emphasize the need for targeted screening programs and personalized interventions to mitigate sarcopenia’s impact, informing healthcare policies and public health strategies in Pakistan.

Social determinants of health but not global genetic ancestry predict dementia prevalence in Latin America.

Leveraging the nonmonolithic structure of Latin America, which represents a large variability in social determinants of health (SDoH) and high levels of genetic admixture, we aim to evaluate the relative contributions of SDoH and genetic ancestry in predicting dementia prevalence in Latin American populations. Community-dwelling participants aged 65 and older (N=3808) from Cuba, Dominican Republic, Mexico, and Peru completed the 10/66 protocol assessments. Dementia was diagnosed using the cross-culturally validated 10/66 algorithm. Multivariate linear regression models adjusted for SDoH were used in the main analysis. This study used cross-sectional data from the 1066 population-based study. Individuals with higher proportions of Native American (>70%) and African American (>70%) ancestry were more likely to exhibit factors contributing to worse SDoH, such as lower educational levels (p<0.001), lower socioeconomic status (p<0.001), and higher frequency of vascular risk factors (p<0.001). After adjusting for measures of SDoH, there was no association between ancestry proportion and dementia probability, and ancestry proportions no longer significantly accounted for the variance in cognitive performance (African predominant p=0.31 [-0.19, 0.59] and Native predominant p=0.74 [-0.24, 0.33]). The findings suggest that social and environmental factors play a more crucial role than genetic ancestry in predicting dementia prevalence in Latin American populations. This underscores the need for public health strategies and policies that address these social determinants to effectively reduce dementia risk in these communities. Countries in Latin America express a large variability in social determinants of health and levels of admixture. After adjustment for downstream societal factors linked to SDoH, genetic ancestry shows no link to dementia. Population ancestry profiles alone do not influence cognitive performance. SDoH are key drivers of racial disparities in dementia and cognitive performance.

Overdose prevention activities led by local public health departments, 2019–2023

BackgroundDrug overdose deaths in the United States increased to historic levels in recent years, with provisional estimates indicating more than 111,000 deaths in the 12 months ending July 2023. In 2019, the Centers for Disease Control and Prevention’s Division of Overdose Prevention in collaboration with the National Association of City and County Health Officials, funded local health departments (LHDs) to work on overdose prevention activities. This paper aims to: 1) describe the overdose prevention activities that LHDs implemented during the four eighteen-month funding cycles; 2) identify programmatic successes and areas of opportunity for LHDs to consider when implementing future overdose prevention activities; and to 3) inform policy considerations and future overdose prevention programming at the local level.MethodsWe used programmatic data to identify overdose prevention activities implemented by 45 LHDs. Activities were double-coded according to the social-ecological model and the U.S. Department of Health and Human Services Overdose Prevention Strategies and Guiding Principles. We analyzed final codes to identify distribution and overlap of the Strategies and Guiding Principles across the social ecological model co-occurrences.ResultsApproximately 55.9% (n=123) of the 220 overdose prevention activities that were coded took place at the community level, 32.3% (n=71) at the individual level, 8.6% (n=19) at the relationship level, and 3.2% (n=7) at the policy level. Most of the activities were coded as coordination, collaboration, and integration (n=52, 23.6%), harm reduction (n=51, 23.1%), data and evidence (n=47, 21.4%) or reducing stigma (n=24, 10.9%). Few activities were related to primary prevention (n=14, 6.4%), equity (n=14, 6.4%), recovery support (n=11, 5.0%), and evidence-based treatment (n=7, 3.2%).ConclusionsLocalities have primarily implemented activities focused on the community and individual levels, with most of these centered around coordination, collaboration, and integration; harm reduction; or data and evidence. This study identified gaps in overdose prevention for LHDs related to treatment and health equity and that more interventions should be implemented at the relationship and policy levels. Continuing these efforts is important as LHDs explore opportunities to enhance and expand their work in various strategy areas across the social ecology. Findings from this study may be used to inform localities as they design and implement future overdose prevention activities.

Trends of fear and anger on YouTube during the initial stage of the COVID-19 outbreak in South Korea

BackgroundThe COVID-19 pandemic has been the most widespread and threatening health crisis experienced by the Korean society. Faced with an unprecedented threat to survival, society has been gripped by social fear and anger, questioning the culpability of this pandemic. This study explored the correlation between social cognitions and negative emotions and their changes in response to the severe events stemming from the COVID-19 pandemic in South Korea.MethodsThe analysis was based on a cognitive-emotional model that links fear and anger to the social causes that trigger them and used discursive content from comments posted on YouTube’s COVID-19-related videos. A total of 182,915 comments from 1,200 videos were collected between January and December 2020. We performed data analyses and visualizations using R, Netminer 4.0, and Gephi software and calculated Pearson’s correlation coefficients between emotions.ResultsYouTube videos were analyzed for keywords indicating cognitive assessments of major events related to COVID-19 and keywords indicating negative emotions. Eight topics were identified through topic modeling: causes and risks, perceptions of China, media and information, infection prevention rules, economic activity, school and infection, political leaders, and religion, politics, and infection. The correlation coefficient between fear and anger was 0.462 (p < .001), indicating a moderate linear relationship between the two emotions. Fear was the highest from January to March in the first year of the COVID-19 outbreak, while anger occurred before and after the outbreak, with fluctuations in both emotions during this period.ConclusionsThis study confirmed that social cognitions and negative emotions are intertwined in response to major events related to the COVID-19 pandemic, with each emotion varying individually rather than being ambiguously mixed. These findings could aid in developing social cognition-emotion-based public health strategies through education and communication during future pandemic outbreaks.

Impact of a Distress Brief Intervention on Suicidal Ideation, Suicide Attempts and Self-harm in the immediate, short and longer term: a mixed method evaluation study protocol

Background The Distress Brief Intervention (DBI) is a new approach aimed at reducing distress and is embedded in Scotland’s suicide prevention and mental health strategies. People in distress can be referred to DBI by front-line healthcare and emergency service staff. DBI promises to make contact within 24 hours and offers people in distress 14 days of compassionate, community-based, and person-centred support. The development of NHS 24, a new specialist National Health Service Mental Health Hub (MHH) embedded in Scotland’s urgent care service created a new national route to access DBI. Protocol This study is a mixed-method evaluation of the impact of DBI on suicidal ideation, suicide attempts and self-harm in the immediate, short and longer term among people presenting in distress. Evaluation participants include adults who access DBI, DBI staff, individuals who have used NHS 24 MHH, and GPs. A combination of analysis of quantitative survey and linked administrative data, including a comparator group analysis, qualitative interview and focus group data will support understanding of whether and how DBI can reduce suicidal ideation, suicidal behaviour and self-harm among those presenting to front-line services in distress. A survey of General Practitioners and a review of existing literature will be used to model typical care pathways for individuals in distress and at risk of self-harm. Modelled resource use and costs will be explored. All data collected will be triangulated through a summative evidence synthesis to develop evidence-based insights and conclusions to inform policy and practice development. Discussion Understanding whether, how and why DBI has helped prevent future suicidal thoughts and behaviour in those with a history of suicidal risk will provide important insights into how the intervention can be further developed and optimised as a suicide prevention intervention.

Religious Involvement, Vegetarian Diet, and Mental Well-Being Among Seventh-day Adventists in Peru.

Mental well-being is conditioned by several factors, including religious involvement and diet. However, this evidence does not exist among members of the Seventh-day Adventist Church (SDA) in Latin America, particularly Peru. This study evaluated the association between religious involvement and vegetarian diet with mental well-being in members of the SDA Church in Peru. In this cross-sectional study, the sample included 767 participants, aged 18 to 59years. A face-to-face and online survey was administered that included information on the dietary regimen and sociodemographic characteristics. Religious involvement and mental well-being were measured using the 12-item version of the General Health Questionnaire (GHQ-12) and the Duke University Religion Index (DUREL), respectively. A multivariate analysis was conducted to investigate the factors associated with mental well-being. Being female (β = 1.80, p < 0.001), coming from the highland region (β = 1.98, p < 0.001), having a basic educational degree (β = 1.85, p < 0.001), a higher level of religious involvement (β = 0.34, p < 0.001), and being vegetarian (β = 1.21, p < 0.001) were associated with greater mental well-being. This evidence highlights the implication of religious participation and a vegetarian diet in mental health, not only among SDA church members but also in a broader context. However, it should be recognized that direct transfer of church-based health promotion interventions and strategies to the general population can present challenges; therefore, it is suggested that these strategies should be adapted and adjusted to consider differences in the community context.

Factors associated with underreporting of tuberculosis cases among private healthcare providers in Semarang City

Tuberculosis (TB) continues to be a global public health challenge, with accurate case reporting being crucial for the implementation of effective control measures. In Semarang City, Indonesia, private healthcare providers play a pivotal role, yet the under-reporting of TB cases in this sector compromises the management and containment of the disease. This study investigates the factors influencing the under-reporting of TB cases among private healthcare providers and explores their consequences for public health strategies. The primary aim of this research is to elucidate the relationship between various determinants such as physicians’ knowledge of TB notification protocols, their commitment to notification processes, the availability of dedicated staff for notification, incentive mechanisms, and the notification format used, and the phenomenon of TB case under-reporting. Methods: Employing the Spearman correlation coefficient, this study evaluates the associations between the identified factors and the under-reporting of TB cases. The findings indicate significant correlations between under-reporting of TB cases and several variables: the physicians' awareness of notification requirements, their commitment to notification procedures, the existence of incentives, the appointment of designated staff for notification tasks, and the format of the notification system (Sig &lt; 0.05). Discussion: The under-reporting of TB cases hinders accurate disease surveillance and timely intervention, thereby perpetuating transmission and increasing the risk of drug-resistant TB strains. The results underscore the necessity for targeted interventions aimed at enhancing TB reporting practices among private healthcare providers. Enhancing these practices is crucial for strengthening the overall TB control strategy and protecting public health.

Geospatial analysis of cardiovascular mortality before and during the COVID-19 pandemic in Peru: analysis of the national death registry to support emergency management in Peru.

COVID-19 has led to significant global mortality, with Peru being among the countries most affected. While pre-existing comorbidities have been linked to most cases, the exact distribution of fatalities within the country remains unclear. We aimed to assess deaths attributed to cardiovascular diseases (CVD) before and during the COVID-19 pandemic across various regions and provinces in Peru. An observational georeferencing study was designed. Peru faced four waves of COVID-19 over three years, with variable impacts across its three regions (Coast, Highlands, and Jungle). Deaths related to cardiovascular diseases, such as heart failure (HF), arrhythmia, acute myocardial infarction (AMI), strokes, and acute coronary syndrome, were examined as primary variables. The study period spanned pre-pandemic years (2017-2019) and pandemic years (2020-2021), utilizing death data from the National Death Information System (SINADEF). The georeferencing analysis was conducted using ArcGIS v10.3. A total of 28,197 deaths were recorded during the study period, with significant increases during the pandemic (2020-2021). Cardiovascular deaths were disproportionately higher during the pandemic, totaling 19,376 compared to 8,821 in the pre-pandemic period (p < 0.001). AMI and HF were the leading causes of mortality, showing significant increases from the pre-pandemic (5,573 and 2,584 deaths) to the pandemic period (12,579 and 5,628 deaths), respectively. Deaths due to CVD predominantly affected individuals aged over 60, with significant increases between the two study periods (7,245 vs. 16,497 deaths, p = 0.002). Geospatial analysis revealed regional disparities in CVD mortality, highlighting provinces like Lima and Callao as COVID-19 critical areas. The substantial increase in cardiovascular deaths during the COVID-19 pandemic in Peru showed distinctive patterns across regions and provinces. Geospatial analysis identified higher-risk areas and can guide specific interventions to mitigate the impact of future health crises. Understanding the dynamic relationship between pandemics and cardiovascular health is crucial for effective public health strategies.

Uncovering COVID-19 transmission tree: identifying traced and untraced infections in an infection network.

This paper presents a comprehensive analysis of COVID-19 transmission dynamics using an infection network derived from epidemiological data in South Korea, covering the period from January 3, 2020, to July 11, 2021. The network illustrates infector-infectee relationships and provides invaluable insights for managing and mitigating the spread of the disease. However, significant missing data hinder conventional analysis of such networks from epidemiological surveillance. To address this challenge, this article suggests a novel approach for categorizing individuals into four distinct groups, based on the classification of their infector or infectee status as either traced or untraced cases among all confirmed cases. The study analyzes the changes in the infection networks among untraced and traced cases across five distinct periods. The four types of cases emphasize the impact of various factors, such as the implementation of public health strategies and the emergence of novel COVID-19 variants, which contribute to the propagation of COVID-19 transmission. One of the key findings is the identification of notable transmission patterns in specific age groups, particularly in those aged 20-29, 40-69, and 0-9, based on the four type classifications. Furthermore, we develop a novel real-time indicator to assess the potential for infectious disease transmission more effectively. By analyzing the lengths of connected components, this indicator facilitates improved predictions and enables policymakers to proactively respond, thereby helping to mitigate the effects of the pandemic on global communities. This study offers a novel approach to categorizing COVID-19 cases, provides insights into transmission patterns, and introduces a real-time indicator for better assessment and management of the disease transmission, thereby supporting more effective public health interventions.

The role of governance in the digital transformation of healthcare: Results of a survey in the WHO Europe Region

Optimal governance is among the key facilitators of the digital transformation of health systems intended to improve access to healthcare, quality, safety, and efficiency, and to attain universal health coverage. This paper highlights the findings of a survey assessing the status of governance of digital health in the WHO European Region.The 2022 survey is a continuation of the 2015 WHO Global Survey on eHealth. The survey focused on national digital health governance, monitoring and evaluation of digital health interventions, and funding and investment in digital health and was conducted through April to October 2022. All 53 Member States of the WHO European Region participated in the survey.The results showed that 83% of the Member States reported having a national digital health strategy in place, and 79% of the Member States reported having a health information system strategy. Most of the priorities of the national digital health strategies were devoted to increasing the accessibility, quality, safety, and efficiency of the health systems, strengthening health information systems, and improving information sharing and interoperability of data. Measures to ensure equity in access to digital healthcare services were directed towards improving broadband connectivity, information and communication technology, digital literacy, and digital health promotion. Oversight for the implementation and operation of the national digital health strategies are mostly delegated to government agencies. The prime source of funding for digital health programs was public funding, though a combination of funding sources was also noted. This analysis revealed increasing adoption of national digital health strategies for access to healthcare and creation of digital health agencies and funding programs for digital health.

A review of the impact of environmental pollutions on reproductive health and risk mitigation strategies

AbstractThe reproductive health system holds paramount importance for human well‐being. Reproductive health is notably susceptible to oxidative stress, triggered by the generation of reactive oxygen species from pollutants such as Cd is often found in cigarette smoke ultimately resulting in diminished fertility among couples. This review aims to comprehensively discuss the repercussions and hazards posed by pollutants to reproductive health, elucidating how pollution can instigate reproductive disorders and proposing mitigation strategies. The first set of questions aimed to avert pregnancy abnormalities and curtail morbidity and mortality rates and underscores the need for antioxidants as a pivotal risk mitigation strategy. Fostering public awareness of a healthy lifestyle is imperative. These sustainable solutions and the involvement of expert organizations at local, national, and global scales, employing a multidisciplinary approach, are indispensable for effective problem‐solving in this domain. Findings from the review highlight a correlation between pregnancy complications, encompassing spontaneous abortions, premature deliveries, and low birth weight (LBW), attributable to pollutants, thereby escalating morbidity and mortality rates.

SYPHILIS IN THE 21ST CENTURY: CHALLENGES AND ADVANCES IN DIAGNOSIS AND TREATMENT

The article titled Syphilis in the 21st Century: Challenges and Advances in Diagnosis and Treatment aimed to analyze the main challenges and significant advances in the diagnosis and treatment of syphilis throughout the 21st century. The research focused on understanding how new technologies and public health strategies have contributed to the improvement of disease management, as well as identifying the existing barriers. A bibliographic review was conducted to compile and synthesize relevant data from previous studies, providing a comprehensive overview of the topic. The explanatory methodology used allowed for a theoretical deepening of the issues involved in the detection and treatment of syphilis. The technical procedures included the analysis of scientific articles, health organization reports, and systematic reviews that addressed both technological advances and the challenges faced by health professionals. Among the main advances discussed were rapid tests and nucleic acid amplification tests (NAATs), which have significantly improved the ability to diagnose the infection early and accurately. Improvements in public awareness and prevention programs were also addressed. Despite the advances, the article also highlighted persistent challenges such as antibiotic resistance and difficulties in accessing effective treatments, especially in less developed regions. Benzathine penicillin G was reaffirmed as the treatment of choice, but distribution logistics and adherence to treatment remain important obstacles. The bibliographic review concluded that, for effective control of syphilis, integrated strategies that combine education, prevention, early diagnosis, and adequate treatment are necessary, as indicated in the reviewed literature.

Relationship between dietary knowledge, food preference, and long-short term health status among Chinese adults.

In recent years, with the improvement of people's living standards and changes in dietary patterns, dietary knowledge and food preference have been playing an increasingly crucial role in health. The aim of our study was to examine the relationship between dietary knowledge, food preference, and long-short term health status among Chinese adults aged 18-70. This study employed cross-sectional data from the 2015 China Health and Nutrition Survey obtained from 4822 adults. We utilized self-assessed health status as an indicator of long-term health status and utilized sickness in the last four weeks as a measure of short-term health status. Taking advantage of ordered probit regression, long-term health status was regressed on all predictors, while the binary logistic regression was used to analyze the factors influencing short-term health status. The propensity score matching is employed to account for potential selection bias in analysis, thereby increasing the robustness and credibility of results. The analysis revealed that dietary knowledge and food preference can improve an individual's long-term health status significantly. However, there is no evidence to show that short-term health status is affected by food preference. Furthermore, dietary knowledge is negatively associated with short-term health status. These findings highlight the importance of dietary education and healthy eating habits in improving the long-term health status of Chinese adults. The study suggests implications for public health strategies aimed at enhancing the health and well-being of Chinese adults.

Improving primary health care for children and adolescents in Europe

Primary health care for children in Europe is often not optimal. Primary care providers might not have been trained adequately in dealing with common conditions affecting children and adolescents, and outdated practices often persist. To address these problems, WHO developed the Pocket Book of Primary Health Care for Children and Adolescents. It is for use by doctors, nurses and other health workers who are responsible for the care of children and adolescents at the primary health care level. It summarizes guidance on how to manage – and when to refer – children and adolescents presenting with common complaints and conditions. It includes information to enable primary health care providers to coordinate the continued care of children and adolescents with long-term conditions and diseases managed by specialists. Preventive and promotive measures from the newborn period to adolescence include advice on the timing and content of well-child visits, the promotion of early childhood development and health messages for adolescents.The recommendations of the Pocket Book apply across the WHO European Region and may be adapted by countries to suit their specific circumstances. A mobile APP for Android and IOS phones is available to facilitate uptake and dissemination. The Pocket Book and APP aim to improve quality of care for children and adolescents at the primary health care level. Quality of care is at the core of the comprehensive European Child and Adolescent Health Strategy that is being developed by Member States supported by WHO and partners to refocus attention on child and adolescent health after the COVID-19 pandemic had scooped attention and resources away from this age group. Countries are encouraged to adapt Pocket Book and Strategy to improve the situation of child and adolescent health and well-being in their settings and monitor progress.

Factors associated with medical consumable availability in level 1 facilities in Malawi: a secondary analysis of a facility census.

Medical consumable stock-outs negatively affect health outcomes not only by impeding or delaying the effective delivery of services but also by discouraging patients from seeking care. Consequently, supply chain strengthening is being adopted as a key component of national health strategies. However, evidence on the factors associated with increased consumable availability is limited. In this study, we used the 2018-19 Harmonised Health Facility Assessment data from Malawi to identify the factors associated with the availability of consumables in level 1 facilities, ie, rural hospitals or health centres with a small number of beds and a sparsely equipped operating room for minor procedures. We estimate a multilevel logistic regression model with a binary outcome variable representing consumable availability (of 130 consumables across 940 facilities) and explanatory variables chosen based on current evidence. Further subgroup analyses are carried out to assess the presence of effect modification by level of care, facility ownership, and a categorisation of consumables by public health or disease programme, Malawi's Essential Medicine List classification, whether the consumable is a drug or not, and level of average national availability. Our results suggest that the following characteristics had a positive association with consumable availability-level 1b facilities or community hospitals had 64% (odds ratio [OR] 1·64, 95% CI 1·37-1·97) higher odds of consumable availability than level 1a facilities or health centres, Christian Health Association of Malawi and private-for-profit ownership had 63% (1·63, 1·40-1·89) and 49% (1·49, 1·24-1·80) higher odds respectively than government-owned facilities, the availability of a computer had 46% (1·46, 1·32-1·62) higher odds than in its absence, pharmacists managing drug orders had 85% (1·85, 1·40-2·44) higher odds than a drug store clerk, proximity to the corresponding regional administrative office (facilities greater than 75 km away had 21% lower odds [0·79, 0·63-0·98] than facilities within 10 km of the district health office), and having three drug order fulfilments in the 3 months before the survey had 14% (1·14, 1·02-1·27) higher odds than one fulfilment in 3 months. Further, consumables categorised as vital in Malawi's Essential Medicine List performed considerably better with 235% (OR 3·35, 95% CI 1·60-7·05) higher odds than other essential or non-essential consumables and drugs performed worse with 79% (0·21, 0·08-0·51) lower odds than other medical consumables in terms of availability across facilities. Our results provide evidence on the areas of intervention with potential to improve consumable availability. Further exploration of the health and resource consequences of the strategies discussed will be useful in guiding investments into supply chain strengthening. UK Research and Innovation as part of the Global Challenges Research Fund (Thanzi La Onse; reference MR/P028004/1), the Wellcome Trust (Thanzi La Mawa; reference 223120/Z/21/Z), the UK Medical Research Council, the UK Department for International Development, and the EU (reference MR/R015600/1).

Navigating the pandemic: an exploration of health behavioral dynamics among Asian Americans during COVID-19

The COVID-19 pandemic brought Asian Americans sharply into focus, revealing both the strengths and vulnerabilities within this community. Despite a myriad of studies on their experiences and health disparities during the outbreak, gaps persist in our understanding of their health literacy, beliefs, and healthcare behaviors. Leveraging the snowball sampling method, our study engaged 20 diverse Asian Americans, delving into facets ranging from English proficiency and health literacy to cultural health beliefs and preventive behaviors. Notably, participants exhibited high English proficiency and health literacy. Their health choices, shaped by their Asian heritage, showcased a proactive approach to combating COVID-19. Most did not defer or sidestep healthcare, underlining their commitment to well-being. These insights underscore the resilience and adaptability of the Asian American community. By decoding their health behaviors and beliefs, our study aims to refine public health strategies, ensuring they resonate not just with Asian Americans but potentially with other ethnic cohorts amidst global health crises.

Assessing our adherence to bone protection standards in metastatic prostate cancer in the largest Irish center: Are we falling behind?

e24145 Background: Prostate cancer ranks as the second most prevalent cancer in men globally, often necessitating androgen deprivation therapy (ADT) as part of its treatment. While ADT effectively diminishes testosterone levels, a vital factor in prostate cancer cell growth, it concurrently poses a notable side effect – an accelerated rate of bone loss. This heightened bone loss elevates the vulnerability of patients to osteoporosis and fractures. The optimization of bone health entails early identification of patients susceptible to osteoporosis and fractures, the implementation of preventative measures, and prompt interventions to mitigate bone loss and fracture risks. Methods: The audit aims to evaluate adherence to established guidelines, such as those outlined by the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO), concerning the assessment and optimization of bone health. A retrospective analysis was performed on the medical records of prostate cancer patients who underwent Androgen Deprivation Therapy (ADT) at St James Hospital in Dublin. Pertinent data, encompassing patient demographics, duration of ADT, documentation of bone health assessment, frequency of Bone Mineral Density (BMD) testing, utilization of preventive measures (e.g., calcium and vitamin D supplementation), and any interventions for bone health optimization (such as bisphosphonate therapy and denosumab), was systematically collected. Results: A comprehensive review encompassed 57 patients, revealing that 38 patients (67%) exhibited metastatic disease. Among them, 42 patients (74%) presented with castrate-sensitive disease. Out of the total, 24 patients (42%) underwent a baseline Dual-Energy X-ray Absorptiometry (DEXA) scan. Results indicated that 12 patients were diagnosed with Osteoporosis, 9 with Osteopenia, and 3 with normal Bone Mineral Density (BMD). At baseline, 26 patients (46%) initiated Calcium and Vitamin D supplements, while 12 patients (21%) commenced Bisphosphonates/Denosumab based on DEXA scan outcomes. Notably, 8 (14%) patients experienced a skeletal/bone-related event which is much higher than reported in literature. Conclusions: The findings are intended to guide healthcare professionals in optimizing bone health strategies, with the ultimate goal of improving patients' quality of life and minimizing the risk of fractures and related complications. Identified areas for improvement in clinical practices will be addressed by implementing recommended recommendations, aiming to enhance patient care, decrease the risk of osteoporosis and fractures, and overall improve patient outcomes. A re-audit is planned to monitor ongoing adherence to guidelines and assess the impact of interventions implemented as a result of this study.

A descriptive epidemiology in syphilis in Tokyo, 2019-2022.

The number of syphilis cases in Tokyo has been found to increase in recent years. We conducted a descriptive epidemiology to elucidate the actual status of syphilis. Data on age, sex, disease stage, and presumed sexual partner of syphilis cases reported in Tokyo were tabulated and analyzed. A total of 9,419 syphilis cases have been reported between 2019 and 2022. There was a particularly sharp rise in the number of reported cases from 2021 to 2022. Comparing 2020 to 2022, the number of syphilis cases among women in their 20s, rapidly increased, more than triple. Furthermore, the number of pregnant women among syphilis cases increased in 2022. Despite the rapid increase in the number of young women with syphilis, there has been no increase in cases of congenital syphilis. One of the reasons may be that syphilis was detected early in pregnancy due to the high antenatal checkup rate in Tokyo. However, the continued incidence of syphilis among young women may increase congenital syphilis in the future. Public health strategy should include educational activities targeting high-risk populations or adolescents, early and appropriate testing, and treatment for preventing progression of syphilis.

Global, regional, and national levels and trends in burden of urticaria: A systematic analysis for the Global Burden of Disease study 2019.

Urticaria places a significant burden on individuals and society due to its widespread nature. The aim of this study was to evaluate the burden of urticaria in different regions and nations by analysing data from the Global Burden of Disease study 2019 (GBD 2019), with the goal of providing information to health care policymakers. By utilising data from the GBD 2019 database, this study analysed metrics such as incidence, prevalence, disability-adjusted life years (DALYs), age-standardised rate (ASR), and estimated annual percentage changes (EAPC) globally and across 204 countries and regions. The data was further stratified by age, sex, and sociodemographic index (SDI). In 2019, global incidence cases, prevalence cases, and overall disease burden as measured by DALYs all increased. The distribution of the burden exhibited marked geographical heterogeneity. At the regional level, the burden is highest in Central and Eastern Europe and Central Asia, with the strongest growth in South Asia, compared with a decline in the high-income Asia Pacific. At the country level, Nepal reports the highest burden of urticaria, while Portugal has the lowest. Gender and age analyses showed that the burden of urticaria is higher in females than in males, with urticaria cases declining with age, especially in children, and picking up among the elderly. The study also finds a correlation between the burden of urticaria and the SDI, with the central part of the SDI showing a consistent increasing trend. This study found that the global burden of urticaria has risen from 1990 to 2019. Factors like geographic location, gender, and SDI influenced the urticaria burden. Overall, these results offer a resource to guide public health strategies seeking to reduce the burden of urticaria.