Urgent Health Problem Research Articles

Effectiveness of a policy to reduce non-urgent night-time consultations in out-of-hours services

Abstract Background The utilization of Out-of-Hours General Practice (OOH-GP) services in the Netherlands has been increasing steadily. This has placed significant pressure on triagists and GPs to provide accessible and high-quality care, particularly because of patients with low-urgency health problems, who can wait to visit their GP during regular working hours. To alleviate the strain on OOH services during the night, the “spoed=spoed” policy has been implemented. This policy stipulates that only patients with urgent health problems can consult with a GP during the night (11 p.m. to 8 a.m.). However, it remains unclear whether this policy has effectively reduced consultations during the night. Methods For this study, we used pseudonymised data from electronic health records of 2/3 of Dutch OOH services (catchment area of 12.3 million), from Nivel Primary Care Database, from 2020-2023. We analysed the effects of the policy on contact rates and proportion of high-urgency health problems, by comparing OOH services that did and did not implement the policy, by comparing 6 months before and after implementation and by analysing variances across OOH services. Results Overall, there were no differences in the number or proportion of high-urgency consultations across OOH services that did and did not implement spoed=spoed. In those that did, there were no differences before and after implementation. However, certain OOH services exhibited a decrease in consultation, while also showing a higher proportion high-urgency health problems. Conclusions There is currently no definitive evidence regarding the effectiveness of “spoed=spoed”. However we should learn from the varied effects and experiences in different OOH-services, to facilitate further implementation or adaptation of the policy. Key messages • OOH services can and should learn from each other on what solutions are implemented to lower the care-burden during the night. • Policies aimed at reducing the utilization of OOH serviced should consider the conaxt from the patient, health care provider and organization.

РАЗРАБОТКА ЭКСПЕРИМЕНТАЛЬНОЙ ЛЕКАРСТВЕННОЙ ФОРМЫ ДЛЯ МЕСТНОГО ПРИМЕНЕНИЯ С ПРОТИВОГРИБКОВЫМ ДЕЙСТВИЕМ

Currently, mycoses are one of the urgent health problems. According to WHO, up to 1/3 of the world's population suffers from fungal pathologies. Currently, fungal infections are becoming increasingly difficult to treat, which is associated both with the identification of new species of fungi that were previously considered non-pathogenic, and with the development of resistance of pathogens to available medicines. The problem of mycoses is becoming more urgent due to the variety of pathways of transmission of pathogens and their high resistance in the external environment, changes in the immune response of the human body. Therefore, it is so important to expand the range and constantly improve the compositions and forms of antifungal agents. The substance of the silver salt pyrazole-3-carboxamide (SSP) synthesized in PGFA showed antifungal activity, which allowed it to be included in the experimental mild dosage form. The purpose of this study is to develop an experimental mild dosage form based on the silver salt of pyrazole–3-carboxamide for topical use in candidiasis dermatomycosis and to evaluate its antifungal activity. Materials and methods. The pharmacologically active component is the pharmaceutical substance of the silver salt N-{4-[(1,3-thiazole-2-yl)sulfamoyl]phenyl}-1-phenyl-5-(4-ethoxyphenyl)pyrazole-3-carboxamide. The antifungal activity of the compound was studied by double serial dilutions in a liquid nutrient medium in relation to reference strains of fungi of the genus Candida: Candida albicans NCTC 885-653, Candida krusei RCPGU-1472/310, Candida glabrata RCPGU-1485/47. To determine the antifungal activity of an experimental mild dosage form in relation to a typical strain of fungi of the genus Candida, a three-nesting variant of the agar diffusion method was used. Statistical processing of the results of chemical studies was carried out according to generally accepted methods using standard EXCEL computer programs. Results and discussion. As a result of the conducted research, the composition of an experimental mild dosage form based on the silver salt of pyrazole-3-carboxamide has been substantiated and developed. A technology for the manufacture of ointment has been developed to ensure the quality of the dosage form, its therapeutic activity and stability. Conclusion. Based on technological and microbiological studies, an experimental mild dosage form based on the silver salt of pyrazole-3-carboxamide has been developed with the aim of further introduction into medical practice for the local treatment of dermatomycosis after appropriate studies.

Time-restricted eating with or without a low-carbohydrate diet improved myocardial status and thyroid function in individuals with metabolic syndrome: secondary analysis of a randomized clinical trial

BackgroundObesity and metabolic syndrome (MetS) have become urgent worldwide health problems, predisposing patients to unfavorable myocardial status and thyroid dysfunction. Low-carbohydrate diet (LCD) and time-restricted eating (TRE) have been confirmed to be effective methods for weight management and improving MetS, but their effects on the myocardium and thyroid are unclear.MethodsWe conducted a secondary analysis in a randomized clinical diet-induced weight-loss trial. Participants (N = 169) diagnosed with MetS were randomized to the LCD group, the 8 h TRE group, or the combination of the LCD and TRE group for 3 months. Myocardial enzymes and thyroid function were tested before and after the intervention. Pearson’s or Spearman’s correlation was assessed between functions of the myocardium and thyroid and cardiometabolic parameters at baseline.ResultsA total of 162 participants who began the trial were included in the intention-to-treat (ITT) analysis, and 57 participants who adhered to their assigned protocol were involved in the per-protocol (PP) analysis. Relative to baseline, lactate dehydrogenase, creatine kinase MB, hydroxybutyrate dehydrogenase, and free triiodothyronine (FT3) declined, and free thyroxine (FT4) increased after all 3 interventions (both analyses). Creatine kinase (CK) decreased only in the TRE (− 18 [44] U/L, P < 0.001) and combination (− 22 [64] U/L, P = 0.003) groups (PP analysis). Thyrotropin (− 0.24 [0.83] μIU/mL, P = 0.011) and T3 (− 0.10 ± 0.04 ng/mL, P = 0.011) decreased in the combination group (ITT analysis). T4 (0.82 ± 0.39 μg/dL, P = 0.046), thyroglobulin antibodies (TgAb, 2 [1] %, P = 0.021), and thyroid microsomal antibodies (TMAb, 2 [2] %, P < 0.001) increased, while the T3/T4 ratio (− 0.01 ± 0.01, P = 0.020) decreased only in the TRE group (PP analysis). However, no significant difference between groups was observed in either analysis. At baseline, CK was positively correlated with the visceral fat area. FT3 was positively associated with triglycerides and total cholesterol. FT4 was negatively related to insulin and C-peptide levels. TgAb and TMAb were negatively correlated with the waist-to-hip ratio.ConclusionsTRE with or without LCD confers remarkable metabolic benefits on myocardial status and thyroid function in subjects with MetS.Trial registrationClinicalTrials.gov, NCT04475822.

IBM Pelatihan Kader dalam Deteksi Dini Lansia dengan Demensia di Desa Deliksari, Gunungpati, Semarang

This research aims to develop a cadre training program in early detection of dementia in the elderly in Deliksari Village, Gunungpati, Semarang. Dementia is an increasingly urgent health problem in Indonesia, including in rural areas such as Deliksari Village. This program uses an educational approach and practical training to increase cadres' knowledge and skills in recognizing early signs of dementia. Training methods include the delivery of theory, case studies, and direct practice in identifying symptoms and behavior that indicate dementia. Program evaluation was carried out to measure the increase in cadres' knowledge and skills in carrying out early detection of dementia. It is hoped that the results of this research can contribute to efforts to prevent and early treat dementia at the rural community level

Comparative analysis of the detection of diseases of the muscular system in minors of Saint Petersburg

BACKGROUND: Diseases of the musculoskeletal system in children and their dynamics and structure are urgent health problems and have important scientific and practical significance. The epidemiological features of the detectability of pathology in different regions are of interest for detailed consideration. AIM: This study aimed to conduct a comparative characterization of the primary morbidity of children with diseases of the musculoskeletal system in St. Petersburg in the 2017–2022 period. MATERIALS AND METHODS: Official collections of statistical reports of the Central Research Institute of Organization and Informatization of Healthcare from 2017 to 2022 were analyzed. Indicators of diseases of the musculoskeletal system and connective tissue in children were analyzed, and a comparative assessment of the ratio of the probabilities of detecting pathologies in general and for individual nosologies presented in the collections in St. Petersburg and the Russian Federation was performed. Digital analysis was performed in Microsoft Office 2010 programs (Word and Excel). RESULTS: The indicators of primary morbidity in St. Petersburg from 2017 to 2022 exceeded the national and regional averages and had a negative upward trend. In all age groups, over 6 years, the odds ratio in favor of St. Petersburg increased with arthropathies in general and deforming dorsopathies and decreased with spondylopathies and systemic connective tissue lesions. Moreover, in children aged 0–14 years, the chances of detection in St. Petersburg increased with respect to reactive arthropathies and fell with juvenile arthritis, whereas in adolescents the increase concerned juvenile arthritis and the decrease in reactive arthropathies. In rheumatoid arthritis, a transition was noted – the probabilities of detection have become lower in favor of the regions in Russia. CONCLUSIONS: In St. Petersburg, an unfavorable trend in the probabilities of detecting diseases of the musculoskeletal system and connective tissue was registered among children. A two-stage increase in indicators was found in 2017–2019 and 2020–2022, and the rate of increase in the detectability of most nosologies during the COVID-19 pandemic exceeded the prepandemic values, indicating the conjugacy of the studied group of diseases with organizational limitations in the outpatient unit, quality and specificity of differential diagnosis, and viral component. The identified features indicate the need for a reassessment of organizational measures and management decisions.

Intensity and associated factors of home health care service needs among elderly patients with chronic diseases in the community: A cross-sectional survey.

This study aimed to investigate the intensity of needs for home health care services (HHCs) among elderly patients with chronic diseases and to identify the associated factors. A cross-sectional survey was conducted in Wuhou District, Chengdu, Sichuan Province, China, from April to November 2021. Convenient sampling was used to screen elderly patients with chronic diseases managed by Yulin Community Health Service Center. The questionnaires included general information and the Chinese version of the Community Healthy Intensity Rating Scale were completed according to patients' conditions. The data were analyzed using descriptive statistics and binary logistic regression. A total of 371 patients (10.40%) completed the survey. The mean age of the elderly patients was 84.04 years (SD=7.07); these patients suffered from 1 to 7 kinds of chronic diseases, and the most common were hypertension (78.98%) and diabetes (40.97%). The need intensity of patients for HHCs was moderate (41.51%) or severe (58.49%). For each additional chronic disease that patients suffered from, the need intensity increases by 1.289 times (OR=1.289; 95% CI: 1.055-1.575, p=.013); in additional, those aged more than 90 years, with a personal monthly income less than 2500 yuan ($387.00), with a poor health current status, and with only basic medical insurance presented greater need intensity (p<.05). Our data analysis revealed that economic status, insurance condition, poor health status, and multiple comorbidities may be the most common factors associated with the need intensity for HHCs. These characteristics may help medical staff to identify and help those with urgent health problems.

Development of Inhaled Tuberculosis Microparticle using Polysaccharide Polymers Containing Rifamycin Groups: In-vitro and In-vivo Study

Tuberculosis (TB) is one of the urgent global health problems. TB therapy involves the use of antibiotics, but unwanted side effects often accompany the treatment of TB with high doses and long periods of time. In an effort to increase the effectiveness of TB treatment and reduce side effects, direct drug delivery to the lungs is the focus of research. One of the approaches used is the development of drug delivery systems that use natural polymers in dry powder inhalation (DPI) formulations. Natural polymers, especially polysaccharides, have various advantages, such as biodegradability, biocompatibility and non-toxicity. This review discusses the use of rifamycin microparticle tuberculosis inhalation using polysaccharide polymers and reviews relevant in-vitro and in-vivo studies. The use of natural polymers, especially polysaccharides, is expected to increase the efficiency of TB therapy by reducing drug doses and systemic side effects and increasing direct drug delivery to infected organs.

Ultrasound criteria for assessing the correction of metabolic-associated fatty liver disease and liver blood flow disorders using arginine in patients with coronary artery disease in combination with COVID-19

Background. Coronavirus disease 2019 (COVID-19) remains one of the most urgent global health problems today. In the conditions of its spread around the world, the global scientific community is trying to study not only respiratory, but also extrapulmonary manifestations of this infection. It is known that with COVID-19, the endothelium, the hemostasis system, and the liver are affected with the occurrence of such a complication as metabolic dysfunction-associated steatotic liver disease (MASLD). The most vulnerable group of patients in terms of coronavirus disease and its complications (including MASLD) are those with coronary heart disease (CAD), therefore the search for effective drugs and optimal ultrasound criteria to evaluate liver steatosis in the dynamics of treatment is the main task of modern medicine. Goal: to determine the ultrasound criteria for assessing the correction of MASLD and liver blood flow disorders using arginine in patients with CAD associated with COVID-19. Materials and methods. A prospective study was conducted in 52 patients with CAD combined with PCR-positive COVID-19. The study was carried out upon admission to the hospital and 6 months after discharge. Group I (n = 27) consisted of CAD + COVID-19 patients who, in addition to standard therapy for MASLD, received arginine for 6 months after discharge from the hospital; group II (comparison group, n = 25) included participants who received standard therapy wi­thout arginine. Results. Splanchnic artery duplex scanning at baseline showed that 21 (78.0 %) patients in group I and 19 (76.0 %) in group II had a decrease in peak systolic velocity (PSV) in the proper hepatic artery (PHA), an increase in portal vein blood flow at the beginning of treatment, as well as increased liver size in 20 (74.0 %) patients in group I and 17 (68.0 %) in group II. An increase in the attenuation coefficient was detected in all patients of groups I and II. There were no differences between the groups at the time of inclusion in the study in terms of splanchnic blood flow and atte­nuation coefficient. After 6 months of arginine treatment, an improvement in the portal vein blood flow and a decrease in blood flow velocity in the PHA, a decrease in the diameter of the portal vein, a decrease in the size of the right and left liver lobes were found in group I, with no improvement in group II. A repeated study revealed a decrease in the attenuation coefficient in group I and no changes in group II. At the beginning of the study, a direct correlation was found between fibrinogen and the attenuation coefficient in group I (r = 0.54; p &lt; 0.05), as well as in group II (r = 0.51; p &lt; 0.05). After 6 months, C-reactive protein decreased in both groups. Conclusions. In patients with CAD combined with COVID-19 in the presence of MASLD, a decrease in the portal vein blood flow and an increase in PSV in the PHA were found. When arginine was used for 6 months in combination with standard therapy, according to the European Society of Cardiology protocols, there was a significant decrease in the attenuation coefficient, PSV in the PHA, and an increase in the portal vein blood flow. This indicates the possibility of using the attenuation coefficient as the main marker, and PSV in the PHA and the portal vein blood flow as additional criteria for ultrasound assessment of MASLD correction with arginine in patients with CAD combined with COVID-19.

Modern pharmacotherapy for cholestasis syndrome

Diseases of the hepatobiliary system today remain an urgent health problem worldwide. A significant percentage of gastroenterological patients are people suffering from cholestasis syndrome. In gastroenterology, there are a number of nosological forms accompanied by the development of cholestasis syndrome. This pathological condition has many etiological factors, but in general, the mechanisms of its formation for various reasons are largely similar. When working with this group of patients, it is necessary to take into account the peculiarities of the clinical picture, which may vary depending on the etiology of the cholestatic syndrome. The fact of the economic burden in this pathology is also important, because sometimes it is necessary to resort to high-tech examination methods and expensive laboratory screening to perform high-quality differential diagnosis. As for the treatment of cholestatic syndrome, at the moment there are many drugs with different mechanisms of action, the predominant part of which, according to randomized clinical trials and meta-analyses, has proven effectiveness. In this article, based on literature sources taken from foreign and domestic databases, the etiology and pathogenesis of the development of cholestasis syndrome, the clinical picture and approaches to the diagnosis of this condition are considered. When considering the treatment of cholestatic syndrome, this article focuses on therapy with ursodeoxycholic acid drugs, in particular Ecurochol. A clinical case is also considered on the example of a patient with cholestasis syndrome who was prescribed treatment with Ecurochol and who showed positive dynamics due to improvements in the ultrasound picture of the abdominal organs.

Metallophthalocyanine as ideal antibiotics without light: Mechanisms and applications

The urgent global health problem of antimicrobial resistance (AMR) calls for the discovery of new antibiotics with innovative modes of action while considering the low toxicity to mammalian cells. This paper proposes a novel strategy for designing antibiotics with selective bacterial toxicity by exploiting the positional differences of electron transport chains (ETC) in bacterial and mammalian cells. The focus is on cytochrome c (cyt C) and its maturation system in E. coli. The catalytic oxidative activity of metallophthalocyanine (MPc), which have a distinctive M-N4 structure, is being investigated. Unlike previous applications based on light-activated reactive oxygen species (ROS) generation, this study exploits the ability of MPcs to oxidize Fe2+ to Fe3+ in cyt C and catalyze the formation of disulfide bonds between cysteine residues to interfere with cyt C maturation, disrupt the bacterial respiratory chain and selectively kills bacteria. In contrast, in mammalian cells, these MPcs are located in the lysosomes and cannot access the ETC in the mitochondria, thus achieving selective bacterial toxicity. Two MPcs that showed effective antibacterial activity in a wound infection model were identified. This study provides a valuable reference for the design of novel antibiotics based on M-N4-based metal complex molecules.

LncRNA FTH1P3: A New Biomarker for Cancer-Related Therapeutic Development.

Cancer is a persistent and urgent health problem that affects the entire world. Not long ago, regulatory biomolecules referred to as long noncoding RNAs (lncRNAs) might have value for their innate abundance and stability. These single-stranded RNAs potentially interfere with several physiological and biochemical cellular processes involved in many human pathological situations, particularly cancer diseases. Ferritin heavy chain1 pseudogene 3 (FTH1P3), a lncRNA that is ubiquitously transcribed and belongs to the ferritin heavy chain (FHC) family, represents a novel class of lncRNAs primarily found in oral squamous cell carcinoma. Further research has shown that FTH1P3 is involved in other malignancies such as uveal melanoma, glioma, esophageal squamous cell carcinoma, non-small cell lung cancer, breast cancer, laryngeal squamous cell carcinoma, and cervical cancer. Accordingly, FTH1P3 significantly enhances cancer symptoms, including cell proliferation, invasion, metastasis, chemoresistance, and inhibition of apoptosis through many specific mechanisms. Notably, the clinical data significantly demonstrated the association of FTH1P3 overexpression with poor prognosis and poor overall survival within the examined samples. Here, we summarize all the research published to date (13 articles) on FTH1P3, focusing on the biological function underlying the regulatory mechanism and its possible clinical relevance.

Gut microbiota: the indispensable player in neurodegenerative diseases.

As one of the most urgent social and health problems in the world, neurodegenerative diseases have always been of interest to researchers. However, the pathological mechanisms and therapeutic approaches are not achieved. In addition to the established roles of oxidative stress, inflammation and immune response, changes of gut microbiota are also closely related to the pathogenesis of neurodegenerative diseases. Gut microbiota is the central player of the gut-brain axis, the dynamic bidirectional communication pathway between gut microbiota and central nervous system, and emerging insights have confirmed its indispensability in the development of neurodegenerative diseases. In this review, we discuss the complex relationship between gut microbiota and the central nervous system from the perspective of the gut-brain axis; review the mechanism of microbiota for the modulation different neurodegenerative diseases and discuss how different dietary patterns affect neurodegenerative diseases via gut microbiota; and prospect the employment of gut microbiota in the therapeutic approach to those diseases. © 2024 Society of Chemical Industry.

Проблемы и возможности медицинского туризма в Челябинской области.

Since January 1, 2019, the Federal project “Development of export of medical services” is being implemented, which is aimed at improving the quality of medical services in the Russian Federation and their promotion on the international market. Despite this, the problems and opportunities of medical tourism remain one of the urgent health problems not only in Russia, but also in the Chelyabinsk region. Through the conducted research, among political, economic, social and technological factors, problems and opportunities affecting the development of the export of medical services in the region were identified. The experts also named the necessary measures for the development and promotion of medical services on the international market Aim: analysis of existing problems in the field of medical tourism and import of medical services offered on the territory of the Russian Federation, and identification of possible prospects for the development of this area of medical activity. Materials and methods. The materials of this study were analytical materials and official statistical data of the FSBI “TSNIIOIZ” of the Ministry of Health of the Russian Federation. When processing the results, the information and analytical method, the statistical method, the method of questioning and expert evaluation, the method of processing and summarizing information were used. Results. The study involved 50 medical workers holding senior positions in medical organizations of the Chelyabinsk region (heads of structural divisions, chief physicians and deputy chief physicians). The study of the opinion of the study participants on the problems and prospects of the development of medical tourism led to the following results: • Shortage of personnel and material and technical resources is the main constraining factor of development in the provision of medical services to foreign citizens • It is necessary to equip medical organizations with a sufficient amount of medical equipment to increase the level of medical services provided to foreign citizens. The analysis of the external environment revealed political, economic, social and technological factors that hinder and contribute to the development of medical tourism in the country. Thus, the leading political factor contributing to the development of the export of medical services, experts called the support of medical tourism from the state. And the respondents consider the sanctions imposed by the European Union and the United States to be the main negative political factor. Respondents consider the relatively low cost of providing paid medical services as the main economic opportunity for the development of medical tourism. Whereas the main negative economic factor is the increase in the cost of medical devices and medical equipment due to restrictions on the import of imported equipment directly and the emergence of parallel imports. The most important for attracting foreign patients among social factors is the level of qualification of medical personnel, as well as high performance indicators in certain medical areas. Significant social threats, from the point of view of the respondents, is the lack of a unified system of voluntary medical insurance and international accreditation for most medical organizations of the Russian Federation. In order to develop medical tourism and increase the demand for Russian medical organizations among foreign tourists, the participants of the experiment consider it necessary to use the latest treatment technologies and achieve an international level of service, as well as create conditions that will help foreign patients to facilitate obtaining a medical visa. Conclusion. The results of the study made it possible to assess the problems of medical tourism and assess the prospects for development from the point of view of the heads of medical organizations of the Chelyabinsk region, as well as to develop a set of measures for the development of medical tourism in the Chelyabinsk region. The scope of the results. The data obtained will allow us to develop a set of measures aimed at the development of medical tourism in Russia, the adoption of which will help to increase the volume of exports of medical services and the number of treated foreign citizens.

Epidemiology of hepatitis C infection among pregnant women and parturients in Nizhny Novgorod

Hepatitis C is an urgent global health problem. The high prevalence of infection among the population leads to the involvement of women of reproductive age in the epidemic process. In order to study the prevalence of specific markers of hepatitis C virus in pregnant women and to assess the risk of intrauterine infection of the fetus, an epidemiologic analysis was conducted using information collections of statistical and analytical materials of Rospotrebnadzor, blood serum samples of pregnant and postpartum women (n = 28394) at admission to obstetric institutions for the period 2018–2022 were examined. According to statistical reporting, the average annual prevalence of anti-HCV prevalence in pregnant women was 1.7% (95% CI: 1.5–1.9%). Women aged 40–49 years were found to be most actively involved in the epidemic process (4.3% [95% CI: 3.3–5.6%]). Among anti-HCV-positive samples, HCV RNA was detected in 47.0% (95% CI: 41.7–52.9%) of cases, the prevalence of current infection confirmed by HCV RNA detection in pregnant women was 0.9% (95% CI: 0.8–1.0%). The pattern of HCV genotypes in pregnant women was as follows: subtype 1b was detected in 34.9% (95% CI: 25.6–45.7%) of cases, subtype 3a in 42.2% (95% DI: 32.1–52.9%), minor subtype 1a was 9.6% (95% CI: 5.0–17.9%) and genotype 2 was 7.0% (95% CI: 3.4–14.9%). Samples containing two genotypes simultaneously (1a/1b, 1b/3a) were 3.6% (95% CI: 1.2–10.1%) and non-genotyped samples were 2.4% (95% CI: 0.7–4.1%). The results of the assessment of the significance of risk factors for perinatal transmission of hepatitis C virus show a high degree of influence on vertical transmission of HCV RNA in the presence of active infection in the mother (RR = 6.4; [95% CI: 0.9–44.6%]: p &lt; 0.05), no statistical significance of HCV genotypic affiliation (p &gt; 0.05) and maternal viral load level (R = 0.00009; p &gt; 0.05). The obtained data argue the necessity of screening examinations for molecular genetic markers of hepatitis C virus in women planning pregnancy in order to conduct antiviral therapy and, as a consequence, to reduce the risk of perinatal infection of children.

Telemedicine decision-making in primary care during the COVID-19 pandemic: Balancing patient agency and provider expertise

ObjectivesThe COVID-19 pandemic precipitated the expansion of telemedicine use worldwide, introducing a new dimension of healthcare decision-making – choosing a visit format – not previously experienced by most patients or providers. To date, the pandemic's impact on decisions about using telemedicine versus in-person visits in primary care has not been fully explored. The purpose of this study was to examine patient and provider accounts of decision-making about the choice between telemedicine and in-person care during the COVID-19 pandemic. MethodsPrimary care providers and patients were recruited from four healthcare systems across three states in the United States. Participants completed semi-structured interviews about their experiences using telemedicine for primary care during the pandemic. Data pertaining to decision-making about telemedicine were examined as a secondary analysis using interpretive description. ResultsTwenty-one providers and 65 patients completed interviews. Patients’ ability to choose their own visit format influenced their level of satisfaction with telemedicine care, while providers expressed concern about leaving visit format entirely up to their patients. Patients and providers generally agreed that telemedicine was well-suited for routine follow-ups, reviewing results, and medication management. However, in cases of urgent health problems, patients and providers differed in their criteria for determining what visit format is most appropriate but agreed that telemedicine could be a useful tool for “quick fixes” and for fast and effective triage. ConclusionsPrimary care patients and providers emphasized the importance of agency during care delivery and shared opportunities for effective triage via telemedicine. Further research should focus on developing tools to support shared healthcare decisions regarding telemedicine use under changing healthcare conditions, particularly for urgent health questions. Public Interest SummaryThe COVID-19 pandemic has increased telemedicine use around the world. This study looked at patient and provider decisions about using telemedicine versus in-person care during the pandemic. We asked 21 primary care providers and 65 patients from four healthcare systems across three U.S. states about their experiences using telemedicine during the pandemic. Patients were more satisfied if they were able to choose whether to have an in-person or video visit, while providers worried that allowing patients to choose the visit format could get in the way of care when patients need physical exams or laboratory testing. Patients and providers gave different reasons for choosing a visit format, but both agreed that telemedicine was useful for “quick fixes” and making decisions together in emergencies. Healthcare systems should create tools to help patients and providers decide when to use telemedicine, especially when managing urgent health issues.

Exploring the mechanism of Si-Ni-San against depression by UPLC-Q-TOF-MS/MS integrated with network pharmacology: experimental research.

Depression is becoming an urgent mental health problem. Si-Ni-San has been widely used to treat depression, yet its underlying pharmacological mechanism is poorly understood. Thus, we aim to explore the antidepressant mechanism of Si-Ni-San by chemical analysis and in-silico methods. Compounds in Si-Ni-San were determined by ultra-high performance liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS). Then, bioactive compounds were obtained from Traditional Chinese Medicines for Systems Pharmacology Database and Analysis Platform and SwissADME, and the potential targets of which were acquired from SwissTargetPrediction. Depression-related targets were collected from GeneCards. The intersection between compound-related targets and depression-related targets were screened out, and the overlapped targets were further performed protein-protein interaction, biological functional and pathway enrichment analysis. Finally, networks of Si-Ni-San against depression were constructed and visualized by Cytoscape. One hundred nineteen compounds in Si-Ni-San were determined, of which 24 bioactive compounds were obtained. Then, 137 overlapped targets of Si-Ni-San against depression were collected. AKT1, PIK3R1, PIK3CA, mTOR, MAPK1 and MAPK8 were the key targets. Furthermore, PI3K-Akt signalling pathway, serotonergic synapse, MAPK signalling pathway and neurotrophin signalling pathway were involved in the antidepressant mechanism of Si-Ni-San. It showed that components like sinensetin, hesperetin, liquiritigenin, naringenin, quercetin, albiflorin and paeoniflorin were the mainly key active compounds for the antidepressant effect of Si-Ni-San. This study demonstrated the key components, key targets and potential pharmacological mechanisms of Si-Ni-San against depression. These results indicate that Si-Ni-San is a promising therapeutic approach for treatment of depression, and may provide evidence for the research and development of drugs for treating depression.

Uso de prontuário eletrônico e parâmetros de acesso e acolhimento segundo dados do terceiro ciclo do PMAQ-AB

Abstract The use of electronic health records (EHR) in primary healthcare (PHC) aims for better integration of services and care quality. One of most the critical points of Brazilian PHC is access. This article aims to analyze, through data from the third evaluation cycle of the Brazilian Program for Improving Access and Quality of Primary Care (PMAQ-AB), the relationship between the use of electronic health records and the parameters of access of the participant teams. Cross-sectional analytical study with secondary data. Data from 38,865 primary care teams, 30,346 health units and 140,444 interviewed users were evaluated. The use of EHR was associated with greater care for non-programmed demands (OR 1.664; 95%CI 1.485-1.866), risk and vulnerability assessment (OR 1.329; 95%CI 1.122-1.574) and use of protocols for clinical conducts (OR 1.656; 95%CI 1.530-1.793), in addition to a greater possibility of scheduling consultation by telephone (OR 3.179; 95%CI 3.030-3.335). Services using EHR are more likely to be the patients first contact (OR 1.226; 95%CI 1.171-1.283) and to be sought when facing urgent health problem (OR 1.198; 95%CI 1.161-1.236). The results point to a concrete possibility of improving access through computerization.

Use of electronic health records and primary health care accessibility according to data from the third cycle of the PMAQ-AB.

The use of electronic health records (EHR) in primary healthcare (PHC) aims for better integration of services and care quality. One of most the critical points of Brazilian PHC is access. This article aims to analyze, through data from the third evaluation cycle of the Brazilian Program for Improving Access and Quality of Primary Care (PMAQ-AB), the relationship between the use of electronic health records and the parameters of access of the participant teams. Cross-sectional analytical study with secondary data. Data from 38,865 primary care teams, 30,346 health units and 140,444 interviewed users were evaluated. The use of EHR was associated with greater care for non-programmed demands (OR 1.664; 95%CI 1.485-1.866), risk and vulnerability assessment (OR 1.329; 95%CI 1.122-1.574) and use of protocols for clinical conducts (OR 1.656; 95%CI 1.530-1.793), in addition to a greater possibility of scheduling consultation by telephone (OR 3.179; 95%CI 3.030-3.335). Services using EHR are more likely to be the patients first contact (OR 1.226; 95%CI 1.171-1.283) and to be sought when facing urgent health problem (OR 1.198; 95%CI 1.161-1.236). The results point to a concrete possibility of improving access through computerization.

Development of an electronic measuring device for height and nutritional status equipped with artificial intelligence for screening stunting toddlers

Background: Technological advancements have changed various aspects of human life, including in the world of health. One technological breakthrough that dominates attention is artificial intelligence (AI). Artificial intelligence has proven its potential to revolutionize many fields, including the health sector. One of the urgent health problems that requires innovative solutions is detecting the problem of stunting in children under five.Purpose: The study aims to develop and test a measuring device that effectively determines the body height and nutritional status in toddlers 0-5 years.Method: This study is in Research and Development (R&amp;D); it consisted of 5 stages: stage I (literature study), stage II (product development), stage III (expert validity and phase trials), stage IV (product revision and final product), and stage V (phase II trials).Results: The electronic measuring device for height and nutritional status has been created. The result is that the tool effectively determines the height and nutritional status. The value of the ultrasonic sensor works quite well, with a maximum test error value of 0.11 and an average of 0.033, which means the calibration value of the tool's sensitivity is valid in determining body height.Conclusion: The electronic measuring device effectively determines the body's height and nutritional status.

Evaluating vaccine-elicited antibody activities against Neisseria gonorrhoeae: cross-protective responses elicited by the 4CMenB meningococcal vaccine.

The bacterial pathogen Neisseria gonorrhoeae is an urgent global health problem due to increasing numbers of infections, coupled with rampant antibiotic resistance. Vaccines against gonorrhea are being prioritized to combat drug-resistant N. gonorrhoeae. Meningococcal serogroup B vaccines such as four-component meningococcal B vaccine (4CMenB) are predicted by epidemiology studies to cross-protect individuals from natural infection with N. gonorrhoeae and elicit antibodies that cross-react with N. gonorrhoeae. Evaluation of vaccine candidates for gonorrhea requires a suite of assays for predicting efficacy in vitro and in animal models of infection, including the role of antibodies elicited by immunization. Here, we present the development and optimization of assays to evaluate antibody functionality after immunization of mice: antibody binding to intact N. gonorrhoeae, serum bactericidal activity, and opsonophagocytic killing activity using primary human neutrophils [polymorphonuclear leukocytes (PMNs)]. These assays were developed with purified antibodies against N. gonorrhoeae and used to evaluate serum from mice that were vaccinated with 4CMenB or given alum as a negative control. Results from these assays will help prioritize gonorrhea vaccine candidates for advanced preclinical to early clinical studies and will contribute to identifying correlates and mechanisms of immune protection against N. gonorrhoeae.