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Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients’ access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.

Objective: Contact tracing has been used in China and several other countries in the WHO Western Pacific Region as part of the COVID-19 response. We describe COVID-19 cases and the number of contacts traced and quarantined per case as part of COVID-19 emergency public health response activities in China. Methods: We abstracted publicly available, online aggregated data published in daily COVID-19 situational reports by China’s National Health Commission and provincial health commissions between 20 January and 29 February 2020. The number of new contacts traced by report date was computed as the difference between total contacts traced in consecutive reports. A proxy for the number of contacts traced per case was computed as the number of new contacts traced divided by the number of new cases. Results: During the study period, China reported 80 968 new COVID-19 cases and 659 899 contacts. In Hubei Province, there were 67 608 cases and 264 878 contacts, representing 83% and 40% of the total, respectively. Non-Hubei provinces reported tracing 1.5 times more contacts than Hubei Province; the weekly number of contacts traced per case was also higher in non-Hubei provinces than in Hubei Province and increased from 17.2 in epidemiological week 4 to 115.7 in epidemiological week 9. Discussion: More contacts per case were reported from areas and periods with lower COVID-19 case counts. With other non-pharmaceutical interventions used in China, contact tracing and quarantining large numbers of potentially infected contacts probably contributed to reducing SARS-CoV-2 transmission.

Most critically ill patients experience malnutrition, resulting in a poor prognosis. This study aimed to evaluate the association of prealbumin (PAB) with the prognosis for severely and critically ill coronavirus disease 2019 (COVID-19) patients and explore factors related to this association. Patients with laboratory-confirmed COVID-19 from West Campus of Union Hospital in Wuhan from January 29, 2020 to March 31, 2020 were enrolled in this study. Patients were classified into the PAB1 (150–400 mg/L; N = 183) and PAB2 (< 150 mg/L; N = 225) groups. Data collection was performed using the hospital’s electronic medical records system. The predictive value of PAB was evaluated by measuring the area under the receiver-operating characteristic (AUROC) curve. Patients were defined as severely or critically ill based on the Guidance for COVID-19 (7th edition) by the National Health Commission of China. During this analysis, 316 patients had severe cases and 65 had critical cases. A reduced PAB level was associated with a higher risk of mortality and a longer hospital stay. The AUROC curve for the prognosis based on the PAB level was 0.93, with sensitivity of 97.2% and specificity of 77.6%. For severe cases, a lower level of PAB was associated with a higher risk of malnutrition, higher NK cell counts, and lower B lymphocyte counts; these factors were not significant in critical cases. C-reactive protein and nutritional status mediated the association between PAB and prognosis. This retrospective analysis suggests that the PAB level on admission is an indicator of the prognosis for COVID-19.

Background The prevalence of atopic dermatitis (AD) has increased, but studies in adult or elderly populations are sparse. Methods We investigated 12-month and lifetime prevalences of AD in the Finnish adult population ≥30 years of age and analyzed living environment factors, socioeconomic factors, lifestyle-related factors, and serum vitamin D levels for their associations with AD in a national health examination survey. Results The lifetime prevalence was 21.9% and 12-month prevalence 10.1%. The highest prevalence (lifetime 28.6%, 12-month 15.4%) was seen in subjects 30-39 years of age. Prevalence decreased with age. Subjects with highly educated parents were more likely to have active AD, though there was no effect of higher education in subjects themselves. Younger age and being an ex-smoker were associated with active AD. Female sex and daily smoking increased the risk in subjects 30-49 years of age. There was no dose– response relationship to serum vitamin D levels and no association with the living environment. Conclusions Our data show that the number of adult patients with atopic dermatitis has grown and prevalence numbers of AD in Finnish adults are among the highest reported. Together with the aging of the society, the burden of AD is not limited to childhood.

This study investigated the association between the different types of plant-based diets and dyslipidaemia in Korean adults using data from the nationally representative sample. Using the 2012–2016 Korea National Health and Nutrition Survey data, a total of 14 167 adults (≥19 years old) participated in this study. Dietary intake was assessed by a semi-quantitative FFQ. Three different plant-based diet indices (overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), unhealthful plant-based diet index (uPDI)), were calculated. Dyslipidaemia and its components (hypertriacylglycerolaemia, hypercholesterolaemia, low HDL-cholesterol, high LDL-cholesterol, use of anti-hyperlipidaemia agent) were measured. Multivariable logistic regression analysis was used to examine the associations between plant-based diet and dyslipidaemia and individual lipid disorders. Totally, 47% of overall population had dyslipidaemia. Individual in the highest quintile of uPDI had 22% greater odds of dyslipidaemia (95 % CI 1·05, 1·41) and 48 % higher odds of hypertriacylglycerolaemia (95 % CI 1·21, 1·81) and 16% higher odds of low HDL-cholesterol (OR: 1·16, 95 % CI 1·00, 1·35) than those in the lowest quintile of uPDI. PDI was associated with 16 % higher odds of low HDL-cholesterol, and hPDI was associated with 25% lower odds of high LDL-cholesterol. However, neither PDI nor hPDI was significantly associated with the prevalence of dyslipidaemia. Greater adherence to unhealthful plant-based diets was associated with greater odds of the dyslipidaemia and its components suggesting the importance of the quality of plant-based diet in South Korean adults for dyslipidaemia prevention.

The main problems of acute kidney injury (AKI) are considered. The necessity of introduction of the AKI concept into the practice of national health care is justified. Specific recommendations for the diagnosis, monitoring, prevention and treatment of this dangerous condition are given.

Objective. To examine compliance to isolation and quarantine recommendations during the early phase of the Covid-19 epidemic in Mexico. Materials and methods. Cross-sectional population-based study (National Health and Nutrition Survey 2020 Covid-19). We estimated the prevalence of compliance with recommendations and assessed its association with individual, household and context level variables using log-binomial models. Results. 48.1% of the population over 10 years old reported staying at home when faced with symptoms or a potential contact with a case. The prevalence was lower in employed vs unemployed population (PR 0.81;95%IC 0.73-0.89), higher among higher socioeconomic position groups vs lower (RP 1.22;95%IC 1.08-1.38), and lower among people living in states with an unspecific public health message regarding isolation and quarantine (RP 0.76;95%IC 0.63-0.91). Conclusions. Compliance to isolation and quarantine recommendations was associated with socioeconomic factors and the quality of public health messages during the Covid-19 pandemic in Mexico. (English) [ABSTRACT FROM AUTHOR] Objetivo. Investigar el cumplimiento de las recomendaciones de aislamiento ante sintomas de Covid-19 o contacto con un caso. Material y metodos. Estudio transversal basado en la Encuesta Nacional de Salud y Nutricion 2020 sobre Covid-19. Se describio la prevalencia de aislamiento y su asociacion con factores del nivel individual, hogar y contexto utilizando modelos de regresion log-binomial. Resultados. El 48.1% de la poblacion >10 anos reporto quedarse en casa ante sintomas o contacto con un caso. La prevalencia de aislamiento fue menor entre poblacion ocupada vs. no-ocupada (RP 0.81;IC95% 0.73-0.89), mayor entre personas con alto nivel socioeconomico vs. bajo (RP 1.22;IC95% 1.08-1.38) y menor entre personas viviendo en estados sin un mensaje especifico sobre aislamiento vs. estados con mensaje especifico (RP 0.76;IC95% 0.63-0.91). Conclusiones. El cumplimiento de las recomendaciones de aislamiento durante la pandemia de Covid-19 estuvo asociado con factores socioeconomicos individuales y con la calidad de los mensajes de salud publica de los estados. (Spanish) [ABSTRACT FROM AUTHOR] Copyright of Salud Publica de Mexico is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. To estimate the willingness to vaccinate against Covid-19 (acceptance) in the Mexican population and to identify socioeconomic factors associated with vaccine hesitancy and refusal. Materials and methods. We estimated the acceptance, refusal and hesitancy proportions using data from the Covid-19 National Health and Nutrition Survey conducted from August to November 2020. Factors associated with refusal and hesitancy were explored using multinomial logistic regression. Results. Covid-19 vaccination acceptance was 62.3%, refusal 28.2% and hesitancy 9.5%. Refusal and hesitancy were associated with being female, having older age, lower educational level, lower socioeconomic status and working in the informal sector. Conclusion. National campaigns to incentivize vaccine acceptance need to consider specific subgroups were the likelihood of hesitancy and refusal is high. In Mexico, refusal and hesitancy were higher in vulnerable groups, and people at a higher risk of Covid-19 complications and death. (English) [ABSTRACT FROM AUTHOR] Objetivo. Estimar la aceptabilidad de la vacunacion contra Covid-19 en la poblacion mexicana e identificar factores socioeconomicos asociados con el rechazo o la duda. Material y metodos. Se estimo la proporcion de aceptabilidad, rechazo y duda utilizando los datos de la Encuesta Nacional de Salud y Nutricion 2020 sobre Covid-19 levantada durante agosto y noviembre de 2020. Se exploraron los factores asociados con rechazo y duda mediante un modelo de regresion multinomial. Resultados. La aceptabilidad de la vacunacion contra Covid-19 fue de 62.3%, el rechazo de 28.2% y la duda de 9.5%. El rechazo y la duda se asociaron con ser mujer, tener mayor edad, menor nivel de educacion, menor nivel socioeconomico y trabajar en el sector informal. Conclusion. Las campanas para incentivar la aceptabilidad de la vacuna necesitan considerar los subgrupos especificos con una alta proporcion de rechazo y duda. En Mexico observamos un mayor rechazo y duda en grupos con mayor riesgo de complicaciones y muerte por Covid-19. (Spanish) [ABSTRACT FROM AUTHOR] Copyright of Salud Publica de Mexico is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND Many studies reported that reproductive desire could be high among transgender individuals. In France, fertility preservation and sperm donation were very little proposed to transgender individuals until recently, mainly because the Bioethics Law allows the use of assisted reproductive technologies only in infertile couples and prohibits surrogacy. OBJECTIVES To evaluate the distribution of care on the French territory concerning fertility preservation and sperm donation in transgender individuals. MATERIALS AND METHODS A multicentric national survey was carried out between January 2019 and October 2020 in 28 assisted reproductive technology centres of the French CECOS (Centres d'Etudes et de Conservation des Oeufs et du Sperme) network. Each centre was questioned to find out how many transgender individuals came, were informed and cared for fertility preservation and sperm donation. RESULTS Concerning fertility preservation, 71.4% of centres received transgender individuals and performed gamete cryopreservation; 581 transgender individuals consulted for fertility preservation. Transgender women were more likely to desire (p

In Indonesia, the national universal health coverage scheme (Jaminan Kesehatan Nasional [JKN]) has consistently overspent against its budget since it was introduced in 2014. In 2017, a new regulation diverted 37.5% of tobacco tax revenue collected at the district and city level to the central government in order to increase government contributions to the JKN. Through a review of policy documents and interviews and focus group discussions with relevant stakeholders, this article explores the history of the JKN and its relationship to local tobacco taxes. Offering an ex‐post assessment of the policy and its implementation, we find it negative on three fronts: funding for local anti‐smoking initiatives and services was cut, the procedures for implementing the policy were complex and time‐consuming, and it did not contribute as much as anticipated to the JKN. These findings underscore potential pitfalls of politically motivated policy that fails to consider implementation and impact. We recommend that the policy be revoked, and local tobacco tax revenue reallocated to its initial purpose, which includes promoting local smoking prevention programs and health service delivery.

Objectives This study investigated severe medication errors (MEs) reported to the National Supervisory Authority for Welfare and Health (Valvira) in Finland and evaluated how the incident documentation applies to learning from errors. Methods This study was a retrospective document analysis consisting of medication-related complaints and authoritative statements investigated by Valvira in 2013 to 2017 (n = 58). Results Medication errors caused death or severe harm in 52% (n = 30) of the cases (n = 58). The majority (83%; n = 48) of the incidents concerned patients older than 60 years. Most likely, the errors occurred in prescribing (n = 38; 47%), followed by administration (n = 15; 19%) and monitoring (n = 14; 17%). The error process often included many failures (n = 24; 41%) or more than one health professional (n = 16; 28%). Antithrombotic agents (n = 17; 13%), opioids (n = 10; 8%), and antipsychotics (n = 10; 8%) were the therapeutic groups most commonly involved in the errors. Almost all error cases (91%; n = 53) were assessed as likely or potentially preventable. In 60% (n = 35) of the cases, the organization reported actions taken to improve medication safety after the occurrence of the investigated incident. Conclusions Medication errors reported to the national health care supervisory authority provide a valuable source of risk information and should be used for learning from severe errors at the level of health care systems. High age remains a key risk factor to severe MEs, which may be associated with a wide range of medications including those not typically perceived as high-alert medications or high-risk administration routes. Despite being complex processes, the severe MEs have a great potential to lead to developing systems, processes, resources, and competencies of health care organizations.

Summary Background In the context of climate change and deforestation, Brazil is facing more frequent and unprecedented wildfires. Wildfire-related PM2·5 is associated with multiple adverse health outcomes; however, the magnitude of these associations in the Brazilian context is unclear. We aimed to estimate the association between daily exposure to wildfire-related PM2·5 and cause-specific hospital admission and attributable health burden in the Brazilian population using a nationwide dataset from 2000 to 2015. Methods In this nationwide time-series analysis, data for daily all-cause, cardiovascular, and respiratory hospital admissions were collected through the Brazilian Unified Health System from 1814 municipalities in Brazil between Jan 1, 2000, and Dec 31, 2015. Daily concentrations of wildfire-related PM2·5 were estimated using the 3D chemical transport model GEOS-Chem at a 2·0° latitude by 2·5° longitude resolution. A time-series analysis was fitted using quasi-Poisson regression to quantify municipality-specific effect estimates, which were then pooled at the regional and national levels using random-effects meta-analyses. Analyses were stratified by sex and ten age groups. The attributable fraction and attributable cases of hospital admissions due to wildfire-related PM2·5 were also calculated. Findings At the national level, a 10 μg/m3 increase in wildfire-related PM2·5 was associated with a 1·65% (95% CI 1·51–1·80) increase in all-cause hospital admissions, a 5·09% (4·73–5·44) increase in respiratory hospital admissions, and a 1·10% (0·78–1·42) increase in cardiovascular hospital admissions, over 0–1 days after the exposure. The effect estimates for all-cause hospital admission did not vary by sex, but were particularly high in children aged 4 years or younger (4·88% [95% CI 4·47–5·28]), children aged 5–9 years (2·33% [1·77–2·90]), and people aged 80 years and older (3·70% [3·20–4·20]) compared with other age groups. We estimated that 0·53% (95% CI 0·48–0·58) of all-cause hospital admissions were attributable to wildfire-related PM2·5, corresponding to 35 cases (95% CI 32–38) per 100 000 residents annually. The attributable rate was greatest for municipalities in the north, south, and central-west regions, and lowest in the northeast region. Results were consistent for all-cause and respiratory diseases across regions, but remained inconsistent for cardiovascular diseases. Interpretation Short-term exposure to wildfire-related PM2·5 was associated with increased risks of all-cause, respiratory, and cardiovascular hospital admissions, particularly among children (0–9 years) and older people (≥80 years). Greater attention should be paid to reducing exposure to wildfire smoke, particularly for the most susceptible populations. Funding Australian Research Council and Australian National Health and Medical Research Council.

Objective Patients with intermittent claudication (IC) are initially treated with supervised exercise therapy (SET), as advised by national and international guidelines. Dutch health insurance companies and the Dutch National Health Care Institute suggested an 87% compliance rate with these guidelines in the Netherlands in 2017 and judged this to be undesirably low. The aim of this study was to evaluate compliance with IC guidelines and to elaborate on the reasons for deviating from them (practice variation) in a large teaching hospital. Methods A retrospective single centre cohort study was conducted at a large teaching hospital in the Netherlands. In total, 420 patients with newly diagnosed IC between 1 January 2017 and 31 December 2018 were analysed. Data included risk profiles and prescribed therapies. Results For all 420 included patients, the compliance rate with the guidelines for SET was 80.5%. The rate of adequately motivated and defensible practice variation was 15.7%; the rate of unjustified practice variation was 3.8%. Meaningful care was seen in 96.2% of cases. Conclusion Deviation from IC guidelines was found in 19.5% of patients. Almost three quarters of this deviation can be explained by the decision to provide personalised, meaningful care.

espanolIntroduccion Se diseno y se envio una encuesta para analizar el impacto de la pandemia por COVID-19 en el funcionamiento y desempeno de los servicios de Traumatologia del Sistema Nacional de Salud y entidades privadas. Material y metodos Estudio descriptivo tipo encuesta difundida a los traumatologos espanoles a traves de plataformas de Internet. Resultados Se obtuvieron 401 respuestas validas. De estos traumatologos, el 85,7% vio reducida su actividad quirurgica entre el 50 y 100%. El 46% fue requerido para colaborar en asistencia de pacientes con COVID-19. Un 43% expreso que durante la primera ola de la pandemia su labor fue infrautilizada. El 52% modifico las indicaciones de tratamiento en diversas fracturas, con variabilidad entre centros y comunidades. Un 30% refiere estar satisfecho con la gestion del Estado y un 60% con la de su comunidad autonoma y centro. Un 70% no esta satisfecho con la formacion sobre el uso de mascarillas y equipos de proteccion individuales (EPI) y un 80% con la formacion para tomar muestras. El 65% no ha dispuesto de equipos de proteccion para desempenar su trabajo. Al 46% se le han denegado medidas de proteccion para tratar pacientes con sospecha o infeccion confirmada. Conclusion La pandemia por COVID-19 ha situado al Sistema Nacional de Salud en una situacion de extrema gravedad. Analizando los resultados, se observa un uso ineficiente de los recursos humanos disponibles, un descontento generalizado y una ausencia de medios y medidas de proteccion y formacion. EnglishIntroduction We designed and conducted a survey to analyze the impact of the COVID-19 pandemic on the operation and performance of the orthopedic departments of the National Health System and private entities. Material and methods Descriptive study of a survey is distributed to Spanish Ortohopedic surgeons via Internet. Results 401 valid responses were obtained, out of these 85.7% had to reduce their surgical activity between 50% and 100%. 46% of the sample were asked to collaborate in other units or services and another 43% felt that their work had been underused. 52% modified the treatment indications in various bone fractures, with variability between centers and communities. 30% reported being satisfied with the management from the state and 60% with that of their province and center. 70% showed little to no satisfaction with the training received on the use of masks and personal protective equipment. An additional of 80% were also unsatisfied with the training received with regard to sample-taking. 65% did not have protective equipment to carry out their work. 46% have been denied protective measures to treat patients with suspected or confirmed infection. Conclusion The COVID-19 pandemic has placed the National Health System in an extremely serious situation. Through the analysis of the results, we can observe an inefficient use of available human resources, a widespread discontent, as well as an absence of means and measures, which has had a direct impact on the number of infected professionals

SUMMARY OBJECTIVE: The aim of this study was to evaluate the frequency of teenage pregnancy in all Brazilian regions and states in the period of 2000-2019 among two age groups, namely, 10-14 and 15-19 years old, and correlate it with the human development index. METHODS: A cross-sectional study was performed by using the data from the Live Birth Info System from the National Health System’s database. RESULTS: The percentage of live births from teenage mothers (age 10-19 years) in Brazil decreased by 37.2% (i.e., 23.4 in 2000 to 14.7% in 2019) in all regions. Amazonas and Maranhão were the only states to show increased fertility rates for teens in the age group of 10-14 years. The fertility index decreased from 80.9-48% in all states among mothers aged 15-19 years. Only the Southeast and South regions showed levels below the Brazilian average (i.e., 38.2 and 39%, respectively). The proportion of live birth showed an inversely proportional trend to the human development index score. CONCLUSIONS: Brazil shows a decline in the percentage of live birth among adolescent mothers and the fertility rate. Live birth is inversely proportional to the human development index score. However, the teenage pregnancy numbers are still high, with great regional inequality in the country.

It is unknown whether persistent metabolic syndrome (MetS) is associated with an increased risk of cholangiocarcinoma (CCA). Therefore, we investigated the risk of CCA according to changes in MetS status.This nationwide cohort study included 8,581,407 adults who underwent anthropometric measurements and laboratory tests in two consecutive national health screenings during 2009-2012 and observed the subjects until 2017. Individuals with cancer, or follow-up duration1 year were excluded (n = 377,915). Subjects were classified into the MetS-free, MetS-developed, MetS-improved, and MetS-persistent groups. The outcome was the incidence of CCA, identified using the claims database. Multivariable Cox proportional hazards regression models were used.Among the 8,203,492 subjects (mean age 48.9 ± 12.8 years; 56.7% male), 7506 CCA patients were newly identified during a median follow-up of 5.1 years. The probability of CCA was consistently higher in the MetS-persistent group than in the MetS-free group (P 0.001). MetS-persistent status was significantly associated with an increased risk of CCA compared with the MetS-free status (unadjusted hazard ratio [HR] 2.8, 95% confidence interval [CI] 2.66-2.95), even after adjusting for multiple covariates (adjusted HR 1.07, 95% CI 1.01-1.13). Improved or newly developed MetS was not associated with CCA risk in the fully adjusted model (aHR 1.02, 95% CI 0.94-1.10 and aHR 0.99, 95% CI 0.92-1.06, respectively).MetS was associated with an increased risk of CCA if it persisted for ≥2 years. Our finding suggests that MetS may be a potentially modifiable risk factor for CCA.

Objectives In 2015, the South African government implemented the national health promotion policy (NHPP), intending to reduce stillbirth and maternal mortality. This study was designed to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African population and immigrant citizens. Study design This was a panel analysis using secondary data issued by Statistic South Africa-Vital Statistics. Methods The author exploited the changes in smoking status that the NHPP exerted between 2015 and 2017. The author then builds credible control and treatment groups based on smoking status for both groups. Women who quitted smoking post-NHPP implementation were considered as the treatment group. Women who persisted with smoking post-NHPP implementation were classified as the control group. The author then used a Two-stage Least Squared Model to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African and immigrant populations. Results The model shows that NHPP averts stillbirths by 8.36% in the South African population residing in the urban areas and by 2.84% in the rural segments of the country. NHPP averts South African maternal mortalities by 20.88% in urban areas and by 15.60% in the rural segments of the country.Regarding the immigrant population, the model shows that NHPP averts immigrant's stillbirths by 7.61% in the urban areas and by 2.79% in the rural segments of the country. In addition, NHPP averts immigrant maternal mortalities by 19.22% in the urban areas and by 13.04% in the rural segments of the country. Conclusions NHPP reduces stillbirth and maternal mortality outcomes slightly biased toward the South African population. These inequalities reflect immigrant's lack of response to the NHPP framework and inadequate access to the South African health system.

OBJECTIVE The adverse health effects of short sleep duration (i.e., six or fewer hours per night) are well established, including an increased risk of cardiovascular disease (CVD) and related mortality. However, there is heterogeneity in perceived sleep need among habitual short sleepers (HSS), with a sizable minority reporting no sleep-related daytime dysfunction. It has not been determined whether health risk associated with short sleep duration is consistent across individuals with and without reported dysfunction. The current study examined self-rated health (SRH), previously demonstrated to predict CVD risk, and objective CVD risk among HSS with and without reported dysfunction in the National Health and Nutrition Examination Surveys (NHANES). METHOD Participants were adults age 40-79 in the 2005-2006 and 2007-2008 NHANES cycles. Assessments included the single item SRH (poor to excellent), self-reported average sleep duration, and self-reported daytime sleep-related dysfunction. Ten-year atherosclerotic CVD and high lifetime CVD risk (≥39%) were calculated using previously validated algorithms. RESULTS HSS with no reported dysfunction rated their overall health significantly better than those with reported dysfunction; however, the "no dysfunction" HSS group evidenced modestly, though significantly, higher 10-year CVD risk compared with their dysfunction-reporting counterparts. High lifetime CVD risk, including younger adults age 20-39, was slightly higher for persons not reporting dysfunction, with the exception of short sleepers at the highest level of dysfunction who had the highest prevalence of high lifetime risk. CONCLUSIONS Findings suggest that the absence of perceived sleep-related dysfunction does not confer lower CVD risk, despite higher SRH. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background As most COVID-19 transmission occurs locally, targeted measures where the likelihood of infection and hospitalization is highest may be a prudent risk management strategy. To date, in the Republic of Ireland, a regional comparison of COVID-19 cases and hospitalizations has not been completed. Here, we investigate (i) the variation in rates of confirmed infection and hospital admissions within geographical units of the Republic of Ireland and (ii) frequency of deviations in risk of infection or risk of hospitalization. Methods We analyzed routinely collected, publicly available data available from the National Health Protection and Surveillance Centre and Health Service Executive from nine geographical units, known as Community Health Organization areas. The observational period included 206 14-day periods (1 September 2020–15 April 2021). Results A total of 206 844 laboratory-confirmed cases and 7721 hospitalizations were reported. The national incidence of confirmed infections was 4508 [95% confidence interval (CI) 4489–4528] per 100 000 people. The risk of hospital admission among confirmed cases was 3.7% (95% CI 3.5–3.9). Across geographical units, the likelihood that rolling 14-day risk of infection or hospitalization exceeded national levels was 9–86% and 0–88%, respectively. In the most affected regions, we estimate this resulted in an excess of 15 180 infections and 1920 hospitalizations. Conclusions Responses to future COVID-19 outbreaks should consider the risk and harm of infection posed to people living in specific regions. Given the recent surges of COVID-19 cases in Europe, every effort should be made to strengthen local surveillance and to tailor community-centred measures to control transmission.

Colonization projects and the consolidation of commodities production maderanching and agriculture one of the main economic activities in Rondônia (RO).Simultaneously to this process, there was an increase in the consumption ofpesticides, resulting in risks to human health and the environment. Based ondatasets of different origins, this article analyzed the spatial distribution ofpesticide commercialization in the different health regions of the state ofRondônia (RO), between 2015 and 2019. We used data from the RondôniaState Pesticide Trade Inspection System (Sistema de Fiscalização doComércio de Agrotóxicos do Estado de Rondônia – SIAFRO), managed by theAgrosilvopastoral Health Defense Agency of the State of Rondônia (Agênciade Defesa Sanitária Agrosilvopastoril do Estado de Rondônia – IDARON);the Phytosanitary Pesticides System (Sistema de Agrotóxicos Fitossanitários– AGROFIT), the National Health Surveillance Agency (Agência Nacional deVigilância Sanitária – ANVISA), the Brazilian Institue of the Environment andRenewable Natural Resources (Instituto Brasileiro do Meio Ambiente e dosRecursos Naturais Renováveis – IBAMA) and of the IBGE Automatic RecoverySystem of the Brazilian Institute of Geography and Statistics (Sistema IBGE deRecuperação Automática do Instituto Brasileiro de Geografia e Estatística –SIDRA/IBGE). The consolidation of these data contributed to the analysis andpresentation of the spatial distribution of the average amount of pesticidessold by health regions in RO and the main active ingredients sold, theiruse classification and quantity applied to each culture. We conclude thatthe production of commodities such as soy, corn, coffee, and pasture are themain drivers of pesticide commercialization in the study region. The main marketed active ingredients suggest potential risks to public health and theenvironment. In addition, the present safety criteria regarding pesticides,especially in Brazil, are outdated and lead to public health and environmentalvulnerability. A criação de projetos de colonização e a consolidação da produçãode commodities tornou a agropecuária uma das principais atividadeseconômicas de Rondônia (RO). Simultaneamente a esse processo,deu-se o aumento do consumo de agrotóxicos, resultando empotenciais riscos à saúde humana e ao meio ambiente. Este artigoapresenta, com base no processamento de diversos bancos dedados, a distribuição espacial da comercialização de agrotóxicosem RO por regiões de saúde entre os anos de 2015 e 2019.Para tanto, foram utilizados dados do Sistema de Fiscalização doComércio de Agrotóxicos de RO (SIAFRO), gerenciado pela Agênciade Defesa Sanitária Agrosilvopastoril de RO (IDARON), consultasao Sistema de Agrotóxicos Fitossanitários (AGROFIT), AgênciaNacional de Vigilância Sanitária (ANVISA), Instituto Brasileiro doMeio Ambiente e dos Recursos Naturais Renováveis (IBAMA) eSistema IBGE de Recuperação Automática do Instituto Brasileiro deGeografia e Estatística (SIDRA/IBGE). A consolidação desses dadoscontribuiu para a análise e a apresentação da distribuição espacialda quantidade média de agrotóxicos comercializada por regiões desaúde de RO e dos principais ingredientes ativos comercializados,classificação de uso e quantidade destinados por cultura. Concluiu-seque a produção de commodities como soja, milho, café epastagem é o principal destino dos agrotóxicos comercializadosnas regiões de saúde de RO e que os principais ingredientes ativoscomercializados apontam um potencial risco à saúde pública e ao meio ambiente. Além disso, os padrões de segurança atuais paraagrotóxicos, sobretudo no Brasil, estão desatualizados e evidenciama vulnerabilidade ambiental e de saúde pública.

Introdução:Devido à grande variedade de formulações químicas entre os dentifrícios infantis e à possibilidade de apresentarem ou não o flúor (F) em sua composição, a vigilância é essencial para o controle da qualidade desses produtos. Objetivo:Analisar a rotulagem e as informações presentes em dentifrícios infantis, disponíveis comercialmente, segundo especificações das Resoluções nº 07, de 10 de fevereiro de 2015, e nº 79, de 28 de agosto de 2000, da Agência Nacional de Vigilância Sanitária (Anvisa). Método:Estudo transversal realizado por meio da análise da disponibilidade, preço e avaliação das embalagens (primárias e secundárias) de dentifrícios infantis à venda no município de Londrina, localizado no Norte do Paraná, Brasil. Os produtos foram adquiridos no mês de maio do ano de 2019. Os dados foram analisados por meio de estatística descritiva. Resultados:Foram avaliados 11 dentifrícios infantis dos quais 73,0% (oito) apresentaram concentração convencional de F (≥ 1.000 ppm F), 9,0% (um) baixa concentração de F (500 ppm F) e 18,0% (dois) eram sem F. O valor do grama do dentifrício sem F foi cerca de três vezes maior que o dos demais produtos. Todos os dentifrícios analisados atendiam às normas estabelecidas pela Resolução nº 79/2000 e 82,0% (nove) estavam em consonância com as exigências da Resolução nº 07/2015. Conclusões: Há uma ampla oferta de dentifrícios infantis no mercado que, em sua grande maioria, encontra-se de acordo com as normas da Anvisa sobre composição e rotulagem. Contudo, ressalta-se a importância da vigilância desses produtos para a garantia do máximo efeito no controle da cárie dentária e o mínimo risco para o desenvolvimento de fluorose dental.

Leishmaniasis is recognized as an important public health problem in some Member States of the Eastern Mediterranean Region owing to its considerable impact on morbidity and its potential to spread in epidemics, which impose a heavy burden on national health services. The increased incidence of leishmaniasis in countries of the Region is due to several reasons including influx of nonimmune population into natural foci of transmission, changes in ecology of vectors and reservoir host, reduction in the use of residual insecticides for the control of malaria and improvements in diagnosis and reporting of positive cases

The paper aims to examine the critical success factors that influence the attitude of health consumers and their intention to use the national health portal (MyHEALTH Portal). The study was constructed from two behavioral models; Diffusion of Innovation and Theory of Reasoned Action. It utilized an online survey hosted on the official portal website with a convenience sampling technique of 223 respondents. Results showed complexity did not significantly contribute towards attitude, while trialability and relative advantage showed significant contributions. Meanwhile, attitude influenced health consumers' intention to use the portal, while subjective norms indicated otherwise. Keywords: Diffusion; socio-cognitive; health portal, health consumer eISSN: 2398-4287© 2021. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v6i17.2809

BACKGROUND Blood pressure (BP) control was only 43.7% in the National Health and Nutrition Survey (NHANES) survey in 2017–2018. Scalable, nonclinic-based strategies to control BP are needed. We therefore conducted a pilot trial of a text-messaging intervention in a national network of retail outlet health kiosks with BP devices. All study procedures were conducted remotely. METHODS Eligible individuals (N = 140), based on average BP greater than or equal to 140/90 mm Hg at kiosks during the prior year, were randomized to intervention vs. usual care. Intervention consisted of tailored text messages providing educational information with embedded links to educational videos on topics related to BP control. BP measurements were obtained at kiosks at 3, 6, and 12 months following randomization; control was defined as BP < 140/90 mm Hg. Follow-up at 12 months was curtailed due to SARS-CoV-2. We therefore combined 12-month (N = 62) or carried forward 6-month (N = 61) data as the primary end point. RESULTS Participants were 51.4% male, 70.7% white/Caucasian, had mean age of 52.1 years, and mean baseline BP 145.5/91.8 mm Hg. At the end point, 37.7% intervention vs. 27.4% usual care subjects achieved BP control (difference, 10.3%, 95% confidence interval -6.2%, 26.8%). In an intention-to-treat analysis with multiple imputation of missing data, 12-month BP control was 29.0% vs. 19.8% favoring intervention (difference, 9.2%. 95% confidence interval -7.3%, 25.7%); intervention vs. control differences in adjusted mean BP levels were systolic BP: -5.4 mm Hg (95% confidence interval: -13.5, 2.7) and diastolic BP: +0.6 mm Hg (95% confidence interval: -4.2, 5.4). CONCLUSIONS These pilot results support the potential for a highly scalable text-messaging intervention to improve BP. CLINICAL TRIALS REGISTRATION Trial Number NCT03515681.

Leisure-time physical activity (LTPA) is a crucial behavior to reduce the global burden of disease. The objective of this study was to understand the relationship between LTPA, employment status, and physical workload (PWL). This study analyzed data from 38 449 individuals interviewed in the National Health Survey (NHS), representative of the Brazilian population. This paper examines LTPA in the last 30 days and whether participants achieved the recommended physical activity (≥150 min week−1) according to employment status and PWL utilizing Poisson regression models. One third and ¼ of the participants reported LTPA in the last 30 days and achieved the recommended LTPA, respectively. Intense PWL was reported by 28.7% [95% confidence interval (CI): 27.8–29.6%] of participants; 32.2% among men (95% CI: 31.0–33.5%); 24.3% among women (95% CI: 23.1–25.5%). Precarious employment was associated with a lower prevalence of physical activity among men [adjusted prevalence ratio (PRa) = 0.92; P = 0.016], but not among women (PRa = 1.11; P = 0.039). Employment policies and protection of the work environment are relevant aspects to stimulate physical activity, and may vary by gender.

We assessed the risk of colorectal cancer (CRC) in patients with ulcerative colitis (UC) using the nationwide population-based claims data.We analyzed the claims data of the Korean National Health Insurance (2006-2015). UC and CRC were defined using ICD-10 codes and UC-specific prescriptions in this study. Age- and sex-matched individuals without UC were randomly selected from the general population. Hazard ratios (HRs), adjusted for different covariates, were calculated using multivariate Cox proportional hazard regression.In total, 30,546 and 88,829 individuals with and without UC, respectively, were enrolled. CRC developed in 85 (0.27%) among UC, and 340 (0.38%) among individuals without UC, respectively. The HR (95% confidence interval [CI]) of CRC in all UC patients was 0.74 (0.58-0.94). Further, UC patients were stratified according to sex (male vs. female: 0.60 [0.44-0.82] vs. 1.10 [0.75-1.61]) and age (HR = 14.37, 2.74, 0.58, and 0.70 for 0-19, 20-39, 40-59, and ≥60 years, respectively). HR was significantly higher for late-onset UC (≥60 years) than for early-onset UC (0-19 years). The long duration of 5-aminosalicylic acid use had a significantly low HR, with reference to the 1st quartile.The risk of CRC varies with age and sex in Korean patients with UC during the first decade after diagnosis. Early-onset UC (40 years) increases the CRC risk.

The Health Reform of the country is a very difficult burden for two reasons: firstly, we need an appropriate economy level in the country, that can bear the new health model, established through reform, and secondly, the country needs a health system that is appropriate either for its economic system or for its tradition and history. Health reformers need to match all the points of the health reform concept, its implementation, and the systems of the country. Due to its Soviet past, Georgia struggled in the last twenty years to find an effective and cost efficient health model for its citizens. Starting from the 90s, Georgia instituted three health reforms and finally found some sustainable measures. The present article explores the three waves of the Georgian Health Care reforms, and analyses the factors of their success and the reasons for their failures. The importance of studying the Health Care systems is derived from Sustainable Development Goals targeting Health issues including health-related topics to improve the population’s health and wellbeing as well as achieve universal coverage of health services. The research contributes to the knowledge regarding the Health Care Reforms, and their practical implications on a country.

Little is known about associations between depression and serum heavy metal levels, dietary vitamin intakes. Thus, we sought to determine the nature of these associations and to predict risks of depression using marginal effects. A data set of 16,371 individuals aged ≥10 years that participated in Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2009 to 2017 (excluding 2014 and 2015) was used to obtain information on sociodemographics, family histories, lifestyles, serum heavy metal levels, food intakes, and depression. Serum cadmium (Cd) and lead (Pb) levels were analyzed by graphite furnace atomic absorption spectrometry and mercury (Hg) levels using a mercury analyzer. Daily vitamin intakes were calculated by 24-h dietary recall. The results obtained showed that females are at higher risk of depression than males. A doubling of serum Cd was associated with a 21% increase in depression (AOR 1.21, 95% CI: 1.07-1.37, p = 0.002), whereas twofold increases in daily vitamin B1, B3 and vitamin A intakes reduced the risk of depression by 17% (0.83, 95% CI: 0.73-0.95, p = 0.005), 20% (0.80, 95% CI: 0.70-0.91, p = 0.001), and 8% (0.92, 95% CI: 0.85-0.99, p = 0.020), respectively. Interactions between heavy metals, vitamin intakes, and sex did not influence the risk of depression. The result shows that increased daily dietary vitamin intake might protect the public against depression. Further studies are needed to reduce the risks posed by heavy metals and to determine more comprehensively the effects of daily dietary vitamin intake on depression.

BackgroundThe popular use of traditional medicine in low-income settings has previously been attributed to poverty, lack of education, and insufficient accessibility to conventional health service. However, in many countries, including in Rwanda, the use of traditional medicine is still popular despite the good accessibility and availability of conventional health services. This study aims to explore why traditional medicine is popularly used in Rwanda where it has achieved universal health coverage.MethodsThe qualitative study, which included in-depth interviews and participant observations, investigated the experience of using traditional medicine as well as the perceived needs and reasons for its use in the Musanze district of northern Rwanda. We recruited 21 participants (15 community members and 6 traditional healers) for in-depth interviews. Thematic analysis was conducted to generate common themes and coding schemes.ResultsOur findings suggest that the characteristics of traditional medicine are responding to community members’ health, social and financial needs which are insufficiently met by the current conventional health services. Participants used traditional medicine particularly to deal with culture-specific illness –uburozi. To treatuburoziappropriately, referrals from hospitals to traditional healers took place spontaneously.ConclusionsIn Rwanda, conventional health services universally cover diseases that are diagnosed by the standard of conventional medicine. However, this universal health coverage may not sufficiently respond patients’ social and financial needs arising from the health needs. Given this, integrating traditional medicine into national health systems, with adequate regulatory framework for quality control, would be beneficial to meet patients’ needs.

Torunn Varmdal,1,2 Ellisiv B Mathiesen,1,3 Tom Wilsgaard,1 Inger Njølstad,1 Audhild Nyrnes,1 Sameline Grimsgaard,1 Kaare Harald Bønaa,2,4 Jan Mannsverk,1 Maja-Lisa Løchen1,5 1Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway; 2Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; 3Department of Neurology, University Hospital of North Norway, Tromsø, Norway; 4Clinic for Heart Disease, St. Olav’s University Hospital, Trondheim, Norway; 5Department of Cardiology, University Hospital of North Norway, Tromsø, NorwayCorrespondence: Torunn VarmdalDepartment of Community Medicine, UiT The Arctic University of Norway, Postboks 6050 Langnes, Tromsø, 9037, NorwayTel +47 930 28 286Email torunn.varmdal@ntnu.noPurpose: To assess whether acute myocardial infarction (MI) diagnoses in national health registers are sufficiently correct and complete to replace manual collection of endpoint data for a population-based, epidemiological study.Patients and Methods: Using the Tromsø Study Cardiovascular Disease Register for 2013– 2014 as gold standard, we calculated correctness (defined as positive predictive value (PPV)) and completeness (defined as sensitivity) of MI cases in the Norwegian Myocardial Infarction Register and the Norwegian Patient Register separately and in combination. We calculated the sensitivity and PPV with 95% confidence intervals using the Clopper-Pearson Exact test.Results: We identified 153 MI cases in the gold standard. In the Norwegian Myocardial Infarction Register, we found a PPV of 97.1% (95% confidence interval (CI) 92.8– 99.2) and a sensitivity of 88.2% (95% CI 82.0– 92.9). In the Norwegian Patient Register, the PPV was 96.3% (95% CI 91.6– 98.8) and the sensitivity was 85.6% (95% CI 79.0– 90.8). The combined dataset of the Norwegian Myocardial Infarction Register and the Norwegian Patient Register had a PPV of 96.6% (95% CI 92.1– 98.9) and a sensitivity of 91.5% (95% CI 85.9– 95.4).Conclusion: MI diagnoses in both the Norwegian Myocardial Infarction Register and the Norwegian Patient Register were highly correct and complete, and each of the registers could be considered as endpoint sources for the Tromsø Study. A combination of the two national registers seemed, however, to represent the most comprehensive data source overall. The benefits of using data from national registers as endpoints in epidemiological studies include faster, less resource-intensive access to nationwide data and considerably lower loss to follow-up, compared to manual data collection in a limited geographical area.Keywords: cardiovascular diseases, data quality, registers, data collection, quality control

« Biologie sans Frontières » (BSF) is a non-governmental organisation whose mission is to develop medical biology where it is most needed, particularly in French-speaking Africa. In Guinea Conakry, with Fondation Mérieux and the Guinean Ministry of Health, BSF is in charge of training "trainers/teachers" of technicians. This training will take place at the National Health School of Kindia, a school that has been completely rehabilitated and re-equipped thanks to the support of Fondation Mérieux. This project is supported by the French Development Agency. BSF has an in-depth knowledge of the local needs in medical biology training. After an audit carried out by two BSF members, the findings were alarming: these trainers had no experience in medical biology and their theoretical knowledge was still of low level. Three training courses were then provided by BSF, the first in biochemistry, sero-immunology and immuno-hematology, the second in cyto-hematology and the last one in bacteriology-parasitology. The basic techniques have been acquired, the "student trainers" have shown great assiduity, but the level remains fragile and will require new training, which is essential to help these future teachers to provide structured, functional and above all useful practical work adapted to local practices and needs.

Objectives Out-of-pocket (OOP) payment is a major health financing mechanisms across developing nations such as Pakistan. Private health expenditures are estimated to be 64.4%, of which 89% are OOP made by the households (National Health Accounts, 2015–16). These high health care expenditures cause households to face financial burden resulting in poverty. This study aims to estimate the incidence and determinants of catastrophic health expenditures and impoverishment for Pakistan. Study design Household-based cross-section study. Methods We used the data from the Household Integrated Economic Survey (2015–16 and 2018–19), carried out by the Pakistan Bureau of Statistics. The well known methodology developed by Wagstaff and Doorslaer was used in this study for estimating the incidence and impoverishment effect of catastrophic health spending. Results It is found that at 10% threshold (out of total consumption expenditures), catastrophic health payments are incurred by 4.51% and 13.15% of households for 2015–16 and 2018–19, respectively. Moreover, following the 40% threshold (out of non-food expenditures), this incidence is 0.45% and 4.57%. Poverty headcount was 23.28% and 18.43% gross of health payments in both the considered years, respectively, whereas it turns out to be 24.68% and 22.02% net of healthcare payments for the respective years, representing an increase in poverty headcounts of 1.4% and 3.59%. Conclusion OOP health payments exert pressure on household's capacity to pay and push them into poverty. This article recommends that the burden of OOP expenditures borne by households should be reduced to prevent them from falling into poverty by initiating some strategies (health financing policy reforms in terms of financial protection) with political support.

Background: Most U.S. patient and health care provider surveys with regard to nasal allergy treatments were conducted before sublingual immunotherapy (SLIT)-tablets and allergy immunotherapy (AIT) shared decision-making tools were available. Objective: Patient and health care provider surveys with regard to current perceptions of nasal allergy burden, symptoms, and treatments were conducted to compare with previous surveys and provide insight into the use of SLIT-tablets and AIT shared decision-making tools. Methods: From November-December 2019, adults (N = 510) diagnosed with nasal allergies and health care providers (N = 304) who treated nasal allergies in the United States completed surveys with regard to nasal allergy management. Results: Of the patient respondents, 42% reported that their symptoms were only somewhat controlled and 48% had avoided activities because of their nasal allergies. In all, 38% were using only over-the-counter (OTC) medications for treatment, and 42%, 7%, and 8% had ever received subcutaneous immunotherapy (SCIT), sublingual allergy drops, or SLIT-tablets, respectively; 56% and 85% reported that they had never discussed SCIT or SLIT, respectively, with their health care provider. Of the health care provider respondents, 45%, 58%, and 20% were very likely to discuss OTC medications, SCIT, or SLIT, respectively. Allergists were more inclined to discuss SCIT with their patients than other health care providers (82% versus 33%, respectively). Most allergists (67%) and other health care providers (62%) reported that they did not use an AIT shared decision-making tool, primarily because of unawareness. Conclusion: The patients with nasal allergies continued to report inadequate symptom control and activity impairment. SLIT-tablets and AIT shared decision-making tools were underused. In the coronavirus disease 2019 era, social distancing may limit office visits, which impacts SCIT administration and prompts increased use of telemedicine and a possible advantage for at-home‐administered SLIT-tablets over SCIT.

BACKGROUND: The use of telemedicine in providing outpatient care for COVID-19 patients is an integral part of the most intensively developing and promising areas of national health care. AIM: This study aims to demonstrate the efficiency of using telemedicine technologies in outpatient care for COVID-19 patients. MATERIALS AND METHODS: This study is the retrospective analysis of remote consultations for 57,256 patients with COVID-19 from April 1, 2020, to May 24, 2020. RESULTS AND DISCUSSION: The results of human resource analyses, the physician workloads, and the categories of observed patient categories are presented. The majority of patients were asymptomatic (45%), a mild form of the disease was observed in 4534 (34%) patients, and moderate cases were observed in 2800 (21%) patients. Concomitant pathology was observed in 60.0% of patients. The capacity of the telemedicine center was 52.8 patients for one physician per shift. CONCLUSIONS: The telemedicine structure of the center, which regulates the interactions of physicians with patients and other healthcare facilities, has enabled the appropriate use of human resources to ensure that therapeutic, diagnostic, and epidemiological activities are adequate and timely in outpatient settings.

Background: The sexual health of young people is an especially important issue for national health policies. Adolescents, in fact, are at elevated risk for adverse sexual and reproductive health outcomes relative to their habits, sexually transmitted infections (STIs), sexual behaviour and teenage pregnancy. The aim of this study was to assess the knowledge about sexuality of students under the age of 18. Moreover, we aimed to explore the influence of sex education on sexual knowledge and behaviour. Methods: The participants were enrolled during a cultural exchange project in September 2019. After completing the questionnaire, all students took part in a sex education course performed by an urologist with expertise in sociology and psychology. The adolescents repeated the same survey in a web form in September 2020, one year after the course. Results: Analyzing the data, sex education lessons helped to improve students’ confidence in approaching all the issues of the questionnaire. Moreover, we observed a significant increase in the role of school as main source of information, while the role of the internet, media and family remained stable. Conclusions: This study encouraged the introduction of school-based sexual education policies, pointing to opportunities for structural early intervention programs.

Introduction: Anemia is very common in Indian subcontinent. In India, according to National Health and Family Survey (NHFS-4), the prevalence of anaemia in India among adolescent girls, 15-19 years is 54.1%. Women during pregnancy are more vulnerable for anemia not only because of the synergistic effects of physiological increase in plasma volume (hemodilution) but also because of increased demand and poor bioavailability of iron in the food. Objective: To find out the impact of health educational intervention on anaemia among pregnant and lactating women. Materials and Methods: A non-randomized interventional trial without control study was conducted in the Rural field practice area of Department of Community Medicine, S.N. Medical college, Bagalkot with the Sample size for pregnant and lactating women is 153, for the period of one year (March 2018- June 2019). Results: There is increase in level of knowledge among pregnant and lactating women regarding anemia after health education intervention and was found to be statistically significant by paired t-test. Conclusion: Health education is one of the cost-effective method in improving the knowledge among pregnant and lactating mothers. Keywords: Pregnant and lactating women, Health education, Anemia.

Introduction. The main goal of the state policy in the field of healthcare is to form a system that ensures the availability of medical care and increases the efficiency of medical services. The volume, type and quality of medical care must correspond to the level of morbidity, the needs of the population and the advanced achievements of medical science. Primary health care is the backbone of the health care delivery system. The problem of it improvement, including in rural areas, is a priority and has national significance. The development of measures to increase the availability of primary health care according to the territorial principle is an urgent scientific and practical problem.The purpose of the study — based on the analysis, methodologically substantiate and develop measures to increase the availability and improve the system of organizing the provision of primary health re to the rural population on a territorial basis.Materials and methods. Mathematical-statistical and analytical (quantitative, structural, comparative) research methods were used.Results and Discussion. In the Chelyabinsk Region, there are disproportions in the provision of the population with medical personnel: the provision of the urban population with doctors and l personnel is significantly higher than that of the rural population. The indicator of staffing with paramedical personnel in full-time positions of feldsher-obstetric stations is 20.1% lower than in the Russian Federation. The index of "combination rate" among doctors working in outpatient departments is 1.2 times higher than the target indicator of the National Health Project, and in rural areas it is 1.1 times. In order to unify the organizational and methodological approaches, the authors proposed a classification of medical stations and their organizational and functional structure.Conclusions. The organization of the provision of primary health care to the rural population according to the territorial-district principle with the formation of an organizational model of the rural medical district will increase the availability of primary medical health care to the rural population.

Objetivo: Identificar cambios en la tendencia anual (TA) de las características de las Licencias Médicas por Depresión del Fondo Nacional de Salud en la Región de Ñuble, Chile 2008-2017. Materiales y Métodos: Estudio descriptivo y de tendencia que incluyó 34.467 de estas licencias médicas registradas en la Comisión de Medicina Preventiva e Invalidez de la Secretaria Ministerial de Salud de la Región de Ñuble, según características en número de licencias, tipo de licencia, tipo de diagnóstico CIE-10, y entidad pagadora de subsidio. Los resultados se presentaron en números absolutos y porcentajes, para el cambio en la TA se construyó un modelo de regresión de Joinpoint, y se utilizó el software Joinpoint Regression Program, Version 4.7.0.0. Resultados: El número de licencias médicas por depresión aumentaron 152,3% del 2008 al 2017, según Tipo de Licencia 99,7% fue por enfermedad o accidente común, por Tipo de Diagnóstico CIE-10 50,7% fue por episodio depresivo inespecífico (F32.9), 71,6% por pagadora de subsidio cajas de compensación. El modelo Joinpoint no identificó un cambio en la TA en el número de las licencias médicas en los 10 años en estudio, más bien hubo un aumento constante estimado en 166 licencias (p=0,122) por cada año. Conclusiones: Las licencias médicas FONASA por depresión van en aumento constante en la Región de Ñuble, se requiere privilegiar las estrategias de promoción y prevención en el nuevo plan de salud mental 2017-2025, y que estos esfuerzos se reflejen en el control de esta patología y en la disminución de este tipo de licencias médicas.

Background Breastfeeding provides the healthiest start to life, but breastfeeding rates amongst Aboriginal and Torres Strait Islanders is lower than non-Indigenous women. Aim To assess the accuracy, quality and appropriate presentation of online breastfeeding information for Aboriginal and Torres Strait Islander women in Australia. Methods An online search conducted in Google, Bing and Yahoo search engines to identify any breastfeeding websites that provided information for Aboriginal and Torres Strait Islander women. Relevant websites were evaluated against: a) National Health and Medical Research Council clinical guidelines, b) the quality of health information on the Internet by using DISCERN instrument, and c) appropriate key design features for Aboriginal and Torres Strait Islander women. Results The search located 348 sites with 31 being eligible for inclusion. Websites from governmental organizations had the highest accuracy while YouTube videos had the lowest accuracy. Three quarters (74%, n = 23) of sites incorporated the national clinical guidelines adequately, and most of the sites (77.8%, n = 24) were considered high quality. Only 23% (n = 7) of sites had sufficient key design features appropriate for Aboriginal and Torres Strait Islander women. Four websites were considered exemplary for their accuracy, quality and cultural appropriateness of information for Aboriginal and Torres Strait Islander women. Conclusion Some websites are tailored to provide breastfeeding information and support to Aboriginal and Torres Strait Islander women. However, only a few contain culturally appropriate key design features. Further participatory action research is required to design online platforms for women from different cultural backgrounds that take into account cultural principles, beliefs and values.

O objetivo deste estudo foi avaliar as prevalências de comportamentos de saúde de brasileiros segundo a participação em programas públicos de estímulo à prática de atividade física. Para isso, foram utilizados dados da Pesquisa Nacional da Saúde 2013, que entrevistou 60.202 adultos e idosos e investigou comportamentos de saúde protetores (consumo de feijão, peixe, carne sem excesso de gordura, frutas e hortaliças; e prática de atividade física) e de risco (consumo de refrigerante, doces e álcool; substituição de refeições; tabagismo e assistir televisão). Foram calculadas as prevalências e intervalos de confiança (95%). Cerca de 10% dos entrevistados participavam destes programas e possuíam comportamentos mais saudáveis (maiores prevalências de prática de atividade física e consumo de peixe; e menor ingestão de doces e tabagismo), quando comparados aos demais, com diferenças entre as macrorregiões do país. Desta forma, a expansão destes programas e a diversificação de suas atividades podem constituir importante estratégia de promoção da saúde no país.

El presente artículo muestra los resultados obtenidos de un proyecto investigativo realizado durante el periodo del 14 de junio al 10 de agosto del 2020 en el contexto de la educación superior privada, en la que se pretende mostrar los hallazgos de la metodología de mediación docente en plataformas digitales, esto como consecuencia de la emergencia sanitaria nacional, y del urbi, vivida a raíz de la pandemia del COVID-19 plasmada en el decreto ejecutivo de emergencia 42227-MP-S, y con base en el documento oficial emitido por las autoridades oficiales, todo esto en la Republica de Costa Rica.

Background Many cancer patients in the low- and middle-income countries seek care with traditional health practitioners (THPs) and use traditional and complementary medicines (T&CMs) for treatment of cancers. Little is known about the perceptions and influence of THPs on cancer patients’ help-seeking and treatment decisions. We aimed to explore perceptions of THPs regarding cancers, cancer causes, and preferred treatments for cancers, in order to identify aspects that can inform interventions to improve cancer outcomes in Uganda. Methods We conducted this ethnographic study in northern Uganda. In-depth interviews were conducted at the respondents’ homes in quiet, open places, and in the absence of none- respondents. Interviews were audio-recorded and transcribed verbatim within a week of the interviews. Thematic qualitative analysis approaches were used to identify themes and subthemes. Results We included 21 respondents in the study; most were male (16/21), married, with median age of 59 years (range 39 – 80). Most respondents perceived cancer as a new and challenging disease, while one respondent thought of cancer as a result of an imbalance within the body. Most confessed unawareness of the causes of cancers, but believed that cancer could result from the interplay of a number of factors including poor diets, ingestions of chemical agents, and assaults by the spirits of the dead. Some reported that cancers (especially of women’s genital tracts) were sexually transmitted, or caused by accumulation of dirt. Only few healers treated cancers. Most respondents reported that they referred cancer patients to biomedical facilities, sometimes after they have first used their medicines. Most respondents hoped that collaborative research with scientists could help them identify potent T&CMs that cure cancers. Conclusion Traditional health practitioners require training on cancer causes, symptoms and signs, and the necessity for prompt initiation of effective treatments in order to improve cancer outcomes. The predisposition of the majority of respondents to refer cancer patients to biomedical services sets a fertile ground for meaningful cooperation between biomedical and traditional health practices. The national health system in the low- and middle-income countries could formally recognize traditional health practices as a component of the national healthcare system, and encourage the two to practice side by side.

This study aimed to investigate the association of previous stain use with hearing impairment in an adult population. Data from the ≥ 40-year-old population in the Korean National Health Insurance Service Health Screening Cohort were used. The hearing impairment group was classified based on the national registry of hearing-impaired persons. Control participants were randomly selected and matched for age, sex, income, and region of residence. The number of days of statin prescription during the 2 years before the diagnosis of hearing impairment was compared between the hearing impairment group and the control group using conditional logistic regression analysis. Additional analyses were conducted according to age and sex. The number of days of previous statin use was not different between the hearing impairment group and the control group (adjusted odds ratio [aOR] = 0.94, 95% confidence interval (CI) = 0.86–1.02, P = 0.118). According to age, in the ≥ 70-year-old group, those with hearing impairment had 11% lower rates of previous statin use than those in the control group (aOR = 0.89, 95% CI = 0.80–0.99, P = 0.039). According to sex, in the male group, 12% lower rates of previous statin use were observed among those with hearing impairment than among those in the control group (aOR = 0.88, 95% CI = 0.79–0.99, P = 0.037). Previous statin use might have an effect on reducing the prevalence of hearing impairment in elderly individuals and men.

espanolEl proceso de consolidacion de empleo del personal interino de sanidad acaecido en 2001, poco antes de la desaparicion del antiguo INSALUD y la transferencia de competencias a las Comunidades Autonomas, constituye un hito historico excepcional. La regla viene dada por la acumulacion de efectivos que pasan largos periodos bajo este estatuto de precariedad con causa en la falta de estabilidad y expresion en muy variadas formas de tratamiento diferenciado respecto al personal fijo. Durante anos han sido numerosas las presiones sobre un legislador (estatal y regional) poco receptivo a poner fin a su situacion de ventaja, pero claramente irregular, derivada de utilizar empleados temporales para cubrir necesidades permanentes. En aplicacion de la norma, tampoco la jurisprudencia contencioso-administrativa y social han sido propicias a los intereses de los afectados. El recurso al Tribunal de Justicia de la Union Europea, durante tanto tiempo una fuente para la reaccion frente a las situaciones de diferencias injustificadas, ha constituido un nuevo reves pues, como se describe en el ensayo, ha devuelto tan peliaguda cuestion al Estado espanol. En el trasfondo se ventila la propia eficacia del Sistema Nacional de Salud. EnglishThe process of consolidating the employment of interim heath staff in 2001, shortly before the disappearance of the former INSALUDand the transfer of powers to the Autonomous Communities, is an exceptional historical milestone. The rule is given by the accumulation of staff who spend long periods under this precarious status due to the lack of stability, and expressed in various forms of differential treatment compared to permanent staff. For years, numerous pressures have been exerted on a legislator (state and regional) unwilling to put an end to these advantageous but clearly irregular situations, by using temporary employment to cover permanent needs. Nor has the case law been favourable to the interests of those concerned in the application of the law. The ultimate appeal to the Court of Justice of the European Union has been a further setback because, as described in the essay, it has returned such a thorny issue to the Spanish State. In the background, the efficacy of the National Health System.

Social isolation is a critical public health issue that affects multiple domains of well-being among older adults, but little is known about social isolation among older military veterans. As such, the purpose of this study was to estimate the prevalence of social isolation among older veteransData were derived from Round 1 of the National Health and Aging Trends Study, which is an annual, longitudinal panel survey of Medicare beneficiaries aged 65 and older. The sample included 1,683 veterans, who were primarily White and male. Weighted logistic regression models were used to predict severe social isolation (having no social participation) and social isolation (having only one source of social participation) among older veterans, while controlling for age, sex, race, marital status, education, income, and metropolitan residency.After accounting for other predictors, results show that veterans who are 85 and older, male, White, unmarried or unpartnered, with lower educational attainment and lower income are greatly at risk of both severe social isolation and social isolation.The results of this study support past research showing that veterans with limited social and economic capital are at great risk of experiencing adverse outcomes in older adulthood, including social isolation. Interventions should therefore aim to improve social connectedness among this population and should address the risk-factors that contribute to social isolation among older veterans.

Type 1 diabetes mellitus (T1DM) is an autoimmune ?-cell destruction, usually leading to absolute insulin deficiency, insulin resistance, or by a combination of both. Both the incidence and prevalence of diabetes T1DM is suspected to be high in India, but in the absence of nation-wide registry, the possibility of exact numbers is unsure. Till date, studies done among the population have seen prevalence more than the incidence of the disease, which has led to late screening and diagnosis of the disease within the community settings. India is already suffering from the burden of type 2 DM, in the process of screening those, patients with T1DM are somewhat getting ignored. Furthermore, cost associated with the treatment expenditure and social status of the people suffering from the disease too have a role to consider which has been totally side-lined in national programmes like National Program for Control of Diabetes, Cardiovascular disease, and Stroke (NPCDCS). There is also scarcity of data on the incidence of T1DM which could aid in formulating better policy avenues for the patients suffering from the disease. Reports on trends in T1DM are more commonly available from countries with better established public health surveillance systems and diabetes research infrastructure. From India, due to scarcity of data on T1DM, we had to rely on published literature of some major centers across the country. Results from the Indian Council of Medical Research (ICMR) first phase, till July 2011 which included 5546 patients found T1DM among 63.9% cases and predominately among children; at registration 11.1% had already developed chronic complication of T1DM. As India is already suffering from the burden of type 2 DM, during current management and treatment, the problem lies at various levels which needs to be addressed. We propose a setting based, life course approach for T1DM where every age group will have access to the health care system either directly or indirectly from intra-natal life till elderly age group through health approach based on scientific methods delivered through health system. In this regard a central registry having enumeration and provisioning of mandatory Insulin to all through a national policy being implemented by NPCDCS is what policy makers must take up at urgent bases if we want to bend the curve of rising T1DM and prevalence of overall diabetes in India.

Background. Traumatic musculoskeletal injuries are more and more frequently regarded as an important health, social and economic problem. According to WHO statistics, injuries are a major present-day health problem. The main aim of the study is to identify the number of new patients who sustained knee structure injuries during a year and to classify them based on data on services provided under National Health Fund agreements. Material and Methods. Information on the number of patients with a knee injury was obtained in a three stage process. First an inventory of relevant diagnoses was determined. Then, the National Health Fund data from 2016–2019 was queried in accordance with the adopted methodology and assumptions. The analysis was based on the report submitted by the NHF in response to the query. Results. According to the NHF reporting data, knee injuries affect approx. 244,000 people per year. There are slightly more men (approx. 52%) than women (48%). People aged 11-20 years constitute the most numerous group of patients with knee injuries, with approx. 41,342 cases per year. The most frequently reported diagnoses in both groups were S80.0 Contusion of knee (approx. 30%), S83.6 Sprain and tear of other and unspecified parts of knee (approx. 21%) and M23.8 Other internal derangements of knee (approx. 9%). According to available data, the overall rate of knee injuries in 2019 was 6.4 per 1000 population. Conclusions. 1. Knee injuries pose a major health problem. In Poland, according to the reporting data, approx. 244,000 knee injuries occur every year. 2. Knee injuries are more common among men than women, and people aged 11–20 years constitute the most numerous group of patients. 3. The National Health Fund reporting data is a very valuable source of information on the magnitude of the problem of injuries.

High-flow nasal cannula is a non-invasive ventilation system that was introduced as an alternative to continuous positive airway pressure), with a marked increase in its use in pediatric care settings. However, the expected budget impact of this intervention has not been explicitly estimated. This study aimed to evaluate the budget impact of the high-flow nasal cannula for acute bronchiolitis in Colombia.A budget impact analysis was performed to evaluate the potential financial impact deriving from high-flow nasal cannula during 2020. The analysis considered a 5-year time horizon and Colombian National Health System perspective. The incremental budget impact was calculated by subtracting the cost of the new treatment, in which a high-flow nasal cannula is reimbursed, from the cost of the conventional treatment without a high-flow nasal cannula (supplemental oxygen through a nasal cannula up to a maximum of 2 liters per minute). Univariate one-way sensitivity analyses were performed.In the base-case analysis the 5-year costs associated with high-flow nasal cannula and no- high-flow nasal cannula were estimated to be US$159,585,618 and US$172,751,689 respectively, indicating savings for Colombian National Health equal to US$13,166,071 if the high-flow nasal cannula is adopted for the routine management of patients with acute bronchiolitis. This result was robust in univariate sensitivity one-way analysis.High-flow nasal cannula was cost-saving in emergency settings for treating infants with acute bronchiolitis. This evidence can be used by decision-makers in our country to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.