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Objective With the completion of the Human Genome Project and swift development of genomic technologies, public health practitioners can use these advancements to more precisely target disease interventions to populations at risk. To integrate these innovations into better health outcomes, public health professionals need to have at least a basic understanding of genomics within various disciplines of public health. This descriptive study focused on the current level of genomics content in accredited master of public health (MPH) programs in the United States. Methods We conducted an internet search on all 171 Council on Education for Public Health (CEPH)–accredited MPH programs in the United States for genomics content in required and elective courses using the search terms “genetics,” “genomics,” and “molecular.” Results Of the 171 CEPH-accredited MPH programs examined, 52 (30.4%) schools and programs in 34 states offered some type of genomics education. Thirty-five (20.5%) schools and programs had a course in genetic epidemiology, 29 (16.9%) had a course in genetic biostatistics or bioinformatics, and 17 (9.9%) had a course in general public health genomics. The remaining 119 offered no course with a focus on genetics or genomics. In addition, some electives or specifically focused courses related to genomics were offered. Conclusion We found inadequate training in public health genomics for MPH students. To realize the promise of precision public health and to increase the understanding of genomics among the public health workforce, MPH programs need to find ways to integrate genomics education into their curricula.

The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures.The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC.The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%.Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.El 14 de marzo de 2020 España declaró el estado de alarma por la pandemia por COVID-19 incluyendo medidas de confinamiento. El objetivo es describir el proceso de desescalada de estas medidas.Un plan de transición hacia una nueva normalidad, del 28 de abril, incluía 4 fases secuenciales incrementando progresivamente las actividades socioeconómicas y la movilidad. Concomitantemente, se implementó una nueva estrategia de diagnóstico precoz, vigilancia y control. Se estableció un mecanismo de decisión bilateral entre Gobierno central y comunidades autónomas (CCAA), guiado por un panel de indicadores cualitativos y cuantitativos de la situación epidemiológica y las capacidades básicas. Las unidades territoriales evaluadas comprendían desde zonas básicas de salud hasta CCAA.El proceso se extendió del 4 de mayo al 21 de junio y se asoció a planes de refuerzo de las capacidades en las CCAA. La incidencia disminuyó de una mediana inicial de 7,4 por 100.000 en 7 días a 2,5 al final del proceso. La mediana de pruebas PCR aumentó del 53% al 89% de los casos sospechosos, y la capacidad total de 4,5 a 9,8 pruebas semanales por 1.000 habitantes; la positividad disminuyó del 3,5% al 1,8%. La mediana de casos con contactos trazados aumentó del 82% al 100%.La recogida y análisis sistemático de información y el diálogo interterritorial logaron un adecuado control del proceso. La situación epidemiológica mejoró, pero sobre todo, se aumentaron las capacidades, en todo el país y con criterios comunes, cuyo mantenimiento y refuerzo fue clave en olas sucesivas.

Purpose Traumatic brain injury (TBI) is one of the major public health concerns worldwide. Developing a TBI registry could facilitate characterizing TBI, monitoring the quality of care, and quantifying the burden of TBI by collecting comparable and standardized epidemiological and clinical data. However, a national standard tool for data collection of the TBI registry has not been developed in Iran yet. This study aimed to develop a national minimum data set (MDS) for a hospital-based registry of patients suffering from TBI in Iran. Methods The MDS was designed in two phases, including a literature review and a Delphi study with content validation by an expert panel. After the literature review, a comprehensive list of administrative and clinical items was obtained. Through a two-round e-Delphi approach conducted by invited experts with clinical and research experience in the field of TBI, the final data elements were selected. Results An MDS of TBI was assigned to two parts: administrative part with 5 categories including 52 data elements, and clinical part with 9 categories including 130 data elements. Conclusion For the first time in Iran, we developed an MDS specified for TBI consisting of 182 data elements. The MDS would facilitate implementing a TBI's national level registry and providing essential, comparable, and standardized information.

OBJECTIVE: The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed. MATERIAL AND METHODS: An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed. RESULTS: A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. CONCLUSIONS: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.

Sleep is a basic need for everyone. In conditions of rest and sleep, the body performs a recovery process to restore the body's stamina to be in optimal condition. The impact of lack of sleep causes a person to have difficulty concentrating, fatigue, headaches, feeling unwell, lazy, decreased memory, confusion, and has an impact on the ability to make decisions. The purpose of this study was to analyze the relationship between stress levels and sleep quality in the final undergraduate students of Public Health at Pahlawan Tuanku Tambusai University in 2021. This type of research was a descriptive correlation study with a Cross Sectional design. This research was conducted in July 2021.2020 with a sample of 60 final undergraduate students in Public Health, Tuanku Tambusai University, obtained using a total sampling technique. Data collection techniques using a questionnaire. Analysis of the data used is univariate analysis and bivariate analysis with Chi Square test. The results showed that there was a significant relationship between stress levels and sleep quality in final students with p value = 0.003. By conducting this research, researchers expect students to prevent stress that can affect sleep quality.

Objective To evaluate the incidence of venous thromboembolism (VTE) in 90-day pre-operative period and at 30 and 90 days post surgery in patients who underwent debulking for ovarian cancer, analyze the impact of extended prophylaxis that was initiated in 2012, and examine the influence of data collection technique on reported rates of VTE. Methods This retrospective database and records study examined rates of VTE in epithelial ovarian cancer patients in Manitoba, Canada between 2004 and 2016. Cases of VTE were identified using ICD codes, drug prescriptions, and records reviews; 4 different data collection methods were used. Analysis was performed with analysis of variance, Kruskal-Wallis and χ2 tests, and interrupted time series models. Results Data collection identified 823 debulking surgeries, with a final cohort of 779 patients; data were analyzed before and after extended prophylaxis intervention. Overall rates of VTE varied by collection method and were 1.82%–5.47%, 0.36%–3.16%, 0.85%–1.46%, and 1.46%–2.79%, respectively. During this timeframe, we noted a significant increase in the use of neoadjuvant chemotherapy (P = 0.010) and stage migration to stage 3 (P Conclusion We report the rates of VTE utilizing four different data collection methods. We found a low overall rate, with some trends requiring further investigation. This study highlights the importance of data collection method on the reported rates of VTE in research.

Background We require high-quality information on the current burden, the types of therapy and resources available, methods of delivery, care pathways and long-term outcomes for people with aphasia. Aim To document and inform international delivery of post-stroke aphasia treatment, to optimise recovery and reintegration of people with aphasia. Methods & Procedures Multi-centre, prospective, non-randomised, open study, employing blinded outcome assessment, where appropriate, including people with post-stroke aphasia, able to attend for 30 minutes during the initial language assessment, at first contact with a speech and language therapist for assessment of aphasia at participating sites. There is no study-mandated intervention. Assessments will occur at baseline (first contact with a speech and language therapist for aphasia assessment), discharge from Speech and Language Therapy (SLT), 6 and 12-months post-stroke. Our primary outcome is changed from baseline in the Amsterdam Nijmegen Everyday Language Test (ANELT/Scenario Test for participants with severe verbal impairments) at 12-months post-stroke. Secondary outcomes at 6 and 12 months include the Therapy Outcome Measure (TOMS), Subjective Index of Physical and Social Outcome (SIPSO), Aphasia Severity Rating Scale (ASRS), Western Aphasia Battery Aphasia Quotient (WAB-AQ), stroke and aphasia quality of life scale (SAQoL-39), European Quality of Life Scale (EQ-5D), lesion description, General Health Questionnaire (GHQ-12), resource use, and satisfaction with therapy provision and success. We will collect demography, clinical data, and therapy content. Routine neuroimaging and medication administration records will be accessed where possible; imaging will be pseudonymised and transferred to a central reading centre. Data will be collected in a central registry. We will describe demography, stroke and aphasia profiles and therapies available. International individual participant data (IPD) meta-analyses will examine treatment responder rates based on minimal detectable change & clinically important changes from baseline for primary and secondary outcomes at 6 and 12 months. Multivariable meta-analyses will examine associations between demography, therapy, medication use and outcomes, considering service characteristics. Where feasible, costs associated with treatment will be reported. Where available, we will detail brain lesion size and site, and examine correlations with SLT and language outcome at 12 months. Conclusion International differences in care, resource utilisation and outcomes will highlight avenues for further aphasia research, promote knowledge sharing and optimise aphasia rehabilitation delivery. IPD meta-analyses will enhance and expand understanding, identifying cost-effective and promising approaches to optimise rehabilitation to benefit people with aphasia.

Introduction Analysing morbidity and using this to improve the quality of patient care is an important component of clinical governance. Several methods of data collection and clinical analysis have been suggested, but to date none have been widely adopted. Method All adult patients sustaining facial fractures were prospectively identified between 01 March 2019 and 28 February 2020, and matched to those who required a return to theatre for surgical complications. Morbidity resulting in a return to theatre was determined using the Clavien-Dindo classification and the Northwestern University error ascribing method. Results During this period, return to theatre occurred for 33/285 (11.6%) procedures and 23/173 (13.3%) of patients being treated for facial fractures. According to the 27 procedures discussed, Clavien-Dindo Grade IIIb was most commonly found (20/27). Error in judgement (13/35) and nature of disease (12/35) were ascribed as the most common causes of error. Presence of a consultant was associated with increased odds of a return to theatre (p=0.014). Conclusions Standardised national data collection of morbidity and error is required for comparisons of outcomes within a single institution or between institutions. This is the first paper to utilise these widely used methods of morbidity analysis for facial fracture surgery. We would recommend further development of an error analysis method that is more specific to those complications from facial fracture surgery.

Objetivo: Realizar uma overview relacionada ao assunto traumatismo em dentes decíduos e permanentes, bem como analisar a qualidade metodológica e o risco de viés dos trabalhos incluídos (PROSPERO CRD42018107840). Métodos: Este trabalho foi conduzido de acordo com o Preferred Reporting Items for Overviews (PRIO). A estratégia de busca foi aplicada nas bases de dados eletrônicas PubMed, WebScience, Embase, Cochrane e Scopus; que incluiu publicações até outubro de 2020, sem restrição de ano e idioma. Foram avaliados os critérios de elegibilidade: trabalhos com enfoque em lesões traumáticas dentárias; apresentar termo “revisão sistemática” (RS) e/ou “meta-análise” no título ou resumo, critérios de elegibilidade, técnicas sistematizadas para coleta e análise de dados, e instrumentos para avaliação da qualidade dos estudos incluídos; identificar as bases de dados utilizadas na pesquisa; abranger o assunto: traumatismo de dentes permanentes e/ou decíduos ou tecidos de suporte. Foi realizada a avaliação da qualidade das RSs utilizando o Assessment of Multiple Systematic Reviews (AMSTAR2) e averiguada a aderência do artigo ao Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Os resultados foram analisados pelo Grading of Recommendations, Assessment, Development and Evaluation (GRADE) a fim de classificar a certeza da evidência científica e avaliado o risco de viés pelo ROBIS. Resultados: Foram identificados 2.561 trabalhos, sendo 2.469 excluídos, totalizando 92 artigos incluídos. Nota-se que a partir do ano de 2018 os trabalhos apresentaram melhor qualidade metodológica. E a maioria dos trabalhos apresentaram certeza da evidência científica alta pelo sistema GRADE modificado, e risco de viés baixo pela ferramenta ROBIS. Conclusão: As revisões sistemáticas e meta-análises incluídas apresentaram dificuldade no processo de estruturação metodológica atribuindo, em média, certeza da evidência científica alta para o GRADE, como também risco de viés baixo pelo ROBIS.

Background: Prospective data collection for perioperative outcomes might increase awareness of surgical results obtained for patients with prostate cancer (PCa) undergoing robot-assisted radical prostatectomy (RARP). This would prompt the implementation of measures aimed at reducing the risk of adverse outcomes. Objective: To assess the efficacy of an audit and feedback process aimed at identifying the most common complications after RARP and at implementing measures to improve outcomes. Design, setting, and participants: Overall, 415 patients treated with RARP by a high-volume surgeon were included. Perioperative outcomes for 187 patients treated between September 2016 and December 2017 were prospectively collected at 30 d according to the European Association of Urology guideline recommendations (group 1). An audit and feedback process was implemented in January 2018 whereby the most common complication (anastomotic leak) was identified and measures aimed at improving outcomes (changes in the anastomotic technique) were implemented. The outcomes for group 1 were then compared to 228 patients treated after implementation of the modified surgical technique (group 2). Surgical procedure: A novel technique for posterior reconstruction and urethrovesical anastomosis was introduced. Measurements: Perioperative outcomes included blood loss, operative time, length of stay, and 30-d postoperative complications. Logistic regression models tested the effect of the novel surgical technique on anastomotic leaks. Results and limitations: Overall, 97 patients (23%) experienced postoperative complications at 30 d. The rate of anastomotic leaks was significantly lower in group 2 compared to group 1 (3.1% vs 9.6%; p < 0.01). Similarly, overall and Clavien-Dindo grade ≥2 complication rates were lower in group 2 versus group 1 (17% vs 31%, and 6% vs 20%; both p ≤ 0.001). In multivariable analyses, treatment after implementation of changes in the anastomotic technique independently predicted a lower risk of complications (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.38–0.89) and of anastomotic leaks (OR 0.43, 95% CI 0.17–0.97). The lack of randomization represents the main limitation. Conclusions: Implementation of changes in the urethrovesical anastomosis technique arising from increased awareness of surgical outcomes reduced the risk of anastomotic leaks. These findings highlight the importance of audit and feedback processes using a standardized method for reporting surgical morbidity. Patient summary: Increased awareness of surgical outcomes prompted us to change our technique for connecting the bladder to the urethra during robot-assisted surgery to remove the prostate in patients with prostate cancer. These changes resulted in significant improvements in surgical outcomes.

Autistic individuals undergoing magnetic resonance imaging (MRI) examinations may face significant challenges, mainly due to sensory overload and MRI environment-related limitations. This study aimed to explore radiographers' perspectives and experiences regarding MRI scanning of autistic individuals. Data collection was achieved using a specifically designed mixed methods questionnaire on Qualtrics. The snowball technique was used. This UK-wide survey was electronically distributed by three main recruitment agencies between December 2020 and February 2021. 130 valid responses were received. A lack of relevant training and knowledge related to autism was noted. Effective communication, optimisation and customisation of the MRI examination, and MRI environment adjustments facilitated the completion of a safe and effective MRI examination. Poor patient-radiographer communication, unavailability of Special Educational Needs (SEN) experts, lack of specialised radiographer training and lack of specific guidelines were identified as the main barriers to successful MRI examinations. Although routine MRI safety and patient care rules will apply, MRI scanning of autistic individuals requires customisation and reasonable adjustments in communication, environment, and training of clinical teams. In addition, guidelines should be established to be used as a reference point to improve clinical practice. The adjustments proposed by radiographers were all consistent with the interventions in the wider literature. MRI practice for personalised care of autistic individuals should be aligned with current evidence, to customise communication and offer workflow and environmental adjustments. Formal training related to autism, integrated within radiography academic curricula and better co-ordination and communication of interdisciplinary teams would provide the necessary skill mix to deliver safe, high quality MRI scans with optimal experience for autistic service users and their carer(s). [Abstract copyright: Copyright © 2021 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.]

Background Although movement variability and long-range correlations (LRCs) have been assessed in relation to neuropathology and aging during walking, to date only a few studies have investigated these aspects in subjects of different skill levels during prolonged overground running. Research question What effect does skill level and run duration have on different stride parameters, measures of variability and long-range correlations? Methods Using a between-subject repeated measures design, we assessed stride mechanics, variability and LRCs in recreational and elite runners over the course of a continuous exhaustive run. All subjects ran at a fixed, pre-determined running speed relative to their maximal performance. Stride parameters were continually recorded using a single foot-mounted inertial measurement unit. It was hypothesized that a significant reduction in the strength of the LRCs would occur over the course of the run and that the observed changes would be more pronounced in the group of recreational runners. Results Runners maintained a consistent stride length (SL), stride time (ST) and contact time (CT) during the run, while peak impact acceleration increased. Across groups, long-range correlations significantly decreased over the course of the run, while the magnitude of the variability remained constant. LRCs did not differ significantly between groups. Significance This is the first study to simultaneously investigate the effects of prolonged running and skill level on a range of stride parameters as well as stride-to-stride variability. Generally, long-range correlations were shown to be sensitive to run duration, while the magnitude of the variability did not differ between earlier and later stages of the run. The lack of a group effect on LRCs supports the idea that the mechanisms responsible for the emergence of temporal patterns in the stride pattern are not influenced by skill level.

The utility of any database or registry depends on the completeness and accuracy of the data it contains. This report documents the validity of data elements within DataDerm, the clinical registry database of the American Academy of Dermatology. An external audit of DataDerm, performed by a third-party vendor, involved the manual review of 1098 individual patient charts from calendar year 2018 from 8 different dermatology practices that used 4 different electronic health records. At each site, 142 discrete data fields were assessed, comparing the data within DataDerm to the source data within the electronic health record. Audited data included 3 domains of data elements (diagnoses, medications, and procedures) and a performance measure ("Biopsy Reporting Time-Clinician to Patient"), which is 1 of several measures used by DataDerm as a Qualified Clinical Data Registry. Overall completeness of data was 95.3%, with a range among practices of 90.6% to 98.5%. Overall accuracy of data was 89.8%, with a range of accuracy among practices of 81.2% to 94.1%. These levels of completeness and accuracy exceed the rates in the literature for registries that are based on data that is extracted from electronic health records; and therefore, this audit validates the excellent quality of data in DataDerm.

BACKGROUND: Use of simulated patients (SP) to assess the quality of pharmacy services and impact of interventions is increasing. The CRiSP (Checklist for Reporting research using Simulated Patient methodology) checklist was recently developed, assisting researchers to report items necessary to meet a minimum agreed standard. OBJECTIVE(S): To identify which CRiSP items were reported in SP studies for community pharmacy research, identify any gaps in reporting and describe the overall quality of reporting for the SP studies identified. METHODS: Papers published during 2018-2020 using SP methodology in community pharmacy settings were identified from MEDLINE and Embase. The 50 most recent ones were selected. Data were extracted independently and in duplicate. Each paper received a coded numerical value denoting compliance with each item of CRiSP (1 = yes, 2 = no, 3 = unclear, 4 = not applicable, 5 = partially complete). Data were analysed using Microsoft Excel and reported as frequencies and percentages of each code for the checklist items, across the 50 papers. RESULTS: No paper fulfilled all items in the CRiSP checklist. The mode(s) of delivery of SP assessments (item 17) was reported in all papers, while use of the term SP (item 1); number of SPs (4a); scenario details (9a); describing procedures12; data collection procedure (18); and ethics approval (23a) were reported in at least 80% of papers. Items not reported in over 50% of papers were: scenario development (8a), validation (8b) and flexibility (9b); materials used (10a) and copies of materials (10b); and procedures for SP identification (15). Researchers found interpretation of the checklist unclear and utilised working definitions to ensure consistency in coding. CONCLUSIONS: This review identified that pharmacy research involving SP methodology is often inadequately reported by researchers. The CRiSP checklist is a comprehensive tool to assess the quality of SP methodology reporting but may require some refinement to ensure consistency in use. ispartof: Research in Social and Administrative Pharmacy vol:18 issue:2 pages:2301-2307 ispartof: location:United States status: published

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity in the United States, and timely treatment is imperative. Delay in treatment of PPH can lead to significant blood loss and increased morbidity and mortality. Supplies and medications essential for treating PPH are typically not located in close proximity to the hemorrhaging patient, leading to inefficiency and delay in timely response to hemorrhage. Methods: An in situ hemorrhage simulation was created dictating the collection of a prespecified list of supplies commonly used in response to PPH on labor and delivery (L&D). Baseline data were collected, then Lean Six Sigma tools were used to construct a process map, including recording times and cumulative distance traveled for collection of each item. The simulation was repeated after development, creation, and deployment of each intervention. For the first intervention, a PPH cart was created containing the supplies most used in response to PPH. Second, a PPH medication kit was created consisting of a refrigerated box containing all medications typically administered during a PPH. Results: The average time to collect a prespecified list of supplies and medications in response to a PPH scenario was 11 minutes 5 seconds (standard deviation [SD] = 3 minutes 33 seconds), with an average cumulative distance traveled of 4,092 feet. Following Intervention 1, the time decreased to 4 minutes 0 seconds, with 918 feet traveled (only one trial performed). Intervention 2 further reduced the average time and cumulative distance to 2 minutes 14 seconds (SD = 16 seconds) and 462 feet, respectively. This represents a 79.8% reduction in time and an 88.7% reduction in distance from baseline to postintervention. Conclusion: A PPH cart and medication kit can significantly reduce the amount of time and distance traveled to obtain materials necessary to treat hemorrhage, thus optimizing a team's ability to efficiently treat PPH.

BACKGROUND In 2018, an innovative, State government funded cannabis medicines drug information service was established for health professionals in New South Wales (NSW). The NSW Cannabis Medicines Advisory Service (CMAS) provides expert clinical guidance and support to medical practitioners considering prescribing a cannabis medicine to their patient(s). AIMS This research examines quality assurance and patient outcomes related to enquirers' experience with NSW CMAS. METHODS Data collection involved an online, anonymous survey with two components. Following a health professional enquiry, quality assurance data was collected about the enquirers' experience with NSW CMAS. The second survey focused on patient outcomes and provides real-world observational data about cannabis medicines safety and effectiveness across a wide range of indications. RESULTS Data collection occurred between January 2020 and June 2021. Preliminary analyses were based on 68 quality assurance and 50 patient outcomes survey responses. General practitioners represented the highest proportion of survey responses (n = 33, 49%). The most common enquiry involved 'patient-specific advice' (n = 50, 74%). Patient-specific information provided by the service was mainly used for prescribing decision support (n = 45, 90%). CONCLUSIONS Preliminary findings highlight the impact of an innovative cannabis medicines drug information service in supporting health professional clinical practice in an area of rapid knowledge translation. Quality assurance data indicates that the service is perceived well by the majority of enquirers. Patient outcomes data across a wide range of indications suggest some effectiveness and a reasonable safety profile for prescribed cannabis medicines for most patients. This article is protected by copyright. All rights reserved.

Objectives To understand the social and individual effects of the disease and make decisions on the allocation of health resources, it is necessary to understand the economic burden of coronavirus disease (COVID-19); however, there are limited data in this field. This study aimed to estimate diagnostic and therapeutic costs of patients with a diagnosis of or suspected of COVID-19 disease admitted to hospitals in northeast Iran. Methods This descriptive and analytical research was conducted as a retrospective study using the data collected from 2980 patients admitted to 30 hospitals from February to April 2020 in Iran. For data collection, an appropriate data capture tool was designed to record detailed resource use. A multivariate regression analysis was performed to examine the association between the treatment costs and sociodemographic, disease severity, and underlying diseases. Data were analyzed using Excel 2017 (Microsoft, Redmond, WA) and SPSS version 21 software (SPSS Inc., Chicago, IL). Results The inpatient costs per patient were Int$416, of which 74% were paid by social health insurance systems, 19% by the government, and 7% by the patients. The largest cost components were hoteling (37%) and medicine (36%). The 4 subscales of age, sex, underlying disease, and severity predicted 48.6% of the cost variance. Conclusion Understanding the economic consequences of diseases can help policymakers to make plans to reduce out-of-pocket payments and make plans for funding. Since COVID-19 is a newly emerging disease and there is no definitive cure for the disease, the discovery of an effective medicine may alter medical costs and reduce the hospital length of stay, therefore significantly reducing treatment costs.

Objective to assess the inter-rater reliability (IRR) of the revised Cochrane risk-of-bias tool for randomised trials (RoB2). Methods Four raters independently applied RoB2 on critical and important outcomes of individually randomized parallel-group trials (RCTs) included in the Cochrane Review “Cannabis and cannabinoids for people with multiple sclerosis.” We calculated Fleiss’ Kappa for multiple raters and time to complete the tool; we performed a calibration exercise on five studies, then we developed an implementation document (ID) specific for the condition, and the intervention addressed by the review with instructions on how to answer the signalling questions of RoB2 tool. We measured IRR before and after the ID adoption Results Eighty results related to seven outcomes from 16 RCTs were assessed. During calibration exercise we reached no agreement for overall judgment (IRR -0.15); IRR for individual domains ranged from no agreement to fair. Mean time to apply the tool was 168.5 minutes per study. Time to complete the calibration exercise and develop the ID was about 40 hours. After the ID adoption ID, overall agreement increased to slightly (IRR 0.11) for the first five studies and moderate (IRR 0.42) for the remaining 11. IRR for individual domains ranged from no agreement to almost perfect. Mean time to apply the tool decreased to 41 minutes. Conclusion RoB2 tool is comprehensive but complex even for high experienced raters. The development of an ID specific for the review may improve reliability substantially.

Although recommendations to manage women with rheumatoid arthritis (RA) during the reproductive phase have been established, there is further need for evidence-based information on drug treatment and safety during pregnancy.1 Registries are excellent data sources to address remaining questions. Therefore, a minimal core data set for registers studying pregnancy in rheumatology has been developed recently by an EULAR task force.2 We evaluated the feasibility of data collection according to this minimal core data set in the daily clinical management of pregnant women with RA within the rheumatology department of the University Hospital of Leuven (UHL). We performed a retrospective patient chart study in a population of 1072 patients (360 men and 712 women) with RA with a planned rheumatology outpatient visit at UHL between November 2019 and November 2020. Women were included if they were diagnosed with RA before getting pregnant, had a recorded pregnancy during the past 5 years and …

Background and Purpose. Physical therapists are at risk for work-related musculoskeletal disorders (WMSDs). Little is known of how therapists respond to injury or of what actions they take to prevent injury. The purpose of this study was to investigate the prevalence and severity of WMSDs in physical therapists, contributing risk factors, and their responses to injury. Subjects. As part of a larger study, a systematic sample of 1 in 4 therapists on a state register (n=824) was surveyed. Methods. An 8-page questionnaire was mailed to each subject. Questions investigated musculoskeletal symptoms, specialty areas, tasks and job-related risk factors, injury prevention strategies, and responses to injury. Results. Lifetime prevalence of WMSDs was 91%, and 1 in 6 physical therapists moved within or left the profession as a result of WMSDs. Younger therapists reported a higher prevalence of WMSDs in most body areas. Use of mobilization and manipulation techniques was related to increased prevalence of thumb symptoms. Risk factors pertaining to workload were related to a higher prevalence of neck and upper-limb symptoms, and postural risk factors were related to a higher prevalence of spinal symptoms. Conclusion and Discussion. Strategies used to reduce work-related injury in industry may also apply to physical therapists. Increased risk of thumb symptoms associated with mobilization techniques suggests that further research is needed to establish recommendations for practice. The issues for therapists who move within or leave the profession are unknown, and further research is needed to better understand their needs and experiences.

Over recent years it has become increasingly clear that health related quality of life (HRQoL) is an important outcome for assessing the effectiveness of bariatric surgery. HRQoL can be measured using uni dimensional tools to assess factors such as mobility, mood, self esteem or eating behavior or multidimensional tools which assess health status in the broadest sense. This chapter will present these different measurement tools and describe their use across a range of studies in the context of bariatric surgery. It will then evaluate the pros and cons of each tool and consider the issues relevant for identifying the best tool for any given situation. Finally, the chapter will conclude that there is no one measure of HRQoL that meets all research or clinical needs for bariatric surgery and that the choice of measure should take into account the definition of HRQoL being used, the function of the measure being used and the practicalities of the data collection process.

The overprovision and irrational use of antibiotics and injections are a major public health concern. Public reporting has been adopted as a strategy to encourage good prescribing practices. This study evaluated the effects of public reporting on antibiotic and injection prescriptions in urban and rural primary care settings in Hubei province, China. A randomized control trial was conducted, with 10 primary care institutions being subject to public reporting and another 10 serving as controls. Prescription indicators were publicly reported monthly over a one-year period. Prescriptions for bronchitis, gastritis and hypertension before and after the intervention were collected. Difference-in-difference tests were performed to estimate the effect size of the intervention on five prescription indicators: percentage of prescriptions containing antibiotics; percentage of prescriptions containing two or more antibiotics; percentage of prescriptions containing injections; percentage of prescriptions containing antibiotic injections; and average prescription cost. Public reporting had varied effects on prescriptions for different diagnoses. It reduced antibiotic prescribing for gastritis. Prescriptions containing injections, especially antibiotic injections, also declined, but only for gastritis. A reduction of prescription costs was noted for bronchitis and gastritis. Public reporting has the potential to encourage good prescribing practices. Its effects vary with different disease conditions.

The present study investigated how intervention might alter the relationship between perpetrating violence and later drug use. A cluster-randomized controlled trial design involving 72 schools (38 intervention, 34 control) and 6390 students attending grades 7 and 8 was employed in Brazil. Drug use and violence were assessed at three points. A random-intercept cross-lagged panel model examined the reciprocal association between drug use and school violence domains across the three data collection waves. For both groups, we found that the cross-lagged effect of perpetration on further drug use in adolescents was stronger than the reverse, but the interrelationship was not statistically significant between #Tamojunto and control schools. The carry-over effects of drug use and violence were also not significantly different between groups. There is a lack of evidence showing that #Tamojunto can modify the dynamics between drug use and school violence across the 21-month period. The direction of the causal effect (i.e., the more perpetration behavior, the more subsequent drug use behavior) is present, but weak in both groups. The trial registration protocol at the national Brazilian Register of Clinical Trials (REBEC) is #RBR-4mnv5g.

ObjectiveAffective disorders are associated with atypical voice patterns; however, automated voice analyses suffer from small sample sizes and untested generalizability on external data. We investigated a generalizable approach to aid clinical evaluation of depression and remission from voice using transfer learning: we train machine learning models on easily accessible non-clinical datasets and test them on novel clinical data in a different language.MethodsA Mixture-of-Experts machine learning model was trained to infer happy/sad emotional state using three publicly available emotional speech corpora in German and US English. We examined the model’s predictive ability to classify the presence of depression on Danish speaking healthy controls (N = 42), patients with first-episode major depressive disorder (MDD) (N = 40), and the subset of the same patients who entered remission (N = 25) based on recorded clinical interviews. The model was evaluated on raw, de-noised, and speaker-diarized data.ResultsThe model showed separation between healthy controls and depressed patients at the first visit, obtaining an AUC of 0.71. Further, speech from patients in remission was indistinguishable from that of the control group. Model predictions were stable throughout the interview, suggesting that 20-30 seconds of speech might be enough to accurately screen a patient. Background noise (but not speaker diarization) heavily impacted predictions.ConclusionA generalizable speech emotion recognition model can effectively reveal changes in speaker depressive states before and after remission in patients with MDD. Data collection settings and data cleaning are crucial when considering automated voice analysis for clinical purposes.Significant outcomes- Using a speech emotion recognition model trained on other languages, we predicted the presence of MDD with an AUC of 0.71.- The speech emotion recognition model could accurately detect changes in voice after patients achieved remission from MDD.- Preprocessing steps, particularly background noise removal, greatly influenced classification performance.Limitations- No data from non-remitters, meaning that changes to voice for that group could not be assessed.- It is unclear how well the model would generalize beyond Germanic languages.Data availability statementDue to the nature of the data (autobiographical interviews in a clinical population), the recordings of the participants cannot be shared publicly. The aggregated model predictions and code used to run the analyses is available athttps://github.com/HLasse/SERDepressionDetection.

Background: Improving the mothers' knowledge and practice regarding preserved food is very important and can reduce the effects of preserved food on their children's health. Aim: To evaluate the effect of video-assisted teaching on mothers' knowledge and practices regarding preserved food and their children health. Subjects and Methods: Design: A quasi-experimental research design was utilized in this study. Setting: This study was applied in Pediatric Outpatient Clinics at Sohag University Hospital. Sample: A convenient sample of (300) mothers was included in the study. Tools of data collection: One tool was used: (I) structured interviewing questionnaire, it consisted of three parts: (I) demographic data of the studied mothers, (II) knowledge assessment tool, and (III) reported practice assessment tool. Results: According to the findings of this study, after participating in a video-assisted structured education program mothers' total knowledge and practice about preserved foods improved with statistically significant differences. Conclusion: The current study concluded that video-assisted structured teaching was effective in improving mothers' knowledge and practices level regarding the effects of preserved food on their children's health. Recommendations: It is very important to provide mothers with a teaching program regarding the effects of preserved food on their children's health to promote and improve their knowledge and practices.

Background: Vaccines are vital in containing the COVID-19 epidemic and may be an essential tool in re-establishing "normalcy". The aim of the research was to investigate COVID‑19 vaccination and predictors of vaccine hesitancy in Zagazig City. Research design: A descriptive, cross-sectional design was used. Setting: The research was carried out in Zagazig City and Shaybah Village, Egypt. Subjects: A multistage systematic random sample involving 997 participants. Tools: Three questionnaires were used for data collection. I. The interview questionnaire consists of three tools: socio-demographic data, individual factors, and knowledge about the COVID-19 vaccine. II. Attitude assessment toward vaccine, and III. Application of the Health Belief Model regarding COVID‑19 vaccination. Results: Only 10% of studied subjects had taken the vaccine, and 24.2% of them had the intention to take the vaccine. In addition, 75.8% of them have vaccine hesitancy. Moreover, 54.0% of the studied subjects had adequate knowledge about the COVID-19 vaccine. The highest percentage of the studied subjects did not know the difference between types of vaccine (40.9%). In addition, 60% of subjects have positive attitudes about the COVID-19 vaccine. Furthermore, 40.3% of subjects have a neutral health belief model regarding the COVID-19 vaccine. Conclusion: The study presented that more than three-quarters of study participants had vaccine hesitancy. In general, more than half of the subjects examined have enough knowledge. Moreover, three-fifths of them have a positive attitude toward the COVID-19 vaccine. Furthermore, two-fifths of the studied subjects had a neutral health belief model about the COVID-19 vaccine. Recommendation: Health awareness about the importance of vaccines to protect from severe infection and deadly complications of COVID- 19 virus

Background It is important to examine perinatal deaths as part of a national mortality audit to identify risk factors. Implementing and re-evaluating recommendations from perinatal mortality audits completes the audit cycle, preventing similar deaths in the future. Lack of implementation results in recommendations recurring. Objectives In this study we examine national perinatal mortality audits’ methodology in four high-income countries (United Kingdom, New Zealand, Ireland, Netherlands) to highlight different approaches taken. We compare the recommendations made in these audits’ reports over the last five years, as well as review national initiatives and programmes addressing them. Study Design This study is an integrative review where two comprehensive literature searches were completed: on established national perinatal mortality audits in high-income countries; and on national initiatives addressing recommendations from these audits. Content analysis of the audits’ recommendations was performed organising them into themes according to topics these focused on. Results Though the methodology of the national perinatal mortality audits varied, all four were state-funded and had standardised online data collection forms to report deaths. The recommendations themes included: Raising public awareness of perinatal mortality risk factors, Detection of fetal growth restriction, Prevention of preterm birth, Resources for data collection and review. Only the UK had various initiatives addressing perinatal mortality risk factors directly. New Zealand included stakeholders in the audit recommendations’ development and provided updates on their implementation. The Netherlands developed a programme for audit recommendation implementation. Ireland created a group which is progressing some recommendations from the audit. Conclusions National perinatal mortality audits are important in identifying contributory factors and making recommendations to address these. Recurring recommendations suggest a failure to resolve the identified issues. This study shows how some challenges are common to high-income countries’ audits, highlighting the need for shared learning of successful initiatives.

Background: Everyone has been affected by the coronavirus disease (COVID-19) epidemic, including students. Understanding public knowledge and adherence level to preventive measures is vital for prevention of COVID-19 pandemic. Aim: to assess adherence to COVID-19 related public health measures among Minia university students based on health belief model. Research design: a descriptive cross-sectional design was used. Setting: Minia University, which comprises (20) faculties. Sample: A systematic random sample consisted of 460 students Data collection Tools: 1st tool: Structured interview questionnaire: included questions related to socio-demographic characteristics, medical data and life style data. 2nd tool: COVID-19 Knowledge Assessment Questionnaire. 3rd tool: COVID-19 Health Belief Scale. 4th tool: Covid-19 Self-Efficacy Scale and the 5th tool: Adherence to COVID-19 related Public Health Measures Scale. Results: less than half of participants their age ranged from 21 – 23yrs. with mean age (21 ± 2.05 yrs.). More than two-thirds of them were knowledgeable about COVID-19 related public health preventive measures with mean score (21.45 ± 3.55). 60.6% of participants students were adherent to these measures. 70.2% of participants have high perceived susceptibility to get COVID-19 while 68.4% of them have high perceived severity. 70.7% of them have high self-efficacy to comply with those preventive measures. Conclusion: There was highly statistically significant relation between participants level of adherence and their perceived susceptibility, perceived severity, perceived barriers, their cues to adhere with those measures and their self-efficacy. Recommendations: Additional research studies in Egypt should be conducted with a broader geographic scope to assess over all community-level of adherence to preventive measures and to identify barriers of noncompliance with these measures.

Background The International Classification of Diseases-10 (ICD-10) came into effect in October 2015. The new procedural codes (ICD-10-PCS) were designed to specify granular aspects of the procedure, including laterality and revised components. This specificity could improve data collection in institutional databases, large registries, and administrative claims data. Given these possible applications, this study’s purpose was to assess the accuracy of ICD-10-PCS coding for revision total knee arthroplasty (rTKA). Methods This multicenter retrospective analysis utilized the rTKA databases at four academic medical centers for all aseptic rTKAs between October 1, 2015 and July 3, 2019. Operative reports were reviewed to determine laterality and revised components (tibial, femoral, liner, and patellar component), which were then compared with the ICD-10-PCS codes associated with the billing records. Proper coding required both component removal and replacement codes. The correct series of removal and replacement codes was determined using the American Joint Replacement Registry’s guidelines. Results In total, 1906 rTKAs were examined, and 98.0% had at least one proper ICD-10-PCS code, indicating an rTKA had occurred. Coding for components replaced was correct in 76.3% of cases. When examining both removal and replacement codes, accuracy dropped to 57.0%. Conclusion Nearly 25% of rTKA procedures were incorrectly coded for replaced components, and over 40% were incorrectly coded for removed and replaced components. ICD-10-PCS codes can accurately identify that an rTKA has occurred; however, the inaccuracy in identifying which specific components were revised should prompt further evaluation of the coding process before utilizing ICD-10-PCS codes to report granular rTKA data. Level of Evidence III, retrospective observational analysis.

Background: Coronavirus disease 2019 (COVID‐19) is a public health problem of global concern. It has a multi negative-impact and it spreads rapidly around the world. Aim of the study: this study was carried out to explore the maternity nurses' knowledge, practices, and attitudes regarding the preventive measures of COVID-19 pandemic. Subjects & Method: A convenience sample of 260 maternity nurses were recruited. Four tools were used for data collection. Results: the vast majority (88.5% & 97.7 respectively) of the study subjects had good knowledge and practices regarding the preventive measures of COVID-19 pandemic. Whereas 48.5% of them had positive attitudes regarding the preventive measures of COVID-19 pandemic. Conclusion: Based on the findings of the present study, it could be concluded that majority of the studied subjects had good knowledge and practices regarding the preventive measures of covid 19 pandemic. On the other hand, less than half of studied subjects had positive attitudes regarding the preventive measures of covid- 19 pandemic. Recommendation: Educational programs should be carried out for maternity nurses to achieve optimistic attitudes and maintain safe practices regarding compliance with the preventive measures of covid 19.

Inadvertent intraoperative hypothermia (core temperature36°C) is a common surgical complication with several adverse events. Hypothermia prediction models can be a tool for providing the healthcare staff with information on the risk of inadvertent hypothermia. Our systematic review aimed to identify, demonstrate, and evaluate the available intraoperative hypothermia risk prediction models in surgical populations.This study is a systematic review of literature.We systematically searched multiple databases (Ovid MEDLINE, Web of Science, Embase, and Cochrane Center Register of Controlled Trials). Two reviewers independently examined abstracts and the full text for eligibility. Data collection was guided by the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS checklist), and methodological quality and applicability were assessed by the Prediction model Risk Of Bias ASsessment Tool (PROBAST).A total of 3,672 references were screened, of which eight articles were included in this study. All the models had a high risk of bias since most of them lacked model validation. Also, they failed to report the model performance and final model presentations, which restricted their clinical application.The researchers should present models in a more standard way and improve the existing models to increase their predictive values for clinical application.

The purpose of this study was to predict dietary supplements (DS) use among Defense Health Agency (DHA) and Veterans Affairs (VA) beneficiaries who were scheduled for surgical procedures.This was a predictive descriptive multicenter study with a convenience sample of 2,623 adult subjects. After institutional review board exemption, data collection occurred preoperatively via electronic survey. Participation was voluntary and data unidentifiable.Data were collected in preoperative anesthesia clinics during preanesthetic evaluations, or in surgery holding areas immediately prior to surgery, using a validated data collection tool. The total convenience sample size was 2,623 subjects from 6 medical centers. Data were voluntarily, anonymously, and verbally obtained from subjects using electronic survey methodology. Collected data included: gender, age, rank, beneficiary status, race, body mass index, tobacco use, marital status, and knowledge of DS side effects and drug interactions. For predictive modeling of DS use, multiple logistic regression was performed for binary outcomes via SPSS.For binary logistic regression the predictors were significant for the following outcomes: taking DS (education, sex, age, and race; P.05), knowledge of side effects (age, race, and rank; P.05), and believe they are having side effects (age; P.05).Understanding DS use is central to predict and anticipate potential negative sequelae in patient outcomes in anesthesia. College education, females, Caucasians, and increasing age are indicators for greater DS use. These results provide opportunities for perianesthesia nurses to improve preoperative assessments, design patient specific perianesthesia care, and enhance patient education. Further research is recommended.

The Society of Thoracic Surgeons Congenital Heart Surgery Database is a comprehensive clinical outcomes registry that captures almost all pediatric cardiac surgical operations in the United States. It is the platform for all activities of The Society of Thoracic Surgeons related to the analysis of outcomes and improvement of quality in this subspecialty. This report summarizes current aggregate national outcomes in congenital and pediatric cardiac surgery performed between July 1, 2016, and June 30, 2020. The reported data on aggregate national outcomes are exemplified by an analysis of 10 prespecified benchmark operation groups performed. This report further reviews related activities in the areas of data collection and analysis, quality measurement, performance improvement, and research.

Patient-reported outcomes (PROs) have been increasingly recognized as valuable information for delivery of optimal perioperative care to high-risk surgical patients in recent years. However, progress from clinical research on PROs has not been widely adopted in routine patient care. This review discusses the current concepts and practice status regarding PROs and addresses the missing links from research to practice adoption to further improve patient's experiences and clinical outcomes in perioperative care. Insufficient empirical research on appropriate PROs and its methodologies, insufficient implementation research to solve the practical issues, and insufficient data collection methods and experiences on ePROs are also discussed. Future research agenda should focus on evidence-supported, PRO-based symptom monitoring systems for early diagnosis and management of impending compromised clinical outcomes.

Background: There is no doubt that the mothers' adaptation helps improve the quality of life, not only for any child with special needs but for the whole family, which greatly helps in improving the child's condition and improving the care provided to him by a conscious parent who can meet the child's needs properly. The present study aimed to evaluate the effect of parent training regarding coping strategies on reducing stress among mothers of children with autism spectrum disorder (ASD). Research design: A quasi-experimental design was used in carrying out this study. Setting at This study was conducted at the Child Psychiatry out-patient clinic at Sohag University Hospital. Sample: A purposive sample of a total of forty mothers and their children with ASD aged 4-12 years participated in this study. Tools: Four tools were utilized for data collection. I- A structured interviewing questionnaire sheet, which included two parts, part 1: Demographic characteristic of the mothers, Part 2: Demographic characteristic of their children, II-Parenting Stress Index: Short Form Abidin (1992), III- Coping Strategies Inventory (CSI), IV- Child Behavior Checklist. The data were collected before, immediately after and 3 months after the implementation of the parent training program. Results: The current study revealed a statistically significant improvement was found between the Parenting Stress Index and the Coping Strategies Inventory of the studied mothers as pre/ immediate post and after three months after the training program implementation (p < 0.05). Conclusion: implementation of parent training regarding coping strategies reduced stress among mothers of children with ASD, so the study mainly recommended that parent training regarding coping strategies for mothers of children with ASD should be conducted to reduce stress among mothers of children with ASD.

Health service programs aim to improve the level of society’s health. On one side, it will give benefit public health, and on the other side, it will have a bad impact if the process is not managed appropriately. Health service activities produces wastes, one of which is solid waste. It is important to know the problem related to the process and cost of the solid medical waste management, which is part of the B3 wastes (hazardous and toxic wastes). The B3 waste management is under the supervision of public health facilities which have the security and cost responsibilities. The costs include investment cost, maintenance cost, cooperation cost or cost of the third-hand management, and consumable cost. This study compares solid medical waste cost between outsourcing systems and self-management systems in the X hospital during the Covid-19 pandemic. This study uses descriptive research in a qualitative approach through observation, document review, and cost calculation for data collection. The study results show that the process of solid medical waste management has been running well. In addition, self-managed solid medical waste management is cheaper than outsourcing management.

Aspects of the physical and social environment play an important role in shaping HIV-related risk/prevention behaviors and access to prevention and treatment services. Here, we describe the feasibility of integrating a web-based survey application to collect risk locations into Qualtrics and compare this approach with a JavaScript-based alternative. Between 2017 and 2018, we enrolled 29 persons living with HIV in Boston Massachusetts to complete an interviewer-administered questionnaire using Qualtrics. Surveys collected demographics; sex/drug use risk behaviors; locations where participants met sex partners, had condomless sex, attended group sex events, and shared a syringe or injection equipment with someone else (up to 10 locations each); and the locations where participants (a) had sex with each sex partner (past 6 months) and (b) used drugs with each drug use partner (past 6 months). Location data were collected using embedded links to an encrypted web-based survey application. Overall, participants provided valid coordinates 93% of the time; when an exact location was not provided, a neighborhood was provided instead, resulting in little missing data. Our findings suggest that this web-based data collection tool (alone or with embedded links in Qualtrics) is a feasible and secure option for collecting risk location data.

Application of pharmacoeconomic data for decision making in medicines management is still nascent in most developing countries. Yet, escalating medication costs amidst rising budgetary constraints call for widespread application of economic evidence to maximize available healthcare resources. This study was a descriptive cross-sectional survey of randomly-selected hospital pharmacists from secondary and tertiary healthcare facilities in Ogun State, Southwestern Nigeria, conducted between June and August 2019. A semi-structured questionnaire was used for primary data collection. Appropriate descriptive and inferential statistics were used for data analysis at p

Penelitian ini bertujuan untuk menginvestigasi dampak pemberian stimulus binaural beats (BB) terhadap aktivitas memori kerja (working memory). Penelitian ini menggunakan metode eksperimen menggunakan studi kasus satu kesempatan (studi kasus satu kesempatan). Penelitian ini melibatkan 30 responden yang terdiri dari laki-laki dan perempuan berusia 18-20 tahun. Para partisipan akan melakukan dua kali pembacaan artikel ilmiah yang berbeda dengan tingkat kognitif yang sama. Pengambilan data pertama dilakukan tanpa memberikan stimulus apa pun, sementara pengambilan data kedua dilakukan dengan memberikan stimulus berupa BB dengan frekuensi 15Hz. Data dikumpulkan dari hasil perekaman perekaman elektroensefalografi (EEG) kemudian diolah menggunakan EEGLab untuk menghitung nilai Kerapatan Spektrum Daya (Power Spectral Density / PSD). Rata-rata nilai PSD sebelum dan setelah stimulus dihitung secara statistika dengan melakukan Paired Sample T Test. Hasil dari penelitian ini menunjukkan bahwa terdapat perbedaan yang signifikan antara nilai rata-rata PSD sebelum dan sesudah diberikan stimulus. Hal ini menunjukkan bahwa BB dapat memberikan dampak terhadap peningkatan kinerja memori pada aktivitas membaca artikel ilmiah.

BACKGROUND: Lack of knowledge and inappropriate attitude toward pain management have been recognized as major obstacles to the application of pain management by health workers. Most of the nurses carry out pain management when performing invasive actions on children is not good. AIM: The purpose of this study was to analyze the relationship between the level of knowledge and the behavior of nurses in pain management in children during invasive procedures. METHODS: This study used an analytic observational design with a cross-sectional engineering design with a total population of 30 nurses and a total sample of 30 nurses at RSI A. Yani Surabaya and used a total sampling technique. The independent variable in this study is the level of knowledge, while the dependent variable is the behavior of nurses when performing invasive actions on children. Data were analyzed using the Fisher Exact Test for significance α = 0.05. The data collection instrument used a questionnaire and observation sheet. RESULTS: The results showed that 23 respondents who have sufficient knowledge with 18 respondents having positive behavior and 5 respondents being negative. While 4 respondents who have good knowledge with positive behavior 3 respondents and 1 respondent behaves negatively. respondents who have less knowledge, there are 3 respondents with negative behavior. p = 0.033 (p < 0.05) then there is a knowledge relationship with the behavior of nurses on pain management in children during invasive procedures. CONCLUSION: The level of knowledge of nurses about pain management in children during invasive procedures obtained a enough level of knowledge. The nurse’s behavior level toward pain management in children during invasive procedures is positive. The results of the analysis using statistical tests showed that there was a relationship between the knowledge and behavior of nurses about pain management in children during invasive procedures.

Osteoporosis, which means “porous bone”, is a disease in which the bones gradually become weak and brittle. Osteoporosis is often known as the silent thief because bone losses occur without symptoms and progressive loss and thinning of bone tissue happens over many years. The aim of the study was to assess the effectiveness of Structured Teaching Programme on knowledge regarding prevention of Osteoporosis among premenopausal women (35-50 years) attending OPDs in a selected hospital, Raipur. Objectives To assess the pretest level of knowledge regarding prevention of osteoporosis among premenopausal women in experimental group and control group. To determine the effectiveness of structured teaching programme on prevention of osteoporosis in experimental group. To find out the association between knowledge regarding prevention of osteoporosis and selected demographics variables of the premenopausal women. Review of literature was prepared relevant to the study. The conceptual framework of the study was based on “Kenny’s open system model. Pilot study was done among patients in general medicine OPD in a selected hospital, Raipur. The main study was conducted in Orthopedics and Obstetrics & Gynecology OPDs in a selected hospital, Raipur. A total of 90 patients included in the study and they were selected using convenient sampling. The instrument used for data collection was structured knowledge questionnaire. Validity and reliability of the tool was done. Data was collected for the period of 4 weeks. Descriptive and inferential statistics were used to analyse the data. It was observed in present study that majority (70%) of the total sample in experimental and control group had inadequate level of knowledge regarding prevention of Osteoporosis. And it was observed that the mean post test score of experimental group with standard deviation was 19.98±3.02 which was apparently higher than that of post test score of control group 14.11±4.74. Statistical differences were computed and the independent t value is 7.003 which was found significant at 0.05. Hence, Structured Teaching Programme was effective on knowledge regarding prevention of Osteoporosis. The study findings also shows that the association between knowledge score and educational status (ᵡ2=9.511, P=0.05), religion (ᵡ2=7.053, P=0.05) and previous knowledge (ᵡ2=46.44, P=0.05) were highly significant. Hence there was a significant association between pre-test knowledge and selected demographic variables of premenopausal women such as age, gender, education, income, religion, marital status, dietary pattern, age of menarche, age of marriage and previous knowledge. Key words: Structured Teaching Programme, Knowledge, Prevention of Osteoporosis, Premenopausal Women, Effectiveness.

Background. Mortality and morbidity in pregnant and maternity women is a big problem in developing countries. In poor countries, about 25-50% of deaths of women of childbearing age are caused by pregnancy-related causes. It is estimated that every year 585,000 women die from pregnancy and childbirth. 99% of these deaths occur in developing countries. According to WHO, 60-80% of maternal deaths are caused by bleeding during childbirth, obstructed labor, sepsis, high blood pressure during pregnancy, and complications from unsafe abortion. The purpose of this study was to determine the relationship between normal delivery care (APN) training on the knowledge and attitudes of midwives at the Bebesen Health Center, Bebesen District, Central Aceh Regency in 2020. Methods. The research method uses an analytical survey method with a cross sectional approach, which is a study to study the dynamics of the correlation between risk factors and effects, by approaching, observing or collecting data at once. The population in this study was all 63 midwives. The sampling method uses a total sampling technique that uses all members of the population as a sample. Data collection was carried out from November 14-16, 2020. Results. The results showed that from the analysis obtained a value for the p-value of good knowledge as many as 20 respondents (31.7%) and a positive attitude that is as many as 32 respondents (50.8%). Conclusion. There is a relationship between normal delivery care training (APN) with knowledge with a p value of 0.014 (p < 0.05) and normal delivery care (APN) with changes in the attitude of midwives with a p value of 0.00 (p < 0.05) in Bebesen Public Health Center, Bebesen District, Central Aceh Regency.

Background Despite recognition that the health outcomes of Asian American subgroups are heterogeneous, research has mainly focused on the six largest subgroups. There is limited knowledge of smaller subgroups and their health outcomes. This scoping review identifies trends in the health outcomes, reveals those which are under-researched, and provide recommendations on data collection with 24 Asian American subgroups. Methods Our literature search of peer-reviewed English language primary source articles published between 1991 and 2018 was conducted across six databases (Embase, PubMed, Web of Sciences, CINAHL, PsychINFO, Academic Search Complete) and Google Scholar, yielding 3844 articles. After duplicate removal, we independently screened 3413 studies to determine whether they met inclusion criteria. Seventy-six studies were identified for inclusion in this review. Data were extracted on study characteristics, content, and findings. Findings Seventy-six studies met the inclusion criteria. The most represented subgroups were Chinese (n = 74), Japanese (n = 60), and Filipino (n = 60), while Indonesian (n = 1), Malaysian (n = 1), and Burmese (n = 1) were included in only one or two studies. Several Asian American subgroups listed in the 2010 U.S. Census were not represented in any of the studies. Overall, the most studied health conditions were cancer (n = 29), diabetes (n = 13), maternal and infant health (n = 10), and cardiovascular disease (n = 9). Studies showed that health outcomes varied greatly across subgroups. Conclusions More research is required to focus on smaller-sized subgroup populations to obtain accurate results and address health disparities for all groups.

Objective To evaluate the quality of a multiyear linkage between the Colorado All-Payers Claims Database (ACPD) and the Colorado Central Cancer Registry. Data sources Secondary 2012-2017 data from the APCD and the Colorado cancer registry. Study design Descriptive analysis of the proportion of cases captured by the linkage in relation to the cases reported by the registry. Data collection/extraction methods We used probabilistic linkage to combine records from both data sources for all patients diagnosed with cancer. Results We successfully linked 93% of the 146,884 patients in the registry. Approximately 63% of linked patients were perfect matches on five identifiers. Of partial matches, 81.6% were matched on four identifiers with missing or partial Social Security Numbers. The linkage rate was lower for uninsured patients at diagnosis (74.7%) or patients with private plans (89.4%) but close to 100% for Medicare and Medicaid enrollees. Most of the 29% of patients who did not have claims at the time of diagnosis were covered by private plans that may not submit claims. Conclusions APCD-registry linkages are a promising source of data to conduct population-based research from multiple payers. However, not all payers submit claims, and the quality of the data may vary by state. This article is protected by copyright. All rights reserved.

Syphilis among men who have sex with men (MSM) has increased greatly in the past twenty years in the U.S. Geographically explicit ecological momentary assessment (GEMA), in which behaviors are geotagged and contextualized in time and space, may contribute to a greater understanding of transmission risk. The objective was to determine the acceptability and feasibility of GEMA for assessing HIV and syphilis transmission risk behaviors among a sample of MSM. Participants responded to a brief survey five times a day for two weeks. Feasibility was measured by participant recruitment, enrollment, prompts received and answered, geotagged prompts, and technical interference with data collection. Acceptability was measured by ratings of enjoyment and willingness for future participation. Summaries of five behavioral measures from the brief survey were calculated. Among the 83 participants contacted, 67.5% (56) expressed interest, 98% (55) were scheduled, and 81.8% (45) were enrolled. Participants answered 78.3% (2,277) of prompts received and 87.7% (1,998) of answered prompts were geotagged. Overall, 70.5% (31) enjoyed participating and 91.1% (41) were willing to participate in the future. Among prompts answered, missingness was low for five behavioral measures (range 0.2% (4) to 0.7% (16)). Feasibility and acceptability were high and missingness was low on behavioral measures in this MSM study population. Most participants reported that they would participate again. Future work should focus on whether GEMA improves our understanding of syphilis and HIV transmission risk.

AIM: This study aims to analyze the effect of access to information, the ability to understand, assess and practice the health literacy of pregnant women. METHODS: This study uses cross-sectional design for the population of pregnant women and uses a lameshow formula to find a sample of 399. Data collection uses questionnaires and the results are processed using the t-test to find the significance of correlation and test the effect of R2 to find out the effect magnitude. RESULTS: Correlation test results showed 3 of 4 variables correlated with health literacy with a value >1.96 yaitu understand (X1.2) (R2 = 0.65), assessment (X1.3) (R2 = 0.80), and application (X1.4) (R2 = 0.57). The ability to judge variable is proven to explain the practice of health literacy by 80%, and the rest is determined by other variables. CONCLUSIONS: Health literacy has been recognized as one of the determinants of health and has become one of the goals of public health development for prevention and efforts to overcome risks in pregnancy.

Health facilities with referral status for COVID-19 cases, reported a decrease in non-COVID inpatients, compared to facilities with non-referral status. The decrease in bed utilization (BOR) was very significant in several health facilities including Langsa Hospital 10-15% before 65-75%,. This study aims to study the Determinants of Factors Affecting the Decrease in Bed Utilization (BOR) at Langsa Hospital during the COVID-19 Pandemic Period in 2021. The research approach uses descriptive qualitative data collection techniques through in-depth interviews and informants are determined by purposive sampling of key informants, namely 4 inpatients and 2 supporting informants. The total number of informants is 6 people. The research instrument is the researcher himself and data collection through interviews, documentation and field observations. Data analysis technique with taxonomy. The results of the study, namely the availability of services due to reduced facilities, hospital policies in implementing health care programs, priority to hospitals from patients in independent practice health care services and community stigma regarding the confirmation of COVID-19 status in each patient, were the driving factors for the decrease in BOR at Langsa Hospital in the 2021 COVID-19 pandemic. It is recommended that the Langsa Hospital management coordinate with IPSRS for the availability of facilities, the health promotion section conducts more effective promotion and socialization methods and nursing provides training on effective communication.

Objective: Violence at work is a major cause of workplace inequality, discrimination, stigmatization, and conflict. The present study intends to describe the pattern of workplace violence (WPV) in a tertiary-level hospital in India with the objectives of discovering the magnitude of self-reported violence, its type, and the circumstances surrounding and response to such incidents.Material and Methods: The study is of a descriptive type. Its participants were either undergraduate or postgraduate residents at the selected hospital. The data collection tool was and a questionnaire adapted from that used in the World Health Organization’s Workplace Violence in the Health Sector Survey. The period of data collection was one month.Results: Three hundred and twenty two completed questionnaires were analyzed; 76.1% of respondents experienced violence at their workplace. The incidents of psychological violence were higher than those of a physical nature (63.1% vs. 42.9%, respectively). Psychological violence was significantly higher during day shifts and in outdoor or emergency room settings, while physical violence was common during night shifts and in indoor wards. Repeat incidents were more commonly associated with psychological violence. Even though most incidents were not reported, 96.0% of respondents considered WPV a major concern, and the improvement of security measures was most widely suggested as a solution to prevent violence at work.Conclusion: The high incidence of WPV in a tertiary healthcare setting reported in this study is in agreement with the findings of similar studies. Improving security measures and doctor- patient communication may help reduce such occurrences. Designing a robust reporting system and conducting regular and thorough audits of violent incidents can help boost the morale of healthcare staffs as well as plan preventive strategies.

Introduction Of the 22.8 million coronavirus disease 2019 (COVID‐19) cases recorded in the United States as of March 21, 2021 with age information, three‐fourths were in the workingage group, indicating the potentially high economic impact of the pandemic. This study estimates the cost of lost work hours associated with the COVID‐19 pandemic between March 2020 through February 2021. Method I used a before‐and‐after analysis of data from the 2017–2021 Current Population Survey to estimate the costs of lost work hours due to economic, workers' own health, and other reasons, from the COVID‐19 pandemic. Results Across March 2020 through February 2021 (a year since the start of the pandemic in the United States), the estimated cost of lost work hours associated with the COVID‐19 pandemic among US full‐time workers was $138 billion (95% confidence interval [CI]: $73.4 billion–$202.46 billion). Shares of the costs attributed to economic, workers' own health, and other reasons were 33.7%, 13.7%, and 52.6%, respectively. Conclusion The $138 billion cost of lost work hours associated with the COVID‐19 pandemic during March 2020 through February 2021 highlights the economic consequences of the pandemic, as well as indicating the potential benefit of public health and safety interventions used to mitigate COVID‐19 spread.

There has been a growing number of oncology drug approvals. Non-interventional postauthorization safety/effectives studies (PASSs/PAESs) aim to provide real-world evidence on the safety/effectiveness of oncology drugs postapproval. To understand the current landscape, a comprehensive search as of March 1, 2021, was conducted in major register/databases. We found that requested studies increased from 1 in 2006-2010 to 47 in 2016-2020. Of 78 total studies identified, 50 focused on safety/risk assessment (64.1%), 6 on effectiveness (7.7%), 3 on drug utilization (3.8%), 1 on disease epidemiology (1.3%), and 18 on effectiveness of additional risk minimization measures (23.1%). For safety/risk assessment studies, 58.9% focused on nonspecific end points (e.g., frequency of adverse events). For effectiveness studies, the leading primary outcome was overall survival. Overall, safety/risk assessment studies concerning nonspecific end points for vascular endothelial growth factor (receptor) inhibitors were most requested. Regarding data sources, though a majority (71.8%) used primary data collection, a growing proportion utilized secondary data sources. Among 23 studies with information available on study design, 10 (43.5%) were single-arm cohort studies, 9 (39.1%) were cross-sectional studies, 3 (13.1%) were comparative cohort studies, and 1 (4.3%) was a nested-case-control study. In conclusion, there was an increasing number of oncology-specific non-interventional PASSs/PAESs, with a majority on safety/risk assessment. Although most utilized primary data collection, there was an increasing use of secondary real-world data sources. Few conducted comparative analyses, and most used single-arm designs. Future efforts are needed to assess how findings of these studies would impact regulatory decisions and improve knowledge of toxicity for clinical/translational development.