World Health Organization Recommends Research Articles

Health literacy in adolescents and young adults in Benin: French translation and validation of the health literacy measure for adolescents (HELMA).

The Health Literacy Measure for Adolescents (HELMA) is a self-assessment validated tool used to measure health literacy in adolescents. This study aims to evaluate the psychometric properties of the French translation of the Health Literacy Measure for Adolescents (F-HELMA). The HELMA questionnaire was translated according to the World Health Organization's (WHO) recommendation for translation and adaptation of instruments. It was pre-tested with 30 students. Subsequently, 495 adolescents and young adults from five senior secondary high schools in Benin completed the questionnaire. A sample of 44 participants completed the questionnaire twice over a 2-week period to determine the test-retest reliability. Construct validity was evaluated using confirmatory factor analysis (CFA) and convergent validity was analyzed the Health Literacy Assessment Tool. The F-HELMA-French translation of the Health Literacy Measure for Adolescents, showed moderate to good psychometric properties. CFA showed good fit indices for a seven-factor model. Reliability figures fell within an acceptable range; Cronbach's alpha ranged from 0.64 (moderate) to 0.89 (good) across the different subscales, and the intraclass coefficient (ICC) ranged from 0.82 to 0.96, indicating good test-retest reliability. Pearson correlation with HLAT-8 showed good convergent validity (r = 0.54, p < 0.001). This study provides support for the use of the F-HELMA, as a valid and reliable instrument to measure health literacy in adolescents and young adults in West African French speaking countries.

Progress with the Second Dose Measles Vaccine Introduction and Coverage in the WHO African Region.

To achieve global and regional measles elimination objectives, the World Health Organization (WHO) recommends coverage of 95% or higher with two doses of measles-containing vaccine. A second dose of measles-containing vaccine (MCV) is typically administered in the second year of life after 12 months of age. We reviewed WHO-UNICEF estimates of national coverage (WUENIC) for the first and second doses of MCV (MCV1 and MCV2, respectively) and calculated drop-out rates between MCV1 and MCV2 for countries in the WHO African Region. From 2013 to 2023, estimated regional MCV2 coverage increased from 7% to 49%, and at the end of 2023, 43 (91%) countries had introduced MCV2 into their routine immunization programs. Countries with more antigens provided in the second year of life had higher mean and median MCV2 coverage levels, and lower drop-out rates between MCV1 and MCV2, as compared to countries providing only MCV2. Despite substantial progress, MCV2 coverage remains below the required levels to achieve and sustain elimination, and many countries have high drop-out rates between MCV1 and MCV2 coverage, indicating challenges in reaching children over 12 months of age. Increasing coverage of MCV2 and other vaccines in the second year of life is essential to achieving higher and equitable routine immunization coverage. This will require continued efforts to understand and mitigate barriers to reaching children after 12 months of age and accelerated implementation of available tools.

Adherence, Adverse Events and Viral Control among Children and Adolescents with HIV in Zambia Switched to an Integrase Inhibitor Regimen.

Based on recent World Health Organization recommendations, there has been a large-scale transition in Sub-Saharan Africa to integrase inhibitor (II)-based antiretroviral therapy (ART) regimens. This study was conducted at an urban referral center in Lusaka, Zambia. This study included 297 children and adolescents with HIV (CAWH) on ART for one year prior to enrollment and followed for 1-4 years after enrollment. ART adherence, ART regimen, and viral load were assessed periodically. Structured interviews were conducted with a subset of 95 children to assess adherence barriers and side effects. Children on protease inhibitor (PI)-based regimens were more likely to report adherence problems than children taking II- or Efavirenz-based regimens (10% vs. 28%, p=0.03) and noted more days with missed doses (median 1 vs. 0, p=0.02). In interviews, the most common reasons given for poor adherence included bad medication taste, not being home when medications were due, and perceived side effects. The PI group was more likely to report that taste was a problem affecting adherence (22% vs. 4%, p=0.05) and headache as an ART side effect (17% vs. 4%, p=0.05). Switching from a PI- to an II-based regimen was associated with improved adherence (72% vs. 92%, p=0.01) and an undetectable viral load (67% vs. 78%). Switching CAWH from PI-based to II-based regimens has many advantages including superior side effect profiles, adherence, and viral suppression. PI taste aversion may be a significant contributor to pediatric adherence issues. Palatability should be considered in pediatric HIV drug development.

How influencers motivate inactive adolescents to be more physically active: a mixed methods study.

Regular physical activity offers numerous health benefits, particularly for adolescents. However, only 14% of school-aged children in Switzerland achieve the World Health Organization's recommendation of 60 min of moderate to vigorous physical activity per day. Changing health behaviors is a complex process in which understanding behavioral and communication patterns is crucial. Because adolescents spend substantial time on social media channels and obtain information from them, these are potential channels for accessing health-related content. This study explores the questions of which influencers and what content motivate adolescents to be more physically active and whether influencers can impact enjoyment and the intention to engage in physical activity. The study employed a convergent mixed methods approach, combining self-assessment questionnaires and semi-structured interviews. Ninety-three adolescents aged 14-20 years who exercised < 1 h per day participated. They followed one of the six participating influencers on Instagram. Over 6 weeks, the questionnaires collected quantitative data, measuring enjoyment, stages of change, and physical activity levels. Furthermore, semi-structured interviews were conducted with 23 adolescents and six influencers to gain in-depth insights. The quantitative findings indicate that adolescent followers enjoyed physical activity more after the social media intervention and at follow-up than at the beginning of the study. The followers' stages of change progressed over time. Compared with those following more athletic influencers, followers of nonathletic influencers (that is, a singer, a journalist, and an eFootballer) showed increased physical activity over time. Qualitative analysis highlighted Instagram factors influencing physical activity, including resonance with influencers' lifestyles and preference for simple, relatable activities. Authentic content was positively associated with increased exercise, particularly among already motivated followers. Unexpectedly, nonathletic influencers, such as a singer, a journalist, and an eFootballer, motivated adolescents best despite their nontraditional focus on physical activity. Their success stems from relatable lifestyles and simple activities that are easily incorporated into their daily routines. Conversely, athletic influencers demonstrated challenging exercises that were fascinating but difficult to adopt. This finding suggests the potential for utilizing nonathletic influencers in future campaigns targeting inactive adolescents.

Improving Blood Transfusion Request Form Documentation: A Quality Improvement Project.

The transfusion quality improvement project (QIP) serves as a valuable toolfor assessing and educating individuals who request blood components.The World Health Organization (WHO) recommends that each institution utilize a blood transfusion request form to ensure the effective conveyance of patient information to the hospital's blood bank. This QIPaimed to implement a transfusion request form and measure compliance with its use. A prospective study was conducted at Al Managil Teaching Hospital, Sudan, from May 1 to August 3, 2024, to address the lack of standardized transfusion request forms. The study included three cycles involving pre-intervention analysis, two phases of intervention with training sessions, and post-intervention evaluations. The interventions focused on developing and implementing a new transfusion request form, training clinical physicians, and reinforcing the form's use. Data from 100 randomly selected transfusion request forms were analyzed for completeness and adherence. The study showed significant improvements in the completeness of transfusion request forms across three cycles. In the first cycle, no data were collected, highlighting the absence of standardized forms. During the second cycle, with the introduction of the new form, the completion rates varied: some fields, such as patient information and clinical details, were fully completed in 50 cases (100%), while critical clinical parameters, such as current hemoglobin (Hb) and platelet (PLT) levels, were completed in only four requests (8%). By the third cycle, there was a substantial increase in completion rates across all domains. For example, patient information fields achieved 100% completion in 50 cases, and clinical parameters saw significant improvement, with current Hb and PLT levels documented in 48 cases (96%). The mean percentage completion increased from 68.1% in the second cycle to 97.9% in the third cycle, demonstrating the effectiveness of the interventions and training sessions. Minor decreases were observed in health insurance documentation and certain clinical details, indicating areas for further improvement. The systematic implementation and iterative evaluation of transfusion request forms significantly enhanced documentation completeness.

Screen Time and its Determinants in Infants and Toddlers: Results from a Metropolitan Area of Istanbul

Objective: This cross sectional study aimed to assess screen time and associated factors in infants and toddlers under the age of 3 years in a metropolitan area. Method: Data were collected from 269 mothers registered in a family health center using a questionnaire. The questionnaire examines the demographic characteristics of families, the time spent by infants and toddlers with screen devices, and factors that may affect screen time, such as income status, education level and resources. Results: Three-quarters of infants and toddlers in this sample used screen devices (n=202, 75.1%). Total screen time ranged from 20 to 270 min/day, with a mean of 101.8±56.2 min/day. Infants and toddlers spent an average of 71.9 min/day watching television, 63.1 min/day using tablets, and 36.85 min/day using mobile phones. Total daily screen time exceeded World Health Organization (WHO) recommendations in 36.3% of infants aged 0-12 months, 84.3% of toddlers aged 13-24 months, and 49.4% of toddlers aged 25-36 months. Age of infant and toddler, maternal education level, and family income were identified as factors associated with risky screen exposure. Conclusion: Families can be educated about the potential consequences of screen time and strategies to reduce screen use. In trainings, families in the risk group should be given priority in terms of factors affecting screen time such as income status, education level and age.

Recommendations for India-specific multiple micronutrient supplement through expert consultation.

Background & objectives Reducing maternal anaemia and enhancing feto-maternal health to achieve desired birth outcomes is a major health concern in India. Micronutrient deficiencies during pregnancy may impact fetal growth and neonatal outcomes. There is increasing interest in using multiple micronutrient supplement (MMS) during pregnancy. However, the World Health Organization (WHO) recommends use of MMS containing Iron and Folic Acid (IFA) in the context of "rigorous research". Against this backdrop, an Indian Council of Medical Research (ICMR)-led MMS design expert group met over six months to review the evidence and decide on the formulation of an India-specific MMS supplement for pregnant mothers for potential use in a research setting. Methods The India-MMS design expert group conducted a series of meetings to assess the available evidence regarding the prevalence of micronutrient deficiencies in pregnant women in India, the health benefits of supplementing with different micronutrients during pregnancy, as well as nutrient interactions within the MMS formulation. Based on these considerations, the expert group reached a consensus on the composition of the MMS tailored for pregnant women in India. Results The India-specific MMS formulation includes five minerals and 10 vitamins, similar to the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) composition. However, the quantities of all vitamins and minerals except Zinc, Vitamin E, and Vitamin B6 differ. Interpretation & conclusions This report provides an overview of the process adopted, the evidence evaluated, and the conclusions from the expert working group meetings to finalize an MMS supplement in pregnancy for the Indian context to be used in a research setting.

Does Self-Reported Trait Mindfulness Contribute to Reducing Perceived Stress in Women Who Practice Yoga and Are Physically Active?

(1) Background: This study aimed to investigate whether yoga practice and physical activity level play an essential role in trait mindfulness and perceived stress reduction. Moreover, the study examined the differences in trait mindfulness and perceived stress between women who practiced yoga and those who engaged in other physical activities or were physically inactive, taking into account the time spent on physical activity in accordance with the World Health Organization recommendations. (2) Methods: A sample of 201 women participated in a cross-sectional online-based study, including 96 yoga practitioners and 105 non-practitioners of yoga (including physically active and inactive individuals). The average age of the participants was 36 years (range, 18-72 years; M = 36.19, SD = 11.64). Respondents completed the Mindful Attention Awareness Scale (MAAS) and the Perceived Stress Scale (PSS-10). (3) Results: Women who practiced yoga and were physically active had a significantly higher level of trait mindfulness and lower perceived stress levels than women who did not practice yoga and were physically inactive. An indirect effect of physical activity on perceived stress through mindfulness was shown only for women practicing yoga for at least 150 min per week. (4) Conclusions: This study revealed the importance of frequent yoga practice in reducing perceived stress and improving mindfulness traits. These findings may serve as a basis for implementing preventive actions in women experiencing high levels of everyday stress.

The Method That Makes Oils and Fats Healthier: Interesterification

Lipids, which provide various additives to the food industry, are developed with various modification techniques. In addition to hydrogenation and fractionation techniques, interesterification has become widespread in recent years. This technique, which has been used for more than a century, is classified as chemical or enzymatic interesterification, depending on the use of metal alcoholate or enzyme as a catalyst during the redistribution of fatty acids in the triglyceride ester on glycerol. Since the partial hydrogenation technique has been abandoned due to the formation of trans fatty acid, interesterification is carried out in the production of trans fat-free oil, in the production of breast milk substitutes, in the optimization of cocoa butter substitutes and equivalents, in the formation of structured lipids with nutritional advantages and in the lipid composition in the edible film. With its expanding area of use, its effect on health has been investigated, and the information obtained from studies on humans is that it does not have a negative effect. However, more work is needed on this subject. On the other hand, the World Health Organization recommends consumption of interesterified fats in order to reduce trans fat consumption. The objective of this review was to gather information about interesterification which has become widespread in the oil industry and has been used in new products. The outcome of this study could help better understanding and utilization of interesterification for future research and applications.

Perception and Attitude of First-Time Mothers Towards Caesarean Section in Secondary Health Care Facility (A Mixed-Method Study)

Abstract Background: Despite the global rise in caesarean section (CS), Nigeria has a CS rate of 2.8%, which is far below the World Health Organisation recommendation of 10%–15%. Primigravida and/or first-time mothers constitute a cohort of women who are prone to obstetric emergencies such as cephalo–pelvic disproportion and obstructed labour. Objectives: To evaluate the first-time mothers’ knowledge, perceptions, and attitudes towards CS. Materials and Methods: This was a mixed-methods study conducted among first-time mothers (primigravids &gt;28weeks and first-time CS-delivered) at Adeoyo Maternity Teaching Hospital, Ibadan, using questionnaires that assessed knowledge and attitude for the quantitative aspect and in-depth interviews for the qualitative aspect using a structured topic guide. Responses from the quantitative aspect were analysed using STATA 15, and each participant’s level of knowledge was scored and categorised as: Good knowledge &gt;70%, fair knowledge 50%–70% and poor knowledge &lt;50%. Content analysis was done for the qualitative aspect, and emerging themes on perception and interpretation in CS were summarised and presented as results for interpretation. Results: About 275 mothers (178 pregnant and 97 CS-delivered) were sampled. Only a few (13.45%) of the participants had good knowledge with an equivocal attitude towards CS. The majority (84%) believed that CS helped in saving lives. Also, there was a statistically significant difference between their knowledge and their educational level, occupation, religion, ethnicity, and family income (P &lt; 0.05). The multinomial regression showed that gainfully employed Christian women significantly had more fair and good knowledge than Muslims (RR = 2.01, 95% CI = 1.13–3.57, P = 0.017) (RR = 2.71, 95% CI = 1.23–5.95, P = 0.013). Conclusion: Only a small number of the participants had good knowledge, and their perceptions about CS varied. The attitudes of participants towards CS appeared mixed, as nearly equal proportions of participants had positive and negative attitudes. Hence, there is a need to increase advocacy, antenatal education, and counselling during antenatal clinic visits. Also, first-time mothers need to be put on insurance to reduce the burden of costs.

P004 BODY MASS INDEX IS RELATED TO SUBTYPES OF ARTERIAL HYPERTENSION IN CHILDREN

Background and Objective: Arterial hypertension (AH) subtypes in the pediatric population may represent distinct pathophysiological subsets, potentially allowing for more targeted interventions and improved blood pressure (BP) management. Emerging evidence suggests that various hemodynamic mechanisms may underlie hypertension development across different age groups. Moreover, overweight and obesity, are closely linked to hypertension and other risk factors. Therefore, this study aims to investigate the relationship between body mass index (BMI) and (AH) subtypes in the pediatric population. Methods: A cross-sectional study was conducted, involving 195 records from 189 children referred to an outpatient cardiology center due to suspected BP abnormalities. Each participant underwent 24-hour ambulatory blood pressure monitoring (24-h ABPM) using a device validated. Demographic, clinical, and anthropometric data were collected. The American Heart Association (2022) criteria were utilized to ensure accurate 24-h ABPM recordings and to classify AH subtypes based on average BP, including: i) isolated diastolic hypertension (IDH); ii) non-divergent systolic-diastolic hypertension (ND-SDH) (pulse pressure [PP]&lt;50 mmHg); iii) divergent systolic-diastolic hypertension (D-SDH) (PP&gt;50 mmHg); and iv) isolated systolic hypertension (ISH). BMI Z-Score was calculated using Colombian reference tables, and nutritional status was determined based on World Health Organization recommendations. Results: Among the participants, 46.0% were male, with a distribution of nutritional status showing 3% underweight, 37% normal weight, 30% overweight, and 30% obese. The average age was 12.3±3.0 years (range: 5-17 years). 24-h ABPM records revealed that 34.0% had normotension, 33.0% had IDH, 16.0% had ND-SDH, 13.0% had D-SDH, and 3% had ISH. The ANOVA test indicated significant differences in BMI Z-Score values among AH subtypes (P value &lt;0.001) (Figure). Conclusions: BMI is related with AH subtypes in children. Specifically, BMI tends to be higher in D-SDH and ISH, which could be characterized by a hyperdynamic state marked by increased activity of the sympathetic nervous system. This finding may help to elucidate the pathophysiology of hypertension in obese children.

Macrodominios de competencias en telesalud de los profesionales del área de la salud

In response to the increasing worldwide implementation of telehealth with the intent of closing the gaps in access to health, the World Health Organization (WHO) stresses the importance of defining competencies for health professionals in this field. This article presents the results of a literature review that identifies telehealth competency domains that strengthen the skills of health professionals. The results were analysed by categorizing the competency domains systematically into macrodomains that encompasskeyaspectsoftelehealthpractice; suchas applicability, remote clinical care, communication, networking, management, professionalism, information technologies, and ethical and legal aspects. These findings, supported by WHO recommendations, provide a solid basis for designing telehealth training programs and can be adapted to local contexts, facilitating the development of policies and strategies to improve the quality and accessibility of health care in remote or underserved settings.

Predictors of Pregnant Women's Decision to Opt for Cesarean Section in Romania.

In Romania, the latest official report indicates that more than half of the births (80,890 cases, representing 52.88% of the total) are performed by cesarean, a rate significantly higher than the World Health Organization (WHO) recommendation of 15-20%. This study aims to identify the predictors associated with women's decisions to opt for cesarean in Romania. An analytical cross-sectional observational study was conducted in the general population of Romania. The study was carried out over the course of 2023, with a total duration of four months. During this period, researchers targeted pregnant women from various regions of the country, regardless of their place of residence, age, or education level. The primary data collection tool was a self-administered online questionnaire, distributed via Google Forms, an accessible and efficient platform that allows for automatic response collection. The questionnaire was distributed online, particularly on social media platforms frequented by pregnant women, such as Facebook, Instagram, and TikTok. A total of 1,301 participants were validated. Socio-demographic and clinical factors significantly influence women's decisions to give birth by cesarean.Among these participants, 435 expressed a preference for cesarean delivery. Key predictors include fear of pain and concern for the child's health. Fear of pain at birth is the first predictor in Romanian women to choose cesarean (OR=2.09; 95% CI: 1.62-2.68). Concerns about the child's health do not increase the likelihood of opting for a cesarean. By utilizing valuable resources such as midwives and implementing strategies like birth plans, significant contributions can be made toward reducing the cesarean rate and improving the childbirth experience for women worldwide.

Trans-fat labelling and potential presence of industrially produced trans-fat in the New Zealand packaged food supply: 2015–2019 & 2022

Background and aimThe World Health Organization (WHO) recommends that countries reduce industrially produced TFA (iTFA) in the food supply. However, New Zealand (NZ) has no mandatory regulation to control amounts of iTFA in foods. The objectives of this study were to assess within the NZ packaged food supply in recent years (2015-19 and 2022): i) the availability of products displaying information on TFA content on nutrition information panels (NIPs), ii) the content of TFA declared, and iii) the presence/potential presence of iTFA (n = 85,892 products). Methods and resultsA database of packaged foods from major NZ supermarkets was used. TFA contents declared on NIPs were benchmarked against limits recommended by the WHO and the Canadian Trans Fat Task Force. Proportions of products listing specific ingredients (containing iTFA) or non-specific ingredients (potentially containing iTFA) were examined. Trends in proportions were assessed (Mantel–Haenszel tests). Among all products and years examined (n = 81,591), 84.0 % did not display information on TFA content. Across all products declaring TFA contents and years 15.4 % and 6.4 %, respectively, were above the WHO and Canadian TFA limits. Across all products and years, 0.8 % and 13.6 % listed ingredients that contained or potentially contained iTFA, respectively. Across 2015–2019, there was a trend of decrease in the proportions of products listing specific (0.9 %–0.7 %; P = 0.018) and non-specific ingredients (15.1 %–12.8 %; P < 0.001). ConclusionInformation on the TFA content and ingredients containing iTFA in NZ packaged foods is lacking and ambiguous and government-led interventions to control and reduce TFA in the food supply are warranted.

Lifestyle modifications among older adults with prehypertension in primary care

In both global and Thai contexts, unhealthy behaviors such as alcohol consumption, smoking, excessive salt intake, and sedentary lifestyles contribute to hypertension. World Health Organization (WHO) recommends lifestyle adjustments for blood pressure control. This quasi-experimental study examined the impact of an intervention on elderly individuals with prehypertension. People living in two villages were selected, matching two others demographically and geographically. The intervention focused on a balanced diet, physical activity, stress management, and reduced tobacco/alcohol use with a low-sodium diet. Blood pressure and heart rate were measured three times after a 10-minute rest using a calibrated sphygmomanometer. The study showed significant improvements with p&amp;lt;0.001. Systolic blood pressure decreased by 5.94 mmHg, diastolic blood pressure decreased by 3.37 mmHg, and heart rate decreased by 4.12 bpm. The findings emphasize the importance of comprehensive lifestyle modifications to manage prehypertension and reduce hypertension-related complications in older people. Further research and interventions are needed to address people with hypertension globally, including in Thailand.

Legislation and policy for involuntary mental healthcare across countries in the FOSTREN network: rationale, development of mapping survey and protocol.

Several countries are currently revising or have already revised their mental health laws to align with the global movement to reduce the use of coercive care. No government has yet fully implemented the recommendation of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) to eliminate the use of coercion in mental healthcare. Consequently, the international field of mental health law and policy is in a degree of flux. To describe the rationale, development and protocol for a project that will map and examine how mental health laws, policies and service capacity across European countries relate to the use of coercive measures, including involuntary admissions and treatment, restraints and seclusion. This will help to better understand the current situation and explore future directions of policies regarding coercive care. The project is being carried out under the purview of the European Cooperation in Science and Technology (COST) action network, entitled FOSTREN (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services). A multidisciplinary group of experts developed a comprehensive survey assessing mental health laws, policies and service frameworks, based on World Health Organization and UNCRPD recommendations. The survey was piloted in three countries, revised and disseminated to 30 FOSTREN country representatives. The survey will provide data for three strands of work on legislation, policies and service-level context. A comprehensive evaluation will be conducted, drawing on findings from all work packages. The project could inform the development of strategies, interventions and legislation to address gaps and promote compliance with international standards.

47 Physical activity, sedentary behavior, and sleep across lifespan in adults across European countries: Background and Design

Abstract Introduction Regular physical activity (PA) has benefits for health throughout the lifespan. In adults, PA benefits musculoskeletal, cardiometabolic health, and overall well-being (Dale et al., 2019). To promote health and well-being, the World Health Organization (WHO) recommends at least 150 minutes of moderate to vigorous (MV)PA or 75 min of vigorous-intensity PA (Bull et al., 2020). However, about 40 – 60% of the EU adults population is leading a predominantly sedentary lifestyle (Nikitara et al., 2021). Sedentary behavior (SB) includes activities such as watching television, playing computer games, and browsing the Internet (Wang et al., 2019). High levels of SB have been associated with decline of PA which, in turn, is associated with negative health outcomes, including obesity. Furthermore, there has been a growing focus on exploring the relationship between SB and sleep duration. This relation between SB and sleep duration is noteworthy, especially when considering that sleep duration guidelines recommend 7-9 hours of sleep for adults in the EU. In 2018, a systematic review synthesized findings from 56 studies that employed iso-temporal substitution models in PA, SB and sleep. Research has shown that changes in the time spent on these movement-related behaviors that make up a 24-h day can interact to influence health outcomes (Trembley et al., 2016). However, to -date, there are no specific recommendations on SB, and sleep is often not included. Therefore, this project will present the background, methods and design of a 24 hour movement summary of behaviors (PA, SB, sleep) for Europe. Methods Utilizing a cross-sectional design we will analyze existing data for PA, SB, and sleep from the Eurostat Organization on European adults 18 to 65+. Descriptive analysis using mean, median, and 95% Confidence Intervals, will be complemented by frequency distributions and histograms. Results The findings from this research have the potential to inform surveillance efforts, public health strategies, evidence-based guidelines, and possibly improve overall well-being. Conclusion Implications of this research may inform researchers on further questions to pursue, policy makers in resource allocation, and practitioners on where to focus intervention efforts.

Indonesian national health policy: Legal analysis of the elimination of mandatory health spending

Pusphose: The elimination of mandatory spending in Law No. 17 of 2023 on Health has sparked controversy, particularly because it contradicts the World Health Organization's recommendation that allocates 5-6% of GDP to health budgeting to facilitate better access to healthcare services. This removal also potentially violates the Indonesian Constitution, which through Article 28E, Article 28H paragraph (2), Article 28D paragraph (3), and Article 34 paragraph (3) guarantees the fulfillment of health rights for vulnerable groups. Method: This study employs a legal dogmatic research method to analyze the constitutionality of eliminating mandatory spending in Law Number 17 of 2023 on Health, as it pertains to the 1945 Constitution of the Republic of Indonesia, using John Rawls' theory of justice as a tool for legal analysis. Result: Law No. 17 of 2023 on Health has eliminated the mandatory spending provision, which previously stipulated a minimum health budget allocation of 5% from the national budget (called APBN) and 10% from the regional budgets (called APBD), as per Law No. 36 of 2009. The new law introduces performance-based budgeting, but it remains unclear how it will be implemented, especially at the regional level. The main criticism is that this potential elimination could reduce health guarantees for vulnerable groups, contradicting the principles of social justice mandated in the Indonesian Constitution. Conclusion: Although the Constitutional Court has rejected a formal review of this law, opportunities still remain for a substantive examination of the real impact of this elimination on the health access of vulnerable groups.

Simulation-based education in the Pacific Islands: educational experience, access, and perspectives of healthcare workers.

The World Health Organization (WHO) recommends simulation-based education (SBE) to acquire skills and accelerate learning. Literature focusing on SBE in the Pacific Islands is limited. The aim of this study was to determine Pacific Island healthcare workers' experiences, perspectives, and access to SBE. This was a cross-sectional survey of Pacific Island healthcare workers. We designed an online questionnaire based on existing literature and expert consultation. The questionnaire included Likert scales, multiple-choice, multi-select and open-ended questions. Participants were healthcare workers recruited from professional networks across the region. Descriptive statistics and relative frequencies summarized data, and comparative testing included unpaired t-tests, Mann-Whitney U, Chi-squared and Fisher's exact tests. Free-text responses were presented to illustrate findings. Responses from 56 clinicians working in 11 Pacific Island countries were included. Fifty were medical doctors (89%), including 31 (55%) surgeons. Participants reported experience with scenario-based simulation (73%), mannequins (71%), and simulated patients (61%). Discrepancies were identified between previous simulation experience and current access for simulated patients (P = 0.002) and animal-based part-task trainers (P = 0.002). SBE was seen as beneficial for procedural skills, communication, decision-making and teamwork. Interest in further SBE was reported by most participants (96%). Barriers included equipment access (59%), clinical workload (45%) and COVID-19 restrictions (45%). Some Pacific Island healthcare workers have experience with SBE, but their ongoing access is predominantly limited to low-technology modalities. Despite challenges, there is interest in SBE initiatives. These findings may inform planning for SBE in the Pacific Islands and may be considered prior to programme implementation.

Lessons learnt from assessing and improving accuracy and positive predictive value of the national HIV testing algorithm in Nigeria.

HIV testing remains an entry point into HIV care and treatment services. In 2007, Nigeria adopted and implemented a two-test rapid HIV testing algorithm of three HIV rapid test kits, following the sequence: Alere Determine (first test), UnigoldTM (second test), and STAT-PAK® as the tie-breaker. Sub-analysis of the 2018 Nigeria HIV/AIDS Indicator and Impact Survey data showed significant discordance between the first and second tests, necessitating an evaluation of the algorithm. This manuscript highlights lessons learnt from that evaluation. A two-phased evaluation method was employed, including abstraction and analysis of retrospective HIV testing data from January 2017 to December 2019 from 24 selected sites supported by the United States President's Emergency Plan for AIDS Relief programme. A prospective evaluation of HIV testing was done among 2895 consecutively enrolled and consented adults, aged 15-64 years, accessing HIV testing services from three selected sites per state across the six geopolitical zones of Nigeria between July 2020 and September 2020. The prospective evaluation was performed both in the field and at the National Reference Laboratory under controlled laboratory conditions. Stakeholder engagements, strategic selection and training of study personnel, and integrated supportive supervision were employed to assure the quality of evaluation procedures and outcomes. The algorithm showed higher sensitivity and specificity in the National Reference Laboratory compared with the field. The approaches to quality assurance were integral to the high-quality study outcomes. We recommend comparison of testing algorithms under evaluation against a gold standard. This study provides context-specific considerations in using World Health Organization recommendations to evaluate the Nigerian national HIV rapid testing algorithm.